[1. Receive presentation, and discuss and consider the potential future elimination by Christus Spohn of the emergency residency program in this region; and all related matters. ]

HAVE SIGNED UP TO COMMENT. WE ARE GOING TO START WITH SPOHN SINCE THEY INITIATED THIS. THANK YOU, DON, FOR BEING HERE.

WE WILL GIVE YOU AS MUCH AS YOU NEED FOR YOUR TIME.

THEN WE WILL HEAR THE OTHER SIDE AS WELL.

OH. LET ME BE CLEAR, TOO.

SORRY. THERE IS, LIKE, A TEN-MINUTE LIMIT FOR YOU. TEN-MINUTE FOR YOU.

ALL OF US HAVE SOMEWHERE WE HAVE TO BE BY 5:30.

SO THIS COURT IS GOING TO END. WE NEED TO GET THROUGH WITH THIS. THIS IS A WORK IN PROGRESS.

WE ARE NOT MEANING TO CUT ANYONE OFF OR STOP ANYTHING, BUT WE WANT TO HEAR EVERYTHING. WE HAVE SOME IDEAS ALSO ABOUT SETTING UP A WORKING GROUP WITH SOME DIFFERENT SELECTED MEMBERS THAT I WOULD LIKE TO FORM A COMMITTEE TO MAYBE ADDRESS THIS AND TALK MORE ABOUT IT IN DEPTH AND STUFF.

IF WE HAVE WILLING PARTICIPANTS. THAT IS MY PLAN FOR THIS MOVING FORWARD. SO THANK YOU ALL.

I WILL GIVE YOU THE FLOORMENT. >> THANK YOU, JUDGE.

THANK YOU-COMMISSIONERS. COMMISSIONER CHESNEY, COMMISSIONER HERNANDEZ, THANK YOU FOR THE FORUM.

I SEE A LETTER, JUDGE, PER CONVERSATION.

I WOULD LIKE TO READ IT. I'M WRITING TO YOU ABOUT THE RECENT DECISION TO PHASE OUT THE EMERGENCY MEDICINE RESIDENTIAL PROGRAM AT CHRISTUS HEALTH SYSTEM BY JUNE, 2026.

THERE HAS BEEN SPECULATION, QUESTIONS, MISINFORMATION ABOUT THE DECISION TO END THE PROGRAM WHICH IS THE PARTNERSHIP IN CONJUNCTION WITH TEXAS A&M. I WANT TO ASSURE YOU THE RESIDENTS AND THE FACULTIES ARE ASSOCIATES.

OUR COMMUNITY, THE DECISION WAS MADE WITH THOROUGH CONSIDERATION OF THE COMMUNITY'S NEEDS. AND THE RESOURCES NEEDED TO SERVE THOSE NEEDS. TO ENSURE THE QUALITY OF CARE OF OUR PATIENTS, WE ARE COMMITTED TO SEEING THE EMERGENCY DEPARTMENT STAFFING AND OTHER HEALTH SERVICES REMAIN STRONG AS WE WIND DOWN THE TEACHING PROGRAM.

OUR FAMILY MEDICINE RESIDENCY AS WELL AS OUR FAMILY MEDICINE OBSTETRICS AND FELLOWSHIP PROGRAMS WILL CONTINUE UNCHANGED. WE HAVE ALSO INVESTED SEPARATELY IN A NURSE RESIDENCY PROGRAM TO SUPPORT NEW GRADUATE NURSES AS

[00:05:02]

THEY DEVELOP SKILLS TO PRACTICE INDEPENDENTLY IN COMPLEX AREAS.

WE ALSO COMMITTED TO THE RESIDENTS CURRENTLY ENROLLED IN THE UNIVERSITY PROGRAM. THE PROGRAM'S DATE OF CLOSURE ISN'T UNTIL JUNE, 2026. FOR ANY IMPACTED ASSOCIATES, WE WILL DO ALL WE CAN TO PROVIDE SUPPORT, INCLUDING BUT LIMITED TO ASSISTING THEM AND FINDING ANOTHER OPEN POSITION WITHIN CHRISTUS. AS WE END THE PROGRAM, IT WILL NOT IMPACT PATIENT CARE AT ALL. OUR EMERGENCY DEPARTMENT WILL REMAIN INTACT AT CHRISTUS SPOHN HOSPITALS.

THE EMERGENCY MEDICAL PROGRAM HAS BEEN AROUND SINCE 2007.

IT WAS CREATED, WE WERE ONLY ONE OF THREE EMERGENCY RESIDENCIES IN THE STATE. NOW THERE ARE 18.

THE PROGRAM HAS BEEN STAFFED FAR AND ABOVE THE GRADUATE MEDICAL EDUCATION GME CAP. IT IS PRIVATELY FUNDED BY CHRISTUS HEALTH FOR MANY YEARS AS A RESULT.

WE ARE PROUD THAT MORE THAN 120 GRADUATES HAVE SUPPORTED AND ARE CURRENT RESIDENTS HERE SUPPORTING TODAY.

THE AMERICAN COLLEGE OF EMERGENCY PHYSICIANS SPONSORED A WORKFORCE STUDY. THERE WILL BE A SURPLUS OF EMERGENCY PHYSICIANS BY 2030. FURTHERMORE, IN 2023, 555 EMERGENCY MEDICINE SLOTS ACROSS THE UNITED STATES WENT UNFILLED.

THE NUMBER WAS UP FROM 2022. 219 WERE UNFULFILLED.

AGAIN, THIS IS NOT AN EASY DECISION.

ULTIMATELY, WE ARE SIMPLY UNABLE TO SUSTAIN THE PROGRAM FOR THE LONG-TERM FUTURE. THE MAJORITY OF THIS PROGRAM HAS BEEN PRIVATELY FUNDED THROUGHOUT THE YEARS BY CHRISTUS HEALTH.

IAS A NONPROFIT, CHRISTUS SPOHN REMAINS DEDICATED TO QUALITY AND AFFORDABLE HEALTH CARE. WE SERVE AND WILL CONTINUE TO HAVE CONSUMER-FOCUSED CARE ACCESSIBLE.

THANK YOU. >> THANK YOU.

>> JUDGE, I WOULD LIKE TO ELABORATE A BIT.

>> YES. >> WHATEVER FORM THAT YOU WISH.

I'M FROM THIS COMMUNITY. BORN AND RAISED HERE.

THIS IS WHERE MY PARENTS COME. MY PARENTS CAME TO THE HOSPITAL AT MEMORIAL. THAT IS WHERE MY NIECE PASSED AWAY. MY DAD RECEIVED GREAT CARE FROM THESE DOCTORS RIGHT HERE. RIGHT HERE.

THIS IS THE TOUGHEST DECISION EVER MADE.

SPOHN HAS A COMMITMENT TO THIS PART OF THE WORLD OF SOUTH TEXAS. THIS COMMITMENT IS FULL, FULLY TO THE COMMUNITY THAT WE SERVE. THAT INCLUDES E.R.

THAT INCLUDES FAMILY MEDICINE. INTERNAL MEDICINE.

CARDIOLOGY. SURGERY.

SPINE, ORTHOPEDIC AND THE VERY DIFFICULT, NEUROLOGY, GASTROENTEROLOGY. THOSE ARE COMMITMENTS FROM SPOHN. THEY ARE SCARCE RESOURCES.

THE DATA WE REVIEWED, IS WHAT I MENTIONED RIGHT THERE.

THE DECISION TO WIND THIS DOWN WAS NOT EASY.

BECAUSE WE SAID IN PRIVATE MEETINGS WITH BOTH THE FACULTY AND IT WAS BROUGHT UP AND THE RESIDENTS, THE FACULTY TOOK CARE OF MY PARENTS. AS YOU LOOK AT THE RELATIONSHIP WITH SPOHN, IT IS A RELATIONSHIP WITH THE HOSPITAL DISTRICT THAT IS SPECIAL. IT IS UNIQUE.

WE CONSIDER IT A PARTNERSHIP. WE ARE PROUD OF IT.

WE ATTEND TO IT. IT IS WHAT YOU DESERVE.

THE COMMITMENTS TO THE WEST SIDE OF TOWN AND TO THOSE IN THE MARGINS, SPOHN'S MISSION HAS ALWAYS BEEN A PART OF.

DATING BACK TO 1905 WHEN THE SISTERS CAME TO CORPUS CHRISTI.

THAT IS EXPANDED. WE ARE BLESSED TO EMPLOY 3,000 ASSOCIATES IN OUR COMMUNITY. ACTUALLY, THERE IS 3,300 INDIVIDUALS THAT WORK AT SPOHN. 3,000 INDIVIDUALS FULL-TIME.

A PAYROLL OF $285 MILLION EACH YEAR.

THAT THE COMMUNITY DESERVES. FOR THE PAST SIX TO SEVEN YEARS, WITH DONORS AND SPOHN, CHRISTUS SPOHN, WE HAVE PROVIDED AN EXCESS APPROACHING HALF A BILLION DOLLARS IN INFRASTRUCTURE IN OUR COMMUNITY. THAT INCLUDES A RENOVATED REBUILT SPOHN SHORELINE. THAT INCLUDES A MASSIVE ADDITION TO SPOHN SOUTH. THE ADDITION OF THE CHRISTUS SEASON SURGICAL HOSPITAL. THAT INCLUDES GROWING, AND I WILL SPEAK TO THAT-- PRIMARY CARE IN OUR COMMUNITY.

THERE IS SEVERAL WAYS, SEVERAL WAYS TO MOVE HEALTH CARE CLOSER TO PATIENTS. HEALTH CARE CLOSER TO YOUR COMMUNITY. NOT ONLY NUECES COUNTY.

DUVAL COUNTY. WE CAN GO DOWN THE LIST.

ONE WAY IS TO PUT UP FREESTANDING E.D.'S AND PLACE THEM IN THE COMMUNITY. STAFF THEM.

FOR YOUR STAFF OR YOUR EMPLOYEES FOR THE COMMUNITIES TO ATTEND

[00:10:03]

TO. THEY GET GOOD CARE.

