Closed Caption Log, Council Worksession
Wednesday, January 30, 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.

TO DO THE BRIEFINGS AND THEN WE WILL GO BACK TO EXECUTIVE SESSION TO DISCUSS ITEM NUMBER 2, WHICH IS TO DISCUSS THE SEPARATION AND TRANSITION OF THE CITY MANAGER AND THE APPOINTMENT AND EMPLOYMENT OF AN ACTING CITY MANAGER. WE ARE GOING INTO EXECUTIVE SESSION. WE SHOULD BE BACK BY ABOUT 10:30. THAT'S WHAT THEY TELL ME. AND WE WILL BRING BACK ALL THE HIP HOPPERS THAT PARTICIPATED IN MONDAY NIGHT -- MONDAY NIGHT.

MAYOR GARCIA: WE'RE BACK. WE HAVE CONCLUDED THE EXECUTIVE SESSION PART THAT DEALS WITH THE PRIVATE CONSULTATION WITH OUR ATTORNEY. AND NO DECISIONS WERE MADE. SO WE WILL NOW GO TO THE BRIEFINGS. AND WE BASICALLY WILL HAVE -- 3 AND 4 WILL PROBABLY BE DISCUSSED TOGETHER BECAUSE THEY ARE RELATED. SO 3 IS A BRIEFING OF THE PROPOSED AMENDMENT TO THE BRACKENRIDGE HOSPITAL LEASE RECORDING REPRODUCTIVE ACTIVE HEALTH SERVICES. AND FOUR IS A BRIEFING ON THE HOSPITAL DISTRICTS AND I SUSPECT THAT THAT BRIEFING COULD INCLUDE HEALTH CARE FINANCING DRIGTS. I DON'T THINK -- THOSE ARE OPTIONS THAT ARE AVAILABLE FOR PURPOSES OF PUBLIC FINANCING OF SERVICES OF THIS KIND. SO LET ME TURN IT OVER TO WHOEVER WANTS TO PICK UP THE BALL. CITY MANAGER?

THANK YOU. MY NAME IS BETTIE DUNKERLEY AND I'M AN ASSISTANT CITY MANAGER WITH THE CITY OF AUSTIN. IN THIS SECTION WE REALLY WANT TO COVER ABOUT THREE OR FOUR DIFFERENT POINTS. ONE, WE'D LIKE TO HAVE THE ASSISTANT STIRN JUST RECAP VERY BRIEFLY SOME OF THE LEGAL QUESTIONS THAT WERE ASKED LAST WEEK. SECONDLY, WE WOULD LIKE TO HIGHLIGHT THE QUESTIONS AND ANSWERS THAT WERE PRESENTED LAST WEEK.

MAYOR GARCIA: ACTUALLY, IT WAS TWO WEEKS AGO.

YOU'RE RIGHT. AND WHEN WE GET TO THE ONE ON THE HOSPITAL DISTRICT, WE WOULD LIKE TO HAVE OUR OUTSIDE ATTORNEY GO OVER IN MORE DETAIL ALL OF THE VARIOUS OPTIONS THAT ARE AVAILABLE CURRENTLY UNDER STATE LAW AND COULD BE MADE AVAILABLE TO US FOR FINANCING OUR HEALTH NEEDS FOR THIS COMMUNITY AND THE SURROUNDING AREAS. AND FINALLY WE WOULD LIKE TO GO OVER THE LEASE LANGUAGE CHANGES THAT HAVE OCCURRED IN THE LAST TWO WEEKS. WE DID MEET WITH THE APPLICANT AND WE WOULD LIKE TO HAVE THAT THE LAST ITEM TO BE DISCUSSED. SO I'D LIKE TO TURN IT OVER TO SALLY HENRY.

SEVERAL LEGAL ISSUES WERE RAISED IN THE PUBLIC HEARING TWO WEEKS AGO. ONE WAS WHETHER WE HAVE AN APPROPRIATE SEPARATION OF CHURCH AND STATE.

MAYOR GARCIA: CAN EVERYBODY HEAR BACK THERE? CAN WE GET MORE VOLUME ON THAT MIC, PLEASE? WHOEVER IS CONTROLLING THE VOLUME. IF YOU COULD GET CLOSER TO THE MIC.

SHOUT OUT SHAM. [LAUGHTER].

MAYOR GARCIA: HE CAN DO THAT BECAUSE HE'S RETIRED. [LAUGHTER].

TWO LEGAL ISSUES WERE RAISED AT THE PUBLIC HEARING. ONE WAS THE -- DO WE HAVE AN APPROPRIATE SEPARATION OF CHURCH AND STATE WITH THE LEASE AMENDMENT. THE SECOND WAS IS THERE A VIOLATION OF THE SEPARATE BY EQUAL PROHIBITION UNDER CIVIL RIGHTS. WE HAVE LOOKED AT BOTH OF THOSE ISSUES IN REVIEWING THE LEASE AND SOME THINGS THAT HAVE BEEN APPLIED BY THE COURTS AND OUR OPINION IS THERE IS NOT A LEGAL PROBLEM WITH EITHER OF THOSE PARTICULAR TWO ISSUES. THAT THE CURRENT ARRANGEMENT AS WELL AS THE LEASE AMENDMENT WILL NOT VIOLATE THE CHURCH AND STATE SEPARATION REQUIREMENTS AND ADDITIONALLY THAT IT WILL NOT VIOLATE THE EQUAL PROTECTION RIGHTS OF WOMEN IN THE DELIVERY AND REPRODUCTIVE SERVICES.

MAYOR GARCIA: OKAY. COUNCILMEMBERS, YOU RECEIVED ADVICE ON THOSE ISSUES, BUT YOU MAY HAVE QUESTIONS AND I'LL RECOGNIZE ANYONE WHO DOES AT THIS TIME. ANYBODY? LET ME EXPLAIN ONE QUICK THING.

GRIFFITH: I DON'T WANT TO BREAK THE RULES HERE.

MAYOR GARCIA: WE'RE IN OPEN SESSION. WE DON'T BREAK THE RULES. WE HAVE THIS ITEM FOR ACTION TOMORROW, AND ONE OF THE THINGS THAT THE COUNCIL IS ASKING REQUESTING IS THAT WE GET ANOTHER OPINION FROM ANOTHER ATTORNEY WITH REGARD TO THOSE TWO ISSUES. SO THAT WILL BE DONE AND THAT WOULD BE AVAILABLE AT A LATER DATE. THE OPTION THAT THE COUNCIL HAS IS TO ACT ON THE ITEM TOMORROW, AND I THINK THERE WILL BE SOME AMENDMENTS THAT WILL BE MADE TO THE RESOLUTION THAT'S ON THE AGENDA. FS APPROPRIATE. AND ALSO -- THAT'S APPROPRIATE. AND ALSO THE APPROVAL OF THE EXECUTION OF THIS CONTRACT CAN BE MADE CONTINGENT ON RECEIVING THOSE LEGAL OPINIONS. AND I THINK THAT THAT'S SOMETHING THAT WE NEED TO HAVE YOU FULLY UNDERSTAND WHAT IT IS THAT THE COUNCIL IS DOING. THE OTHER OPTION IS THAT WE WAIT ONE WEEK UNTIL WE RECEIVE THE LETTERS FROM THE ATTORNEYS THAT CLARIFY CLEARLY WHAT YOU ARE SAYING, AND THAT IS THAT WE ARE NOT VIOLATING THE SEPARATE, BUT EQUAL PROVISION. AND THAT WE ARE NOT VIOLATING THE SEPARATION OF CHUCHB AND STATE. AND IF THERE'S ANYTHING DIFFERENT, YOU CAN CORRECT ME ON THAT. IT'S BEEN A TOUGH MORNING THIS MORNING ALREADY. CITY ATTORNEY, IF WE CAN GET THOSE OPINIONS ... ANY OTHER QUESTIONS? YOU HAD A QUESTION OR A COMMENT, COUNCILMEMBER?

GRIFFITH: YES. MS. JEFFERSON, WHEN IS THE APPROPRIATE TIME TO TALK ABOUT IN TERMS OF THE HUMAN CONCERNS? IS THIS AN APPROPRIATE TIME OR IS THERE ANOTHER TIME?

IT'S BEEN SCHEDULED FOR -- [INAUDIBLE]. AND THE ISSUE FOR THE BRACKENRIDGE HOSPITAL LEASE ARE PRETTY WIDE OPEN AT THIS POINT.

GRIFFITH: OKAY. SO PERHAPS AFTER THE BRIEFING?

I'LL LEAVE IT TO THE PRESIDING OFFICER.

MAYOR GARCIA: IT IS APPROPRIATE AT THIS TIME TO ASK WHATEVER QUESTIONS THAT YOU HAVE WITH REGARD TO THE LEASE REGARDING REPRODUCTIVE HEALTH SERVICES. SO FINANCIAL, LEGAL, WHATEVER. YOU CAN ASK QUESTIONS AT THIS TIME.

GRIFFITH: WILL THOSE THINGS BE ADDRESSED IN THE BRIEFING OR NOT? THE HUMAN AND THE FINANCIAL QUESTIONS?

WELL, I THINK THE BRIEFING IS GOING TO BE COMPRISED PRIMARILY OF QUESTIONS THAT WE RECEIVED FROM YOU, THE COUNCIL AND THE PUBLIC. AND MANY OF THOSE I DO THINK TOUCH ON IT. WE MIGHT WANT TO GO THROUGH THERE. AND IF YOU FIND SOMETHING THAT TOUCHES ON ON IT, THAT MIGHT BE -- .

MAYOR GARCIA: LET ME HANDLE IT THIS WAY. WHY DON'T YOU LAY OUT YOUR QUESTIONS AND THAT WAY THE STAFF CAN RESPOND TO THOSE QUESTIONS SO THEY CAN BE SPECIFIC AS OPPOSED TO HAVING STAFF GO THROUGH THINGS THAT MAY HAVE ALREADY BEEN SETTLED IN THE MINDS OF THE COUNCILMEMBERS.

