Dr. Eduardo Sanchez, the state's chief health official since 2001, announced this week that he is stepping down in October to spend more time with his family.

Since he took the helm, Sanchez has overseen a massive legislation-mandated overhaul that included consolidating the Texas Department of Health with agencies on substance abuse and mental health, forming the Texas Department of State Health Services.

That agency, with 11,500 employees and a $2.4 billion annual budget, oversees public health programs, immunizations, state hospitals, bio- terrorism preparedness and other programs in a state where a quarter of the population is uninsured.

Texas spends about $20 billion on health and human services programs annually, about 30 percent of all state spending. Forty-four states spend more per capita on public health, and 45 spend more per capita on mental health services.

"First and foremost, I want to make clear that this has been a difficult decision to make," Sanchez wrote his department's employees Monday. "However, it's made with my responsibilities to my family as my first priority. I have to give more of my time and of myself to my wife and children."

Sanchez, who is married to Katherine Sanchez, has four children.

Colleagues described Sanchez as a visionary leader who fought the state's childhood obesity problem and helped increase Texas' child immunization rate from 69.5 percent in 2000 to 75.4 percent in 2004.

"I think it's a real loss for Texas, a real loss for the system in transition, not to have him at the helm," said King Davis, executive director of the Hogg Foundation for Mental Health at the University of Texas at Austin.

The state's next commissioner will be charged with continuing to implement changes mandated by the 2003 legislation that revamped the state's health and human services agencies. And with the next session of the Legislature beginning in January, the new chief will need to immediately delve into the state's most pressing public health issues, such as obesity, immunization rates and border health issues.

Gov. Rick Perry on Tuesday commended Sanchez's efforts to lead the public health response to Hurricanes Rita and Katrina last year, when nearly 400,000 evacuees sought refuge in Texas.

Sanchez was traveling Tuesday and could not be reached for comment.

"Resigning for family reasons is sometimes looked at as suspicious, but in this case, it's true," department spokesman Doug McBride said. The job involves "a lot of travel, a lot of hours away from family."

State Sen. Judith Zaffirini, D-Laredo, credited Sanchez's sincere testimony to lawmakers with the 2005 passage of an HIV medication program that she said would save the lives of 20,000 Texans.

"Sometimes, as he testified, I sensed that he was in pain. . . . It pained him to talk about the health care needs of the people of Texas," Zaffirini said. "He truly, deeply cared."

Sanchez, a certified family-practice physician, was the health authority and chief medical officer for the Austin-Travis County Health and Human Services Department from 1994-98 and lead physician of the Seton Topfer Community Health Center in Austin from 2000-01.

Diana Resnik, senior vice president for community care at Seton, who has known Sanchez for two decades, said he has a particular passion for the uninsured.

"I'm shocked" he is leaving, she said. "He's made a huge contribution, and he was great in that role."

Sanchez replaced William "Reyn" Archer III, who resigned in 2000 after complaints of racially charged comments about Hispanics and inappropriate comments to an African American employee.

State officials said they will conduct a nationwide search for Sanchez's replacement and hope to be finished by the time Sanchez's resignation becomes effective Oct. 6.

"We'd like to see a clone of Dr. Sanchez," said Dr. Ladon Homer, president of the Texas Medical Association.

Age: 46

Education: M.D., University of Texas Southwestern Medical School; master's degree in public health, UT School of Public Health; master's degree in biomedical engineering, Duke University; bachelor's degrees in biomedical engineering and chemistry, Boston University.

Family: wife Katherine; one son, age 14; three daughters, ages 12, 6 and 3

Hometown: Grew up in Corpus Christi.

Notable: Received the 2005 Public Health Award from the American Academy of Family Physicians.

Dr. Sanchez's message to Department of State Health Services employees

Dear Colleagues,

It's with some regret that I find myself letting you know about my formal notice to Gov. Rick Perry that I intend to resign as commissioner of DSHS, effective Oct. 6, 2006.

First and foremost, I want to make clear that this has been a difficult decision to make. However, it's made with my responsibilities to my family as my first priority. I have to give more of my time and of myself to my wife and children.

I am so very grateful to have served as the first commissioner of DSHS. I'm so proud to have worked with all of you, and I will miss the sense of satisfaction that I feel every day because of the work you do that I get to brag about.

You may be asking yourselves why I'm making this announcement four months in advance. My rationale is to openly and transparently focus on transition and on preparing for next year's legislative session.