REALLY GOOD CARE. OR ANOTHER WAY IS TO PUT PRIMARY CARE AND SPECIALTY CARE IN CLINICS CLOSER.

WE HAVE CHOSEN THE SECOND. FOR AT LEAST A COUPLE OF REASONS. IT SETS UP A RESPONSIBILITY AND A CODE RESPONSIBILITY WITH PATIENT.

LEARNING AND ASSUMING RESPONSIBILITY FOR OUR HEALTH CARE. IT SETS UP THOSE, AND WE ARE IN DIRE NEED OF THAT. WE SET UP 26 PRIMARY CARE PROVIDERS. NURSE PRACTITIONERS, INTERNAL MEDICINE, FAMILY PRACTICE. COMMISSIONERS, JUDGE, WE NEED ABOUT 1 $162 OF THOSE. IF YOU GO TO PORTLAND, FOR OUR CLINIC, IT MIGHT TAKE YOU 90 DAYS TO GET IN.

OVER ON THE ISLAND, WHERE WE HAVE THE ONLY CLINIC THROUGH THE HEALTH SYSTEM, IT WILL TAKE YOU 30-40 DAYS.

WE DON'T NEED THREE PROVIDERS ON THE ISLAND.

WE NEED SIX. WE NEED SIX PROVIDERS AT LEAST ON THE ISLAND. WE NEED ANOTHER 10-15 ON THE SOUTH SIDE OF TOWN BY SPOHN SOUTH.

WE NEED SIX PROVIDERS AT LEAST IN PORTLAND.

WE NEED PROVIDERS IN ROCKPORT. MATHIS.

WE NEED CARE WITH THE COLLABORATION OF THE HOSPITAL DISTRICT FOR THE UNDERSERVED AREAS.

ALL WE UTILIZE IN TECHNOLOGY, ARE WE UTILIZING OUR BUS SYSTEM, OUR EXTENDERS TO MAKE SURE WE ARE CARING FOR THOSE.

SPOHN IS BLESSED TO SERVE THE POOR.

THAT HAS BEEN OUR MISSION SINCE THE FOUNDING OF THOSE BEFORE ME.

SPOHN IS FULLY COMMITTED TO THIS PART OF THE COASTAL BEND.

TO THE COASTAL BEND. TO THIS PART OF TEXAS.

THE NEEDS OF THIS COMMUNITY ARE THERE.

THEY ARE AROUND INTERNAL MEDICINE, FAMILY MEDICINE.

THEY ARE AROUND NEUROLOGY. WE HAVE A REAL DEFICIT.

THEY ARE AROUND GASTROENTEROLOGY.

WE WILL HAVE A REAL DEFICIT. THEY ARE AROUND ELECTROPHYSIOLOGY WHEN IT COMES TO CARDIOLOGY.

WITH DOCTORS COMING IN FROM OUT OF TOWN.

WE WILL CONTINUE THOSE COMMITMENTS TO GROW THOSE.

TO GET BACK TO OUR RELATIONSHIP WITH THE HOSPITAL DISTRICT, IT IS ONE THAT WE ARE PROUD OF. AND IT IS A PARTNERSHIP.

THAT WILL CONTINUE, AND IT WILL GO.

IT WILL GROW WITH THAT COLLABORATION OF THE TEAM.

IT WILL GROW IN THE AREAS THAT THE COMMUNITY NEEDS.

WE WILL UTILIZE TECHNOLOGY. THIS IS A VERY DIFFERENT ENVIRONMENT THAN IT WAS IN 1997. WHEN THIS AGREEMENT BEGAN.

THAT IS MORE IMPORTANT, I BELIEVE, THAN EVER.

GIVEN WHERE WE ARE IN HEALTH CARE.

GIVEN THE COST. THE COST OF SEEING A PATIENT-- THE COST OF SEEING A DOCTOR IN A PRIMARY CARE CLINIC PALES IN COMPARISON TO THE COST TO THE RESIDENTS, TO EMPLOYERS, OF GOING TO AN E.R. WE HAVE MADE THE COMMITMENT IN THE E.R. SETTING. THE COMMITMENTS IN THE E.R.

SETTING. FOR THE BEST CARE.

THE BEST CARE AROUND. THERE ARE FOUR LARGE E.R.S IN TOWN. TWO BY SPOHN.

TWO BY HCA. ONE HAS A RESIDENCY PROGRAM.

WE WILL GO BACK TO A SETTING THAT HAS E.R. DOCTORS, BOARD E.R. DOCTORS, THE RIGHT COMPLEMENT OF THEM, THE RIGHT SETTING FOR THEM TO PROCEED. WE WILL FOCUS OUR TIME AND OUR RESOURCES ON WHAT WE SPOKE OF JUST NOW.

I REALIZE, I REALIZE THE HARDEST-- THIS HAS BEEN THE HARDEST DECISION OF MY CAREER. IT IS.

BAR NONE, THIS IS WHERE MY FAMILY RECEIVES CARE.

I'M COMMITTED, JUDGE, COMMISSIONERS, YOU MENTIONED A GROUP COMING TOGETHER. I'M COMMITTED TO BEGIN THAT WITH THE MEETING. WE MET THIS MORNING.

COMMISSIONER CHESNEY, THANK YOU. COMMISSIONER MAREZ, THANK YOU.

IT WAS OPEN. IT WAS DELIBERATE.

IT WAS PROFESSIONAL. SPOKE TO THE NEEDS OF THE COMMUNITY. I BELIEVE IT IS YOUR CALL, JU JUDGE. INCLUDE A MEMBER OF THE HOSPITAL DISTRICT. WHATEVER YOU MIGHT THINK.

THERE HAS BEEN INFORMATION POSTED ON SOCIAL MEDIA THAT ATTACKS ME PERSONALLY. I THINK THAT COMES WITH THE JOB.

NOT THAT IT HAS DO, BUT IT DOES. OKAY? THAT HAS NOT BEEN POSTED BY SPOHN.

I REALIZED EARLIER A BIT AGO, THAT A PRIVATE CONVERSATION WITH THE FACULTY WAS RECORDED. NOW THE PRESS HAS IT.

OKAY. THERE IS NOTHING IN THAT MEETING THAT I'M CONCERNED ABOUT. NOTHING.

BUT I AM CONCERNED THAT THE NEXT MEETING I HAVE TO GO TO, WE HAVE TO OUT OUR PHONES BECAUSE WE DON'T TRUST EACH OTHER.

THE MEETING TODAY WAS NOT RECORDED WITH COMMISSIONER CHESNEY, COMMISSIONER MAREZ. IT WAS A MEETING TO GET TO SOME SOLUTIONS AND PROBLEM-SOLVING. I WOULD HAVE TO SAY IT SHOULD INVOLVE OTHER SPECIALTIES THAT ARE SO DESPERATELY NEEDED.

[00:15:02]

AND ALL ENVIRONMENTS HAVE SECURE RESOURCES.

THE STUDIES I JUST NOTED ARE FROM THE AMERICAN COLLEGE OF EMERGENCY PHYSICIANS. NOT FROM SPOHN.

THE PROGRAM WAS NEEDED IN 2007. THERE WERE THREE RESIDENCY PROGRAMS. 18 NOW.

THOSE RESOURCES ARE NEEDED IN OTHER AREAS.

WE WILL CONTINUE TO RESOURCE EVERY DEPARTMENT.

THE E.R., RADIOLOGY, ANESTHESIA, PATHOLOGY.

SPECIALTIES THAT I MENTIONED, AND OTHERS.

WE WILL CONTINUE TO PROVIDE CAPITAL THAT NO OTHER COMPANY WILL MATCH IN THIS AREA FOR HEALTH CARE.

NONE. WE WILL CONTINUE TO RECRUIT INTO TOWN THOSE PHYSICIAN THAT IS ARE HERE FULL-TIME.

I THANK YOU FOR THE TIME. I THANK YOU FOR THE TIME,

COMMISSIONERS. >> THANK YOU.

AND I APPRECIATE YOU YOUR WILLINGNESS TO SERVE ON THIS COMMITTEE AND LEAD THE COMMITTEE.

I WOULD ASK ALL MEMBERS THAT WE ASK TO SERVE ON THIS IN THE FUTURE IN ORDER TO MOVE FORWARD WITH SOLUTIONS THAT THERE IS NO SECRET RECORDINGS. THIS IS A WORKING COMMITTEE.

>> JUDGE, I'M WILLING TO MEET WITH COMMISSIONERS.

IN I'M A HOSPITAL DISTRICT MEMBER.

I'M NOT SAYING THAT CAN'T EVOLVE INTO SOMETHING ELSE RIGHT NOW.

>> I WOULD ASK YOU TO RECONSIDER AND AT LEAST TO HAVE A COMMUNITY ADVOCATE. KAREN URBAN HAS OFFERED TO SERVE ON THIS. AND AT LEAST A DOCTOR FROM THEIR SIDE. WE CAN'T REALLY HEAR ISSUES OR FIND PROBLEMS OR SEE WHERE WE CAN MEET IN THE MIDDLE IF WE DON'T ALLOW BOTH SIDES IN. I WOULD ASK YOU TO SERIOUSLY RECONSIDER. I HOPE THAT YOU WOULD.

I WOULD ASK ANYONE WHO STEPS UP TO DO THIS TO DO THIS IN GOOD FAITH. THIS IS FOR OUR COMMUNITY.

THIS IS NOT ABOUT GETTING ON THE NEWS OR GETTING A GOTCHA MOMENT OR RECORDING SOMEONE WITHOUT THEIR KNOWLEDGE.

OR FINDING SOMETHING TO MOVE FORWARD.

THIS IS ABOUT FINDING SOLUTIONS FOR OUR COMMUNITY AND MOVING FORWARD IN THE BEST INTEREST OF OUR CITIZENS.

>> I WAS NOT AWARE I WAS BEING RECORDED.

I WILL REINFORCE THAT. I WILL RECONSIDER, AT YOUR REQUEST. I CAN'T GIVE YOU AN ANSWER RIGHT NOW. BUT I WILL, JUDGE.

>> JUDGE, I WANT TO CLARIFY ON THAT.

