Nov 15, 2023 Commissioners Court - Regular

[1. CALL TO ORDER]

[00:00:56]

CHOSE US FROM THE FOUNDATIONS OF THE WORLD , ANYTHING THAT WAS CREATED , YOU CHOSE US. EVEN THIS MOMENT IN TIME, YOU KNEW WHO WOULD BE GATHERED IN THIS ROOM, WHO WOULD BE PRESENT, WHO WOULD BE CHOSEN TO BE ON THIS PANELING BOARD AND I AM GRATEFUL TO YOU, THEY ARE HERE BY YOUR DIVINE APPOINTMENT. LORD, I PRAY TODAY, THE SCRIPTURES SAID LET'S IT BE THE LORD WHO DAILY LOADS US UP WITH BENEFITS, THE GOD OF OUR SALVATION, I PRAY FOR EVERYONE IN THIS ROOM THAT THEY WOULD BE BLESSED ABUNDANTLY, MORE THAN THEY CAN ASK OR THINK, IN JESUS NAME I ASK YOU TO DO ALL THESE THINGS,

AMEN. >> AMEN. I PLEDGE ALLEGIANCE TO THE FLAG OF THE UNITED STATES OF AMERICA AND TO THE REPUBLIC FOR WHICH IT STANDS ONE NATION UNDER GOD INDIVISIBLE WITH

LIBERTY AND JUSTICE FOR ALL. >> THANK YOU, YOU MAY BE

SEATED. >> IT IS WEDNESDAY, NOVEMBER THE 15TH. IT IS 908 , WE HAVE ALL MEMBERS OF THE COMMISSIONERS COURT PRESENT , WE ARE IN THE HE NUECES COUNTY COURTHOUSE AT 901 LEOPARD, I WILL CERTIFY, WE HAVE A QUORUM.

MOVING ON TO ITEM D ANNOUNCEMENT ON DISCLOSURES OF CONFLICTS OF INTEREST, IF ANYBODY HAS WHAT AND WITH HIS

[1. In recognition of Marcial Martinez, Jr.'s 30 years of service with Nueces County.]

THE NUN, WE WILL MOVE ON , 30 YEARS OF SERVICE WITH NUECES.

I THINK, HELLO. 30 YEARS, PRETTY AWESOME.

>> GOOD MORNING, LADIES AND GENTLEMEN. I STAND BEFORE YOU TO BID FAREWELL TO A CAREER THAT HAS SPANNED 30 YEARS. I

HAVE HAD THE OPPORTUNITY >> CAN YOU SPEAK IN THE

MICROPHONE? >> SORRY.

>> I HAD THE OPPORTUNITY TO LOOK-- WORK ALONG SOME OF THE MOST DEDICATED, SKILLED MEN AND WOMEN IN LAW ENFORCEMENT, I THINK EACH ONE OF THEM FOR THEIR GUIDANCE AND SUPPORT THROUGH THE YEARS , TO MY FAMILY, THANK YOU FOR YOUR LOVE, SUPPORT, AND ALLOWING ME TO DO WHAT I LOVE. I LOOK FORWARD TO THE NEW CHAPTER IN MY LIFE AND WILL ALWAYS REMEMBER THE AMAZING PEOPLE WHO ENABLED ME TO LIVE OUT MY

DREAMS THANK YOU. >> THANK YOU, WE ARE SO GRATEFUL. UNDERSTAND THAT SHE RETIRED FROM NUECES COUNTY. WE HAVE A SYMBOLIC WATCH, IT HAS NOT BEEN ENGRAVED. I WANT TO TAKE A PICTURE WITH YOU. WE WOULD LOVE TO GET A PHOTO. IF YOU WOULD LIKE YOUR PARENTS TO COME TOO.

[1. In recognition of "World Prematurity Day" - November 17, 2023.]

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THAT. >> GOOD MORNING. THE MARCH OF DIMES FOUNDATION WORKS TO PROMOTE THE HEALTH OF INFANTS AND WOMEN BY SUPPORTING RESEARCH, LEADING PROGRAMS, AND PROVIDING EDUCATION AND ADVOCACY. PREMATURE BIRTH IS THE LEADING CAUSE OF DEATH IN NEWBORN BASES. PREMATURITY IS DEFINED AS BIRTH BEFORE 37 COMPLETED WEEKS OF GESTATION.

PREMATURE BABIES MAY SUFFER COMPLICATIONS AND LIFELINE -- LIFELONG COMPLICATIONS. WHEREAS, IN TEXAS, MARCH OF DIMES HAS WORKED EXTENSIVELY TO ADVOCATE FOR MOMS AND BABIES WITH ABOUT 80,000 BABIES BORN CREAM -- PREMATURE EVERY YEAR.

THE MONTH OF NOVEMBER IS RECOGNIZED AS PREMATURITY AWARENESS MONTH. NOVEMBER 17TH IS RECOGNIZED AS PREMATURE DAY. BE IT RESOLVED THAT THE COMMISSIONER COURT OF NUECES COUNTY DECLARES NOVEMBER 17TH AS WORLD PREMATURE DAY IN NUECES COUNTY. IT FURTHER ENCOURAGES THE CITIZENS TO LEARN ABOUT THE RISKS ASSOCIATED WITH PREMATURE BIRTHS AND WHAT THEY CAN DO TO LOWER PREMATURE BIRTH RATES.

DULY ADOPTED, ON THIS 15TH DAY OF NOVEMBER, 2023.

>> I WILL MAKE THE MOTION. >> SECOND.

>> WE HAVE A MOTION IN A SECOND, ALL OF THOSE IN FAVOR SAY AYE. MISS SUE, I THINK YOU ARE HERE, DO YOU WANT TO SPEAK TO US? WE ARE ALL WEARING OUR PURPLE TODAY.

>> GOOD MORNING, THANK YOU ALL THAT KNEW IN ADVANCE FOR WEARING PURPLE, I APPRECIATE THE SUPPORT. I WILL TRY TO KEEP THIS SHORT BUT I WANT TO SAY A FEW WORDS. ANYBODY THAT HAS KNOWN ME FOR MORE THAN 10 MINUTES KNOWS I'M AN AVID SUPPORTER OF MARCH OF DIMES, I HAVE AND FOR OVER 25 YEARS.

