Friday, June 30, 2017
TAC Chapter 134
CHAPTER 134: BENEFITS – GUIDELINES FOR MEDICAL SERVICES,
CHARGES, AND PAYMENTS
Title
28 Texas Administrative Code (TAC) § 134.500, § 134.530 and § 134.540
§134.500. Definitions.
(a) The following words and terms, when used in
this subchapter, have the following meanings, unless the context clearly
indicates otherwise:
(1) Brand name drug--A drug marketed under a proprietary,
trademark-protected name.
(2) Certified workers' compensation health care network (certified
network)--An organization that is certified in accordance with Insurance Code
Chapter 1305 and department rules.
(3) Closed formulary--All available Food and Drug Administration (FDA)
approved prescription and nonprescription drugs prescribed and dispensed for
outpatient use, but excludes:
(A) drugs identified with a status of "N" in the current
edition of the Official Disability Guidelines Treatment in Workers' Comp (ODG)
/ Appendix A, ODG Workers' Compensation Drug Formulary, and any updates;
(B) any prescription drug created through compounding [any
compound that contains a drug identified with a status of "N" in the
current edition of the ODG Treatment in Workers' Comp (ODG) / Appendix A, ODG
Workers' Compensation Drug Formulary, and any updates]; and
(C) any investigational or experimental drug for which there is early,
developing scientific or clinical evidence demonstrating the potential efficacy
of the treatment, but which is not yet broadly accepted as the prevailing
standard of care as defined in Labor Code §413.014(a).
(4) Compounding--As defined under Occupations Code §551.003(9), the
preparation, mixing, assembling, packaging, or labeling of a drug or device:
(A) as the result of a practitioner's prescription drug order based on
the practitioner-patient-pharmacist relationship in the course of professional
practice;
(B) for administration to a patient by a practitioner as the result of
a practitioner's initiative based on the practitioner-patient-pharmacist
relationship in the course of professional practice;
(C) in anticipation of a prescription drug order based on a routine,
regularly observed prescribing pattern; or
(D) for or as an incident to research, teaching, or chemical analysis
and not for selling or dispensing, except as allowed under Occupations Code
§562.154 or Occupations Code Chapter 563.
(5) Generic--See generically equivalent in definition of paragraph (6)
of this section.
(6) Generically equivalent--As defined under Occupations Code §562.001,
a drug that, when compared to the prescribed drug, is:
(A) pharmaceutically equivalent--Drug products that have identical
amounts of the same active chemical ingredients in the same dosage form and
that meet the identical compendia or other applicable standards of strength,
quality, and purity according to the United States Pharmacopoeia or another
nationally recognized compendium; and
(B) therapeutically equivalent--Pharmaceutically equivalent drug
products that, if administered in the same amounts, will provide the same
therapeutic effect, identical in duration and intensity.
(7) Medical emergency--The sudden onset of a medical condition
manifested by acute symptoms of sufficient severity, including severe pain that
in the absence of immediate medical attention could reasonably be expected to
result in:
(A) placing the patient's health or bodily functions in serious
jeopardy; or
(B) serious dysfunction of any body organ or part.
(8) Nonprescription drug or over-the-counter medication--A non-narcotic
drug that may be sold without a prescription and that is labeled and packaged
in compliance with state or federal law.
(9) Open formulary--Includes all available Food and Drug Administration
(FDA) approved prescription and nonprescription drugs prescribed and dispensed
for outpatient use, but does not include drugs that lack FDA approval, or
non-drug items.
(10) Prescribing doctor--A physician or dentist who prescribes
prescription drugs or over the counter medications in accordance with the physician's
or dentist's license and state and federal laws and rules. For purposes of this
chapter, prescribing doctor includes an advanced practice nurse or physician
assistant to whom a physician has delegated the authority to carry out or sign
prescription drug orders, under Occupations Code Chapter 157, who prescribes
prescription drugs or over the counter medication under the physician's
supervision and in accordance with the health care practitioner's license and
state and federal laws and rules.
(11) Prescription--An order for a prescription or nonprescription drug
to be dispensed.
(12) Prescription drug--
(A) A substance for which federal or state law requires a prescription
before the substance may be legally dispensed to the public;
(B) A drug that under federal law is required, before being dispensed
or delivered, to be labeled with the statement: "Caution: federal law
prohibits dispensing without prescription;" "Rx only;" or
another legend that complies with federal law; or
(C) A drug that is required by federal or state statute or regulation
to be dispensed on prescription or that is restricted to use by a prescribing
doctor only.
