Closed Caption Log, Council Worksession
Wednesday, January 9, 2002

Note: Since these log files are derived from the Closed Captions created during the Channel 6 live cablecasts, there are occasional spelling and grammatical errors. These Closed Caption logs are not official records of Council Meetings and cannot be relied on for official purposes. For official records or transcripts, please contact the City Clerk at (512) 974-2210.

MAYOR GARCIA: GOOD MORNING, EVERYBODY, IS THIS THING ON? CAN ANYBODY HEAR ME BACK THERE? I GUESS IF YOU CAN'T HEAR ME YOU CAN'T ANSWER THE QUESTION, RIGHT? IT'S WEDNESDAY MORNING, JANUARY THE 9TH. IT'S ABOUT 10:10. WE ARE AT THE ONE TEXAS CENTER, 505 BARTON SPRINGS ROAD. THE THIRD FLOOR TRAINING ROOM FOR THE AUSTIN, TEXAS -- CITY COUNCIL WORK SESSION. WE HAVE A COUPLE OF BRIEFINGS. I HAVE ASKED THE COUNCIL IF WE COULD REINSTITUTE THE WORK SESSIONS. THIS IS THE FIRST ONE THAT WE WILL HAVE, HOPEFULLY NOT THE LAST ONE. THE WORK SESSIONS ARE NOT INTENDED AT THIS TIME TO HAVE ANY ACTION ITEMS. THIS SESSION -- THESE SESSIONS ARE INTENDED TO BE BRIEFING SESSIONS. BUT FROM TIME TO TIME, WE MAY HAVE A NEED TO PUT EITHER EXECUTIVE SESSION ITEMS ON THIS AGENDA OR ACTION ITEMS, IF THE NEEDS ARISE. HERE AT THE MEETING WE HAVE THE CITY MANAGER, JESUS GARZA FROM PLACE 2 COUNCILMEMBER RAUL ALVAREZ, PLACE 4, COUNCILMEMBER GRIFFITH PLACE 5, WILL WYNN, SPELLED WYNN NOT NGUYN.

WYNN: THANK YOU.

THAT'S A JOKE BECAUSE THERE WAS AN ARTICLE THAT CAME OUTLET WHERE THEY QUOTED ME AS SAYING THAT I WAS WORKING WITH NEW COUNCILMEMBERS, ALVAREZ, THOMAS AND WYNN, THEY SPELLED IT NGUYN. I TOLD THEM I SAID I DIDN'T KNOW THAT WE HAD A VIETNAMESE PERSON ON THE COUNCIL. INCIDENTALLY, NGUYN SPELLED THAT WAY MEANS KING. [ LAUGHTER ].

WYNN: AH I KNEW I WANTED TO COME TO THIS WORK SESSION FOR SOME REASON.

MAYOR GARCIA: I HAPPEN TO KNOW THAT BECAUSE I'M MARRIED TO ONE OF THOSE WOMEN THAT HAS TO RESEARCH EVERYTHING. SHE RESEARCHED IT AND TOLD ME THAT THE OTHER DAY. WE HAVE TWO ITEMS ON THE AGENDA TODAY. THE FIRST ONE IS A BRIEFING ON THE PROPOSED AMENDMENT TO BRACKENRIDGE HOSPITAL LEASE REGARDING REPRODUCTIVE HEALTH SERVICES. THE SECOND ONE IS AN OVERVIEW OF THE CITY AUDITOR'S 2001 ACCOMPLISHMENTS. THOSE OF YOU THAT -- ON THE SECOND ITEM, THOSE OF YOU WHO WANT TO SEE THE REPORT, I SUSPECT WE HAVE EXTRA COPIES OF THAT? STEVE? WE DO?

[INAUDIBLE]

MAYOR GARCIA: OKAY. CITY MANAGER?

GARZA: YES, SIR, MAYOR, MEMBERS OF COUNCIL --

MAYOR GARCIA: LET ME SAY I HAVE CALLED THIS MEETING TO ORDER, WE ARE IN SESSION NOW.

GARZA: MAYOR, MEMBERS OF COUNCIL, AS YOU WELL KNOW, WE HAVE TRIED TO MAKE A PRESENTATION OF THIS ITEM BACK THIS LAST FALL AND IT DIDN'T QUITE WORK OUT FOR US. WE WENT BACK TO THE NEGOTIATING TABLE TO WORK OUT VARIOUS ISSUES. WE HAVE BASICALLY REACHED THE FRAMEWORK OF AN AGREEMENT WITH SETON. THE DOCUMENT ITSELF, I'M TOLD, IS NOT READY. THAT IS ONE OF THE REASONS THAT WE HAVE REQUESTED THAT THE PUBLIC HEARING THAT WAS SET FOR TOMORROW NIGHT BE CANCELLED. SO IT GIVES US AN OPPORTUNITY TO ACTUALLY GET A DOCUMENT OUT FOR PEOPLE TO READ, FOR US TO BE ABLE TO TALK TO THE VARIOUS INTEREST GROUPS SO THEY KNOW THE PARTICULARS OF HOW THIS AGREEMENT WILL WORK, HOW ALL OF THE VARIOUS ASPECTS OF THE HOSPITAL WITHIN A HOSPITAL CONCEPT WILL OPERATE. SO WITH THAT INTRODUCTION, LET ME ASK JOHN STEVENS AND BETTIE DUNKERLY WHO HAVE BEEN LEADING THE NEGOTIATION ON THIS, AND TRISH, TO WALK THROUGH THE PRESENTATION AND TO TRY TO ANSWER ANY QUESTIONS THAT THE COUNCIL MIGHT HAVE.

THANK YOU VERY MUCH. MY NAME IS BETTIE DUNKERLY. I'M AN ASSISTANT CITY MANAGER --

MAYOR GARCIA: JUST A SECOND. THERE IS AN OVERHEAD OVER HERE. I DON'T KNOW IF PEOPLE -- WELL, I KNOW THAT PEOPLE IN THE BACK CAN'T SEE THAT. DO WE HAVE A TV CAMERA BACK THERE THAT WILL SHOW THAT OVERHEAD? THEY GOT IT. GOOD.

GARZA: THAT CONCLUDES OR PRESENTATION. [ LAUGHTER ].

THAT'S VERY GOOD. FROM.

NO. GOOD. BEFORE WE START, I WOULD LIKE TO REMIND YOU WHO OUR TEAM IS. I HAVE TO MY LEFT JOHN STEVENS, WHO HAS BEEN WORKING ON MOST OF THE FINANCIAL ISSUES. PART TRICIA YOUNG, WHO IS HEADS OF OUR COMMUNITY HEALTH CLINICS, PATRICIA YOUNG, BEEN A KEY ROLE IN THE NEGOTIATIONS. THEN SALLY HENLY FROM THE LAW DEPARTMENT. IN ADDITION TO THOSE FOLKS, WE'VE HAD BETSY ATTELL IN THE AUDIENCE, BETSY IF YOU WILL RAISE YOUR HAND. BETSY HAS OVER 30 YEARS OF HEALTH CARE CLINIC EXPERIENCE. SHE'S ALSO THE ADMINISTRATOR -- HAS BEEN THE ADMINISTRATOR OF WOMEN AND CHILDREN'S SERVICES AT PARKLAND HOSPITAL IN DALLAS, WHICH IS THE LARGEST MATERNITY TEE SERVICE IN THE UNITED STATES. ANN KITCHEN HAS HELPS US WITH A LOT OF DISPRO ISSUES AS WELL AS OTHER ISSUES, THEN CHUCK GRIFFITH AND DAVE COATS HAS BEEN INSTRUMENTAL IN OUR WORK. I WOULD LIKE TO REMIND YOU, WE REALLY WANT TO COVER ABOUT FIVE TOPICS THIS MORNING. A LITTLE BIT ABOUT THE BACKGROUND AND LEASE PROVISIONS TO REMIND YOU OF WHERE WE WERE, WHERE WE ARE GOING. AN OVERVIEW OF THE CURRENT SERVICES AT THE HOSPITAL.

MAYOR GARCIA: LET ME INTERRUPT YOU ONE MORE TIME. COUNCILMEMBER SLUSHER IS ATTENDING A MEETING OF THE CAPITAL AREA PLANNING COUNCIL, CAPCO, SO WILL NOT BE HERE TODAY. AND MAYOR PRO TEM AND COUNCILMEMBER THOMAS SHOULD BE COMING SHORTLY.

CORRECT. THE THIRD THE HOSPITAL WITHIN A HOSPITAL OPTION, THE PROPOSED FINANCIAL TERMS AND THE CONTINUITY OF PATIENT CARE AND THEN LASTLY WE WANT TO REMIND THE AUDIENCE ABOUT WHAT HAPPENS AFTER THIS, WHEN THE PEOPLE HEARINGS ARE AND FINALLY WHEN WE ARE GOING TO BE REQUESTING THE COUNCIL CONSIDER THIS ITEM FORMALLY ON THE CITY COUNCIL AGENDA. AS ALL OF YOU KNOW, BRACKENRIDGE HOSPITAL HAS SERVED AS A CORNERSTONE IN THIS COMMUNITY FOR HEALTH CARE SINCE 1884. SERVING PEOPLE REGARDLESS OF THEIR ABILITY TO PAY, BEING THE SAFETY NET HOSPITAL FOR OUR AREA. ACCESS TO REPRODUCTIVE HEALTH CARE HAS ALWAYS BEEN FUNDAMENTAL TO THE HEALTH AND WELL-BEING OF WOMEN IN THIS COMMUNITY. AND OUR GOAL THROUGH THIS -- THIS PROCESS THAT WE HAVE BEEN THROUGH HAS BEEN TO MAINTAIN ACCESS FOR EVERYONE IN NEED OF REPRODUCTIVE SERVICES TO MAINTAIN A SEAMLESS DELIVERY SYSTEM AS POSSIBLE AND TO MAINTAIN THE HIGH QUALITY OF CARE THAT IS CURRENTLY AVAILABLE AT BRACKENRIDGE. WE WANT TO DIVIDE THE PRESENTATION INTO SEVERAL PARTS. SALLY HENLY WILL TAKE THE PART ABOUT THE LEASE TERMS, TRISH WILL COVER SERVICES AND FOLLOW UP WITH THE CONTINUITY PIECE AND JOHN STEVENS WILL HANDLE THE FINANCIAL ISSUES. I WOULD LIKE TO TURN IT OVER TO SALLY RIGHT NOW.

ON PAGE 5 YOU WILL SEE THE SPECIFIC LEASE TERMS REGARDING REPRODUCTIVE SERVICES. REPRODUCTIVE SERVICES, WERE, AS YOU KNOW, AN IMPORTANT PART OF THE ORIGINAL LEASE. THEY WERE INCLUDED AS AN ESSENTIAL HEALTH SERVICES REQUIRED UNDER THE LEASE. IT -- THE LEASE DID ACKNOWLEDGE, HOWEVER, THAT ALTHOUGH SETON POLICIES EXCLUDE THE PROVISION OF ABORTIONS AND ABORTIFACIENTS, HOWEVER BECAUSE THE CITY DEMANDS THAT REPRODUCTIVE SERVICES ... ON THE NEXT PAGE, YOU HAVE THE DEFINITION OF REPRODUCTIVE SERVICES, WHICH HAVE YOU STERILIZATION PROCEDURES, FAMILY PLANNING AND COUNSELING SERVICES, FULL INFORMATION REGARDING PREGNANCY OPTIONS AND REFERRALS TO HEALTH CARE PROVIDERS TO SERVICES NOT PROVIDED AT BRACKENRIDGE. METHODS OF CONTRACEPTION, INCLUDING ABORIFACETIONS AND EMERGENCY MEDICATIONS WHICH PREVENT CONCEPTION. IT WAS ANTICIPATED THAT CITY EMPLOYEES OR CONTRACTORS WOULD PROVIDE SOME OF THOSE SERVICES AT THE BEGINNING OF THE LEASE. PAGE 7, CHANGE IN ETHICAL RELIGIOUS DIRECTIVES. IF WE SPECIFICALLY PROVIDED THIS -- THIS PROVISION SO THAT SHOULD SETON NOTIFY THE CITY THAT THEIR ETHICAL AND RELIGIOUS DIRECTIVES CHANGED DURING THE TERM OF THE LEASE AND THERE WERE -- THE CHANGES RESULTED IN THE SETON'S INABILITY TO PERFORM SOME OF THE OBLIGATIONS UNDER THE LEASE, THEY WOULD ADVISE US OF THAT. WE WOULD DISCUSS WAYS IN WHICH WE COULD POTENTIALLY RESOLVE THE PROBLEM, AND IF WE COULD NOT AGREE ON SUCH A RESOLUTION, AND SETON WAS NOT OTHERWISE ABLE TO CURE SUCH DEFAULT OR THE INABILITY TO PROVIDE THAT SERVICE, THE CITY COULD EXERCISE ITS REMEDIES FOR SUCH SETON DEFAULTS. AS YOU KNOW, WE'VE BEEN IN A FAIRLY LENGTHY PROCESS WITH SETON. THEY GAVE US NOTICE BACK IN JUNE. WE HAVE BEEN IN DISCUSSION SINCE THAT TIME OF A WAY TO CONTINUE TO PROVIDE RESPRUKT ACTIVE SERVICES ON -- REPRODUCTIVE SERVICES ON THE BRACKENRIDGE CAMPUS. SO THE CHANGES REQUIRED IS THAT THE SERVICES CANNOT BE PROVIDED IN FACILITIES MANAGED BY SETON. AND SETON CANNOT FACILITATE THE PROVISION OF THOSE SERVICES. WHICH LEADS US TO THE OVERVIEW OF THE CURRENT SERVICES BEING PROVIDED. ON PAGE 10 OF YOUR PRESENTATION, --

IF YOU COULD INTRODUCE YOURSELF.

I'M SORRY, I'M TRISH YOUNG, OFFICER THE PRIMARY CARE CLINICS. -- OVER THE PRIMARY CARE CLINICS, I WILL BE TALKING ABOUT CURRENT SERVICES AT BRACKENRIDGE AS WELL AS THE PROPOSAL WE ARE BRINGING FORT TO YOU TODAY. APPROXIMATELY TWO-THIRDS OF THE PATIENTS DELIVERED AT BRACKENRIDGE ARE COMMUNITY HEALTH CLINIC PATIENTS, PATIENTS WITHIN OUR SYSTEM THAT WE TAKE CARE OF RIGHT NOW. THE REMAINDER OF THE PATIENTS RECEIVE THEIR PRENATAL CARE FROM OTHER COMMUNITY PROVIDERS, AS WELL AS PRIVATE PROVIDERS IN OUR AREA. THE SERVICES THAT WE PROVIDE AT OUR CLINICS INCLUDE PRENATAL CARE, FAMILY PLANNING WHICH ALSO ADDRESSES BIRTH CONTROL METHODS, COUNSELING, INFORMATION ABOUT EXTRA ACCEPT ACTIVES AND TUBAL LIGATION, STERILIZATION PROCEDURES, ET CETERA. WE ALSO DISPENSE EXTRA ACCEPT ACTIVES TO OUR PATIENTS IN THE -- CONTRACEPTIVES TO OUR PATIENTS IN THE CLINICS. CURRENTLY THERE ARE FAMILY PLANNING, COUNSELING STAFF THAT DO COUNSEL WOMEN WHO REQUIRE INFORMATION ABOUT CONTRACEPTIVE METHODS AND HELP THEM OBTAIN THOSE METHODS PRIOR TO LEAVING THE HOSPITAL IF THEY DESIRE. THE CURRENT REPRODUCTIVE HEALTH SERVICES PROVIDED AT BRACKENRIDGE ARE LISTED ON PAGE 11. RIGHT NOW TUBAL LIGATIONS, FAMILY PLAN COUNSELING AND BIRTH CONTROL METHODS ARE BEING PROVIDED AT BRACKENRIDGE, BUT THEY ARE DONE THROUGH CITY -- EITHER CITY EMPLOYEES OR CITY ARRANGEMENTS. EMERGENCY CONTRACEPTION IS ALSO PROVIDED AT BRACKENRIDGE ER. ON PAGE 12, WE TRIED TO ELSE STRAIGHT FOR YOU THE CURRENT PATIENT FLOW. WHAT HAPPENS TO -- ILLUSTRATE THE CURRENT PATIENT FLOW, WHAT HAPPENS WHEN THEY COME INTO BRACKENRIDGE. THE PATIENT CAN COME IN ON THE FIRST OR SECOND FLOOR IF THEY ARE READY TO DELIVER A BABY, OR DIRECTLY TO THE ER IF THEY ARE READY TO DELIVER A BABY OR SEEKING SOME OTHER SERVICE THROUGH THE EMERGENCY ROOM. THERE IS A TRIAGE PROCESS THAT OCCURS WITH THE PATIENT COMING INTO DELIVER AT BRACKENRIDGE. AND AN ASSESSMENT IS PERFORMED AS TO WHAT INFORMATION THAT -- THAT PATIENT MAY NEED. IF A PATIENT IS SCHEDULED TO RECEIVE A TUBAL LIGATION, THE PATIENT, THEY CHECK TO SEE WHETHER THAT PATIENT HAS RECEIVED OR SIGNED ALL OF THE APPROPRIATE FORMS FOR CONSENT. IF -- IF THAT'S THE CASE, THE PERSON WILL MOVE TO THE FLOOR TO BE DELIVERED. WILL RECEIVE THAT PROCEDURE. IF A WOMAN REQUESTS A TUBAL LIGATION THAT IS PART OF A CESAREAN PROCEDURE, CESAREAN DELIVERY, THAT PROCEDURE WILL HAPPEN AS PART OF THE DELIVERY. IF A WOMAN WOULD REQUEST A TUBAL LIGATION WITHIN A NORMAL VAGINAL BIRTH, THAT PROCEDURE OCCURS SUBSEQUENT TO THE BIRTH. EITHER WITHIN A MATTER OF HOURS OR POSSIBLY A MATTER OF DAYS.

MAYOR GARCIA: ARE THOSE PROCEDURES DONE ON THE FIFTH FLOOR? PROPOSED TO BE DONE ON THE FIFTH FLOOR OR SECOND FLOOR?

THOSE PROCEDURES IN OUR PROPOSAL ARE PROPOSED TO BE DONE ON THE FIFTH FLOOR.

MAYOR GARCIA: FIFTH FLOOR.