UNFORTUNATELY WE NO LONGER HAVE A LOCAL OFFICE AND A LOCAL WALK EACH YEAR, BUT STILL, YOU WILL SEE ME IN THE SPRINGTIME WEARING MY LITTLE EARRINGS AND ASKING FOR DONATIONS , DOING MY RAFFLES, ALL OF THAT DIFFERENT STUFF. PREMATURITY IS DEFINED AS ANY , BEING BORN BEFORE 37 WEEKS. A LATE PRETERM IS BETWEEN 34 AND 36 WEEKS . VERY PRETERM IS AT OR BELOW 32 WEEKS , AND EXTREMELY PRETERM IS AT OR BELOW 28 WEEKS. THERE IS NOW ANOTHER CATEGORY , EXCUSE ME, WHICH IS A MICRO PREEMIE , THAT IS A BABY BORN WEIGHING LESS THAN ONE POUND 12 OUNCES, OR BEFORE 26 WEEKS. THE MARCH OF DIMES , WE MAY ALL KNOW, WAS CREATED IN 1938, THE ORIGINAL PURPOSE WAS TO FIND THE CURES FOR POLIO WHICH WAS DONE , THE NEXT MISSION WAS TO HELP FIGHT BIRTH DEFECTS AND INFANT MORTALITY . THE SHIFT

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FOR THE DAY. >> THANK YOU, THANK YOU FOR ALL OF YOUR YEARS OF CONTRIBUTIONS TO THIS WORTHY CAUSE TOO. I HAD A PREEMIE GREAT GRANDBABY. WE ARE VERY THANKFUL FOR ALL OF THE WORK AND RESEARCH , DOCTORS, EVERYONE.

>> DALE CAN ATTEST, I HAVE THE OFFICE VERY WELL TRAINED, PEOPLE COME IN AND THEY SEE MY LITTLE RELATED TO THE MARCH OF DIMES AND THEY ASK A QUESTION, SOMEBODY WILL, INEVITABLY ANSWERED, IT IS FOR THE BABIES.

>> VERY TRUE. >> THANK YOU. WE HAVE THIS FOR YOU. I THINK IT NEEDS TO BE SIGNED BY ONE MORE PERSON , BUT DID YOU WANT TO DO A PHOTO WITH US? YOU ARE MORE THAN WELCOME.

I JUST DON'T WANT YOU TO FEEL LIKE WE HAVE TWO.

[G. PUBLIC COMMENT: This section provides the public the opportunity to address the Commissioners Court on any issues within its jurisdiction. The Commissioners Court may not take formal action on any requests made during the Public Comment period which are not on the Agenda, but can refer such requests to County staff for review if appropriate.]

>> GOOD MORNING, MY NAME IS JOE ORTIZ I LIVE AT 2505 PRESS, I CAME HERE A TIME AGO ASKING FOR YOU ALL TO BE MORE CREATIVE IN THE WAY YOU OBTAIN FUNDS, ONE OF THEM WAS THE PLANNING, THE NUECES COUNTY PLANNING, COME TO FIND OUT THAT ONE OF YOUR COMMISSIONERS BROUGHT THIS UP BUT ANOTHER ONE CONTRADICTED IT, SAYING THAT THE ASSOCIATION, HE GOT IN CONTACT WITH THE BILLERS ASSOCIATION SAYING IT WAS NOT TRUE. THIS IS WHAT WE NEED, WE NEED TO FIND OUT IF WHAT WE ARE SEEING IS REALLY TRUE, THIS WAS INVESTIGATED AND FOUND OUT THAT

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I'M ASKING YOU ALL, AS COUNTY COMMISSIONERS , PLEASE RESPOND TO THE PEOPLE THAT REALLY NEED THE HELP. IN ORDER TO MAINTAIN DRAINAGE AND WATER, FRESHWATER, FROM THE COUNTY. THAT IS ALL I'M ASKING, PLEASE RETURN THE PHONE CALLS IN MY DISTRICT ,

THANK YOU, MA'AM. >> CRAIG PETERSON.

>> ALL RIGHT, GOOD MORNING. MY NAME IS DR. CRAIG PETERSON I LIVE AT 15360 GYPSY STREET, I AM ONE OF THE MEMBERS WITH THE MEDICINE PROGRAM. I WOULD LIKE TO TAKE THIS OPPORTUNITY TO EXPRESS MY APPRECIATION FOR THE SUPPORT WE HAVE RECEIVED FROM THE COMMUNITY. IT HAS BEEN INCREDIBLY MOVING TO HEAR PATIENTS, FAMILY MEMBERS, AND OTHERS SPEAK ON OUR SUPPORT. I ALSO WISH TO EXPRESS SINCERE THANKS TO OUR MAYOR AND ALL MEMBERS OF CITY COUNCIL FOR GIVING US AN AUDIENCE. WE WERE INEXPERIENCED AND MAY OR MAY NOT HAVE APPLAUDED WHEN WE SHOULD HAVE, BUT YOU WERE GRACIOUS NONETHELESS. I CANNOT SPEAK HIGHLY ENOUGH OF THE SUPPORT WE RECEIVED FROM JUDGE SCOTT ON THE COMMISSIONERS COURT. YOU HAVE TRULY GONE ABOVE AND BEYOND. SOME COMMISSIONERS HAVE GONE SO FAR AS TO ATTEND AND SPEAK IN PUBLIC COMMENT, YOU HAVE BEEN EXCELLENT REPRESENTATIVES OF YOUR CONSTITUENCY. I AM VERY GRATEFUL FOR THE CARE AND ATTENTION YOU HAVE PAID TO THIS ISSUE. HE MOVED QUICKLY AND DECISIVELY. THANK YOU FOR TAKING ACTION. AS GRATEFUL AS I AM FOR ALL OF YOU AND YOUR EFFORTS ON OUR BEHALF, I AM CONCERNED THAT THE TENTATIVE AGREEMENT THAT PROVIDES FUNDING FOR THE NEXT FIVE YEARS WILL NOT BE ENOUGH TO ENSURE LONG-TERM SURVIVAL, LET ALONE SUCCESS FOR THE RESIDENCY PROGRAM. IT TAKES 36 MEANT-- MONTHS TO COMPLETE RESIDENCY. EFFECTIVELY, IT IS A 48 MONTH CYCLE. IN THE FALL OF 2024 WE WILL BE RECRUITING THE CLASS OF 2028. WHEN THAT CLASS IS IN THEIR FINAL YEAR THE INTERNS, AT THAT TIME, WILL NOT HAVE FUNDING. PRACTICALLY SPEAKING, A FIVE-YEAR EXTENSION ONLY DELAYS THIS BY ONE YEAR, AT A COST OF $18 MILLION IN ADDITION TO THE FUNDING ALREADY RECEIVED. WE WILL NOT BE ABLE TO RECRUIT RESIDENTS IN GOOD FAITH TO A PROGRAM THAT WILL NOT EXIST FOR THE DURATION OF THEIR TRAINING. MANY OF THEM WILL TRANSFER TO OTHER PROGRAMS. DUE TO THE ROLLING NATURE , RESIDENCY PROGRAM CAN ONLY OPERATE AT A FULLY FUNCTIONING CAPACITY WITH THE PROMISE OF LONGEVITY. THOSE WITH HIGH SCHOOL AGE CHILDREN ARE NO DOUBT LOOKING TO -- LOOKING FORWARD. DEGREES THAT THOSE INSTITUTIONS ARE ONLY GUARANTEED TO 2029, IT WOULD BE IRRESPONSIBLE AS A PARENT TO SUPPORT YOUR CHILD'S CHOICE OF A SCHOOL KNOWING THAT THEY WOULD HAVE TO TRANSFER BEFORE ■ COMPLETING THEIR DEGREE, NO MATTER HOW STORIED THE INSTITUTION IS. THIS BRINGS EVEN MORE TRUE FOR RESIDENCY TRAINING WHICH IS THE CULMINATION OF MOST PHYSICIANS ACADEMIC JOURNEYS. THE FOUNDATION IN WHICH THEIR CAREER IN MEDICINE IS BUILT. WITH SUCH UNCERTAINTY WE WILL NOT BE ABLE TO RECRUIT, IN GOOD FAITH, NOR WOULD STUDENTS CHOOSE TO TRAIN HERE REGARDLESS OF HOW WELL TRAINED CURRENT AND PAST RESIDENTS ARE. THANK YOU SO MUCH FOR YOUR TIME AND CONSIDERATION IN THE MATTER, I KNOW WE CAN FIND A RESOLUTION TOGETHER THAT ENSURES QUALITY CARE FOR DECADES TO COME, THANK

