Travis County Commissioners Court
Tuesday, November 30, 2010,
Item 23
Number 23, receive briefing from Travis County sheriff's office on issues regarding psychiatric services.
the county judge sent out an email yesterday indicating that we would reach this item at 11 a.m.
y'all didn't get that email.
>> no, sir.
>> sorry about that.
I think I sent it to the county sheriff and major long.
>> that's why.
>> [laughter]
>> I won't tell him you said that.
okay.
>> good morning, judge and Commissioners.
my name is mark salon, Travis County sheriffs.
we're here this morning to ask you to consider a reclassification of our current psychiatric news practitioner to mental health practitioner.
I believe it was two weeks ago and I believe it was at Commissioner Davis' behest, medical director mike summers was here and he gave you kind of a readers digest version at the Travis County jail.
a readers digest but very comprehensive version, I might add.
we can go back over all of those details and further describe our situation.
you hear our mantra kind of occurrence after occurrence or situation after situation that we are the largest mental health provider in central Texas, and we are hands down the largest mental health provider in central Texas.
mr. Summers very accurately described our current situation.
and the particular bullet point that we would like to discuss this morning is the physicians assistant nurse practitioner and reclassify of the psychiatric mental health nurse practitioner.
we are lost our nurse practitioner on October 30th.
she accepted a salary for another agency that was just about $35,000 more than the salary that we were paying her.
from our understanding, the salary was $74,000 that was her current salary at that time.
she was a nine and a half year nurse practitioner, an entrance level nurse practitioner is about $90,000.
in order for us to have any type of competitive edge in this process, in concert with our overwhelming need given the type of services that we are mandated to provide, we are the only mental health provider that can't close our door.
with that said, this is a good starting point for us and a good starting point to enhance our services.
>> are we expecting any help at all from the state?
and because, you know, and here we're saying and, of course, that was a real good overview that y'all gave a couple weeks ago and we really dug deep into the issue uncovering a lot of things that I wasn't aware of until they were revealed to me in the court.
and I知 concerned because it's -- it's -- it has financial implications that are deep.
and, of course, looking at the Austin mental -- the Austin mental health -- the number of beds that they do not have available and, of course, this position being one that probably needs to be filled and, of course, adjust maybe the pay salary so we can have somebody there to take care of the mentally challenged persons that we have incarcerated in our jail.
and, of course, the statistics that were revealed at the last meeting before you came before the court was, like I said, was shocking to the degree that more than 25% of persons incarcerated within the jail population itself, we're talking about more than 600 folks that we have to deal with and, of course, not getting the medical attention probably that they may need as far as the psychiatric nurse practitioner and it's hard to retain them because they go other places and, of course, there's a shortfall.
along with the medication and the prescriptions that's necessary to deal with this.
so the question I would like to bring this morning, has there been any relief that we can maybe foresee that will come -- that maybe is coming from the state that will help us in this regard since we are the largest regional caretaker within our jail system of incarceration for the mentally challenged persons here within Travis County.
and it's really -- it's a big deal.
it's a big alarming figure, millions of dollars, over $20 million what we're talking about according to the last time we discussed this issue.
so my question is what are we doing to maybe ask the state of Texas to help us because it's really like an unfunded mandate to a degree.
and, of course, the taxpayers of Travis County have to bore that cost out of our general fund.
and is there any relief, financial relief for us coming from the state of Texas?
can somebody maybe look -- can you help maybe address that?
>> from every indication, the state of Texas has cut their services to the state agencies.
there doesn't appear to be any relief in sight for county and/or city government particularly when they are cutting their own funding to their state entities themselves.
>> well, what are other local governments doing at the county level with this issue?
because it's an issue -- in other words, the mentally challenged persons throughout the state of Texas, just not only concentrated in Travis County, what are they doing to address their -- their financial challenges having to deal with the mentally challenged individuals?
