Travis County Commissioners Court
Tuesday, October 19, 2010,
Item 3
Item number 3, consider and take appropriate action regarding request for local hospitals for stationing of available starflight aircraft, st. David's and seton. Mr. Hobby.
>> thank you very much, judge and Commissioners. This particular item is asking you to consider and take appropriate action regarding request from local hospitals for staging of available aircraft, available starflight aircraft. This has been a long series of months in which we tried to have discussions and we've had good discussions on both the placement of aircraft, really we're talking about the 12-7 aircraft that's available. The purchase of a new aircraft if we did, as well as looking at some social issues. Today what I would like to do is just simply come and provide you that particular feedback. I know we do not have much time and sometimes I take too much time so I’m going to try to be as precise as I can be, but also give you a recommendation. Back in April of -- 20th, I was here and asked that we have a delay because of the fact that I felt like it would be good for us to continue to have discussions with both networks. In regards to the stationing of the 12-7 aircraft. But also to discuss, which I found when I talked with them individually, that there were some social issues of which we all had in common. Hospital issues that we had in common. You granted me that, but I wanted to find out once we received the third aircraft and we're going to try to use it as a spare and keep it at the hangar and rotate it among the other two aircraft, it also gave us opportunity during that span of time to test that. And also do an assessment at the same time. To see if it was really doing what we thought it would do. And that is provide greater availability for all the services that we provide. That's something I’m going to be emphasizing too as I go through this, and that is that regardless of what decision you make today, the beautiful part this is that starflight is a public service, it's a public aircraft, meaning it serves hospitals, medical, but it also serves other aspects. Search and rescue, we recently did that when we had the flooding in Williamson county. With this third aircraft which I’m so thankful you purchased and approved, we were able to fly all three aircraft and we've done that on several occasions under emergency circumstances. So I’d like to start off, if I could, I’ve given you the backup. I’ve kind of explained how we started from the last time that we met. And then I gave you a summary in regards to the first meeting. The first meeting was really -- it was held in April, but it was really to -- right after the 20th, we met on April 30th and we met, I met with mark clayton with -- who was the senior vice president with st. David's and greg david of brackenridge. Those have been the two representatives I’ve been meeting with and I’ve been honored to meet with those two gentlemen. They are true professionals. They represent two great hospitals. But that first meeting was really just kind of a format be meeting, establishing the fact that we were going to talk about the aircraft, but we are also going to talk about those social users committee. So then we started off from there. On June 15th, the second meeting was held. I brought in our Travis County medical director. And the way we formatted the meeting is first part of the meeting would be where we would talk about social issue and then -- and I’d bring in special guests with special projects, and then the second half of the meeting would be talking about the station location. But dr. Paul henchy and -- they came in and basically presented a pilot program that is underway and it's called the community health care medic program, and it basically assists residents who often use the 911 system. It's already proven itself and that is we're helping the resident get to the best possible care that they can possible give and where they need to go and not necessarily the e.r. That went well. Both hospitals responded favorably to that presentation and immediately were going to try to have their staffs intervene with them. And then we started talking about the various options. We had already gone over all the options months ago prior to these meetings, but there we began to talk about what are some options we could look at that we could actually share in coming up with a collaboration. Judge, you are the one who kind of sent me on this mission of would it be possible for us to do something together. Of course, I had done that early on and I’m still in favor of that and that is something that I strive for. And honestly I think the gentlemen with me had opened discussion to strive for the same thing. We agreed to meet within 30 days. We had our third meeting on Friday, September 3. In that meeting I had roger jeffries who is our executive manager of justice and public safety and he came in and gave a wonderful presentation and had a booklet in regards to a project he's working on, the sobering center and supportive services. Again, this was received well and they would like to have more information regarding that. But after mr. Jeffries left, we had some discussion in regards to, again, the station location. I presented and you have that as your backup a new consideration option and that was partnerships for community benefit. And so they allowed me to present that, but I have to admit I didn't come away from that particular meeting that they were interested in that nor were they interested in the other options. However, I asked them to consider it and to get back with me within a week because I really felt like it was time for me to make a recommendation to you and we're also getting close to the October 1st deadline. So I left it with hope that we might could do that. I did not receive any feedback from them and so I wrote my recommendation, set it up for September 28th, and then I found out that both greg and mark were out at the same conference. I delayed it two weeks because I really wanted to have them here. And we went forward with that. I did send the backup and this is what I’m reading from today. And then me finding out that they are not going to be able to be here, I realized I had two weeks so I decided, let's have another meeting, a fourth meeting, just to see if there might be opportunity, and we had that meeting and we discussed not social issues, social issues was kind of at the third meeting, both representatives agreed we perhaps shouldn't bring that up as part of this, and so I feel much hope for that. In the forth meeting, both representatives says they would be willing to review and look into those social issues and those particular projects so I felt good about that.
