Two public forums to gather public opinions about the agency drew just nine speakers
Part 1 in a Series
Updated Thursday May 3, 2018, at 9:12am to correct Sara Black’s name
Consultants for Central Health threw open the doors, laid out plentiful food, and even provided child care for attendees, but almost no one came. All but a half-dozen of the 130 seats available were empty.
Central Health is paying for the care of some 143,000 uninsured Travis County residents this fiscal year, involving about 400,000 patient encounters, according to information compiled as part of the FY 2018 budget currently under review for approval in mid-September by the Travis County Commissioners Court.
Yet a total of nine people showed up to provide feedback at the two public meetings held August 8th and 9th at the Emma S. Barrientos Mexican American Cultural Center. Collectively they said Central Health is misusing funds by giving $35 million a year to the University of Texas Dell Medical School, failing to serve huge areas of Eastern Travis County, and losing sight of its statutory mission to serve the healthcare needs of indigents.
Blanca Lesmes, co-founder of BB Imaging and Healthcare Consulting, is leading the public outreach under a $17,600 subcontract from Dayton, Ohio-based Germane Solutions. Germane has a $315,000 consulting contract for an independent Performance Review of Central Health (aka Travis County Healthcare District).
In addition to the meetings, the work also involves reviewing patient surveys collected from CommUnityCare Clinics, reviewing “thousands of pages” of documents supplied by Central Health, and accepting comments via email to [email protected]. Comments will be accepted until December 1 and findings will be shared with the public in January.
First night’s critics
Attorney Fred Lewis was the first of the four people who spoke at the August 8th meeting. He aired his often-repeated view that as a special-purpose district under Texas statutes Central Health has but one mission: to provide healthcare for poor people. Yet every year it sends $35 million to the University of Texas Dell Medical School “and receives a pittance of healthcare services.”
Lewis contrasted this arrangement to Dallas-based Parkland Health and Hospital System that maintains performance metrics for healthcare services and pays providers for services only after rendered. “That’s not how the UT Medical School operates,” he said. “They’re allowed to spend money any way they want.”
“UT has probably provided $5 million at most in healthcare” out of the $105 million it has received from Central Health, he said.
“Central Health doesn’t understand its mission,” Lewis said, “There are tens of thousands of people who should have gotten healthcare but didn’t because of the money spent on the medical school.”
He also criticized the $250,000 that Central Health has committed for its share of funding Capital City Innovation Inc., a nonprofit organization of which it is a member along with the University of Texas at Austin representing itself, the Dell Medical School at the University of Texas and the University of Texas System; and Ascension Health Texas, doing business as Seton Healthcare Family.
Each founding member agreed to ante up that amount in seed money to the organization that “is intended to be a catalyst in encouraging innovation activities and developing an innovation ecosystem in close proximity to the Dell Medical School, Dell Seton Medical Center at the University of Texas, and Central Health Brackenridge Campus,” according to a May 13, 2016, memo from Patricia Young Brown, then president and CEO of Central Health.
“It’s not Central Health’s mission to build a medical complex,” Lewis said. “They need to stick to their mission.”
Eastern Travis County without services
Rebecca Birch, president of the Del Valle ISD Board of Trustees, said there was not a single health clinic within an area of Eastern Travis County spanning 174 square miles.
“We met and spoke with Central Health and it has fallen on deaf ears,” she said.
“My citizens have been paying taxes for 10 years and gotten no services. We have the neediest people in Travis County and gotten no services. I’d like to see we get something for the money we’ve been paying.”
The lack of services in that part of the county was even more urgent, personally, for Richard Franklin, an African American and a former Del Valle ISD trustee. He recounted the story of the night his wife, Birch, who is white, suffered a severe migraine headache.
“I threw her in car at 3am.” Franklin said he was “driving like bat out of hell down dark and winding roads. I can’t tell you stress and anxiety I felt thinking I might be in if pulled over, with a white woman beside me screaming and who couldn’t speak for herself.”
Franklin said he been in conversations with Central Health for nine months about providing services in his part of the community. “When is enough, enough? … We need help now. People are dying.”