(13) Statement of medical necessity--A written statement from the
prescribing doctor to establish the need for treatments or services, or
prescriptions, including the need for a brand name drug where applicable. A
statement of medical necessity shall include:
(A) the injured employee's full name;
(B) date of injury;
(C) social security number;
(D) diagnosis code(s);
(E) whether the drug has previously been prescribed and dispensed, if
known, and whether the inability to obtain the drug poses an unreasonable risk
of a medical emergency; and
(F) how the prescription treats the diagnosis, promotes recovery, or
enhances the ability of the injured employee to return to or retain employment.
(14) Substitution--As defined under Occupations Code §551.003(41), the
dispensing of a drug or a brand of drug other than the drug or brand of drug
ordered or prescribed.
(b) This section will become effective for all
drugs that are prescribed and dispensed for outpatient use on or after MM/DD/YY
(intended to be a date certain approximately sixty days after the rule amendment
is finally adopted).
§134.530. Requirements for Use of the Closed Formulary for Claims Not Subject to
Certified Networks.
(a) Applicability.
The closed formulary applies to all drugs that are prescribed and dispensed for
outpatient use for claims not subject to a certified network on or after
September 1, 2011 when the date of injury occurred on or after September 1,
2011.
(b) Preauthorization
for claims subject to the Division's closed formulary.
(1) Preauthorization is only required for:
(A) drugs identified with a status of "N" in the current
edition of the ODG Treatment in Workers' Comp (ODG) / Appendix A, ODG Workers'
Compensation Drug Formulary, and any updates;
(B) any prescription drug created through compounding [any
compound that contains a drug identified with a status of "N" in the
current edition of the ODG Treatment in Workers' Comp (ODG) / Appendix A, ODG
Workers' Compensation Drug Formulary, and any updates]; and
(C) any investigational or experimental drug for which there is early,
developing scientific or clinical evidence demonstrating the potential efficacy
of the treatment, but which is not yet broadly accepted as the prevailing
standard of care as defined in Labor Code §413.014(a).
(2) When §134.600(p)(12) of this title (relating to Preauthorization,
Concurrent Review, and Voluntary Certification of Health Care) conflicts with
this section, this section prevails.
(c) Preauthorization
of intrathecal drug delivery systems.
(1) An intrathecal drug delivery system requires preauthorization in
accordance with §134.600 of this title and the preauthorization request must
include the prescribing doctor's drug regime plan of care, and the anticipated
dosage or range of dosages for the administration of pain medication.
(2) Refills of an intrathecal drug delivery system with drugs excluded
from the closed formulary, which are billed using Healthcare Common Procedure
Coding System (HCPCS) Level II J codes, and submitted on a CMS-1500 or UB-04
billing form, require preauthorization on an annual basis. Preauthorization for
these refills is also required whenever:
(A) the medications, dosage or range of dosages, or the drug regime
proposed by the prescribing doctor differs from the medications, dosage or
range of dosages, or drug regime previously preauthorized by that prescribing
doctor; or
(B) there is a change in prescribing doctor.
(d) Treatment
guidelines. Except as provided by this subsection, the prescribing of drugs
shall be in accordance with §137.100 of this title (relating to Treatment
Guidelines), the division's adopted treatment guidelines.
(1) Prescription and nonprescription drugs included in the division's
closed formulary and recommended by the division's adopted treatment guidelines
may be prescribed and dispensed without preauthorization.
(2) Prescription and nonprescription drugs included in the division's
closed formulary that exceed or are not addressed by the division's adopted
treatment guidelines may be prescribed and dispensed without preauthorization.
(3) Drugs included in the closed formulary that are prescribed and
dispensed without preauthorization are subject to retrospective review of
medical necessity and reasonableness of health care by the insurance carrier in
accordance with subsection (g) of this section.
(e) Appeals process
for drugs excluded from the closed formulary.
(1) For situations in which the prescribing doctor determines and
documents that a drug excluded from the closed formulary is necessary to treat
an injured employee's compensable injury and has prescribed the drug, the
prescribing doctor, other requestor, or injured employee must request approval
of the drug by requesting preauthorization, including reconsideration, in
accordance with §134.600 of this title and applicable provisions of Chapter 19
of this title (relating to Agents' Licensing).