YOU. >> THANK YOU. MICHAEL ABEYTA

YOUR. -- >> MY NAME IS MICHAEL BORDOER,

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TRAINING PROGRAM IN THE COASTAL BEND. I HAVE READ, WITH GREAT INTEREST, THE NEWS OF FUNDING THAT WOULD ALLOW OUR PROGRAM TO CONTINUE FOR ANOTHER FIVE YEARS. I HEARD ABOUT THIS THROUGH THE LOCAL NEWS. FIVE YEARS OF FUNDING SOUNDS WONDERFUL TO A PROGRAM THAT RECEIVED WERE JUST OVER A MONTH AGO OF A PHASEOUT, WHICH PRACTICALLY SPEAKING, AMOUNTED TO A CLOSER NEXT YEAR. I HAVE A CONCERN, MY FEARS IMPLEMENTATION OF A PLAN THAT DOES NOT ACHIEVE WHAT YOU MAY HAVE BEEN LED TO BELIEVE IT WOULD , AND THAT GREAT EXPENSE TO THE TAXPAYERS OF THE COUNTY, AS REPORTED ON LOCAL NEWS FOR $18 MILLION THE PROGRAM WOULD BE SAVED FOR FIVE MORE YEARS, BUT I AM CONCERNED THAT THE PROGRAM WOULD NOT BE SAVED FOR NECESSARILY EVEN MORE THAN A YEAR AND HERE IS WHY, AND CHD FUNDING WOULD AGAIN FOR THE 2024 TO 2025 ACADEMIC YEAR WHICH STARTS IN JUNE, NEXT OCTOBER, WHICH IS LESS THAN ONE YEAR AWAY WE WOULD START RECRUITING AND INTERVIEWING FOR OUR CLASS OF 2028. THIS CLASS WOULD GRADUATE IN JUNE OF 2028 AT THE END OF THE FOURTH YEAR OF FUNDING , THE CLASS OF 2028 WOULD BE THIRD-YEAR RESIDENTS THAT YEAR, THE PROBLEM IS THAT FIRST-YEAR RESIDENTS IN THE 2027 TO 2028 YEAR WOULD NOT HAVE GUARANTEED FUNDING TO FINISH THEIR TRAINING , THAT MEANS THAT NO INCOMING FIRST-YEAR RESIDENT WHICH YOU -- WOULD CHOOSE TO TRAIN. THE CLASS OF 2028 WOULD GRADUATE WITHOUT HAVING A FULL COMPLEMENT OF RESIDENTS AT THE PROGRAM, THIS IS THE LIFEBLOOD OF A PROGRAM. I'M TELLING YOU THIS TODAY BECAUSE IT WOULD BE CONSIDERED UNETHICAL TO EVEN INTERVIEW RESIDENTS NEXT YEAR BECAUSE OF HOW THEIR TRAINING WOULD BE NEGATIVELY IMPACTED BY THIS PLAN . FOR $18 MILLION WE ARE NOT GETTING FIVE YEARS. WE ARE NOT NECESSARILY GETTING CLOSE TO A FULL YEAR. IF MY RESIDENCY PROGRAM LEADERSHIP HAD BEEN ABLE TO PARTICIPATE IN THESE DISCUSSIONS, THAT ERROR IN REASONING COULD HAVE BEEN EASILY AVOIDED , BUT THERE WAS AN NDA, UNFORTUNATELY NO REPRESENTATIVES FROM MY PROGRAM WERE ABLE TO PARTICIPATE , PERHAPS THIS COULD HAVE BEEN AVOIDED IF THEY HAD COME TO THE SPECIAL COMMITTEE FORMED BY JUDGE CONNIE SCOTT OVER THE ISSUE, WE APPRECIATE THIS.

THERE IS ANOTHER WAY. THIS WAY ISN'T HAVING OUR E.R. TRAINING PROGRAM TRANSFER TO ANOTHER SYSTEM HERE IN CORPUS, AND CHD WOULD NOT SPEND $18 MILLION, THEY WOULD BE ABLE TO COMPLETE THEIR VISION FOR HEALTHCARE AND E.R. TRAINING WOULD REMAIN IN CORPUS WHERE FACULTY AND RESIDENTS ARE VALUED FOR THE BENEFITS WE BRING TO ALL, THANK YOU.