>> part of the initiative we've tried to undertake, mr. Davis, is to work within the -- the coaches system, and coaches is a acronym for community oriented health services, and that is where the correctional facility works with the community health provider, and in this case integral care, and it is a working relationship that allows for when a patient comes from the jail and to the street allows for a much better continuity of care and easier, seamless transition from the jail back to the street.
integral care is a taxpayer funded entity as is the sheriff's office.
when we put our money back into integral care and through contract services, we're funding a taxpayer funded entity.
so that in and of itself is a win-win proposition, and to increase our networking and our inter operability with integral care, of course, is another win-win proposition when those two organizations work cooperatively together.
so again, from -- from a standpoint of us working in every way that we can outside of -- outside of somebody handing us money or pouring money into us from the state or from some other type of funding source, we're trying to take our taxpayer dollars to the best utilization that we can.
>> I guess what I知 trying to get to, what are they doing to deal with their mentally challenged persons, especially if they do not have bed capacity and bed cutbacks at the state level, what are they doing?
because this is 20 some odd million dollars here.
>> they are doing essentially the same thing we're doing and we have essentially the same challenges that we have.
in harris county, for instance, they have a lot greater community support with their psychiatric stabilization center.
>> okay.
>> and the -- and the interaction with their hostel district within -- and working with the sheriff's office and working with the jail population as well.
and we don't have those same advantages here in Travis County.
so there -- there is a significant dynamic that makes us different and makes almost every other county different than every other county.
one of the issues, from our research that we found is you could take a jail population and say given this jail population, these are the amount of correction officers that you need.
and that equation work out pretty well and it works out from county to county and works out with jail population and size of county to county, county to county.
but one of the things we have seen is that same equation doesn't factor in from an inmate treatment he equation, and particularly from the mental health treatment equation.
there is a specific dynamic that differs almost institution to institution and one of the big factors in that is what community support is in place and what -- what community interaction is in plays with the jail population devoid of what community support is in place.
and when there is a -- a large amount of community support in place, you have somewhat of a relief to the correctional institution and just the opposite is true, when there is not a large community supported resource in place, then it affects negatively into the jail population.
and we have in Travis County we have the largest suicide rate of any county in Texas, and that in and of itself says volumes regarding what type of resources we have in place from a community standpoint.
a great article that was written here not too long ago, it was written in 2010, I can't give you the exact month, it's called broken, written by the chronicle, and it's an excellent article regarding the overall mental health services or the lack of mental health services in Travis County.
and I strongly urge you all, I値l actually send you an email and a copy to the link if you haven't read it already.
so in answer to your question, Commissioner, there is a direct correlation between the community services or the lack of community services into the services available and offered within the confines of the jail.
>> okay.
thank you.
>> you're welcome.
>> let me make sure I understand what the ask is today.
I知 looking at the backup memo, I知 looking at the agenda item, and I知 listening.
the agenda item is narrowly worded.
the action we can take under it is authorize a market salary survey, which you all believe we need.
right?
>> yes, judge.
>> move approval of it.
>> second.
>> mr. Arsman you would be the one to do it?
>> yes, sir.
>> any advisement?
>> I will tell you the sheriff's office gave us a heads up this was coming a couple weeks ago and we've already begun it.
in fact, we're pretty much done with it.
not quite done.
>> all in favor?
that passes by unanimous vote.
now you are authorized to complete it.
now, that's the action we're authorized to take in 23.
but the backup says that you need some other actions later.
under a more broadly worded item.
and that's what I知 reading -- those are your four points on page 2, right?
>> yes, sir.
>> so what else do we need to help?
>> we need another part-time psychiatrist.
