Health Department Cut: Children's Story on Immunizations

The San Angelo Standard Times ran a column by City of San Angelo Health Director Sandra Villareal.  It stated:

The Health Department has experienced some significant changes this fiscal year, which began Oct. 1. 

In January, the Texas Department of State Health Services suddenly changed policies for the Texas Vaccines for Children childhood vaccine program. This was in response to reductions in state and federal immunization funds, increased federal accountability for publicly funded vaccines, as well as increases in prices for some vaccines.

These changes have affected a portion of San Angelo’s citizenry and how the Health Department conducts business.

The January referenced above did not occur after Oct. 1.  The "sudden change" came January 2012, according to a December 28, 2011 memo from Texas Vaccines for Children:

The following changes to TVFC patient eligibility are effective beginning January 1, 2012.

1. Children who have private insurance that covers vaccines will no longer be eligible for TVFC vaccines in public health department clinics, but instead will be referred to their medical home for immunization services. In some cases, local health departments may be the medical home that provides comprehensive healthcare services. In these cases, private insurance is accepted in those public health settings. Private stock vaccine must be purchased and/or acquired in order to continue vaccinating fully, privately insured children.

Any vaccines given to "privately insured children" from January 1 to October 1, 2012 had to come from private stock.  This change should be reflected in 2012 immunization numbers and/or department costs.:

A rough estimate suggests half of all children and adults who were served by the Health Department’s Immunization Division were insured.

Here's the immunization history from City Budget documents:

Actual Doses of Vaccine (the only immunization measure listed)
FY '03-04 - 18,000
FY '04-05 - 18,000
FY '05-06 - 19,000
FY '06-07 - 15,000
FY '07-08 - 16,000

Number of Children's Immunizations:
FY '08-09 - 7,629
FY '09-10 - 6,340
FY '10-11 - 4,600
FY '11-12 - 6,657 Budgeted
FY '12-13 - 2,300 Budgeted

Oddly, a September 2012 State Immunization Report on Increasing Vaccine Coverage had this to say about local health departments:

Local Health Department (LHD) Contracts
 
Immunization contracts with LHDs require activities that support the medical home.  LHDs should vaccinate children who come to public clinics for immunization services and assist them in applying for Medicaid or the Children’s Health Insurance Program (CHIP) as appropriate. They should explain benefits of a medical home and refer families to possible medical home providers for future care.  LHDs report on the number of children referred to Medicaid, CHIP, and medical homes three times per year.

This calls to question our local health department's capabilities in helping children quality for Medicaid or CHIP, as it jettisoned social services several years back.  The City dropped the its Pediatric Clinic long ago, closed its pharmacy (which ran a Pharmaceutical Assistance Program for the public), and shed Social Services.

Mayor Alvin New and Interim City Manager Michael Dane entertained feedback from a State Health Department physician on health department budget cuts.  The doctor lamented the draconian cuts to immunizations and the STD clinic.  New lectured the physician on how neighboring communities get more state funding than San Angelo.  My take is the cut is part of San Angelo's state/federal shakedown. 

City Council approved cuts of $138,000, apparently not worried about the upcoming flu season or children's health.  This same council approved another holiday, cost of at least $135,000, and an unfunded $225,000 for Downtown Master Development.  It's not that this council won't spend, it won't spend on effective public health programs, like childhood immunizations and STD clinic services.

The City had 10 public health nurses in '03-04.  It's now down to one nurse, a 90% drop. It once spent $30,000 a year on vaccines. that's now zero.

If the Health Department implodes much further, there will be no need for a Health Services Director.   I imagine Sandra Villareal is in a terrible spot.  That's the same place many residents find themselves in getting basic public health services.

Update 4-11-15:  I ran across the city's fiction on this issue in news story.  "The STD clinic was eliminated in 2012 when a state policy change resulted in a funding loss."  The City cut funding so they could ask the state and feds to backfill.  That's clearly their motivation.  

