ORDER NO. 30603
KERB COUNTY JUVENILE DETENTION FACILITY CONTRACT WITH DR.
CHRIS MERIWETHER
Came to be heard this the 13th day of November, 2007, with a motion made by
Commissioner Baldwin, seconded by Commissioner Oehler. The Court
unanimously approved by vote of 4-0-0 to:
Approve the contract between the Kerr County Juvenile Detention Facility and Dr.
Chris Meriwether to act as the facility's Health Director.
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' , (~ COMMISSIONERS' COURT AGENDA REQUEST
PLEASE FURNISH ONE ORIGINAL AND NINE COPIES OF THIS
REQUEST AND DOCUMENTS TO BE REVIEWED BY THE COURT.
MADE BY: Kevin Stanton
MEETING DATE: 11-12-07
OFFICE: Juvenile Detention
TIME PREFERRED: Early
SUBJECT: Consider, discuss and take action on approving a contract between the Kerr
County Juvenile Detention Facility and Dr. Chris Meriwether to act as the facilities
Health Director.
EXECUTIVE SESSION REQUESTED: (PLEASE STATE REASON)
NAME OF PERSON ADDRESSING THE COURT: Kevin Stanton
ESTIMATED LENGTH OF PRESENTATION: 2 Minutes
IF PERSONNEL MATTER -NAME OF EMPLOYEE:
Time for submitting this request for Court to assure that the matter is posted in
accordance with Title 5, Chapter 551 and 552, Government Code, is as follows:
THIS REQUEST RECEIVED BY:
Meeting scheduled for Mondays
5:00 P.M. previous Tuesday.

THIS REQUEST RECEIVED ON:
All Agenda Requests will be screened by the County Judge's Office to determine if adequate
information has been prepared for the Court's formal consideration and action at time of Court
Meetings. Your cooperation will be appreciated and contribute towards you request being
addressed at the earliest opportunity. See Agenda Request Rules Adopted by Commissioners'
Court.

KERR COUNTY JUVENILE DETENTION FACILITY
October 31, 2007
Dear Dr. Meriwether:
Thank you for your consideration to be our Medical Officer. We have attached the
"Treatment Procedures and Orders" for your review We would ask that you consider
ordering an Emergency Box with the medications included in your attached orders to
facilitate our ability to respond to the children's needs quickly and efficiently. If there is
anything else that you need or require, please do not hesitate to ask. We look forward to
working with you and appreciate your help.
Sincerely,
Kevin Stanton
Kerr County JDC Director
3501 LEGION DRIVE KERRVILLE, TEXAS • 78028
PHONE: 830-257-6110 • FAX: 830-257-7735
Treatment Procedures and Orders
Abdominal pain -
• Without nausea, examine abdomen and check for bowel sounds and
inquire about bowel habits. Increase fluids and instruct to return for
fever, increased pain, or nausea.
• With nausea or vomiting, put resident in isolation, and examine
abdomen. If fever is present, consider a UTI or other abdomen
etiology. Contact Dr. Meriwether.
Allergy, shots -
• According to individual's order, which must be on file at the infirmary
/ child's medical record. Observe for 10-15 minutes after injection.
• Severe reaction (anaphylaxis, breathing difficulties)
Epinephrine 1:1000 - 0.01 cc per kilogram of body weight
administered subcutaneous.
Maximum dose of 0.3 cc, may repeat on 20 minutes if
necessary.
Notify Dr. Meriwether immediately, or ER (after normal
business hours).
Allergies, simple -
• Give Benadryl, Dimetapp, Sudafed per age/weight
Animal Bites -
• Wash thoroughly with soap. Try to capture animal if it can be done
safely. Notify Dr. Meriwether immediately.
Asthma -
• Most asthmatics will have their own medicine -give the routine
dosage daily.
• For acute respiratory distress, inhaled medicines are fastest acting.
Give Proventil or Ventolin per age/weight via nebulizer.
May repeat as necessary.
Call Dr. Meriwether.
• Call office for any exacerbation of asthma, especially of new onset.
Bed-Wetting - (enuresis)
• Every case should be reported to Dr. Meriwether and Administrative
Staff (R.N. and JDC Director), who will then work out a plan for
management.
Treatment Procedures and Orders
Bleeding -
• Apply sterile pressure dressing. Tourniquet only in extreme cases.
Nosebleed can almost always be controlled by compressing the soft
portion of the nose with a finger against the nasal septum. The patient
should sit erect with the head forward.
Bruises or bumps -
• Apply ice. Consider possibility of fracture or deep injury.