(2) If preauthorization is being requested by an injured employee or a
requestor other than the prescribing doctor, and the injured employee or other
requestor requests a statement of medical necessity, the prescribing doctor
shall provide a statement of medical necessity to facilitate the
preauthorization submission as set forth in §134.502 of this title (relating to
Pharmaceutical Services).
(3) If preauthorization for a drug excluded from the closed formulary
is denied, the requestor may submit a request for medical dispute resolution in
accordance with §133.308 of this title (relating to MDR by Independent Review
Organizations).
(4) In the event of an unreasonable risk of a medical emergency, an
interlocutory order may be obtained in accordance with §133.306 of this title
(relating to Interlocutory Orders for Medical Benefits) or §134.550 of this title
(relating to Medical Interlocutory Order).
(f) Initial
pharmaceutical coverage.
(1) Drugs included in the closed formulary which are prescribed for
initial pharmaceutical coverage, in accordance with Labor Code §413.0141, may
be dispensed without preauthorization and are not subject to retrospective
review of medical necessity.
(2) Drugs excluded from the closed formulary which are prescribed for
initial pharmaceutical coverage, in accordance with Labor Code §413.0141, may
be dispensed without preauthorization, except as referenced in subsection (b)(1)(C)
of this section, and are subject to retrospective review of medical necessity.
(g) Retrospective
review. Except as provided in subsection (f)(1) of this section, drugs that do
not require preauthorization are subject to retrospective review for medical
necessity in accordance with §133.230 of this title (relating to Insurance
Carrier Audit of a Medical Bill) and §133.240 of this title (relating to
Medical Payments and Denials), and applicable provisions of Chapter 19 of this
title.
(1) Health care, including a prescription for a drug, provided in
accordance with §137.100 of this title is presumed reasonable as specified in
Labor Code §413.017, and is also presumed to be health care reasonably required
as defined by Labor Code §401.011(22-a).
(2) In order for an insurance carrier to deny payment subject to a
retrospective review for pharmaceutical services that are recommended by the
division's adopted treatment guidelines, §137.100 of this title, the denial
must be supported by documentation of evidence-based medicine that outweighs
the presumption of reasonableness established under Labor Code §413.017.
(3) A prescribing doctor who prescribes pharmaceutical services that
exceed, are not recommended, or are not addressed by §137.100 of this title, is
required to provide documentation upon request in accordance with §134.500(13)
of this title (relating to Definitions) and §134.502(e) and (f) of this title.
(h) This section will become effective for all
drugs that are prescribed and dispensed for outpatient use on or after MM/DD/YY
(intended to be a date certain approximately sixty days after the rule
amendment is finally adopted).
§134.540. Requirements for Use of the Closed Formulary for Claims Subject to
Certified Networks.
(a) Applicability.
The closed formulary applies to all drugs that are prescribed and dispensed for
outpatient use for claims subject to a certified network on or after September
1, 2011 when the date of injury occurred on or after September 1, 2011.
(b) Preauthorization
for claims subject to the Division's closed formulary. Preauthorization is only
required for:
(1) drugs identified with a status of "N" in the current
edition of the ODG Treatment in Workers' Comp (ODG) / Appendix A, ODG Workers'
Compensation Drug Formulary, and any updates;
(2) any prescription drug created through compounding [any
compound that contains a drug identified with a status of "N" in the
current edition of the ODG Treatment in Workers' Comp (ODG) / Appendix A, ODG
Workers' Compensation Drug Formulary, and any updates]; and
(3) any investigational or experimental drug for which there is early,
developing scientific or clinical evidence demonstrating the potential efficacy
of the treatment, but which is not yet broadly accepted as the prevailing
standard of care as defined in Labor Code §413.014(a).
(c) Preauthorization
of intrathecal drug delivery systems.
(1) An intrathecal drug delivery system requires preauthorization in
accordance with the certified network's treatment guidelines and
preauthorization requirements pursuant to Insurance Code Chapter 1305 and
Chapter 10 of this title (relating to Workers' Compensation Health Care
Networks).
(2) Refills of an intrathecal drug delivery system with drugs excluded
from the closed formulary, which are billed using Healthcare Common Procedure
Coding System (HCPCS) Level II J codes, and submitted on a CMS-1500 or UB-04
billing form, require preauthorization on an annual basis. Preauthorization for
these refills is also required whenever:
(A) the medications, dosage or range of dosages, or the drug regime
proposed by the prescribing doctor differs from the medications dosage or range
of dosages, or drug regime previously preauthorized by that prescribing doctor;
or
(B) there is a change prescribing doctor.