GRIFFITH: MAYOR, THANK YOU. THAT'S A GREAT APPROACH. MY QUESTION AND MY CONCERNS ARE LEGAL, AND THOSE HAVE BEEN LAID OUT. IN HUMAN, THE HUMAN CONCERNS FOR ME ARE THAT I HAVE TOURED THE AREA OF BRACKENRIDGE WHERE REPRODUCTIVE SERVICES -- WHERE PEOPLE HAVE BABIES WITH TWO OBSTETRICIANS ON TWO DIFFERENT OCCASIONS. DIDN'T WANT TO APPEAR ONE TIME. GOT TWO TOURS WITH TWO SEPARATE OBJECT STRE TRITIONS AND HAVE COUNSELED WITH A THIRD ONE THAT PRACTICES AT BRACK. AND THE THIRD ONE IS IN COMPLETE AGREEMENT WITH THE FIRST TWO IN TERMS OF THREE QUESTIONS, WHAT'S BEST -- NOT OKAY, NOT PASSABLE, NOT -- ON PROCEDURES THAT ARE RISKY. AND MY QUESTION IS IF WE MAKE A CHANGE, I WANT SOMETHING BETTER IN TERMS OF THE HEALTH AND SAFETY OF THE MOMS AND THE BABIES. I MEAN, I HAVE RUN ACROSS OR HAVE BEEN IN CONVERSATION WITH AND CONTACTED AND THEN CONTACTED BY NO HEALTH PROIFLS, CERTAINLY NO PEOPLE WHO DELIVER BABIES WHO THINK THAT WHAT'S BEING PROPOSED IS GOING TO BE BETTER FOR THE MOMS OR THE BABIES OR THE STAFF MEMBERS. SO THAT'S WHY I'M NOT GOING TO BE READY TO STEP THE PROPOSAL AS PRESENTED NOW TOMORROW BECAUSE OF THOSE HEALTH CONCERNS THAT HAVE BEEN BROUGHT TO ME BY PEOPLE THAT DELIVER BABIES AND TAKE CARE OF MOTHERS. SO THAT'S ONE THING I'D LIKE TO HEAR MORE ABOUT. I DON'T KNOW HOW MANY OF YOU HAVE TOURED THE AREA OR LOOKED AT IT. WHAT THE OBSTETRICIANS THAT I'VE TALKED WITH SAY IS IT IS A BEAUTIFULLY LAID OUT FACILITY. THE LABOR AND DELIVERY ROOMS AND WHERE MOST OF THE TIME WHEN AN UNCOMPLICATED PREGNANCY, THERE IS NO PROBLEMS AND EVERYTHING GOES NATURALLY AND WELL. WHEN IT MATTERS NOT TO BE STRUNG OUT ALL OVER THE BUILDING IS WHEN SOMETHING GOES WRONG. AND FOR YOU, THE MOM OR THE BABY. AND THE WAY IT'S LAID OUT NOW, THE NEONATAL INTENSIVE CARE UNIT IS ABOUT 12 STEPS FROM WHERE THE BABY IS ACTUALLY BORN. AND IF A BABY IS BORN CHOKING AND TURNING BLUE, THEY ARE JUST MINUTES, IF NOT SECONDS AWAY FROM EXPERT TECHNICAL HEALTH. THE SAME THING WITH THE MOM. IF THE MOM GETS IN TROUBLE UNEXPECTEDLY, THE OPERATING ROOM WHERE THE LIGHTS ARE ON AND THE AN TEASEOLOGIST IS STANDING THERE AND EVERYTHING IS READY TO GO AND IT'S ABOUT 90 STEPS AWAY. SO I DON'T KNOW IF WHAT'S PROPOSED IS GOING TO BE BETTER FOR THE MOMS AND THE BABIES. ALSO IN TERM OF THE TAXPAYERS. I'M WONDERING IF THERE'S NOT SOME WASTE IN WHAT'S BEING PROPOSED. SO I'M NOT SURE WE'RE GOING TO BE READY TODAY IN TERMS OF THIS BEING VOTED ON TOMORROW. AND IN TERMS OF THE -- [INAUDIBLE]. WHEN THIS FIRST CAME UP, I TALKED WITH MEMBERS MEMBERS -- [INAUDIBLE]. WHO HAVE HAD PROBLEMS. THEY THOUGHT THEY WERE UNDER THE CONTRACT ENTITLED. SO I ASKED THE AUDITOR IF THEIR DEPARTMENT WOULD TAKE A LOOK AT THIS AND SEE IF THERE WERE ANY UNRESOLVED ISSUES THAT WE NEEDED TO LOOK AT BEFORE WE VOTED. AND HERE'S THE RESPONSE. THERE ARE A NUMBER OF UNRESOLVED ISSUES THAT PREVENT US FROM -- UPON THE VIABILITY OF THE PROEMD AMENDMENT. BULLET NUMBER 1, IS THE COMMUNITY BOARD HAVE THE RIGHT TO ASK FOR THE FINANCIAL AND/OR OPERATING DATA RELATED TO THE PROPOSED CHANGES AND THE LEVEL OF SERVICE AND ACCESS? DID THIS HAPPEN? AND I PRESENTED DID THIS HAPPEN. [INAUDIBLE]. SECOND BULLET, DOESN'T THE CURRENT LEASE CALL FOR THE CITY TO ACT TO CHANGE SERVICES ONLY AFTER THE COMMUNITY BOARD HAD THE OPPORTUNITY TO REVIEW THE PROPOSED SERVICE CHANGES AND THE FINANCIAL IMPACT UPON THE CITY AND SETON IF THIS PASSES. NEXT BULLET, SHOULD THE COMMUNITY BOARD BE INCLUDED IN THE PROPOSED AMENDMENT IF THERE ARE TO BE ANY CHANGE IN THE OVERSIGHT ROLE OF THE BOARD? NEXT, IF SO, WHO WILL BE THE OVERSIGHT WATCHDOG FOR BRACKENRIDGE? NEXT BULLET, ASSUMING MANY OF THE EXPENSES THAT FORM THE BASIS FOR THE CITY'S POLICY, OPERATING ROOM POLICY, WILL ACTUALLY BE SHARED OR ALLOCATED BASED UPON DATA PROVIDED BY SETON, HOW WILL THIS DATA BE VERIFIED? NEXT, IS THE LANGUAGE NEEDED TO ADDRESS THE CONFIDENTIALITY OF SETON -- HEAR NEXT, IS THE AUDIT CLAUSE TO ENSURE THE CITY'S RIGHT TO AUDIT SETON'S BOOKS AND RECORDS PERTAINING TO THE LEASE AGREEMENT. WELL, WHAT MIGHT THAT BE LIKE? HERE IS A -- A POSSIBLE -- [INAUDIBLE]. THAT WOULD HELP IN THAT DEPARTMENT. THE OFFICE OF THE CITY AUDITOR SHALL HAVE THE RIGHT TO ACCESS, EXAMINE, ANALYZE AND VERIFY ALL OF SETON'S RECORDS, ACCOUNTS AND DATA PERTINENT TO THE EXECUTION OF THIS LEASE AGREEMENT AMENDMENT AND RECORDS, ACCOUNTS AND DATA MAINTAINED BY OUTSIDE CONTRACTORS HIRED BY SETON FOR BRACKENRIDGE HOSPITAL. I FEEL LIKE THIS IS -- [INAUDIBLE]. AND WHATEVER TIME WE NEED TO TAKE TO LEARN MORE ABOUT HOW IT'S GOING TO WORK AND THAT IT'S BEST FOR THE MOMS AND THE BABIES. THAT'S THE BOTTOM LINE.

I WOULD LIKE TO RESPOND TO SOME OF THOSE. WHILE THE REST OF OUR GROUP IS GETTING THEIR THOUGHTS TOGETHER. AND I THINK THE FIRST ONE IS WE TRIED TO CLARIFY MANY TIMES IS THAT THE NEW HOSPITAL WILL HAVE A SEPARATE BOARD. AND THAT BOARD WILL BE APPOINTED BY THE COUNCIL. SO AT THAT TIME AT THAT APPOINTMENT -- AND IT ALSO YOUR DECISION WHETHER YOU WANT THAT HOSPITAL AND THAT BOARD UNDER THE SAME OVERSIGHT BOARDS THAT OVERLOOKS THE BRACKENRIDGE OPERATION. SO AGAIN, THAT'S AT OUR DISCRETION AND THAT WOULD BE A SEPARATE ITEM AND NOT SOMETHING THAT WOULD BE IN THE LEASE BECAUSE THE LEASE PERTAINS TO OUR RELATIONSHIP WITH SETON, AND THIS ISSUE IS GOING TO BE THE COUNCIL'S PREROGATIVE TO APPOINT THE BOARD AND TO DECIDE WHETHER TO BE THE SAME OVERSIGHT COMMITTEE OR A DIFFERENT OVERSIGHT COMMITTEE. SO THAT WOULD BE YOUR ACTION THERE. WE HAVE TAKEN THIS PROPOSAL TO THE OVERSIGHT COMMITTEE ON SEVERAL OCCASIONS, SO I THINK THAT THAT WAS COVERED. AS FAR AS THE BUDGET IS CONCERNED FOR THE HOSPITAL, THERE ARE SOME ALLOCATED COSTS IN THE AREA OF UTILITIES, IN THE AREA OF HOUSEKEEPING AND THINGS LIKE THAT, AND THOSE COSTS ARE GOING TO BE NEGOTIATED WITH SETON. YOU CAN'T COME TO AN -- IF WE CAN'T COME TO AN AGREEMENT, WE'LL GET AN ARBITRATOR. AS FAR AS THE UTILITY COSTS, I THINK WE'LL HAVE A WAY TO AUDIT THAT WITH THE UTILITIES. AND ANY OTHER COSTS OR IS SERVICES THAT WE'RE BUYING FROM THEM, PERHAPS THE X-RAY, LAB, SOMETHING LIKE THAT, WE'RE PERFECTLY FREE TO PRICE AND BUY FROM SOMEBODY ELSE. SO I THINK WE HAVE A FAIRLY GOOD COVERAGE THERE. NOW, THE CONFIDENTIALITY ISSUE THAT'S BEING BROUGHT UP, I WOULD ASK YOU TO RESPOND TO THAT.

UNDER THE CURRENT LEASE THERE ARE PARTICULAR THINGS REGARDING THE FINANCIAL NCHLS. AND OVERSIGHT COUNCIL HAS THE ABILITY TO REQUEST FINANCIAL INFORMATION RELATED TO THOSE AREAS THAT THEY OVERSEE. [INAUDIBLE]. SHOULD WE WESH TO RENEGOTIATE THAT KIND OF ARRANGEMENT BUT IT IS SET OUT IN THE CURRENT LEASE AS TO WHAT IS THE RIGHTS OF THE CITY UNDER THE LEASE. SO WE WOULD HAVE TO LOOK AT THAT.

MAYOR GARCIA: THAT'S NOT PART OF THIS DISCUSSION. THAT WOULD BE ANOTHER PART OF THE CONTRACT?

WELL, IT WOULD BE PART OF THE LEASE, BUT NOT PARTICULARLY RELATED TO REPRODUCTIVE SERVICES.

MAYOR GARCIA: THAT'S RIGHT. SO THAT WOULD REQUIRE THAT WE GO INTO FURTHER DISCUSSIONS WITH SETON AND THEN BRING IT TO US THE AMENDMENTS TO ANOTHER PART OF THE AGREEMENT?

YES.

MAYOR GARCIA: OKAY. THE FIRST PART OF THE QUESTION THAT COUNCILMEMBER GRIFFITH ASKED PERTAINS TO SOMETHING ELSE OTHER THAN FINANCIAL. AND I DON'T KNOW IF YOU CAN ANSWER THAT.

WITH REGARDS TO THE ISSUES REGARDING I GUESS I'LL CALL IT THE SEPARATION OF SERVICE, RIGHT NOW COMPREHENSIVE OBSTETRICAL SERVICES ARE PROVIDED ON THE SECOND FLOOR AND OTHER FLOORS OF BRACKENRIDGE. IN ORDER, THE SERVICES ARE PROVIDED IN MORE THAN ONE PARTICULAR AREA IN BRACKENRIDGE. IT IS CONTEMPLATED THAT THE HOSPITAL ON THE FIFTH FLOOR WOULD PROVIDE FULL OBSTETRICAL SERVICES THAT ARE CURRENTLY PROVIDED ON THE SEC FLOOR. SO THERE'S NO DIFFERENCE IN THE SERVICE PROVIDED OTHER THAN THE ABILITY TO PERFORM STERILIZATION PROCEDURES ON THE FIFTH FLOOR. IT'S THE SAME DOCTORS WHO DELIVER IN BOTH LOCATIONS. IT'S DIFFERENT NURSING STAFF, OF COURSE, BECAUSE THEY'RE EMPLOYED BY SETON. THE ISSUE REGARDING THE CLOSENESS OF LABOR AND DELIVERY TO THE NICU AS IT CURRENTLY EXISTS AT BRACKENRIDGE, IT IS A WONDERFUL THING, BUT I'D LIKE TO POINT OUT THAT THE NICU IS A REGIONAL NICU. THERE ARE BABIES THAT ARE TRANSPORTED FROM OTHER HOSPITALS AND OTHER REGIONS OF CENTRAL TEXAS THAT COME TO THAT HOSPITAL. THEY'RE DEALT WITH AS TO WHERE THEY ARE BORN, THEY'RE STABILIZED, TRANSFERRED TO THAT UNIT. THE FACT -- I'D ALSO LIKE TO POINT OUT THAT AT ONE POINT IN TIME THIS COMMUNITY HAD RENAISSANCE HOSPITAL, WHICH BASICALLY WAS A STAND ALONE BIRTHING CENTER. AGAIN, IF SOMETHING WENT WRONG WITH THE CHILD AND THERE WERE COMPLICATIONS, THAT CHILD WAS TRANSPORTED TO BRACKENRIDGE HOSPITAL. I THINK THE FACT THAT WE'RE ON THE FIFTH FLOOR AND ONLY AN ELEVATOR AWAY, IS IN OUR FAVOR.

AND NICU IS.

NEONATAL INTENSIVE CARE UNIT. [ONE MOMENT, PLEASE, WHILE CAPTIONERS CHANGE]

GRIFFITH:... TO ENSURE COMPAREABILITY IN CARE AND QUALITY SERVICES [INAUDIBLE]. WE SEEM TO HAVE THE [INAUDIBLE] ORGANIZATIONS THAT ARE MOST AND THE UNANIMOUS OVERSIGHT.

SLUSHER: I KNOW AT THE HEARING LAST WEEK THE STAFF WENT OVER THE OVERSIGHT RECOMMENDATIONS OF WHAT'S BEEN INCORPORATED INTO THE AGREEMENT. COULD WE AS BRIEFLY AS POSSIBLE DO THAT AT THE END?

YES. THAT'S ACTUALLY [INAUDIBLE].

SLUSHER: WE'VE WORKED UP TO THAT.

GARZA: BEFORE YOU BEGIN, I WANT TO THANK THE MAYOR AND COUNCIL. WHEN THIS DISCUSSION FIRST STARTED, WE ACTUALLY TALKED ABOUT IT, ALTERNATIVES OF INSURANCE PROVIDERS. [AUDIO DIFFICULTIES] BLACK

GARZA: WHEN WE BEGAN TO TALK ABOUT THAT, WHAT WE WERE TOLD WAS THE PREFERENCE WAS THE FORMER IDENTITY WITH BRACKENRIDGE HOSPITAL, THOSE SERVICES [INAUDIBLE] IT WAS AT THAT POINT WE GAVE UP ON TRYING TO NEGOTIATE ON EITHER THE [INAUDIBLE]. WE BEGAN TO LOOT AT THE FUTURE [INAUDIBLE]. SO WE DID EXPLORE ALTERNATIVES AND OPTIONS. IN FACT, WE DISCUSSED THOSE. BUT IT WAS BECAUSE [INAUDIBLE] [AUDIO DIFFICULTIES]NO CARRIERRINGCONNECT 1200c

MAYOR GARCIA: TOMORROW, ITEM NO. 33 IS THE ACTION ITEM. WE DON'T HAVE AN ITEM FOR EXECUTIVE SESSION WITH REGARD TO BRACKENRIDGE. THERE CAN BE SOME MORE QUESTIONS I GUESS... [AUDIO DIFFICULTIES].