Burns -
• Sunburn -general cooling of the skin. Apply solarcaine or other
topical anesthetics.
Remember -PREVENTION
• 2"d degree -blisters or burns through the top layer of skin.
Cleanse area well then apply antibiotic ointment and sterile
dressing.
Change dressing daily.
• 3`d degree -full thickness burn
Cover with sterile dressing and call Dr. Meriwether.
Common Cold -
• Without fever - Benadryl Elixir or Dimetapp per age/weight.
• With fever - if associated with thick green nasal discharge, give:
Tylenol per age/weight
If fever persists over 48 hours, call Dr. Meriwether
Communicable disease -
• Consider all staff and residents with rashes and fever as having a
contagious problem until advised to the contrary by physician. Isolate
until released by physician.
Compound fracture -
• Stop the bleeding with local pressure or tourniquet. Check for distal
pulses, cover area with sterile dressing ad apply splint in position of
deformity. Call office immediately, or ER (after normal business
hours).
• If no distal pulses present, splint in position of deformity, notify office
(or ER after normal business hours) and transport immediately.
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Treatment Procedures and Orders
Constipation -
• Offer extra fruits (prunes, etc.). Increase resident's fluids.
Convulsions -
• Notify Dr. Meriwether. If feverish, sponge with cool water. Prevent
the patients from hurting themselves.
Cuts -
• Clean with soap and water. Apply sterile dressing - if necessary. If
bleeding is severe or cut extensive, apply sterile dressing and pressure
to control the bleeding and take to physician at once, or ER after
normal business hours. Check tetanus.
Diarrhea -
• Bloody diarrhea with fever; call office or ER after normal business
hours, isolation precautions.
• Simple watery diarrhea: Donnagel 2-3 tsp initially, then 1-2 tsp. Every
3-4 hours, 4 doses maximum. Push fluids. Diet of clear fluids for 12-
24 hours, advance diet as tolerated.
• Call office if greater than 10 children came down with diarrhea.
Ears -
• Swimmers ear -flush with hydrogen peroxide and water solution. No
swimming for 1 day. Cortisporin ear drops three times daily.
• Ear pain - Auralgen 3 drops in affected ear and Tylenol per
age/weight.
• Ear discharge with fever -Call Dr. Meriwether.
Eves _
• Conjunctivitis (pink eye) -flush with saline twice a day. Notify Dr.
Meriwether for visit /medication.
• Foreign body -flush with copious amount of saline or water - if
unable to remove call office or ER (after normal business hours).
• Chemical burns -Call office immediately or ER (after normal
business hours).
• Penetrating injury -Call office immediately or ER (after normal
business hours).
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Treatment Procedures and Orders
Fever -
• > 102 -Tylenol or Advil for patient's age/weight. Cool shower and
rest. Cool fluids. May alternate Tylenol or Advil every 2 hours for
fever over 102.
• > 104 -Tepid shower, push cool fluids, assess for cause and call
office or ER (after normal business hours). Alternate Tylenol or
Advil every 2 hours for age/weight. Isolate the resident.
NOTE: Fever is a symptom or sign of an underlying cause, which should be
looked for carefully. Any fever lasting over 48 hours should be brought to
Dr. Meriwether's attention.
Fractures -
• Assess distal pulses, apply air splint, and reassess pulses. Apply ice
packs to local area of swelling. Tylenol or Advil for pain. Call office
or ER (after normal business hours).
Fungal Infections -
• Apply common anti-fungal cream such as Lotrimin to affected areas.
General Anxiety -
• Talking with the child is the best form of therapy. May give Benadryl
per age/weight to aid in sleeping but no more than one dose for two
(2) nights.
General Heat Rash -
• Cleanse, cool showers, Hydrocortisone cream to areas.
Headache -
• Migraines -keep child in a dark, quiet place. Child will possibly
have their own medication. If so, administer as per individuals
physicians orders. If headache lasts longer than 2-3 hours, call office
or ER (after normal business hours).
• Simple headache -Tylenol or Advil for patient's age/weight, fluids,
and rest.
REMEMBER: Headache can be a symptom of heat exhaustion.

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Treatment Procedures and Orders
Head Iniu
• Always notify Dr. Meriwether and obtain vital signs for report.
• Loss of consciousness (even for seconds) obtain baseline vital signs,
Glascow Coma Scale, call office or ER (after normal business hours).
• Laceration or abrasion -cleanse with soap and water. If 1/z inch long
or '/4 inch deep, call office or ER (after normal business hours).
• Monitor for vomiting, excessive sleepiness, or altered mental status,
apply ice to area.