GOING FORWARD. CURRENTLY, IF A WOMAN DOES RECEIVE A TUBAL LIGATION, AFTER HER NORMAL DELIVERY, SHE -- THE ACTUAL PROCEDURE TAKES PLACE IN -- ON THE FIRST FLOOR OF THE HOSPITAL, JUST A MATTER OF WHERE THE PROCEDURE ITSELF TAKES PLACE. IF A WOMAN DOES NOT RECEIVE A STERILIZATION PROCEDURE AND REQUIRES SOME FAMILY PLANNING COUNSELING, THAT OCCURS POST PARTUM, WHERE THERE'S A VISIT FROM THE NURSE AND WE HELP HER SORT THROUGH THE INFORMATION AND PROVIDE -- HELP HER OBTAIN THE CONTRACEPTIVE IF THE IF I SEE IN FACT DISPENSES A PRESCRIPTION FOR HER. THERE'S A PHARMACY THAT THE PATIENT CAN RECEIVE OR ACTUALLY FILL THAT PRESCRIPTION AT BRACKENRIDGE RIGHT NOW. MOVING FORWARD TO OUR PROPOSE UNDER THE HOSPITAL -- PROPOSAL UNDER A HOSPITAL WITHIN A HOSPITAL, THE GOALS FOR THIS PROPOSAL ARE TO ENSURE THAT THE REPRODUCTIVE HEALTH SERVICES CONTINUE TO BE MADE AVAILABLE ONSITE AT THE BRACKENRIDGE CAMPUS. THAT WE ALSO CREATE A SEAMLESS DELIVERY OF SERVICE TO THOSE PATIENTS. THE SPECIFICS OF THE PROPOSAL ARE THAT WE WOULD -- THE CITY WOULD OPERATE A -- THE FIFTH FLOOR, WHAT IS CURRENTLY THE FIFTH FLOOR OF THE PATIENT TOWER AS A HOSPITAL WITHIN A HOSPITAL FOR WOMEN'S REPRODUCTIVE HEALTH CARE SERVICES, WHICH WOULD INCLUDE FULL DELIVERY SERVICES AND ANY OTHER REPRODUCTIVE SERVICES REQUIRED. SETON WILL NOT GOVERN, MANAGE OR OPERATE THE HOSPITAL. IT WILL BE SEPARATELY LICENSED TO THE CITY. THE HOSPITAL -- THIS HOSPITAL WOULD NOT BE SUBJECT TO ETHICAL AND RELIGIOUS DIRECTIVES AND FROM THE PROVIDER'S STANDPOINT THE SAME PROVIDERS THAT DELIVER WOMEN ON THE SECOND FLOOR OF BRACKENRIDGE WOULD ALSO BE THE DOCTORS THAT DELIVER ON THE FIFTH FLOOR. SO ALL IF I SEES AND CERTIFIED NURSE MID WIVES, ANYONE WHO HAS PRIVILEGES AT THE HOSPITAL COULD DELIVER ON BOTH FLOORS.

DOCTORS AND MID WIVES.

DOCTORS AND MID WIVES, YES.

UNDER THE PROPOSED TERMS, SETON WOULD NO LONGER LEASE THE FIFTH FLOOR. AND THEY WOULD DELIVER TO THE CITY A FULLY LICENSED AND OPERABLE FACILITY. THE FIFTH FLOOR WOULD BE OPERATED BY THE CITY AS A SEPARATE HOSPITAL, IT WILL HAVE ITS OWN HOSPITAL LICENSE, TO PROVIDE OBJECT STREETCAL AND GIANT -- OBSTRETICAL AND GYNECOLOGICAL SERVICES, INCLUDING NURSERY, PHARMACY, LABORATORY, EVERYTHING THAT'S REQUIRED BY LAW AND LICENSE TO PROVIDE THOSE SERVICES. SETON WOULD NO LONGER BE OBLIGATED TO PROVIDE REPRODUCTIVE SERVICES ON THE OTHER FLOORS AT BRACKENRIDGE HOSPITAL UNDER THIS PROPOSAL. CITY STAFF WILL CONTINUE TO VISIT PATIENTS ON BRACKENRIDGE HOSPITAL FLOORS TO PROVIDE EDUCATION SERVICES AS THEY DO TODAY. ADDITIONALLY, THERE'S PROVISION OF LEASE CURRENTLY THAT PROVIDES A MECHANISM FOR RENEGOTIATION OF THE LEASE SHOULD THE ERD'S CHANGE IN THE FUTURE. THE PROVISION WE ARE OPERATING UNDER RIGHT NOW REMAINS INTACT. IF THERE ARE CHANGE REGARDING SETON'S OBLIGATIONS OTHER THAN REPRODUCTIVE, THE CITY CAN UTILIZE THIS PROVISION TO REACH AN AGREEMENT REGARDING ANY FUTURE CHANGE IN SERVICES.

I'M JOHN STEVENS, DIRECTOR OF FINANCIAL SERVICES. AND I WOULD LIKE TO TAKE A FEW MOMENTS TO WALK YOU THROUGH THE PROPOSED FINANCIAL TERMS FOR THE AMENDMENT TO THE LEASE. LET ME SEE IF THERE'S QUESTIONS FOR MS. YOUNG. ANYBODY HAVE ANY QUESTIONS?

WYNN: YES, MAYOR.

MAYOR GARCIA: COUNCILMEMBER WYNN?

WYNN: MS. YOUNG, THE ISSUE OF THE SEPARATE LICENSE THAT THE CITY WILL MAINTAIN ON THE FIFTH FLOOR, IS THERE ANY -- I GUESS CONCERN THAT I WOULD HAVE WOULD BE THAT SOMEHOW THE CITY LOSES THAT LICENSE AND PERHAPS -- I MEAN LOSES IT BECAUSE OF SOME COMPLICATION JUST IN LOGISTICS OF HAVING A HOSPITAL WITHIN A HOSPITAL. I MEAN, HAVE WE RESEARCHED, YOU KNOW, THE LICENSING AGENCIES AND HAVE SORT OF RUN SOME TRAPS, IS THERE ANYTHING THAT WOULD CONCERN US THAT JUST THIS -- YOU KNOW -- IT APPEARS TO BE SORT OF A STRANGE DEAL HAVING A HOSPITAL WITHIN A HOSPITAL, BUT SOMEHOW THAT MIGHT COMPLICATE OR JEOPARDIZE THE CITY'S LICENSE FOR THAT HOSPITAL SOMETIME IN THE FUTURE.

WE HAVE, THERE ARE NO RESTRICTIONS -- THERE ARE NO LICENSING RESTRICTIONS I GUESS IF I CAN USE THAT TERM OF HAVING A HOSPITAL WITHIN A HOSPITAL. IT'S DONE NOW IN OTHER SETTINGS, TYPICALLY EITHER FOR LONG-TERM CARE, YOU MAY SEE A LONG-TERM CARE FACILITY SEPARATELY LICENSED AND OPERATING WITHIN A HOSPITAL. IT MAY BE UNUSUAL TO SEE A HOSPITAL LICENSED FOR WOMEN'S SERVICES SOLELY. BUT THERE'S NO PROHIBITION ON THAT. ADDITIONALLY, WE HAVE TALKED WITH JCHO, THE ACCREDITATION BODY AROUND THE ISSUES OF HOSPITAL WITHIN A HOSPITAL AND ARE THERE ANY PROBLEMS WITH THAT. THEY HAVE INDICATED THERE ARE NOT. THEY HAVE GIVEN US SPECIFICALLY SOME GUIDANCE ABOUT THINGS THAT WE FEED TO ATTEND TO IN TERMS OF RECEIVING THAT -- NEED TO ATTEND TO IN TERMS OF RECEIVING ACCREDITATION. THAT ACCREDITATION BY ITSELF WOULD -- YOU HAVE TO -- TOUGH HAVE MET ALL OF YOUR LICENSING REQUIREMENTS IN ORDER TO RECEIVE THAT ACCREDITATION. SO I DON'T FEEL THAT THERE'S ANY -- ANY REGULATORY ISSUES AROUND OPERATING A HOSPITAL WITHIN A HOSPITAL.

NO INDICATIONS THAT BECAUSE IT'S A HOSPITAL WITHIN A HOSPITAL THAT THE PARAMETERS, THAT THE BAR MIGHT BE A LITTLE HIGHER OR THERE MIGHT BE OTHER THINGS TO --

I DON'T THINK THE BAR IS HIGHER, I THINK IT IS THE SAME. THE STANDARDS FOR -- FOR ACCREDITATION BY JHCO ARE PRETTY HIGH. I DON'T THINK THAT RESULTS IN ANY DIFFERENT LEVELS OF QUALITY OF CARE.

OKAY.

LASTLY, IT SAYS THAT THE CITY STAFF WILL CONTINUE TO VISIT PATIENTS ON THE BRACKENRIDGE FLOORS TO PROVIDE EDUCATIONAL SERVICES. ARE THERE ANY RESTRICTIONS WHATSOEVER ON EDUCATIONAL SERVICES.

NO, THERE ARE NO REGULATORY RESTRICTIONS. WE -- WE HAVE AGREED THAT THERE ARE NO PHYSICAL OR OTHER RESTRICTS.

AND NO RESTRICTIONS BY SETON.

THAT'S CORRECT.

THAT IS --

THAT'S CORRECT. THERE ARE NO RESTRICTIONS.

WYNN: OKAY. THANK YOU.

MAYOR GARCIA: COUNCILMEMBER GRIFFITH?

GRIFFITH: YES. IS IT JACO?

YES, MA'AM.

IS THAT THE STATE?

NO, IT'S NOT GIFT WHO IS THAT, WHO --

GRIFFITH: WHO IS THAT, ACT CREDITS THE HOSPITAL?

IT'S A PRIVATE BODY THAT PROVIDES ACCREDITATION FOR ALL HOSPITALS ACROSS THE COUNTRY. THERE IS A STATE ACCREDITATION PROCESS.

GRIFFITH: WILL -- WILL THAT BE TRIGGERED, ALSO, AS WELL AS THE PRIVATE ONE?

NO. JACO ACCREDITATION IS A VOLUNTARY ACCREDITATION, BUT THERE ARE CERTAIN PROGRAMS SUCH AS MEDICARE THAT DO REQUIRE ACCREDITATION BY THEM IN ORDER TO REQUIRE PARTICIPATION IN THAT PROGRAM.

GRIFFITH: IS ANY KIND OF STATE ACCREDITATION GOING TO BE NECESSARY?

I WOULD LOOK AT IT AS ONE OR THE OTHER. IF YOU DO NOT DO JACO, YOU WOULD GO THROUGH THE STATE PROCESS. MOST MANAGED CARE PLANS REQUIRE ONE -- I WOULD SAY ALL, REQUIRE ONE OR THE OTHER.

GRIFFITH: SO HOW DID YOU DECIDE TO GO ONE WAY RATHER THAN THE OTHER?

WELL, I WOULD SAY THAT WE HAVEN'T -- WE ARE ASSUMING AT THIS POINT THAT WE WOULD DO JACO ACCURATE DATING. I THINK BECAUSE MEDICARE REQUIRES IT, ALSO THE ACCREDITATION IS REQUIRED BY MOST PLANS. OF COURSE A LARGE PART OF OUR ACTIVITY OCCURS IN MEDICAID AND MEDICAID MANAGED MEDICARE PROGRAM. IT SEEM LIKE JACO WAS THE PREFERABLE ROUTE TO GO.

SO THE STATE ACCREDITATION WOULDN'T DO WHAT WAS NECESSARY TO GET REIMBURSED BY MEDICARE AND MEDICAID?

THAT'S MY UNDERSTANDING, YES.

GRIFFITH: OKAY. WELL, LET'S SEE THAT THAT'S THE CASE, I'M SURE IT IS IF YOU SAY SO.

I DON'T THINK IT'S A DECISION THAT WE HAVE TO MAKE TODAY. BUT IT'S OBVIOUSLY A DECISION --

GRIFFITH: BUT IT WILL BE A CHOICE.

YES.

GRIFFITH: AT SOME POINT CAN WE EVALUATE WHETHER IT WOULD BE BETTER TO GO WITH THE STATE ACCREDITATION OR --

CERTAINLY.

-- OR JACO, ALONG THOSE LINES CAN WE HAVE A LINE ITEM BREAK DOWN OF THE COSTS. IF YOU GO WITH THE STATE ACCREDITATION OR JACO. AND I'M SURE WE ARE GOING TO SEE RIGHT AWAY WHAT THE LINE ITEM BREAK DOWN IS ON THE COSTS.

UH-HUH.

GRIFFITH: AT LEAST OF ONE KIND.

UH-HUH.

MAYOR GARCIA: BUT THERE IS RECIPROCITY. IF YOU GET ONE, THE OTHER ONE WILL RECOGNIZE IT, RIGHT, BETWEEN THE TWO?

IT'S -- ACCREDITATION AGENCIES?

I THINK THAT I AM GOING TO LET BETSY ATTELL SPEAK TO THAT. I WOULDN'T EXACTLY CALL IT RECIPROCITY. IT'S A MATTER OF WHAT IS RECOGNIZED BY THE PLANS. IT'S A LEVEL OF RECOGNITION OF A QUALITY PROCESS THAT'S RECOGNIZED FOR THAT FACILITY.

MAYOR GARCIA: SO THEY MOVE PARALLEL TO EACH OTHER, NOT NECESSARILY ONE, YOU KNOW, FACING THE OTHER ONE.

YES.

MAYOR GARCIA: OKAY. MAYOR PRO TEM DO YOU HAVE ANY QUESTIONS ON THIS ISSUE FOR MS. YOUNG? OR COUNCILMEMBER ALVAREZ?

GOODMAN: LET ME ASK, MAYOR, SORRY TO BE LATE. HAVE YOU GONE THROUGH THIS ENTIRE PACKET?

MAYOR GARCIA: NO, WE HAVE GONE THROUGH PAGES ONE THROUGH 17. AND WE ARE GOING TO GO TO PAGE 19, PROPOSED FINANCIAL TERMS AS SOON AS WE FINISH THE QUESTION AND ANSWER PERIOD WITH MS. YOUNG.

GOODMAN: WELL, I DO HAVE SOME QUESTIONS RELATIVE TO WHAT IS IN THE SUMMARY HERE. BUT I DON'T KNOW IF THIS IS THE APPROPRIATE TIME FOR THOSE.

MAYOR GARCIA: IF IT HAS TO DO WITH THE PROVISION OF SERVICES, I THINK IT'S APPROPRIATE AT THIS TIME. IF IT HAS TO DO WITH FINANCE, IT WOULD BE APPROPRIATE AFTER MR. STEVENS MAKES HIS PRESENTATION.

GOODMAN: WELL, MAYBE IT IS INDIRECTLY. IT'S ABOUT THE FUTURE REEVALUATION AND POSSIBLE FUTURE OPERATIONS. THIS IS A LITTLE BIT CRYPTIC AND I'M ASSUMING THAT, YOU KNOW, THERE MAY BE FINANCIAL IMPLICATIONS THAT CAUSED YOU TO WRITE THIS PARAGRAPH. BUT I'M KIND OF CURIOUS ABOUT -- IT SAYS THE CITY MAY ELECT TO CONTINUE, BUT IF THE PARTIES CANNOT REACH AGREEMENT FOR THE NEW HOSPITAL AND THE CITY ELECTS NOT DID CONTINUE THE PHYSICAL OR REVERTS, SO I'M CURIOUS ABOUT THE PREMISE THAT WE ARE ASSUMING WE WOULD BE ABLE TO STOP OPERATION AND WHERE RESPRUKT ACTIVE -- REPRODUCTIVE SERVICES WOULD THEN BE PROVIDED.

THAT IS PART OF OUR DISCUSSION UNDER THE FINANCIAL TERMS. WOULD IT BE OKAY TO -- TO HOLD THAT QUESTION UNTIL THEN? OKAY.

MAYOR GARCIA: COUNCILMEMBER ALVAREZ?

ALVAREZ: YEAH, I HAD -- COUNCILMEMBER WYNN ASKED SOME OF THE QUESTIONS THAT I HAD, BUT -- THOSE ARE ON LATTER PAGES. DOES THAT MEAN WE CAN WAIT UNTIL THEN. YOU ARE GOING TO ADDRESS THE ISSUE OF EMERGENCY CONTRACEPTION AS WELL?

UH-HUH.

MAYOR GARCIA: COUNCILMEMBER GRIFFITH?

GRIFFITH: YES, SIR, THANK YOU. DID I UNDERSTAND IF THERE'S ANOTHER CHANGE IN RELIGIOUS DIRECTIVES, THAT WE DO NOT GO OUT THEN FOR REQUEST FOR QUALIFICATIONS AND/OR PROPOSALS?

WELL -- WE WOULD GO BACK TO THE PROCESS OF 817 AGAIN. SHOULD SETON COME TO US AND SAY THERE'S SOME OTHER SERVICE THAT THEY ARE REQUIRED TO PROVIDE UNDER THE LEASE THAT THEY COULD NO LONGER PROVIDE OTHER THAN REPRODUCTIVE SERVICES, WE WOULD THEN DISCUSS WAYS TO RESOLVE THAT PROBLEM AND IF NOT, WE COULD EVENTUALLY GET TO THE POINT WHERE SETON WOULD BE IN DEFAULT.

WHICH IS THE SITUATION NOW.

YES.

GRIFFITH: SO IT COULD JUST GO -- IT COULD JUST HAPPEN OVER AND OVER AND OVER AND OVER AGAIN? EVERY TIME THERE'S A CHANGE?

UM, SHOULD THERE BE ANY CHANGES, WE DON'T AT THIS POINT ANTICIPATE ANY FORTHCOMING, BUT SHOULD THERE BE ANY CHANGES THAT AFFECT OTHER SERVICES, REALIZE THAT THE ERD'S AT THIS POINT, THE ONLY ISSUE THAT HAS COME UP ARE REPRODUCTIVE SERVICES.

WHAT IF THERE'S ANOTHER CHANGE IN THAT AREA, THEN WHAT HAPPENS?

WELL, THIS -- THIS AMENDMENT WOULD NO LONGER REQUIRE SETON TO PROVIDE REPRODUCTIVE SERVICES.

GRIFFITH: WOULD NO LONGER WHAT?

WOULD NO LONGER REQUIRE SETON TO PROVIDE REPRODUCTIVE SERVICES GOING FORT --

DOES THAT MEAN IF THERE'S ANOTHER DIRECTIVE CHANGE IN THE AREA OF REPRODUCTIVE SERVICES, THEN WE GO OUT?

IT WOULD NOT AFFECT THE LEASE BECAUSE THEY ARE NO LONGER REQUIRED TO PROVIDE IT.

GRIFFITH: SO WE WOULD GO OUT THEN?

NO. WE WOULD CONTINUE WITH THE OPERATION --

THE CHANGES WOULD NOT AFFECT THE LEASE AT THIS POINT BECAUSE YOU WOULD HAVE -- YOU WOULD HAVE SEGREGATED, SEVERED THAT PIECE TO BE DONE ON THE FIFTH FLOOR. AS A CONSEQUENCE, IT'S UNLIKELY THAT A CHANGE WOULD AFFECT IT.

GRIFFITH: I SEE WHAT YOU ARE SAYING.

MAYOR GARCIA: FURTHER QUESTIONS? MR. STEVENS?