“The lack of healthcare affects everything,” Franklin said. “It causes people to lose jobs, lose lives, and suffer.”
Former board member’s perspective
Frank Rodriguez served on the Central Health Board of Managers for eight years and said he created the organization’s first budget. But “at some point Central Health moved away from support of the poor to the broader population and “got away from indigents.”
Rodriguez said that in a relatively short period of time Central Health had developed an advanced healthcare system for the county, but having said that, there are issues that need to be addressed.
Central Health needs a “laser focus on its mission.”
Regarding the $35 million a year going to the UT Dell Medical School, he said. “I was on the board and voted for that. I believed that services would be provided to the poor and that hasn’t happened.”
Second night’s critics
The August 9th meeting was for Spanish speakers and the introduction was given in Spanish, but all those who offered comments did so in English.
Jill Ramirez is CEO of the Latino HealthCare Forum, a local community based nonprofit that strives “to provide vulnerable populations access to comprehensive, culturally competent, quality primary healthcare services,” according to the organization’s website.
She also chairs the City of Austin’s Hispanic/Latino Quality of Life Resource Advisory Commission.
Ramirez was the first of five people to address the panel August 9th.
She said her first interaction began around 2009 when Central Health decided to close the Northeast Clinic on Springdale Road. She said she spoke—to no avail—at several Central Health board meetings about the difficulties that would be faced by parents and children who would find it difficult to travel to another clinic in Northwest Austin.
“There is still no clinic in the (Northeast) area,” she said. “People without cars have to take up to two buses to make it to other clinics.”
She said Central Health had planned for a year and a half to close the Northeast Clinic but never looked for a nearby location. Instead, land was purchased on the west side of I-35 and a clinic was built there, she said, “against the wishes of residents, I might add.”
More recently, Ramirez said, Central Health closed a clinic in Del Valle and a walk-in clinic at the Southeast Health and Wellness Center.
She said the Medical Assistance Program was once open to people who had no insurance but now it’s hard to qualify.
Like Fred Lewis the preceding night, Ramirez criticized the money being given to the University of Texas Dell Medical School. She hammered the lack of transparency, saying that “Central Health has twisted and complicated finances and it’s hard to follow the money.”
Central Health board meetings are available only on the Internet, and not aired on television, she added.
“They have no idea what it’s like to have no healthcare, no car or no gas for the car, or just basic necessities” Ramirez said. “They are not reaching out to make things better or trying to understand the difference between population health—which is everybody—and indigent care. They are not the same.”
She ended by complementing new Central Health CEO Mike Geeslin. “He has been visiting with many in the community and has an open mind and he understands the difference between population health and indigent care.”
Vincent Tovar said he agreed with everything that Ramirez said.
“They need to stop the cycle of Central Health not doing what it’s supposed to do and fulfill its mission of providing healthcare. The $35 million a year going to the medical school should be going to indigent healthcare services,” he said. “People are dying from long waiting lists.”
Tovar said “There is a disconnect from top to bottom, about where money goes, and a lack of respect.
“If Central Health wanted to know what the situation looks like, they would not see all these empty seats (at this meeting).”
Sara Blok Black talked about the difficulty she experienced in trying to find out if she qualified for healthcare under the Medical Assistance Program. She said she told the clerk that she didn’t want to provide a pay stub and resented being asked if she had filed a tax return.
“I needed medical attention badly, but she said I had to pay federal taxes,” Blok Black said. “She said I had to prove who I was.”
Susanna Woody is a school board trustee for Del Valle ISD and a candidate for Travis County commissioner. She’s running in Precinct 4 for the seat held since January 1995 by Commissioner Margaret Gómez.
“People from Travis County are excluded from healthy foods, health facilities, and mental healthcare,” Woody said. “This is a real problem for us.”
“We’ve had lot of talk for the last 10 years and we want to see some action,” Wood said. “We asked for a plan to address our concerns for healthcare in our area. I want a viable plan and a long-term plan, and a sustainable long-term facility to treat people.”
Miriam Paredes asked how the public outreach was being conducted.
Blanca Lesmes replied that the information was being gathered via newsletters, documents, and patient surveys. “This is only one piece of it,” she said.