(d) Treatment
guidelines. The prescribing of drugs shall be in accordance with the certified
network's treatment guidelines and preauthorization requirements pursuant to
Insurance Code Chapter 1305 and Chapter 10 of this title. Drugs included in the
closed formulary that are prescribed and dispensed without preauthorization are
subject to retrospective review of medical necessity and reasonableness of
health care by the insurance carrier in accordance with subsection (f) of this section.
(e) Appeals process
for drugs excluded from the closed formulary.
(1) For situations in which the prescribing doctor determines and
documents that a drug excluded from the closed formulary is necessary to treat
an injured employee's compensable injury and has prescribed the drug, the
prescribing doctor, other requestor, or injured employee must request approval
of the drug in a specific instance by requesting preauthorization in accordance
with the certified network's preauthorization process established pursuant to
Chapter 10, Subchapter F of this title (relating to Utilization Review and
Retrospective Review) and applicable provisions of Chapter 19 of this title (relating
to Agents' Licensing).
(2) If preauthorization is pursued by an injured employee or requestor
other than the prescribing doctor, and the injured employee or other requestor
requests a statement of medical necessity, the prescribing doctor shall provide
a statement of medical necessity to facilitate the preauthorization submission
as set forth in §134.502 of this title (relating to Pharmaceutical Services).
(3) If preauthorization for a drug excluded from the closed formulary
is denied, the requestor may submit a request for medical dispute resolution in
accordance with §133.308 of this title (relating to MDR by Independent Review
Organizations).
(4) In the event of an unreasonable risk of a medical emergency, an
interlocutory order may be obtained in accordance with §133.306 of this title
(relating to Interlocutory Orders for Medical Benefits) or §134.550 of this title
(relating to Medical Interlocutory Order).
(f) Initial
pharmaceutical coverage.
(1) Drugs included in the closed formulary which are prescribed for
initial pharmaceutical coverage, in accordance with Labor Code §413.0141, may
be dispensed without preauthorization and are not subject to retrospective
review of medical necessity.
(2) Drugs excluded from the closed formulary which are prescribed for
initial pharmaceutical coverage, in accordance with Labor Code §413.0141, may
be dispensed without preauthorization and are subject to retrospective review
of medical necessity.
(g) Retrospective
review. Except as provided in subsection (f)(1) of this section, drugs that do
not require preauthorization are subject to retrospective review for medical
necessity in accordance with §133.230 of this title (relating to Insurance
Carrier Audit of a Medical Bill), §133.240 of this title (relating to Medical
Payments and Denials), the Insurance Code, Chapter 1305, applicable provisions
of Chapters 10 and 19 of this title.
(1) In order for an insurance carrier to deny payment subject to a
retrospective review for pharmaceutical services that fall within the treatment
parameters of the certified network's treatment guidelines, the denial must be
supported by documentation of evidence-based medicine that outweighs the
evidence-basis of the certified network's treatment guidelines.
(2) A prescribing doctor who prescribes pharmaceutical services that
exceed, are not recommended, or are not addressed by the certified network's
treatment guidelines, is required to provide documentation upon request in
accordance with §134.500(13) of this title (relating to Definitions) and
§134.502(e) and(f) of this title.
(h) This section will become effective for all
drugs that are prescribed and dispensed for outpatient use on or after MM/DD/YY
(intended to be a date certain approximately sixty days after the rule
amendment is finally adopted).
Thursday, June 15, 2017
The Health Cell - June 20
|
Monday, June 5, 2017
Charles R. "Chuck" Bauer, MD
It is with a sad heart that we inform you that
Charles R. “Chuck” Bauer, MD passed away Sunday, June 4, 2017. Dr. Bauer was
loved and admired for all his service to the United States, Texas and to San
Antonio.
Dr. Bauer graduated from Marquette University School of
Medicine in 1958 and completed a rotating internship at St. Mary's Hospital. He
entered the US Air Force and spent 3 years as a flight surgeon at Tinker AFB,
Oklahoma. From 1962-1967 he completed four years of general surgery residency
and an additional year in Plastic and Reconstructive Surgery and Thoracic and
Cardiovascular Surgery at the University of Florida, Gainesville, Florida. From
1967-1970 he was stationed at Tachikawa Air Base, Japan caring for Vietnam war
casualties. Dr. Bauer was Commander, 659th Air Transportable Hospital, USAF
Hospital Luke, and USAF Kessler Medical Center (Brig. General position). He
retired in 1982 as a Colonel with Chief Physician and Chief Flight Surgeon
ratings and was awarded the Legion of Merit with 2 oak leaf clusters.