I'M JOHN STEVENS, DIRECTOR OF FINANCIAL SERVICES. THE PROPOSED FINANCIAL TERMS BEGIN ON PAGE 19, I NEED TO ASK IN ADVANCE FOR YOUR FOR BARE I CAN'T ANSWER, THE TERMS OF -- FORBEAR ANCE, THE TERMS ARE SOMEWHAT COMPLICATED. I WOULD LIKE TO TALK ABOUT TALKING ABOUT THE COSTS THAT WILL BE INCURRED TO RENOVATE THE FIFTH FLOOR AND TURN IT INTO THE HOSPITAL WITHIN A HOSPITAL. THERE ARE BASICALLY TWO TYPES OF CAPITAL COSTS. SETON WILL BE RESPONSIBLE FOR COMPLETING ALL OF THE NECESSARY REASON VAGUES TO THE FIFTH FLOOR AND TURNING OVER A FULLY LICENSABLE HOSPITAL TO THE CITY. THE TOTAL CONSTRUCTION AND EQUIPMENT COSTS AT THIS POINT ARE ESTIMATED TO BE APPROXIMATELY 9.3 MILLION. THIS IS AN INCREASE OVER THE EARLIER ESTIMATE THAT I BELIEVE WE HAD PROVIDED, WHICH WAS BETWEEN 7 AND 8 MILLION. IT'S AN INCREASE OF APPROXIMATELY 1.7 MILLION, THERE WERE 3 REASONS FOR THE INCREASE IN COSTS. IN THE EARLIER NUMBER, WE DIDN'T HAVE A GOOD HANDLE ON OUR INFORMATION TECHNOLOGY COSTS. WE ALSO HAVE INCLUDED NOW IN THE TOTAL COSTS WHAT WE ARE CALLING AN INITIAL OVERHEAD ALLOWANCE, WHICH ARE START-UP COSTS THAT WILL BE ALLOWED TO ADD TO THE TOTAL COSTS THAT WILL BE AMORTIZED. IN ADDITION WE DID NOT HAVE A GOOD NUMBER FOR PROJECT CONTINGENCY IN THERE BEFORE. WE NOW HAVE AN 8% PROJECT IN CONTINGENCY INCLUDED. SO THE TOTAL COSTS HAVE GONE UP. HOWEVER, MOST OF THOSE COSTS WILL BE COSTS THAT THE CITY WILL BE ABLE TO RECOVER THROUGH ITS DEPRECIATION. THE TOTAL COSTS AGAIN ARE BROKEN DOWN INTO BASICALLY TWO TYPES. WHAT WE ARE CALLING TO CATEGORIES OF COSTS. THOSE ARE EXPANSION COSTS THAT ARE INCURRED PRIMARILY FOR THE NEED TO EXPAND OB SERVICES IN BRACKENRIDGE HOSPITAL. THEN THE NON-EXPANSION COSTS, WHICH ARE PRIMARILY RELATED TO THE SEPARATELY LICENSABLE FACILITY. BOTH TYPES OF THESE COSTS WILL BE DEAPPRECIATED OVER THE REMAINING PERIOD OF THE 30 YEAR INITIAL LEASE WITH BRACKENRIDGE, SHOULD BE ABOUT 23 YEARS BY THE TIME WE EXPECT THE FACILITY TO BEGIN OPERATING. THEY WILL BOTH BE APPRECIATED WITH AN INTEREST RATE FACTOR THAT IS EQUAL TO THE FACTOR, INTEREST RATE FACTOR FOR A DOUBLE A RATED TAX EXEMPT OBLIGATION. WE HAVE USED A 4.5% ESTIMATE IN OUR PRO FORMA. LOOKING ON -- YES, SIR?

MAYOR GARCIA: LET ME STOP YOU BECAUSE THIS CONCEPT OF DEPRECIATION IS ONE THAT IS NOT UNIVERSALLY UNDERSTOOD. WHAT WE ARE TALKING ABOUT IS SETON SPENDING SOME MONEY TO DO THE RENOVATIONS AND THEN THE CITY WOULD -- WOULD BE PAYING THEM BACK FOR THAT THROUGH A PERIOD OF -- OF THE -- THE USE OF THAT PARTICULAR FACILITY. AND THAT WOULD BE DONE BY REDUCTION AND --

SETON, YES, SIR, SETON IS CURRENTLY PAYING A LEASE PAYMENT TO THE CITY FOR BRACKENRIDGE HOSPITAL, A RENT PAYMENT, IF YOU WILL, OF 1.8 MILLION. THEY WILL REDUCE THAT RENT PAYMENT TO THE CITY FOR THE TOTAL COSTS OF THE CONSTRUCTION. AND THEN IN -- IN THE OPERATING STATEMENT FOR THE NEW HOSPITAL, THE CITY WILL INCLUDE DEPRECIATION ON THE NON-EXPANSION COSTS, THE COSTS THAT IT ESSENTIALLY IS NOT GOING TO HAVE TO PAY FOR. AND SO THE NET OF THOSE WILL BE THE EFFECT OF THAT WILL BE THAT THE CITY WILL PAY FOR THE EXPANSION COSTS, AND SETON WILL PAY FOR THE NON-EXPANSION COSTS. OVER THE -- THE SUM OF THOSE COSTS TOGETHER WITH THE INTEREST RATE FACTOR WILL BE DEDUCTED ANNUALLY OVER THE TERM, THE REMAINING TERM OF THE LEASE.

THE INTEREST RATE ASSUMPTION IS 4.5%.

AT THIS POINT IT IS.

MAYOR GARCIA: IS THAT GOING TO MOVE BACK OR UP OR DOWN.

AT SOME POINT WE WILL FIX IT WHEN WE SIGN THE AMENDMENT TO THE LEASE. HOPEFULLY THAT WILL BE SOON. IT SHOULD BE APPROXIMATELY THAT 4.5% INTEREST RATE. WE ARE GOING TO USE THE RATE THAT WILL BE PUBLISHED IN THE BOND BUYER WHEN WE CLOSE THE -- WHEN WE EXECUTE THE AMENDMENT. TURNING TO PAGE 20, TO SHOW YOU HOW THE PAYMENT FOR THE CAPITAL COSTS WILL OCCUR. AGAIN, IF YOU LOOK ON THE LEFT-HAND SIDE, YOU SEE THE EXPANSION COSTS RELATED TO PROVIDING ADDITIONAL OB SERVICES IN BRACKENRIDGE COME TO APPROXIMATELY 6.8 MILLION. THE NON-EXPANSION COSTS FOR SEPARATE LICENSURE ARE 2.5 MILLION. WITH THE TOTAL COST AGAIN ESTIMATED TO BE AT THIS .9.3 MILLION. I AM SHOWING YOU TWO SCENARIOS HERE. THE FIFTH FLOOR HOSPITAL SCENARIO IS THE SCENARIO UNDER THE PROPOSED LEASE AMENDMENT. THE POST FIFTH FLOOR HOSPITAL SCENARIO IS WHAT HAPPENS IF AT THE END OF THE FIVE YEAR PERIOD PROPOSED FOR THE LEASE AMENDMENT, WE CANNOT REACH AGREEMENT ON FUTURE FUNDING AT THAT POINT, THERE MAY BE WHAT WE CALL A FRIENDLY UNWIND SCENARIO THAT WILL BE INVOKED. AND AT THAT POINT WE WILL ACTUALLY SWITCH WHO IS PAYING FOR WHAT SO THAT THE CITY WILL END UP PAYING FOR A LESSER SHARE OF THE COSTS IF WE DECIDE TO UNWIND THE AGREEMENT AT THIS POINT. LOOKING AT THE FIFTH FLOOR SCENARIO, THOUGH, THE EXPANSION COSTS OF 6.8 MILLION, AGAIN SETON, THE CITY WILL ESSENTIALLY PAY FOR THOSE COSTS BECAUSE SETON WILL REDUCE IT RENT PAYMENT TO THE CITY FOR THE DEPRECIATION OF THOSE COSTS. THEN A NON-EXPANSION COST, THE CITY WILL RECOUP BECAUSE IT WILL INCLUDE THOSE COSTS IN ITS OPERATING STATEMENT AND WE EXPECT THAT THERE WILL BE A DEFICIT INCURRED IN THE OPERATING STATEMENT WHICH SETON WILL BE OBLIGATED TO FUND. AGAIN UNDER THE FRIENDLY UNWIND PERIOD, IF THE CITY DECIDES TO PURSUE OTHER OPTIONS IF WE CAN'T REACH AGREEMENT ON FUNDING ON THE FIFTH FLOOR HOSPITAL DEFICIT, THEN SETON WILL PAY FOR THE EXPANSION COSTS AND THE CITY WILL PAY FOR THE NON-EXPANSION COSTS. IF YOU LOOK ON PAGE 21 AT THE FLOW OF FUNDS, AGAIN SOME OF THIS INFORMATION IS REPEATED FROM ONE PAGE TO THE NEXT. UNDER THE -- UNDER THE CURRENT LEASE THE CITY PAYS SETON 5.6 MILLION FOR CHARITY CARE. UNDER THE LEASE AMENDMENT THAT'S PROPOSED, THAT 5.6 MILLION DOLLAR PAYMENT BY THE CITY WILL BE REDUCED FOR THE DEPRECIATION AMOUNT THAT'S RELATED TO THE NON-EXPANSION CONSTRUCTION COSTS. THE SEPARATE LICENSURE CONSTRUCTION COSTS. AND FOR THE OPERATING DEFICIT THAT WE EXPECT TO INCUR. BECAUSE WE DO EXPECT THAT THAT FIFTH FLOOR FACILITY WILL OPERATE AT A DEFICIT. ALSO, UNDER THE CURRENT LEASE, SETON PAYS THE CITY $1.8 MILLION FOR RENT, AND THAT PAYMENT WILL BE REDUCED UNDER THE LEASE AMENDMENT FOR TWO THINGS: ONE IS FOR THE DEPRECIATION OF THE TOTAL CONSTRUCTION COSTS, AND THE OR IS FOR THE REDUCTION -- THE OTHER IS FOR THE REDUCTION OF THE FIFTH FLOOR SQUARE FOOTAGE THAT'S ASSOCIATED WITH THE HOSPITAL WITHIN A HOSPITAL. ON PAGE 22 WE HAVE OPERATING ESTIMATES FOR THE FIFTH FLOOR HOSPITAL. WE ARE CURRENTLY ESTIMATING THAT OUR NET PATIENT REVENUE, NET OF CONTRACTUAL ALLOWANCES, WILL BE APPROXIMATELY 2.8 MILLION. WE ALSO EXPECT THAT THE NEW HOSPITAL WILL RECEIVE DISPROPORTIONATE SHARE REVENUES AS BRACKENRIDGE DOES NOW IN THE AMOUNT OF $400,000, SO THE TOTAL REVENUES WE ARE ESTIMATING AT THIS POINT FOR THE HOSPITAL WITHIN A HOSPITAL ARE 3.2 MILLION. AND IN OUR BUDGET THAT WE DEVELOP AND THAT WE AGREE UPON MUTUALLY WITH SETON, WE WILL INCLUDE ALL OF THE REVENUES THAT ARE ATTRIBUTABLE TO THE OPERATION OF THE NEW HOSPITAL. OUR CURRENT ESTIMATE FOR THE OPERATING EXPENSES IS $6 MILLION. THE OPERATING EXPENSES INCLUDE OVERHEAD, CITY OVERHEAD THAT'S ALLOCATED THROUGH THE CITY'S COST ALLOCATION PLAN, INCLUDES CLAIMS EXPENSE AND ALSO INCLUDES SERVICES THAT WE WOULD BE PURCHASING FROM SETON SUCH AS HOUSE KEEPING, DIETARY AND SECURITY. THAT WOULD BRING US TO OUR CURRENT ESTIMATED OPERATING DEFICIT, WHICH WILL BE -- WHICH WOULD BE 2.8 MILLION UNDER THIS SCENARIO. THAT BUDGETED DEFICIT, THAT 2.8 MILLION WILL BE DIVIDED BY 12 AND THAT AMOUNT WILL BE DEDUCTED MONTHLY FROM THE CHARITY CARE PAYMENTS THAT WE MAKE TO SETON. AND THEN IN ADDITION, WE WILL ALSO DEDUCT FROM THE CHARITY CARE PAYMENT THAT WE MAKE TO SETON THE DEPRECIATION AMOUNT ON THE NON-EXPANSION CONSTRUCTION COSTS, ESTIMATED AT ABOUT 170,000 AT THIS POINT. SO SETON, THE TOTAL DEDUCTION FROM OUR CHARITY CARE WOULD BE 2.97 MILLION, ALMOST 3 MILLION. AGAIN AT THE MOMENT, WE ARE PAYING SETON 5.6 MILLION. WE WOULD REDUCE THAT BY APPROXIMATELY 3 MILLION AND INSTEAD PAY SETON 2.6 MILLION FOR CHARITY CARE.

ALVAREZ: JOHN? MAY I ASK A COUPLE OF QUESTIONS?

MAYOR GARCIA: COUNCILMEMBER ALVAREZ?

ALVAREZ: BEFORE WE MOVE ON. SO YOU SAID THAT UNDER THE AGREEMENT WE HAVE THE 5.6 MILLION THAT WE TYPICALLY PROVIDE FOR THE CHARITY CARE AND WE ARE GOING TO SUBTRACT THE DEPRECIATION OF NON-EXPANSION CONSTRUCTION COSTS AND OPERATING DEFICIT, YOU SAID THE OPERATING DEFICIT IS ABOUT 3 MILLION. SO WHAT WOULD THE DEPRECIATION FOR THE NON-EXPANSION CONSTRUCTION COSTS --

THAT'S ESTIMATED ABOUT 170,000 NOW.

ALVAREZ: 170,000?

YES.

MAYOR GARCIA: PER YEAR.

ALVAREZ: PER YEAR.

PER YEAR.

ALVAREZ: I'M TRYING TO GET A BETTER UNDERSTANDING OF WHAT THE -- THE DIFFERENCE BETWEEN THE EXPANSION COSTS AND THE NON-EXPANSION COSTS, SO THE EXPANSION COSTS ARE THOSE THE ACTUAL PHYSICAL CHANGES THAT HAVE TO BE DONE IN THE FLOOR AND SO WHAT DO THE NON-EXPANSION --

THE EXPANSION COSTS AGAIN ARE THE COSTS THAT ARE PRIMARILY RELATED TO THE FACT THAT WE ARE GOING TO PROVIDE ADDITIONAL SPACE IN WHICH OBSTRETIC AND GYNECOLOGICAL SERVICES WILL BE PROVIDED. SETON HAS -- BRACKENRIDGE HOSPITAL BECAUSE OF INCREASED PATIENT FLOW AND INCREASED SERVICES THAT ARE NEEDED TO BE PROVIDED FOR OB AND GYN SERVICES, JUST NEEDS MORE SPACE IN WHICH TO PROVIDE THOSE SERVICES.

THAT'S FOR THE EXPANSION OF SERVICES BEYOND WHAT ALREADY --

RIGHT.

ALVAREZ: -- IS PROVIDED THERE.

THAT'S RIGHT. THEN THE NON-EXPANSION COSTS ARE THE COSTS THAT HAVE TO BE INCURRED, FOR EXAMPLE, WE ARE GOING TO HAVE A SEPARATE ELEVATOR THAT WILL TAKE PATIENTS UP TO THE FIFTH FLOOR. AND THAT SEPARATE ELEVATOR IS INCLUDED IN THE NON-EXPANSION COSTS BECAUSE THAT'S NOT REQUIRED TO NECESSARILY TO PROVIDE ADDITIONAL SPACE TO PROVIDE THOSE SERVICES. IT'S SIMPLY REQUIRED BECAUSE OF THE SEPARATE LICENSURE REQUIREMENTS, THE REQUIREMENT THAT WE WILL HAVE A SEPARATE LICENSE.

ALVAREZ: THEN IN TERMS OF THE OPERATING EXPENSES THAT'S LISTED THERE, ON PAGE 22, THEY ESTIMATED 6 MILLION, DO WE HAVE ANY IDEA HOW THAT COMPARES TO -- TO WHAT SETON IS CURRENTLY DOING? IS THERE ANY WAY OF DOING THAT? LIKE WHAT -- WHAT THE OPERATING EXPENSES ARE FOR --

TRISH, DO YOU --

ALVAREZ: AT LEAST FOR THE PART THAT THEY PROVIDE.

THE 6 MILLION INCLUDES OUR ESTIMATES OF STAFFING COSTS, SUPPLIES, OPERATING EXPENSES, ANY SERVICES THAT WE PURCHASE OUTSIDE FROM -- FROM VENDORS AND SUCH. IT INCLUDES COSTS FOR IF I SEE FEES THAT WE MAY HAVE TO PAY FOR COVERAGE FOR THE -- PHYSICIAN FEES THAT WE MAY HAVE TO PAY FOR COVERAGE FOR THE HOSPITAL AND IT ALSO INCLUDES AMOUNTS FOR SERVICES THAT SETON WILL PROVIDE TO US. IT'S THE AMOUNTS THAT WE HAVE AGREED TO THAT THEY WILL CHARGE US FOR THOSE SERVICES FOR THINGS SUCH AS DIETARY, HOUSEKEEPING, SECURITY. SO IT'S BASED ON OUR COST ESTIMATES ON OUR -- BASED ON OUR COST STRUCTURE. IT'S NOT NECESSARY -- IT'S NOT BASED ON SETON'S STRUCTURE, IT'S BASED ON WHAT THE CITY EXPECTS.

ALVAREZ: OKAY. I WOULD PROBABLY LIKE TO TALK TO YOU ALL MAYBE LATER ABOUT -- ABOUT THAT NUMBER.

THIS WON'T BE ANYONE'S LAST SHOT AT GOING THROUGH THE NUMBERS. [ LAUGHTER ].

ALVAREZ: THANKS, MAYOR.

MOVING ON TO PAGE 23, THE S OF THE LEASE AMENDMENT PROVIDE THAT PRIOR TO THE BEGINNING OF EACH YEAR, SETON AND THE CITY WILL SIT DOWN AND DEVELOP A MUTUALLY AGREED UPON BUDGET FOR THE NEXT FISCAL YEAR. IF WE CAN'T REACH MUTUAL AGREEMENT ON WHAT THAT BUDGET OUGHT TO BE, THEN WE CAN HAVE OUR BUDGET DEVELOPMENT ARBITRATED BY A KNOWLEDGEABLE MUTUALLY AGREED UPON THIRD PARTY. THE -- THE CITY WILL REDUCE ITS MONTHLY CHARITY CARE PAYMENT AGAIN TO SETON BY THE SUM OF THE BUDGETED OPERATING DEFICIT AND THE DEPRECIATION AMOUNT AND THEN AT THE END OF THE YEAR, THE BUDGETED OPERATING DEFICIT, THAT IS THE OPERATING DEFICIT THAT WE EXPECTED AT THE BEGINNING OF THE YEAR, WILL BE COMPARED TO THE ACTUAL OPERATING DEFICIT. AND WE WILL HAVE A [INAUDIBLE] PROVISION SUBJECT TO THE LIMITATIONS THAT YOU SEE HERE. THE EXCESS OF OUR ACTUAL OVER OUR BUDGETED DEFICIT WILL BE ADDED TO THE BUDGETED OPERATING DEFICIT FOR THE NEXT YEAR. SUBJECT TO THE LIMITATIONS OF VARIANCE ON THAT DEFICIT. FOR EXAMPLE, THE DEFICIT, THE ESTIMATED DEFICIT THAT WE SHOWED YOU ON THE PREVIOUS PAGE WAS 2.8 MILLION. IF IN FACT IN THE FIRST YEAR OF OPERATION, IF THAT'S OUR BUDGETED OPERATING DEFICIT AND OUR ACTUAL DEFICIT ENDS UP BEING 3.3 MILLION, RATHER THAN 2.8, THAT'S A DIFFERENCE OF 500,000, SETON WOULD PAY 420,000 OF THAT, IN OTHER WORDS THEY WOULD PAY 15% OF THAT 2.8 OF THE BUDGETED OPERATING DEFICIT AND THE CITY WOULD PAY THE ADDITIONAL 80,000. SO DURING THE FIRST YEAR, IF THERE'S A VARIANCE BETWEEN THE OPERATING -- THE ACTUAL OPERATING DEFICIT AND THE BUDGETED OPERATING DEFICIT, SETON WILL PAY UP TO 15% OF THE VARIANCE OF THE BUDGETED OPERATING DEFICIT. THEN IN YEARS TWO AND THREE, THAT GOES DOWN TO 10%. KEEP IN MIND THAT WE WILL HAVE BETTER EXPERIENCE AS WE MOVE ON AND THAT WE ARE RESETTING THE BUDGET AT THE BEGINNING OF EACH YEAR DURING THAT FIVE YEAR PERIOD. THEN IN YEARS FOUR AND FIVE, THE -- THE VARIANCE GOES DOWN TO 5%.