WE WERE TALKING ABOUT WHY THE HOSPITAL [INAUDIBLE] I ALSO WANTED TO POINT OUT THE LEASE DOES NOT IN ANY WAY REQUIRE THAT OUR PATIENTS UTILIZE THE FIFTH FLOOR. WHAT IS KEY TO MAKING AN EXCELLENT HOSPITAL IS THE [INAUDIBLE] AND THE PEOPLE WHO WORK THERE AND WHO RELY HEAVILY ON THE DOCTORS WHO ARE DELIVERING PATIENTS THERE TO HELP US DEVELOP OUR PROPERTY CALLS AND OUR PRACTICES AND ENSURE THAT QUALITY CARE IS PROVIDED. 514 ASKS WHY THE HOSPITAL WOULD HAVE A SEPARATE ELEVATOR ENTRANCE. SEPARATE ELEVATOR EXTERNAL, I WANT TO EMPHASIZE WE'RE PROPOSING A SEPARATE ENTRANCE THAT ALLOWS PATIENTS AND VISITORS DIRECT ACCESS TO THE CITY HOSPITAL WITHOUT HAVING TO GO THROUGH BRACK HODGE. WHAT WE'RE TRYING TO MINIMIZE IS LESSENING CONFUSION. A PERSON GETS IN AN INTERIOR ELEVATOR, GETS OFF ON THE WRONG FLOOR, HAS TO GET BACK ON, AN ELEVATOR PROVIDES DIRECT ACCESS. TRANSPORTATION OF PATIENTS BETWEEN FACILITIES IS NOT GOING TO BE DONE VIA THE EXTERNAL ELEVATOR. THAT IS DOES VIA THE INTERNAL ELEVATOR. THE EXTERNAL ELEVATOR IS FOR EXTERNAL ACCESS TO THE FACILITY. 5 15SHTION IF THE CITY HOSPITAL IS NOT SUBJECT TO CATHOLIC RELIGIOUS INSTRUCTIONS, WHY WON'T ABORTIONS BE HELD THERE? I THINK EVERYBODY IS [INAUDIBLE] THOSE TYPICALLY ARE NOT PERFORMED ON A IN-PATIENT SETTING, THE MOST COSTLY SETTING FOR THAT. IT WAS A CONDITION TO THE LEASE IN 1995, THE CITY AGREED SETON WOULD NOT BE REQUIRED TO PERFORM OR PERMIT THE PERFORMANCE OF ABORTIONS AT THE HOSPITAL. SETON CANNOT PREVENT THE CITY FROM CHOOSE TO GO PROVIDE ABORGTSDZ AT THE NEW HOSPITAL AS A LEGAL MATTER, BUT SETON WOULD THEN BE [INAUDIBLE] TO THE NEW HOSPITAL. THE CITY HAS CHOSEN NOT TO PROVIDE ABORTIONS AT THE NEW HOSPITAL, TO CONTINUE ARRANGEMENTS THAT ARE IN PLACE TODAY.

MAYOR GARCIA: SO WE PROVIDE THOSE SERVICES EVEN WHEN WE RAN THE HOSPITAL, RIGHT?

NO, WE DID NOT.

THERE HAS BEEN -- THE CITY HAS MADE ARRANGEMENTS FOR CHARITY CARE FISHTS RECEIVE MELLY NECESSARY ABORTIONS AT OTHER FACILITIES, AND THOSE ARRANGEMENTS HAVE BEEN IN PLACE AND THEY WILL CONTINUE. THE CITY WILL CONTINUE TO PROVIDE THAT SERVICE. THERE HAS BEEN SOME QUESTION REGARDING ECTOPIC PREGNANCIES AND WE WANTED TO CLARIFY THAT. CATHOLIC HOSPITALS MAY INDUCE [INAUDIBLE] TO PROVIDE TREESMT AN ECTOPIC PREGNANCY TO SAY THE LIFE OF A MOTHER EVEN THOUGH AN UNDESIRED AND UNAFFORDABLE RESULT OF TREATMENT WAS THE TERMINATION OF THE PREGNANCY. THAT HAPPENS IN CATHOLIC HOSPITALS AND IT CAN OCCUR AT [INAUDIBLE] HOSPITALS AS WELL. 516 ADDRESSES THE ROLE OF THE PATIENT ASSISTANCE ORGANIZATION COUNSELOR AND THE TREATMENT [INAUDIBLE] TO PREVENT EMERGENCY ROOM. THERE HAS BEEN SOME FAIRLY SIGNIFICANT CONFUSION ABOUT WHAT THE ROLE OF THE COUNSELOR IS AND HOW INFORMATION IS PROVIDED TO PATIENTS. I WANT TO POINT OUT THAT CURRENTLY THE MAJORITY OF VICTIMS WHO HAVE EXPERIENCED RAPE OR SEXUAL ASSAULTS ARE TAKEN DIRECTLY TO ST. DAVID'S HOSPITAL. ST. DAVID'S HOSPITAL HAS THAT SAME PROGRAM -- [INAUDIBLE] EXAMINER, AND IT IS A COMMUNITY STANDARD THAT [INAUDIBLE] HAVE THAT PROGRAM AND THE MAJORITY OF VICTIMS GO THERE. THE VICTIM DOES PRESENT TO THE EMERGENCY ROOM AT BRACKENRIDGE HOSPITAL, SHE IS INFORMED THAT THE ST. DAVID'S PROGRAM IS [INAUDIBLE] SHE SHOULD CHOOSE TO HAVE HER CARE THERE, THEY COULD TRANSPORT HER. IF SHE CHOOSES TO STAY AT BRACKENRIDGE TO RECEIVE TREATMENT, SHE DOES SO AND EMERGENCY CONTRACEPTION TODAY IS OFFERED TO HER. WE WOULD CONTINUE THE SAME PRACTICE WHEN THE FIFTH FLOOR IS IN PLACE. A WOK SHOULD SHE COME TO BRACK WOULD STILL BE INFORMED THAT ST. DAVID'S PROGRAM DOES EXIST AND SHOULD SHE CHOOSE AVAILABLE SERVICES SHE WOULD BE TRANSPORTED. IF SHE CHOOSES TO STAY AT BRACKENRIDGE, SHE AGAIN WILL BE INFORMED THAT EMERGENCY CONTRACEPTION SERVICES, PREGNANCY PREVENTION SERVICES, ARE NOT PROVIDED BY SETON THAT ARE PROVIDED BY THE CITY. IF SHE REQUIRES MEDICAL TREATMENT, SHE WILL RECEIVE IT. AND IF SHE NEEDS OR WANTS EMERGENCY CONTRACEPTIVE SERVICES THAT RAPE OR SEXUAL ASSAULT VICTIM WILL RECEIVE THEM ON THE FIFTH FLOOR. THE PATIENT ASSISTANCE COUNSELOR IS A PROVISION -- WE ASK THAT A PROVISION BE PUT IN THAT NOT ONLY IS CURRENTLY THE PATIENT IS INFORMED, CURRENTLY IF SOMEONE COMES TO BRACKENRIDGE AND THEY HAVE BEEN RAPED OR SEXUALLY ASSAULTED, THEY ARE INFORMED THAT A PATIENT'S ORGANIZATION IS AVAILABLE TO [INAUDIBLE] TO PROVIDE SUPPORT. WHAT WE HAVE ASKED IS THAT A PROACTIVE STEP BE TAKEN, THAT IN ADDITION TO THE BEING INFORMED OF THAT, THAT THE PATIENT -- THAT THE ORGANIZATION ITSELF BE INFORMED THAT A PATIENT IS THERE IN THE EMERGENCY DEPARTMENT AND MAY REQUIRE THE SERVICES. THE ROLE OF THAT PATIENT ASSISTANCE COUNSELOR IS NOT TO PROVIDE MEDICAL INFORMATION OR MEDICAL TREATMENT. IT IS TO SUPPORT THE VICTIM THROUGH HER EXPERIENCE. AND THAT GOES IN THE EMERGENCY ROOM AS WELL AS POST EMERGENCY ROOM TREATMENT AS SHE HANDLES THE EFFECTS OF HER ASSAULT. IF A PATIENT DOES REQUIRE ANY TYPE OF TRANSPORT ASSISTANCE TO GET TO THE FIFTH FLOOR, WE WILL ARRANGE FOR THAT AND THAT ASSISTANCE WILL OCCUR. THE CITY HOSPITAL WILL BE NOTIFIED OF A PATIENT'S ARRIVAL IF WE EXPECT THAT A PATIENT WILL BE COMING THERE.

MAYOR GARCIA: COUNCILMEMBER WYNN.

WYNN: REGARDING THE PROGRAM THAT IS ESTABLISHED AT ST. DAVID'S, I GUESS A BIG PIECE OF THAT IS HOPEFULLY FOR LAW ENFORCEMENT PROSECUTION, I GUESS.

FORENSICS AND --.

WYNN: IF FOR WHATEVER REASON A WOMAN DECIDES NOT TO BE TRANSPORTED TO ST. DAVID'S AND THEN IS TREATED AT BRACK, COMBINATION OF SECOND AND/OR FIFTH FLOOR, FROM A LAW ENFORCEMENT STANDPOINT, DOES THAT SOMEHOW COMPROMISE?

NO, IT STILL HAPPENS, THE FORENSIC ASPECTS OF COLLECTING SPECIMEN AND OTHER EVIDENCE COLLECTION STILL OCCURS AT BRACKENRIDGE. IT'S JUST THAT -- THE SAME NURSES ARE SPECIFICALLY TRAINED NOT ONLY IN FORENSICS, THIS FORENSIC ASPECT OF RAPE AND SEXUAL ASSAULT, BUT ALSO ARE SKILLED AND TRAINED AROUND COUNSELING VICTIMS. SO IT KIND OF ADDS ANOTHER DIMENSION. IT'S NOT COME PROMSD THE PROCESS IS FOLLOWED -- COMPROMISED.

MAYOR GARCIA: COUNCILMEMBER THOMAS.

THOMAS: ON THE SAME QUESTION AS TO BRACKENRIDGE, DO WE HAVE ANYTHING [INAUDIBLE] WHY IS IT THAT WE DON'T HAVE THE SAME THAT BRACKENRIDGE HAS. IT LOOKS LIKE THE LAW ENFORCEMENT [INAUDIBLE] A PERSON COME IN THAT IS SEXUALLY ASSAULTED, WILL YOU TELL THEM [INAUDIBLE] ST. DAVID'S. WHY IS THAT?

MY UNDERSTANDING OF THE HISTORY OF THIS IS I THINK IN THE VERY EARLY '90s, LIKE MAYBE 1992, IT WAS A COMMUNITY DECISION THAT ST. DAVID'S WOULD -- I BELIEVE IT CAME ACTUALLY FROM GRANT FUNDING AND ESTABLISHED THE SAME PROGRAM. AND THE ACTUAL TRAINING FOR THESE NURSES OCCURS THROUGH THE STATE OF TEXAS. AND IT'S NOT -- IT'S NOT JUST ANYBODY KIND OF SIGNS UP FOR IT AND IT OCCURS. THERE WAS A COMMUNITY DECISION, AND THERE IS -- I BELIEVE IT'S CALLED -- WHAT'S IT CALLED? SEXUAL ASSAULT TASK FORCE THAT EXISTS. IT'S A GROUP OF FOLKS THAT MEET MONTHLY. IT INCLUDES REPRESENTATIVES OF BRACKENRIDGE, ST. DAVID'S, I BELIEVE OTHER HOSPITALS IN THE COMMUNITY, AND THEY FOCUS ON THIS PARTICULAR ISSUE. BUT THE SAME PROGRAM ITSELF WAS ESTABLISHED AND HAS OPERATED AT ST. DAVID'S FROM ITS INCEPTION.

MAYOR GARCIA: THAT WAS NOT NECESSARILY A COMMUNITY DECISION. THAT WAS A HEALTH COMMUNITY DECISION.

I'M SORRY. THANK YOU. HEALTH COMMUNITY DECISION. MOVE TO GO 517, I BELIEVE THIS QUESTION WAS BROUGHT UP BY DR. BRAND AT THE JANUARY 17th MEETING. [INAUDIBLE] RECEIVE EMERGENCY CONTRACEPTION. HE SPECIFICALLY REFERENCED A CASE OF A VICTIM WHO HAD SEVERE INJURIES AND COULD NOT BE MOVED. EMERGENCY CONTRACEPTION IS EFFECTIVE WHEN IT'S ADMINISTERED WITHIN 72 HOURS OF ASSAULT. A RARE CIRCUMSTANCE COULD OCCUR THAT A WOMAN [INAUDIBLE] SUSTAINED INJURIES SHUCH THAT SHE COULD NOT BE MOVED FROM BRACKENRIDGE WITHIN -- I THINK IT'S PRIOR TO 72 HOURS. REALIZE ALSO THAT IN ORDER FOR A WOMAN TO RECEIVE EMERGENCY CONTRACEPTION, SHE HAS TO BE ABLE TO TAKE THE MEDICATION ORALLY. THAT CIRCUMSTANCE WOULD BASICALLY INCLUDE THAT SHE COULD IN FACT TAKE IT ORALLY. IF SHE CANNOT FOR SOME OTHER REASON BE MOVED TO THE FIFTH FLOOR, THERE IS A CHANCE THAT A WOMAN COULD NOT RECEIVE EMERGENCY MEDICATION TO PREVENT CONCEPTION BECAUSE IT COULD NOT BE DELIVERED BY BRACKENRIDGE EMPLOYEES.

MAYOR GARCIA: IT CANNOT BE DONE [INAUDIBLE].

I'M SORRY?

MAYOR GARCIA: THE MEDICATION CANNOT BE --

NO, IT'S AN ORAL MEDICATION.

TRISH, YOU MIGHT WANT TO RECOUNT THE NUMBER OF INSTANCES.

WE WENT -- WE LOOKED AT TWO YEARS' WORTH OF DATA AT BRACKENRIDGE, AND THERE WAS -- I CAN REMEMBER ONE SPECIFICALLY AND THERE POSSIBLY WERE TWO INSTANCES OF RAPE VICTIMS WHO WERE ACTUALLY HOSPITALIZED FOR OVERNIGHT OBSERVATIONS. IN THE TWO YEARS THAT WE LOOKED AT, THERE WERE NO RAPE VICTIMS THAT WERE NOT TREATED AND RELEASED AT THE TIME. IN OTHER WORDS, THERE WAS NO CIRCUMSTANCE IN THE LAST FEW YEARS WHERE SOMEONE HAD THE SAME INJURIES AND WAS HOSPITALIZED FOR THE 72-HOUR PERIOD. SO IT IS A RARE OCCURRENCE.

