1. CITIZENS' COMMUNICATION. (CARL RICHffi) (6:37)

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1 2. MINUTES OF MEETING -November 22, 2004 TRAVIS COUNTY HOSPITAL DISTRICT BOARD OF MANAGERS On the 22nd day of November 22, 2004, the Travis County Hospital District Board of Managers convened at 6:37 PM at the Granger Building, 314 West 11th Street, Austin, Texas Secretary for the meeting was Cindy Trautmann. Manager Rose Lancaster is absent from the meeting. 1. CITIZENS' COMMUNICATION. (CARL RICHffi) (6:37) Clerk's Notes: No speakers. RECENE PRESENTATION ABOUT A LEGISLATNE EFFORT TO INCREASE RESOURCES AVAILABLE TO TRAUMA CENTERS ACROSS THE STATE AND A REGIONAL STRATEGY TO IMPROVE HEALTHCARE ANDAUTHORIZE EXPENDITURES AND/OR THE USE OF RESOURCES FOR THE EFFORT. (CARL RICHIE) (6:38) Clerk's Notes: Item not ready; item passed to 12/2/04. 3 RECEIVE A PRESENTATION ABOUT ADMINISTRATION. (CARL RICHIE) (6:39-7:11) HEALTH CARE Clerk's Notes: John Guest is the immediate past Administrator for the Harris County Hospital District. Prior to that he was the Administrator for the Bexar County Hospital District. Mr. Guest stated his availability to assist the Travis County Hospital District and gave synopsis of the hospital districts with which he was previously associated.

2 4. RECEIVE A REPORT FROM THE PERSONNEL COMMITTEE. (8:09-8:15) (8:24) Clerk's Notes: Cyd Grimes, Purchasing Agent for Travis County presented the report. So far, 70 resumes for the Administrator position have been received. The position was posted with various professional publications and on the County website. Vice-Chair Richie believes that the focus should be on reviewing the resumes received. Ms. Grimes stated that several of the applications were from Texans. Progress is being made on the evaluation matrix. Search Consultant RFP's are due December I st, Ms. Grimes will give a report at the Board's next meeting. Legislative Consultant proposals have been received. Ms. Grimes proposed that each member of the committee evaluate each proposal independently and then meet as a group and short list the consultants via the committee's scoring sheets. Ms. Grimes reported the names of the proposers -HiliCo Partners, Marsha Jones; Kemp Smith; Akin, Gump Strauss Hauer and Peld; Randy Kane and Mark Rodriguez; Homero Lucerio and Ellen Williams; Susan Ross, Jaime Capello, Mario Martinez and Jane Mathis. 5 RECEIVE A REPORT FROM THE BUDGET COMMITTEE. (6:39-7:11) Clerk's Notes: Report previously received under Trish Young's report. Chainnan Heidrick asked Manager Young if the City's report was to be submitted to the auditor, Susan Spataro. Manager Young believes that since monies to the City are listed in the District's budget as one line item, that the financial report from the CEO of the Community Care Network would not be, in his opinion necessary to provide to the Travis County Auditor for an Auditor's report but the Auditor may want the same. Chairman Heidrick asked when the District would receive its monthly financial statements from the Auditor. Mr. Collins responded that pursuant to the MOU with the Auditor, the financial reports should be received by the middle of the month following the month being reported. Mr. Collins believes that because of new accounts being set up and new procedures, that the Auditor has not yet received all information needed to compile and presenthe monthly financial reports to the Board. Mr. Collins further reported to the Board that he had been in contract with the Auditor's office and they have assured him that all information now has been received for them to compile a financial report. Once the report is received by Temporary Administrator Collins, he will place the item on the Board's agenda.

3 6. RECEIVE THE OCTOBER MONTHLY INVESTMENT REPORT AND RATIFY HOSPITAL DISTRICT INVESTMENTS FOR OCTOBER, (7:11-7:23) Clerk's Notes: Mary Mayes, Cash Investment Manager presented the Monthly Investment Report for the District. Tax revenue received for October was approximately $280,000.00; November, $1,200, The Public Investment Act requires the acceptance sheet be signed by designated Board Members and returned to the Cash Investment Manager. Ms. Mayes continued her report of where the cash was invested. The collateral requirement is no longer in effect after the cash is placed in the TexPool accounts. Ms. Mayes provided each Board Manager with a copy of the Investment Policies of the District. The Board discussed investment of District funds in treasury notes. Motion made by Vice-Chair Richie and seconded by Thomas Young to ratify the investments made by the Cash Investment Manager by signing the appropriate Resolution. Chairman Clarke Heidrick Vice-Chair Carl Richie Manager Tom Coopwood Manager Thomas Young Manager Victoria Hsu Manager Frank Rodriguez Manager Rose Lancaster Manager Donald Patrick Manager Rosie Mendoza Absent 7 APPROVE A REQUEST FOR PROPOSALS OR A REQUEST FOR QUALIFICIATIONS FOR AUDITING SERVICES FOR THE TRAVIS COUNTY HOSPITAL DISTRICT. (8:15-8:17) Clerk's Notes: Ms. Grimes reported that Managers Mendoza and Young provided comments for the RFQ. Ms. Grimes plans to have the RFQ completed within a week. She requested authorization from the Board to issue the RFQ after review from the Finance Committee. Motion by Manager Donald Patrick and seconded by Manager Mendoza to authorize Ms. Cyd Grimes, Travis County Purchasing Agent, after meeting with the Finance Committee, to publish the RFQ. Mr. Collins, Temporary Administrator advised the Board of Managers that if the final authority is delegated at this time to the Finance Committee, there