MAYOR GARCIA: MR. STEVENS, I THINK I GOT FLIPPED ON THAT ONE. IF THE EXCESS OF ACTUAL OVER BUDGET IS 500,000, YOU SAID THAT SETON WOULD PAY 400,000 OF THAT.

420,000 OF THAT. 15% OF THE BUDGETED OPERATING DEFICIT OF 2.8 WOULD BE 420,000. THAT WOULD BE THE LIMIT OF THEIR -- OF THEIR EXPOSURE UNDER THAT.

MAYOR GARCIA: OKAY. SO IT'S NOT BASED ON THE EXCESS, IT'S BASED ON THE ACTUAL -- ON THE BUDGETED DEFICIT.

YES. AND THE PERCENTAGE VARIANCE BETWEEN THE BUDGETED DEFICIT AND THE ACTUAL DEFICIT.

MAYOR GARCIA: OKAY. THAT MAKES SENSE, OKAY.

WYNN: MAYOR?

MAYOR GARCIA: COUNCILMEMBER WYNN.

WYNN: MR. STEVENS, JUST FOR MY SAKE, THE FIRST POINT THAT SETON AND THE CITY WILL DEVELOP A MUTUALLY AGREED UPON BUDGET, WHAT YOU MEAN BY THAT IS THE BUDGET FOR THE FIFTH FLOOR CITY HOSPITAL; IS THAT CORRECT?

THAT'S CORRECT, THE BUDGET FOR THE FIFTH FLOOR CITY HOSPITAL.

WYNN: AND THERE'S NO CITY PURVIEW, WE DON'T BOTHER TO DO THIS FOR THE BRACKENRIDGE HOSPITAL BUDGET, WE JUST BOTHER TO DO THIS MUTUALLY AGREED UPON BUDGET FOR THE FIFTH FLOOR CITY HOSPITAL.

THAT'S RIGHT. FOR THE SEPARATELY LICENSED HOSPITAL ON THE FIFTH FLOOR, RIGHT.

GOODMAN: LATER ON, CAN WE FOLLOW UP A LITTLE BIT ON THAT AND TALK ABOUT WHAT MECHANICS OF AGREEMENT YOU ALL HAVE BEEN DISCUSSING?

CERTAINLY. ON PAGE 24, OTHER TERMS ARE THAT THE -- THE CITY AND SETON WILL EVALUATE THE FIFTH FLOOR ARRANGEMENT DURING THE THIRD FISCAL YEAR, WHICH WE EXPECT TO BEGIN AT THIS POINT ON OCTOBER THE 1ST OF 05. AND AT THAT POINT IF AGREEMENT ON FUTURE FUNDING FOR THE FIFTH FLOOR HOSPITAL CAN'T BE REACHED, THE CITY HAS TWO OPTIONS THAT IT CAN EXERCISE ON OR BEFORE THE BEGINNING OF THE FIFTH YEAR. THE FIRST OPTION WOULD BE TO CONTINUE TO OPERATE THE FIFTH FLOOR IN WHICH CASE THE REDUCTION TO CHARITY CARE, THAT THE CITY COULD MAKE FOR THE OPERATING DEFICIT, WOULD BE CAPPED AT 3.4 MILLION GOING FORWARD. THEN THE SECOND OPTION THAT THE CITY HAS WOULD BE TO CLOSE THE FIFTH FLOOR FACILITY AND TO -- TO FIND ANOTHER WAY TO -- TO PROVIDE REPRODUCTIVE SERVICES. FOR EXAMPLE, LOOK FOR ANOTHER PROVIDER. UNDER THAT SCENARIO, SETON WOULD AGREE TO PAY THE COST OF PROVIDING THOSE SERVICES THROUGH ANOTHER PROVIDER UP TO, AGAIN, 3.4 MILLION. AND UNDER THOSE SCENARIOS, AGAIN, THE PAYMENT FOR THE CAPITAL COSTS SWITCHES. IF THE CITY CHOOSES OPTION 2, THEN THE CITY WILL END UP PAYING FOR THE NON-EXPANSION, THE SMALLER NUMBER, OF THE CAPITAL COSTS RATHER THAN THE LARGER NUMBER. THAT CONCLUDES THE PRESENTATION ON THE FINANCIAL TERMS.

GRIFFITH: MAYOR PRO TEM?

GOODMAN: COUNCILMEMBER?

GRIFFITH: YES. BEFORE WE LEAVE THE FINANCIAL TERMS, CAN WE GO BACK TO PAGE 20 FOR A MINUTE? EXPANSION COSTS AND NON-EXPANSION COSTS. WOULD IT BE POSSIBLE FOR US TO GET A BREAKDOWN OF WHAT'S BEING CALLED EXPANSION COSTS? AND WHAT'S BEING CALLED NON-EXPANSION COSTS?

YES.

GRIFFITH: THANK YOU.

WE CAN PROVIDE THAT TO YOU.

GRIFFITH: GREAT.

GOODMAN: THANK YOU, THAT WAS ALSO GOING TO BE A QUESTION THAT I WOULD ASK LATER. I WANTED TO FIND OUT ABOUT THE PHARMACY AND WHETHER THAT WAS EXPANSION OR NON-EXPANSION.

NON-EXPANSION. THE PHARMACY IS NON-EXPANSION.

GOODMAN: THEN I WANT TO TALK ABOUT THAT.

UH-HUH.

GOODMAN: OKAY. MAYOR?

ANY OTHER QUESTIONS?

ALVAREZ: MAYOR PRO TEM? ON THAT LAST PAGE, 24, I JUST WANTED TO KIND OF GO THROUGH IT AGAIN AND MAKE SURE THAT I UNDERSTAND. BUT THIS IS -- I GUESS THAT SECOND BULLET THERE THAT IF WE CANNOT REACH AN AGREEMENT, THIS IS AFTER THE THIRD YEAR, IS THAT CORRECT? WE ARE TRYING TO REACH AN AGREEMENT BEYOND THAT, THEN WE HAVE THESE TWO OPTIONS. UNDER NUMBER ONE, IT'S -- IT SAYS THAT THE REDUCTION IN -- IN CHARITY CARE WOULD BE CAPPED AT 3.4 MILLION ANNUALLY. SO THIS IS ASSUMING THAT WE CONTINUE TO OPERATE THAT FIFTH FLOOR --

THAT'S CORRECT.

ALVAREZ: SO WHAT WE ARE SAYING IS THAT THE 3.4 MILLION, THAT WOULD BE THE CAP FOR THE DEPRECIATION COSTS AND THE OPERATING DEFICIT OR JUST --

ONLY THE OPERATING DEFICIT DID NOT INCLUDE THE DEPRECIATION COSTS.

ALVAREZ: SO WHY IS THAT NECESSARY? THAT 3.4 MILLION DOLLAR CAP?

THAT'S A NEGOTIATED TERM UNDER THE LEASE THAT -- THAT SETON -- THE 5.6 MILLION THAT WE PAY TO SETON FOR CHARITY CARE IS CAPPED. IT DOES NOT -- GO UP WITH AN INFLATION FACTOR OVER THE YEARS. SO THAT WAS SIMPLY A NEGOTIATED TERM.

ALVAREZ: SO THAT PUTS, YOU KNOW, LIKE -- PRESSURES US TO MAKE SURE THAT WE STAY UNDER -- AT LEAST ON THE OPERATING DEFICIT SIDE, THAT WE ARE NOT EXCEEDING THAT AT LEAST. AND THEN UNDER THE SECOND OPTION, THIS IS THE ONE THAT I THINK I DON'T UNDERSTAND AS MUCH. SO NOW UNDER THE SECOND OPTION WE ARE ASSUMING THAT WE GO TO ANOTHER PROVIDER TO PROVIDE THOSE SERVICES THAT ARE BEING PROVIDED ON THE FIFTH FLOOR. AND SO THEN WE ARE WITHHOLDING THE 3.4 MILLION PER YEAR, FROM THE CHARITY CARE, AND -- AND THAT -- OKAY. THEN THE OTHER PART OF IT HAS TO DO WITH NON-EXPANSION COSTS? I GUESS I'M TRYING TO UNDERSTAND THE RATIONALE FOR THOSE TWO ITEMS THERE.

THE RATIONALE IS THAT IF WE CAN'T REACH AGREEMENT, IF THE FIFTH FLOOR IS NOT OPERATING AS WELL AS WE THINK IT SHOULD BE, IF IT ENDS UP THAT THE DEFICIT IS SIGNIFICANTLY LARGER THAN 3.4, THEN THE CITY HAS THE OPTION OF SAYING THIS ARRANGEMENT DID NOT WORK OUT FOR US AND WE ARE GOING TO SEEK ANOTHER PROVIDER TO PROVIDE THOSE SERVICES. IT COULD BE DONE, YOU KNOW, THROUGH ANOTHER HOSPITAL IN THE AREA AT THAT POINT. IT COULD POSSIBLY BE DONE OTHER WAYS, I ASSUME, IN THE -- IN THE CITY FACILITIES ELSEWHERE. AND SETON WOULD AGREE TO PAY THE COST THAT WE WILL INCUR TO PROVIDE THOSE REPRODUCTIVE SERVICES, AGAIN UP TO A CAP OF 3.4.

ALVAREZ: 3.4 MILLION. THIS IS JUST ASSUMING THAT WE DECIDE TO DO THAT VOLUNTARILY, NOT IF THEY -- WE CAN NO LONGER PROVIDE IT, CAN HE CAN'T ANY LONGER PROVIDE THOSE -- WE CAN'T ANY LONGER PROVIDE THOSE SERVICES IN THE HOSPITAL BECAUSE OF? RELIGIOUS DIRECTIVE, DOES THIS GOVERN UNDER THAT SCENARIO, ALSO? OR NOT? I GUESS NOT BECAUSE -- WE WOULD HAVE TO RENEGOTIATE --

GARZA: IF THERE WAS A CHANGE THAT SAID THIS CONCEPT OF A HOSPITAL WITHIN A HOSPITAL DOESN'T PASS MUSTER ANY LONGER, THEN YOU ARE BACK TO 8.17. WHAT THIS WAS INTENDED TO DO, WAS IN THE EVENT THAT THE ECONOMIES OF SCALE ON THIS SMALL OF AN OPERATION SIMPLY DON'T WORK FINANCIALLY, IS THAT IT WOULD GIVE US, RATHER THAN CARRY THAT BURDEN FORWARD AND HAVE IT CONTINUING GAP IN TERMS OF OPERATING DEFICITS, IT WOULD GIVE US AN ALTERNATIVE TO GO TO A DIFFERENT PROVIDER AND SAY, "WE HAVE A -- WE HAVE A GROUP OF INDIVIDUALS THAT NEED SERVICES AND WE WOULD CONTRACT FOR YOU TO DELIVERIES AS WELL AS OTHER SERVICES IN TERMS OF REPRODUCTIVE SERVICES," THAT COULD BE MORE ECONOMICAL THAN OPERATING A HOSPITAL WITHIN A HOSPITAL. IT GIVES US THAT OPTION. AND WHAT SETON HAS AGREED IS THAT SINCE THEY ARE CAPPING A DEDUCTION OF THEIR CHARITY CARE UP TO 3.4 MILLION, IS THAT WE SIMPLY WOULD TAKE THAT POT OF DOLLARS AND GO PROVIDE AND PURCHASE THOSE SERVICES SOMEWHERE ELSE. THIS IS NOT IDEAL. I THINK EVERYBODY THAT WE HAVE TALKED TO WITH RESPECT TO THIS ISSUE, IT WAS VERY IMPORTANT THAT THOSE SERVICES REMAIN AT BRACKENRIDGE HOSPITAL. BUT WE ALSO WANT TO BE ABLE TO GIVE US THAT OPTION TO ENTERTAIN THAT DISCUSSION IF IT PROVES TO BE SUCH A FINANCIAL BURDEN THAT WE DON'T THINK IT WOULD BE SOMETHING THAT COULD WORK OUT INTO THE FUTURE. IT'S JUST A CAUTIONARY APPROACH.

ALVAREZ: THANKS, MR. CITY MANAGER. ONE LAST QUESTION. ABOUT THAT SECOND OPTION. SO WE HAD 3.4 MILLION PART OF IT, THAT WE WOULD DO SOME CHARITY CARE. THEN THERE'S A PART THAT SAYS -- THE CAPITAL COSTS IS REVERSED WITH CITY PAYING NON-EXPANSION COSTS. SO -- AND LET'S SEE. SO UNDER THIS AGREEMENT THAT YOU HAVE LAID OUT, IT SEEMS LIKE SETON PAYS EXPANSION COSTS AND THE CITY PAYS NON-EXPANSION COSTS, I'M TRYING TO FIGURE OUT HOW THAT REVERSES THE -- THE -- THE RELATIONSHIP. [ONE MOMENT PLEASE FOR CHANGE IN CAPTIONERS] DPAR GAR FURTHER QUESTIONS FOR MR. STEVENS?

MAYOR, JUST A WARNING ABOUT LATER. WHAT I REALLY NEED TO SEE, I THINK, IS A LIST TO BREAK OUT AS FAR AS IT'S POSSIBLE TO DO FOR EXPANSION AND NON-EXPANSION BECAUSE I'M NOT SURE THAT I'M UNDERSTANDING WHY SOMETHING IS EXPANSION OR NOT.

WE HAVE THAT DETAILED.

GARCIA: THANK YOU, MR. STEVENS. MS. YOUNG, WE'LL GET BACK TO YOU.

TALK ABOUT CONTINUITY OF PATIENT CARE. UNDER OUR PROPOSAL WE'VE GOT SOME ITEMS REGARDING PATIENT FLOW. THIS HAS BEEN OF SIGNIFICANT CONCERN TO MANY MEMBERS OF OUR RESPECTIVE ORGANIZATIONS AS WELL AS THE COMMUNITY. OUR OBJECTIVE AND -- IN MANAGING THE PROPOSED FACILITY AND THE FLOW OF PATIENTS BETWEEN THE PROPOSED BRACKENRIDGE HOSPITAL AND THE -- HOSPITAL WITHIN A HOSPITAL AND THE EXISTING BRACKENRIDGE HOSPITAL IS TO MANAGE OUR CAPACITY, MANAGE THE CAPACITY ON THE CITY HOSPITAL IN SUCH A WAY THAT WE RESERVE THE NECESSARY CAPACITY TO MEET THE DEMANDS FOR THE STERILIZATION PROCEDURES. SO THAT'S OUR HIGHEST PRIORITY THAT ANY WOMAN WHO IS REQUESTING A STERILIZATION PROCEDURE, THAT CAPACITY BE THERE AND THAT PROCEDURE BE PROVIDED THERE. WE THEN WANT TO MANAGE THE REMAINING CAPACITY SUCH THAT WE REFORM TO THE FINANCIAL PROJECTIONS THAT WE SET FORTH OR THAT WE WILL DETERMINE IN TERMS OF OPERATING BUDGET TO MAKE SURE THAT WE MEET -- THAT WE ACTUALLY DO THE NUMBER OF DELIVERIES THAT WE EXPECT TO DO TO GENERATE THE REVENUE NECESSARY TO MEET THE BUDGET. OUR PATIENT FLOW PRINCIPLES INCLUDE THAT SERVICES WILL BE PROVIDED IN A SEAMLESS MANNER AS AS SEAMLESS AS POSSIBLE. AND WE WILL WORK WITH SETON AND THE BRACKENRIDGE ADMINISTRATORS AND STAFF TO ACCOMPLISH THAT. PATIENTS WILL BE EDUCATED DURING PRENATAL CARE FOR THE HOSPITAL SERVICES. AND THE WAY WE PROPOSE TO DO THAT IS TO CREATE THE NECESSARY COMMUNICATIONS LINKAGES AND RELATIONSHIPS OR STRENGTHEN THOSE THAT ALREADY EXIST WITH BOTH THE CITY'S CLINICS AS WELL AS THE COMMUNITY PROVIDERS TO EDUCATE THEM ABOUT HOW SERVICES ARE PROVIDED IN THE TWO HOSPITALS AND CREATE THE REFERRAL PROTOCOL FOR THE PATIENT TO THE RESPECTIVE FACILITIES. THE KEY HERE IS MAKING SURE THAT THE PATIENT KNOWS IN ADVANCE WHERE THEY'RE GOING TO DELIVER. AND WE WILL HAVE TO WORK WITH ALL THE PROVIDERS WHO DELIVER OR HAVE THEIR PATIENTS' BABIES DELIVERED AT BRACKENRIDGE EITHER ON THE FIFTH FLOOR OR IN THE BRACKENRIDGE FACILITY SECOND FLOOR, HAVE THEM DIRECTED TO THE RIGHT SETTING INITIALLY. EVERY PATIENT WILL HAVE ACCESS TO FAMILY PLANNING COUNSELING SERVICES WHETHER THEY'RE ON THE SECOND FLOOR, WHETHER THEY'RE ON THE FIFTH FLOOR. ON THE NEXT SUPPLIED SLIED ON PAGE 28, WHAT WE'RE PROPOSING IS THAT, OF COURSE, ANY PATIENT THAT IS REQUESTING A STERILIZATION PROCEDURE THAT THEY WILL BE AUTOMATICALLY REFERRED TO THE FIFTH FLOOR. AGAIN, WE WILL EDUCATE ALL THE PROVIDERS TO REFER THEIR PATIENTS THERE FOR DELIVERY AND WE WILL ESTABLISH A PREREGISTRATION SYSTEM SO WE KNOW WHEN THOSE PATIENTS ARE SCHEDULED TO DELIVER, EITHER BY AN ACTUAL SCHEDULED ASSESS SARIAN DATE OR A APPROXIMATE RANGE OF THEIR DELIVERY DATE. FOR OUR COMMUNITY HEALTH CENTER PATIENTS, OF COURSE IF THEY'RE HAVING A STERILIZATION PROCEDURE, THEY WILL BE DELIVERED ON THE FIFTH FLOOR. AND TO THE EXTENT THAT GIVEN THE SCHEDULED DELIVERIES. AND WHEN I SAY SCHEDULED, WE ALL KNOW THAT'S A LITTLE BIT MOOT BECAUSE BABIES DON'T ARRIVE EXACTLY WHEN THEY'RE ANTICIPATED OR WHEN WE WOULD LIKE THEM TO COME, BUT WITHIN A SCHEDULING SCHEME WE CAN DETERMINE IN ADVANCE WHETHER A WOMAN SHOULD -- WILL BE ABLE TO DELIVER ON THE FIFTH FLOOR OR WE WILL DIRECT HER TO THE SECOND FLOOR. SO WE MAKE SURE SHE DOESN'T GO TO THE WRONG PLACE AT THE VERY BEGINNING. WE ARE SUGGESTING THAT ANY PATIENT THAT IS NOT A COMMUNITY HEALTH CENTER PATIENT, THAT IS NOT REQUESTING A STERILIZATION PROCEDURE, IN OTHER WORDS, SHE'S NOT GOING TO HAVE A TUBAL LIGATION, WE WILL DIRECT HER TO DELIVER AT BRACKENRIDGE AND THAT'S JUST THE MANAGEMENT CAPACITY AT BOTH BRACKENRIDGE AND THE FIFTH FLOOR HOSPITAL. AGAIN, ANY PATIENT FROM A COMMUNITY PROVIDER THAT'S REQUESTING A TUBAL LIGATION WILL RECEIVE THOSE SERVICES ON THE FIFTH FLOOR. THE CAPACITY IS GOING TO FLEX DAY-TO-DAY. IT'S GOING TO BE DEPENDENT UPON WHEN WOMEN ARE SCHEDULED FOR DELIVERY, SO IT WILL HAVE TO BE MANAGED CLOSELY. BUT WE IMAGINE THAT TWO-THIRDS OF THE PATIENTS THAT DO DELIVER AT BRACKENRIDGE ARE ALREADY OUR PATIENTS IN THE CITY. SO WE HAVE A BETTER ABILITY TO MANAGE THAT. THE REGISTRATION SYSTEM OVERVIEW IS SHOWN ON PAGE 29. AND AGAIN, TALKING ABOUT -- THIS JUST ILLUSTRATES WHAT YOU SEE IN THE CHART. THE CHC PATIENT AND DURING THE PRENATAL COUNSELING PERIOD WE'VE DETERMINED THAT OUR PATIENT IS -- CHOOSES A STERILIZATION PROCEDURE, AND THEN WE WILL PREREGISTER THAT PATIENT INTO THE FIFTH FLOOR TO HAVE THAT DELIVERY AND THAT SERVICE PROVIDED. AND IF THEY'RE NOT REQUESTING A STERILIZATION PROCEDURE, THEN AGAIN BASED ON THE CAPACITY THEY'LL BE -- THERE WILL BE AN ABILITY TO CHOOSE EITHER BRACKENRIDGE OR THE CITY. AND REALIZE ALSO THAT THE PROVIDER IS -- THE PROVIDER IS A KEY COMPONENT OF THE DECISION MAKING, IT'S NOT DONE WITHOUT CLINICIAN'S INPUT AND DECISION ABOUT THAT. SO THAT IS AN ELEMENT OF THE DECISION MAKING. FOR NON-COMMUNITY CLINIC -- COMMUNITY HEALTH CENTER PATIENTS, NO NON-CITY CLINIC PATIENTS, THEY WILL BE DIRECTED TO THE FIFTH FLOOR IF THEY'RE REQUESTING A STERILIZATION PROCEDURE ASSOCIATED WITH A SCHEDULED DELIVERY. IF NOT, THEY WILL BE DIRECTED TO BRACKENRIDGE. AND WE WILL WORK AGAIN WITH THE PROVIDERS IN THEIR OFFICES WITH THAT INFORMATION IN ADVANCE SO THE PATIENT KNOWS WHERE THEY'RE GOING. IF A PATIENT COMES IN TO THE ER AND THEY HAVE NOT HAD PRENATAL CARE, THEY ARE NOT A CANDIDATE FOR A STERILIZATION PROCEDURE. IF YOU ARE A MEDICAID PATIENT, YOU HAD TO HAVE CONSENTED TO THAT PROCEDURE AT LEAST 30 DAYS PRIOR TO IT BEING PERFORMED. IF YOU -- FOR ANY OTHER PATIENT THERE'S A GUIDELINE THAT SAYS THE PHYSICIAN WOULD NOT CONSENT TO PERFORMING A STERILIZATION PROCEDURES WITHIN 72 HOURS OF LABOR AND DELIVERY. IT'S A PROTECTION FOR BOTH THE PATIENT AND PHYSICIAN IN TERMS OF MAKING SUCH A SERIOUS DECISION. AND SO SOMEONE -- IF A WOMAN CAME INTO BRACKENRIDGE ER NEVER SEEN A DOCTOR AND IS READY TO DELIVER, SHE'S NOT GOING TO RECEIVE A TUBAL LIGATION AT THAT POINT BECAUSE THE DOCTORS WOULD NOT CONSENT TO PERFORM THAT. IF THAT PATIENT WOULD BE -- TYPICALLY WHAT HAPPENS WITH THAT PATIENT, WHAT HAPPENS TODAY AND WHAT WILL CONTINUE, THAT PATIENT COMES IN AND HAS NOT RECEIVED PRENATAL CARE, THEY WILL BE EVALUATED IN THE ER AND IF THEY'RE READY TO DELIVER, THEY WILL BE SENT TO THE SECOND FLOOR TO DELIVER THAT CHILD AND THE CITY HOSPITAL WILL NOT BE INVOLVED AT ALL IN THAT, EXCEPT POSSIBLY FOR A REFERRAL INTO OUR CLINIC SYSTEM TO ESTABLISH THAT PATIENT IN A MEDICAL FOR FUTURE PRENATAL CARE, FOR FUTURE MEDICAL CARE.

