Dr. Preston Darby's Final Trip

Dr. Preston Darby passed away peacefully with family this morning, after a long battle with Lou Gehrig's disease.  His body suffered the ravages of  ALS and eventually, the toll wore on his spirit.  To friends Pres remained a gracious, Southern gentlemen, with a penchant for storytelling. My last visit with Pres was alongside Dr. Ralph Chase.  The combination left me with a general ache in the midsection.  It came from the best medicine, laughter.

Over the years Pres regaled me with stories of rural South Carolina, his writing class with Elmer Kelton, antics at Community Health Club and doctoring in Afghanistan.  He spoke of his writing, often referring to his "God awful" short stories and first novel. Pres' books include Tears of the Oppressed, which chronicled his medical mission work in Afghanistan during Soviet Occupation.  The Reluctant Assassin showed John Wilkes Booth surviving his injuries and subsequent adventures as a world traveler.  After assassinating President Lincoln, Booth meets a host of notable characters in this lark of a story. 

Close friend and fellow author Ken Casper helped Pres revive his moribund first novel.  Together they worked, week in and week out.  The result is ManKillers.  It's a tale of love and loss in the post Civil War South.  It was published in December of 2010.

Notable character, loved by many?  That's Pres Darby.  San Angelo lost another treasure.  My thoughts and prayers are with Pam and the family.

I see Darby whole in heaven, catching up with loved ones.  After an appropriate period of reuniting, I bet Pres says "Pardon my intrusion, but where do you keep the pen and paper?"  After securing such, I see Pres running barefoot on the clouds.  It's a record time...

Update 3-15-11:  The Standard Times highlighted Dr. Darby's life in story and obituary.

Update 3-19-11:  Emmanuel Episcopal Church overflowed with love today.  Hundreds turned out to remember Pres Darby's unique character and vitality.  After hearing Pam and family members speak, I realize it'd be awhile before Pres asked God about the pen and paper.  He and Steven have much catching up to do.

Adding ASU & Howard College

Proposed budget cuts by the Texas legislature total $244 million for the Concho Valley (plus Runnels County).  An additional $15 million will come out of the hide of Howard College and Angelo State University.

HHS-- $206 million
Public Education--$23 million
Higher Education--$15 million

Cuts are from 2010-2011 state budget spending.  Higher education cuts add to Tom Green County's misery, making the total now $207 million or $1,907 per citizen.:  

 
Scroll down for posts with HHS and Public Education cuts by county.  The big picture should be seen.

Update 3-14-11:  SAISD said cuts will be between $9 and $12 million per year.  This is much higher than CPPP's estimate of $7 million for Tom Green County.  It adds $11 to $17 million to the Concho Valley total, now $255 to $261 million for the biennium.   That's a quarter of a billion for mostly rural Central West Texas.

Texas Budget Train Cutting through Concho Valley

Concho Valley counties will see an average $830 hit per person under proposed Texas budget cuts.  The cuts are relative to state funds expended in 2010-2011  The breakdown by county is:

(Clicking on the graph will enlarge the image for better viewing.)

One might expect the Concho Valley Council of Governments to weigh in on the issue.  An economic hit of $230 million warrants comment, especially from an organization charged with regional economic development.  So far, CVCOG has been publicly silent.  That doesn't mean they aren't working behind closed doors on behalf of stressed local school systems and ailing hospital districts.  The question is how they plan to help.

Update 4:05 pm:  SAISD announced it would eliminate teacher positions through attrition and not renewing poor performers.  It didn't say how many teacher positions would be eliminated to achieve budget savings of over 10%..  How many losing work will also lose health insurance for their families, layering stress on Shannon Medical Center?  Shannon already faces cuts in Medicaid, CHIP and UPL Program payments.  As the Concho Valley's safety net hospital, it sees 80% of the uninsured.  How many people will SAISD add to the nearly 200 newly uninsured from the City of San Angelo?  It bears watching.

Update 4:55 pm:  Kiah Collier stated 45 teacher positions would be eliminated, 25 via retirement and 20 through non-renewals.  How many other district positions will disappear?  How many people will lose health insurance as a result?

Legislative Budget Cuts Loom for Concho Valley

Texas legislators consider deep cuts to health and public education.  The one-two $230 million punch could create more hardship for Concho Valley communities.  This analysis includes Runnels County, which is served by Shannon Medical Center and San Angelo Community Medical Center.  The county breakdown follows, starting with those with cuts between $7 million and $3 million:.

Counties with cuts less than $2.5 million include:

Tom Green County will take the biggest hit, a combined $192 million:

This does not include budget cuts to Angelo State University or Howard College.  Nor does it cover potential Upper Payment Limit Program cuts to area hospitals.  As state funded positions are eliminated, how many people will lose health insurance coverage, potentially qualifying for slashed Medicaid?  As cuts feedback on each other, pain will spread.  That's predictable.