I am humbled by you, the DSHS employees. I am energized by your public service. I thank you for all that you do.

Regards,

Eduardo

AUSTIN - Texas Health Commissioner Dr. Eduardo Sanchez, who managed public health services during an era of steep budget cuts, a changing political landscape and ever-expanding duties, is resigning.

Sanchez sent his letter of resignation, effective Oct. 6, to Gov. Rick Perry on Monday and then broke the news "with some regret" to 11,500 health department employees in an e-mail.

"First and foremost, I want to make clear that this has been a difficult decision to make," he told employees.

"However, it's made with my responsibilities to my family as my first priority. I have to give more of my time to my wife and children," said Sanchez, 46, who has four children, ranging in age from 3 to 14.

The commissioner, who served nearly five years, was not available to discuss his decision further, said department spokesman Doug McBride.

During Sanchez's tenure, the health department managed medical relief for evacuees of hurricanes Katrina and Rita, held statewide planning conferences on pandemic bird flu, and crafted anti-terrorism plans.

Meanwhile, it kept up its traditional duties of regulating seafood safety, promoting childhood immunizations, battling childhood obesity and fighting mosquito-borne illnesses such as West Nile virus.

In a major statewide consolidation of health and human services agencies stemming from legislation passed in 2003, the health department also took on responsibilities for mental health, substance abuse and state mental hospitals.

In his letter to Perry, Sanchez said he intends to spend the rest of his tenure helping develop a complete appropriations request for lawmakers and a smooth transition to new leadership.

Perry issued a statement commending Sanchez's service and wishing him well.

"Dr. Sanchez has served the people of Texas with an unwavering commitment to improving public health for all Texans," said Perry, noting his work in diabetes prevention and healthier lifestyles.

House State Affairs Committee Chairman Rep. David Swinford, R-Dumas, however, has sharply criticized Sanchez and his staff for not quickly embracing a tobacco prevention product promoted by one of Swinford's constituents.

Health staffers note that Sanchez underwent an unusually tough public grilling April 18 from Swinford on the subject of tobacco prevention spending.

Other officials and lawmakers offered high praise for Sanchez, who took the helm of the health department in 2001. His predecessor, Dr. William "Reyn" Archer III, resigned after repeated complaints that he had made comments offensive to women and racial minorities.

"Dr. Sanchez has provided visionary, enthusiastic and capable leadership over our state's health services programs," said Health and Human Services Commissioner Albert Hawkins, Sanchez's boss.

House Public Health Committee member Rep. Garnet Coleman, D-Houston, said he thinks Sanchez had a tough order to fill after lawmakers slashed billions from the budget in 2003.

"I am surprised he's stayed on as long as he has if you talk about providing good health resources under a scenario of declining resources," Coleman said. "For someone who has a master's degree in public health, a physician, surely that has to be trying."

AUSTIN - Texas Health Commissioner Dr. Eduardo Sanchez, the state's top health official, is resigning after nearly five years on the job.

Sanchez sent an e-mail to employees of the Texas Department of State Health Services on Monday, telling them he had already informed Gov. Rick Perry of his plans to step down effective Oct. 6.

The agency is responsible for a catalog of programs, including disease prevention and control.

"First and foremost, I want to make clear that this has been a difficult decision to make. However, it's made with my responsibilities to my family as my first priority. I have to give more of my time and of myself to my wife and children," Sanchez wrote.

Perry's office did not immediately return telephone messages seeking comment.

During his tenure, Sanchez juggled managing state health services with legislative budget cuts, a wave of Hurricane Katrina evacuees and developing new response plans to terrorist attacks.

He also took on the long-term goal of battling obesity among Texans.

Sanchez was a family practice doctor with a background in public health when he was appointed to the job in 2001. At the time, he listed improving the rate of immunizations and border health care as two priorities.

Sanchez was appointed to replace William "Reyn" Archer III, who resigned in 2000 after being criticized for comments he made about blacks and Hispanics.

The KENS 5 I-Team has learned that officials from the Centers for Disease Control and Prevention are in San Antonio looking over cases of a rare disease that have surfaced.

KENS 5 has confirmed that 10 cases of Legionnaire's Disease are being looked into, and two of those people have already died.

Legionnaire's, which gets its name from the bacteria Legionella, is a form of pneumonia that first surfaced in 1976 when 221 people contracted the disease while attending an American Legion conference in Philadelphia. Thirty-four people died from that outbreak.