MAYOR GARCIA: MS. YOUNG, WHAT PERCENTAGE OF THE WOMEN THAT SHOW UP AT BRACKENRIDGE FALL IN THAT CATEGORY?

IT'S ABOUT 10%.

MAYOR GARCIA: 10%?

I BELIEVE THAT'S IT. I'M SURE THAT FLUCTUATES FROM YEAR TO YEAR, BUT THE PHYSICIANS SAY THAT'S NECESSARILY CONSTANT. THAT'S A LARGER EDUCATION ISSUE.

MAYOR GARCIA: AND AFTER THEY HAVE THEIR CHILD, IS THERE ANY EDUCATION?

WE WOULD HOPE THAT WE COULD -- WHAT TYPICALLY HAPPENS IS IN THE CITY CLINICS WE SEE VIRTUALLY 100% OF THE NEWBORN BABY IN OUR CLINIC SYSTEM, EVEN IF THEY HAVE ANOTHER PROVIDER IN THE COMMUNITY. WE APPOINT THE BABY FOR THE TWO-WEEK FOLLOW-UP INTO OUR CLINIC. THAT IS OUR OPPORTUNITY ALSO TO BRING THE MOTHER AND GET HER ESTABLISHED INTO CARE IF SHE HAS NOT ESTABLISHED A HOME WITH ANOTHER PROVIDER. SO WE TRY TO CREATE THAT LINKAGE UPON DISCHARGE OF THE MOTHER AND THE BABY FROM THE HOSPITAL. ON PAGE 30 WE HAVE PRINCIPLES AROUND OUR PREREGISTRATION SCHEDULING. AND OUR OBJECTIVE IS TO RECEIVE THE HIGHEST QUALITY CARE. PRENATAL COUNSELING MUST INCLUDE AN EDUCATION AND TOUR ABOUT WHERE THE DELIVERY WILL BE PERFORMED. SO WE'RE GIVING INFORMATION TO THAT WOMAN AHEAD OF TIME. WE WANT THE -- WE BELIEVE THE PREREGISTRATION WILL HELP US ENSURE THAT THE PREGNANT WOMEN KNOW WHERE THEY'RE GOING AT THE BEGINNING AND DON'T END UP IN THE WRONG PLACE. IT DOESN'T MEAN THAT THAT WON'T HAPPEN. THERE WILL BE CONFUSION, BUT WE HOPE TO MINIMIZE THAT. I ALSO -- AGAIN, WITH REGARD TO THE SELECTION OF A STERILIZATION PROCEDURE, THERE ARE INFORMED CHOICE REQUIREMENTS. WE HAVE THE MEDICAID REQUIREMENT THAT A WOMAN RECEIVING A STERILIZATION CONSENT AT LEAST 30 DAYS BEFORE. AND IF A WOMAN -- IF SHE'S NOT MEDICAID, IN ORDER TO RECEIVE A STERILIZATION PROCEDURE, SHE MUST HAVE CONSENTED AT LEAST 72 HOURS PRIOR TO HER DELIVERY, LABOR OR DELIVERY. ON THE LAST PAGE WE'VE PREPARED A FLOW CHART, PER SE. IT'S GOT LOTS OF BOXES OF ON IT, SO I'M NOT GOING TO TAKE YOU THROUGH EVERY BOX. WE TRIED TO DEMONSTRATE THE FLOW FOR PATIENT. ON THE LEFT-HAND SIDE OF THE PATIENT FOR A COMMUNITY HEALTH CARE PATIENT, AGAIN, IF THAT PATIENT HAS REQUESTED A TUBAL LIGATION ASSOCIATED WITH THE DELIVERY OR THEY WANT A TUBAL LIGATION ON AN OUTPATIENT BASIS NOT RELATED TO DELIVERY, BUT THEY'VE DECIDED TO ELECT THAT METHOD OF BIRTH CONTROL, WE'VE SCHEDULED THAT PATIENT DIRECTLY INTO THE FIFTH FLOOR. AND THE FAISHT RECEIVES THE SAME LEVEL OF CARE ON THE FIFTH FLOOR AS THEY WOULD ON THE SECOND FLOOR IN TERMS OF THEIR DELIVERY SERVICES. IF THE PATIENT DOES NOT REQUEST STERILIZATION PROCEDURE, THEN WE GO THROUGH THAT PROCESS OF DETERMINING WHETHER THERE IS CAPACITY ON THE FIFTH FLOOR, AND IF THERE IS, THEY HAVE A CHOICE OF WHETHER THEY WANT TO DELIVER THERE OR AT BRACKENRIDGE. IF IT'S A COMMUNITY PROVIDER, A PATIENT OF A COMMUNITY PROVIDER BEING A NON-CITY CLINIC PATIENT, THEY'RE REQUESTING A TUBAL LIGATION, AND THEY WILL BE PREREGISTERED INTO THE FIFTH FLOOR. IF THEY'RE NOT, THEY WILL BE DIRECTED UPON DELIVERY TO ARRIVE AT BRACKENRIDGE. IF THE -- IF THE PATIENT IS NOT RECEIVING A TUBAL LIGATION THROUGH THE TRIAGE PROCESS BOTH WHEN THEY'RE BROUGHT IN AND ASSESSED AND POSTPARTUM AFTER THEY'VE DELIVERED, WE WILL PROVIDE THE EDUCATION COUNSELING THAT THEY REQUIRE TO HANDLE THEIR BIRTH CONTROL REQUIREMENTS, WHATEVER THEY CHOOSE. THERE WILL BE A PHARMACY ON THE FIFTH FLOOR. AND WE WILL DISPENSE MEDICATION THROUGH THAT PHARMACY. AND WE DISPENSE MEDICATION FROM THAT PHARMACY FOR ALL THE PATIENTS ON THE FIFTH FLOOR.

MAYOR GARCIA: THE MORNING AFTER PILLS AND ABORTIONS ARE -- THEY USE OTHER PROTOCOLS, RIGHT?

WELL, WITH REGARD TO PREGNANCY PREVENTION, IF -- WHAT WE HAVE DETERMINED IS THAT THE EMERGENCY CONTRACEPTIVE SERVICES WILL BE PROVIDED ON THE FIFTH FLOOR. SO IF A PATIENT IS EITHER NEEDING INFORMATION OR NEEDING SERVICES, THEY WILL BE INFORMED THAT THOSE SERVICES ARE PROVIDED ON THE FIFTH FLOOR AND WE'LL PROVIDE THEM ON THE FIFTH FLOOR. WE DON'T HAVE TO PROVIDE THE SERVICES ONLY ON THE FIFTH FLOOR. THOSE SERVICES ALSO COULD BE PROVIDED IN OUR CLINICS AND OTHER SETTINGS, BUT THEY WILL BE PROVIDED ON THE FIFTH FLOOR.

MAYOR GARCIA: AND THE SAME THING APPLIES TO REQUESTED ABORTIONS?

I'M SORRY.

THE REQUESTED ABORTIONS RIGHT NOW ARE HANDLED BY CONTRACT. WE HANDLE THOSE THROUGH SEPARATE.

THOSE ARE NOT PROVIDED AT BRACKENRIDGE.

WE HAVE A CONTRACT FOR THAT SPECIFIC SERVICE.

MAYOR GARCIA: ALL RIGHT.

GOODMAN: MAYOR, COULD I ASK SOMETHING?

MAYOR GARCIA: SORRY? GO GOOD COULD I FOLLOW-UP?

MAYOR GARCIA: SURE, MAYOR PRO TEM GOODMAN.

THIS IS WHAT I MEANT ABOUT THE LOGISTICS, WHICHEVER ONE OF THOSE IS THE WORD. INFORMATION WOULD BE PROVIDED TO A WOMAN ONLY IF SHE WENT TO THE FIFTH FLOOR?

NO. INFORMATION ABOUT WHERE SHE DELIVERS WILL BE PROVIDED TO EVERY PATIENT.

GOODMAN: FOR ANY SERVICES AND CHOICE?

RIGHT.

GOODMAN: INFORMATION THAT YOUR CHOICE WILL BE PROVIDED TO EVERY WOMAN WHO WALKS INTO BRACKENRIDGE?

WELL, I THINK WE NEED TO UNDERSTAND THAT THESE CHOICES ARE MADE IN ADVANCE OF THEIR COMING TO BRACKENRIDGE AND THEY'RE DONE WITH -- THEY'RE DONE IN CONJUNCTION WITH THEIR PHYSICIAN OR OTHER PROVIDER THAT'S TAKEN CARE OF THEM. SO A DECISION TO HAVE TUBAL LIGATION IS A DECISION THAT'S TYPICALLY MADE PROBABLY SOMEWHERE IN THE SEVENTH -- THE EIGHTH MONTH OF DELIVERY.

GOODMAN: I'M THINKING OF A BROADER SKIRT. EVERY WOMAN WHO COMES IN TO BRACKENRIDGE IS NOT NECESSARILY PLANNING A PREGNANCY, BUT THERE MAY BE EMERGENCY CIRCUMSTANCES. THERE MAY BE PEOPLE WHO ARE VISITING, THERE MAY BE PEOPLE WHO HAVE NOT GONE TO A PHYSICIAN AHEAD OF TIME AND THERE MAY BE RAPE VICTIMS OR WHAT HAVE YOU, SO I WANT TO KNOW ABOUT WHENEVER ANY WOMAN WALKS IN THE DOOR HOW WILL INFORMATION ABOUT THE CHOICES OR ESPECIALLY IMMEDIATE CHOICES BE GIVEN TO HER? WILL SHE HAVE TO MAKE HER WAY TO THE FIFTH FLOOR TO FIND OUT OR WILL THAT BE A COUNSELING OR INFORMATION OR WHATEVER KIND OF A SERVICE BE IMMEDIATELY AVAILABLE TO EVERY WOMAN WHO WALKS THROUGH THE DOOR, WHETHER SHE NEEDS IT OR NOT?

WELL, LET ME SEE IF WE CAN SEPARATE IT INTO A COUPLE OF CATEGORIES. WITH REGARD TO EMERGENCY CONTRACEPTION, IF SOMEONE COMES IN SEEKING THAT INFORMATION OR HAS THE NEED OF THAT SERVICE, THEY COME THROUGH THE EMERGENCY ROOM. BUT THE PATIENT WILL BE INFORMED THAT THOSE SERVICES ARE NOT PROVIDED BY SETON, BUT THEY ARE PROVIDED BY THE CITY. AND THAT PATIENT WILL BE REFERRED TO US ON THE FIFTH FLOOR. THE PATIENT WOULD NOT WALK INTO, SAY, THE REGISTRATION DESK AND ASK FOR THAT INFORMATION. THE PERSON IN NEED OF MEDICAL SERVICES ARE GOING TO BE DIRECTED TO THE EMERGENCY ROOM TO RECEIVE THOSE SERVICES. SO THE INFORMATION IS DISSEMINATED BY CLINICAL INDIVIDUALS, NOT BY ADMINISTRATORS OR CLERKS.

GOODMAN: I'M NOT TRYING TO TALK ABOUT WHETHER IT'S A CLERK OR ADMINISTRATOR OR WHATEVER.

NO, BUT I'M TRYING TO CLARIFY WHERE THE INFORMATION IS EXCHANGED AND OCCURS. I GUESS I WOULD ASK YOU A CLARIFYING QUESTION TOO. WHEN YOU SAY IF A WOMAN WALKS INTO BRACKENRIDGE REQUESTING A SERVICE, ARE YOU SAYING -- .

GOODMAN: SHE'S MAYBE NOT EVEN REQUESTING THE SERVICE. SHE DOESN'T KNOW, PERHAPS, WHAT EVEN TO REQUEST. I'M TRYING TO FIND OUT WHETHER INFORMATION WILL BE IMMEDIATELY AVAILABLE ABOUT THE CHOICES FOR COUNSELING OR MEDICAL HELP OR WHAT HAVE YOU. IF YOU'RE GOING TO THE EMERGENCY ROOM, THAT'S JUST ONE POSSIBLE SCENARIO OF HOW A WOMAN WALKS IN TO BRACKENRIDGE NOT KNOWING PERHAPS WHAT TO DO NEXT. AND SO I'M TRYING TO -- .

LET ME SEE IF I CAN TRY TO ANSWER IN TERMS OF HITTING THE MARK. I'M ASSUMING A PATIENT IS NOT PREGNANT, CORRECT, OR MAYBE SHE IS PREGNANT AND HAS NEVER RECEIVED PRENATAL COUNSELING.

GOODMAN: WE DON'T KNOW. IT DOESN'T MATTER. WHATEVER POSSIBLE SCENARIO YOU CAN IMAGINE. ANY WOMAN WHO WALKS IN, WHAT WOULD HAPPEN?

OKAY. LET'S TAKE A COUPLE OF SCENARIOS. IF A WOMAN WAS PREGNANT AND SHE HAD NEVER RECEIVED PRENATAL CARE. LET'S SAY SHE'S NOT ABOUT TO DELIVER, SHE'S SIX MONTHS AWAY OR THREE MONTHS AWAY. WHAT THEY WOULD DO AT BRACKENRIDGE IS TRY TO GET HER INTO A PHYSICIAN TO RECEIVE PRENATAL CARE. MORE LIKELY THAN NOT SHE'S GOING TO BE REFERRED TO US AND WE ARE GOING TO ESTABLISH HER AS A PATIENT AND THEREFORE WE WILL TREAT HER. AND WHEN SHE DELIVERS SHE WILL DELIVER AT BRACKENRIDGE AND WE WILL -- WE WILL WORK WITH HER TO MAKE -- HELP HER MAKE HER DECISIONS ABOUT HER BIRTH CONTROL METHODS OR HER DELIVERY OR HER STERILIZATION PROCEDURE IF SHE REQUESTS IT. SO THE GOAL IS TO GET HER INTO A MEDICAL HOME, NOT TO DEAL WITH THAT AT BRACKENRIDGE BECAUSE BRACKENRIDGE JUST DOES THE DELIVERY SERVICES. SO THEY WOULD BE -- WHAT WE WOULD DO IS TAKE HER THROUGH THE ELIGIBILITY -- WHAT BRACKENRIDGE DOES NOW WITH ANY PATIENT THAT JUST A WALKS IN NOT NECESSARILY REQUESTING SERVICES AT BRACKENRIDGE, BUT REQUESTING INFORMATION IS TO DETERMINE WHAT THEIR REQUIREMENTS ARE AND THEN REFER THEM TO THE APPROPRIATE PLACE.

.

GOODMAN: I'M NOT BEING CLEAR ENOUGH ABOUT WHAT I'M ASKING, BUT I'M WORK ON THAT LATER. SOMETHING YOU JUST SAID, THOUGH, DID ALSO KIND OF MAKE ME THINK OF SOMETHING I HADN'T THOUGHT OF. WHEN IS -- WHEN A WOMAN WALKS INTO BRACKENRIDGE, NOW, THAT IS A SETON EMPLOYEE THAT THEY WILL SPEAK TO, RIGHT?

UH-HUH.

GOODMAN: OKAY. SO IF THERE'S ANY INFORMATION REQUESTED LIKE THAT, THE SETON EMPLOYEE WILL REFER THE ASKER OF THE QUESTION TO THE FIFTH FLOOR?