I can give you the whole story as to why we need that.
we have a potential resource available to assume that position to augment our services with our current part-time psychiatrist.
we contracted with integral care on October 1 to provide us a full-time psychiatrist, 160 hours per month.
and on October 20th, that resource went away.
that resource from 160 hours, according to the interlocal, there is 40 hours a month currently being provided by the medical director of integral care, dr. Norman, who very graciously and very kindly has assumed these duties, but it's a fourth of what was initially agreed to with integral care.
integral care had located another psychiatrist that was supposed to come on board for us on November 19th and they also backed out of that deal.
so it goes back to -- to all the bullet points that director summers brought to your attention two weeks ago and our inability to find resources, let alone with -- from even a separate standpoint not from a monetary standpoint, but just to find and locate the resources themselves.
this time last year we had a full-time psychiatrist, a half-time psychiatrist and a nurse practitioner and right now we're running with a half-time psychiatrist.
so consequently, we have the availability or potentially the availability, and I値l let director summers speak to that specifically and where we stand today, but we have the availability to fill this half-time position with a psychiatrist who is interested in this position who has a -- who has some background on the dynamic and the complexities of what is expected of him given the dynamic and complexities of the Travis County jail because he's an associate with our current half-time psychiatrist.
>> when will you know whether you have funding for the second half-time psychiatrist?
>> well, we're currently in the process of establishing another interlocal with integral care to provide a psychiatric nurse practitioner to fill as a stop-gap measure to fill our lack of a -- nurse practitioner.
>> but you mentioned a minute ago you may have funding for the second half-time person.
>> well, that's possible.
>> I didn't mishear you, did i?
you did say that.
>> I may have.
>> when will you know for sure whether you have that funding?
>> I think we could probably know by the end of the day.
>> well, we've looked at this and talked about we think there's some savings in some other operating line items that will get us through this year.
and I think the sheriff's office and the budget office has tried to make --
>> is that the money you had in mind?
>> yes, sir.
that's not to say the population couldn't change or some unforeseen things.
this year doesn't seem to be a problem, next year we'll need to work on it beginning right now through the budget process.
>> any problem bringing that back to the court next Tuesday?
we're not posted today.
>> I think that would be important.
you are speaking number 3 and 4 on your wish list would be addition to a half-time psych and psych nurse, correct?
>> yes, Commissioner.
>> full-time.
>> I believe we can do both of them tore this year only with existing resources.
that would be one-time resources.
but on a one-time basis.
>> do a budget item during this budget process.
>> yes, sir.
>> but as to the full-time psychiatrist, how can we help with that?
is that the market salary survey that may impact that?
>> the full-time was part of integral care and from every indication we're not having any luck.
we're not having any luck filling that position.
>> finding the person.
>> yes, sir.
>> you've got the money but you don't have the person.
>> we have the money dedicated to the interlocal and we're -- as I said, within the last two months we've lost two psychiatrists that were potentially -- one was on the hook and one that never really bit on the hook.
so as I said, that resource, that -- what was supposed to be 160 hours a month is still 40 hours a month with the medical director of integral care and although I don't know, I would say that his ability to continue even at 40 hours a month is going to be somewhat diminished given his overall responsibilities.
so -- so with that said, our full-time psychiatrist, the availability to fill that position does not look good and maybe director summers has additional information regarding that is correct but we have not received anything from dr. Norman regarding his ability to fill that -- to fill that position.
>> and this --
>> so that kind of hangs out there.
>> and this is because the -- the -- the numbers of individuals who fit the criteria for this kind of work is small and -- and we are concerned that the salary is not appropriate for that -- that population of psychiatrists?
is that where we are here?
>> it is at least those two concerns, Commissioner.
>> I want to applaud you because in the past we have shied away from embracing being the largest mental health facility in the region and I do want to applaud the sheriff's department in general for what has been a fee change in our embrace of what we have become for lack of services and funding from the state.
and a desire to become a very good mental health provider of last resort rather than an unwilling mental health provider of last resort.
so --
>> travis put the full-time person on next week's agenda also.
>> all right.
>> director summers, were you about to give comments?
>> no, sir, just here to answer questions.