After being out of uniform for 22 years Colonel Bauer was one
of the first physicians recruited into the Texas Medical Brigade (then known as
the Texas Medical Rangers) during the initial organization of the Brigade.
During his tenure in the Medical Brigade, Colonel Dr. Bauer held almost every
important position appropriate for a physician. He responded as the Chief
Medical Officer to Hurricanes Katrina, Rita, Dean, Dolly, Ike, and Gustav.
Upon retirement from the Air Force, Dr. Bauer joined the
faculty at the University of Texas Health Science Center San Antonio as a
general and trauma surgeon and as the Assistant Dean for Ambulatory and
Emergency Services. He was instrumental in the founding of the Division of
Trauma and Emergency Surgery, the Division of Emergency Medicine. He is a
founding member of the Department of Emergency Medicine. Doctor Bauer served
until his death as an Adjunct Professor of Emergency Medicine.
He was board certified in general surgery, emergency medicine
and medical management. The American College of Physician Executives recognized
him as a Certified Physician Executive (CPE). He continued clinical practice in
emergency medicine and trauma surgery resuscitation at University Hospital.
Dr. Bauer was interested in Disaster Response and
Preparedness after arriving in San Antonio. He was the founding Chair of the
Southwest Texas Regional Advisory Council (STRAC) and which he continued as the
Chair Emeritus. He chaired the Bexar County Medical Society Emergency and
Disaster Preparedness Committee from 1985–2006. He was nationally recognized
for his contributions to medical preparedness and training for disasters by
FEMA and by the Medial Reserve Corps Program of the US Department of Health and
Humans Services.
Dr. Bauer developed the South Texas Poison Center located at
the UT Health Science Center and was instrumental in the establishment of the
Texas Poison Center Network. He retired as a Colonel from the Texas State
Guard, and served as the Commander of the Alamo Group, Texas Medical Rangers.
Dr. Bauer was recognized by the San Antonio Business Journal with a Life Time
Achievement Award for his community and medical services to San Antonio and Texas
and has also received the 2009 Governor’s Lonestar Achievement Award.
He completed numerous courses and taught on the subjects of
HazMat, Biological, Chemical, Nuclear and Radiation, Disaster Response, and
Hospital Emergency Incident Command. He had been the course director for close
to 100 Advanced Trauma Life Support Courses and also taught Advanced Cardiac
Life Support, Pediatric Life Support, Advanced HazMat Life Support and Advanced
Pediatric Life Support.
Dr. Charles R. Bauer dedicated his life to
medicine, to serving the citizens of the United States of America and the State
of Texas. There is no one that had done more for our community with such grace
and humility. He has a heart of gold and was earlier this year awarded the
Bexar County Medical Society’s highest honor, the Golden Aesculapius Award.
He will be truly missed!
Melody
Newsom
Chief Operating Officer
Bexar County Medical Society
4334 North Loop 1604 West Ste 200
San Antonio, TX 78249
Rosary for Dr.
Charles Bauer will be held at 7pm, June 15th, 2017 at Porter Loring
Funeral Home, located at 1101 McCullough, San Antonio, TX 78212.
Services will be
at 11:30am, June 16th, 2017 at Porter Loring Main Chapel, with
burial to follow at Ft Sam at 1:15pm
Thursday, June 1, 2017
Friday, May 26, 2017
Mayor Ivy Taylor
2017 Candidate Questionnaire
2017 Mayoral/City Council Candidates
Health Care Questions
Ivy Taylor
1. Despite affecting everyone in this community, "community health and wellness" has not been a big priority at City Hall. "Community health and wellness" had one third of the ranking that "streets" received in community input via SpeakUPSanAntonio. Yet it impacts our well being, workforce, economic development and the prosperity of San Antonio.
What health-related areas do you think deserve increased attention, priority, and local resources, and, if elected, how would you elevate the discussion of these health issues at City Hall and lead effective action to improve health and healthcare in our community?
1
Teen
pregnancy, obesity and subsequent diabetes rates, and access to healthy food.