>> THANK YOU. >> MARILYN BORDOER .

>> GOOD MORNING JUDGE SCOTT AND COMMISSIONERS , I AM MARILYN BORDOER, I AM THE DENTIST WHO IS MARRIED TO DOC HER MICHAEL BORDOER. I WOULD LIKE TO REVIEW FOR ADDITIONAL DATA POINTS THAT HAVE EMERGED SINCE WE LAST CAME , AND A PROMISING SOLUTION.

WEDNESDAY LAST WEEK, THEY AGREED TO FIVE YEARS OF AND CHD FUNDING FOR $18 MILLION. I ASSUME THAT FIVE YEARS WAS THE LONGEST TERM THAT THE AND CHD COULD NEGOTIATE, AS YOU JUST HEARD, THIS ONLY TAKES THE CANNED DOWN THE ROAD UNTIL OCTOBER OF NEXT YEAR THIS REAFFIRMS WHAT WE ARTY KNOW, RESPOND DOES NOT REALLY WANT AN EM RESIDENCY PROGRAM . DATA POINT NUMBER TWO, YESTERDAY, SPOT ANNOUNCED CONFERENCE SPACES USED TO TEACH RESIDENTS WOULD NOT BE AVAILABLE FROM NOW UNTIL MARCH 31ST. THEY NEEDED FOR COMPUTER TRAINING. I CAN DISTRIBUTE THIS MEMO IF DESIRED. AGAIN, THE RESIDENCY STAFF WAS NOT CONSULTED AHEAD OF TIME TO FIND A SOLUTION.

CLASSROOM TEACHING IS A REQUIREMENT OF ACADEMIC TRAINING AND THEY ARE JUST NOT COMMITTED TO ACADEMIC TRAINING.

AGAIN, IT APPEARS FROM THEIR ACTIONS THAT THEY DO NOT WANT THIS RESIDENCY. DATA POINT NUMBER THREE. THEY PUBLICLY ANNOUNCED YESTERDAY, AT THE NCHD MEETING THAT THEY WOULD BE A WILLING HOME FOR THE PROGRAM , FROM WHAT I UNDERSTAND THEY WOULD NOT NEED ONGOING YEARLY FUNDING, PERHAPS SOME CAPITAL IMPROVEMENT FUNDS TO PROPERLY HOUSE THE PROGRAM. THIS WOULD BE MUCH LESS THAN $18 MILLION . MORE IMPORTANTLY, THE PROGRAM COULD CONTINUE ON WITH OUT A TIME LIMIT ON FUNDING . THEY ARE WILLING TO PUT A RING ON IT. DATA POINT NUMBER FOUR,

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THANK YOU. >> JUAN RAMIREZ.

>> GOOD MORNING, HONORABLE JUDGE SCOTT AND COUNTY COMMISSIONERS, MY NUMB -- MY NAME IS DR. JUAN RAMIREZ. I HAVE BEEN HERE IN THE COMMUNITY FOR ABOUT FIVE YEARS, SINCE THEN, SIX YEARS ACTUALLY, SINCE THEN I HAVE BEEN THE MEDICAL DIRECTOR . JUST TO START, I'M GOING TO BE BRIEF, I KNOW EVERYBODY HAS THINGS TO DO TODAY, JUST TO START, EVEN THOUGH THE RESIDENCY PROGRAM BELONGS TO SPOHN , THAT IS NOT MY HOSPITAL. WE STILL HAVE A LOT OF AND IF IT'S WE HAVE STILL GREAT BENEFITS FROM THE RESIDENCE. EVERY YEAR I GET SOME OF THE RESIDENCE COMING TO WORK FOR ME. THEY ARE COMING TO WORK AS NEW MITERS SINCE WE DO NOT HAVE ENOUGH DOCTORS IN THE COMMITTEE. THAT IS A LIFESAVER FOR US , IT SUPPORTS OUR SYSTEM. THE RESIDENCY PROGRAM IS NOT ONLY AN ASSET FOR THE HOSPITAL, BUT IS AN ASSET FOR THE COMMUNITY , THAT IS SOMETHING THAT HAS TO BE VERY CLEAR, THE RESIDENCY IS NEEDED AND IT DOESN'T ONLY BENEFIT ONE SYSTEM, IT BENEFITS BOTH SYSTEMS. I KNOW GOING TO KATRINA I WAS TRAINED IN NEW ORLEANS AND I WENT TO KATRINA. I HAD TO LIVE UNDER THE BRIDGE OF BATON ROUGE FOR SIX MONTHS IT IS A DIFFERENT SITUATION THAN IT IS RIGHT NOW. IT IS SOMETHING COMPARABLE WITH THE HORRIBLE FEELING OF NOT HAVING A HOME . THAT IS WHY I SHOW A LOT OF SYMPATHY WITH THE SITUATION AND WHAT WE ARE GOING THROUGH ALL OF THESE PROCESSES. OUR CEO CONFIRMED YESTERDAY THAT HE IS WILLING TO WORK WITH A SPONSOR LINE LEADERSHIP . HE IS WILLING TO WORK WITH THE NUECES COUNTY MEDICAL DISTRICT.

THAT IS BASICALLY WHAT WE WANT TO SAY, WE WANT TO MAKE SURE THAT WE ARE HERE , AND WHATEVER THE DECISION IS MADE , WE WILL SUPPORT EITHER WAY. I PERSONALLY BELIEVE THAT THE PROGRAM IS STRONG , I PERSONALLY HAVE SUPERVISED THE RESIDENCE COMING FROM THE PROGRAM , AND I PERSONALLY HAVE GIVEN RECOMMENDATIONS WHEN THEY MOVE UP IN THE LETTER FOR FUTURE TRAINING OR FOR BEZEL HOSS -- BETTER HOSPITALS OR FOR

GOING OUT OF TOWN. THANK YOU. >> THANK YOU. VERONICA WILSON.

>> GOOD MORNING JUDGE, GOOD MORNING COMMISSIONERS, IS IT A LITTLE BIT COLD?

>> I TURNED THE FAN ON. GOOD MORNING, I AM VERONICA WILSON I LIVE AT 19 GREAT LAKES DRIVE. I WANT TO SPEAK TO THE MEETING

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>> THANK YOU. DAVID GILMORE.