SINCE-- I'M NOT PUBLIC. I'M JUST RESPONDING.

>> HE DID A PRESENTATION. THIS IS FINE.

WE CAN TALK. THIS IS ALL ABOUT THIS.

HE WAS SCHEDULED TO SPEAK. NO.

NO. PUBLIC COMMENT IS NO TALKING.

YES. HE DID A PRESENTATION.

WE ARE GOING TO ALLOW ONE DOCTOR TO DO THE SAME.

THEN WE WILL DO PUBLIC COMMENT. >> YEAH.

I DEFINITELY WANT TO HEAR THE PRESENTATIONS.

I AM DISAPPOINTED. WE HAD THIS CONVERSATION OUT OUTSIDE. ALL THE PROGRESS THAT WAS MADE THIS MORNING, YOU ARE KIND OF THROWING OUT THE WINDOW IF YOU DON'T RECONSIDER. YOU GAVE COMMISSIONER F MAREZ AND ME YOUR WORD THAT YOU WOULD DO THIS.

I UNDERSTAND THAT SOMETHING HAPPENED BETWEEN WHEN WE MET, THAT YOU JUST DICTATED OR TALKED ABOUT, WHERE SOMEONE SENT SOME RECORDING OF SOME MEETING THAT I DON'T KNOW ANYTHING ABOUT AND QUITE HONESTLY, IT IS NOT MY BUSINESS.

WHAT YOU ARE DOING, SO THAT WE ARE CLEAR, IF YOU DON'T WANT TO MEET IN THIS GROUP, THAT IS UP TO YOU.

YOU ARE THEN GOING BACK ON YOUR WORD TO ME AND COMMISSIONER MAREZ THAT YOU WOULD HAVE THAT CONVERSATION BECAUSE I GET THAT YOU ARE UPTIGHT ABOUT THAT. AND YOU HAVE A LACK OF TRUST.

IF YOU DON'T THINK ALL OF THESE PEOPLE IN THE ROOM HAVE A LACK OF TRUST WITH YOU, YOU ARE MISCALCULATING.

THEY ARE STILL WILLING TO SIT IN A ROOM WITH YOU.

THEY DON'T HAVE MUCH TRUST IN YOU RIGHT NOW.

I WOULD ASK STRONGLY THAT YOU CONSIDER BASED ON THE FACT THAT YOU DID GIVE COMMISSIONER MAREZ AND MYSELF YOUR WORD, THAT YOU WOULD HAVE THAT MEETING. LET ME TELL YOU.

FEELINGS ARE HURT. YOU AND I HAD A GREAT CONVERSATION TODAY. MY FEELINGS WERE HURT BIG-TIME BECAUSE I GOT BLINDSIDED BY THIS LIKE EVERYBODY ELSE DID.

HOSPITAL DISTRICT BOARD MEMBERS THAT I TALKED TO GOT BLINDSIDED.

SPOHN ADVISORY BOARD MEMBERS GOT BLINDSIDED.

SO IF YOU DON'T THINK MY FEELINGS WERE HURT, AS YOU SAW IT THIS MORNING, BUT WE GOT THROUGH IT.

WE WORKED THROUGH IT. WE CAME UP WHAT I THOUGHT WAS A REASONABLE PLAN. YOU DIDN'T COMMIT TO ANYTHING.

I DIDN'T COMMIT TO ANYTHING. YOU COMMITTED TO YOUR POSITION.

I COMMITTED TO MINE. I THINK YOUR DECISION IS WRONG.

YOU THINK THAT I'M WRONG IN MY DECISION.

WE COMMITTED TO SIT DOWN AND HAVE, AS I CALLED THEM, THE

PEACE TALKS. >> YES, SIR.

>> BEFORE WE GO TO WAR. AND NOW IF YOU ARE BACKING OUT OF THE PEACE TALKS, THAT PUTS ME IN A REALLY BAD SPOT.

BECAUSE THERE IS NO POINT IN GOING AND HAVING A MEETING IF THEY ARE NOT INVOLVED AND INCLUDED IN THIS BECAUSE I CAN'T SPEAK FOR THEM. THE HOSPITAL DISTRICT CAN'T SPEAK FOR THEM. YOU CAN'T SPEAK FOR THEM.

THE JUDGE-- IF THEY ARE NOT IN THE ROOM, THERE IS NO POINT IN EVEN HAVING THAT MEETING. WE MIGHT AS JUST-- WE MIGHT AS WELL JUST GO DOWN THE ROAD AND SEE HOW IT FALLS.

I'M SUPER DISAPPOINTED. >> I WAS TOO, SIR.

>> WHAT HAPPENED TO YOU DIDN'T HAPPEN TO YOU BECAUSE I DID IT.

OR COMMISSIONER MAREZ DID IT. YOU GAVE YOUR WORD TO US.

IF YOU NEED TO COOL DOWN ABOUT IT, I GET IT.

[00:20:01]

WE HAVE ALL BEEN UPTIGHT ABOUT. THIS I'M TRULY ASKING YOU TO RECONSIDER THIS AND COME INTO IT BECAUSE I REALLY FELT GOOD COMING OUT OF THAT MEETING. THAT WE WERE GOING TO GO IN WITH OPEN MINDS AND OPEN HEARTS AND REALLY TRY TO SEE.

WE TALKED ABOUT HOW MAYBE THE COMMUNITY WOULD STEP UP.

MAYBE THE HOSPITAL NEEDS TO DO MORE.

YOU KNOW, WE TALKED ABOUT A LOT OF WHAT-IFS.

IF WE CAN'T GET IN THE ROOM WITH THE PEOPLE THAT MAKE THE DIFFERENCE, THEN I DON'T KNOW WHAT TO DO.

BECAUSE I DON'T HAVE THE EXPERTISE THAT THESE DOCTORS HAVE. TO BE ABLE TO TALK-- YOU KNOW, I GOT THEIR INFORMATION. I CAN'T TALK IT LIKE THEY.

CAN I DON'T LIVE IT. I DON'T BREATHE IT.

I'M TRYING TO ADVOCATE FOR THEM THE BEST WAY I KNOW HOW TO.

SO PLEASE RECONSIDER THAT DECISION BECAUSE-- YOU KNOW, YEAH. I'M NOT SEEING SOMETHING HANDLED LIKE THIS IN A LONG TIME. I'M TRYING TO GET BACK ON TRACK.

FORGET THE EGOS AND THE PERSONALITIES.

FORGET ALL THE EMOTION. LET'S SEE IF WE CAN HELP THIS COMMUNITY. I'M ASKING YOU TO DO THE SAME THING YOU ASKED ME TO DO THIS MORNING.

HEY, LET'S PUT IT ASIDE AND WORK THROUGH THIS.

PLEASE DO THAT. THIS IS A SUPER EMOTIONAL ISSUE.

IT IS A FACTUAL ISSUE. I MEAN, I MET WITH THE DOCTORS BEFORE I MET WITH YOU. I TOLD THEM, LOOK, I'M NOT SAYING DON'T BRING YOUR EMOTION. THAT IS IMPORTANT.

BRING ME FACTS. I NEED FACTS.

BECAUSE SPOHN SAYS THIS. AND I NEED REBUTTAL FOR FACTS.

SO THAT WE CAN HAVE AN INTELLECTUAL DISCUSSION.

NOT AN EMOTIONAL ONE. >> YES, SIR.

>> IF YOU WON'T COME TO THE TABLE, IT IS GOING TO BE HARD TO

HAVE A DISCUSSION. >> COMMISSIONER CHESNEY, YES, SIR. IT WAS A PLEASURE SEEING YOU

TUESDAY EVENING. >> SAME SORRY.

>> I HAD THE PLEASURE OF SEEFING YOU TUESDAY EVENING.

I MENTIONED I MADE MYSELF AVAILABLE.

YOU CALLED THIS MORNING AND I DROPPED EVERYTHING.

IT IS NEEDED. >> THERE IS NO PATCH.

NO BLUE STARS. >> I APPRECIATE IT.

>> I APPRECIATE THE TIME. I VERY MUCH ENJOYED THE CONVERSATION THIS MORNING. COMMISSIONER MAREZ, COMMISSIONER CHESNEY. IT WAS HONEST, STRAIGHTFORWARD.

I TOLD YOU THE STORY OF A DO DOCTOR.

I WILL TELL YOU WHAT IS ON MY MIND AND WHAT I THINK AND WHAT I FEEL. THAT WAY I DON'T HAVE TO REMEMBER WHAT I SAID. THAT IS WHAT I DID.

OKAY? I WILL RECONSIDER.

RIGHT NOW, SIR, I CANNOT GIVE YOU THAT WORD.

I WILL FOLLOW UP. THIS WILL NOT LANGUISH.

RIGHT NOW, THERE IS DISAPPOINTMENT ON ALL SIDES.

THE COMMITMENT SPOHN HAS IS IRONCLAD.

YOU WANTED INFORMATION. THAT IS FROM THE AMERICAN COLLEGE OF EMERGENCY PHYSICIANS. THAT IS NOT FROM SPOHN.

THAT IS THE NUMBER OF RESIDENCY PROGRAMS TODAY AND 2007.

THOSE ARE THE TRUE NUMBERS. THE CAPITAL COMMITMENT TO REGION. THOSE ARE TRUE NUMBERS.

THE NUMBER OF PEOPLE EMPLOYED BY SPOHN.

AND THE $285 MILLION IN YEARLY SALARIES AND BENEFITS THAT GO TO THOSE, THAT CLEAN OUR HOSPITALS AND DO THE WORK.

>> LET ME BE CLEAR, THOUGH, ALSO.

THIS COMMITTEE IS GOING FORWARD. WE WOULD LOVE TO HAVE YOUR INPUT. I BELIEVE IT IS VITAL TO HAVE YOUR INPUT ON IT. BUT WE ARE GOING TO GO FORWARD WITH THIS COMMITTEE, AND YOU ARE NOT THERE, THEN SPOHN IS THE ONE LOSING OUT WITH THE INFORMATION THAT THEY CAN'T SHARE.

>> JUDGE, THANK YOU. COMMISSIONERS, THANK YOU.