With two deaths in San Antonio, state and local health departments and the CDC are investigating to find the source of bacteria.

"Our last few cases have just been over the last couple of days, so that concerns us a little bit that there might be an exposure somewhere that we're not completely aware of at this point," said Dr. Sandra Guerra-Cantu, with the Texas Department of State Health Services.

Health officials aren't sure where the recent cases came from, but they do know that Legionnaire's is responsible for the two deaths and eight other cases in the city.

"The majority of these individuals have been previously fragile in health or previously not healthy," epidemiologist Roger Sanchez said.

The two individuals that did die of the disease had a history of cancer, which San Antonio Metropolitan Health District officials say made them more susceptible to the disease.

However, Metro Health officials say that there are normally only seven or eight cases in Bexar County each year, and to have 10 cases in the past two months causes concern.

"When we have a cluster as we do with the 10 cases or so, we start becoming worried that there is an ongoing exposure somewhere that we haven't identified, and that's why we're so concerned at this point," Guerra-Cantu said.

CDC officials arrived on Monday to help with the investigation, and while the focus is mainly on two North Side hospitals, health officials are now asking all San Antonio area hospitals to take a close look at their records.

"We've expanded our surveillance network to ask other hospitals if they have been diagnosing any community-acquired pneumonias, or any other pneumonias that have the look of Legionella disease," Sanchez said.

While the health district would not confirm which hospitals are affected, KENS 5 did receive this response from the Baptist Health System late Tuesday. Officials there said, "Several patients have been treated for Legionella in two of our hospitals in recent months. Staff and physicians have developed a heightened awareness and are working closely with public health organizations to deal with this influx."

Legionnaire's is not spread person to person, and it is usually found in a water source, like drinking water or the water used in air conditioning units.

The CDC estimates that anywhere from 8,000 to 18,000 people are hospitalized each year for Legionnaire's, but many never know they have it.

The state’s program for crisis mental health services is up for a hefty round of fine-tuning, officials say. Legislators, agency staff and others – citing increasing costs, inefficiencies and complaints from a variety of stakeholders – are looking at ways to make the system work better. The problem isn’t new, and was placed on the list of interim charges for the House Committee on Human Services.

In addition, representatives of the Department of State Health Services (DSHS) testified before the committee this week that quickly identifying people who need mental health treatment in a crisis situation is very difficult, and the state’s system for doing so needs a lot of overhaul.

To that end, DSHS is already using federal grant money for a Mental Health Transformation Project – a task force of policy experts looking at how to overhaul the system, and a Crisis Services Redesign.

Ideally, the mental health crisis system allows health care workers and law enforcement officers who come across people who need mental health treatment to quickly determine that need and match those people up with local mental health professionals. Examples include emergency room doctors treating a suicide victim or police responding to a call where mental health intervention – as opposed to jail time – might be the more appropriate response.
But in a crisis, the system doesn’t function so smoothly. And it’s not just on one end, but on all ends, said Dr. Edwardo Sanchez, the commissioner of DSHS.

“If an individual shows up in an emergency room, the ability to get the history of that person based on what’s happened in our system is – from the perspective of those hospitals – a challenge, to say the least,” he said. Scathing survey
The Department of State Health Services conducted a review of crisis services in February, with surprising results. The survey asked law enforcement and health professionals to rate the state-contracted local agencies’ services. Among law enforcement, only 21 percent of those surveyed thought that local mental health authorities were “competent.” Although 50 percent said that authorities were “sometimes competent,” 24 percent found them to be not competent. Hospital surveys showed the same trend.
Rep. Suzanna Gratia Hupp (R-Lampasas) said the fact that one quarter of respondents felt that officials were not competent was astounding.

“There’s some pretty ugly statistics in there that don’t make us look real good,” Hupp said during a May 24 hearing on the issue. After hearing testimony about the survey, Hupp said she thinks that even if it was flawed, it should be an eye-opening red flag for the state.

“We’re still in the investigative and transitional stages of it,” she said. “The results of the survey were frankly horrendous. However, I think we need to scrutinize that and determine was it honestly because the providers were incompetent, or is it because of perception, or is it a combination of the two.”