I GUESS IT WOULD DEPEND ON WHAT INFORMATION THEY'RE ASKING FOR.

GOODMAN: ANY INFORMATION ABOUT CHOICE OR REPRODUCTIVE SERVICES, WHAT WOULD -- WHAT WOULD THE BRACKENRIDGE EMPLOYEE DO?

I WOULD VENTURE TO SAY THAT IF THE PATIENT IS WALKING OFF FROM THE STREET NOT REQUESTING SERVICES AT BRACK, BUT JUST REQUESTING INFORMATION, THEY WOULD EITHER REFER THEM TO THE FIFTH FLOOR OR THEY WOULD TRY TO REFER US TO THE COMMUNITY CLINICS AS A PRIOR TO ESTABLISH A RELATIONSHIP WITH THAT PATIENT AND GET GIVE THEM THE INFORMATION THAT THEY NEED.

GOODMAN: BUT THEY WILL TELL THEM WHERE TO GO?

YES. THEY WILL PROVIDE THEM -- YES. WHATEVER SERVICES THAT THEY'RE SEEKING THEY WILL TELL THEM WHERE THEY CAN FIND THOSE SERVICES, YES.

MAYOR GARCIA: MAYOR PRO TEM, LET ME INTERRUPT YOU FOR JUST A MINUTE, TALKING ABOUT THE FIFTH FLOOR. THE VISITORS CAN ONLY PARK AND THEN SWITCH FROM THE HOSPITAL TO THE PARKING GARAGE HERE, VISITORS CAN ONLY PARK IN THE FIFTH FLOOR GARAGE, SO THERE'S A BLACK TAHOE THAT'S PARKED IN A RESERVED PARKING PLACE AND IF YOU DON'T MOVE IT, THEY'RE GOING TO TOW IT.

OUR DEFICIT JUST WENT DOWN BY $30,000.

MAYOR GARCIA: SO I NEEDED TO MAKE THAT ANNOUNCEMENT JUST TO MAKE SURE. SORRY TO INTERRUPT YOU MS. YOUNG. [LAUGHTER]. BACK TO YOU, MAYOR PRO TEM.

GOODMAN: THANKS. WELL, I'LL LEAVE OFF FOR NOW BECAUSE I'M NOT BEING ABLE TO COMMUNICATE WHAT IT IS I'M TRYING TO ASK, AND I THINK THAT YOU ARE SEEING THINGS IN A VERY NARROW FOCUS PERHAPS YOU'VE ALL BEEN TALKING AMONG YOURSELVES FOR SO LONG THAT YOU KNOW AUTOMATICALLY WHAT SCENARIOS YOU'RE THINKING OF AND I DON'T BECAUSE I HAVEN'T BEEN PART OF THE DISCUSSIONS. SO WHAT I'M TRYING TO FIND OUT ABOUT IS THE MECHANICS OF -- THE PHYSICAL MECHANICS OF HOW ANYBODY, ESPECIALLY A WOMAN, WILL WALK IN UNESCORTED LOOKING FOR INFORMATION OR SERVICES, PERHAPS EVEN EMERGENCIES THAT ARE NOT NECESSARILY THE EMERGENCY ROOM, BUT THEY ARE IMMEDIATE. AND I WANT TO FIND OUT THINGS ABOUT WHO WILL GIVE THAT PERSON INFORMATION, WHO WILL ESCORT HER, I WOULD HOPE, TO THE FIFTH FLOOR OR, YOU KNOW, WHATEVER. IF IT'S NOT SOMETHING SO IMMEDIATE IN REFERRING HER TO A CLINIC, I WANT TO KNOW WHAT THE MECHANICS OF SOME OF THAT IS AND THE FOLLOW-UP IS. BUT FOR SOMEONE WHO WANTS TO TALK TO SOMEONE IN THE HOSPITAL RIGHT THEN ABOUT A POSSIBLE IMMEDIATE, BUT NOT EMERGENCY SITUATION, I WANT TO KNOW HOW THEY GET FROM POINT A TO POINT B OR IF THEY'RE ON THEIR OWN.

I UNDERSTAND. AND THAT IS PART OF WHAT WE WILL -- WHAT I THINK YOU'RE TALKING ABOUT IS A BROADER -- HOW DO PEOPLE GET WHERE THEY NEED TO GO FOR INFORMATION AND SERVICES? AND THAT'S PART OF THE COMMUNICATIONS PROTOCOL THAT WE'LL HAVE TO COORDINATE TO SAY HOW DO WE WANT TO HANDLE THAT. IN OTHER WORDS, IF A WOMAN JUST WALKS IN AND IS REQUESTING INFORMATION, DO WE WANT TO -- DO WE WANT TO BASICALLY SAY WE WANT YOU TO GO TALK TO THE FOLKS ON THE FIFTH FLOOR OR DO WE WANT TO SAY HERE'S THIS IF THEY'RE LOOKING FOR THIS. IF THEY NEED A MEDICAL APPOINTMENT, WE CAN REFER THEM TO THE CLINICS. I THINK I UNDERSTAND.

I THINK OUR OBJECTIVE IS THIS, MAYOR PRO TEM, IF I MAY, IS THAT WE'RE GOING TO SEE TO IT THAT THERE IS NO SHORT-CIRCUITING OF MAKING SURE THAT ALL THE INFORMATION IS AVAILABLE TO THAT INDIVIDUAL THAT NEED TO BE AVAILABLE TO THE INDIVIDUAL SO THAT THEY CAN MAKE WHATEVER DECISIONS THEY WANT TO MAKE WITH RESPECT TO ANY -- WHATEVER ISSUES THAT THEY WANT TO MAKE, WE WANT TO MAKE SURE THAT THAT INFORMATION COMES AND WE ARE THERE TO PROVIDE IT AND THAT'S THE PROTOCOL THAT SHE IS TALKING ABOUT. WE WANT TO MAKE SURE THAT THAT IS PART OF THIS.

MAYOR GARCIA: COUNCILMEMBER GRIFFITH?

GRIFFITH: YES, MAYOR, THANK YOU. I, LIKE THE MAYOR PRO TEM, AM INTERESTED IN LOGISTICS. AND I THINK IT'S REALLY IMPORTANT THAT WHAT SHE'S TALKING ABOUT AND OTHER THINGS THAT ARE OF CONCERN IN THE COMMUNITY AND ON THE COUNCIL GET IN THE CONTRACT. WHAT IS THE STATUS OF THE CONTRACT NOW? CAN WE TALK ABOUT WHAT'S IN IT NOW, WHAT'S NOT IN IT NOW? CAN WE TALK ABOUT WHAT WE WOULD LIKE TO SEE IN IT? WHAT'S THE STATUS OF THE CONTRACT? FOR INSTANCE, FOLLOWING UP ON WHAT THE MAYOR PRO TEM WAS BRINGING UP, SAY SALLY CITIZEN, IN HER MIND IS A RAPE VICTIM AND SHE COMES IN TO THE EMERGENCY ROOM. WHO WILL SHE SEE? WHO DOES THAT PERSON WORK FOR AND WHAT HAPPENS AFTER THAT? AND WILL THAT BE IN THE CONTRACT? AND THAT'S ONE EXAMPLE. THERE ARE FOUR OR FIVE OTHERS THAT I'D LIKE TO TALK ABOUT THAT I THINK ARE IMPORTANT TO ACTUALLY BE WRITTEN IN THE DEAL SO THERE WON'T BE ANY MISUNDERSTANDINGS OR ANY TOING AND FROING DOWN THE LINE.

WE DO HAVE PROVISIONS THAT ARE BEING DRAFTED THAT ADDRESS THAT TYPE OF SITUATION THAT YOU JUST DESCRIBED. WE HOPE TO HAVE A DRAFT AVAILABLE BY THE END OF THE WEEK, BY FRIDAY, THE DAY AFTER TOMORROW. THAT'S WHAT WE INTEND TO SHARE WITH YOU OBVIOUSLY AS WELL AS THE PUBLIC TO GIVE THEM A CHANCE TO REVIEW THAT AND COMMENT AND BRING THEIR COMMENTS ON THE.

GRIFFITH: THERE ARE SEVERAL THINGS THAT I THINK IS REAL IMPORTANT TO GET IN THERE AND CLEAR AND STRAIGHT. SHALL I GIVE THOSE TO YOU OR WHAT'S PROPER?

CERTAINLY.

GRIFFITH: HOW WOULD YOU PREFER IT?

YOU CAN GIVE IT TO ME DIRECTLY. THERE ARE A SERIES OF PROVISIONS, I GUESS CONCEPTUAL PROVISIONS THAT I -- THAT WE HAVE IN FACT SHARED WITH SOME OF THE COMMITTEES -- COMMUNITY ADVOCATES AROUND THESE ISSUES. THEY WERE THE CONCERNS THEY DID HAVE ABOUT THE THINGS THAT YOU JUST DESCRIBED SUCH AS HOW WILL A PATIENT BE INFORMED, HOW WILL THEY GET THE INFORMATION?

WHO GETS THEM AND THEN WHAT HAPPENS?

I'M SORRY?

GRIFFITH: LIKE WHEN THEY COME IN, WHO DO THEY SEE? WHO DOES THIS PERSON WORK FOR? IS THERE A HAND OFF? WHO HANDS OFF TO WHOM?

THOSE ARE THE KINDS OF THINGS WE ADDRESS. WE REVIEWED THE CONCEPTUAL PROVISIONS OF THOSE AND THEN THE LANGUAGE WILL ADDRESS IT SPECIFICALLY.

GRIFFITH: OKAY. THAT'S GOOD.

MAYOR GARCIA: I WOULD REQUEST THAT COUNCILMEMBERS GET THOSE QUESTIONS TO MS. YOUNG BECAUSE THE PUBLIC HEARING THAT'S SCHEDULED FOR TODAY HAS BEEN POSTPONED AND MS. DUNKERLEY, CAN YOU TELL US WHAT THE DATE ARE? YOU SENT US AN E-MAIL.

WE ARE POPING THE PUBLIC HEARING TO THE 17TH TO DO EXACTLY WHAT YOU'RE ASKING TO DO TO GIVE US TIME TO COMPLETE THE ACTUAL DOCUMENT SO THE PUBLIC CAN HAVE TIME TO LOOK AT IT AND EVALUATE IT BEFORE THE PUBLIC HEARING. SO THE PUBLIC HEARING ON THE 17TH AND THEN WE'LL BE ASKING FOR COUNCIL ACTION ON THE 31ST. SO THAT SHOULD GIVE US SOME TIME TO WORK OUT ALL OF THOSE DETAILS.

GRIFFITH: OKAY. SO YOU'RE NEGOTIATING, BUT THERE WILL NOT BE ANYTHING EXECUTED FOR THE PUBLIC AND THE COUNCIL TO SEE THE OUTLINE.

MAYOR GARCIA: THE ITEM INCLUDES -- THE AMENDMENT OF THE CONTRACT WILL NOT BE ON THE 17TH, WILL IT.

IT WILL BE ON THE 31ST.

MAYOR GARCIA: SO WE HAVE THOSE TWO OPPORTUNITIES TO GET THE QUESTIONS IN AND GET THEM ANSWERED EITHER ON THE 17TH WHEN WE HAVE THE PUBLIC HEARING OR DEFINITELY ON THE 31ST WHEN WE HAVE TO MAKE A DECISION.

GRIFFITH: I DON'T DOUBT AT ALL THAT IT CAN GET DONE SOME WAY AND SEAMLESSLY IN THAT THE PASSING AROUND WILL HAPPEN AND THE WORK WILL GET DONE. WHAT I'M INTERESTED IN IS THE A CONTRACT THAT WILL PROVIDE THE BEST OPTIONS. AND THE BEST SERVICE AT THE -- AND NOT ONLY THE WOMEN AND BABIES WILL HAVE THE BEST POSSIBLE SERVICE, BUT ALSO THE TAXPAYERS WILL HAVE TT DEAL. THAT'S WHAT I'LL BE LOOKING FOR IN THAT CONTRACT, AND THE SPECIFICS OF HOW THAT'S GOING TO WORK. THAT MAKE SENSE?

MAYOR GARCIA: FURTHER QUESTIONS OR COMMENTS?

GOODMAN: YES, MAYOR. CAN I FOLLOW-UP ON WHAT WE'VE BEEN TALKING ABOUT? DID I UNDERSTAND YOU TO SAY YOU HAD WRITTEN OUT SOME OF THOSE PROTOCOLS AND PROVIDED THEM TO PEOPLE IN THE COMMUNITY?

NOT PROTOCOLS. WITHIN THE DRAFT OF THE LEASE AMENDMENT WE HAVE WRITTEN PROVISIONS THAT ADDRESS THE VERY THING THAT WE'RE TALKING ABOUT IN TERMS OF THE ACTS OF POINTS OF INFORMATION, WHAT THE RIGHTS AND RESPONSIBILITIES ARE OF EACH PARTY TO DO THEIR PART.

GOODMAN: BUT YOU DISTRIBUTED SOMETHING WRITTEN?

NO, WE DID NOT. I SHARED WITH THEM VERBALLY THE EIGHT OR I DON'T KNOW, 10 OR SO ITEMS OF -- THEIR POINTS OF CONCERN, WHICH ARE THE SAME CONCERNS YOU'VE DRAFTED, AND THOSE ARE BEING PUT INTO DRAFT LANGUAGE NOW.

GOODMAN: BY NOW, WHAT DOES THAT MEAN? THAT WE'LL SEE ON FRIDAY?

YES, MA'AM.

GOODMAN: COULDN'T WE HAVE HAD THIS BEFORE NOW? AT LEAST A DRAFT? IT'S NOTHING NEW THAT WE'RE TALKING ABOUT.

WE'VE BEEN WORKING ON IT CONTINUALLY AND WE FEEL AT THIS POINT BY FRIDAY WE WILL HAVE LANGUAGE THAT IS ACCEPTABLE TO BOTH THE CITY AND SETON AROUND THOSE PROVISIONS THAT WE FEEL COMFORTABLE IN SHARING, THE OBJECTIVES THAT WE'RE TRYING TO ACCOMPLISH.

GOODMAN: OKAY. WELL, I'M NOT GOING TO BEAT A DEAD HORSE OR BELABOR THIS, BUT ALL ALONG MY FRUSTRATION HAS BEEN THAT I AND THE PUBLIC KNOW VIRTUALLY NOTHING ABOUT WHAT YOU'VE ALL BEEN DISCUSSING. I HAVE SEEN NOTHING WRITTEN. AND IN FACT, FOLKS IN THE PUBLIC HAVE HAD MORE INFORMATION THAN I HAVE HAD BECAUSE THEY MAY HAVE BEEN SPEAKING WITH YOU OBVIOUSLY MORE THAN I HAVE. WHEN WE FIRST ENTERED INTO THIS CONTRACT IT WAS A VERY, VERY SIGNIFICANT UNDERTAKING AND THE PROVISIONS OF THAT CONTRACT WERE VERY, VERY CRITICAL OF EVEN BEING ABLE TO HALFWAY SUPPORT GOING IN WITH SETON BECAUSE OF THE DIFFICULTIES THAT THEY HAVE WITH THE DOCTOR. THIS TIME YOU'RE WORKING ON THE MOST CONTROVERSIAL AND DIFFICULT AND SENSITIVE PART OF THAT CONTRACT IN MY OPINION, AND I HAVE SEEN VIRTUALLY NOTHING. WE'RE HAVING A BRIEFING TODAY THAT IS EXTREMELY BRIEF AND THERE ARE NO DETAILS. AND SOMETHING AS SIMPLISTIC AS WANTING TO KNOW WHAT THE SEQUENCE OF EVENTS WILL BE FOR A WOMAN WALKING INTO THE HOSPITAL TO MAKE SURE THAT NO ONE WAS ACCIDENTALLY TURNED AWAY OR NOT GIVEN THE HELP SHE NEEDED TO FIND THE SERVICES AND CHOICES SHE NEEDSEEM TO BE SO SIMPLE THAT THEY OUGHT TO HAVE BEEN AT LEAST IN DRAFT FORM WRITTEN DOWN LONG BEFORE THIS BECAUSE THAT'S OBVIOUSLY VERY IMPORTANT IN A LOT OF PEOPLE'S MINDS, INCLUDING MINE. SO FRIDAY I GUESS WILL HAVE TO DO IT, BUT I'M FRUSTRATED AND CONTINUE TO BE FRUSTRATED AND STARTING TO BE ANGRY BECAUSE THERE'S STILL NO REAL LANGUAGE FOR ME TO LOOK AT. AND I JUST THINK THAT EVEN THOUGH WE HAVE UNTIL THE 31ST, THAT IS NOT A LONG TIME FRAME CONSIDERING HOW LONG WE'VE BEEN WORKING ON THIS. I WON'T MENTION IT AGAIN, BUT IT'S BEEN MY FRUSTRATION AND IT CONTINUES TO BE.

MAYOR PRO TEM, LET ME FIRST OF ALL -- I THINK WE AGREE WITH YOU THAT THERE'S NOT A MORE SENSITIVE AND IMPORTANT ISSUE WITH RESPECT TO THE PROVISION OF SERVICES, HEALTH SERVICES. I THINK YOU MAKE A POINT, A GOOD POINT ABOUT WHETHER THE DATA OF HOW THE PROCEDURES AND THE PROTOCOLS THAT HAVE BEEN WRITTEN. I KNOW THAT TRISH AND BETTIE AND JOHN HAVE BEEN WORKING WITH SALLY TIRELESSLY TO GET THIS DONE. THERE HAVE BEEN THINGS THAT HAVE HELD US UP IN GETTING THAT DONE. NOTWITHSTANDING THE ISSUE OF HOW WE WERE GOING TO DEAL WITH THE QUESTION OF EMERGENCY CONTRACEPTION, WHICH WAS THE LAST ISSUE THAT HELD US UP FOR A WHILE. THE DATA IN AND THE INFORMATION THAT HAVE BEEN PRESENT UNDERSTAND A MACRO LEVEL IN TERMS OF A HOSPITAL WITHIN A HOSPITAL, THE RENOVATION OF THAT FIFTH FLOOR, THAT DATA HAS BEEN OUT. THE CONCEPT OF A HOSPITAL WITHIN A HOSPITAL WAS A CONCEPT THAT WE WENT TO BECAUSE IN VISITING WITH THE COMMUNITY THEY INDICATED THAT IT WAS VERY IMPORTANT THAT THOSE SERVICES CONTINUE AT BRACKENRIDGE HOSPITAL. AS YOU RECALL, WE INITIALLY TOYED WITH THE IDEA OF HAVING PRIVATE SERVICES PROVIDED TO THAT GROUP OF INDIVIDUALS OFF SITE AT ANOTHER HOSPITAL OR ANOTHER FACILITY. WE WERE REQUESTED AT THAT POINT NOT TO DO THAT BECAUSE IT WAS VERY IMPORTANT THAT THIS SERVICE CONTINUE. AS YOU KNOW UNDER THE CURRENT AGREEMENT OR THE CURRENT PROTOCOLS AND PROCEDURES, WE HAVE OUR OWN EMPLOYEES TO INTERACT WITH PEOPLE THAT ARE NEEDING THOSE SERVICES WITHIN A HOSPITAL. AND I THINK WE'LL BE ABLE TO WORK THROUGH THE ISSUES THAT ARE OF CONCERN TO YOU AND THE COMMUNITY TO ENSURE THAT INFORMATION GETS PROVIDED IN A WAY THAT DOESN'T PRECLUDE OPTIONS OR PRECLUDE INFORMATION TO THE COMMUNITY THAT'S IMPORTANT FOR THEM TO HAVE. WE UNDERSTAND IT AND WE UNDERSTAND YOUR FRUSTRATION. OUR INTENT IS TO HAVE A COMPLETE AGREEMENT DONE AT THE TIME WE PRESENT THIS TO THE CITY COUNCIL AND NOT AN ITEM THAT WE'VE PUT ON FOR YOU TO ASK US TO NEGOTIATE NEXT, BUT HAVE A CONTRACT, WE'LL HAVE ALL THOSE QUESTIONS ANSWERED. WE CERTAINLY DON'T WANT TO RUSH INTO THIS. WE'LL PUT THAT ON THE AGENDA IF THE COUNCIL DECIDES ON THE 31ST THAT YOU NEED OTHER WEEK TO CONTINUE TO GO THROUGH THAT DOCUMENT AND ASK QUESTIONS AND HAVE THOSE QUESTIONS ANSWERED, WE CERTAINLY WILL DO WHATEVER THE COUNCIL NEEDS TO HAVE DONE TO MAKE SURE THAT WE HAVE COMPLETE AND TOTAL ACCESS TO THE INFORMATION AND MAKE SURE THAT YOU KNOW EXACTLY WHAT'S IN THAT DOCUMENT THAT YOU'RE APPROVING.