>> I WOULD ASK WHO IS GOING TO BE PRESENTING FOR THE PHYSICIANS. YOU WILL GET TEN MINUTES OR JUST LIKE THE OTHER, AND THEN ALL THE OTHER DOCTORS WILL GET THE PUBLIC COMMENT. ANYONE THAT WISHES TO SPEAK IN THE TIME THAT WE HAVE LEFT, WE WILL GET YOU ALL UP THERE AS MANY AS WE CAN. I WILL STATE AGAIN, THAT WE ARE GOING TO FORM THIS COMMITTEE. I WOULD LIKE FOR IT TO BE TWO PEOPLE FROM SPOHN, TWO PEOPLE FROM THE HOSPITAL DISTRICT BOARD, TWO FROM OUR COMMISSIONER'S COURT, COMMISSIONER CHESNEY AND COMMISSIONER MAREZ HAVE ALREADY AGREED. I HAVE TALKED TO KAREN URBAN.

SHE HAS AGREED TO SERVE AS WELL. I WOULD LIKE TO HAVE TWO PHYSICIANS THAT ARE WILLING TO OPENLY COME IN AND DISCUSS THIS THING. NO RECORDINGS FROM ANYONE.

I WOULD LIKE ALL OF YOU TO COMMIT TO THAT.

THAT WE WANT SOLUTIONS WITH THIS COMMITTEE.

OR AT LEAST UNDERSTANDING. MOVING FORWARD.

AND YOU HAVE TO HAVE THE RIGHT HEART IN COMING FORWARD AND WANTING THE BEST FOR THIS COMMUNITY.

THANK YOU. I'M SORRY.

IF YOU WILL STATE YOUR NAME. I HAVE A WHOLE LIST OF DOCTORS UP HERE. YES.

>> MY NAME IS JOHN HERRICK. I'M ONE OF THE ASSOCIATE PROGRAM DIRECTORS FOR THE PROGRAM. WE DID ALL PLAN ON SPEAKING, BUT I CAN TRY AND SUMMARIZE AS MUCH AS WE CAN IN TEN MINUTES.

SO WE CAN PROCEED. FIRST, AS I MENTIONED, MY NAME IS JOHN HERRICK. I FIRST CAME TO CORPUS IN 1997.

FOR A ONE-MONTH MEDICAL STUDENT ROTATION.

THAT ROTATION WAS ANOTHER HOSPITAL.

I BECAME VERY INTRIGUED BY MEMORIAL MEDICAL CENTER.

MY DREAM WAS TO WORK TEACHING RESIDENT AND TO WORK AT A COUNTY HOSPITAL WITH UNDERSERVED PATIENTS WHERE I FELT LIKE I COULD REALLY MAKE A DIFFERENCE. AT THAT TIME, THERE WAS NO EMERGENCY MEDICINE RESIDENCY HERE.

I HAD TO GO TO NEW YORK TO GET THE TRAINING THAT I NEEDED.

I KEPT THE NAMES OF CONTACTS IN CORPUS CHRISTI.

[00:25:01]

I CHECKED IN PERIODICALLY. I HEARD IN 2005 THAT SPOHN WAS WANTING TO START AN EMERGENCY MEDICINE RESIDENCY.

THERE WERE GREAT JOBS ALL OVER THE COUNTRY.

I FELT THAT MEMORIAL WAS A PERFECT FIT FOR ME.

I MOVED HERE IN 2006. WE THEN GOT THE PROGRAM ACCREDITED AND TOOK OUR FIRST RESIDENTS IN 2007.

I REMEMBER LEARNING ABOUT NCHD, NUECES AID, THE CLINIC CARD ON MY FIRST SHIFT IN 200 #. THIS WAS AN AMAZING PROGRAM.

I HAD COME FROM NEW YORK CITY. I HAD BEEN IN OHIO.

I NEVER HAD SEEN ANY PROGRAM THAT CAPTURED SO MANY VULNERABLE PATIENTS AND GAVE THEM CARE. THEY USUALLY FALL THROUGH THE CRACKS. WITH NUECES AID AND NCHD, THEY DID NOT. WE ARE THE FACE OF NCHD.

WHEN A NUECES AID PATIENT HAS AN EMERGENCY, THEY COME SEE THESE DOCS. WHEN THEY HAVE A HEART ATTACK, A STROKE, A MAJOR TRAUMA, THESE ARE THE DOCS THAT TAKE CARE OF THEM. WE CONSIDER IT A GREAT PRIVILEGE TO TAKE CARE OF THE NCHD PATIENTS.

WE MAKE SURE THAT THEY ARE TREATED WITH THE UTMOST DIGNITY AND RESPECT. WHEN WE ARE GONE, SHORELINE IS MOST LIKELY TO BE STAFFED BY REPLACEMENTS THAT WILL FLY IN AND OUT. THEY GENERALLY WORK A FEW SHIFTS AND THEN GO TO THEIR RESPECTIVE CITY OR WHEREVER THEY LIVE.

THEY WON'T KNOW WHAT NCHD IS, LIKE WE DO.

I JUST FEAR THAT WITH THE ENDING O'.

>> THIS RESIDENCY, THE CARE OF THE NCHD PATIENTS WILL BE FOREVER ALTERED. I WILL TOUCH ON SOME OF THE ECONOMIC SUMMARY. SOME BACKGROUND.

NUECES AID CONTRACT STIPULATES THAT TWO PROGRAMS MUST EXIST.

ELIMINATING EM RESULTS IN ONLY ONE PROGRAM.

A FELLOWSHIP WITH TWO FELLOWS IN JER RAT RICKS GERIATRICS OR OBSTETRICS IS NOT EQUIVALENT. AT THE TIME OF THE INITIAL CONTRACT, THERE WERE ONLY FM AND EM RESIDENCIES.

THE DEFINITION OF A RESIDENT IS NOT EQUIVALENT TO A FELLOW.

FELLOWS ARE GRADUATED RESIDENTS THAT ARE UNDERGOING ADDITIONAL SUB-SPECIALTY CERTIFICATION THAT IS COMPLETED AFTER BECOMING A FULLY TRAINED AND BOARD-ELIGIBLE OR BOORT-CERTIFIED PHYSICIAN.

THERE IS ALSO GOING TO BE SIGNIFICANT DOWNSTREAM EFFECTS.

NOT JUST IN THE E.R. MANY OF THE TRAUMA SURGEONS HAVE COME TO US. ONE THAT IS GOING TO SPEAK TO TODAY, AND THE SERVICE WOULD BE GREATLY DISRUPTED.

THE SURGEONS COME AND TAKE JOBS HERE BECAUSE OF WORKING WITH THE RESIDENTS. THERE WOULD BE SUBSTANTIAL ATTRITION OF OUR TRAUMA SURGEONS.

SOME OF WHOM HAVE ALREADY SAID THEY ARE GONE.

AND THEY FEEL THAT THE LEVEL TWO TRAUMA DESIGNATION WOULD BE AT RISK. EXPENSE TO HIRE NURSE PRACTICERS, ADDITIONAL TRAUMA SURGEONS, FAR NEGATES ANY COST SAVINGS BY THE CHRISTUS SYSTEM. THE LAG TIME TO RECRUIT THE TEAM OF SURGEONS AND NURSE PRACTITIONERS OR PAS NEEDED WOULD NOT KEEP PACE WITH THE RATE OF THE EM RESIDENTS LEAVING OR GRADUATING AND PUT THE LEVEL TWO TRAUMA ACCREDITATION AT RISK. THE AMERICAN COLLEGE OF SURGEONS JUST PERFORMED A SURVEY WITH US. THEY CITED THE RELATIONSHIP BETWEEN THE TRAUMA SERVICE AND THE ED, MAINLY THE EM RESIDENTS AS A MAJOR STRENGTH OF OUR TRAUMA PROGRAM.

WE HAVE A LOT MORE THAN TEN MINUTES HERE.

I'M GOING TO START SUMMARIZING. FREELANCE.

ONE OF THE OTHER THINGS THAT JUST CAME UP IS THA THE RESIDENTS WILL NOT-- NO ONE WILL HAVE TO LEAVE.

THEY WILL GO THROUGH 2026. AND TO BE ACCREDITED, THERE ARE SIGNIFICANT HURDLES TO THAT. YOU HAVE TO HAVE AT LEAST 18 RESIDENTS AT ALL TIME TO BE AN ACCREDITED PROGRAM AND MAINTAIN.

THAT THEY ARE PROPOSING TO PHASE OUT 12 PER YEAR.

EVEN BY DEFINITION, IN THE THIRD YEAR, YOU WOULD NOT HAVE 18 RESIDENTS. WE DON'T KNOW IF SPOHN WENT TO THE ACDME AND GOT SPECIAL PERMISSION TO DO A PHASE-OUT OR IF THEY DIDN'T KNOW ABOUT THE REGULATIONS.

WE DON'T KNOW. WHAT THE PHASE-OUT IS BASED ON.

THAT IS NOT BEEN SHARED WITH US. >> SOUNDS LIKE A GOOD QUESTION FOR THE GROUP. YES.

>> COMMUNITY IMPACTS. WE HAVE A TRACK RECORD OF STRONG COMMITMENT TO OUR COMMUNITY. GO BACK TO THE COVID DAYS.

THE HOSPITAL WAS FAR OVERWHELMED WITH THE NUMBER OF DOCTORS NEEDED, AND USUALLY, THE SYSTEMS DON'T CROSS.

THERE IS I.C.U. DOCTORS, THERE IS E.R. DOCTORS.

IN JULY, WHEN COVID HIT, THERE WAS AN I.C.U. NORMALLY TAKING

[00:30:03]

CARE OF 40-50. THEIR SERVICE SWELLED TO 150.

SPECIAL SHIFTS WERE CREATED. I WORKED THE FIRST DAY.

WE ALL WORKED EXTRA SHIFTS. NOT IN THE E.R.

UPSTAIRS, TAKING CARE OF COVID PATIENTS, MANAGING THE VENTS, RUNNING THE CODES. AND WITH THE LOSS OF A RESIDENCY, YOU ARE LOSING 36 BODIES F FOR THE NEXT PANDEMIC.

