Garland, TX – In a recent vote, the Garland City Council authorized city staff to negotiate an agreement with MD Health Pathways, a telehealth provider that employs a controversial opt-out business model. With council members fulfilling full-time responsibilities, they rely heavily on accurate and comprehensive information from city staff to ensure that the best interests of Garland residents are prioritized. It is puzzling to consider: how did the City of Garland arrive at the decision to choose MD Health Pathways as our community’s telehealth provider if there are other options that people here would like better?
A Look Back
During the May 5, 2025, work session, Councilmember Ed Moore explicitly questioned City Manager Judson Rex about the city’s thoroughness in vetting MD Health Pathways, asking, “I want to ask the City Manager, though, have we already done our due diligence in the way of background, in the way of the company and the way of identifying..?”
Rex’s response, however, shifted focus from the due diligence process to the pressing healthcare issues in Garland. “I can tell you there was some due diligence before it got to a council committee… our healthcare footprint from a facility standpoint in Garland is underwhelming,” he stated, attributing the city’s healthcare woes to its lower-income demographic and high uninsured population.
Despite Rex’s assurances, multiple council members expressed to the Gazette their belief that MD Health Pathways was the only telehealth service working with cities, and that they had inquired about such information, feeling assured this was the only option.
Councilmember Moore continued to press on, asking if the city had liability concerns regarding endorsing a private company. City Attorney Brian England offered reassurances, stating, “I’ve looked at the liability aspect as far as what the city’s exposure to [is]. If something goes wrong, there’s really no waiver of immunity there… we have sovereign immunity to always go back to as a local government.”
It is important to note that both Rex and England were instrumental in bringing MD Health Pathways to the council’s attention by presenting the company to Councilmember Chris Ott. Given that city staff is required to remain impartial, it is reasonable for council members to assume that the staff had explored all viable options and did their due diligence before recommending a specific provider.
While England’s comments may provide some comfort regarding legal exposure, they do not alleviate the responsibility of city staff to ensure that council members are presented with all relevant information, including alternative telehealth providers.
Alternative Option
For instance, the City of San Antonio utilizes a telehealth provider named RightSite, which does not impose monthly fees on the city or its users. Instead, it operates on a model where payment is made only for insured services, allowing everyone, regardless of insurance status, to access the service without incurring charges. This model raises the question of whether similar options were thoroughly explored by Garland’s city staff.
It begs the question: How did Garland arrive at the decision to choose MD Health Pathways?