BRC's Maintenance Discussion Dings Dickson Appointment

San Angelo Development Corporation entertained  the following agenda item in its February 27 board meeting:

DISCUSSION AND POSSIBLE ACTION REGARDING MAINTENANCE OF THE BUSINESS RESOURCE CENTER (BRC) LOCATED AT 69 NORTH CHADBOURNE TO INCLUDE POSSIBLE CONTRACTS FOR AIR CONDITIONING SYSTEMS, THE ELEVATOR AND OTHER BUILDING SYSTEMS AND ROUTINE MAINTENANCE EITHER BY CONTRACT WITH CITY FACILITIES MAINTENANCE OR WITH PRIVATE COMMERCIAL PROVIDERS, AND ANY OTHER MATTERS RELATED THERETO (Presentation by Robert Schneeman, Interim Director of Economic Development) 

Development Corporation President Larry Teague commented on City Maintenance.  His message was:

There is no maintenance (routine or preventive).  They wait until it breaks, then they fix it.

Assistant City Manager/CFO Michael Dane was present at the meeting.  It's not clear what he carried back, given City Manager Daniel Valenzuela permanently promoted the two people responsible for City maintenance the last six years.

“They have brought stability and departmental unity between Water Utilities, Operations and the other departments,” Valenzuela said.

Valenzuela highlighted the pair's ability to get along, which may be the ultimate aim.

San Angelo's water situation is headed toward a huge crisis with the projected Cline Shale boom.  One fracked well uses 1.5 million gallons of water.  The City's population is projected to grow by at least a third.  Elected leaders defend the projected intrusion with comments like, "Smells like money to me."

In February 2011 Ricky Dickson's salary was $101,843.  Will Wilde's stood at $110,304 including his car allowance.  The Standard Times reported Dickson's new salary at $119,168.  Oddly, this is the salary the Development Corporation wanted to pay their new leader.

It remains to be seen if a "go along-get along leader" is what San Angelo needs in the water area, where big changes loom on the horizon

Rapid Turnaround for ASU Hoops Hire

Angelo State University Athletic Director Sean Johnson announced Head Basketball Coach Fred Rike had been fired.  That was Sunday afternoon, March 3rd.  The Standard Times indicated Rike had just been told of his termination.

Johnson informed Rike of the decision Saturday night after the game. 

ASU's Rampage quoted Johnson on the search in the March 8th edition:

Johnson said that he has some people in mind for the job, but right now, ASU has an “open search” going for the head coach position.

Johnson said that he intends to dig deep into all the candidates as quickly as possible because ASU wants to fill the position before the semester ends.

On Friday March 22nd Johnson introduced new head coach Chris Beard as a press conference.  That's a mere 18 days to interview candidates, check references, conduct background checks, extend an offer, get a "yes" response and set up a press conference with the new coach in attendance.

The Rampage stated on Rike's termination:

Johnson said that the decision was not a spur-of-the-moment move, but one that he and ASU President Dr. Brian May had discussed for months before making it final.

Coincidentally,  new coach Chris Beard spent ten years as Coach Knight's assistant at Texas Tech, first for legendary Bobby, then under son Pat.  Angelo State has been part of the Texas Tech University System for the last six years

Since Johnson and May don't make spur-of-the-moment decisions, I'm led to believe this move was underfoot for some time.  That would explain the quick turnaround.

Who's the next "under-performer" to get the axe based on body of work?

Update 3-31-13:  ASU advertized the position with the NCAA on March 6th.  Two weeks and two days later the University had its man.  

Update 3-31-13:  The Women's basketball coach search was also swift.  A March 8th resignation turned into a March 14 NCAA posting.  ASU named new head coach Cayla Petree on March 29.    That's another three week decision for a pair that doesn't make spur of the moment decisions.

New Water Utilities Chief Named: Dickson Official

City Manager Daniel Valenzuela never veered from his interim appointment of Ricky Dickson as Water Utilities Chief, officially making that position permanent in a press release.