CORPUS WOULD BE DIFFERENTLY STAFFED.

(INAUDIBLE). >> VENTILATORS.

EMERGENCY MEDICINE PHYSICIANS ARE SKILLED IN CRITICAL CARE, ABLE TO TAKE CARE OF VENTILATORS.

AND INTUBATE PATIENTS, PLACE CENTRAL LINES, ADVANCED.

>> THANK YOU. >> ALONG THAT SAME LINES IS HURRICANES. WERE PRONE-- WE ARE PRONE TO HURRICANES. WHEN THE LAST MAJOR HURRICANE, WE DIVIDE UP INTO TEAMS. WE STAY.

WE DON'T LEAVE. IF YOU HAVE OUT-STAFFED PHYSICIANS FLYING FROM OUT OF TOWN THAT ARE NOT EVEN HERE, THEY ARE NOT EVEN GOING TO BE ABLE TO GET HERE TO WORK THEIR SHIFTS. WE LIVE HERE.

WE STAY HERE. WE TAKE CARE OF THE PATIENTS.

HOW MANY HOURS DID PEOPLE STAY? 72 HOURS IN THE HOSPITAL.

SLEEPING IN THE HOSPITAL. >> WE WILL HAVE TO ASK YOU TO WAIT UNTIL YOUR PUBLIC-SPEAKING, PLEASE, BEFORE THIS GETS OUT OF

HAND. >> THE COMMUNITY WOULD BE MUCH LESS PREPARED FOR A FUTURE NATURAL DISASTER.

JUST SOME OF THE PERSONAL AND BUSINESS IMPACTS.

50 FAMILIES MOVED HERE WITH THE RESIDENTS WE HAVE.

36 RESIDENTS AND 16 FACULTIES. THERE HAS BEEN MENTION THAT THEY WOULD FIND OTHER ROLES IN SPOHN. WE ARE ALL EMERGENCY MEDICINE TEACHERS. SO THERE IS NO OTHER EMERGENCY MEDICINE ROLE SIMILAR. THERE IS NO OTHER JOB FOR US IN THE SPOHN SYSTEM. THE NEXT CLOSEST EMERGENCY MEDICINE RESIDENCIES ARE SAN ANTONIO, AUSTIN, AND HOUSTON.

THERE ARE NO EQUIVALENT ROLES IN THE SYSTEM.

FOR US. WE HAVE TALKED ABOUT THE TRAUMA SERVICE. TALK A LITTLE BIT ABOUT THE FINANCES OR THE UNAFFORDABILITY OF THE RESIDENCY.

WE STAFF THE EMERGENCY DEPARTMENT WITH SIX DOCTORS.

TWO ATTENDINGS. I'M AN AEND THE ATTENDING.

AND FOUR RESIDENTS AT ALL TIMES. THEY ARE ALSO PHYSICIANS.

THERE ARE SIX PHYSICIANS IN SPOHN E.R. AT ANY TIME.

IF FOUR ARE GONE, MAYBE THEY COULD GET BY WITH-- IF FOUR RESIDENTS ARE GONE. AND THERE ARE TWO ATTENDINGS.

JUST TO PAY FOR TWO MORE OF US IS APPROXIMATELY $5 MILLION IS WHICH IS THE WHOLE COST OF THE RESIDENCY RIGHT THERE.

THAT IS NOT INCLUDING ON THE TRAUMA SERVICE AND THE NICU.

THEY WORK HARD. THEY WORK 80 HOURS A WEEK WHEN THEY ARE ON THE MICU. TO REPLACE WITH A NURSE PRACTITIONER THAT WORKED 40 HOURS A WEEK, THE TRAUMA TEAM, THE TRAUMA DIRECTOR ESTIMATES THAT HE WOULD NEED FOUR TO SIX NURSE PRACTITIONERS TO REPLACE ON HIS SERVICE AT THREE TO FOUR TIMES THE COST. THE FINANCIAL-- OTHER PEOPLE HAVE CALLED. WHEN I TALK TO OTHER C.E.O.'S.

THEY DON'T GET IT. AS FAR AS THE COST FOR THAT, OTHER CITIES ARE CLAMORING TO START EMERGENCY MEDICINE PROGRAMS. SOMETIMES FOR THE WRONG REASONS.

SOMETIMES BECAUSE THEY ARE SO PROFITABLE.

THEY PROVIDE SO MUCH LABOR FOR THE HOSPITAL.

WE HAVEN'T BEEN-- WE DON'T KNOW WHAT SPOHN IS DOING DIFFERENTLY THAT EVERYONE ELSE IS WANTING TO START.

WE ARE THE ONLY ONE IN THE COUNTRY BEING CLOSED.

>> WE ARE ABOUT AT THAT TIME DUE.

ANY OF THE COMMISSIONERS HAVE ANYTHING YOU WANT TO SAY BEFORE WE MOVE INTO PUBLIC COMMENT? I WOULD LIKE TO ASK IF, YOU KNOW, IF YOU COULD GET BACK TO ME WITH TWO NAMES OF PHYSICIANS THAT ARE WILLING TO PARTICIPATE IN THIS WITH THE REQUIREMENTS THAT I ASKED. AND IF YOU COULD GET BACK TO ME ANY TIME SOON, WE WOULD LIKE TO GET THIS STARTED AS SOON AS POSSIBLE. YES.

I KNOW WE HAVE SOME HOSPITAL DISTRICT BOARD MEMBERS.

I WOULD ASK ART GRAS THAT DOE IF HE WOULD SERVE AS WELL.

I SEE DR. READY IN THE BACK. IF THE TWO OF YOU WOULD AGREE

[00:35:02]

RIGHT NOW, THEN I HAVE MY COMMISSIONERS, THE HOSPITAL DISTRICT, AND HOPEFULLY, ANOTHER ONE FROM SPOHN.

AND THEN THE TWO DOCTORS. I KNOW KAREN URBAN HAS ALREADY AGREED. THE SOONER WE GET THIS MOVING, THE BETTER DISCUSSIONS CAN BE MADE.

I'M NOT SURE WHAT KIND OF SOLUTIONS WE CAN FIND.

WE ALL WANT TO DO WHAT'S BEST FOR THIS COMMUNITY.

>> I APPRECIATE THAT. THANK YOU, JUDGE SCOTT.

THANK YOU, COMMISSIONER. >> YES, PLEASE.

>> DR. HERRICK, WE GOT SOME INFORMATION PROVIDED TO US.

IT WASN'T SIGNED BY ANYBODY IN PARTICULAR.

I DON'T KNOW WHO SUBMITTED IT. >> WE AS A GROUP WORKED ON THAT.

THAT DOCUMENT. >> OKAY.

THAT WAS SUBMITTED BY YOU AS A GROUP OF DOCTORS?

>> YES, YES. >> NEXT TIME, JUST PUT A SIGNATURE ON IT. (LAUGHTER).

>> THIS IS MY FIRST TIME BEING IN A FORMAT.

I'M A LITTLE NERVOUS. NEXT TIME I WILL BE BETTER.

>> IT IS OKAY. WE WANT TO MAKE SURE IT IS FROM YOU. (LAUGHTER).

>> SO THE QUESTION THAT I HAVE HEARD A LOT ABOUT IS ON THE RETENTION. WE DON'T RETAIN LOT OF DOCTORS OUT OF THE PROGRAM. CAN YOU KIND OF TALK TO THAT

SPECIFICALLY A LITTLE BIT, TOO? >> DEFINITELY.

>> THERE IS SO MUCH GOING AROUND.

I DON'T KNOW WHAT. >> SO I CAN LOOK AT THESE THREE GENTLEMEN RIGHT HERE. THESE ARE ALL GRADUATES OF THE PROGRAM THAT DR. BRODEUR, WE KEPT STRAIGHT OUT OF RESIDENCY.

DR. PETER SON HAD A FOUR-YEAR MILITARY COMMITMENT AND SERVED.

AND CAME RIGHT BACK. DR. CAMBRON WENT SOMEWHERE ELSE FOR A YEAR BUT JUST GOT BACK HERE AS SOON AS HE CAN.

YOU KNOW, OUTSIDE OF THAT, WE HAVE ABOUT A 50% RETENTION RATE HERE, AND IT IS NOT JUST, IT IS NOT JUST SPOHN.

THERE ARE OTHER COMPETITORS IN TOWN.

THTHERE IS PHYSICIAN'S PREMIER. THEY HAVE FIVE LOCATIONS IN TOWN. THOSE ARE MOSTLY STAFFED BY OUR GRADUATES. A HUGE PERCENT OF THEM.

IN FACT, THREE OF THE MEDICAL DIRECTORS OF THE DIFFERENT PREMIERS ARE ALL OUR GRADUATES. MOST OF THEM AT EMERGENCY MEDICINE AND A HUGE PERCENTAGE OF THE DOCTORS IN TOWN ARE FROM OUR PROGRAM. THAT EXTENDS TO KINGSVILLE.

YOU WANTED FACTS. OUT OF THE GRADUATING CLASS, OUT OF THE THIRD-YEARS, THEY ARE ALREADY LOOKING FOR JOBS NEXT YEAR. WE HAVE FOUR THAT WANT TO STAY IN THE COMMUNITY, OUT OF THE CURRENT GRADUATING CLASS.

SINCE T THIS HAS HAPPENED, THEY ARE LOOKING ELSEWHERE.

THAT IS JUST ANOTHER LOSS AND ANOTHER EXAMPLE.

THAT IS AN AVERAGE PERCENTAGE. THAT IS HIGHER THAN I WOULD SAY THE NATIONAL AVERAGE OF RETENTION.

WE HAVE-- PEOPLE LOVE CORPUS, AND A LOT OF-- WE'VE GOT PEOPLE THAT HAVE STAYED FROM VERMONT. IT SEEMS LIKE THE FURTHER AWAY, THEY COME AND THEY WANT TO STAY. WE HAVE HAD PEOPLE FROM ALL OVER THE COUNTRY. BECOME CORPUS CHRISTI RESIDENTS.