>> I don't know what we can do accept address the salary of the full-time psychiatrist.
anything else the Commissioners court can do?
>> not at this moment.
>> the full-time psychiatrist is a contract so that wouldn't be a Travis County employee, but that's actual contract with Travis County integral care.
>> that's correct.
>> and the market study would just be dealing with the reclassification of the nurse practitioner, the existing nurse practitioner and an additional new nurse practitioner that would be -- that would focus on psychiatric services.
>> that's correct, in concert with the establishment of another contract for this half-time psychiatrist.
>> right.
>> that would duplicate or replicate the already half-time contract that's in place for our current half-time psychiatrist.
>> so the psychiatrists are on -- would be on contract with mhmr and would be managed by mhmr, correct?
>> no, ma'am, only the full time.
>> the part time would be our employee?
>> well, they are paid as a part-time employee for us, yes.
>> and as far as the psychiatric nurses, you are asking for an additional psychiatric nurse for two full-time psychiatric nurses?
>> yes.
the reclass of the current nurse practitioner/physicians assistant to a psychiatric mental health nurse practitioner and an additional psychiatric mental health nurse practitioner.
>> so both of those would be full-time employees of Travis County?
>> that's correct.
>> so you would consider -- and I知 just trying to wrap my brain around this.
this agenda item is about having to -- needing -- requesting to do a market salary survey to look at salary levels for this specialized community, but it seems that these other items also go to concern that perhaps low staffing levels are leading to people who are qualified not wanting to take the job?
>> yes.
>> okay.
>> as well as avoid a significant void that was created by the whole that was left by a full-time psychiatrist roll on October 20th, and our inability to -- to have and even a stop gap from not a full-time psychiatrist, it's augmenting those hours.
so a fourth of those hours are being augmented, once again, very graciously by the medical director of integral care.
>> integral's care's position is they are looking for a full "time psychiatrist.
>> yes, sir.
>> as best they can.
>> yes.
>> I知 sorry, judge, just so I知 clear, did you want this to come back next week under p.b.o.
or the department?
>> put it under other and if you feel real bold, put it under p.b.o.
anything else today?
really the item ought to be worded in a way it clearly indicates our intention to take action.
now, do we think that the -- does our contract with integral care provide sufficient funds to add a full-time psychiatrist?
>> I知 not sure of your question.
the contract with integral care is for a full-time psychiatrist.
the current contract.
>> so we reimburse that 100%?
>> no, we have not.
we had a savings from the hours that were not filled for the remaining hours in October --
>> but when we approved the interlocal, we agreed to reimburse that 100%.
>> yes.
>> my question is is a salary set for that full-time psychiatrist sufficient to attract one?
>> well, we've not heard anything contrary to that.
>> why don't we give them a phone call between now and next Tuesday.
>> we'll do that.
>> let's just add that as a possible action item too, mr. Gatlin.
>> okay.
>> you have confidence in your agenda writing skills, don't you?
>> well, and I知 also going to go back and look at the tape again for everything I missed.
>> [laughter] what I didn't get back now, I値l get back.
>> my name is john kitchen.
may I have your name?
>> mark salway.
>> right now it's assumption.
your office released Texas assistant without any court order at all whatsoever the federal government came, put him into federal jail without your permission.
>> mr. Kim, I don't think we can legally discuss that on this item.
sorry.
it's unrelated.
>> thank you.
>> thank you all very much.
see you next Tuesday.
>> thank you very much.
>> we'll give you a specific time on Monday to avoid a long wait.
okay?
>> sounds good.
The Closed Caption log for this Commissioners Court agenda item is provided by Travis County Internet Services. Since this file is derived from the Closed Captions created during live cablecasts, there are occasional spelling and grammatical errors. This Closed Caption log is not an official record the Commissioners Court Meeting and cannot be relied on for official purposes. For official records please contact the County Clerk at (512) 854-4722.
Last Modified:
Tuesday, November 30, 2010 2:08 PM