>> in particular is it the sobering?
>> yes, ma'am. Yes, Commissioner. And the other one is the pilot project for the ms. They are not committing anything other than looking into it but they were very positive. In that fourth meeting there was another option that was presented by greg, but there's also we discussed the other two options which were rotating the aircraft as well as use of the hangar. They asked questions about the hangar and I said I would have to get back with them since it's operational, and I did. However, the agreement too was they were going to try to -- before Monday or Tuesday, get with each other, check with the organizations, get with each other, see if there is any possible collaboration and get with me. You received the next morning a letter or a memo from mark clayton to me and then, of course, sent another one I think yesterday. So that's for you to consider as well. Basically I did not receive any calls saying they had collaborated and had been able to work anything out. As I told them I would, I go back to my recommendation, and even though I regret we were not able to come to any type of a joint solution, I need to go forward with the recommendation because we bought an aircraft and in fairness to the program and residents we need to move forward. What you see is something that I also say in this second paragraph that I mentioned earlier that I wanted to mention, that is, even though starflight is based at a hospital location, it will remain a community asset and resource for 911, search and rescue, law enforcement, homeland security. That's very important. But in reviewing a you will the consideration options along with transport performance data, and this is something we did in the meetings, for the first fiscal year 2009 and first months of 2010, starflight management and emergency services recommends seton hospital unrestricted of $2 million be provided for five years and enhancement offers to brackenridge and
>> [inaudible] and I’ve attached their original recommendation. I presented bullets as to why it would be beneficial for us to be with the seton family of hospitals and that is our long-term relationship, centrally located, close proximity to the hangar, for weather moves, et cetera, and the percentages of transports, and this is very important, fiscal year 2009 was 68% of the transports were with the seton network taken first 10 months of 10, 65%. This last bullet is important and that's something seton has said from the beginning, and that is both are level one trauma centers and seton staff indicated intentions of having staff at each location regardless of how this decision is determined. And so that has a great impact on us as well. So I thank you for that, allowing me the opportunity to present this recommendation and your consideration.
>> let me make sure I understand the $3.2 million. Where does that end up?
>> that is -- it will go actually to the star light operations. And it's an unrestricted gift to starflight for operational expense. And it's really designed, judge, to pay for those maintenance, scheduled maintenance calls that will come about starting next year. This is in no way associated with the purchase of the aircraft. That's something you did and that's something he did as a county. So there's no ownership of the aircraft whatsoever. This is strictly designated toward operational costs.
>> and the $3.2 million payable in what manner?
>> it will be over the next five years in increments broken out. I believe it comes out to -- if I remember right, it comes out to about 500,000 a year. Maybe a little more.
>> five times 500,000 is $2.5 million.
>> no, no, it's -- it's 640. Okay. I didn't want to waste time.
>> all right. And the starflight management is supportive of the recommendation?
>> yes, sir.