From my experience with the Mayor’s Fitness Council -- which have already
focused on communications, community, health care, and healthy schools -- and
the San Antonio Business Group on Health, I would also include teen pregnancy.
2. Bexar County is the primary source of funding for indigent health care in our area through the Bexar County Hospital District and University Health System. How would you, if elected, promote cooperative efforts to increase services and access to care for the citizens of San Antonio?
Through a close working relationship with Bexar County Judge Nelson
Wolff, I have coordinated on several efforts, including the creation of the
Criminal Justice Coordinating Council (CJCC). This joint effort focuses on
several issues such as reintegration and mental health in the criminal justice
system. If re-elected, I will explore the feasibility of additional services
and access to care for the citizens of San Antonio.
3. The disparity of health care between our poorest and wealthiest zip codes/districts is quite striking (Bexar County Health Collaborative 2016 report). How would you, if elected, reduce health disparities and improve health outcomes for our lower income communities/citizens?
1
I
consider education to be the great equalizer, and, long term, I see the issue
of health disparities and improving health outcomes as no different. By
improving educational outcomes for our most vulnerable populations, the disparity
between the poorest and wealthiest zip codes could be reduced. In the short-term,
I think community-wide education efforts to inform lower-income citizens of
existing programs is a step in the right direction.
4. San Antonio has a high incidence of obesity and diabetes mellitus and has been ranked as high as second in the nation for obesity in recent years. Past city efforts attempting to improve these rates, such as trying to reduce the prevalence of sugary drinks in our community, have been met with controversy. What ideas do you have to reduce the incidence of these chronic health issues?
1
Again,
I believe education is key in reducing the incidence of these chronic health
problems. Although the city has some jurisdictional responsibility, just as
much if not more lies with the food and grocery industries. As someone who
lives in the East Side, I can tell you from firsthand experience the difficulty
it can be in buying healthy food in certain parts of town, also known as food
deserts. Just as it shouldn’t matter which zip code you live in to determine
your educational outcomes, it also shouldn’t matter when it comes to having access
to healthy and nutritious food.
5. According to the CDC, child abuse and neglect are serious problems that can have lasting harmful effects on its victims. The goal in preventing child abuse and neglect is clear — to stop this violence from happening in the first place. What local policies, resources and efforts will you support to promote safe, stable, nurturing relationships and environments for all children and families?
1
Promoting
safe, stable, nurturing relationships and environments for all children and
families is something that comes in all shapes and sizes. At the municipal
level, the city of San Antonio promotes via delegate agency funding many
programs that promote these causes. Mentorship in particular has been a focus
of mine, whether as a Big Sister in Big Brothers Big Sisters, or through my
efforts with My Brother’s Keeper, which seeks to improve outcomes for boys and
men of color in our community.
CD 8 Manny Pelaez
2017
Candidate Questionnaire
2017 Mayoral/City Council Candidates
Health Care Questions
Manny Pelaez, District 8
1. Despite affecting everyone in
this community, "community health and wellness" has not been a big
priority at City Hall. "Community health and wellness" had one third
of the ranking that "streets" received in community input via
SpeakUPSanAntonio. Yet it impacts our well being, workforce, economic
development and the prosperity of San Antonio.
What health-related areas do you think deserve
increased attention, priority, and local resources, and, if elected, how
would you elevate the discussion of these health issues at City Hall and lead
effective action to improve health and healthcare in our community?
San Antonio is woefully low on the list of cities that are
considered walkable. Except for a small handful of walkable pockets and parks,
San Antonio offers very little for citizens who want to bike, walk, jog, and
play outside. Social scientists now know that where a person lives
is inextricably tied to how a person lives and that person’s health.
I, and many others, are alarmed at San Antonio’s health problems that
have direct relationships to how our city is laid out, developed, and planned.
I am particularly alarmed by city planner’s refusal to embrace walkability as a
best-practice for future development. We need city council
leadership that is willing to admit something very difficult to admit:
That we’ve been doing it all wrong. If elected I will make walkable communities the topic of a long
and difficult discussion with planners, developers, neighborhood associations,
the medical community, schools, VIA, and opinion leaders. I will force a long
overdue conversation about changing the way we have allowed San Antonio to develop. We can no longer
apply the car-centric model of planning and thumb our nose at science.
