On Texas Hospital Districts and Non-District Clinics and Whether The Ends Justify the MeansSomervell County Salon-Glen Rose, Rainbow, Nemo, Glass....Texas


On Texas Hospital Districts and Non-District Clinics and Whether The Ends Justify the Means

22 May 2019 at 4:31:42 PM

There is another argument made about spending taxpayer money outside the district that says that if the clinic, wherever it is located, makes money which then comes back to fund the hospital, it's fine. That's regardless if the clinic already exists within another hospital district and without ensuring that a district has an intergovernmental agreement to operate in a different area outside the hospital district territory. Reminding as I talk about this that the easy way to resolve this would be for Somervelll County Hospital District to quit shying away from getting a legal opinion from the Texas Attorney General. Having an opinion would go a long way to shutting up those, including myself, who don't want our taxmoney being spent outside the district. 

So, two different instances I want to talk about. One is, money, according to Chapter 283 of the Health and Safety Code as well as Article 9 Section 9 of the Texas Constitution indicate that hospital districts are territorially bounded and there for the benefit of the citizens who reside there and pay taxes for services. A hospital does not have to become a hospital district but if they do and it's voted in, then they should abide by what is ultimately a restriction bounded by the county boundaries. You and I aren't likely to go drive up to Allen, Texas, to use the therapy clinic there that our tax money is paying for. It is there BECAUSE the board sees it as a revenue generator, where Ray Reynolds the CEO of Glen Rose Medical Center, admits that it is in another market. 

The point of having a hospital district is to collect taxes from citizens FOR the residents of the district, not to be a money-making operation all over Texas. 

Worse is when there is a clinic that already exists within another hospital district. That is Pecan Family Medical Center, which is in Pecan Plantation near Granbury in Hood County, Texas. Pecan Plantation is a gated community so you cannot just up and walk or drive  in there, as you could with a public clinic. And yet, our Somervell County tax money is going to pay for it, including the lease as well as renovations.

The doctors are already being paid out of Somervell County Hospital District budget, thus are employees of the district (Say, reminds me, why in the fool is Steven Vasick on the board still??) If you lived in Hood County, you would pay ZERO taxes for the hospital district because Hood County Hospital District has a contract with Lake Granbury Medical Center, which is a for-profit hospital, to operate a public clinic for the benefit of its residents (bet there is no gate around that). So WE are paying taxes in another hospital district for people that live in a gated community that pay NO TAXES (and I was actually told one time by the guard at the gate that I should be grateful to Pecan Plantation for having the clinic that would keep the hospital going. Oh, right. Thanks, Mistah) 

It's also interesting to me that the various items that Somervell County Hospital District votes on for Pecan Plantation are listed THIS way >>>>>> in the budget, as if somehow none of our tax money is going out for Pecan. It is. Whitsett shows that it's entirely fungible how Pecan Clinic appears in the budget. "Mike likes to keep Pecan separated" and yet he doesn't put ALL the items with revenue and expense in the same bucket even though it's the district that is paying for it. 

Steven Vacick shows the problem with picking and choosing items to put in different parts of the budget. "Makes it look like we're losing half a million dollars in the therapy department". 

Here, from the March 28 2019 is Somervell County Hospital District board preparing to accept a biid for remodeling a clinic at Pecan. 

Frankly, in listening to this discussion, I don't know why, 1, the current hospital board didn't ask for a copy of the previous Pecan Clinic report and 2. have someone that knows, at the very least, data and spreadsheets, go LOOK at how the information comes out. Seems to me, being a techie, that there could be a data dump that shows some main criteria, which could then be filtered or resorted according to a second criteria. Overall, really, Somervell County Hospital District CANNOT GET THE NUMBERS TO KNOW FOR SURE WHERE THE MONEY GOES? And yet voted to give Ray Reynolds a raise to $175,000 a year? 

The second part of this is, well, if it makes money, doesn't that make it okay? Again, in my opinion, not when the district says it's boundary-driven. There are probably lots of places one could get money to operate the hospital IF ONE WERE A PROFIT CENTER LOOKING FOR REVENUE and to expand the base. 