• If a result of a fall or trauma, immobilize patient's head and neck, call
office or ER (after normal business hours).
Heat Exhaustion -
• Keep resident cool and put to bed in their dorm room. Obtain baseline
vital signs. Call Dr. Meriwether or ER (after normal business hours).
Indigestion -
• Rolaids, Maalox chewables, or Pepto-Bismol for age/weight. Refrain
from greasy/spicy food as necessary.
Ingestion of Poisons -
• DO NOT INDUCE vomiting for gasoline, fuel, kerosene, acids, or
alkali. For other poisons, dilute with water and induce vomiting.
Notify Dr. Meriwether or ER (after normal business hours). If not
immediately available, call nearest poison center for advice.
Insect bites and stings -
• Remove the stinger, if present. Ice will reduce the discomfort. Apply
approved ointment.
Menstrual -
• Mild to moderate -Tylenol and rest
• Moderate to severe - Motrin 600-800 mg every eight hours with food.
• Severe with vomiting -Call Dr. Meriwether or ER (after normal
business hours).
Muscle cramps with soreness -
• Falls or strains -local heat, analgesic cream, and Advil.
• Severe swelling or redness -Call Dr. Meriwether, Tylenol or Advil
for age/weight.
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Treatment Procedures and Orders
Nausea -
• Can often be a symptom of heat exhaustion. Make sure the child is
rested and cool. Emetrol as directed on bottle. Administer Pepto-
Bismol, Mylanta, Maalox, or Rolaids. If nausea persists > 48 hours
notify Dr. Meriwether.
Poison Ivy and other agitative rashes -
• Clean regularly. Benadryl Elixir for age/weight. Hydrocortisone
three times a day.
• For severe itching -baking soda baths, and Benadryl.
• If severe, Call Dr. Meriwether.
Scabies, impetigo, ringworm, and pediculosis -
• Dr. Meriwether will prescribe treatment.
• Facility Administrator and Dr. Meriwether will determine continued
detention options for youth.
Snake bites -
• Call office, or hospital immediately. Keep child as quiet as possible.
Keep part in dependent position; do not apply ice or heat. Transport
to Emergency facility immediately.
If possible, bring dead snake along for proper identification.
Sore throat -
• Simple pains without pus on tonsils -cold fluids, chloroseptic or
cepacol lozenges, Tylenol per age/weight for pain.
• With fever and swollen glands -call Dr. Meriwether.
Sprains -
• Apply ice packs to area of swelling -heat should not be used in
sprains, wrap with an ace bandage or splint. Call Dr. Meriwether.
Tylenol or Advil per age/weight for pain.
Sunstroke -
• Reduce temperate. Notify Dr. Meriwether.
Swollen Glands -
• Check for bites or cuts and treat accordingly. Tylenol for pain. If
very inflamed and tender, call Dr. Meriwether.
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Treatment Procedures and Orders
Stv _
• Warm water compresses three times a day. Call Dr. Meriwether
regarding ophthalmic ointment, apply three times a day. Gently
massage the affected area.
Ticks -
• Remove with tick removal kit. Place the tick in Texas Dept. of Health
Zoology package provided. Cleanse site with Betadine, leave on for
20 minutes, and then wipe off with alcohol. Apply antibiotic ointment
and dressing if applicable.
Toothache -
• Tylenol, Advil per age/weight. Ambesol to area of pain. Benadryl
Elixir per age/weight. If pain is persistent, or fever/exudates
develops, refer to Facility Dentist.
Vomiting -
• If associated with high fever, call Dr. Meriwether.
• Phenergan suppositories for age/weight, push clear fluids and advance
diet as tolerated.
• Persistent vomiting should be brought to Dr. Meriwether's attention.
Yeast Infection -
• Primary therapy - Lotrimin cream 2-3 times daily for 7 days.
• Call office for persistent problems.
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Emergency Box
a.	Epinephrine
b.	Proventil
c.	Ventolin
d.	Cortiporin
e.	Auralgen
f.	Lotrimin
g.	Benedryl
h.	Emetrol
i.	Hydrocortisone
j.	Betadine
k.	Ambesol
1.	Phenergan
m.	Donnagel
We also have first aid kits throughout the facility.
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CONTRACT FOR PHYSICIAN HEALTH SERVICES
This Agreement is made on this the ~, day of ~~~-- by and between Kerr County
~1'(KCJ),Dr. Chris Meriwether ,herein after referred to as Provider.