>> YES. OVERALL, I KNOW MOST OF THE STATS. WE HAD 109 OF THE GRADUATES WORK OR PROVIDE SOME DEGREE OF SERVICE.

SOME OF THAT WOULD BE MOONLIGHTING OR DURING THEIR THIRD YEAR, AND FILL THE SHIFTS. THAT IS ANOTHER FACTOR.

THEY RELY HEAVILY ON OUR RESIDENTS TO STAFF THAT.

THOSE ARE ALL GOING TO BE COST-SHIFTED.

THERE IS SIGNIFICANT BONUSES AND THINGS LIKE THAT THAT HAVE TO BE PAID. THERE IS A HUGE PIPELINE OF NEEDED FECISIONS-- PHYSICIANS THAT WILL BE LOST.

>> AND TO ME, THAT IS VERY ENCOURAGING.

HONESTLY, IF YOU DIDN'T RETAIN ANY OF THEM, I WOULD STILL SAY THIS WAS A GREAT PROGRAM. WE GET ALL THESE PEOPLE, WHILE THEY ARE HERE. YOU GET 36 PEOPLE WORKING IN THE COMMUNITY. PLUS THE FACULTY.

WHAT ARE YOU-- WHETHER YOU RETAINED THEM OR NOT, IT IS IMPORTANT, BUT IT IS NOT THAT COMPELLING FOR ME.

IT IS MORE COMPELLING THAT SIX OUT OF 12 STAYED LAST YEAR.

THAT WAS SOME MISINFORMATION THAT WAS AROUND.

THAT PEOPLE WEREN'T STAYING HERE.

UNFORTUNATELY, THAT IS WHY WE ARE DOING THIS.

TO GET THE TRUTH OUT. >> THAT WOULD BE THE NORM.

SO LET'S SAY THE MARKETS ARE TIGHTER IN AUSTIN AND PLACES LIKE THAT. SO PEOPLE MAY JUST GO FOR TRAINING AND NOT RETAIN BECAUSE IN THE SAN DIEGOS AND PLACES WITH GREAT WEATHER, PEOPLE ARE JUST ALLOWED TO COME AND TRAIN.

THEN THEY HAVE TO LEAVE BECAUSE THERE IS NO SPOTS.

THE FACT THAT WE RETAIN ANY PHYSICIAN SOAS THAT THERE IS A NEED HERE FOR THE PHYSICIANS. THE FACT THAT WE HAVE BEEN ABLE TO-- WE HAVE POSITIONS FOR FOUR WAITING SHOWS THAT THERE IS

[00:40:05]

GREAT NEED FOR. THAT I CAN SPEAK TO, YOU KNOW, THE STUDY THAT WAS JUST QUOTED. THAT IS THE AMERICAN COLLEGE OF EMERGENCY PHYSICIANS. OUR SPECIALTY WAS HURT.

THEY PREDICTED THERE MIGHT BE AN OVERSURPLUS.

THAT CAME OUT IN 2019. I BELIEVE.

WHEN THAT STUDY CAME OUT. THEY SAID THERE MIGHT BE A SURPLUS OF EMERGENCY MEDICINE PHYSICIANS.

THEY HAVE ALREADY TAKEN THAT BACK.

THEY DIDN'T ACCOUNT FOR THE HIGH RATE OF ATTRITION OF PHYSICIANS IN COVID. PEOPLE GOT BURNED-OUT.

MANY DIED. WERE PERMANENTLY INJURED.

THEY HAVE REVERSED THEIR POSITION ON THAT STUDY.

EVEN IN OUR OWN CLASS, WE DID SEE A REDUCTION LAST YEAR IN THE SLIGHT NUMBER OF APPLICANTS. THIS YEAR THAT HAD ALREADY REVERSED. WE HAVE BEEN ASKED, WE HAD TO SHUT DOWN OUR RECRUITING. ON THE FIRST DAY THAT WE OPENED UP OUR RECRUITING, IT IS CALLED THE NEW HAMPSHIRE NATIONAL MATCH PROGRAM. WE HAD 600 APPLICATIONS FOR PEOPLE THAT WANTED TO APPLY FOR OUR PROGRAM.

600 PEOPLE ARE WILLING TO COME TO CORPUS CHRISTI.

WE HAVE TO WHITTLE THAT DOWN TO 12.

THE FACT THAT THEY SAY THERE IS AN OVERSURPLUS, NOT HERE.

YOU KNOW, MAYBE THERE ARE IN THE SAN DIEGOS AND OTHER PLACES THAT PEOPLE REALLY WANT TO GO, BUT I LOVE CORPUS.

IT IS A TRADITIONALLY HARD PLACE TO RECRUIT FOR PHYSICIANS.

>> I HAVE ALWAYS FELT IF YOU CAN GET PEOPLE HERE, THOUGH, THEY WILL STAY. IT IS HARD TO RECRUIT THEM TO COME HERE UNTIL THEY GET HERE AND REALIZE WHAT A WONDERFUL PLACE IT IS. I MEAN, I HAVE HEARD THAT FROM BUSINESSMEN ALL OVER SOUTH TEXAS.

IT IS REALLY HARD TO RECRUIT THEM HERE.

THE FACT THAT YOU HAVE THEM HERE AND HAVE THEM CAPTIVE, IF YOU WILL. THEY CAN GET INVOLVED IN THE

COMMUNITY. >> WE TRY TO GET THEM HERE TO ROTATE. EVEN AS A MONTH MEDICAL STUDENT.

IF WE CAN GET THEM HERE FOR A MONTH, WE KNOW THEY WILL RATE US HIGH. WE CAN GET THEM.

YOU KNOW, PEOPLE COME HERE. THEY SEE AMAZING STUFF.

CORPUS HAS A LOT OF PATHOLOGY AND A LOT OF SICK PATIENTS.

THEY GET TO DO A LOT IN THE RESIDENCY.

AND THEY WANT TO COME BACK. THAT IS EXACTLY RIGHT.

IF WE GET THEM HERE, WE CAN KEEP A LOT OF THEM.

>> WELL, I WILL LET OTHER PEOPLE TALK.

ONE THING MR. DOMINGUEZ AND I DID AGREE ON, THE REPUTATION OF YOUR PROGRAM IS SPECTACULAR. IT IS ONE OF THE BEST IN THE COUNTRY. AND SPOHN SHOULD BE PROUD OF.

THAT YOU SHOULD BE PROUD OF. THAT AND ALL THE DOCTORS FROM THE ROOM SHOULD BE PROUD OF. THAT THAT IS EVEN MORE BEFUDDLING TO ME THAT WE WANT TO SHUT ONE OF THE BEST PROGRAMS IN THE COUNTRY DOWN. AND WE WANT TO TAKE 52 PEOPLE THAT DO EMERGENCY MEDICINE OUT OF OUR COMMUNITY.

THAT DOESN'T MAKE SENSE TO ME. HOPEFULLY, AS WE MOVE FORWARD, WE WILL BE ABLE TO HAVE SOME OF THOSE CONVERSATIONS GOING FORWARD. AGAIN, I WANT TO LET OTHER PEOPLE TALK. I WANT TO CONGRATULATE YOU AND YOUR PROGRAM BECAUSE IT IS-- NOBODY QUESTIONS-- YOU ARE GETTING THE TOP OF THE TOP FROM THE RECRUITS.

YOUR TOP THREE MATCHES. YOU ARE GETTING EVERYTHING YOU WANT. AND IT IS BECAUSE YOU ARE SO GOOD. AND BELIEVE ME, NOBODY-- I DON'T THINK ANYBODY IS ARGUING THAT POINT DURING THIS DISCUSSION.

CONGRATULATIONS ON THAT. THANK YOU FOR BEING HERE.

>> THANK YOU. >> COMMISSIONER MAREZ WOULD LIKE

TO SPEAK. >> YES.

SURE. >> JUDGE, I THANK YOU FOR CALLING UPON THAT COMMITTEE. I AGREE.

YOU KNOW, WE WANT WILLING PARTNERS TO BE PART OF THAT GROUP. WE HOPE THAT EVERY PARTY IS REPRESENTED BECAUSE THAT IS THE ONLY WAY IT IS GOING TO SUCCEED.

I WILL SAY THIS PUBLICLY SO WE DON'T FORGET.

THERE ARE FUNDING SOURCES THAT WE HAVE LOCALLY, OBVIOUSLY THROUGH THE NUECES COUNTY HEALTH DISTRICT.

WE APPRECIATE THEIR PARTNERSHIP THAT HAVE HELPED US THROUGHOUT THE YEARS. WITH THE COUNTY BUDGET.

BUT ALSO IS THERE A WAY THAT WE CAN LOOK AT INCENTIVE VISING RECRUITMENT? THE PROGRAM ITSELF MAYBE? RIGHT? WE DON'T KNOW ALL THE DETAILS YET. WE KNOW SOME OF SIT PRO PRY AIR THE. IT IS A STRANGE MIX OF HAVING A NOT FOR PROFIT HOSPITAL WORKING AND DOING THE CARE.

THAT IS OUR PART, THAT IS OUR COMMITMENT TO THE COMMUNITY.

I THINK OF MY TIME. ANY TIME I'M WITH MY DOCTOR, I ALWAYS FEEL LIKE, YOU KNOW, LIKE WITH A PRIEST.

LET ME JUST SPILL ALL MY GUILT. OUT.

(LAUGHTER). >> AND SHARE MY ACCOUNTN'T FOR-- ACCOUNTABILITY FOR MYSELF. BUT NOT AS AN EXCUSE.

AS AN ELECTED OFFICIAL, IT IS TOUGH.

I'M SURE MEDICINE HAS TO BE WORSE.

YOU OVEREAT, YOU DON'T EXERCISE. YOU DON'T DO A LOT OF THINGS THAT SNEAK UP ON YOU. I HAVE BEEN IN THOSE BEDS.

AT SPOHN QUP SHORELINE. MY FAMILY MEMBERS HAVE BEEN THERE. LOST FAMILY MEMBERS THERE.

THE QUALITY OF CARE THAT Y'ALL PROVIDE IS REMARKABLE.