SLUSHER: MAYOR, I JUST WANT TO MAKE SURE THAT -- IT WOULD NOT BE BECAUSE THEY COULDN'T TAKE IT ORALLY, IT WOULD BE BECAUSE SETON, BY PHILOSOPHY, WOULD NOT ADMINISTER IT AND THEN THE WOMAN WOULDN'T BE THEORETICALLY IN THE SITUATION TO BE MOVED TO TO THE FIFTH FLOOR SO THEREFORE SHE WOULD NOT BE ABLE TO GET THE SERVICE.

YES.

MAYOR GARCIA: THEY CAN MOVE A PATIENT FROM ONE FLOOR TO THE OTHER. I THINK THE ANSWER THAT YOU GAVE WAS THAT THE WOMAN COULD NOT TAKE THE MEDICATION ORALLY.

WELL, WHAT I'M SAYING IS SHE COULD NOT TAKE THE MEDICATION ORALLY, THEN SHE COULD NOT BE MOVED FROM THE BRK RIDGE FACILITY. SHE COULD TAKE IT BUT COULD NOT BE MOVED I I GUESS IS WHAT I'M SAYING.

MAYOR GARCIA: BUT IF THEY ARE ON THE SECOND FLOOR OR ANOTHER FLOOR -- THEY ARE IN THE EMERGENCY ROOM, CAN THEY NOT BE MOVED TO THE FIFTH FLOOR IF THEY ARE ABLE TO TAKE THE MEDICATION AND HAVE THE MEDICATION --

IT'S AN ISSUE WHETHER THEY ARE MEDICALLY STABLE IN ORDER TO BE TRANSPORTED.

MAYOR GARCIA: BUT THE DECISION IS NOT WHETHER THEY CAN BE MOVED. THE DECISION IS WHETHER THEY CAN ACTUALLY TAKE THE MEDICATION. CORRECT?

SLUSHER: THAT THERE IS -- WHAT IT SEEMS LIKE HERE TLRX IS A POTENTIAL SITUATION WHERE A WOMAN COULD FAIL TO RECEIVE THE SERVICES BECAUSE OF THE ETIOLOGY OF THOSE THAT WOULD CONTRACT WITH THE OPERATING HOSPITAL.

IF SHE WAS NOT MELLY STABLE ENOUGH TO BE TRANSPORTED TO RECEIVE THOSE SERVICES, YES.

MAYOR GARCIA: NOT EVEN TO THE FIFTH FLOOR?

CORRECT.

MAYOR GARCIA: THERE'S SITUATIONS WHERE A PERSON COULD NOT BE MOVED AT ALL FROM ONE FLOOR TO THE OTHER?

IN THEORY, YES.

THAT IS IN THEORY. THAT'S WHY WE WENT BACK AND RESEARCHED THE LAST TWO YEARS TO SEE IF THERE WERE ANY REAL CASES WHERE A PATIENT WAS NOT EITHER DISCHARGED WITHIN 72 HOURS OR COULD NOT HAVE BEEN MOVED, AND WE DID NOT FIND ONE. SO I THINK IT IS REALLY VERY THEORETICAL.

MAYOR GARCIA: RIGHT. BUT THE REALITY IS THAT THE REASON THEY WOULD NOT MOVE HER TO THE FIFTH FLOOR IS BECAUSE SHE PROBABLY COULDN'T SWALLOW IT.

MORE THAN LIKELY. SHE COULD BE ON A VENTILATOR AND THAT WOULD PRECLUDE HER FROM BEING ABLE TO TAKE IT. MORE THAN LIKELY, YES, THAT WOULD BE --.

SLUSHER: UNDER THE [INAUDIBLE] THAT THEY LET A RAPE VICTIM LAY THERE AND NOT BE -- WOULD NOT GIVE THEM THE CONTRACEPTIVE, EMERGENCY CONTRACEPTIVE EVEN [INAUDIBLE] THAT'S THE REASON FOR -- [INAUDIBLE] AT LEAST THEORETICALLY, THAT A RAPE VICTIM WOULD NOT RECEIVE EMERGENCY CONTRACEPTIVE BECAUSE OF THE ETIOLOGY OF THE --.

MAYOR GARCIA: I DIDN'T THINK THAT SETON UNDER THIS ARRANGEMENT COULD PROHIBIT SOMEBODY FROM, LET'S SAY, THE RELATIVE OF THE WOMAN SAYS, YOU KNOW, I WANT HER TO TAKE THE CONTRACEPTIVE PILL, IF SHE COULD ACTUALLY AT A TIME, SETON DOESN'T HAVE ANY RIGHT TO KEEP THAT PERSON IN THEIR CUSTODY DURING THIS.

SLUSHER: WHAT THEY ARE SAYING IS [INAUDIBLE].

MAYOR GARCIA: THEY CANNOT BE MOVED, YES. IF THEY CANNOT BE MOVED, YES. BUT I THINK THAT -- THE WAY I UNDERSTAND IT IS THE CRITERIA IS NOT WHETHER THEY CAN BE MOVED, THE CRITERIA IS WHETHER THEY CAN ACTUALLY TAKE THE PILL BECAUSE THEY MAY NOT BE ABLE TO SWALLOW IT.

SLUSHER: WELL, BUT PROBABLY THAT WOULD PROBABLY MEAN THAT WE WOULDN'T GET INTO THE SITUATION [INAUDIBLE] BUT THERE HAS BEEN SITUATIONS WHERE THE -- [INAUDIBLE] WOULD REVENT A WOMAN OR NOT ALLOW HER TO HAVE EMERGENCY CONTRACEPTION WHEN SHE WANTED IT BECAUSE SHE COULDN'T BE PHYSICALLY MOVED TO THE OTHER FLOOR BECAUSE OF HER INJURIES.

COUNCILMEMBER, WE CAN EVEN NARROW THAT FIELD A LITTLE. WHILE SETON WOULD BE ALLOWED TO DO AN OFF YOU LOOKS TEST [INAUDIBLE] THAT WOULD MAKE THIS VERY FAR OUT THEORETICAL SITUATION EVEN SMALLER.

SLUSHER: YEAH, I WOULD LIKE TO ELIMINATE IT. AS I SAID BEFORE, WE'RE NOT IN THE [INAUDIBLE] HERE, BUT THIS REALLY DOES GET AT THE CORE OF THE PROBLEM WHAT HAS BEEN SET UP HERE WITH THE CHANGE [INAUDIBLE] CHANGE IN THE APPLICATION.

GOODMAN: MAYOR, CAN I FOLLOW UP? [INAUDIBLE] AND I THOUGHT IN IS STHAETIONS WE'VE BEEN HAVING [INAUDIBLE] THAT IT WAS ALWAYS [INAUDIBLE] A AGREEMENT BETWEEN PATIENTS AND DOCTORS [INAUDIBLE] SO IN THIS CASE, IF A PERSON HURTS SO BADLY THEY CAN'T SWALLOW [INAUDIBLE] BUT IF THEY CANNOT BE MOVED BECAUSE OF THEIR INJURIES [INAUDIBLE] I DON'T UNDERSTAND WHY SOMEONE FROM THE CITY, FROM THE [INAUDIBLE] OR THE DOCTORS COULDN'T MAKE SURE THAT THAT PATIENT HAS A CHOICE. SO WHY HAVE WE NOT FOUND A WAY FOR THAT TO HAPPEN? BECAUSE EVEN THOUGH IT IS [INAUDIBLE] IT'S NOT IMPOSSIBLE.

[INAUDIBLE] IF IT WOULD NOT BE APPROPRIATE FOR SOMEONE ELSE, A NON-SETON FACILITY, TO COME IN AND ADMINISTER MEDICATION TO A PATIENT [INAUDIBLE]. THEY HAVE NO AUTHORITY -- HAVE NO AUTHORITY TO ADMINISTER MEDICATION. THEY HAVE NO ABILITY TO WRITE IN THE MEDICAL RECORDS WHAT THEY'VE DONE, CHARTS, DOCUMENTS.

GOODMAN: AND THAT WAS THE RELATIONSHIP BETWEEN THE DOCTOR AND THE PATIENT. IS THAT NOT -- [INAUDIBLE].

IF THE DOCTOR CAME -- WE'LL TALK ABOUT THIS A LITTLE LATER ON. THE DOCTOR CANNOT PREVENT THE -- CANNOT PREVENT THE DOCTOR FROM ADVICING THE PATIENT THAT THEY COULD TAKE THIS MEDICATION. THE DOCTOR IS PREVENTED AS WELL BECAUSE THAT WOULD BE IN CONTRADICTION TO THE [INAUDIBLE]. THE DOCTORS CANNOT DO ANYTHING THAT IS PROHIBITED -- LIKE HE COULD NOT PERFORM A TOOBL LIGATION. HE COULD NOT ADMINISTER MEDICATION. THAT IS [INAUDIBLE].

GOODMAN: THAT IS VERY DIFFERENT [INAUDIBLE] THE RELATIONSHIP BETWEEN THE DOCTOR AND THE PATIENT IS SUPPOSED TO BE [INAUDIBLE] AND YOU ARE TELLING ME THAT IF A DOCTOR CHOOSES [INAUDIBLE] EMERGENCY CONTRACEPTION TO A PATIENT [INAUDIBLE] WITHIN SETON CONTROL [INAUDIBLE] THEN THAT IS -- AND THAT'S CONTRADICTORY TO WHAT -- [INAUDIBLE].

THE RELATIONSHIP OF THE PATIENT AND THE DOCTOR [INAUDIBLE].

I'M NOT SURE I REALLY CAN RESPOND EXCEPT THAT THE DISTINCTION IS WHAT WOULD BE A MEDICAL RECORD DOCUMENT, ACTION THAT WOULD TAKE PLACE ON THE HOSPITAL PREMISES. SO A DOCTOR AND A VISITOR AND MANY OTHER PEOPLE CAN HAVE ANY CONVERSATION AND GIVE THE PATIENT ANY KIND OF COUNSEL, BUT THE DOCTOR COULD NOT SAY I'M GOING TO GET AN OPERATING ROOM WITHIN SETON AND DO A TOOBL LIGATION AND THE DOCTOR COULD NOT ADMINISTER A CONTRACEPTIVE MEDICATION UNDER CONDITIONS THAT WERE AGAINST THE [INAUDIBLE] TO A PATIENT WHO WAS HOSPITALIZED IN THAT FACILITY. THAT IS THE GAP. SO THE DOCTOR COULD HAVE A CONVERSATION ABOUT FAMILY PLANNING. THE DOCTOR COULD HAVE THE PERSON COME TO HIS OR HER OFFICE. THE DOCTOR CAN DO LOTS OF THINGS THAT FALL OUD SIGHT OF THIS. BUT WHEN HE IS OPERATING WITHIN THE HOSPITAL, WHAT HE WOULD DO -- WHAT HE WOULD DO AND DOCUMENT THERE WOULD FALL UNDER THE [INAUDIBLE].

SO THAT'S WHY WE HAVE FIFTH FLOOR, SO WE CAN TRANSPORT THEM THERE AND DO THOSE THINGS. IT'S A VERY RARE INSTANCE WHERE THEY WOULD BE SO ILL THEY COULD NOT BE MOVED, AND [INAUDIBLE].

GOODMAN: I'M SURE IT IS RARE. BUT [INAUDIBLE] CIRCUMSTANCES THAT I KNOW OF HAPPEN WHERE SERIOUS INJURIES HAVE BEEN SUSTAINED AND [INAUDIBLE] THAT WOULD NOT HURT THEM IN ANY WAY. SO I ASSUME THAT THAT PATIENT WOULD BE IN [INAUDIBLE] CARE.

GENERALLY THEY WOULD BE ABLE TO BE MOVED WITHIN [INAUDIBLE] WE WERE TRYING TO RESPOND TO A THEORETICAL QUESTION. WE COULD NOT FIND ANY DOCUMENTS IN THE LAST TWO YEARS WHERE THIS WOULD HAVE EVER COME UP.

GOODMAN: [INAUDIBLE].

IS IT CLEAR, THOUGH, WHAT WE WERE TRYING TO DISTINGUISH BETWEEN DOCTOR'S ADVICE AND --.

GARZA: LET ME ASK THIS. IF SOMEONE IS IN THE EMERGENCY ROOM [INAUDIBLE] NEEDING AN OPERATION [INAUDIBLE] BUT YOU'VE GOT THE SAME INJURIES WHERE SOMEONE ADVISES [INAUDIBLE] IN ORDER TO LIVE YOU'VE GOT TO GET THIS OPERATION DONE, ARE THERE CIRCUMSTANCES WHERE WE WOULD TAKE PEOPLE TO INTENSIVE CARE AND DON'T MOVE THEM AT ALL EVEN THOUGH YOU HAVE [INAUDIBLE] IN THE HOSPITAL TO DO TESTING AND OTHER THINGS? I WOULD THINK THE IDEA THAT YOU CAN'T MOVE SOMEBODY TO IC AUSMT BECAUSE OF ADDITIONAL TESTING -- I DON'T UNDERSTAND WHERE -- I KNOW IF I WERE [INAUDIBLE] KOOSHTION I'LL TAKE MY CHANCES.

IT WOULD BE GRAVE. AND THERE ARE TYPICALLY MEDICAL -- WITHIN A HOSPITAL, THERE ARE MEDICAL TRANSPORT TEAMS THAT WOULD FACILITATE.