Whereas, Dr. Chris Meriwether(Provider) is licensed to practice medicine in the State of Texas,
is not on probation or under other disciplinary restrictions, is covered by malpractice insurance,
and is suitable to provide all medical services authorized under said license for persons in
custody in the KCJ;
Now, therefore, the parties agree as follows:
ARTICLE I
PURPOSE: The purpose of the contract is to provide health services to persons in custody at the
KCJ located in Kerr County, Texas.
ARTICLE II
TERM: The term of this contract is for a one year period commencing on above date when
endorsed and may be terminated by either party in writing with thirty days notice. If the KCJ
determines that Provider has breached this Agreement, the KCJ may, at the KCJ's sole
discretion, request corrective action from Provider prior to initiating termination of this
agreement. If Provider indicates an unwillingness to take corrective action, the KCJ may
terminate this agreement with twenty-four hours notice. The date of commencement of the term
of said agreement may be modified by agreement of the parties.
ARTICLE III
SERVICES: Provider agrees to administer and provide all medical services allowed by law;
including but not limited to medical screening, physician referrals, administering medications,
documenting medical services, administering immunizations, maintaining immunization records,
maintaining medical files, administering annual TB tests on all staff, providing medical services
under physician's orders, ordering medical confinement, provide telephone consultation as
needed, and provide advice and assistance to the County for meeting necessary state and federal
reporting. Provider shall immediately report any signs of abuse or neglect to Kerr County Sheriff
and any other agency required by law.
ARTICLE IV
COMPENSATION: In full and complete consideration for health services provided under this
contract, Provider, as an independent contractor, shall be compensated for medical treatment
through the person in custody's insurance company or sponsoring agency. Provider is responsible
for his own invoicing. Upon Provider's request, KCJ shall provide such information as is
statutorily allowed to assist said provider in collection of his receivables. Non-patient services
provided at the request of the KCJ shall be compensated at the rate of sixty dollars per telephone
call and sixty dollars per office consultation.
ARTICLE V
CONFIDENTIALITY: Each party agrees to maintain all juvenile information confidential and
shall not disclose such information except as allowed by Federal and State law.
ARTICLE VI
RELATIONSHIP: It is understood and agreed that the Provider is not an employee of the KCJ.
The parties agree that this contract is for the provision of the medical services described herein
and hereby renounce the existence of any other relationship. In no event shall the Kerr County
have any obligation or liability whatsoever with respect to any debts, obligations or liabilities of
Provider, and Provider shall have no authority to bind Kerr County to any contract, matter or
obligation. Provider agrees to hold Kerr County harmless for any potential liability Provider
incurs providing services of this contract. It is understood that Provider is sub-contractor only
and Kerr County is not bound or obligated to any benefits or services reserved for employees of
the County.
ARTICLE VII
NON-EXCLUSION: This contract is not exclusive and KCJ reserves the right to contract with
additional parties for the provision of the aforementioned services to the KCJ.
ARTICLE VIII
GOVERNING LAW: This contract shall be governed by and construed and interpreted in
accordance with the laws of the State of Texas. This contract shall be enforceable in Kerr
County, Texas and venue shall lie in Kerr County, Texas.
ARTICLE IX
SEVERABILITY: If any term, covenant or condition of this contract or the application thereof to
any person or circumstance shall, to any extent, be invalid or unenforceable, the remainder of this
contract or the application of such term, covenant or condition to persons or circumstances other
than those to which it is invalid or unenforceable, shall not be affected thereby, and each term,
covenant or condition of this contract shall be valid and shall be enforced to the fullest extent
permitted by law.
ARTICLE X
NOTICES: Any notice or communication hereunder must be in writing, and may be given by
registered or certified mail; if given be registered or certified mail, same shall be deemed to have
been given and received when registered or certified letter containing such notice, properly
addressed, with postage prepaid, is deposited in the United States Mail; and if given otherwise
than by registered or certified mail, it shall be deemed to have been given when delivered to and
received by the parry to whom it is addressed. It is agreed each party shall provide a current
address to the other and shall promptly notify the other party of any change thereof.
ARTICLE XI
ENTIRE AGREEMENT: This contract is a total and complete integration of any and all
undertakings existing between the parties hereto and supercedes any prior oral or written
agreements, promises or representations between them. The headings of various paragraphs of
this contract are for convenience only, and shall not define, interpret, affect or prescribe the
meaning and interpretation of the provisions of this contract.
KERR COUNTY JAIL
Bye
Kerr Coun Judge
Date: 1/~~ ~ ~
HEALTH SERVICES PROVIDER
Date: ~l ~ ~ ~
Address:
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