  • Lubbock Hospital District -every clinic they have is within the Lubbock County borders
  • Tarrant Hospital District -every clinic they have is within Tarrant County borders
  • Parker Hospital District- every clinkc they have is within Parker County borders
  • Harris Hospital District- every clinic they have is within Harris County borders

Does the fact that Somervell County Hospital District is a small district compared to these others mean that there's an exception for the hospital district law regarding this? I don't think so. Somervell County had a number of choices for how to run a hospital, including whether public or private or a district. They chose to do a petition to create a hospital district which very narrowly passed, meaning that almost half of the people who voted DID NOT WANT ONE. 

In other words, hospitals need money and need supported. I agree with this, I've never been in favor of closing the hospital but have wanted to look at other possibilities that might lower taxes for residents here. That would have included joining with a for-profit hospital and perhaps very good emergency services. After all, Gary Marks pointed out some years ago that there are a lot of hospitals within 25 miles of GRMC. A second factor is that apparently, because Glen Rose Medical Center is no longe a trauma level 4 hospital and Comanche Peak has an arrangement with LGMC to send people there, the impetus for requiring there to be a hospital of some size does not exist. And finally, as we all know, generally people that come to the hospital here quite often are sent to another larger hospital anyway after getting stabliized. Is there really anything wrong with having a very good emergency clinic while partnering with another larger hospital? Doesn't seem like that should be, since at one point GRMC was partnering with Baylor Medical Center (now probably Scott and White).. 

At an ethical level, the idea that "Hey, we can ignore the fact that we're using taxpayer money to go lease and staff clinics in Allen, Texas, because, after all, we may make money from them to flow back into the district". doesn't seem right.  Again, first, it's not like there's a direct relationship to the clinic for the benefit of citizens here. But the argument is "The End Justifies the Means". Let's extrapolate from that. It would be okay for taxpayer funded Glen Rose ISD to build a stadium in Hood County and lease it out, even though there's another school district there? After all, they might make money even though except for sports games, no one from Somervell County would be using the stadium. How about the Somervell County Water District? Can they decide they aren't making enough money from the residents here and go lease a lake and lease employees to run it  in Parker County for extra revenue? 

How about if every legal hospital district in the state of texas decided to come open up a clinic managed by some entity  in Somervell County. I mentioned 4 different hospital districts, above, although there are many more in Texas. At a simplistic level, although one certainly cannot prevent private clinics from opening, a clinic run by another hospital district would be competing with the revenue Somervell County Hospital District wanted to make to serve its citizens. 

And let's talk about the "ends justify the means" argument, ie, if we have a good outcome doesn't matter if it was wrong that we sent taxpayer money into clinics through DFW in order to get revenue. What if it's a noble cause? Ends, no matter how laudable, are no justification for using questionable means to achieve them. (Mike Myer) . Suppose Somervell County Hospital District decided to open up a prostitution ring in Dallas County, which brought in quite a bit of money, would that make it okay? There's an interesting law enforcement article from PoliceOne that addresses the ethics of this type of thing.

Noble cause corruption is a teleological (ends-oriented) approach to an ethical dilemma that says law enforcement professionals will utilize unethical, and sometimes illegal, means to obtain a desired result.

Remember, we are talking about good officers trying to do the right thing (noble cause), but due to bureaucratic red tape, a lack of evidence, or any other roadblock to “getting the job done,” they feel forced to bend or even break the rules to catch the bad guy (corruption).

The bottom line: noble cause corruption — and thus, teleological ideologies in general — dramatically increase the likelihood of a serious situation that could easily turn horribly messy, ending your career in law enforcement and, potentially, scarring or ending the lives of you and/or others.

A recent example of the ends justifying the means were the people, including two actresses, who lied on college applications about their children, in order to get them into a good school.  One, Lori Loughlin lied that her daughter was a rowing "coxswain" and paid $500,000 while other athletes who applied were shut out.  We are a nation of laws, and, when there is a taint against what Somervell County Hospital District is doing, they can easily solve it by asking for a Texas Attorney General opinion. My question is always, given that there have been multiple opportunities, why haven't they voted to do that? 

In Somervell County Hospital District's case, they are directly managing Pecan Family Medical Center without a middleman. So, does that make it okay to spend taxpayer money in other areas outside the district if you add a middle management layer to it? Money laundering operates on the same principle. The middle management company wants to make a buck, of course, but finding hospitals that exist within territorial bounded hospital districts to do it is unethical and opportunistic. Worse, though, the elected board that should be more careful about the law is also opportunitic and in my opnion, they look shady by not doing due dilligence to ensure they are following the law. 


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