GARZA: YOU COULDN'T PROVIDE SERVICES. I'M HAVING A HARD TIME UNDERSTANDING WHICH SERVICES YOU COULDN'T MOVE SOMEONE TO A DIFFERENT FLOOR TO PROVIDE A SERVICE AND THEN MOVE THEM BACK TO ICU ONCE THAT SERVICE IS PROVIDED.

YOU COULD CERTAINLY DO THAT IF THEY WERE ABLE TO SWALLOW AND THEY THOUGHT IT WAS [INAUDIBLE].

[INAUDIBLE] DOES SPECIFICALLY ADDRESS THE ANAT ME WE'VE BEEN TALKING ABOUT. THE QUESTION WAS STATED SPECIFICALLY DOCTORS AND NURSES REQUIRED TO SIGN A STATEMENT THEY WOULD COMPLY WITH THE [INAUDIBLE] AND DOCTORS ON SETON'S MEDICAL STAFF ARE REQUIRED TO COMPLY [INAUDIBLE] IF THEY ARE NOT AVAILABLE. AND WE JUST WENT OVER SOME OF THIS. IT'S REPETITIVE. [INAUDIBLE] PROCEDURES THAT CAN BE PERFORMED AT SETON AND IN SOME CASES THE MEDICATION THAT CAN BE ADMINISTERED THERE. LIKE MOST OTHER HOSPITALS, SETON EXPECTS THAT ALL EMPLOYEES WILL FOLLOW THE POLICIES AND PROCEDURES OF THE EMPLOYER, AND SETON'S STAFF IS EXPECTED TO ADHERE TO [INAUDIBLE]. [INAUDIBLE] SOME PROFESSIONAL STAFFS ARE SUBJECT TO REGULATORY OBLIGATIONS [INAUDIBLE] PROVIDE THEM INFORMATION THEY NEED TO UNDERSTAND THEIR MEDICAL CONDITION AND/OR THE TREATMENT OPTIONS. PHYSICIANS ARE REQUIRED TO ADHERE TO THE MEDICAL STAFF BYLAWS OF ANY HOSPITAL AT WHICH THEY HOLD PRIVILEGES. MEDICAL STAFF BYLAWS ADDRESS THE TREATMENT PROVIDED TO THE PATIENT AT THAT PARTICULAR FACILITY, BUT DO NOT ADDRESS THE INFORMATION THAT MAY BE SHARED BETWEEN THE PHYSICIAN AND THE PATIENT. THAT IS A [INAUDIBLE] PRIVILEGE RELATIONSHIP. SETON'S MEDICAL STAFF BYLAWS REQUIRE ADHERENCE [INAUDIBLE] WHILE THOSE PHYSICIANS ARE PRACTICING IN SETON'S FACILITIES. THE EFFECTIVENESS REQUIREMENT IS THAT PHYSICIANS MAY NOT PERFORM PROCEDURES OR DISPENSE MEDICATIONS IN SETON'S FACILITY WHICH THOSE FACILITIES DO NOT OR CANNOT PROVIDE. THIS DOES NOT EXTEND THROUGH [INAUDIBLE] CONFIDENTIAL PATIENT RELATIONSHIP OR THE TEXAS MEDICAL PRACTICE ACT WHICH ALL PHYSICIANS MUST ADHERE. I'M GOING TO SKIP THE NEXT SLIDE. IT WAS DISCUSSED EARLIER REGARDING VIOLATION OF CONSTITUTIONAL REQUIREMENTS.

YES, --.

GRIFFITH: BEFORE WE LEAVE THE SEXUAL ASSAULT AND RAPE YEAR, I HAD A COUPLE OF QUESTIONS THERE. ON PAGE 15 OF THE DRAFT DOCUMENT IT SAYS THE CITY WILL PROVIDE MEDICATIONS FOR THE PURPOSE OF EMERGENCY CONTRACEPTION TO WOMEN WHO, QUOTE, WHO HAVE EXPERIENCED RAPE OR SEXUAL ASSAULT, SO THAT EMERGENCY CONTRACEPTION WILL BE AVAILABLE AT THE NEW HOSPITAL. THAT IS A PHRASE THAT SEEMS TO BE COMING IN AND OUT ON A DAILY BASIS. HOW DOES IT READ IN THE CURRENT ITERATION OF THE [INAUDIBLE]? THAT WAS SOMETHING THAT THERE WAS A LOT OF INTEREST IN NOT HAVING THERE. IS IT IN OR OUT?

ARE YOU REFERRING TO [INAUDIBLE].

GRIFFITH: I'M ON PAGE 15 -- IT'S 19.3, RIGHT. IS IT IN OR OUT TODAY?

I'M SORRY, COULD YOU ASK ME AGAIN WHAT WAS IN OUR OUT?

GRIFFITH: SURE. THIS SENTENCE, I UNDERSTAND, IS KIND OF THE REVOLVEING [INAUDIBLE] SOME DAYS IT'S IN AND SOME DAYS IT'S OUT. THE ANCILLARY SERVICE AGREEMENT SHALL PROVIDE THAT SETON MAY TERMINATE THE SAME, MEANING THE LEASE, IF THE CITY INTENTIONALLY AND KNOWINGLY PROVIDES ABORTIONS WITHIN THE NEW HOSPITAL. THE CITY WILL PROVIDE MEDICATIONS FOR THE PURPOSE OF EMERGENCY CONTRACEPTION TO WOMEN WHO HAVE EXPERIENCED RAPE OR SEXUAL ASSAULT.

THAT PHRASE IS IN.

GRIFFITH: THAT IS IN. OKAY.

WE WERE -- I'M SORRY.

GRIFFITH: NO, THERE'S BEEN A LOT OF INTEREST IN NOT HAVING THAT IN. CAN YOU TELL ME WHAT THE DIFFERENCE IS IN HAVING THIS IN ON OR HAVING THIS OUT?

YES.

GRIFFITH: I KNOW ANOTHER TIME LAST WEEK IT WAS OUT. AND THAT SEEMS VERY IMPORTANT. I SEE SOME PEOPLE WHO ARE INTERESTED IN [INAUDIBLE].

WE DID HAVE A DISCUSSION AND DID REMOVE IT LAST WEEK. SUBSEQUENT TO THAT, WE WERE ADVISED BY SETON THAT BY MAKING THAT CHANGE, WE HAD CREATED A AMBIGUITY IN THE LANGUAGE OF SECTION 19.3, AND BASICALLY -- THE AMBIGUITY HAD TO DO WITH WE REFERRED TO THE PRACTICE THAT EMERGENCY CONTRACEPTIVE SERVICES WOULD CONTINUE IN THE NEW HOSPITAL AS BEING PROVIDED FOR AT BRACKENRIDGE TODAY. THE WAY THEY ARE BEING PROVIDED AT BRACKENRIDGE TODAY IS EMERGENCY CONTRACEPTION IS OFFERED TO WOMEN WHO HAVE EXPERIENCED RAPE OR SEXUAL ASSAULT. IF A WOMAN COMES IN REQUESTING PREGNANCY PREVENTION SERVICES FOR OTHER THAN RAPE OR SEXUAL ASSAULT, SHE CURRENTLY IS REFERRED TO -- I SHOULD SAY SHE EITHER COMES IN OR CALLS, SHE IS REFERRED EITHER TO HER PRIVATE DOCTOR TO HAVE THAT HAPPEN IN HER DOCTOR'S OFFICE OR SHE IS REFERRED TO A CLINIC OR A PLANNED PARENTHOOD. SO THE CURRENT PRACTICE TODAY IS THAT IS NOT CONSIDERED A MEDICAL EMERGENCY, BUT THE PATIENT IS REFERRED TO ANOTHER SOURCE FOR THAT SERVICE. SO THE LANGUAGE IN 19.3 THAT SET THAT -- THAT WAS ADDED BACK TO CLARIFY THAT THAT IS THE CURRENT PRACTICE AND WHAT THE PROPOSED AMENDMENT DOES IS -- OR INCLUDES IS TO CONTINUE THAT CURRENT PRACTICE. WHAT WE WOULD INTEND TO DO ON THE CITY HOSPITAL IS TO FOLLOW A SIMILAR PROCESS IN THAT SOMEONE DID COME IN REQUESTING A SERVICE OR GOAL IS TO HAVE THAT PATIENT NOT ONLY RECEIVE MEDICATION, WE WANT THEM TO RECEIVE THE FAMILY PLANNING AND EDUCATIONAL COUNSELING FOR THAT, WHATEVER CREATED THAT CONDITION, WE WANT TO HELP THEM NOT CREATE IT AGAIN. OUR PROCESS WOULD BE TO GET THAT PATIENT INTO OUR CLINIC, GET THEM WITH THE FAMILY PLANNING COUNSELOR OR DOCTOR OR NURSE AND TREAT THAT AS A WHOLE SERVICE TO THE PATIENT AND NOT JUST THE ADMINISTRATION OF MEDICATION. SO WHAT WE TRIED TO CLARIFY IS THAT WE WOULD CONTINUE THE CURRENT PRACTICE UP TO THIS DAY WHEN WE HAVE THE HOSPITAL ON THE FIFTH FLOOR. IT DOES NOT PREVENT THE WOMAN FROM BEING INFORMED OF THE INFORMATION. THEY WOULD STILL BE INFORMED SEATED TON DOES NOT PROVIDE IT. THEY WOULD STILL BE INFORMED THE SERVICES PROVIDED THROUGH THE CITY HOSPITAL. BUT WHETHER WE ACTUALLY HANDLE IT IN THE CITY HOSPITAL, WHAT WE WANT TO DO IS MAKE THE CONNECTIVITY OF THE WOMAN [INAUDIBLE] THE DOCTOR FOR THE SERVICES.

GRIFFITH: THAT'S SOMETHING WE MAY NEED TO REVISIT.

GOODMAN: MAYOR, COULD I ASK ONE MORE QUESTION? I JUST WANT TO GET SOME THINGS CLEAR THAT MAYBE I'VE BEEN MISHEARING OR [INAUDIBLE]. DID NOT WE JUST SAY AWHILE AGO THAT IF A WOMAN IS NOT OVULATING SETON STAFF COULD ADMINISTER THE EMERGENCY CONTRACEPTION?

YES.

GOODMAN: SO [INAUDIBLE] ABOUT SOMEONE WHO COULD NOT BE MOVED FROM BRACK TO THE FIFTH FLOOR, SO IS EVERY WOMAN WHO [INAUDIBLE] TO BRACKENRIDGE NOW [INAUDIBLE]?

NO. NO. THAT IS -- THAT IS A -- I GUESS A PRACTICE [INAUDIBLE] THAT WAS DISCUSSED IN PAST MONTHS. BUT THAT IS -- THAT IS BECOMING -- THAT WILL BE THE PRACTICE IN THE [INAUDIBLE] OVULATION. THAT WILL NOT OCCUR AT BRACKENRIDGE, AND THERE AGREEMENT THAT THE SERVICES CONTINUE AS THEY ARE BEING PROVIDED TODAY AS BRACKENRIDGE HOSPITAL. AND WHEN THE NEW HOSPITAL WOULD OPEN, THAT THE CITY WOULD TAKE OVER [INAUDIBLE]. THE COMMON PRACTICE TODAY IS IN ANY CASE, YOU WILL CERTAINLY ADMINISTER [INAUDIBLE] BEFORE PROVIDING THAT MEDICATION [INAUDIBLE]. [ONE MOMENT, PLEASE].

I'M SORRY, MY COPY IS --

ONE BACK. THERE YOU ARE.

[INAUDIBLE] STATE HOSPITAL. OUR CURRENT ESTIMATE IS THAT IN ORDER TO PURCHASE HOSPITAL'S INVENTORY FROM THE WORKING STAFF REQUIREMENT -- WORKING CAPITAL REQUIREMENT IS THAT THE HOSPITAL WOULDN'T BE DEPENDENT ON [INAUDIBLE] WE ESTIMATE THAT MAY REQUIRE 60 OR 70 MILLION TO TAKE BACK THE HOSPITAL. THAT -- A LARGE PORTION OF THAT IS THE WORKING CAPITAL THAT IS REQUIRED AS THE STARTUP. WHEN YOU START BILLING FOR SERVICES, YOU CANNOT COLLECT REVENUE FOR THAT. PARTICULARLY [INAUDIBLE]. IF THE CITY WERE TO TAKE BACK THE HOSPITAL, IT WOULD LOSE THE FUNDING STREAM FOR THE FQHC CLINIC AND THE HEALTH AND HUMAN SERVICES DEPARTMENT, WHICH CURRENTLY IS ABOUT $D MILLION. THAT 9 MILLION IN FUNDING COMES FROM A DISPROPORTIONATE SHARE REVENUE THAT SETON SEES CURRENTLY AND UNDER THE TERMS OF THE LEASE PAYS FOR THE CITY AS ADDITIONAL RENT FOR BRACKENRIDGE HOSPITAL. SO IN OTHER WORDS, THOSE MONEYS WOULD HAVE TO BE -- THAT WOULD CURRENTLY BE RECEIVED FROM THE CLINIC WOULD HAVE TO BE DIVERTED TO THE HOSPITALS. ALTHOUGH THE CITY WOULD BE ENTITLED TO REVENUE FROM THE NEW HOSPITAL, IT WOULD HAVE TO USE THAT MONEY FOR RENOVATIONS AND EQUIPMENT THAT ARE CURRENTLY FUNDED BY SETON. THE MONEY WOULD NOT BE AVAILABLE TO THE CLINIC SO IT WOULD CREATE A GAP THERE.

