New DSHS commissioner secures funding for $2.6 billion budget
Dr. David Lakey discusses hits, misses during legislative session
BY TERRIE GONZALEZ

Dr. David Lakey (second from left), commissioner of the State Department of Health Services, visited with administrators at Rusk State Hospital recently. Joining him from Austin were Dee Porter (left), chief operating officer for DSHS, and (far right) Ben Delgado, associate commissioner of DSHS. RSH Superintendent Ted Debbs (third from left) and Douglas Johnson, RSH clinical director, escorted the group around the RSH campus.

David Lakey has officially been baptized, but not with water.

As the commissioner for the Department of State Health Services (DSHS), his first assignment was to guide the agency's $5.2 billion biennial budget request before the 80th Texas Legislature.

Because he was selected for the department's top job only two weeks before the session began last January, Dr. Lakey predicted that the experience was nothing anyone could adequately prepare for in such a short period of time.

"It will be baptism by fire," he predicted in December 2006, during an interview with the Cherokeean Herald.

He not only survived the roughand tumble 180 days of the session, he walked away with a 3.6 percent net gain and a $2.6 billion annual budget.

On his second visit to Rusk in just 11 months, Dr. Lakey spoke with the Cherokeean Herald about Rusk State Hospital and the results of the last legislative session.

80th Legislative session

Dr. Lakey earned the respect of State Rep. Chuck Hopson (D-Jacksonville), who is a member of both the Appropriations Committee and the sub-committee on Health and Human Services where Dr. Lakey spent many hours providing testimony. From state mental hospitals to county health departments and substance abuse programs, Dr. Lakey was the point-man for tough questions directed at his department by legislators.

If Rep. Hopson, who is a licensed pharmacist, had to give Dr. Lakey a grade for his performance during the session, he told the Cherokeean Herald, "I would give him a 97.

"He is really smart, and is probably one of the leading national authorities on infectious diseases. He has a tremendous understanding of public health issues like pandemic flu.

"If he didn't have the answer to one of our questions, he always had staff present who did."

A modest Dr. Lakey declined to rate himself with a score on the Legislative session, but he quickly ticked off successes.

"We were successful in securing an additional $82 million for mental health crisis services," he said. The additional money will allow DSHS to open six new psychiatric emergency observation sites, provide children's outpatient and crisis stabilization services for 87,000 people, and train and certify 340 community center staff (such as ACCESS in Cherokee County) to respond to crisis calls.

Funding for state mental health facilities totaled $634 million, representing a $14.6 million increase to maintain caseloads. "We have to keep up with population projections in Texas," he said. The average daily census is expected to increase from 2,237 clients in 2006 to 2,477 in 2008 and 2009.

Rusk State Hospital (RSH) has fared well under the umbrella of DSHS. In September 2006, the hospital was funded for a new, 35-bed forensic unit which added 167 employees and firmly ranked the hospital as the largest single employer in Cherokee County with 1,000 jobs. The hospital is funded to serve 337 patients daily.

The hospital's annual budget has increased from $28 million in 2005 to $36 million in 2007.

Dr. Lakey was also pleased with additional funding on two more fronts during the session. "We received technology funds to combat tuberculosis and HIV."

But what he didn't accomplish is a personal disappointment. "We didn't get wages of nurses increased." He pointed to a banner snapping in the wind at Rusk State Hospital near U.S.Highway 69 saying, "Now hiring RNs."

The nursing shortage is acute throughout Texas, and facilities like RSH are implementing creative solutions by establishing symbiotic relationships with area nursing schools to allow students to participate in clinical rotations in Rusk. They hope by helping nursing schools with rotations that some of the new graduates will choose to work at state hospitals.

Dr. Lakey seems to embrace the adage, "an ounce of prevention is worth a pound of cure."

"If you address the front end (of mental illness, TB or HIV), then you don't end up in a hospital," he said.

New initiatives like "Ready or Not," a series of emergency preparedness seminars being held around the state to prepare for disasters and emergencies like Hurricane Katrina, are also designed to address the "front end."

In late September, Dr. Lakey was invited to testify before the House Committee on Homeland Security's subcommittee on emerging threats, cybersecurity, science and technology in Washington, D.C.

He explained the "all hazards" approach of health and medical emergency preparedness and predicted that Texas will score in the high 90s out of a possible 100 following a recent evaluation on a strategic stockpile plan by the Center for Disease Control.

"In pandemic preparations, we must plan for a scenario where 30-40 percent of the workforce is absent," he said.

He has helped establish 10 high-level containment laboratories with the ability to diagnose infections of significant public health concern. "Eight of them can diagnose H5N1 avian influenza about three hours after a sample is submitted."

Dr. Lakey's experience as the chief of the Clinical and Infectious Disease department and medical director for the Center for Pulmonary and Infectious Disease Control at the University of Texas Health Center in Tyler propelled him to the short list a year ago when Dr. Eduardo Sanchez decided to retire as commissioner of DSHS.

As a member of the elite Medical Rangers, Dr. Lakey's resume and leadership caught the attention of Albert Hawkins, who heads Health & Human Services (HHSC), and Gov. Rick Perry, who appointed both men to their positions.

During his second visit to RSH in only 11 months, Dr. Lakey took a walking tour of the campus with hospital administrators while Superintendent Ted Debbs found himself unexpectedly called away for an hour-long conference call.

"This turned out to be a good opportunity for him to spend time with our executive staff," said Mr. Debbs. "He heard from staff on barriers they sometimes have that makes it harder for them to do their job."

HHSC is experiencing minor growing pains since the 2004 consolidation of 12 state health agencies into one megaagency. With its $16 billion budget, which includes DSHS, the agency is second to education in state funding.

"We want to identify the gaps, and we identified several human resource issues that can be improved," Dr. Lakey said.

The DSHS commissioner praised RSH, which serves a 33-county catchment area that includes Houston and Harris County. "They do really good work."

A surprise inspection last January by the Joint Commission, which certifies all public and private hospitals, confirms Dr. Lakey's high opinion of RSH. The commission returned a sterling report card.

Joint Commission inspectors told Mr. Debbs that few hospitals meet the exacting standards of cleanliness, patient care, records keeping and facilities maintenance. RSH sailed through the inspection with a near-perfect score.

Mr. Debbs praised Dr. Lakey's success during the 80th Legislature. "He focused on the internal dynamics of the agency and worked to get us (state mental facilities) understood and accepted."

When the 81st session convenes in January 2009, Dr. Lakey will have put in two years on the "front end" of DSHS, and he'll be ready.