HHS Cuts Projected at $206 Million for Concho Valley

“There is still a lot of concern about what the base budget does, the cuts, and where those cuts are being made and I think we’re still trying to find some additional savings,” said Rep. Drew Darby, R-San Angelo.

Projected savings for Health & Human Services are $206 million for the Concho Valley, plus Runnels County.  Tom Green County, slated to lose $185 million, comprises most of the cuts. Over $330 million is needed to maintain current services, of which the federal government would pay 60%. 

The most common cut for surrounding counties is in the $1 million range, however Runnels ($6 million) and McCulloch ($3.7 million) stand to lose much more.  .

The $206 million in Concho Valley cuts represents 30% of 2010-2011 budget.  Coke, Concho, Crockett and Sterling Counties could see over a 33% cut in HHS spending in their communities.

Major HHS Programs include Medicaid Acute Care and nursing home funding, community care, public health and consumer protection programs, child & adult protective services, foster care/adoption, day care regulation, Early Childhood Intervention, vocational rehabilitation, and federal disability determination.

How does the job decimator multiply $206 million in lost funds?  It remains to be seen.

Medicaid Cuts for Tom Green County & Concho Valley

The Center for Public Policy Priorities published county-by-county estimates showing the impact of proposed Medicaid cuts.  The negative impact on Tom Green County hospitals, doctors and nursing homes is nearly $116 million.  Over half of that amount, $64 million, comes from the loss of federal stimulus money.  CPPP's data does not include Medicaid UPL funds, currently distributed to Shannon Medical Center and San Angelo Community Medical Center.  Cuts could be closer to $120 million.

Area providers, especially doctors and hospitals, serve people outside Tom Green County.  The following graph shows the impact of $152 million in Medicaid cuts on the Concho Valley and Runnels County.

How will a $152 million revenue loss wash through area hospitals, clinics and nursing homes? The job decimator, the opposite of the job multiplier, may be coming to the Concho Valley's health sector.

Will Shannon or Community ask the City of San Angelo for job maintenance funding, like Ethicon?  They'd have the right to, given the City's driving nearly 200 people from the health insurance rolls.

Update:  On March 1 City Council entered executive session "to discuss an offer of financial or other incentive to a company or companies with whom the City of San Angelo is conducting economic development negotiations and which the City of San Angelo seeks to have, locate, stay or expand in San Angelo."

Update 3-27-11:   SAST reported the Legislative Budget Board released an analysis showing the state could lose 271,746 jobs in 2012 and 335,244 jobs in 2013 if the House budget goes through as is.

Tom Green County's Indigent Health Fractal

Tom Green County spent $7.5 million less than the 8% general tax levy for Indigent Healthcare in the last decade.  In 1999 the county spent $1.96 million, needing assistance from the state.  The Indigent Health budget for 2011 is $458,579.  Contrast this $1.5 million decline with unrelenting increases in health insurance premiums.

The County does contribute $1 million, technically not part of Indigent Health, to Medicaid's UPL Payment Program.  Giving the County credit for this contribution raises the 2011 total to $1.46 million, still far below the 8% requirement of $2.01 million.  By the end of this fiscal year the Indigent Healthcare surplus could exceed $8 million.  What happens to these funds?  The County outlined their use in a recent document:

SURPLUS FUNDS - funds not expended during a budget year. Shall be maintained and accounted for using generally accepted accounting principles. May be used to increase yields to defer taxes.

The County pattern repeats elsewhere in fractal form.  The City of San Angelo took a similar line, deferring tax increases to fund retiree health insurance promises.  City Council increased premiums as high as 34 to 58% for retiree dependents.  As a result, 192 people dropped health insurance, 45 employees/retirees and 147 dependents.  The health insurance massacre occurred while the City participates in the fed's Early Retiree Reinsurance Program. 

Texas state legislators look to gut Medicaid and CHIP.  A recent report showed Medicaid paying hospitals 22% of charges for potentially preventable re-admissions.  How far below actual costs does Medicaid currently pay?  Under stressed state and federal budgets, UPL money must be at risk.  When that goes, virtually every healthcare funder, government and corporate, will be in retrenchment mode.. 

Chaos theory provides insight as to what may happen.  The system becomes increasingly unstable until it reaches a point of maximum instability, the bifurcation point, after which the system reorders at a new level.  Politically, this is occurring in the Middle East, where corrupt, heavy handed rulers hold billions in oil money and send business to close friends and associates.  Their people woke up and protested.  I don't expect Americans to do so anytime soon.

That leaves one question.  How might the slow motion collapse of health care financing express in San Angelo and Tom Green County?

A storm is coming.  Who will weather it?

Update 3-5-2011:  The Texas state legislature proposed a 10% cut in Medicaid funding.  Will Bishop Mike inform Lady Justice?  How long before she unleashes her sword on local and state officials?