>> any questions before we let representatives from st. David's and seton address us if they wish? Court members? I do see mr. Clayton and mr. Hartman. Would you all like to give comments? We do appreciate you all meeting and trying to work through these issues. We knew when you undertook this assignment it would not be easy. Mr. Hobby's presence probably added to the difficulty.
>> I’ll go ahead and go first. Thank you, judge, members of the court for the opportunity to be here again. I’ll keep it short and be happy to answer questions. I want to let you know I’ve got dr. Ty crocker, with practice of physicians that provides care for a number of emergency rooms across Texas and he the medical director for emergency medicine there. I think danny did a good job summarizing it. We've had lots of meeting, productive meetings, and as we said from the beginning, seton and st. David's have corroborated. The sobriety from straight-line winds is one I’m intrigued by on a weekly basis the meeting with paul and discussion of e.m.s., we've begun to work with that program to do some of our outreach programs and think we can grow that. The meetings were productive from that perspective and we look forward to continuing to do that. With regard to the helicopter, it goes back to what we said when we first came here, it's hard to split a helicopter and you are talking significant investment in terms of crew quarters, fueling stations that obviously in addition to our gift, we've got them at brackenridge and our agreement also commits us to make crew enhancements at university medical center brackenridge in addition to the new -- to the work at dell children's. We think that the fact that the staff has looked at this twice and made recommendations, both times strong recommendations with the supported of the starflight management, we think is significant. And we just think it's time at this point to go ahead and make the decision so we can begin doing the crew -- the crew quarters, the additional work we need to do and begin to deliver on our promise to you with the letter and make our first payment in January which is when we're planning to make the first $640,000 payment, January of this year. If you look at the volume of flights, landings and takeoffs from dell children and university brackenridge, dell children's alone is almost equal to the entire st. David's network in terms of liftoffs and landings. That's probably the most significant factor how do you minimize the amount of crew takeoffs from one site to another in order to reduce the number of takeoffs and landing which is where the biggest safety issues occur and time constraints. In addition, resources that we have at dell children's and particularly our work that dr. Crocker has done on training and working with the starflight technicians we think is significant as well and I would like for him to quickly describe that work and we'll turn it over to mark with st. David's.
>> I am pat cracker. One of the important things I think that we can bring to the county and the people who live in the county is some increased education. It's a phenomena across e.m.s. Systems across the country that paramedics learn about pediatric emergencies, but because children are far less likely involved in severe accidents or have critical incidents those wane. We have a program that brings practicing paramedics and county emts into the emergency department and allows them to learn more about how we approach pediatric emergency medicine because children are very different. It can be very difficult to evaluate and we help them build their skills. That program includes a didactics that have about 20 focused readings on the starflight university website now that they go back to and spend over a month, a considerable amount of time focusing on children. Having the helicopter stationed at dell allows us to do two other things. Right now I’m told we have over 300 calls of interested paramedics and emts in the county who want to do this training. We're able to train six a month right now. So we'll never get through that pile. If we can get the helicopter there, we'll be able to -- seton will fund increasing this program up to do 144 a year and we're trying to expand this to brackenridge as well. That includes the sim labs. Finally and maybe one of the biggest gains is when the helicopter is at dell and the crews are not flying, we will incorporate them into all of our critical resuscitations for trauma that arrive by ground and critical medicine. We can build a lot of expertise into the starflight team which is already pretty good, but this would make them stronger.
>> final word. We would like to see you all accept the staff recommendation and in many ways there's been a lot of attempts to arrive a political solution between the two organizations, and again, we'll continue to collaborate with st. David's plot the location would be best for starflight patients and the crew. Thank you.
>> any questions? Mr. Clayton.
>> good afternoon.
>> afternoon.