WYNN: AND ON THE INVENTORY PART OF THIS, WE ALL KNOW THAT SETON HAS MADE SOME SUBSTANTIAL IMPROVEMENTS TO THE FACILITIES OVER THERE. IF WE TAKE BACK THE HOSPITAL, I PRESUME THAT OBVIOUSLY WE, YOU KNOW, TERMINATE THE LEASE AGREEMENT WITH SETON. WHAT HAPPENS TO THE DOLLARS THAT THEY'VE PUT INTO THE [INAUDIBLE]? I MEAN DOES THIS INVENTORY ASSUMPTION ALSO --

THIS ESTIMATE DOES NOT INCLUDE THE COST OF THE CAPITAL. 60 MILLION IS [INAUDIBLE]. THIS IS JUST THE EQUIPMENT LIKE BEDS AND MACHINES AND THINGS LIKE THAT. I DID HAVE THOSE DETAILS, AND I THIS IT'S IN THE RANGE OF ABOUT 15, 20 MILLION DOLLARS FOR JUST THE EQUIPMENT. THAT DOES NOT ACCOUNT FOR THE CONTRIBUTION TO THE CAPITAL [INAUDIBLE].

WYNN: WOULD THE CITY HAVE SOME RESPONSIBILITY FOR TAKING OVER, YOU KNOW, THE RENOVATED CHILDREN'S HOSPITAL OR WHATEVER THE CASE MAY BE, ARE WE OBLIGATED TO PAY SETON BACK FOR THEIR ASSISTANCE?

NO, TIBL TERMS OF THE LEASE WOULD [INAUDIBLE]. -- I BELIEVE THE TERMS OF THE LEASE WOULD [INAUDIBLE].

WYNN: THEN THE SECOND QUESTION I GUESS IS PERHAPS NOT ONLY FINANCIAL NECESSARILY, BUT IS THERE ANY INDICATION THAT IF WE TAKE BACK BRACKENRIDGE, IF WE RUN THE CITY HOSPITAL AGAIN, FROM -- YOU KNOW, JUST FROM AN EMPLOYEE STANDPOINT, FROM, YOU KNOW, FROM DOCTORS AND NURSES, WOULD WE HAVE CONCERNS OF KEEPING THE EXISTING EMPLOYEES AND/OR ATTRACTING THE SAME LEVEL OF MEDICAL EXPERTISE?

THAT WOULD BE DIFFICULT TO SPECULATE ON. ALL I CAN SAY IS -- REPORT THE EXPERIENCE I HAVE [INAUDIBLE] IN 1990 WHEN WE OWNED THE HOSPITAL. WE HAD A $38 MILLION DEFICIT [INAUDIBLE] AT THAT TIME. WE HAD A [INAUDIBLE] IT WAS SOMETHING LIKE FOUR OR FIVE ADMINISTRATORS IN THE FIVE OR SIX YEARS THAT I WAS HERE BEFORE THE LEASE. I THINK THE CITY MANAGER MAY HAVE SOME COMMENTS TOO. I DO KNOW THAT WE HAD TROUBLE KEEPING SALARIES COMPETITIVE AT THAT TIME. AND SO IF YOU HAVE ANY COMMENTS --.

GARZA: THERE'S SEVERAL THINGS. ONE IS THE HEALTH CARE INDUSTRY, BASICALLY YOU HAVE CHA, COLUMBIA HEALTH CARE, AND YOU HAVE THE DAUGHTERS OF CHARITY, THEN YOU WOULD HAVE [INAUDIBLE] THE DISADVANTAGE -- WE WOULD HAVE SEVERAL DISADVANTAGES. ONE, EVERYTHING WOULD BE IN PUBLIC. IN TERMS OF STRATEGY, MARKET SHARE, THINGS OF THAT NATURE, YOU WOULD BE DOING THINGS IN VERY OPEN FASHION AND IT WOULD HURT YOURSELF FINANCIALLY. [INAUDIBLE] WE COULDN'T COMPETE WITH THE PRIVATE SECTOR T SECOND THING, YOU WOULD HAVE TO PAY YOUR ADMINISTRATORS SOMEWHERE BETWEEN 250 TO 275 A YEAR, HIRE NUBL AVOID -- THAT'S THE TURNOVER THAT WE'VE HAD AT THAT POSITION. SEEMED LIKE EVERY TWO OR THREE YEARS WE WERE TURN OVER A NEW ADMINISTRATOR. SO YOU HAVE THOSE KIND OF DRAWBACKS. AND THEN I THINK, YOU KNOW, YOU COULD WORK THESE [INAUDIBLE] COMPETITIVE SALARIES AND TRY TO OBTAIN PAYING CUSTOMERS, THINGS OF THAT NATURE, TO KIND OF OFF SET LOSSES. BUT TO THE DEGREE -- I DON'T THINK WE'LL HAVE ANY DIFFERENT EXPERIENCE EXCEPT THAT YOU RUN A DEFICIT EVERY YEAR. THEN YOU WOULD HAVE TO FIGURE OUT A WAY TO PAY FOR THAT DEFICIT OR RUN IT INTO THE INVESTMENT POOL WHICH WE DID BACK THEN. THOSE ARE SOME CHOICES THAT --

I THINK THERE'S ONE OTHER DIFFERENCE TOO.

MAYOR GARCIA: LET ME SUMMARIZE IT THIS WAY. WE DON'T WANT TO GET INTO THIS [INAUDIBLE]. WE WERE THERE BEFORE. I WAS ON THE COUNCIL AT THAT TIME. AND THE WHOLE HEALTH CARE INDUSTRY IS MUCH MORE COMPLEX THAN WE CAN [INAUDIBLE]. THAT'S WHAT THE ISSUE IS. ST. DAVID'S [INAUDIBLE] COLUMBIA. AND IT'S -- YOU KNOW, IF YOU GO TO A SEMINAR WHERE THEY TALK ABOUT HEALTH CARE AT THE NATIONAL LEVEL [INAUDIBLE]. IT REQUIRES A DEGREE OF EXPERTISE THAT THE CITY DOES NOT HAVE TO RUN ONE HOSPITAL. YOU ALMOST HAVE TO HAVE A SYSTEM THAT MUCH LARGER CITIES [INAUDIBLE] TO ADDRESS ALL THE NEEDS THAT COME WITH HAVING TO RUN A HOSPITAL. THAT IS ONE COUNCILMEMBER'S ASSESSMENT OF IT WHO WAS THERE [INAUDIBLE].

WYNN: I GUESS MY POINT IS THERE ARE -- THE ANSWER TO THE QUESTION WAS PURELY FINANCIAL. WHAT ARE THE COSTS TO TAKE BACK THE HOSPITAL IN ITS ENTIRETY. WELL, IT'S TENS OF MILLIONS OF DOLLARS, BUT I'M ALSO HEARING THERE IS SUBSTANTIAL COMPETITIVE COSTS AND SUBSTANTIAL ADMINISTRATIVE COSTS. PERHAPS MEDICAL COSTS WHICH, AGAIN [INAUDIBLE].

MAYOR GARCIA: OKAY.

GRIFFITH: HAVE WE -- ONE OF THE THINGS THAT HAS BEEN SUGGESTED IS THAT WE DON'T HAVE ANY CHOICE. AND I'M WONDERING IF IN LIGHT OF WHAT COUNCILMEMBER SLUSHER HAS TOLD YOU, -- [INAUDIBLE] WE MAY NEED TO FIND OUT [INAUDIBLE]. AND THE ONLY WAY TO DO THAT IS TO [INAUDIBLE] IT UP AND JUST ASK. BECAUSE TAKING IT BACK AND RUNNING IT OURSELVES IS NOT [INAUDIBLE]. THERE MAY BE A [INAUDIBLE] ONE OF THE THINGS THAT DR. BLAND POINTED OUT IN HIS REMARKS, IF YOU DON'T -- IF YOU DON'T [INAUDIBLE] OPEN PROCESS, IF YOU DON'T, THEN YOU ARE MAKING [INAUDIBLE].

MAYOR GARCIA: LET ME JUST COMMENT ON THAT. THE DECISION THAT WAS MADE WHEN WE [INAUDIBLE] WAS ONE IN WHICH WE HAD OTHER PROPOSALS. AT THAT TIME ST. DAVID'S WAS NOT IN THE COLUMBIA SYSTEM. BUT THEY WERE MOVING IN THAT DIRECTION. SO THE COUNCIL EVALUATED THE PROPOSAL AND THEY DECIDED THAT GIVEN WHAT WE [INAUDIBLE], THIS OFFERED THE BEST -- THE BEST SITUATION. THAT'S THE REASON [INAUDIBLE]. ONE THAT WAS PRECEDED BY A SUBSTANTIAL AMOUNT OF INVESTIGATION BY COUNCIL. SO OBVIOUSLY THERE ARE CHOICES, AND WHEN WE GET TO QUESTION NO. -- [INAUDIBLE] OR THE HOSPITAL CARE AND THE HEALTH CARE ISSUES, THOSE BOTH REQUIRE A [INAUDIBLE] THAT EVERYBODY IN ADMINISTRATION HAS --.

WOULD YOU LIKE US TO -- [INAUDIBLE].

MAYOR GARCIA: YEAH, I THINK WE PROBABLY ARE AT THAT POINT. AND THE QUESTIONS THAT COUNCILMEMBER WYNN AND COUNCILMEMBER SLUSHER ASKED ARE A PERFECT SEGUE INTO A HEALTH CARE FINANCING DISTRICT OR HOSPITAL -- [INAUDIBLE]. BECAUSE THAT IS PROBABLY THE OPTION THAT, YOU KNOW, EVERYBODY HAD TALKED ABOUT, AND QUESTION NO. 17 [INAUDIBLE].

THANK YOU. MY NAME IS JOHN AND I'M WITH THE LAW FIRM OF FULLBRIGHT AND IT'S BEEN MY PLEASURE TO WORK ON THIS TRANSACTION BOTH IN 195 AND NOW. BOTH THEN AND NOW WE'VE EVALUATED THE HOSPITAL DISTRICT REQUIREMENTS, AND YOU SEE HERE IN THE ANSWER TO NO. 17 SOME INFORMATION THAT I'LL JUST SUMMARIZE FOR YOU BRIEFLY, AND THEN I'LL BE HAPPY TO TAKE QUESTIONS ON IT. BASICALLY, THE TEXAS CONSTITUTION AUTHORIZES HOSPITAL DISTRICTS TO BE CREATED UNDER EITHER SPECIAL LAWS THAT ARE ADOPTED BY THE LEGISLATURE SPECIFICALLY FOR A PARTICULAR DISTRICT, AND THE MIDLAND COUNTY HOSPITAL DISTRICT IS AN EXAMPLE OF THAT AND MANY OTHERS AROUND THE STATE. THE OTHER WAY THAT YOU CAN CREATE A HOSPITAL DISTRICT IS TO TAKE ADVANTAGE OF ONE OF THE GENERAL LAWS. THESE ARE IN CHAPTER 281 AND FOLLOWING CHAPTSZ OF THE TEXAS HEALTH AND SAFETY CODE. AND THE THREE PROVISIONS UNDER THE GENERAL LAWS THAT ARE RELEVANT FOR THE AUSTIN-TRAVIS COUNTY AREA ARE THAT ONE WOULD ALLOW THE TRAVIS COUNTY COMMISSIONERS COURT TO TAKE THE INITIATIVE TO CREATE A DISTRICT WHERE THE COMMISSIONERS COURT ITSELF WOULD GOVERN THE DISTRICT. ANOTHER WOULD ALLOW THE TRAVIS COUNTY COMMISSIONERS COURT TO TAKE THE INITIATIVE TO CREATE A DISTRICT WHERE THE -- THERE WOULD BE A BOARD CONTROLLED ESSENTIALLY BY THE COMMISSIONERS COURT T DIFFICULTY WITH THOSE IS THOSE WOULD ONLY BE FOR THE TRAVIS COUNTY AREA. SO IF AND WHEN WE SAID THAT COUNCILMEMBERS QUESTIONS TO GO MORE TO HOW DO YOU HARNESS THE RESOURCES OF A MULTI-COUNTY REGION, THE ONLY WAY THAT YOU CAN DO THAT APART FROM GOING TO THE LEGISLATURE AND GETTING A SPECIFIC STATUTE TO CREATE THE DISTRICT, IS THROUGH A VOTER PETITION UNDER CHAPTER 286 OF THE HEALTH AND SAFETY CODE. AND UNDER THE VOTER PETITION ROUTE, WHAT HAPPENS IS THAT IF YOU IDENTIFIED, SAY, THREE COUNTIES WHICH THE DISTRICT WERE TO BE CREATED, AT LEAST 100 VOTERS IN EACH COUNTY WOULD HAVE TO SUBMIT PETITIONS THAT WOULD IDENTIFY THE DISTRICT. THERE IS SOME REQUIREMENTS YOU HAVE TO SET UP, FACTUAL INFORMATION ABOUT HOW THE DISTRICT WOULD BE GOVERNED, ET CETERA. IF THE COUNTY COMMISSIONERS COURT IN EACH OF THE THREE COUNTIES, AGAIN, THESE ARE HYPOTHETICAL, WERE TO DETERMINE THE PETITION WAS CORRECT, THERE WOULD BE AN ELECTION. OF COURSE WE HAVE TO GET PRE-CLEARANCE UNDER THOSE [INAUDIBLE] HOLD THE ELECTION AND THEN IF THE ELECTION PASSES, THE DISTRICT WILL BE CREATED. I GUESS A COUPLE OF POINTS RELEVANT TO DISTRICTS GENERALLY WHETHER UNDER SPECIAL LAW OR UNDER CHAPTER 286. THE GREAT ADVANTAGE THAT A HOSPITAL DISTRICT HAS THAT A HEALTH SERVICES DISTRICT DOES NOT HAVE A THE ABILITY TO LEVY PROPERTY TAX. THE HEALTH SERVICE DISTRICT IS CON TM PLATED BY 287 OF THE HEALTH AND SAFETY CODE, IT BASICALLY IS FUNDED BY CONTRIBUTIONS FROM GOVERNMENTAL ENTITIES. SO THE GOVERNING BOARDS OF EACH OF THOSE ENTITIES HAS TO ACT BASICALLY IN A COORDINATED MANNER TO APPROPRIATE OUT OF THEIR OWN INDIVIDUAL BUDGETS MONEY TO PAY FOR THAT DISTRICT. WHEREAS IF YOU HAD A HOSPITAL DISTRICT, THAT DISTRICT'S GOVERNING BODY COULD LEF ATTACKS TO PROVIDE SERVICES -- LEVY A TAX. THERE HAS IN RECENT YEARS BEEN AN ADDITIONAL FUNDING TOOL GIVEN TO HOSPITAL DISTRICTS AND THAT'S IN THE FORM OF SALES TAX. THERE IS A FAIRLY COMPLICATED CALCULATION YOU WOULD HAVE TO GO THROUGH TO DETERMINE IF YOU WERE MAXED OUT AT THE SALES TAX RATE IN RELATIVE AREAS. BUT I THINK THIS IS A TOOL THAT IS USED IN A COUNTY LIKE TRAVIS WHERE YOU HAVE A LOT OF TAX EXEMPT PROPERTY OR YOU HAVE FACILITIES TO GENERATE A SUBSTANTIAL AMOUNT OF [INAUDIBLE]. UNDER A CHAPTER 286 HOSPITAL DISTRICT COVERING MULTIPLE COUNTIES AND FORMED BY VOTER PETITIONS, YOU COULD EVALUATE AND IMPLEMENT THOSE PROPERTY SALES TAX, AGAIN, SUBJECT TO THE CALCULATIONS [INAUDIBLE].