Ricky Dickson and Shane Kelton have been appointed the directors of the City of San Angelo’s Water Utilities and Operations departments, respectively. Both had served as interim directors of their departments since November.

In announcing his decision, City Manager Daniel Valenzuela praised Dickson and Kelton’s performance, saying he is “quite pleased with their efforts and quick response to pressing issues. Further, they have brought stability and interdepartmental unity between Water Utilities, Operations and the other departments.

“It has always been a top priority for me to place the right people in the right positions,” the city manager added. “I feel very strongly that both Ricky and Shane will excel in the director positions and will continue being assets to the City.”

Water Utilities consists of eight divisions: Customer Service/Water Conservation, Twin Buttes, Utility Maintenance, Water Distribution/Waste Water Collection, Water Utilities Engineering, Water Reclamation, Water Production and Water Quality.

Dickson worked for former Water Chief Will Wilde for seventeen of his twenty two years with the City.  Was Dickson impacted by Wilde's repeated questionable ethics and dismissive management style? 

Prior to Daniel's appointment as City Manager the Public Works Director had to be a licensed engineer.  The minimum standard in the job description stated:

Must have a degree in Engineering and be able to become a registered engineer in the State of Texas.  

Either this no longer exists or the minimum standard was waived.  Another standard stated:

Knowledge of methods and techniques of street, water and wastewater systems design, construction and operations.

Consider Dickson's statement in the press release on his permanent hiring.

“My aim has been and will be to ensure the Water Utilities Department is proactive,” Dickson said, “whether that be addressing customer service issues, promoting conservation, completing capital projects or working with City leadership to strengthen our water supply. Our department is keenly aware that water is San Angelo’s greatest priority.”

Consider his history, where a "proactive position" would be an about face for someone associated with San Angelo's water transmission lines and public streets for twenty two years of service.  The City has been decidedly reactive for much of the last two decades, doing repairs only after major water main or street surface failures.

Anyone listening to Carollo Engineering's Hutch Mussallam at the March 19 City Council meeting heard how the City's water treatment plant does not meet current standards, another ding in this supposed "proactive stance."

The City became more proactive in water line replacement several years ago, but progress on the promised schedule lags badly.  Ricky left street maintenance before the City considered a comprehensive street maintenance and replacement plan, a proposal made by City Engineer Clinton Bailey at the recent City Council Strategic Planning session.

Replacing Will Wilde with a former understudy is an underwhelming development for a City in the midst of the Hickory pipeline project, water treatment plant replacement and upgrade for radium removal.  Did City Manager Valenzuela settle for a "quick response and interdepartmental unity" when something much greater was required?

Update 3-22-13:  The Standard Times ran a story on the permanent appointments.  City Manager Daniel Valenzuela's comments on their interim appointment are interesting to read in hindsight.

Update 7-6-13:  City Council member Charlotte Farmer expressed her displeasure at Dickson's not preparing the information she requested in the June 18 council meeting.  A proactive leader would've been prepared.

Update 7-7-13:  City Council wanted South Pool pumping brought back to Council after 60 days of operation.  Dickson missed the deadline twice.   How is that proactive?

MedHab LLC & Development Corporation Update

San Angelo Development Corporation's board packet for March 20 showed MedHab LLC received no incentive payments as of February 2013.  The City paid zero dollars of an expected $800,000 in aid so far this fiscal year.

Oddly, the February 27 Development Corporation meeting had several friction points between the board and the City.  The board didn't appreciate paying $62,000 for Shawn Lewis to get a professional certification and Lewis not complete the program before leaving for Longmont, Colorado.  The board invited City Manager Daniel Valenzuela to today's meeting to learn of his vision for reorganizing economic development.   Development Corporation leadership felt they needed an update in order to progress on several fronts, including replacing key employees.

Many City and Development Corporation employees who crafted, presented and executed the MedHab deal are gone.  That includes Harold Dominguez, Shawn Lewis, Donna Osborne and Cindy Hartin (who was in the job less than one year). 