>> good to see you all. Thank you for the time to speak with you. I want to thank mr. Hobby for the thoughtful consideration and the discussions we've had over the last number of months. Imagine you all are been b. As tired as maybe we are of this discussion. But I would like to offer maybe some points that I think were salient to me in looking at this decision. And also you've gotten a couple of letters from me in the last few days, so it will reiterate some of those things. But sort of in a constant drum beat in terms of the things that we felt were in the best interest of the county and of the starflight program, and that is to have an independent analysis of this question. I don't really believe that with the recommendation being brought for you some months ago of this aircraft being stationed at dell that there was an incentive for the seton family of hospitals to come up with a different solution that created a sharing of the aircraft or a collaboration. I mean just if you lay it out there, they either get this aircraft which they've indicated they are going to do it one way or the other, or they share it with us. And the sharing is not in their best interest even if you look at -- if you look at dell representing only 15% of the transports, and if you look at mr. Hobby's analysis, which indicates that of the total specialty team transports, which include the teams and peds, nicu, et cetera, st. David's had a 102 special active team transports during 2009 and the seton family having 68. If you look at the specialty teams in terms of picking them up and taking them out on a transport mission. Again, it comes back to an independent analysis could also bring to the table some thoughts that we put forward that is it more foreign have a station based where the patients are coming to, in the case of dell, where the patients are coming to, or is it more important to have the station located closer to where the patients are coming from? I think an independent analysis would indicate the latter. And we're willing to contribute half towards that analysis as well as to participate in a request for proposal process that would not have one system saying I’ll give you this and accepting that with the risk or rejecting that with the risk of that system saying we're going to get our own aircraft. So, you know, we are here where we are with a recommendation brought before you. I believe you'll carry the day on their recommendation, but we -- we don't think this has been a fair process. I’ve offered a -- some option and alternatives. There's been no takers on that primarily because there's really been no incentive. And I think the concern is that because the total transfers are greater than ours, you mentioned 68 or 60%, danny, then he mentioned in his last bullet point, very important he emphasized that because the seton family represents a greater number of the transfers to. That's a big threat. That if that was -- they didn't align with that financially the program, if they aligned with us, let's say, chose one or the other, we're not saying that's what they do, but the other side would pull their volume to their own aircraft. So I understand the predicament that we're all in. I’ve more than once said we needed some more time and bring in an independent analysis. There's been notation others that. I take it you are not interested in independent analysis and I respect that decision.
>> any questions for mr. Clayton? Mr. Hobby, any final words?
>> no, sir, believe it or not, I do not have any final words.
>> I do find that hard to believe. I move we go along with staff's recommendation and enter into an agreement with seton where we place the helicopter at dell children's hospital in exchange for five payments that total $3.2 million.
>> second.
>> judge?
>> any discussion on the motion? Commissioner huber.
>> yes, I would just like to say that I tremendously appreciate and respect all the effort that danny hobby and the starflight crew have put into this. I have to say that I’m extremely disappointed in what I see as two systems that, to me I have not yet been convinced they are not working on their competitive edge working on this helicopter. We are in a growing region. I think we need the kind of leadership that steps beyond itself and works together in partnerships. And I basically will be voting a protest vote against this because I believe we should have seen a partnership emerge out of this. I probably would have supported another study, but I think the Travis County at this point has to make a decision on where they are going to go and I’m really, really, really disappointed in the lack of collaborative leadership for the benefit and partnership for the benefit of the region.
>> judge, may i?
>> yes.
>> I do want to thank you all for participating in the meetings and I am very gratified of the partnership that is emerging with regard to the sobriety center, it is very much needed. And we have other opportunities to collaborate particularly on an emergency mental health wing, perhaps. Perhaps a secure wing with regard to del valle correctional patients. We do have a great deal of work to do in the public health arena and emergency services and the-what is unfortunately increasing interphase between emergency health and preventive and ongoing chronic rather than acute circumstances. So I know that we have much to collaborate on and that this will not be our last opportunity, but I do want to say that the deciding factor for me, and we've spoken about this before, was the -- was our trauma response rather than our interfacility capacity at starflight. And I think that our trauma response, I think the statistics speak plainly in favor of the decision that the motion that's before us, the interfacility transports, although extremely important are not our primary mission with starflight. Our primary mission is the trauma response.