2. Bexar County is the
primary source of funding for indigent health care in our area through the
Bexar County Hospital District and University Health System. How would you, if
elected, promote cooperative efforts to increase services and access to care
for the citizens of San Antonio? I am the General Counsel for Family Violence
Prevention Services, also known as The Battered Women & Children’s Shelter.
I have first hand experience and expertise in delivery of services to
vulnerable populations. I also have hands-on experience with creating
coalitions between government and private organizations for the purpose of
The county and city governments have done significant work in bringing
private institutions to the table to help address problems related to indigence;
San Antonio can and must do more. Other cities, such as San Diego and Chicago,
invest much more (per capita) in time and money creating opportunities for
NGOs, hospitals, medical schools, and private practitioners to
leverage their own expertise in helping the communities address problems like
diabetes, cancer, infectious disease, alcoholism, child abuse, and mental
health. We must look to those cities that are being bold in this regard
and we must not be shy from adopting their strategies. Also, we must be
more demanding of ourselves and hold each other more accountable. I
plan on creating an incentive program so that the city will reward medical
students, dental students, and nursing students for their pro-bono
community service. My aim would be to inculcate in them a desire to keep
serving after they graduate.
3. The disparity of
health care between our poorest and wealthiest zip codes/districts is quite
striking (Bexar County Health Collaborative 2016 report). How would you, if
elected, reduce health disparities and improve health outcomes for our lower
income communities/citizens? See
answer to question #1. I believe that walkability and transit is also
directly related to making it more difficult for people to access resources, go
to school, travel to and from work, and traverse the city to visit their
doctors. There is no debate that access to resources and access to
school, work, and healthcare are essential to bridging the gap between poverty
and thrivability. A quick look at the poorest neighborhoods in San
Antonio reveals to any observer that those neighborhoods were not built or
designed with access in mind. In order to ameliorate our poor citizens'
lack of access we must commit ourselves to a transit system that is efficient and
sustainable. To that end, I will work with VIA, the Metropolitan Planning
Organization, the Advanced Transportation District, the Economic Development
Foundation, schools, and the healthcare industry leaders to recommit ourselves
to the most basic of principles: That a world-class city seeking to progress
and evolve must not leave its vulnerable populations behind.
4. San Antonio has a
high incidence of obesity and diabetes mellitus and has been ranked as high as
second in the nation for obesity in recent years. Past city efforts attempting
to improve these rates, such as trying to reduce the prevalence of sugary drinks
in our community, have been met with controversy. What ideas do you have to
reduce the incidence of these chronic health issues? First,
we need city leadership that is willing to face controversy head-on. Effective
leadership requires us to be unafraid of critics and those special interests
that make money from selling products that imperil our citizens’s health. (eg.
smoking in restaurants, vape shops, etc). Second, we know that prohibition and
heavy-handed regulations rarely work. But, we certainly know that
incentive programs DO work. As such, I will push city council to consider
tax and fee abatements to restaurants and hotels that demonstrate adoption of
healthy menus. I will push our council to adopt tax and fee abatement for large
employers that institute healthy lifestyle programs that result in
their workforce’s weight loss or achievement of other healthy lifestyle
metrics. These are not innovative and unique programs - - they already exist
and have proven effective in other cities.
5. According to the CDC, child
abuse and neglect are serious problems that can have lasting harmful effects on
its victims. The goal in preventing child abuse and neglect is clear — to stop
this violence from happening in the first place. What local policies,
resources and efforts will you support to promote safe, stable, nurturing
relationships and environments for all children and families? Child abuse,
domestic violence, substance abuse, and mental health are enmeshed and should
be approached with a no-silos strategy. I have dedicated my career to
domestic violence and child abuse prevention. In my work with the Rape Crisis
Center, the Battered Women & Children’s Shelter, the criminal
courts system, the jail system, and the Texas Family Violence Council I have
come to realize that San Antonio is in the throes of an epidemic of violence
and abuse. Thankfully, our local judges, law enforcement, district
attorney, and County leaders have dedicated mountains of resources,
time, and effort to address the problem of abuse and violence. But more can be
done. We must bring churches, schools, and doctors to the table.
Oftentimes, teachers, doctors, and pastors are the first to see the signs of
abuse. City Council must create a network of advocates and watchdogs. Doctors,
teachers, and pastors must be given quick and easy-to-access resources to help
them respond to concerns of abuse. We must also work together to
help each other track at-risk citizens to make sure that someone is
always watching and so that they do not get lost because of a lack of
interconnectedness between those of us that care.
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