Lesmes said that more time might be needed “to advertise, to get to people using the services.”
Paredes said, “I’m here as proxy to several family members and relatives who tried to access services and were poorly treated. There are too many obstacles to participate in this setting. It is intimidating to get to. I have a car and I speak the language, but I don’t have a sense of clear communication or culturally effective communication that is representative of the people I know when they access services. They (Central Health) don’t understand things as simple as transportation. They are tone deaf.
“I suggest a true forum be held to bring grievances forward and air grievances in a real and authentic way. That would be the beginning of solving all the other problems.
“My challenge to you is when the assessment comes out to have a true representation of people’s experiences,” Paredes said. “This (audience) is not representative of people’s experiences.”
Location, location, location
The turnout for these meetings was so small that speakers were given five minutes instead of the initially announced three minutes to address a panel that included Lesmes, Claudia Perez of BB Imaging, and Grant Stafford of Germane Solutions. Speakers also were given multiple opportunities to air their opinions. Each meeting lasted an hour instead of the scheduled 90 minutes.
The Communication and Community Outreach Assessment Plan, which The Austin Bulldog obtained from Central Health through a public information request, said that a “location in East Central Austin” would be selected for these public input meetings.
Instead the meetings were held at the Mexican American Cultural Center, 600 River St., located in a crowded corner of southeast downtown dominated by Rainey Street bars and restaurants and four blocks from the nearest bus stop. Temperatures were well into the nineties both nights.
In a follow-up phone interview about the meeting location, The Austin Bulldog asked, is the Mexican American Cultural Center in Central East Austin?
Lesmes replied, “I’d have to look at a map if we’re going to be super specific.”
Stafford added, “We looked at dozens of options, and made the decision this was the most appropriate option available when many stakeholders would attend, and culturally appropriate for Hispanic and other populations in Travis County.”
The meetings were publicly announced through legal notices—not display ads—published in the Austin American-Statesman and in Ahora Sí, the newspaper’s Spanish language publication. No information was published in community newspapers that serve minority readers.
A press release was issued August 1.
In addition, a tersely worded notice was inserted at the tag end of a seven-page Central Health Community Update newsletter emailed July 31, 2017, that went to about 4,000 people. The first of two Facebook notices was posted late August 3, the second the morning of August 8, the day of the first public input meeting.
None of these announcements mentioned public transportation options.
“The timing could’ve been wrong, the location could’ve been wrong,” Lesmes said. “Which one was it, I don’t know. We could say all of those are wrong.”
How many email responses has been received through [email protected]? “We got three,” Lesmes said.
HUB certification in doubt
Companies that responded to the Request for Qualifications issued April 6, 2017, for the Performance Review of Central Health were instructed to ensure that Historically Underutilized Businesses were given the maximum opportunity to participate in the work. To be eligible, HUB contractors and subcontractors must be certified by a recognized governmental program.
Although BB Imaging and Healthcare Consulting is listed in advertising for the public meetings as a certified HUB vendor, none of the online databases—including the City of Austin, State of Texas, and Texas Unified Certification Program for HUB vendors lists the company.
When asked in a telephone interview for proof of the certification, Lesmes said, “Call the City of Austin.”
The Austin Bulldog called the City of Austin’s Small and Minority Resources Department and was told that BB Imaging is not certified with the City.
Friday morning, August 25, The Austin Bulldog emailed Lesmes, Germane Solutions, and Central Health officials to ask for proof of certification. No response had been received when this story was published.
This report was made possible by contributions to The Austin Bulldog, which operates as a 501(c)(3) nonprofit for investigative reporting in the public interest. You can help support this independent coverage by making a tax-deductible tax-deductible contribution.
Central Health Community Update, July 31, 2017 (7 pages, with the Performance Review Community Meetings notice on p. 6)
Email Inqury About BB Imaging HUB Certification, August 25, 2017 (2 pages)
Fliers in English and Spanish (2 pages)
Germane Solutions Contract, June 22, 2017 (17 pages)
Request for Qualifications for Performance Review of Central Health, April 6, 2017 (33 pages)
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