MAYOR GARCIA: WE PROBABLY NEED TO HAVE SOMETHING TO BE DISTRIBUTED TO THE PUBLIC WHEN WE HAVE OUR PUBLIC HEARING ON THE 17TH. AND MAKE IT AVAILABLE AS SOON AS POSSIBLE SO THAT PEOPLE CAN LOOK AT IT. AND LIKE THE CITY MANAGER SAYS, IF WE NEED TO EITHER KEEP THE PUBLIC HEARING OPEN FOR ONE MORE WEEK OR ACTUALLY WE DON'T HAVE A MEETING ON THE 24TH, SO IT WOULD BE THE 31ST. AND THEN MOVE THE DECISION TO FEBRUARY, WE CAN DO THAT. SO WE'RE GOING TO MAKE SURE THAT WE TIE DOWN AS MANY OF THE DETAILS THAT WE CAN. THERE ARE SOME THINGS THAT THERE'S NO WAY -- SOME SITUATIONS THAT COME UP THAT THERE'S NO WAY FOR US TO WRITE PROTOCOL FOR. SO WE WOULD EXPECT GOOD JUDGMENT ON THE PART OF THE PEOPLE IS EXERCISED SO THAT THE FUNDAMENTAL PRINCIPLES RESPECTING THE DIGNITY OF THE WOMEN THAT SHOW UP THERE IS RESPECTED.

I GUESS I WOULD LIKE TO ADD ONE CLARIFYING POINT. THE LAJ THAT WE'RE DRAFTING........ DRAFTING -- THE LANGUAGE THAT WE'RE DRAFTING FOR THE LEASE AEMENTD, IT WILL NOT INCLUDE DETAILED PROTOCOLS IS KIND OF THE TERM WE'RE USING TODAY. IT WILL DETAIL THE PARAMETERS UNDER WHICH THOSE PROTOCOLS WILL BE DEVELOPED AND THEN THE PROTOCOLS WILL BE DEVELOPED AS WE IMPLEMENT THE HOSPITAL, BUT WE WILL PROVIDE HOW INFORMATION WILL BE PROVIDED, BUT IT MAY NOT NECESSARILY SAY WHICH STAFF WILL DO IT BECAUSE WE DON'T KNOW WHICH STAFF TODAY.

MAYOR GARCIA: NOT IN THE CONTRACT, IT WILL BE IN THE PROTOCOL MANUAL, I GUESS.

YES.

MAYOR GARCIA: FURTHER QUESTIONS FOR MS. YOUNG OR ANYBODY ELSE? COUNCILMEMBER GRIFFITH?

GRIFFITH: YES. WE HAVE AN ADVISORY GROUP, A COUNCIL THAT ADVISES US ON BRACKENRIDGE OPERATIONS. THAT GROUP WORKED VERY DILIGENTLY ON THE RECOMMENDATIONS TO US. AND I'D LIKE TO SEE WHICH OF THOSE RECOMMENDATIONS ARE GOING TO BE IN THE CONTRACT AND WHICH ONES ARE NOT AND WOULD LIKE TO SEE AS MANY OF THOSE RECOMMENDATIONS AS POSSIBLE IN THE CONTRACT. AND IF NOT, WHY NOT? BECAUSE THEY WORKED REALLY HARD AND THEY'RE VERY PROFESSIONAL AND VERY WELL QUALIFIED FOLKS AND HAD A STRONG UNANIMOUS RECOMMENDATION FOR IT. SO LET'S LOOK AT THOSE CAREFULLY IN TERMS OF HOW MUCH OF THAT CAN GO IN. AND I'D LIKE TO SEE WHY ANY OF THOSE RECOMMENDATIONS DON'T GO, IF ANY OF THEM DON'T.

MAYOR GARCIA: FURTHER QUESTIONS, COMMENTS? MS. YOUNG, MR. STEEFBS, MS. DUNKERLEY, SALLY, THANK YOU VERY MUCH. I ALSO WANT TO RECOGNIZE REPRESENTATIVE ANN KITCHEN. THANK YOU SO MUCH FOR BEING HERE. THE REPRESENTATIVE HAD WORKED DILIGENTLY ON ISSUES OF THIS KIND. WE ALSO HAVE THE PLANNED PARENTHOOD I GUESS PARENT OR CHAIRPERSON, PEGGY RUMBURG. THANK YOU FOR BEING HERE. AND WE ALSO HAVE THE SETON HOSPITAL CEO, CHARLES BARNETT HERE. SIR, THANK YOU SO MUCH FOR BEING HERE. AND THANK ALL OF YOU FOR WORKING WITH A VERY DIFFICULT ISSUE IN A WAY THAT MAKES A LOT OF SENSE. SO WE'LL BE WORKING WITH YOU OVER THE NEXT FEW WEEKS. LET ME ANNOUNCE, COUNCILMEMBERS, ALSO THAT IF YOU WANT AN ITEM ON THE WORK SESSION, I'D LIKE FOR YOU TO ANNOUNCE IT THE WEEK BEFORE SO THAT WE CAN PUT IT ON THE AGENDA. AND DO IT JUST LIKE WE DO THE OTHER -- THE OTHER ANNOUNCEMENTS. I THINK WE'RE GOING TO HAVE A WORK SESSION ITEM LATER ON ON AIR QUALITY. AND AND THAT WILL NOT BE AT THE NEXT MEETING, BUT SOMETIME EARLY IN THE SPRING. OKAY. ANYBODY WANT TO ANNOUNCE THAT THEY'RE GOING TO HAVE ANY -- ANY ITEMS FOR THE NEXT WORK SESSION? OKAY. THINK ABOUT IT AND TALK TO THE AGENDA PERSON. THE LAST ITEM ON THE WORK SESSION AGENDA IS AN OVERVIEW OF THE CITY AUDITOR'S 2001 ACCOMPLISHMENTS. AND IT LOOKS -- THE DOCUMENT LOOKS LIKE THIS FOR THOSE OF YOU WHO ARE INTERESTED IN IT. I THINK YOU HAVE SOME IN THE BACK.

WE'VE GOT SOME IN THE BACK.

MAYOR GARCIA: OKAY. WELCOME STEVE MORGAN, CITY AUDITOR AND HIS ASSISTANTS, WHO WILL MAKE THE PRESENTATION.

GOOD MORNING MAYOR, MAYOR PRO TEM AND COUNCILMEMBERS. I'M STEVE MORGAN, CITY AUDITOR. AND TODAY WE'RE GOING TO PRESENT THE AUDIT OFFICE'S ACCOMPLISHMENTS FOR FISCAL YEAR 2001.

MAYOR GARCIA: STEVE, IF VISITORS THAT ARE HAVING CONVERSATIONS IN THE ROOM COULD TAKE THEM TO -- OUTSIDE THE ROOM, WE'D APPRECIATE IT. THERE'S ENOUGH ROOM OUT IN THE HALLWAY AND THAT WILL ALLOW US TO CONTINUE THIS WORK SESSION.

THANK YOU, MAYOR. WE DID PRESENT THIS REPORT LAST MONTH TO THE AUDIT COMMITTEE, HOWEVER, WE'RE HONORED TODAY TO PRESENT THE REPORT TO THE ENTIRE COUNCIL. AND AS CITY AUDITOR I'M VERY PROUD OF MY OFFICE'S ACCOMPLISHMENTS DURING MY FIRST YEAR AS CITY AUDITOR. AND I'M ALSO -- I WANT TO THANK THE ENTIRE COUNCIL FOR THE BUDGETARY AND POLICY SUPPORT THAT YOU GAVE TO THE AUDIT OFFICE DURING MY FIRST YEAR AS AUDITOR. AND ALSO FOR THE MESSAGE THAT HONEST, ACCOUNTABLE, ETHICAL AND EFFECTIVE GOVERNMENT ARE THE FOUR CORNERSTONES OF THE SERVICES THAT THE CITY DELIVERS TO ITS CITIZENS. I ALSO WANT TO RECOGNIZE THE MEMBERS OF MY STAFF WHO SUPPORTED THIS MESSAGE AND MADE THE REALITY OF THESE ACCOMPLISHMENTS HAPPEN. COLLEEN WEARING, DEPUTY CITY AUDITOR AND ALSO ACE SENT CITY AUDITOR'S PAGE GRAVES, TAYLOR DUDLEY, JACK SIMMONS AND CN DOUGHERTY. I ALSO ACKNOWLEDGE THE MANY CONTRIBUTIONS OF OUR STAFF WHO EITHER MET OR COMPETE KPEEDED THE EXPECTATIONS OF THE ASSISTANT CITY AUDITORS. FOR EXAMPLE, BRIAN WILLIAMS, WHO IS ACTUALLY HERE TODAY, HEADS UP OUR INVESTIGATIONS UNIT AND MADE SOME MAJOR CONTRIBUTIONS TO THE REPORT THAT YOU'RE ABOUT TO HEAR. FINALLY I'D LIKE TO ACKNOWLEDGE JOAN ULE TO MY LEFT WHO IS GOING TO HELP PRESENT THE REPORT AND MIKE ELDER. AND THEY REALLY ARE RESPONSIBLE FOR CREATING THE HIGH QUALITY REPORT THAT YOU'VE GOT IN FRONT OF YOU. NOW, OUR MISSION, THE CITY AUDITOR'S MISSION IS TO MAKE -- HELP MAKE CITY GOVERNMENT BETTER AND MORE ACCOUNTABLE. TODAY'S REPORT LEAVES NO DOUBT THAT IN FISCAL YEAR 2001, WE MADE THIS MISSION STATEMENT A REALITY. TO CARRY OUT OUR MISSION, WE PLAYED THREE ROLES. OUR MOST IMPORTANT ROLE IS TO ESTABLISH ACCOUNTABILITY FOR MEETING COUNCIL AND CITIZEN EXPECTATIONS. TO DO THIS WE PLAY A SECOND ROLE TO PROVIDE INFORMATION TO SUPPORT MAYOR AND COUNCIL DECISION MAKING AND TO BE A FORCE FOR POSITIVE CHANGES IN CITY POLICIES, PROGRAMS AND ASSISTANCE. TO CARRY OUT THESE ROLES, WE DELIVER FOUR SERVICES, AUDITS WHERE WE PRIMARILY CONDUCT PERFORMANCE AUDITS TO ENSURE CITIZENS GET THE RESULTS THEY'RE PAYING FOR. INVESTIGATIONS WHERE WE DETER, DETECT AND INVESTIGATE FRAUD, WASTE AND ABUSE AND WHERE WE SEND A MESSAGE THAT -- TO ALL OF US IN PUBLIC SERVICE THAT HIGH INTEGRITY IS EXPECTED. WE ALSO PROVIDE QUICK RESPONSE WHERE WE GET THE RIGHT ANSWERS TO YOUR QUESTIONS JUST IN TIME AND ASSISTANCE WHICH SUPPORTS OUR EFFORT NOT ONLY TO EVALUATE PAST PERFORMANCE, BUT ANTICIPATE FUTURE RISK TO THE CITY AND STAY ACTIVELY ENGAGED TO HELP MITIGATE THE RISKS AND HELP THE CITY IMPLEMENT THE BEST PRACTICES. ON TO THE KEY RESULTS REGARDING OVERALL COUNCIL SATISFACTION WITH OUR WORK, WHILE I'M VERY PLEASED THAT THE PERFORMANCE MEASURES THAT YOU SEE UP THERE DEMONSTRATE THAT WE MET OR EXCEEDED THE COUNCIL'S EXPECTATIONS, WE STILL HAVE ROOM TO IMPROVE AND WE'RE DEDICATED TO THE CONCEPT OF CONTINUOUS IMPROVEMENT. IN ADDITION TO REBUILDING THE AUDITOR'S OFFICE, DURING MY FIRST YEAR AS CITY OUGHTER I WORKED VERY HARD TO IMPROVE COMMUNICATION WITH THE COUNCIL. SPECIFICALLY IN 2001 WE INVOLVED MAYOR AND COUNCILMEMBERS DURING CRITICAL STAGES OF MAJOR PROJECTS. FOR EXAMPLE, WE REVIEWED AUDIT OBJECTIVES WITH COUNCILMEMBERS BEFORE LAUNCHING INTO FIELD WORK. WE ALSO STRENGTHENED PROACTIVE COMMUNICATION ON SENSITIVE AUDITS AND INVESTIGATION ISSUES TO HELP PREVENT SURPRISES. WE SOLICITED COUNCIL INPUT ON ANNUAL SERVICE PLANNING, FOR EXAMPLE, IN OCTOBER AND NOVEMBER WE GOT INPUT FROM ALL -- FROM THE MAYOR AND ALL OF THE COUNCILMEMBERS ON OUR 2002 SERVICE PLAN. WE FACILITATED ROUTINE REPORTING OF DEPARTMENT ACTION PLANS. AND THIS IS A WAY WHERE ONCE A MAJOR AUDIT IS PRESENTED WE ASKED THE DEPARTMENT TO COME BACK TO THE COUNCIL AUDIT COMMITTEE WITH AN ACTION PLAN THAT SAYS WHAT PROGRESS THEY'VE MADE ON IMPLEMENTING THE RECOMMENDATIONS. AND FINALLY WE IMPROVED AVAILABILITY OF OCA STAFF THROUGH QUICK RESPONSE AND ASSISTANCE. SO WHAT WE'RE GOING TO DO NOW IS JOAN IS GOING TO PRESENT THE HIGHLIGHTS FOR EACH OF OUR FOUR DIRECT SERVICES AND ALSO COMMENT ON SOME OF OUR INTERNAL EFFORTS TO IMPROVE THE AUDIT OFFICE. JOAN?

THANK YOU. I'M JOAN ULE. AND I'M GOING TO TAKE YOU THROUGH THE PERFORMANCE RESULT FOR EACH OF OUR ACTIVITIES AND THEN ALSO SOME HIGHLIGHTS AND TALK ABOUT OUR INTERNAL CAPACITY AND PROFESSIONAL DEVELOPMENT AND LEADERSHIP CONTRIBUTIONS. OUR AUDIT SERVICES ARE -- OUR FOUR MAIN LARGEST SERVICE AND OUR KEY INDICATORS THERE COMES FROM THE RESULT OF PERCENTAGE OF RECOMMENDATIONS REPORTED IMPLEMENTED OVER AN AVERAGE OF THREE YEARS. OUR TARGET FOR THAT WAS 75%, AND THE ACTUAL RESULT WAS 92%. AND WE REALLY DO ACKNOWLEDGE CREDIT TO MANAGEMENT FOR MAKING THOSE IMPROVEMENTS AND THE SHARED OUTCOME BETWEEN OCA AND MANAGEMENT. IN TERMS OF OUTPUT, WE PRODUCED 13 AUDIT REPORTS COMPARED TO A TARGET OF 12. JUST TO GO OVER SOME OF THE HIGHLIGHTS, WE'VE HAD A -- IF YOU'VE HAD A CHANCE TO LOOK THROUGH THE REPORT, PAGE 2 HAS A LOT OF THE SAME DETAIL I'M GOING TO GO OVER. EACH OF OUR PROJECTS IN THE AUDIT ACTIVITIES HAS SOME SIGNIFICANT RESULTS THAT WE THINK ARE IMPORTANT. AND AS STEVE SAID, MANAGEMENT HAS COME BACK FROM EACH OF THESE PROJECTS AND PRESENTED ACTUAL PLANS TO ADDRESS THE NEEDED IMPROVEMENTS. IN THE AREA OF ENVIRONMENTAL HEALTH SERVICES, WHAT WE FOUND THERE WAS A NEED TO STRENGTHEN THE TRAINING AND THE MEASUREMENT OF PERFORMANCE OF THE RESTAURANT INSPECTORS AND ALSO TO STAEN A FEE STRUCTURE TO FULLY FUND THE FUNCTION AND TO REALLY INCREASE INCENTIVES FOR VOLUNTARY COMPLIANCE WITH REGULATIONS. IN FLEET MAINTENANCE AND REPAIR, WE SAW THERE THE NEED FOR IMPROVED SERVICE DELIVERY LEVELS IN A NUMBER OF AREAS, INCLUDING PREVENTIVE MAINTENANCE. AND AS WE NOTED IN THE AUDIT, IT HAS AN IMPACT ON AIR QUALITY. AND THE FOURTH ISSUE, WE FOUND THE NEED TO REDUCE TIME TO THE FACILITIES TO TRACK THE COSTS ASSOCIATED WITH HIRING NEW HIRES AND SET GOALS FOR REDUCING TURNOVER IN THE HIRES. EMPLOYEE SAFETY WAS OUR LARGEST PROJECT. WE HAD FOUR AUDIT REPORTS COME OUT OF THAT. WE LOOKED AT THE CORPORATE SAFETY EFFORT OVERALL AND THEY THEN WE DID DETAIL TESTING IN THREE DEPARTMENTS THAT HAD HIGH JORK INJURIES AND HIGH COSTS ASSOCIATED WITH THE INJURIES. THOSE DEPARTMENTS WERE EMS, PARKS AND SOLID WASTE SERVICES. AND WE FOUND THERE WAS A NEED TO STRENGTHEN THE ACCOUNTABILITY OF THE MANAGEMENT FOR THE SAFETY RESULTS AND ALSO TO IMPROVE INCENTIVES TO EMPLOYEES TO WORK SAFELY, FOLLOW PROCEDURES AND JUST IN GENERAL A STRONGER OVERSIGHT OF THE SAFETY EFFORT WITHIN THOSE DEPARTMENTS AND THE CITY AS A WHOLE. FINALLY IN OUR FOLLOW-UP ACTIVITY, IN ADDITION TO OUR SIX MONTHS REPORTING OF THE REPORTED STATUS OF IMPLEMENTATION OF RECOMMENDATIONS, WE ALSO DID FIELD WORK TEST WORK VERIFICATIONS THAT THE INTENT OF THE RECOMMENDATIONS HAD BEEN MET. AND WE DID THAT FOR THE CUSTOMER FOR THE UTILITY BILLING, STREET CUT AUDITS AND THE STRATEGY AUDIT. AND WE FOUND FOR THE MOST PART THE RECOMMENDATIONS HAD BEEN ACHIEVED. THE INTENT HAD BEEN MET, EXCEPT FOR MORE IMPROVEMENT NEEDED IN THE TRANSPORTATION STRATEGY. THAT'S IT FOR OUR AUDIT PURPOSES. MOVING ON TO INVESTIGATIONS. AGAIN, THIS IS OUR SERVICE TO STRENGTHEN THE ENVIRONMENT BY INVESTIGATING THE ALLEGATIONS OF FRAUD, WASTE AND ABUSE. AND OUR KEY RESULT THERE IS A PERCENTAGE OF CASES WOULD GET ACCOUNTABILITY ACTION. AND WE ESSENTIALLY ACHIEVED OUR TARGET THERE OF 60% OF THE CASES THAT WERE COMPLETED. WE ALSO HAD A DOLLAR IMPACT OF $850,000 AGAINST A TARGET OF 260,000. WE KPL EXCEEDED THAT TARGET. THAT TARGET IS REALLY AN ESTIMATE OVER TIME. AND THE ACTUAL RESULT WILL DEPEND ON THE NATURE OF THE CASES THAT ARE RECEIVED AND ALSO THE RESULT OF LITIGATION AND OTHER ACTION. SOME OF THE HIGHLIGHTS THAT WE HAVE 63 CASES OF INVESTIGATIONS COMPLETION, 17 CASES OF ASSISTANCE TO OTHER AGENCIES SUCH AS THE DISTRICT ATTORNEY. OTHER OUTCOMES FROM THIS ACTIVITY INCLUDE NOT ONLY THE DOLLAR RECOVERIES, BUT ALSO EVIDENCE THAT SUPPORTS THE PERSONNEL ACTION, IMPROVED CONTROLS TO MITIGATE FUTURE VIOLATIONS AND RISK OF FUTURE VIOLATIONS AND BETTER INFORMATION AND REPORTING FACILITIES. AND ALSO IN THIS ACTIVITY WE ESTABLISHED A MANAGEMENT AND INTEGRITY COMMITTEE THIS PAST YEAR DURING 2001 WHERE THE HUMAN RESOURCES DEPARTMENT, POLICE AND LAW ARE ALL WORKING TOGETHER WITH OCA STRENGTHENING THE COMMUNICATION ABOUT INVESTIGATIONS, BUT IT'S ALSO ESTABLISHING A MORE EFFECTIVE CORPORATE APPROACH TO CONDUCTING INVESTIGATIONS.