[00:45:04]

I CAN IMAGINE HOW YOU ALL SURVIVED DURING COVID.

I ALWAYS THOUGHT THAT WOULD BE THE TOUGHEST TEST THAT WE FOUND.

AND IT IS UFLT UNFORTUNATE THAT THIS DECISION HAS BEEN MADE.

I ALWAYS TRY TO BE OPTIMISTIC. IN THAT WE HAVE THIS DISCUSSION TODAY, TO BE ABLE TO MOVE FORWARD.

I THANK THE JUDGE FOR CALLING UPON THE COMMITTEE TO COME TOGETHER. I THINK OF MY DAUGHTER.

SHE IS A STUDENT RIGHT NOW. ONE OF THEIR CALLS AND ONE OF HER CLASSES-- I DON'T KNOW WHAT KIND OF BIOLOGY OR CHEMISTRY CLASS SHE IS TAKING. SHE IS SO BRILLIANT.

THTHEY ARE TALKING ABOUT FINDING THE NEW SET OF-- WHAT IS IT? ANTIBIOTIC-RESISTANT DRUGS OR WHATEVER.

RIGHT? SOMETHING LIKE THAT.

SHE TOLD ME. IT WENT RIGHT OVER MY HEAD.

I WANT HER TO COME BACK ONE DAY. IF SHE GOES INTO MEDICINE, THIS WOULD BE A GREAT PLACE TO START. HOPEFULLY, TO BE CLOSE TO

FAMILY. >> YES.

>> BUT YOU KNOW, IN LOOKING AT THIS, I FEEL THAT WE ARE TAKING THE RIGHT STEPS. RIGHT? WE CANNOT BE THE ONLY PART OF THE SOLUTION.

WE CAN BE A GREAT PART OF IT. RIGHT? SO I HOPE THAT TODAY WITH THIS CALL TO ACTION THAT WE HAVE HAD, FROM THE JUDGE, FROM THE MAJORITY OF THE COURT, FROM OUR PARTNERS HERE, THAT WE ARE GOING TO MAKE IT HAPPEN.

THIS ISSUE IS NOT GOING TO GO AWAY.

WE ARE GOING TO CONTINUE TO DISCUSS IT.

HOPE IS A GREAT THING. AND YOU KNOW, I HOPE THAT THIS WILL HELP WITH OUR RECRUITMENT. OUR RETENTION.

THAT WE DON'T LOSE ANYONE. I AGREE.

WE HAVE A BEAUTIFUL COMMUNITY. IF YOU HAVE ANY VISITING PHYSICIANS, ONLY BRING THEM BETWEEN RIGHT NOW AND APRIL.

RIGHT? WE KNOW THAT.

THEY WILL DREAD THE SUMMER. THAT IS SOMETHING TOTALLY DIFFERENT. RIGHT.

THANK YOU ALL FOR YOUR WORK. YOU HAVE MY COMMITMENT TO BE ON THIS COMMITTEE. THANK YOU, JUDGE, TO PUT ALL THE EFFORT IN. TO TRY TO FIND A SOLUTION.

>> WELL, I ASSUME-- I HOPE THE TALKS DO HAPPEN.

A REASONABLE GROUP, WE ARE WILLING TO NEGOTIATE AND COMPROMISE WHERE NEEDED. AND DO ALL OF THAT IN GOOD FAITH. I CAN ASSURE YOU THAT.

>> THANK YOU. THANK YOU ALL FOR BEING HERE.

>> CAN I SAY SOMETHING? >> OH, YES.

I'M SORRY. >> I MEAN, IT IS IRONIC THAT WE TALK ABOUT COMMUNICATION IN BIG GROUPS.

WE HAVE THE SAME PROBLEM HERE. THERE IS ONLY FIVE OF US.

I DIDN'T KNOW WE HAD A COMMITTEE.

>> WE JUST FORMED IT. JUST NOW.

(LAUGHTER). >> BUT ANYWAY, I WANT TO LET YOU KNOW, THAT COMUN COMMUNICATION IS BOTH WAYS.

RIGHT? I REALLY CARE FOR RESIDENCY.

I SUPPORT IT. I LOOK AT BOTH SIDES, TOO.

IT IS NOT JUST THE ONE-SIEFDED THING.

WE CAN BLAME WHOEVER WE WANT TO BLAME.

IT IS A TWO-SIDES TO EVERYTHING. IT HAS A STORY.

I WISH I HAD ALL YOU GUYS SUPPORT HECTOR GARCIA.

THAT IS WHAT WE NEEDED. TO SUPPORT THE HECTOR GARCIA.

>> I WAS THERE. I WAS AT THE RIBBON-CUTTING.

>> VERY FEW OF YOU WERE THERE. THAT IS THE INDIGENT CARE.

TO ME, MY PASSION IS THE INDIGENT CARE.

WITH THE HOSPITAL DISTRICT. YOU KNOW? I DON'T KNOW HOW MANY DOCTORS ARE GOING TO GO WORK FOR INDIGENT CARE WHEN THEY LEAVE. THE DOCTOR YOU MENTIONED A WHILE AGO, HOW MANY OF YOU ACTUALLY WORK FOR SPOHN?

THE ONES WHO GRADUATED? >> WHAT?

>> HE WAS TALKING ABOUT THREE DOCTORS.

>> ALL OF YOU. >> ALL OF YOU WORK FOR SPOHN? OH, GOOD. CONGRATULATIONS.

THAT IS REALLY WHAT I LOOK AT. WHO IS GOING TO STAY AND WORK AT SPOHN? YOU KNOW? BECAUSE IF YOU TRAIN THEM AND YOU CAN GO ANYWHERE YOU WANT TO GO, THEN WE ARE SPENDING MONEY THAT WE SHOULDN'T BE SPENDING.

TO ME. RIGHT? I MEAN, I THINK SPOHN PROBABLY SHOULD HAVE A TWO-YEAR CONTRACT ONCE YOU GRADUATE. YOU HAVE TO STAY AT SPOHN.

BECAUSE EVERYBODY WANTS YOU WHEN YOU GRADUATE.

NOBODY WANTS TO PAY FOR YOU WHEN YOU GRADUATE.

IF EVERYBODY WOULD GET TOGETHER. THE E.R.S, THE HOSPITALS, AND THEY SAID COME TO THE TABLE, OKAY.

WE ARE GOING TO HELP PAY FOR THOSE $280 MILLION THAT HAVE BEEN SPENT BY SPOHN. YOU KNOW, AND THEN YOU CAN HAVE WHATEVER YOU WANT WHEN YOU GRADUATE.

I'M LOOKING AT BOTH SIDES HERE. WHEN THEY GRADUATE, THEY SHOULD HAVE AN OPTION. I ALWAYS SAY WE SHOULD HAVE A CONTRACT. WHEN THEY GRADUATE.

TO STAY THERE AT LEAST TWO YEARS.

YOU KNOW? WE LOSE POLICE OFFICERS LIKE THAT. WE LOSE SHERIFF'S OFFICERS LIKE THAT. BECAUSE WE TRAIN THEM AND WE LOSE THEM. YOU KNOW? AND YOU KNOW, WHEN I SAW THEM TALK ABOUT THOSE SIX, I SAID HOW MANY OF THOSE SIX WORK FOR SPOHN?

>> WE HAVE A GREAT RETENTION RATE.

>> THE RETENTION IS HERE LOCALLY.

I DON'T KNOW IF IT IS FOR SPOHN. THAT IS WHAT I'M SAYING.

MAYBE WE ALL NEED TO COME TO THE TABLE.

YOU KNOW, TAKE A LITTLE SKIN IN THE GAME.

[00:50:01]

PUT A LITTLE BIT OF MONEY AND SAY HERE IS THE MONEY TO TRAIN THE PEOPLE. WHERE DO THEY GO WHEN THEY GRADUATE. THAT IS GOOD.

MY CONCERN IS ALSO THE E.R. MY CONCERN IS ALSO THE FACT THAT THE WAITING TIME THE-- I HATE TO WAIT IN THE E.R.

>> ABSOLUTELY. >> I KNOW IT MAKES IT EASIER WITH THE RESIDENCY. I WOULD LIKE TO HEAR THAT, TOO.

SEE WHAT THEIR COMMITMENT IS. I KNOW THE RESIDENCIES HELP.

I LIKE TO HEAR WHAT IS THE COMMITMENT FROM SPOHN.

ARE THEY WILLING TO MAKE AN OPEN COMMITMENT TO SAY, HEY, YOU KNOW WHAT? WE ARE GOING TO HIRE MORE DOCTORS IN THE NEXT TWO YEARS. THEY NEED TO COME TO THE TABLE, TOO, AND SAY WHAT THEY ARE GOING TO DO.

THERE IS ONLY TWO RESIDENCY PROGRAMS HERE.

THAT THEY ARE REQUIRED TO HAVE. TWO.

IT JUST SAYS TWO. THE ONLY ONES MANDATORY IS THE FAMILY MEDICINE RESIDENCY. THAT ONE WE HAVE TO HAVE.

THE OTHER ONE WAS CREATED BY SPOHN.

THAT GOES, THEY HAVE TO REPLACE THAT WITH SOMETHING ELSE THAT IS GOING TO BENEFIT THE COMMUNITY, I THINK.

SO I UNDERSTAND. I MIGHT BE WRONG.

AGAIN, SO I THINK THAT RESIDENCY, THERE MIGHT BE SOMETHING ELSE OUT THERE THAT IS GOING TO BE GOOD.

WE DON'T KNOW. WE CAN'T JUST SHUT THE DOORS TO EVERYTHING ELSE EITHER. AND NOT GIVE SOMETHING ELSE A CHANCE. TO GROW LIKE THE RESIDENCY GREW.

IF YOU WANT TO KEEP THE RESIDENCY, MAYBE WE NEED TO GET TOGETHER AND SAY HEY, HOW MUCH ARE WE ALL PUT ON THE TABLE? MAKE IT WORK AND KEEP SOME OF THE RESIDENCY.

WE ARE ALL PITCHING IN. WE STILL HAVE ANOTHER RESIDENCY THIS BOND IS GOING TO BRING IN. NOTHING WRONG WITH HAVING THREE.