>> judge, there is a comment if you don't mind that I think is important to say. You know, these two gentlemen -- sorry, pat, you are a friend too, but I would hope and I told them so that we'll continue our relationship. The decision that's made today if you make it is not in any way going to, I hope, divide or separate us from our existing relationship. I will still do everything in my power, mark, to work with st. David's because we have contracts with each other, and we do want to continue that relationship. And I also want to have, you know, mark now serves on the ms advisory board so if there is anything that needs to happen in starflight as far as service improvement, if he has any questions on anything, then I expect to be there to support him in that. Same thing with greg. Greg, I look forward to the relationship, and pat, this is the ex president for many, many years on the ms advisory board. So even though there's going to be a decision made about a 12-7 aircraft located at a helipad, that in no way in my mind severs the relationships between these two networks and starflight.
>> for the public's understanding, no matter which way this motion goes, it increases the capacity of starflight for both hospital networks in this region. And it always was intended to.
>>
>> [inaudible] was appointed in February of this year and that allowed pretty much nine months for negotiation. I think I remarked myself that it thought it would be miraculous if they reached a compromise that was a win, win, win for both parties and the county. Unfortunately we're talking about one helicopter and where it should go. So I mean I think here we are with the facts that have not really changed over the last nine months, and I knew it would be a tough decision sooner or later, and I just think we've come to the point where we need to make the decision and move on down the road. Starflight is there to pick up patients that need to be rushed to the hospital. And, you know, we'll staff them up as much as we can and have them available, and when the calls come, we'll follow the protocol that we've been following historically, and dispatch starflight to serve its purpose and mission. So that doesn't change. And so we would like to work with both of you and other health care providers to use starflight when it's necessary to do so. So we appreciate your help and I don't know that -- you know, not to be cynical, but I knew it was a leap of faith that we placed on you and it would have been a different thing if we had two helicopters and two networks basically trying to get one apiece. Unfortunately two networks and one helicopter is where we've been.
>> and what I would like to say is thanks to everybody for working together for this period of time. I think expectations were there for some kind of joint recommendation and yeah, it is kind of bad that we didn't get one, however, I think some good came from all of this. There's nothing like waiting for the right time for an idea. I have long supported the sobriety center and I think perhaps that the time has come for that, I think it's another good service that this community could really take advantage of. It would improve the health of the community no doubt. And so for that I’m grateful to you, everyone, for giving it all you've got for nine months. That's quite a period of time to keep talking with each other, so thanks so.
>> any more discussion? All in favor of the motion? Shows Commissioners Gomez, eckhardt and Gomez voting in favor. Commissioner huber voting again. That motion carries on 3-2. 3-1. Sorry, ms. Porter, it's late in the afternoon. Now, why don't we announce that we'll take up on in executive session two items. We have postponed this grievance hearing several times already so we need to go ahead and do it. It's number 29, conduct hearing and take appropriate action on appeal from June 18, 2010, Travis County grievance panel decision in sergio flores versus constable richard mccontain, precinct 3. Pursuant to Travis County code section 9.25 k. This is under the consultation with attorney and personnel matters. And since we discussed the purchase of the automobile, let's announce it and try to get both of these done and then finish the executive session discussions. 19 is consider and take appropriate action on request to authorize Travis County constable precinct 3 to purchase a chevy van, vin number 1 gceg 25 h 9 k 7169133 for $1,000. It will be taken into executive session for security and consultation with attorney exceptions. We're only announcing those two items. We'll come back top story court before taking any -- come back to open court before taking any action and also announce the rest of executive session when we come back.
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Last Modified:
Tuesday, October 19, 2010 2:33 PM