WYNN: MAYOR? I'M SORRY, WHAT DO YOU MEAN BY ACCOUNTABILITY ACTION?

ACCOUNTABILITY ACTION COULD INCLUDE PERSONNEL ACTION FOR A TERMINATION WHERE WRONGDOING IS FOUND. AN ACTUAL PROSECUTION, MAYBE SOME ACTION TO PREVENT -- .

IT'S REALLY TRYING TO GET AT THE RESULTS, THE RESULTS THAT OCCUR FROM INVESTIGATIONS. THERE'S A LOT OF DIFFERENT RESULTS. AND THOSE RESULTS MAY BE FURTHER DOWNSTREAM THAN THE ACTUAL INVESTIGATION. LIKE, FOR EXAMPLE, IF WE GO INTO LITIGATION SUPPORT, WE MAY NOT GET THE RESULT UNTIL TWO YEARS AFTER THE INVESTIGATION IS OVER WITH. BUT IT VARIES ACROSS THE BOARD. AND WE DO SUPPORT, FOR EXAMPLE, PERSONNEL ACTIONS LIKE, FOR EXAMPLE, DISMISSALS BECAUSE AN EMPLOYEE HAS DONE SOMETHING THAT IS AN INTEGRITY VIOLATION.

MOVING ON TO OUR QUICK RESPONSE SERVICE. THIS IS WHERE WE -- THE QUICK INDEPENDENT INFORMATION IF IT'S NEEDED. AND OUR KEY RESULT INDICATOR THERE IS CUSTOMER SATISFACTION AND QUALITY OF THE RESPONSE THAT WE GIVE. AND AGAINST -- ON A SCALE OF ONE TO FOUR, OR RESULT WAS 3.8, COMPARED TO A TARGET OF 3.0. AND OUR OUTPUT IN THIS ACTIVITY WERE LESS THAN ANTICIPATED. WE HAD EIGHT ACTUAL RESPONSES DURING THE 2001 AND WE EXPECTED TO PROVIDE 20. ONE OF THOSE EIGHT WHICH WAS PRIOR YEAR REQUESTS AND THE REST WERE FROM THE SEVEN REQUESTS FROM SR 2001, AND WE COULD NOT GET THE REQUESTS DONE. SOME OF THE HIGHLIGHTS IN THE RESPONSES AND THE REQUESTS FROM EACH ONE THAT WERE PROVIDED ARE WE QOUNTFIDE THE O. O. QUANTIFIED THE HEALTH COSTS WITH THE AIR QUALITY IN AUSTIN AND THIS REINFORCES THE NEED FOR THE PREVENTIVE MAINTENANCE FOR THE CITY'S FLEET. WE SUMMARIZED OF THE GENERAL FUND FOR THE PAST FIVE YEARS AND TOOK INTO ACCOUNT REORGANIZATION AND RESTRUCTURING THAT HAVE OCCURRED IN THE CITY'S DEPARTMENTS. IN THE AIR CULTURAL ARTS CONTRACT, WE LOOKED AT THE FUNDING ALLOCATION PROCESS AND FOUND THAT IT WAS ESSENTIALLY UNCHANGED, ALTHOUGH IT WAS BETTER DOCUMENTED AS DETERMINED BY THE ART COMMISSION. FOR AUSTIN ENERGY BAD DEBT, WE FOUND THERE THAT THE UTILITY HAD EXCEEDED ITS BAD DEBT ESTIMATES FOR PRIOR YEARS OF FY '98 TO FY 2000 AND HAD NOT ISSUED CUTOFF NOTICES FOR 14 MONTHS DUE TO BILLING PROBLEMS AND EXTREME WEATHER CONDITIONS. FOR THE SKIP 2 ANDERSON MILL HOUSING PROJECT, WE ESTABLISHED DELAYS THERE IN AFFORDABLE HOUSING AND ALSO THE CURRENT PROJECT PHASES AND SCHEDULED EFFECTIVE WITH THE ORIGINAL PROJECT PLANS. THEN ON THE YOU WILL RICK WATER LINE REPAIR, WE REVIEWED THE CONTROL FOR FUTURE WATER LINE BREAKS. MOVING ON TO ASSISTANCE, THIS IS OUR PROACTIVE SERVICE OF HELPING DEPARTMENTS ANTICIPATE -- .

MAYOR GARCIA: LET ME ASK ONE QUESTION. ON SCIPI II, FOLLOWING THE RESPONSE THAT YOU GAVE, I THINK ITS CITY THEN STIEDED TO TAKE OVER THAT PROJECT, CORRECT?

[INAUDIBLE].

MAYOR GARCIA: I THINK THE CITY IS -- .

YES, THE CITY IS -- WHAT WE'VE DONE IS TAKEN SEVERAL OF THEIR LINES AND WE'VE HAD TO DO A COUPLE OF THINGS TO A COUPLE OF THEM. SO WE'VE TAKEN THE LOTS AND BUILT HOUSE OZ THEM. AND I THINK WE'VE PRETTY MUCH HAD THEM -- .

I BELIEVE THAT'S CORRECT. PART OF THE COMPLEXITY OF IS, PART OF WHAT THE DOCUMENT IS INTENDED TO REPORT AND IT WILL BE DIFFICULT FOR ME TO DO HERE. I'LL DISCUSS IT. THERE WERE A NUMBER OF DIFFERENT FACES OF PROJECTS OVER A LARGE GEOGRAPHIC AREA AND WE HAD TO READJUST SOME OF THE AGREEMENTS AND ARRANGEMENTS AND IT BECAME VERY CONFUSING ABOUT WHO WAS GOING TO BE RESPONSIBLE FOR WHICH AREAS AROUND UNDER WHICH TIME LINE. SO WE SHOWED WHAT KIND OF THE RESET WAS AND WHAT WAS BEHIND PROJECTIONS AND WHAT WAS CURRENTLY BEING PROMISED. AND IT IS A VARIETY OF THINGS.

MAYOR GARCIA: BUT I THOUGHT SKIP TWO WAS A PRETTY WELL-DEFINED AREA.

IT IS ON THE FOUNDERS, BUT IT YOU LOOK AT IT, THERE'S A WHOLE LOT OF SEPARATE PROJECTS IN IT.

THERE'S NOT ANY CONTINUITY. THE BLOCKS ARE EVERYWHERE.

AND IT'S REALLY ABOUT A HALF DOZEN OF DIFFERENT EFFORTS WITHIN THERE. ORIGINALLY IT WAS ANDERSON MILL.

WANT TO COVER ASSISTANCE? CAN WE MOVE ON.

ANY MORE QUESTIONS?

I WOULD ONLY WANT TO MAKE A COMMENT BACK TO THE MAYOR AND COUNCIL ON THE ISSUE THAT COUNCILMEMBER WYNN RAISED. WITH RESPECT TO THE INVESTIGATION, THE DATA AND THE INFORMATION THEY USE TO KEEP THE INTEGRITY OF THE CHARTER THAT'S PROVIDED TO MANAGEMENT AND THE ACTIONS THAT ARE ULTIMATELY TAKEN IN THE DECISION OF MANAGEMENT AND THE AUDITORS IS SIMPLY USED AS A RESURS TO DETERMINE IN FACT WHAT THE APPROPRIATE ACTION MIGHT BE. THE COUNCIL CANNOT BE INVOLVED IN AN ISSUE OF PERSONNEL MATTERS. AND I'M ASSUMING THAT THE AUDITOR KEEPS THAT INFORMATION CONFIDENTIAL BECAUSE OTHERWISE IT COULD GET DIFFICULT WITH RESPECT TO THE CHARTER AND MIGHT RUN INTO SOME CONFLICTS.

WE DO. AND CERTAINLY ON AN INVESTIGATION WE'RE KEEPING THE INFORMATION CONFIDENTIAL. BUT WE ALSO SEE OUR ROLE AS BEYOND JUST INVESTIGATING. WE ALSO SEE A ROLE TO ASSIST MANAGEMENT WITH DETER RANTS AND ALSO DETECTION BECAUSE THERE NEEDS TO BE MORE THAN JUST WAITING TO SEE IF SOMEBODY GIVES YOU A CALL.

AND I WANT TO ALSO SAY THAT STEVE HAS DONE AN OUTSTANDING JOB ON THIS BECAUSE BEFORE WE WERE DISCONNECTED. AND MY OFFICE SELDOM KNEW WHAT WAS GOING ON AND HOW THE REQUEST HAD BEEN MADE AND WHO HAD MADE THE REQUESTS. AND THIS INTEGRITY COMMITTEE ESTABLISHED WHAT TOBY, A REPRESENTATIVE IN MY OFFICE, HAS KEPT US INFORMED OF WHAT THOSE THE ISSUES ARE AND WHAT THE SPECIFIC REQUESTED THING IS. AND I APPRECIATE STEVE'S COOPERATION.

I'D LIKE TO ADD ONE THING. NOT TO PAT EVERYBODY ON THE BACK HERE, BUT THIS IS AN OPPORTUNITY. JUST RECENTLY WE'VE REALLY STARTED WORKING MORE WITH THE POLICE DEPARTMENT BECAUSE THEY REORGANIZED OVER THERE AND THE OFFICERS INVOLVED UNIT IS NOW HANDLING ALSO ANY INVESTIGATION THAT INVOLVES A CITY EMPLOYEE. SO IT'S KIND OF LIKE NOW WE HAVE A TEAM APPROACH, WHICH IS RECOMMENDED BY THE ASSOCIATION OF CERTIFIED PRODUCT EXAMINERS. SO WHAT WE MOVED TO IS KIND OF AN INDIVIDUAL, EVERYBODY DOING DIFFERENT THINGS, TO A TEAM APPROACH. AND I THINK THE CITY MANAGER AND I SIGNED THAT AGREEMENT NO MORE THAN A YEAR AGO, BUT IT'S TAKEN AWHILE, BUT IT'S REALLY PAYING OFF.

I CAN'T BELIEVE THE ASSOCIATION OF [INAUDIBLE]. [LAUGHTER].

IT'S RIGHT HERE IN AUSTIN, TOO.

MOVING ON TO ASSISTANCE. ARE YOU READY?

YES.

OKAY. AGAIN. THAT'S OUR PROACTIVE SERVICE FOR HELPING DEPARTMENTS I AM POLICEMEN THOSE FACTORS. AND -- IMPLEMENT THOSE FACTORS. AND THE VARIOUS DEPARTMENT AND OUR KEY RESULT THERE IS THE CUSTOMER SATISFACTION AND THE RESULTS THAT WERE ACHIEVED FROM THOSE PROJECTS. AND WE HAVE AN OUTSTANDING RESULT THERE OF 4.ON A SCALE OF ONE TO FOUR. REFLATLY EXCEEDED OUR TARGET OF OUTPUT WITH 16 COMPARED TO 15 TARGETED. AND SOME OF THE HIGHLIGHTS INCLUDE OUR BUSINESS PLAN REVIEW WHERE WE PARTNERED WITH THE BUDGET OFFICE AND WE MET WITH THE EXECUTIVE MANAGEMENT OF EACH CITY DEPARTMENT, WENT THROUGH THEIR PRIOR YEAR RESULTS AND REASSIGNED THEIR RESERVICES AND STRENGTH OF SERVICE DELIVERY. IN OUR AVIATION DEPARTMENT, WE HELPED THEM ESTABLISH AN INTERNAL AUDIT FUNCTION AND DO A RISK ASSESSMENT OF THEIR REVENUE SERVICES AND AS WELL AS OPERATION AREAS AND FROM THAT DEVELOPED A SERVICE PLAN SO THEY CAN DO MORE TO MANAGE THEIR OWN RISK INTERNALLY. WE ALSO HELPED THEM WITH A PARKING PROCEDURES MANUAL AND EVALUATING THE PARKING CONTROL FOLLOWING UP ON THE FY 2000 PARKING MANAGEMENT THAT WE HAD DONE OVER THERE. [ONE MOMENT, PLEASE, WHILE CAPTIONERS CHANGE] TEST TEST TEST THIS IS A TEST,

OUR OFFICE IS RECOGNIZED IN GOVERNMENT AUDITING AS ONE OF THE PREMIER AUDITING OFFICES IN THE GOVERNMENT. THIS IS THE CASE BECAUSE OF PARS PAIGHTS IN THE PROFESSION, CONTRIBUTING TO PROFESSIONAL ORGANIZATIONS. WE HOLD POSITIONS IN PROFESSIONAL AUDITING ORGANIZATIONS SUCH AS THE INSTITUTE OF INTERNAL AUDITOR, THE ASSOCIATION OF GOVERNMENTAL ACCOUNTANTS, NATIONAL ASSOCIATION OF BLACK ACCOUNTANTS AND OTHERS. WE ALSO SERVE AS SPEAKERS AND MODERATORS AND TRAINERS AT VARIES CONFERENCES AND -- VARIOUS CONFERENCES AND TRAINING, FOR EXAMPLE IN THE AREA OF PERFORMANCE MEASURE, WE CONTRIBUTE TO PROFESSIONAL PUBLICATIONS. SO ALL OF THESE THINGS HELP US CONTRIBUTE TO THE PROFESSION, HELP OUR PROFESSION CONTRIBUTE BACK TO US BY KEEPING US UP ON BEST PRACTICES AND HELPING US SERVE THE CITY. FINALLY, WE STRENGTHEN OUR OFFICE CREDENTIALS BY OBTAINING FIVE CERTIFICATIONS. THOSE WERE THREE CERTIFIED GOVERNMENT AUDITING PROFESSIONALS, ONE CERTIFIED FRAUD EXAMINER AND ONE CERTIFIED INFORMATION SYSTEMS AUDITOR CERTIFICATION. SO THAT SUMMARIZES OUR ACCOMPLISHMENTS FOR FY2001. STEVE SAID WE ARE PROUD OF THIS YEAR. THE ACCOMPLISHMENTS THAT WE HAD. AND WE DO STRIVE TO CONTINUOUSLY IMPROVE. SO IF YOU HAVE ANY QUESTIONS, WE WOULD BE GLAD TO TAKE THEM.

QUESTIONS?

ONE THING, JOHNNY, ON THE BACK -- JOAN, ON THE BACK OF THE REPORT IS A LIST OF ALL OF OUR PROJECTS, IT ALSO HAS ON WEBSITE AND HOTLINE, JUST KIND OF A HANDY LIST.

MAYOR GARCIA: MAYOR PRO TEM?

GOODMAN:, WELL, I DIDN'T HAVE ANY QUESTIONS. I WAS GOING TO SAY THAT I ALSO THINK THE AUDITOR'S OFFICE HAS DONE A FINE JOB. REMEMBER BEING BANG TO OUR COMMITTEE MEETING WHERE THE QUICK RESPONSE SERVICES WERE MORE AVAILABLE THAN COUNCILMEMBERS THOUGHT, I JUST WANT TO REMIND US ALL THAT WE WERE WAY DOWN ON WHAT THEY WERE PREPARED TO RECEIVE AND WORK ON. SO WE -- WE OWE THEM SOME. [ LAUGHTER ].

ALSO, I THINK WE HAVE 12 BUDGETED FOR THIS YEAR, TARGET FOR THIS YEAR. SO YOU CAN INCREASE THE NUMBER OF REQUESTS THAT YOU MAKE.

MAYOR GARCIA: LET ME SAY THAT DURING THE -- MY TDY, TEMPORARY DUTY THAT I HAD ELSEWHERE, BEFORE I CAME BACK TO COUNCIL, WHEN I CAME BACK, I NOTICED VERY DISTINCT IMPROVEMENT. I WANT TO COMMEND ALL OF YOU. JUST WANT TO MAKE ONE COMMENT, THAT IS THAT THE DISCUSSIONS THAT WE'VE HAD ABOUT THE REPORTS SHOWING THE FINDINGS SO THAT THE COUNCIL CAN SAY, YOU KNOW, THIS FIND -- THESENGS -- THESE FINDINGS COME FROM THE CITY AUDITOR, WORK WITH THE CITY MANAGER IN SEEING HOW THOSE FINDINGS ARE PUT INTO ACTION, SO TO SPEAK. SO, AGAIN, THE REQUEST IS -- I WOULD LIKE TO HAVE THEM HIGHLIGHTED SO THAT COUNCILMEMBERS WHO DON'T HAVE A LOT OF TIME TO READ A LOT OF THE REPORTS THAT COME TO US CAN FIND THEM AND IDENTIFY QUICKLY WHAT THOSE FINDINGS ARE.

WE WILL ALSO BULLET THOSE OUT IN THE COUNCIL'S SUMMARY. FOR THE REPORTS.

MAYOR GARCIA: THANK YOU, THANK YOU SO VERY MUCH FOR THE REPORT. AND GOOD LUCK WITH 2002 EFFORTS.

THANK YOU FOR THE OPPORTUNITY TODAY. WE REALLY APPRECIATE IT.

THANK YOU.

MAYOR GARCIA: COUNCIL, THAT'S ALL OF THE ITEMS THAT WE HAVE IN THIS WORK SESSION. I WILL ENTERTAIN A MOTION TO ADJOURN. MOTION BY COUNCILMEMBER GRIFFITH, SECONDED BY COUNCILMEMBER WYNN. ALL THOSE IN FAVOR SIGNIFY BY SAYING AYE.

AYE.

MOTION CARRIES, WE ARE ADJOURNED.

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