4 should be a posting of the meeting of the Finance Committee to comply with the Open Meetings Act. Chainnan Heidrick asked if that would be the procedure if the authority was given to Mr. Collins to review the RFQ and then give the go ahead to publish the RFQ. Mr. Collins answered that a meeting would not need to be posted if he was given the authority to review and then authorize publishing of the RFQ. Friendly Amendment proposed by Chainnan Heidrick and consented to by Manager Donald Patrick and Manager Rosie Mendoza to authorize Mr. Collins to review the changes made to the RFQ and authorize the RFQ to be published. Chainnan Clarke Heidrick Vice-Chair Carl Richie Manager Tom Coopwood Manager Thomas Young Manager Victoria Hsu Manager Frank Rodriguez Manager Rose Lancaster Manager Donald Patrick Manager Rosie Mendoza Absent 8. CONS mer CHARGES FOR STANDING AND AD HOC COMMITTEES. (CLARKE HEmRICK) (8:28-8:30) (9:04-9:16) Clerk's Notes: ChainIlan Heidrick stated he had ed to the Board Managers and Mr. Collins a draft of the responsibilities of each committee. [Hard copies were provided to the Board at the meeting.] ChainIlan Heidrick reported receiving an from Manager Rodriguez in reference to the Strategic Planning Committee. 9. ACCEPT WRITTEN INSTRUMENTS FROM THE CITY OF AUSTIN CONVEYING TITLE TO LAND, BUILDINGS, AND EQUIPMENT USED TO PROVIDE MEDICAL SERVICES OR HOSPITAL CARE, INCLUDING GERIATRIC CARE, TO INDIGENT OR NEEDY PERSONS. Clerk's Notes: Item not ready; item passed to 12/02/ AUTHORIZE EXECUTION OF A CONTRACT WITH TRA VIS COUNTY FOR PERFORMANCE OF SERVICES AND THE TRANSFER OF ASSETS TO THETRA VIS COUNTY HOSPITAL DISTRICT. Clerk's Notes: Item not ready; item passed to 12/02/04

5 11 APPROVE THE DESIGN OF THE TRAVIS COUNTY HOSPITAL DISTRICT SEAL AND AUTHORIZE THE TRAVIS COUNTY PURCHASING AGENT TO ACQUIRE THE OFFICIAL SEAL OR APPROVE A PROCESS FOR DESIGNING A TRAVIS COUNTY HOSPITAL DISTRICT SEAL. (8:09) (8:18-8:24) Clerk's Notes: Manager Coopwood reported that the process of obtaining a design for a Travis County Hospital District seal has not worked out. Manager Coopwood proposed that Ms. Grimes issue and RFP for a seal. Manager Donald Patrick stated he had someone he wanted to speak to about a seal design. Mr. Collins stated he believed there were a number of artists in the community who would volunteer to design the seal. Mr. Collins further stated that it would be important to word the RFP carefully so that a responder would know that submission of a seal design also conveys the copyright for the seal to the Travis County Hospital District. He believes the most complicated factor would be the criteria for evaluating the seal designs. All designs can be submitted to the Board, or the Seal Committee can confer and select designs to be submitted to the Board. Chainnan Hedrick asked if an RFP needed to be issued if the District was not paying for the design. Mr. Collins responded that although an RFP was not required, he believed the RFP process was the most convenient way to notify the community of the seal design and to receive a variety and number of responses. Additionally issuing an RFP is a concrete manner in which to advise designers that the copyright does convey to the District. Vice-Chair Richie proposed that Manager Coopwood and two other individuals review all designs and then submit three or four designs for the Board's review. Ms. Grimes believes that the RFP could and should be done in an infonnal process. The Seal Committee is comprised of Managers Coopwood, Patrick and Hsu. Mr. Collins advised the Board that if the Seal Committee was charged with presenting one design to the Board, in essence, making the decision of what seal would representhe Travis County Hospital District, a posting for their meeting would be required because authority to act in the Board's stead was delegated. Manager Young proposed that at least two or more designs be presented to the Board by the Seal Committee.