>> GOOD MORNING, DAVID GILMER, 7934 RANCHO BEAST BOULEVARD, I'M HERE TO SPEAK ON WASTE DISPOSAL, I NUMBER 3249 DASH 23. THE LAST TIME I WAS HERE IT WAS MY FIRST MEETING AND IT WAS NICE TO SEE THE ATTENTION TO DETAIL, THE REFERRING TO THE COUNTY ATTORNEY ON DIFFERENT TOPICS THAT YOU GUYS WERE DISCUSSING TO MAKE SURE THAT VERBIAGE WAS IN THE CONTRACTS TO PROTECT YOURSELVES. THAT BEING SAID, COMING TO THIS AGREEMENT, IT STARTS WITH THE DETAILS, IT STARTS WITH FILING FOR AN OPPORTUNITY TO BID , REQUIRING DOCUMENTS NOT PROVIDED BY THE CURRENT PROVIDER, HERE WE ARE, AGAIN, I'M GOING AROUND VISITING THE DIFFERENT APARTMENTS WITH THE CONTAINERS, I HAVE SHOWED YOU THE VIDEOS OF THE COMPACTORS, THE SECOND ONE, BOTH HAVE BEEN PULLED NOW, I WENT DOWN TODAY TO CHECK , STILL NO SAFETY SWITCH ON THAT, THE DOOR IS STILL OPEN AND IT RUNS, IT IS NOT LEAKING THIS TIME, BUT THANK GOD THEY HAVE THE TRUSTY BROOM UP THERE TO PUSH THE DOOR OPEN TO HOLD IT SO THAT THE WIND DOES NOT CATCH IT AND EMPLOYEES CAN LOADED. THESE ARE THE ATTENTION TO DETAILS THAT SHOULD HAVE BEEN TAKEN CARE OF BY THE PROVIDER THAT IS DOING IT FOR YOU GUYS NOW. THIS IS WHAT REPUBLIC STANDS FOR. WE HAVE THREE BRAND PILLARS, SAFETY, WE WANT TO MAKE SURE THAT THINGS ARE DONE SAFELY FOR OUR EMPLOYEES AND YOUR EMPLOYEES. RELIABILITY, WE ARE GOING TO DO WHAT WE SAY, WE ARE GOING TO MAKE SURE THAT EVERYTHING IS DONE IN THE CORRECT WAY, AND THAT WE HAVE ENVIRONMENTAL RESPONSIBLE. YOU CANNOT HAVE LEAKS GOING DOWN IN THE SEWERS, THE DRAINS. THESE ARE VERY IMPORTANT TO REPUBLIC SERVICES, THAT IS WHAT IS GOING TO SEPARATE US, A $730 DIFFERENCE BETWEEN THE CONTRACTS THAT, RIGHT NOW, THAT YOU GUYS ARE PAYING TO WHAT IT WOULD BE WITH US. I HAVE NEVER SEEN A CONTRACT OR A GO DOWN IN THREE YEARS, BUT IT IS PRETTY EVIDENT WHY YOU CAN GET THINGS DONE CHEAPLY IF NO ONE IS MONITORING THE SAFETY AND THE ENVIRONMENTAL AND JUST BEING RELIABLE AND DOING WHAT THEY SAY THEY ARE GOING TO DO. I AM POOR YOU GUYS TODAY TO TAKE THAT INTO ACCOUNT BEFORE YOU MAKE YOUR DECISION, IT IS A VERY MINIMAL AMOUNT OF MONEY, BUT WHEN I WAS HERE LAST TIME, MR. HERNANDEZ TALKED ABOUT THE SLIP AND FALL HE HAD OUT THERE BEFORE WITH CONTAINERS LEAKING. THAT BEING SAID, I JUST WANT TO SAY THANK YOU FOR TAKING THE TIME TO LISTEN TO ME TODAY AND TAKING A LOOK AT ALL OF THE VIDEOS AND STUFF THAT I HAD SENT YOU GUYS, HOPEFULLY WE CAN MOVE FORWARD IN THE RIGHT

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MUCH. >> THANK YOU.

>> IS THERE ANYONE THAT CAME IN LATER THAT WISHES TO SPEAK? IF YOU WOULD GO UP TO THE PODIUM AND STATE YOUR NAME AND

ADDRESS, PLEASE. >> HELLO, MY NAME IS SUNNY TIRE FROM 2010 MAGNOLIA DRIVE, THANK YOU FOR ALLOWING ME TO SAY SOME WORDS. I WANT TO ECHO SOME WORDS I SPOKE PUBLICLY YESTERDAY. ON OCTOBER 12, IT KIND OF SEEMS LIKE A LIFETIME AGO, IT HAS BEEN THE MOST STRESSFUL, AND REMEMBER I'M AN E.R. DOCTOR, BUT SOME OF THE MOST HUMBLING WEEKS OF MY LIFE.

SOMEONE ASKED ME ON THE 12, WHAT ARE YOU GOING TO DO. I SAID, THAT IS EASY, WE ARE GOING TO FIGHT, BUT THEN THEY ASKED AGAIN, NO, WHAT ARE YOU GOING TO DO. I HAD NOT REALLY THOUGHT ABOUT THAT. I STILL REALLY HAVE NOT TODAY AND I DON'T THINK ANY OF THESE GUYS REALLY HAVE COME A BECAUSE IT HAS NOT BEEN ABOUT US AS INDIVIDUALS, IT HAS ALWAYS BEEN ABOUT SERVING OUR COMMUNITY. WE HAVE BEEN ABSOLUTELY HUMBLED BY HOW HARD THE COMMUNITY HAS FOUGHT ALONGSIDE US, HOW HARD ALL OF YOU SEATED BEFORE ME HAVE FOUGHT FOR US. OUR VISION, OUR GOAL, AS IT WAS MEANT TO PROVIDE THIS VULNERABLE COMMUNITY WITH THE HIGHEST QUALITY, MOST UP-TO-DATE, AND MOST EVIDENCE-BASED CARE POSSIBLE. PATIENT COMES FIRST.