Cindy Hartin's last agenda item before the Development Corporation board was:

Presentation of Annual Report for the Concho Valley Center for Entrepreneurial Development (CVCED) (Presentation by Cindy Hartin, Economic Development Coordinator and Johnny Ross, MedHab LLC)

The minutes of that presentation state:

Mr. Schneeman introduced Mr. Johnny Ross from MedHab. Mr. Ross provided an update on the progress of his business and StepRite product. MedHab will be launching the retail product in March. Two employees have been hired and an estimated eight positions will be filled in 2013. Manufacturing and distribution will be moved to San Angelo once there is FDA approval and a redundancy location is identified. MedHab projects to sell approximately 10,900 units in 2013. Mr. Teague asked if this was a realistic number and Mr. Ross stated that TMAC has analyzed the production and believe that the manufacturing process can hit that number.

The first mention of a retail product came via KLST. The news report suggested a December start date for San Angelo production for sports retail stores.

Production was to begin in June 2012 before leaking back to October, December and now March 2013.

The shift from medical device to athletic store novelty item is a marked change in strategy, given the huge difference in pricing power.

Note:  the February 13 report indicates MedHab's retail product will not be made in San Angelo.  Elusive FDA approval is the trigger for San Angelo and another site, referred to as a redundancy location, to garner jobs.

Abilene courted MedHab alongside San Angelo, while Lubbock pressed hard afterwards.  Where might this redundant location be and how much economic development aid will they offer?  Stay tuned as MedHab LLC turns. By the end of 2013 will they provide 10 of the promised "up to 227" jobs?

Texas Community Hospital Drought, Perry-Burgess Send Water Away

Consider the impact of Texas' growing legion of uninsureds on nonprofit, safety net hospitals and providers, given uninsured drought got worse last year.

The 2012 uninsured rate in Texas was 28.8 percent, or nearly three in 10 adults — an all-time high. In 2011, 27.6 percent of adults in Texas were without health insurance.

Louisiana, the No. 2 uninsured spot, has 24 percent of residents without coverage, but the 4.8 percentage points between that state and Texas qualifies as "the largest number separating these two spots on record."

Note:  Texas pulled away from neighbor Louisiana in the uninsured horse race.

There are no rain clouds on the horizon for uninsured Texans.  Governor Perry went on offense, determined to extend his twelve year string of ignoring the problem.  Joining Perry was Dr. Michael Burgess, an OB/GYN who practiced for years at a for-profit HCA hospital in Lewisville.

Nonprofit, safety net hospitals in Texas work hard to survive amidst a scorching earth.  By refusing federal money for Medicaid expansion, Perry and Burgess sent away the water trucks.  They closed their opinion piece with:

"No one cares more about the health of Texans than Texans."  

I.e., Perry and Burgess don't care.

MedHab Assigned Founder's Patent

The U.S. Patent Office approved MedHab's patent #8,384,551.  Power Engineering.com reported on March 2nd the three inventors assigned their patent to MedHab:  The inventors include MedHab's two co-founders, Johnny Ross and Tim Saguera, as well as Johnny Ross' wife   The patent information remains the same.

Abstract A sensor device has an insole, a sensor body abutting the insole, pressure sensors operably mounted on the sensor body for generating a pressure data signal, and an accelerometer mounted on the insole for generating a movement data signal indicating the measuring movement of the insole. A transmitter is used for transmitting the pressure data signal and the movement data signal to a reporting device having a receiver for receiving the pressure data signal and the movement data signal. The reporting device further has a processor and a computer-readable medium for storing the pressure data signal and the movement data signal. 

Did any money change hands for the patent assignment?  Power Engineering had no information in that regard.

MedHab is in the midst of its third capital raise.  Did any of those proceeds go toward the patent assignment?  Board member, investor and San Angelo Mayor Alvin New might know the answer.