Clearly, the current system leaves a lot to be desired, said Jose Rodriguez, the El Paso County Attorney. His office in particular, has had difficulty getting the El Paso County Mental Health and Mental Retardation (MHMR) to accept emergency mental health patients, both from hospitals and police. The MHMR, he said, claims they don’t have the proper facilities, and has adopted a policy of only accepting patients who can pay for their care, effectively diverting indigent patients back to jails, or to emergency rooms – both of which are much more expensive for the state, which is picking up the bill.

In cases originating in hospitals, Rodriguez said, patients denied care at MHMR facilities often return to emergency rooms. Once they’ve overstayed their welcome there, he said, many of them end up in homeless shelters, as there is no other place to take them.

Local MHMR officials say meeting the state’s goals is difficult. Some cited the provisions of HB 2292 (the health and human services reform bill of 2003) as making the effort tougher. Others, like Joe Lovelace of the Hill Country MHMR, said that spending overall is simply down.

“Spending has not kept pace with inflation,” he said. The answer, he said, is to invest more money on programs like disease management – which lowers costs by developing long-term strategies for treating illness – and by spending money to more quickly identify mental health cases in crisis situations.

Denise Brady, director of public policy for the Mental Health Association of Texas, offered up a report drafted by an independent group her association contracted with on the issue.

“They found it very, very hard to prove that any particular individual ended up in one place because something did or didn’t happen to them,” Brady said. “But, if you look at the data, and you see how our funding has gone down when you look at our population has gone up. When you see the trends...it’s pretty impossible to not draw the conclusions yourself that the lack of the mental health system funding is causing all these other crises in emergency rooms and in our jails and in our prisons.”

Shifting the burden

Properly diagnosing people with mental health problems has been a problem for years. DSHS studies show that a large percentage of the prison population has some form of mental illness. Many are incarcerated for non-violent crimes, which would make them ideal candidates for outpatient mental health treatment.

While the key problem in the past has been properly screening and identifying these patients, that is exacerbated by overcrowding, such as in the case of El Paso. Nonetheless, DSHS is looking at innovative solutions to the problem to see if they hold potential models to the state.

One program is the Bexar County Jail Diversion Program, in which the Bexar County Sheriff’s Office and San Antonio Police Department have teamed up to address the problem. With an estimated 14 percent of the jail population believed to have some form of mental illness, properly identifying them the benefits of the system are believed to be greater than the costs.

The program includes interventions at several steps in the criminal justice process. There is a mobile outreach team, a crisis intervention team of officers specifically trained to deal with mentally ill persons, pre-trial services and a mental health docket to pre-screen people with severe mental illness who can then be released directly to mental health agencies for long-term commitment as a part of probation.

So far, the program has successfully diverted 1,732 patients from prison. Although the costs depend on what outcomes (particularly sentence lengths) the patients would have incurred, estimates are that the program has saved anywhere from $3.8 million to $5 million.

Flawed as the system is, Lovelace said, Texas is actually better off than most other states. In a recent study that rated mental health care systems across the country and gave the nation as a whole a “D” grade, Texas got a “C.”

Distributed by www.lonestarreport.org

BEAUMONT - Jefferson County hospitals could have a shot at more federal dollars for providing health care for the poor under a new system the county plans to implement.

Rather than paying hospitals directly for providing care to indigent Jefferson County residents, the county plans to start putting the money into an account to be used as matching funds for federal health-care dollars.

The arrangement with Baptist Hospitals of Southeast Texas, Christus Hospitals and The Medical Center of Southeast Texas was approved Monday by Jefferson County Commissioners Court.

The county pays the hospitals about $1.2 million a year now for indigent health care, Commissioner Bo Alfred said. The county pays a discounted rate, which doesn't represent actual cost of caring for the patient.

The new arrangement will not reduce the county's cost, but could reduce hospital losses for providing care for people who cannot pay, Alfred said.

In the health care arena, the state loses out on millions of federal dollars every year by failing to provide adequate matching funds. If approved by state and federal officials, the local account could be used as state matching funds would be.

The new approach would start with the new fiscal year in October, County Judge Carl Griffith said.

County officials also are considering a new method for working with the mentally ill.

A mental health unit within the Jefferson County Sheriff's Department is being considered. Deputies would be trained to work with the mentally ill and work to put those in need of mental health services in an appropriate facility instead of in jail. The idea was discussed in a Monday workshop.

"There's so many areas this makes a lot of sense," Griffith said.

Sheriff Mitch Woods and officials at Spindletop MHMR have been asked to bring a formal proposal to Commissioners Court to be considered as part of the county budget process this summer.