EVERYBODY SAW THAT , THE COASTAL BEND SO THAT. TOGETHER WE HAVE BEEN ABLE TO GET A HANDFUL OF PEOPLE THAT MADE THAT DECISION ON OCTOBER 12 , JUST MAYBE, TO SEE IT TOO. WE WOULD ALL BE NAIVE TO THINK THAT THAT IS THE END. IT IS ONLY THE FIRST STEP IN A REALLY TREACHEROUS JOURNEY AHEAD OF US. THIS AFTERNOON, I HOPE TO SAY THAT, WELL, DAVID OVERCAME GOLIATH, THAT OUR SMALL GROUP OF E.R. DOCTORS WITH THE IMMEASURABLE HELP OF THE COMMISSIONERS COURT ON THIS COMMUNITY, OVERCAME THAT GIANT OF A DECISION THAT WAS MADE ON OCTOBER 12TH TO CLOSE THE RESIDENCY. I WON'T BE ABLE TO SAY THAT WE HAVE OVERCOME IT IF IT IS ONLY TEMPORARY. HOW DO I EVER FEEL SAFE AGAIN WITH A DEADLINE ON MY LIVELIHOOD, MORE IMPORTANTLY, HOW COULD I EVER INSTILL FAITH IN MY PATIENTS IN MY COMMUNITY KNOWING THAT THERE'S A DEADLINE ON THEIR ACCESS TO QUALITY CARE. I'M NOT ONLY SPEAKING ABOUT EMERGENCY CARE, MY WIFE IS A LOCAL FAMILY DOCTOR, SHE IS FELLOWSHIP TRAINED IN GERIATRICS WHICH MEANS HER SPECIALTY IS OUR EXTREMELY VULNERABLE, ELDERLY POP ELATION. SHE IS THE ONLY PHYSICIAN IN HER CLINIC, IT IS DIFFICULT TO RECRUIT DOCTORS OF ALL SPECIALTIES. SHE MANAGES OVER 2000 PATIENTS BY HERSELF, SHE IS THE ONLY ACCESS TO CARE THAT THEY HAVE. IF YOU ASK HER WHY SHE PRACTICES IN CORPUS CHRISTI, WHEN THE ENTIRETY OF HER FAMILY AND FRIENDS ARE HUNDREDS OF MILES AWAY SHE WOULD SAY IT IS AS I PRACTICE HERE. YOU ASKED ME THE SAME, WHY I PRACTICE HERE WHEN MY FAMILY AND ALL OF MY FRIENDS ARE ALSO HUNDREDS OF MILES AWAY IT IS BECAUSE THIS RESIDENCY IS HERE. PUTTING A DEADLINE ON THE RESIDENCY PUTS A DEADLINE ON ME BEING HERE, WHICH PUTS A DEADLINE ON HER BEING HERE WHICH PUTS A DEADLINE ON ACCESS FOR OVER 2000 MEMBERS OF THE COMMUNITY. THERE ARE OVER 50 MORE STORIES LIKE THAT IN THE RESIDENCY. WHAT IS TO SAY THIS WON'T HAPPEN AGAIN TOMORROW. A REAL BATTLE WILL BE TO ENSURE THAT IT IS NOT LOST, TO ENSURE THAT SOMETHING SO DEBILITATING TO THIS COMMUNITY CAN NEVER HAPPEN AGAIN. WE NOT ONLY OWE THIS TO OURSELVES, WE OWE IT TO THE COASTAL BEND, THANK YOU.

>> THANK YOU. I THINK, COMMISSIONER CHESNEY, YOU

WANTED TO SPEAK? >> I CAN DO IT IN PUBLIC COMMENT, IS THERE A WAY TO BUMP UP THE ITEM SINCE IT IS AN AGENDA ITEM? I CAN MAKE IT AS A PUBLIC COMMENT.

>> I WOULD BUMP UP THE ITEM. >> I CAN JUST MAKE A PUBLIC

COMMENT. >> JUST MAKE A PUBLIC COMMENT IF WE ARE GOING TO BRING IT BACK ANYWAY.

>> WILL YOU SIGN YET? >> YEAH, I HAVE YOU ON HERE.

>> I WOULD LIKE TO MAKE A COMMENT TOO.

>> YOU CAN BRING UP THE ITEM TWICE, BRING IT UP AT THIS TIME AND THEN LATER AFTER THE MEETING.

>> HOWEVER YOU WANT TO DO IT. >> I WILL TELL YOU, PUBLIC COMMENT IS WHEN AN AGENDA ITEM IS BEFORE US. I THINK THAT US, AS ELECTED OFFICIALS, SHOULD BE TAKING TIME OUT OF PUBLIC COMMENT, THAT, IN MY OPINION, AVERTS THE OPEN MEETINGS REQUIREMENT THAT WE ARE REQUIRED TO FOLLOW. I WOULD SUGGEST THAT WE PUSH THE ITEM UP, I THINK WE ALL WANT TO WEIGH IN AND WE KNOW THAT THE DOCTORS HAVE TWO MEETINGS TO SPLIT TO AMONGST ALL OF THE ROUNDS AND EVERYTHING ELSE THAT THEY HAVE TO DO. I WOULD LIKE TO SEE IT MOVED UP.

>> OKAY, I WILL MOVE IT UP. >> THEY HAVE A MEETING SCHEDULED FOR TODAY , HE WILL BE ABLE TO REPORT AFTER THAT

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>> YOU LET US KNOW LAST NIGHT.

>> IF THERE IS NO ONE ELSE WHO WISHES TO SPEAK ON PUBLIC

COMMENT, YES, PLEASE. >> GOOD MORNING, MY NAME IS DR. CARL SERENO, I'M ACTUALLY HERE TO REPRESENT NUECES COUNTY MEDICAL SOCIETY. I WANTED TO READ A BRIEF STATEMENT FROM THE SOCIETY. THE NUECES COUNTY MEDICAL SOCIETY IS IN SUPPORT OF THE RESIDENCY PROGRAM , THE SOCIETY RECOGNIZES THE IMPORTANCE OF EMERGENCY MEDICINE RESIDENCY PROGRAMS AND THE TRAINING AND PRODUCTIVITY OF HIGHLY SKILLED PHYSICIANS, AND ALSO RECOGNIZES NUECES COUNTY COUNTY DISTRICT IN ITS VITAL ROLE THAT IT HAS PLAYED IN THE HEALTH AND WELL-BEING OF THE COUNTY RESIDENTS IN INDIGENT CARE.