MAYOR GARCIA: QUESTIONS? COUNCILMEMBER GRIFFITH.

GRIFFITH: YES. ARE THERE ANY MULTI-COUNTY HOSPITAL DISTRICTS?

I BELIEVE THERE ARE SOME. THERE'S HOSPITAL DISTRICTS THAT COVER PARTS OF [INAUDIBLE], BUT IF THERE ARE SOME.

GRIFFITH: PARTS WHAF?

DALLAM AND [INAUDIBLE].

GRIFFITH: HOW WOULD HAVING A HOSPITAL DISTRICT CHANGE THIS 30-YEAR LEASE?

IT WOULD NOT NECESSARILY CHANGE THE LEASE. THE TEXAS CONSTITUTION PROVIDES THAT WHEN A HOSPITAL DISTRICT IS CREATED, TWO THINGS HAPPEN THAT I THINK WOULD BE RELEVANT TO THE -- TO THIS SITUATION. THE FIRST THING THAT HAPPENS IS THAT A HOSPITAL DISTRICT IS BY CONSTITUTION REQUIRED TO BE THE ENTITY THAT PROVIDES CARE TO THE MEDICAL INDIGENT. AND THE CITIES AND COUNTIES, WHILE THEY CAN STILL CONTINUE TO PROVIDE PUBLIC HEALTH SERVICES SUCH AS [INAUDIBLE] AND PERHAPS VACCINATION AND THAT SORT OF THING, ARE NOT SUPPOSED TO THEN FUND HOSPITAL CARE, MEDICAL CARE FOR THE MEMORIAL DAILY INDIGENT. SO THERE'S A SWITCHING -- FOR THE MEDICALLY INDIGENT. THE SECOND THING AND PROBABLY GETS DIRECTLY TO YOUR QUESTION IS THAT, AGAIN, BY CONSTITUTION MANDATE, TITLE TO THE CITY-OWNED HOSPITAL WOULD REST IN THE HOSPITAL DISTRICT AND WOULD PASS TO [INAUDIBLE] PURSUANT OR SUBJECT TO THE LEASE. IN OTHER WORDS, AT THE TIME THAT THE LEASE WAS PUT INTO PLACE IN 1995, WE KNEW THAT HOSPITAL DISTRICTS WERE OUT THERE AND THAT THERE COULD BE A CIRCUMSTANCE WHERE ONE WAS CREATED. AND I BELIEVE THE END RESULT IS ONE CAME INTO BEING DURING THE TERM OF THIS LEASE IS THE HOSPITAL DISTRICT WOULD TAKE THE PLACE AS THE CITY, IF YOU WILL, AS THE LANDLORD.

GRIFFITH: HAS THAT HAPPENED ELSEWHERE?

NOT TO MY KNOWLEDGE.

MAYOR GARCIA: QUESTIONS? COUNCILMEMBER SLUSHER.

SLUSHER: SO YOU SAY THERE IS AN ELECTION ON A MULTIPLE-COUNTY HOSPITAL DISTRICT HAS SOME COUNTIES AND NOT OTHERS, COULD IT THEN GO FORWARD, AND IF THAT WOULD CHANGE THE AMOUNT OF TAX THAT WOULD BE CHARGED ON [INAUDIBLE] TALK ABOUT THAT AND I HAVE A FOLLOWUP QUESTION.

IT MAY BE POSSIBLE TO CRAFT A BALLOT PROPOSITION SO THAT IT'S CLEAR -- IF IT DOESN'T GO FORWARD IN ONE COUNTY, IT WOULD STILL [INAUDIBLE] THAT WOULD HAVE TO BE LOOKED INTO BECAUSE PART OF THE ISSUE IN THE VOTERS' MINDS IS -- [INAUDIBLE] THEY MIGHT HAVE VOTED ON THE ASSUMPTION THERE WAS EITHER LARGE [INAUDIBLE] SPREAD OVER THE REGION, AND FRANKLY MORE [INAUDIBLE] WOULD HAVE TO BE DONE TO SEE IF IT WAS POSSIBLE TO PUT TO THE VOTERS THAT KIND OF ALTERNATIVE. IT MIGHT BE POSSIBLE. I'M NOT SURE.

SLUSHER: OKAY [INAUDIBLE] STUDY FURTHER. SO RIGHT NOW WE HAVE PEOPLE THAT COME FROM SURROUNDING COUNTIES TO BRACK AND THE CITY PICKS UP SOME OF THAT COST TOO. BUT IF HOSPITAL DISTRICT PASSED AND SOME COUNTIES [INAUDIBLE] AND WENT FOR IT ANYWAY, THE FOLKS IN THOSE COUNTIES WOULD STILL BE ABLE TO COME TO THIS HOSPITAL [INAUDIBLE].

YES. THE -- THERE WOULD BE A HOSPITAL DISTRICT OWNED HOSPITAL SUBJECT TO THIS LEASE WOULD BE IN THE SAME POSITION THAT BRACKENRIDGE IS NOW IN THAT IT WOULD HAVE THE LEGAL RIGHT UNDER THE INDIGENT CARE ACT TO SEND A BILL FOR SERVICES TO WHATEVER COUNTY THE PERSON'S RESIDENCE IS IN, IS MY UNDERSTANDING. [INAUDIBLE].

SLUSHER: OKAY. SO I MEAN THERE WOULD BE A SITUATION WHERE ACTUALLY PEOPLE IN THE COUNTY WOULD BE DECIDING WELL, DO WE WANT TO PAY FOR OUR MEDICAL -- EMERGENCY MEDICAL CARE, DO WE WANT TO LEAVE OPEN THE POSSIBILITY FOLKS IN OUR COUNTY CAN GO UP TO TRAVIS COUNTY AND GET THE SERVICES AND HAVE THE TAXPAYERS OF THAT AREA PAY FOR IT.

YES, SIR. IT IS MY UNDERSTANDING THAT THE -- HISTORICALLY THE OBSTACLE TO GETTING SOMETHING LIKE THIS CREATED IS PERSUADING THE VOTERS IN THE COUNTIES WHERE THE VOTERS MAY NOT CURRENTLY PERCEIVE THAT THEY HAVE A BURDEN, THAT SOMETHING BETTER WILL COME WITH THIS FOR THEM IS WORKED OUT [INAUDIBLE].

SLUSHER: AND THEN TALK TO ME A LITTLE BIT ABOUT WHAT THE LAWS ARE AFFECTING PRIVATE HOSPITALS NOW AND [INAUDIBLE] CARE AND HOW THAT WOULD CHANGE IF THERE WERE HOSPITAL DISTRICTS?

WELL, GENERALLY SPEAKING, I THINK THERE ARE TWO CONCEPTS TO BE ADDRESSED WITH RESPECT TO THE PRIVATE HOSPITALS. ONE IS THAT ANY HOSPITAL, PROFIT NONPROFIT, PUBLIC, WHATEVER, IS SUBJECT TO CERTAIN RULES RELATING TO DEALING WITH A PATIENT WHO PRESENTS WHO MAY NEED EMERGENCY CAREMENT AND THOSE RULES ARE CONSISTENT THROUGHOUT, WOULD NOT BE AFFECTED BY [INAUDIBLE]. IF SOMEONE SHOWS UP AT BRACKENRIDGE HOSPITAL AND NEEDS EMERGENCY CARE, THEY ARE GOING TO HAVE TO GET TREATMENT BECAUSE BRACKENRIDGE HAS EMERGENCY -- HAS THAT --.

SLUSHER: WHAT IF THEY SHOW UP AT A PRIVATE HOSPITAL?

THE SAME FEDERAL RULES RELATING TO THE NEED TO PROVIDE THE CARE ON EMERGENCY BASIS AT LEAST UNTIL YOU CAN MAKE AN APPROPRIATE TRANSFER TO [INAUDIBLE]. SO THERE IS NO -- NOTHING IN THAT SET OF LAWS THAT WOULD BE DIFFERENT [INAUDIBLE]. NOW, THE OTHER ISSUE THAT RELATES TO NON-PROFITS THAT IS A DIFFERENCE BETWEEN NON-PROFITS AND FOR PROFIT IS THAT CHARITABLE ORGANIZATIONS THAT OPERATE HOSPITALS IN [INAUDIBLE] HAVE TO PROVIDE A CERTAIN LEVEL OF CARE IN ORDER TO MAINTAIN THOSE TAX EXEMPTIONS AND HAVE TO REPORT ON THAT. WHICH IS TAKEN INTO ACCOUNT IN THE LEASE NEGOTIATIONS IN 1995 BY [INAUDIBLE] THAT REQUIRE SETON TO PROVIDE -- CONTINUE TO PROVIDE FOR THE LEASE IF IT WAS STATUE TORELY MANDATED CHARITY CARE [INAUDIBLE]. OF COURSE WHAT HAPPENED ACCORDING TO THE FINANCIAL REPORTS [INAUDIBLE] WITH STATE REQUIRED CARE THE CITY FUNDED CARE [INAUDIBLE].

SLUSHER: OKAY. AND PRIVATE HOSPITALS ARE REQUIRED TO -- IF SOMEONE SHOWS UP, NEEDS EMERGENCY TREATMENT, TO TREAT THEM.

YOU CAN'T TURN SOMEONE AWAY.

SLUSHER: BUT ARE THEY REQUIRED TO PROVIDE A SPECIFIC LEVEL OF INDIGENT CARE?

I DON'T BELIEVE SO.

SLUSHER: AND WHEN YOU SAID THEN SOMEBODY COMES IN TO A PRIVATE HOSPITAL AND [INAUDIBLE] THAT THEY WOULD HAVE TO BE TREATED UNTIL APPROPRIATE TRANSFER CAN BE ARRANGED, WAS THAT APPROPRIATE TRANSFER TO A CHARITY OR PUBLIC HOSPITAL? OR ELABORATE ON WHAT YOU MEANT.

I THINK IF YOU HAVE A CERTAIN ENVIRONMENT WHERE YOU HAVE A HOSPITAL THAT HAS THE AVAILABLE SERVICES [INAUDIBLE] WOULD OCCUR IF THE PATIENT TRANSITIONED [INAUDIBLE]. SO IF YOU DID HAVE [INAUDIBLE] THEY COULD BE MOVED. THE ALTERNATIVE IS SOMETIMES THE PATIENT STAYS IN PRIVATE HOSPITALS [INAUDIBLE] AND THE CARE IS FUNDED. SEE, IT JUST DEPENDS ON WHAT FACILITIES ARE [INAUDIBLE].

THEY ARE REQUIRED TO PROVIDE EMERGENCY TREATMENT. AND THEY ARE NOT -- THEY ARE NOT REQUIRED TO GO BEYOND THAT IN TERMS OF THE CARE.

SLUSHER: THAT'S ALL HAVE I, MAYOR.

MAYOR GARCIA: FURTHER QUESTIONS?

GRIFFITH: [INAUDIBLE] EMERGENCY CONTRACEPTIVES FOR [INAUDIBLE].

NOT -- HOSPITAL PRACTICES [INAUDIBLE] NOT EVERY EMERGENCY DEPARTMENT HAS THE SAME POLICY ON THAT.

GRIFFITH: SO HAVE YOU LIVED TO [INAUDIBLE].

YOU WOULD HAVE TO LOOK AT OUT A FACILITY BASIS. I THINK WE WERE ON 522, QUESTION 15.

MAYOR GARCIA: ACTUALLY WE JUST HAVE --

A COUPLE MORE.