FOUR: I MEAN, I DON'T CARE. WE WILL PAY FOR THEM, RIGHT? YOU KNOW, WE ALL WANT SOMEBODY WHO IS TRAINED AND READY TO GO.

NOBODY WANTS TO -- >> I CAN SPEAK A LITTLE BIT TO SOME OF THE FRUSTRATIONS WITH WAITING TIMES AND THINGS LIKE THAT. I WAS HERE GETTING THE PROGRAM ACCREDITED. I WORKED A SHIFT AT SHORELINE.

I WILL NEVER FORGET THE FIRST DAY I WORKED THERE WITH NO RESIDENTS. THERE WAS 17 CHARTS IN THE RACK.

THAT MEANS 17 PATIENTS HAD BEEN WAITING ALL NIGHT TO BE SEEN.

AND THE FIRST FIVE OR SIX I SAW WERE DEBTLY ILL.

DEATHLY ILL. LOW BLOOD PRESSURE.

HEART RATES OF 150. THERE IS NO WAY THEY SHOULD HAVE BEEN WAITING WITH THOSE WAIT TIMES.

WITH THE RESIDENTS, WE HAVE SOLVED THAT.

WE SOLVED THAT THE DAY THE RESIDENT SEE MOVED FROM MEMORIAL TO SHORELINE. THE METRICS DECREASED GREATLY.

NOW ALL WAITING TIMES ARE BASED ON NURSE STAFFING.

THERE IS NOT ENOUGH NURSES TO STAFF THE BEDS.

UPSTAIRS. THEY HOLD PATIENTS IN THE EMERGENCY DEPARTMENT. WE WILL GO TO THE WAITING ROOM AND SEE PEOPLE. WE WORK IN TRIAGE TO DECREASE WAITING ROOM TIMES TO GET TESTS ORDERED.

IF THEY NEED AN X-RAY, WE MEET THEM UP-FRONT.

WE START THE WORKUP. DRAW THE BLOOD AND GET IT.

THE WAITING TIME IS DECREASED SIGNIFICANTLY WITH THE RESIDENTS. NO MATTER WHAT STAFFING MODEL THEY GO BACK TO, THEY WILL NOT HAVE SIX.

THAT IS ASTRONOMICALLY-- TO GO TO SIX WOULD BE PAYING THE HOURLY RATE THAT WE DID-- THAT WOULD BE $10 MILLION A YEAR TO STAFF IT WITH SIX DOCTORS. WE WORK FOR MUCH LESS.

ABOUT $20 AN HOUR LESS THAN THE AVERAGE TEXAS E.R. DOC.

WE LIKE WHAT WE DO. WE HAVE NEVER TAKE AN SHIFT BONUS TO WORK AT SHORELINE. WE MAKE OUR OWN SCHEDULE.

SO STARTING JULY 1, THE COSTS ARE GOING-- AND WAITING TIMES ARE GOING TO GO BACK TO WHAT IT WAS ON THOSE FIRST SHIFTS.

THAT IS PROBABLY ANOTHER THING THAT IS IMPORTANT TO UNDERSTAND HERE. THIS DOESN'T START IN 2026.

SO IF THERE IS NO NEW CLASS, ALL THE HOSPITAL STAFFING IS BASED ON 36, HAVING 36 RESIDENTS. THERE ARE GAPS STARTING JULY 1 THAT WILL AFFECT WAITING TIMES, TRAUMA CARE, ACCREDITATION AND

KIND OF THE SNOWBALL EFFECT. >> THEY ARE RESIDENTS UNTIL 2026. RIGHT?

>> THEY ARE PROPOSING WE NOT TAKE A NEW CLASS.

STARTING JULY 1, THERE WOULD BE 24.

THERE IS 12 RESIDENTS. FIRST-YEAR RESIDENTS.

12 SECOND-YEAR. 12 THIRD-YEAR.

THEY ARE PROPOSING THAT WE DO NOT TAKE A NEW CLASS.

SO JULY 1, WE WOULD NOT HAVE A NEW GROUP OF 12 RESIDENTS.

WE WOULD STILL HAVE 12 SECOND-YEARS AND 12 THIRD-YEARS.

WE GO TO 24 RESIDENTS STARTING JULY 1.

IF NONE OF THEM LEFT. THESE GUYS ARE SUPERSTARS.

THIS IS OUT NATIONALLY. THEY HAVE IVY LEAGUE PLACES

[00:55:03]

WANTING THEM. THEY ARE GOING TO HAVE TO DECIDE IF THEY WANT TO STAY HERE OR NOT.

>> WELL, I THINK ALL DOCTORS LIKE THE START.

THEY TAKE CARE OF YOU. ESPECIALLY THE ONES IN TRAUMA.

I ADMIRE THOSE A LOT. TRAUMA DOCTORS ARE MY FAVORITE.

RIGHT? THE THING IS, LET ME TELL YOU.

WHAT BOTHERS ME, WE ASK FOR MORE DOCTORS.

WHEN WE SEE OUR DOCTOR, YOU KNOW, I SEE A PA.

THREE TIMES IN A ROW. I WANT TO SEE MY DOCTOR.

I SEE A PA. >> SO WHEN THESE DOCTORS ARE GONE, THEY REASON REPLACED. THEY WILL BE REPLACED.

>> I GET CHARGED THE SAME AMOUNT OF MONEY.

ARE WE SHORT ON DOCTORS? OR DOCTORS DON'T WANT TO --

>> YES. NATIONALLY.

>> THE PAS DO A GREAT JOB. DON'T GET ME WRONG.

MAYBE WE NEED TO HAVE A RESIDENCY FOR PAS.

I DON'T KNOW. MAYBE IT IS A GOOD THING TO HAVE. EVERYBODY IS USING THOSE PAS

NOW. >> WE WORK WITH NURSE PRACTITIONERS. OR PAS AND PPAS.

THAT IS WHAT-- WHO THESE DOCS WILL BE REPLACED WITH.

THE FINANCIAL REALITY. YOU CAN'T AFFORD TO REPLACE A

RESIDENT DOCTOR. >> NOTHING WITH A PA.

NOTHING WRONG WITH A PA. I'M SORRY.

JUDGE, THANK YOU VERY MUCH. I APPRECIATE IT.

>> THANK YOU, COMMISSIONER. >> YOU KNOW, I DON'T THINK WE HAVE ANY-- I DON'T KNOW WHY WE WOULD HAVE A COMMITTEE-- WE CAN'T TELL SPOHN WHAT TO DO. WE CAN'T TELL THE DOCTORS WHAT TO DO. WE DON'T HAVE A CONTRACT WITH THEM. WE DON'T HAVE A CONTRACT WITH ANYONE. THE HOSPITAL DISTRICT HAS AN AGREEMENT. RIGHT? THEY HAVE AN AGREEMENT. THEY KEPT THE AGREEMENT.

YOU KNOW, THEY HAVE THE RESIDENCIES.

THEY GET RID OF ONE. THEY HAVE TO PUT ANOTHER ONE.

I DON'T KNOW HERE. YOU KNOW, I DON'T EVEN KNOW EITHER ONE OF YOU WENT TO THE HOSPITAL DISTRICT OR NOT.

IF THE DOCTORS DIDN'T GO AND SPOHN DIDN'T GO TO THE HOSPITAL DISTRICT, SHAME ON YOU. YOU SHOULD HAVE GONE FIRST TO THE HOSPITAL DISTRICT. OKAY?

THANK YOU. >> THANK YOU.

COMMISSIONER HERNANDEZ WOULD LIKE TO SPEAK FIRST.

THEN WE ARE GOING TO GET EVERYBODY STARTED ON THE PUBLIC SPEAKING. THREE MINUTES EACH.

>> YES, JUNK. FYES, JUDGE.

I LIKE THE IDEA OF FORMING THIS COMMITTEE.

THANK YOU TO THE GENTLEMEN VOLUNTEERING TO PARTICIPATE.

THE FASTER WE GET THIS COMMITTEE GOING, THE BETTER IT WILL BE FOR THE COMMUNITY SO WE CAN GET THINGS DONE RIGHT.

THANK YOU. >> THANK YOU.

[E. 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.]

I'M JUST GOING TO START DOWN THE LIST.

YOU WILL HAVE THREE MINUTES WHEN YOU GET UP TO THE PODIUM, PLEASE STATE YOUR NAME AND ADDRESS. I HAVE THIS LIST THAT WAS E-MAILED TO ME. I ASSUME THIS LIST WISHES TO SPEAK PUBLICLY AS WELL. I DON'T KNOW WHERE PAYTON IS.

WHERE I GOT IT. I ASSUME.

WE WILL START WITH DR. SANDRA WILLIAMS.

>> CAN YOU PULL THAT MIC UP, PLEASE?

THANK YOU. >> I'M A LITTLE BIT TALL HERE.

>> STATE YOUR NAME AND ADDRESS AS WELL.

>> GOOD AFTERNOON. MY NAME IS SANDRA WILLIAMS. I'M NOT A NEW CEASE COUNTY RESIDENT.

I LIVE IN HOUSTON, TEXAS. I PRACTICE IN ANGLETON, TEXAS.

I'M CURRENTLY THE PRESIDENT OF THE TEXAS COLLEGE OF EMERGENCY PHYSICIANS. WE ARE THE PROFESSIONAL ORGANIZATION THAT REPRESENTS OVER 2,100 EMERGENCY MEDICAL PHYSICIANS IN THE STATE. AS WELL AS ALL OF THE EMERGENCY MEDICINE PROGRAMS IN THE STATE. THE FIRST THING I WANT TO TALK TO YOU GUYS ABOUT IS WHAT EXACTLY MAKES AN EMERGENCY MEDICINE RESIDENCY TRAINED PHYSICIAN.

WE GO THROUGH A LOT OF TRAINING AND A LOT OF SCHOOLING THAT MAKES US VERY DIFFERENT FROM THOSE THAT ARE A PHYSICIAN'S ASSISTANT OR A NURSE PRACTITIONER.

WE GO TO UNDERGRAD AND GET A DEGREE IN SOMETHING.