Dear commissioners court:

I would like to make two points regarding the upcoming Certificates of Obligations (COO) vote. My points are as follows:

1. University Medical Center (UMC) and Hospital Board of Managers continue to neglect “Mental Health” care by not including it in its strategic plan or COO plan. Not one dollar in the COO is assigned to improve mental health care at UMC! Here are five facts about mental health:

A. Mental illness affects one in five individuals, while 1 in 25 have a serious mental illness (Bipolar, Depression, Schizophrenia).

B. Patients suffering from severe mental disorders, such as schizophrenia, major depression and bipolar disorders, have a reduced life expectancy compared to the general population of up to 10–25 years. This is not only due to the mental illness, but the effect of the illness on comorbidities like diabetes, hypertension, obesity and access to care.

C. The 2022 State of Mental Health in America report, ranked Texas last out of all 50 states and the District of Columbia for overall access to mental healthcare. Texas Governor Greg Abbott cut millions in funding from the department that oversees mental health programs. Local communities are expected to make up the difference. UMC has not!

D. Mental health care is instrumental in improving our physical health. You cannot have one without the other. Unfortunately, UMC has no community clinics with psychiatrists, psychiatric providers, counselors or case management services to address the mental health of El Pasoans. Care in the Emergency Department (ED) is not psychiatric care. It is like only treating diabetes, hypertension, heart disease only in the ED and not in the community clinics.

E. By refusing to address or much less improve mental health access and the mental health needs of our community, UMC continues to perpetuate the negative stigma about mental health. If we do not provide it or talk about it, it does not exist! The mantra is, “it is not in our mission, it is up to the state (which Texas is one of the worst in funding)!”

My second point:

2. The Hospital District, Board of Trustees and Commissioners Court are not providing sound fiscal oversight over the operations at UMC (which is hemorrhaging money again) and financial outcomes of the hospital. Consequently, reliance on our tax dollars to stop the hemorrhage will continue with passage of the COO.

A third quarter review of the June 30, 2022 UMC financial reports found on their website show the following:

A. UMC is “hemorrhaging red” in operations this fiscal year (like the past three years also), at the tune of ($127 million) over budget as of June 2022. Only the El Paso Children’s Hospital, $9.6 million and El Paso Health $6.7 million entities are in the black. Why doesn’t the Board of Managers and Commissioners Court demand that operations be streamlined prior to incurring more debt? UMC is already about $514 million in debt (including interest) and with the COO’s true cost of debt, which according to the UMC Public Notice, is $686 million dollars, the total debt would be over $1 billion ($1.2B). Assigning this to taxpayers as inflation is at 9% and families struggle is unconscionable!

B. Overall, due to our county taxes and CARES/COVID government funds ($97 million in taxes or non-operating revenue) UMC (on a combined statement) is reporting a ($15 million) loss as of June 2022. Again, imagine the positive balance if operations were not ($127 million) over budget this year?

C. UMC had operating losses of $119.9 million in 2021, $82.9 million in 2020, and $114 million in 2019. Due to primarily our taxes (non-operating revenue), UMC had a profit of $63.8 million in 2021, $30.9 million in 2020, and a loss of $10.9 million in 2019. If operations were improved, perhaps UMC would be proposing a lower tax rate, provide mental health services or expand based on their efficiencies!

D. The payor mix for UMC is good. Per the June 2022 financials, the payor mix is made up by the following payors: Medicare 27.5%, Medicaid 18%, Charity Care 13.6%, Commercial 10%, HMO/PPO 7.4%, Other 8.6% and Self-pay is 14.9%. Not everyone that is treated at UMC has no income or receives free care. On the contrary, 85% of patients treated at UMC are funded (they do receive state money for charity care) and they have made improvements in their payor mix in comparison to last year. Unfortunately, more income (revenue) is quickly offset by increased expenses and operational inefficiencies. It astounds me that $340 million in COO are being proposed by hospital leadership and the Board of Managers when the operations of UMC are bleeding money, this year, just like they did in 2021, 2020 and 2019!” The major factors controlling the bleeding are county taxes and CARES/COVID relief funds from the government. Based on the current performance and past, three-year history, why would anyone propose to continue operating (at significant losses) in this manner and incur further debt? The Board of Managers and Commissioners court need to act and explain to taxpayers why the bleeding is tolerated and why they would like it to continue?

We are faced with mental health and physical health challenges in a time when not enough providers, human and financial resources are available. It is unfortunate that we are going through challenging times, inflation is up to 9% and we are heading into a recession. Best practices in the business world expect streamlined operations and resiliency to adapt and survive for the long term. Incurring debt to $1.2 billion dollars and expanding services that will require taxpayer dollars in the future to sustain is not a wise business decision. The Hospital Leadership, Board of Trustees and Commissioners Court should demonstrate excellence in their oversight of hospital operations and taxpayer taxes. To approve COO for UMC which neglects mental health care and has a current and past record of being unable to streamline operations is a disaster waiting to happen for El Paso taxpayers. You can hold UMC accountable for taxpayer money by requesting fiscal and operational responsibility. Commissioners Court: It is a NO brainer! Just vote NO and demand excellence!

About the Author:

Alfredo H. Arellano is an El Paso native who graduated from Cathedral High School and UTEP. Arellano has worked in El Paso treating patients with mental health concerns for over 30 years. His goal is to bring to the Southwest the best evidenced-based and up to date treatments for psychiatric and mental health problems. Arellano worked at Thomason Hospital for 14+ years. Arellano has served on the Board of Managers for Emergence Health Network and Centro San Vicente. Arellano has his own Outpatient Psychiatric Practice, specializing in Transcranial Magnetic Stimulation.

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