Tarrant County Commissioners in August approved placing an $800 million bond proposal for the John Peter Smith Health Network on the Nov. 6 ballot. If voters give the bond the green light, the money would go toward funding an identified $1.2 billion worth of improvements to the Tarrant County Hospital District. These projects include construction of a new mental and behavioral health facility, improvements to the main JPS Hospital patient tower, ambulatory and cancer care facilities, and the building of four new community care clinics. Commissioners said the tax rate would not increase if the bond passed. “We have to understand that this is the beginning, it is not the end, because buildings don’t solve problems,” Precinct 2 Commissioner Andy Nguyen said at an Aug. 14 commissioners meeting. “It is the implementation of our health care plan and our mental health plan that will solve problems.” Tarrant County created JPS Health Network in 1906 as a countywide hospital district to furnish medical aid and hospital care. Commissioners appoint the hospital district’s board of managers and approve the hospital district’s annual budget and tax rate. The JPS board of managers oversee the county hospital and set service rates to produce sufficient revenue. JPS has maintained a tax rate of $0.224429 per $100 valuation since 2017 and has one of the lowest amounts of debt of any large Texas public hospital, according to district documents. Tarrant County Precinct 3 Commissioner Gary Fickes, whose precinct includes Grapevine, Colleyville and Southlake, said the improvements to the hospital district would ripple up to the northeast part of the county. “You would be shocked at the number of people in our area that do use John Peter Smith,” Fickes said. “When the economy slows down like it was in 2008 … there were a lot of people in our area that didn’t have jobs, and when you don’t have a job you don’t have insurance. And JPS became their safety net.”

A shifting perception

In 2015 the hospital district examined the possibility of a bond. It would have been the first bond for JPS since 1985, but after a town hall meeting commissioners chose not to call for the bond. Fickes said the newly proposed bond program is better planned and more transparent. In 2016 the commissioners appointed a Citizens Blue Ribbon Committee to review current and future needs of the JPS Health Network. In February the Blue Ribbon Committee presented its findings and recommendations for JPS improvements to the commissioners. Fickes credited the committee with the bond moving forward this year. “It’s a whole different attitude [from 2015], and I think a lot of that is that JPS has become an extremely good facility and has a good reputation, and they’ve got great leadership at JPS,” he said. “[JPS President and CEO] Robert [Earley] and his team have done a great job in building that hospital to where it is today. … I think that the time is now, and we’ve got to move forward.” Earley said his mission since becoming the hospital’s CEO in 2009 has been to get the hospital to perform at its highest level of service. “JPS needed to be re-instored with pride within its employees, and I think it also needed a very singular focus towards its patients, because when you do things right by your patients  and you do things right by your employees, you do things right as an overall organization,” Earley said in a May interview with Community Impact Newspaper. “Last year we had … 1.2 million times where people needed our services, which means we’ve got to be there. We play an instrumental part in the community.”

Mental health needs

A 2015 study of the county jail’s inmates showed that a quarter of the inmates in the jail system were screened for mental illness, leading county officials to recognize the need for more mental health facilities. The study also identified a need for a separate resource coordination center to provide information and referrals throughout the community regarding mental health concerns. Fickes emphasized the need for the mental and behavioral health facility that is proposed in the bond. “What’s going on all across the country is we’re treating people with mental health problems by putting them in jail instead of putting them in a hospital and giving them the proper care,” he said. “Cities and counties simply don’t have the facilities, and we’re trying to increase and expand our facilities to handle that.” Currently JPS is Tarrant County’s only psychiatric emergency center. These services would be updated and expanded if the bond is approved, Tarrant County Administrator G.K. Maenius said. “JPS and this community as a whole is in dire need of more mental health and behavioral health care, facilities and services,” he said.

Private sector involvement

Fickes said that while the bond proposal is for up to $800 million, that does not mean the county will have to spend that amount of money. He said there are opportunities to use the private sector to help with the bond projects instead. “By utilizing the private sector, we may have the opportunity to bring those numbers down a little bit,” Fickes said. This is a facet that will help make up the difference of the $800 million and the $1.2 billion worth of improvements needed, Maenius said. “[The bond will be issued] during the course of the next 10 years … in addition to the $800 million, JPS would bring cash reserves of at least $300 million more over that time, and that will make it $1.1 billion, and then efficiencies that we can accomplish, public-private partnerships we’re looking forward to, will make up the difference in that,” he said. Fickes said the hospital district plans to build new parking garages, which is an area where the private sector could come into play by having it build and operate those. The bond proposal also includes four new community clinics that could cost $20 million each, but Fickes said the county could look at long-term leases with those facilities. “We will use reserves or excess revenue over expenses to construct this to where we’re not having to do anything with the tax rate,” Fickes said. “Our goal is that we will not raise the tax rate.”