Travis County Commissioners Court is strengthening its financial oversight of Central Health, the county's public health district, but not to the extent some critics have demanded. On Tuesday, the commission voted 4-0-1 to amend Central Health's financial policies to require the district pay for an outside accountant hired by the county if the court finds Central Health's financial information is not reliable or not provided in a timely manner or in accordance with state law. The court also called for Central Health to provide annual audits of its four affiliated nonprofits: Capital City Innovation Inc., CommUnityCare, Community Care Collaborative and Sendero Health Plans. The changes come after critics of Central Health urged the court to order an independent audit of the $105 million the health district received for The University of Texas Dell Medical School project. Those critics alleged the school misspent money and not kept proper records. Clay Johnston, the school's dean, said the allegations were false. The court's vote did not include an order for an independent audit. Central Health has sent Dell Medical School annual payments of $35 million after Travis County voters approved a ballot measure in 2012 to help create Dell Medical School and improve local health care. Critics of the arrangement said they want assurance the money is being used for indigent health care and not for other purposes. “I don’t see how transferring money that sits in the bank of UT unexpended benefits the indigent,” Austin lawyer Fred Lewis told the court Tuesday. Lewis has led recent calls for Central Health to undergo third-party financial audits. Officials with Central Health and Dell Medical School have defended the payments and said they are in line with state law and an affiliation agreement between the two entities. Commissioner Brigid Shea, who abstained from Tuesday's vote, said during the court's session that while she supports the medical school, she has some concerns. “Since we are the fiduciary stewards of Central Health—counties are the ones who are responsible for the fiscal operations—I simply want for the community to feel as though we are being as transparent and complete as we can be,” Shea said. “I don’t want to have somebody come back to us later in the course of a lawsuit perhaps, saying, ‘What were you thinking?’” Travis County Judge Sarah Eckhardt said the $35 million amount must result in a significant return on investment. “Right now we don’t know whether that $35 million investment will generate more than $35 million worth of health care. It is a gamble,” she said. The court can re-assess Central Health's financial policies in the future, Eckhardt said. Additional reporting by Kelli Weldon