6 A motion made by Manager Young and seconded by Vice-Chair Richie to form a Seal Committee comprised of Managers Coopwood, Patrick and Hsu and for the Committee to review and cull submitted designs and then present two or more designs to the Board for consideration. Chainnan Clarke Heidrick Vice-Chair Carl Richie Manager Tom Coopwood Manager Thomas Young Manager Victoria Hsu Manager Frank Rodriguez Manager Rose Lancaster Manager Donald Patrick Manager Rosie Mendoza Absent 12. RECENE A BRIEFING FROM TRISH YOUNG, CHIEF EXECUTNE OFFICER OF THE COMMUNITY CARE SERVICES DEPARTMENT OF THE CITGY OF AUSTIN, ON THE OPERATION AND STATUS OF PROGRAMS AND POLICIES FOR THE DELIVERY OF HEALTH CARE IN THE TRAVIS COUNTY HOSITAL DISTRICT AND APPROVE DIRECTIVES FOR THE OPERATION AND EXECUTION OF THE PROGRAMS AND POLICIES OF THE TRAVIS COUNTY HOSPITAL DISTRICT. (7:24-8:08) Clerk's Notes: Trish Young of the City of Austin Community Care Services Department presented the October financial report and an update on the MAP Program and Clinic operations. Clinic operations were transferred to the District from the City on September 30th. Revenue and Receivables are starting from zero. Ms. Young explained the adjustments to the report in payroll; contractual commodities; change in pharmacy dispensing. Walgreens is now the dispenser of pharmacy items; that report is still being fine tuned. 13 AUTHORIZE EXPENDITURE OF ENHANCEMENT PROGRAM FUNDS. (THOMAS COOPWOOD) (8:30) Clerk's Notes: Chainnan Heidrick opened discussion of the budgeted enhancements monies [$5,000,000.00] and how and when the money would be spent and to what needs and deserving entities. He stated an option would be for the Primary Care, Hospital, and Mental Health Committees would go through a series of meetings in which they would work through their charges

7 to the best of their ability and then the Chairs of those Committees sitting down with the Strategic Planning Committee and Manager Rodriguez and combine some of the priorities and come back to the Board with some recommendations. Manager Coopwood stated his reason for posting the item was so the enhancement money would not be overlooked. Manager Coopwood questioned whether money should be given to an organization with a specific request for its use or to communicate to the entity to utilize the money the best way they see fit. He also questioned if accountability standards should playa part in the enhancement money. Chainnan Heidrick spoke of potential goals of benchmarking goals of the District -specialty care, mental health, trauma care, and primary care. Another issue for the committees to consider is recouping the cost of care of outside of county patients. He asked each committee to identify and delineate needs into short term and long care. Manager Rodriguez spoke on strategic planning on a long term basis and doing a good job in identifying issues and being accountable to the taxpayers which would include perfonnance evaluations of agencies and entities working within the District goals. Vice-Chair Richie proposed a retreat style meeting to identify and prioritize Issues. Manager Patrick addressed the issue of needing full time help, someone who can identify what is going on with indigent care at this time. He believes it is important for the Board to set policies and recognize that the Board cannot do a hands on management of services provided due to expertise and time constraints in addition to not having sufficient information; that job should be one of a trusted Administrator who has a good track record and experience. Manager Patrick recognized the diversity and professional backgrounds of the Board members. He also feels that the number one priority is to find and put in place an Administrator so that the work of the District can move forward. Vice-Chair Richie propounded a timeline for hiring and having on board an Administrator as March 1 st. He also expressed the importance of being careful and making the right decision as to who will be the Administrator. Manager Patrick does not feel comfortable making long range plans until an Administrator is in place. Manager Young cautioned that even with fulltime staff members, the process will not be easy.

8 Manger Mendoza believes that the Board needs to be involved with what is going on with other entities, such as the Mayor's Task Force on Mental Health. Chainnan Heidrick believes meaningful progress can be made between now and when an Administrator is hired. He also brought up the fact that he has been approached by many people in reference to staff positions other than the Administrator. His belief is that the Administrator should hire the staff members. Other Board Members stated the same experience and concurred that the Administrator would do the interviewing and selecting of pennanent personnel for the District office. Vice-Chair Richie, Legislative Committee, asked Mr. Collins to look at the enabling statutes, the original bill allowing the District to be created and make a comparison of what was in the original bill and what was actually enacted so that the District may approach the legislature for the items not included in passed version. Mr. Collins asked if just items appropriate to this District should be delineated or all items. Vice-Chair Richie wants only those items appropriate to the District. Manager Young suggested that using the committee structure, each committee come up with its goals and provide the same to the Planning Committee. Chairman Heidrick agreed. Mr. Collins suggested a standing item of Report of Committees on each agenda posted. Chairman Heidrick concurred. A motion to adjourn was made by Manager Patrick and seconded by Manager Thomas Young. Attested to by: --- d~ ~~=" ~ Secretary Travis County Hospital District Board of Managers