Salazar's PPACA Coaching for Area Employers

Liliana Salazar presented her lecture, “Understanding the Implications of Health Care Reform on Employers,” on Feb. 27 at Angelo State University's C.J. Davidson Conference Center.  Here's how ASU promoted the talk:

As an employee benefits compliance professional, Salazar possesses extensive experience addressing employers’ responsibilities under federal, state and local laws.  She interacts with regulatory agencies, such as the Department of Labor, Internal Revenue Service, Centers for Medicare & Medicaid Services, Department of Health and Human Services and state insurance departments, to address the applicability of laws and regulations to group health plans. 

Salazar and her staff are actively involved in identifying and implementing cost-effective employer solutions that comply with new health care reform mandates, including defined contribution plans and consumer-driven health care plans. 

As Congress crafted and passed PPACA, I sensed health reform would accelerate the decline of employer sponsored health insurance.  Frankly, I saw this as an unstated aim of the bill.

Citizens may have heard Mayor Alvin New talk about the City's health insurance as a "defined contribution" health plan.  Changes made the last three years sent some 200 people from the City sponsored health insurance coverage.

The Standard Times reported on Salazar's lecture:

Salazar talked about how the goal of the health care reform is to get everybody legally residing in the United States coverage with health care insurance. She mentioned the three means for a person obtaining that insurance in 2014: through a private insurance company, employer benefits and federal exchanges.

Salazar helped business leaders understand where they fit in PPACA's complex scheme.  Smaller employers could get federal tax credits (a direct subsidy) for offering insurance to their employees.  Larger employers will need to provide coverage or pay a penalty, however the penalty is a fraction of the cost of providing coverage. 

There is widespread agreement that employers will continue to do less in the healthcare benefit arena.  This is from LIMRA

A new LIMRA survey of U.S. employers found more than half of employers have increased or plan to increase deductibles, co-pays or the contributions from employees to cover the cost of coverage for their medical plans. This follows a 15-year trend of health care cost-shifting by employers to their employees. According to a Kaiser/HRET survey, premiums for families have nearly tripled since 1999 – from $5,791 to $15,745 in 2012. Simultaneously, Department of Labor statistics show that employees’ wages have been stagnant over the past 10 years. 

GAO took a shotgun approach to estimating PPACA's impact, as seen in the image below:

The tale of the tape is:

Employers covered fewer Americans as a percentage in 2011.  The percent dropped from 55.3% in 2010 to 55.1% in 2011.  This is down from 64.2% in 1997.  If employers covered Americans at the 1997 rate, there'd be 28 million more people with health coverage.

Liliana Salazar's role/visit is another step in the great employer health insurance shedding.  I don't consider myself a coach, but brace for change.  Individuals will shoulder a much larger responsibility for health care and retirement.

Update 11-23-13:  Confirming my last sentence, Obama advisor and health economist David Cutler said "The trend in health care nationally is to put more and more on the patient."

City Council's Strategic Planning Session

City Council held a special Strategic Planning workshop on February 26th.  City Manager Daniel Valenzuela sought feedback for council on priorities for the coming budget (2013-14) and five year capital plan (2013-18).  Council met for two hours and forty minutes.  Through discussion they generated 10-15 major ideas, filling two and a quarter flip chart pages. 

Oddly, no one mentioned the city's pension plan and its need for funding.  For all the past talk of health insurance becoming a beast, this item was passed over.  Given implementation of PPACA and GASB accounting requirements, employee and retiree health insurance deserves strategic prominence. 

Mayor Alvin New believes early retirees can get another job, one providing a health insurance benefit.  He thinks health insurance should be a defined contribution benefit, where the city ponies up a fixed amount per year for employee coverage.  Should costs go up significantly, employees and retirees would bear the burden, as they did in 2011.

New floated the idea of using health insurance monies for capital items in the past.  He also wanted the city's pension fund revisited.  Both health insurance and retirement are critical elements of the city's operating budget.  It will interesting discerning the city's plans in both areas.

Since neither is strategically important, how might each do their part to contribute to over $400 million in capital needs?  Employees need to pay attention.  They know what this Council did to them the last three years.  I expect Council and staff to deliver more of the same.