ALSO RECOGNIZING THAT NCHD IS PARAMOUNT FOR SUSTAINING HIGH QUALITY MEDICAL CARE. THE NUECES COUNTY MEDICAL SOCIETY URGES THE COMMISSION AS WELL AS THE HOSPITAL RESTRICT TO TAKE THE FOLLOWING ACTIONS, ONE, ALLOCATE AND SIT HERE -- SECURE FUNDING FOR THE RESIDENCY PROGRAM TO ENSURE SUSTAINED OPERATION AND GROWTH SO THAT THEY MAY CONTINUE TO SERVE THE RESIDENTS , AND THE SURROUNDING RURAL AREAS. TWO, ENCOURAGE THE COLLABORATION TO IDENTIFY OPPORTUNITIES TO DEVELOP A LONG-TERM AGREEMENT NUMBER THREE, IF IT CANNOT BE REACHED , THAT THERE BE COLLABORATION WITH OTHER HEALTHCARE ENTITIES WILLING TO PROVIDE A LONG-TERM SOLUTION INCLUDING TRANSFERRING THE PROGRAM TO OTHER HOSPITAL SYSTEMS. THE ONGOING SUPPORT AND COLLABORATION WITH THE HOSPITAL DISTRICT AND THE COMMISSION TO ACHIEVE GOALS OUTLINED , WE LOOK FORWARD TO YOUR COOPERATION AND YOUR SUPPORT, THANK YOU.

>> THANK YOU. YOU ALL FOR BEING HERE THIS MORNING. IF THERE ARE NO OTHERS WISHING TO SPEAK ON PUBLIC COMMENT, I WILL GO AHEAD AND BRING UP 382, REGULAR AGENDA ITEM, RECEIVING AN UPDATE RELATING TO THE EMERGENCY MEDICINE RESIDENCY PROGRAM , WE BOTH TALKED TO HIM LAST NIGHT . THEY WERE WANTING TO DO THIS, POSSIBLY AT 3:30'S AFTERNOON, WE WERE GOING TO BRING IT UP LATE. I DO AGREE WITH THE FACT THAT HE NEEDS TO PRESENT TO HIS BOARD BEFORE HE COMES IN AND PRESENTS TO US , AND THEIR DISCUSSION FROM YOUR MEETING. HE IN NO WAY, SHAPE, OR FORM, IS NOT WANTING TO BE HERE, HE JUST HAS PROTOCOLS TO FOLLOW AS WELL. COMMISSIONER CHESNEY.

>> THANK YOU JUDGE, LET ME START BY SAYING AND ECHOING SOME OF THE COMMENTS THAT THE DOCTORS HAVE SO ELOQUENTLY MADE TODAY, THANK YOU TO THE HOSPITAL DISTRICT BOARD FOR JUMPING ON THIS, I AM SORRY, I'M COLD, I'M CHATTERING APPEAR. WE WOULD NOT BE IN THIS POSITION WERE IT NOT FOR THE HELP OF THE HOSPITAL DISTRICT, THEY HAVE ALWAYS BEEN A GREAT PARTNER FOR NUECES COUNTY, THEY HAVE REALLY STEPPED UP. WE HAVE SPENT COUNTLESS HOURS AT THE RICK-- THE REQUEST, CREATING THIS COMMITTEE AND WORKING WITH THE DISTRICT. WE HAVE GONE BACK AND FORTH ON THIS. WE REALLY FELT THAT THE TIME THAT THE HOSPITAL DISTRICT HAD COME UP WITH SOMETHING THAT WE HAD ALL ASKED FOR, GO BACK AND SEE IF THEY WOULD BE WILLING TO KEEP THIS. THAT WOULD BE THE EASIEST WAY TO START . WE ALL GOT TO A POINT WHERE WE FELT LIKE, AND I'M NOT TRYING TO SPEAK COLLECTIVELY, IF I'M NOT DOING IT RIGHT, SOMEONE WILL CORRECT ME, I GOT TO THE POINT WHERE I FELT LIKE WE WERE TRYING TO PUT A SQUARE PEG INTO A ROUND HOLE BECAUSE SPOHN DID NOT WANT THE PROGRAM, THAT IS NOT A CRITIQUE, IT IS JUST THAT THEY HAVE GONE A DIFFERENT DIRECTION IN A CORPORATE MANNER. I DO NOT WANT MY COMMENTS TO BE TAKEN NEGATIVELY ABOUT SPOHN AT ALL. THEY HAVE MADE A BUSINESS DECISION THAT THIS IS NOT WHAT IS BEST FOR THEIR BUSINESS.

THEY HAVE MADE A BUSINESS DECISION THAT THIS IS WHAT IS BEST FOR THEIRS. THEREFORE, THE FEELING IN THE ROOM AND THE COMMITTEE, WE WOULD RATHER JUST GO . AGAIN, THEY DID NOT COME TO THOSE MEETINGS , THAT IS NOT A CRITIQUE, IT IS JUST A FACT.

[00:45:02]

AS I HAVE SAID TO THEM, THIS COULD BLOW UP THE WHOLE THING, THIS IS A HIGH RISK , HIGH REWARD ASK AT THE LAST MOMENT.

I'M SAYING THIS TO YOU AS YOU ARE SITTING IN THIS ROOM NODDING YOUR HEAD IN AGREEMENT COME I WANT TO MAKE SURE THAT IS IT, IT IS A BIG ASK, THIS CLOSE, WORKING ON CONTRACTS, WE ARE SAYING, ALL RIGHT, WE NEED TO SHIFT AGAIN. IT IS A BIG FINANCIAL REQUEST. HCA IS NOT MAKING THAT FINANCIAL REQUEST, THEY ARE THING WE WANT THIS, WE WILL TAKE THIS, WE WILL NEED SOME TRANSITION MONEY . I GET THAT THERE IS NOTHING ON THE TABLE, THAT IS THE HIGH RISK OF THIS, IF IT DOES NOT WORK OUT THE DEVILS ARE ALWAYS IN THE DETAILS, THIS COULD BLOW UP THE WHOLE THING. THE DOCTORS, I HAVE SAID THAT TO THEM, I HAVE ARGUED IT IS AND IT-- IT IS NOT THE RIGHT WAY OF SAYING IT, I HAVE REALLY PLAYED DEVILS ADVOCATE WITH THEM, MY BACK AND FORTH WITH THE REPRESENTATIVES, THEY STILL FEEL STRONGLY THAT IT IS REALLY BETTER TO TRY TO DO THIS NOW. IT REALLY PUTS THEM IN A BAD SPOT IF WE TAKE THE FIVE-YEAR PLAN . WITH THAT SAID, KNOWING ALL OF THE RISKS AND THE REWARD, ALL THE HOURS THAT WE HAVE SPENT ON THIS, AND WE PLANNED ON DOING THIS IN THE EXECUTIVE SESSION AND LETTING THE WHOLE COURT KNOW WHERE WE WERE, BECAUSE WE CAN ONLY TALK BETWEEN OURSELVES, WE HAVE NOT HAVE THE OPPORTUNITY TO SHARE THIS WITH THE REST OF THE COURT YET, THAT IS WHY WE PUT IT ON THE AGENDA TO DO IT TODAY. YOU KNOW, THE NDA, AS FAR AS I'M CONCERNED, THOSE DETAILS HAVE BEEN MADE PUBLIC. TO ME, THE HECK WITH THE NDA, LET'S GET THE DOCTORS TO THE TABLE AND GET THIS WORKED OUT. THOSE DETAILS ARE NOW PUBLIC, THEY HAVE BEEN RELEASED TO THE MEDIA, EVERYBODY KNOWS WHAT THE DEAL IS, EVERYBODY KNOWS WHAT THE PROPOSAL IS. THAT NDA HAS BEEN BREACHED, FORGIVEN, WHATEVER THE CASE MAY BE, AT THIS POINT, IF WE COULD GET SPOHN AND HCA TO THE TABLE , I THINK IT COULD BE WORKED OUT.