MAYOR GARCIA: PAGE 22.

22 AND 23. THERE WAS A QUESTION FROM THE MAYOR PRO TEM REGARDING REQUEST TO EXPLAIN APPROPRIATE [INAUDIBLE] AS WE HAD USED TONIGHT ONE OF THE SLIDES IN THE FORMER PRESENTATION. ALSO IN SECTION 1914. WHAT WE MEANT BY THE TERM "APPROPRIATE ACCESS "SOY THAT THE PATIENT IS STABLE TO TRANSPORT, THE SERVICE IS THEN IDENTIFIED AND THE PATIENT IS TAKEN TO THAT APPROPRIATE LOCATION. THE TRANSFER AGREEMENT ITSELF BETWEEN THE FACILITY WILL CONTAIN A PROVISION FOR PATIENTS TO BE TRANSFERRED. THOSE WOULD BE KNOWN IN ADVANCE. SO ALL THOSE CONDITIONS WILL HAVE BEEN MET AND THE REQUIREMENTS TO TRANSPORT A PATIENT WILL HAVE OCCURRED IN ORDER TO ENSURE THAT THAT, QUOTE UNQUOTE, APPROPRIATE ACCESS IS OBTAINED. IT WAS PROBABLY MORE OF A TERM THAT WE USED THAT DOESN'T HAVE A LOT OF MEANING TO OTHERS OUTSIDE HEALTH CARE. OUR LAST QUESTION, AGAIN, THIS QUESTION WAS POSED BY DR. BRAND, WHY DON'T WE HAVE A THREE-MONTH COOLING OFF HEARD AND HAVE NON-CITY CONSULTANTS TO DISCUSS SERVICE WITH BRACKENRIDGE HOSPITAL. SFAF AT THIS POINT WOULD NOT RECOMMEND -- STAFF AT THIS POINT WOULD NOT RECOMMEND A COOLING OFF PERIOD. REGARDLESS OF WHETHER A MEDICAL SCHOOL OPERATES, THEY DO REQUIRE PAYMENT FOR SERVICES RENDERED AND ALSO IF WE WERE TO HAVE A MEDICAL SCHOOL COME AND RUN THE HOSPITAL, THEY WOULD EXPECT THE CITY TO PROVIDE FACILITIES, ANCILLARY, AS WELL AS COMMITMENTS, ALL THE EXPENSES TO RUN A HOSPITAL AS WELL A AS COMMITMENT TO CAPITAL INVESTMENT FOR THE LATEST TECHNOLOGY, RESEARCH, ET CETERA. A MEDICAL SCHOOL WOULD NOT BEAR THE FINANCIAL RISK OF A SAFETY NET TRAUMA HOSPITAL, 11 COUNTY REGIONAL TRAUMA HOSPITAL, NOR WOULD THEY TAKE THE RISK OF PROVIDING CHARITY CARE TO THE REGION. SO THAT WOULD BECOME THE RESPONSIBILITY OF THE CITY FOR THAT BURDEN. I THINK IT RELATES BACK TO THE QUESTIONS WE HAD EARLIER WHO WOULD COME AND [INAUDIBLE] OUR HOSPITAL AND TAKE THAT RISK.

MAYOR GARCIA: DURING THE DISCUSSIONS THAT WE HAD EARLY ON WHEN WE WERE TALKING ABOUT THE -- LEASING THE HOSPITAL, THERE WAS DISCUSSION ABOUT THE FACT THAT THOSE [INAUDIBLE] IN THE TEXAS LAW WHERE THE COUNTIES NOT THE CITY. AND I HAVEN'T HEARD THAT AGAIN IN ALL OF THESE DISCUSSIONS. WHERE ARE WE ON THAT?

I THINK WHERE WE'VE ALWAYS BEEN.

GARZA: I THINK THAT THE COUNTY'S POSITION ON THAT IS THAT ONCE WE'VE MADE EXPENDITURES FOR HEALTH CARE, WHATEVER THOSE ARE OR DETERMINED TO BE, THE COUNTY'S POSITION IS THE CITY CAN'T WITHDRAW FROM THAT. THEIR RESPONSIBILITY WOULD BE [INAUDIBLE] ABOVE THAT. THAT WOULD BE THEIR RESPONSIBILITY. OF COURSE, WE TAKE A DIFFERENT VIEW. WE -- [INAUDIBLE] THEY ARE THE ONES THAT WOULD BE [INAUDIBLE]. THEY USED THEIR TAX DOLLARS [INAUDIBLE] WE ANNEXED ALL THOSE AREAS IN '97, ASSUMED THE RESPONSIBILITY FOR EMERGENCY SERVICES [INAUDIBLE] I DON'T KNOW [INAUDIBLE] IT WAS REAL ADIFFICULT SITUATION.

SLUSHER: MAYOR, CITY MANAGER, HOW DID THE OTHER COUNTIES, THE OTHER 253 COUNTIES [INAUDIBLE]? DID THEY HAVE A DIFFERENT PHILOSOPHY AND INTERPRETATION THAN TRAVIS COUNTY DOES?

GARZA: I THINK THAT TEXAS LAW IS NOT PARTICULARLY GENEROUS WHEN IT COMES TO INDIGENT HEALTH CARE. I THINK THAT THE COUNTIES [INAUDIBLE] AND I THINK YOU WILL FIND MOST RURAL COUNTIES DO JUST THAT, THEY PROVIDE THE MINIMUM CARE. THAT IS ONE OF THE REASONS, AND I THINK SETON MAY HAVE SOME DOCUMENTATION ABOUT THIS, WHY THIS HOSPITAL SERVES AS A SAFETY NET NOT JUST FOR PEOPLE IN TRAVIS COUNTY, BUT I THINK WHEN YOU HAVE RESIDENTS IN SURROUNDING COUNTIES THAT NEED EMERGENCY AND ACUTE CARE WILL FIND THEMSELVES AT BRACKENRIDGE HOSPITAL GETTING THAT CARE. AT THE EXPENSE OF WHAT WE PAY AND AT THE EXPENSE OF WHAT SETON PAYS, AND MAYBE SOME SMALL REIMBURSEMENT, SOMETIMES MAYBE NOT. I THINK THAT MOST MAJOR METROPOLITAN URBAN AREAS, TARNTD COUNTY, DALLAS COUNTY, BEAR CAN COUNTY AND THEN LUBBOCK ALL HAVE HOSPITALS. WE ARE THE ONLY MAJOR TEXAS CITY THAT DOES NOT HAVE THAT. AND THAT IS HOW EARLY ON THOSE COMMUNITIES DEALT WITH HEALTH CARE. INDIGENT HEALTH CARE. AND THE SAFETY NET HOSPITALS [INAUDIBLE]. FOR WHATEVER REASON, WE NEVER WERE ABLE TO GET THAT DISCUSSION GOING AND GETTING [INAUDIBLE] GENUINE SUPPORT FROM THE PUBLIC TO CREATE A DISTRICT [INAUDIBLE]. BUT I THINK WHAT YOU WILL FIND IS THOSE COUNTIES, THERE'S ALL KINDS OF VAERTSZ. I WOULD BE SURPRISED IF THE RURAL COUNTIES OR POOR COUNTIES YOU HAVE ANYTHING BUT THE BEAR MINIMUM BE PROVIDED AND THAT'S WHY SOMETIMES WHEN HEALTH CARE SYSTEMS [INAUDIBLE] ARE NOT WHAT IT OUGHT TO BE.

SLUSHER: DOES TRAVIS COUNTY THEN STEPPING UP TO PROVIDE THE BARE MINOR IS THE CITY JUST PICKING IT UP?

GARZA: THEY PROVIDE THREE TO FOUR MILLION DOLLARS FOR BRACKENRIDGE, I BELIEVE. AS PART OF THAT -- IS THAT RIGHT?

[INAUDIBLE].

GARZA: IS THE NUMBER STILL ABOUT THREE -- 3.8 MILLION. AND I THINK THEN THAT THEY RUN THEIR COUNTY CLINICS [INAUDIBLE]. AND SO -- AND THEY TAKE CARE OF RESIDENTS THAT ARE IN THE COUNTY. HOWEVER, JUST SOMETHING THAT HAS HAPPENED RECENTLY, YOU ARE ABOUT TO ANNEX DEL VALLE, AND THE CITY HAD TO STEP UP AND PROVIDE A MILLION DOLLARS IN THE '02 BUDGET FOR HEALTH CARE FOR DEL VALLE BECAUSE THE COUNTY ESSENTIALLY TOOK THE CITY YOU ARE ANNEX THANKING AREA, THEY BECOME CITY RESIDENTS NOW, THEY ARE NO LONGER COUNTY RESIDENTS, THEREFORE WE DON'T HAVE TO PAY. I WAS A LITTLEN MATED WITH MY STATS ABOUT THAT [INAUDIBLE] I REALLY THINK THE POSITION WE SHOULD HAVE HAD WAS SORRY, COUNTY, THEY ARE STILL COUNTY RESIDENTS, YOU OUGHT TO PAY THE MILLION DOLLARS [INAUDIBLE].

SLUSHER: OF COURSE YOU ARE RIGHT, THEY ARE STILL COUNTY RESIDENTS, WHICH 85% OF THEM ARE IN THE CITY, SO THAT'S THE WAY THE FORMULA OUGHT TO BE ALLOCATED. WHAT THAT MEANS IS THAT THE 85% IN THE CITY, THE CITY TAXPAYER FUNDS ALL THAT AND THEN 15% IN THE COUNTY, THE CITY TAXPAYERS PICK UP 85% OF THAT.

MAYOR GARCIA: I THINK THAT'S ONE OF THE REASONS WE FELT THE DISCUSSION -- [INAUDIBLE]. WE DON'T GET ANYWHERE.

SLUSHER: I UNDERSTAND.

MAYOR GARCIA: ANYWAY --.

GARZA: THAT'S A COMMISSION FORM OF GOVERNMENT FOR YOU. IT'S A VERY BAD FORM OF GOVERNMENT. [LAUGHTER].

MAYOR GARCIA: COUNCILMEMBER GRIFFITH.

GRIFFITH: YES. SPEAKING OF FINANCING, HI A MEDICAID QUESTION. THAT'S ONE THING WE HAVEN'T TALKED ABOUT YET IS MEDICAID REIMBURSEMENTS AND HOW MEDICAID FITS INTO ALL THESE QUESTIONS, ESPECIALLY IN TERMS OF REPRODUCTIVE. WILL A MEDICAID PATIENT [INAUDIBLE] BE ABLE TO GET SERVICES PAID FOR IF THE DELIVERY [INAUDIBLE] SETON IS THE STATE'S MEDICAID MANAGED CARE PROVIDER. AND AUSTIN -- AN AUSTIN WOMAN WOULD BE RECEIVEING [INAUDIBLE] WILL SETON HOSPITAL'S PLAN INCLUDE THE NEW HOSPITALS IN THEIR NETWORK, WILL THAT THEN CONSTITUTE ANY CONFLICT WITH THE [INAUDIBLE].

THE CITY WILL BECOME A PROVIDER, THE CITY HOSPITAL WILL BECOME A PROVIDER FOR THE MEDICAID AS WELL AS MEDICAID MANAGED CARE. SETON HEALTH PLAN IS THE THIRD PARTY ADMINISTRATOR. IT DOES NOT -- WE'RE NOT PRECLUDE FRD PARTICIPATING IN MEDICAID MANAGED CARE BECAUSE SETON PARTICIPATES [INAUDIBLE] THEIR HEALTH PLAN ADMINISTERS THAT. AND IF WE PERFORM A SERVICE FOR A MEDICAID PATIENT, WE WILL BILL AND RECEIVE REIMBURSEMENT FROM THE STATE.

GRIFFITH: SO THAT WOULD NOT BE A CONFLICT WITH THE [INAUDIBLE]?

NO.

MAYOR GARCIA: YEAH, WE NEED TO -- WE ARE ABOUT 50 MINUTES BEYOND THE TIME FOR THIS, SO THANK YOU VERY MUCH. WE WILL CONTINUE THIS DISCUSSION AT THE TIME THAT THE ACTION ITEM COMES UP.

GARZA: MAYOR, I THINK THAT COUNCILMEMBER ALVAREZ COUNCILMEMBER ALVAREZ RAISED THE POINT, WE'RE DONE WITH OUR PRESENTATION AND WE DON'T INTEND TO WALK THROUGH THE PRESENTATION YOU HAD A MINUTE AGO. WE'RE HAPPY OBVIOUSLY --.

MAYOR GARCIA: TOMORROW WE'LL JUST HAVE -- TOMORROW WE WILL JUST HAVE QUESTIONS. THANK YOU FOR THE PRESENTATION. APOLOGIZE ABOUT THE MISSTATEMENT OF THE LAST NAME.

MAYOR GARCIA: THERE BEING NO FURTHER BUSINESS TO COME BEFORE THIS MEETING, I'LL ENTERTAIN A MOTION TO ADJOURN.

[INAUDIBLE].

MAYOR GARCIA: NO, WE DON'T HAVE TIME. WE'RE OUT OF TIME.

GARZA: I WOULD SUGGEST MAYBE DO YOU THAT FIRST TOMORROW.

SLUSHER: YEAH.

GARZA: DO THAT FIRST.

MAYOR GARCIA: ENTERTAIN A MOTION TO ADJOURN FROM COUNCILMEMBER GRIFFITH, SECONDED BY COUNCILMEMBER THOMAS. ALL THOSE IN FAVOR SIGNIFY BY SAYING AYE?

AYE.

MAYOR GARCIA: MOTION CARRIES. WE'RE OUT OF HERE.

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