IF THEY DO NOT WANT IT, THERE IS NO SHAME IN IT, IT IS FINE, NOBODY IS GOING TO SHAME YOU FOR NOT KEEPING A PROGRAM THAT IF YOU HAVE MADE A CORPORATE DECISION TO GO IN AND ENTERED THE DIRECTION, LET IT GO, ALL WE ARE ASKING IS FOR THE HOSPITAL DISTRICT TO TABLE IT, THE DOCTORS CAN GET TO THE TABLE, WORK THIS OUT, ASK THEM TO TRANSFER IT OVER, BECAUSE WHAT I LEARNED, APPARENTLY, JUDGE, IT IS A PRETTY EASY PROCESS IF THEY AGREE TO TRANSFER IT. LET'S NOT PUT THE HOSPITAL DISTRICT IN THE POSITION OF SPENDING ALL OF THAT MONEY IF WE DON'T HAVE TO. OR SPENDING IT A DIFFERENT WAY. IT IS ALL GOING TO INDIGENT CARE, IT IS ALL A JUSTIFIED EXPENSE, I HAVE NO PROBLEM SUPPORTING THE HOSPITAL DISTRICT IN THAT EXPENSE BECAUSE I THINK THAT THEY ARE DOING IT FOR THE RIGHT REASONS AND DOING IT WITHIN THEIR MISSION, BUT I UNDERSTAND WHAT THE DOCTORS ARE SAYING, ARE WE REALLY BUYING ENOUGH TIME TO KEEP THE PROGRAM ALIVE?

>> BEFORE YOU TABLE. >> I WANT TO KEEP HOURS ON THE AGENDA. I WANT JOHNNY TO COME BACK AND TELL US, I'M ASKING THAT THE HOSPITAL DISTRICT CONSIDER TABLING THE PROPOSAL TO BRING EVERYBODY TO THE TABLE THAT NEEDS TO BE AT THE TABLE TO TRY TO SAVE THE PROGRAM FOR THE LONG-TERM, NOT FOR A SHORT-TERM FIX. I FEEL AS STRONGLY NOW AS I DID THEN IF WE DON'T KEEP THIS FOR THE LONG TERM, IF WE DON'T KEEP THESE DOCTORS IN THIS COMMUNITY WILL BE A DRAMATIC AFFECT ON THE COMMUNITY. IT WILL HURT THE AGING COMMUNITY THE MOST.

[00:50:15]

THIS APPROACH. THANK YOU. >> THANK YOU, JUDGE. WHEN WE TALK NONDISCLOSURE AGREEMENTS, THAT IS NOT SOMETHING THAT WE HAVE ENTERED INTO, THAT IS SOMETHING THAT THE HOSPITAL RESTRICT HAS ENTERED INTO WITH THE SPOHN SYSTEM, I AGREE WITH WHAT COMMISSIONER CHESNEY HAS SPENT, THE AMOUNT OF TIME THAT WE SPENT, REPRESENTED BY MEDICAL PROFESSIONALS, TO DOCTORS , MEMBERS OF THE NUECES COUNTY HEALTH DISTRICT, AND THE COMMUNITY APPOINTED WHO HAS BEEN AMAZING. WHAT KAREN HAS DONE IN HELPING US CONNECT ON THE ISSUE. I AGREE, THAT WAS ONE OF THE THINGS THAT WE TALKED ABOUT ON MONDAY, THIS IS OUR FIRST CHANCE TO BE ABLE TO SAY THIS PUBLICLY, I WAS SURPRISED THAT THE MONTH -- MEDIA WAS NOT WANTING A SOUNDBITE. I AGREE, ONE THING I SAID, WELL, SOMETIMES YOU HAVE TO PUSH IT TO SURVIVE ANOTHER DAY, THAT MEANS SOMETHING. WE ALL FELT THAT THIS WAS NOT THE BEST PLAN. WE KNEW THAT THIS ONLY REALLY GAVE US, BASICALLY A YEAR. WITHOUT STILL CAPPING OURSELVES AT THE END. THIS IS NOT TO PUT ONE HOSPITAL SYSTEM OVER THE OTHER , IT IS JUST PRIORITIES, THAT IS WHAT THIS IS ABOUT. WE NEED TO PROTECT THESE 52 POSITIONS AND THOSE FAMILIES, THOSE HOUSEHOLDS, THE PEOPLE WHO ARE ACTUALLY LIVING HERE AND PROTECT THEM AS MUCH AS POSSIBLE. EVEN THOUGH THE HOSPITAL DISTRICTS VISION AND SCOPE IS A LITTLE BIT MORE LIMITED BECAUSE THAT IS WITH THE INDIGENT PART OF IT, WE, COLLECTIVELY, SEE IT AS A BIGGER ISSUE, THIS IS A COUNTY WIDE, COASTAL ISSUE. THIS IS NOT EVEN CORPUS CHRISTI, THIS IS THE ENTIRE COASTAL BEND. WE ARE TALKING ABOUT A BIG SYSTEM HERE IN OUR AREA THAT IS IMPACTED BY SOME OF THESE DECISIONS. I WO