Friday, December 10, 2010

UTMB wants out of prison healthcare contract thanks to $61 million out-of-pocket costs

Might universities cease providing health care in the Texas prison system, reverting to TDCJ-employed doctors at the agency's 85 in-prison health clinics? Mike Ward at the Austin Statesman reports:
Making good on an earlier threat, officials at the University of Texas Medical Branch in Galveston are seeking to stop providing medical care to the state's 154,000 convicts at in-prison clinics it now runs.

Prison officials said Thursday the move could trigger a complete restructuring of how Texas provides health care to its prison convicts at a time when mushrooming costs are expected to leave the Galveston school and Texas Tech University tens of millions of dollars in the red.

"This is a fundamental shift they are proposing," said Brad Livingston, executive director of the Texas Department of Criminal Justice.

In a Nov. 22 letter to Livingston, UTMB proposed ending its 16-year contract with the Correctional Managed Health Care Committee , a state agency created to oversee and monitor prisoners' care, and contracting directly with the prison system.

Dr. David Callender, UTMB's president, said in the letter that the university "is principally interested in continuing to provide offender health care services at UTMB facilities on Galveston Island."

The acute care at the prison hospital is the most lucrative part of the prison health care system; the 85 in-prison clinics have been tagged in the past as money-losers.
UTMB said recently it will be carrying $61 million in debt outside its budget by the end of FY 2011 (next August) to care for Texas prisoners. A recent column in the Galveston Daily News, forwarded to me by an alert reader, argued for exactly this approach, claiming the university should continue to provide hospital services in Galveston but that:
The other 76 percent of the contract makes no sense. That money is spent at the prisons. There is no academic interest there. Doctors are not trained there. Neither are nurses.

The services the medical branch provides are on a contract basis, and the state resolutely has declined to pay for the costs. That leaves the medical branch to cover the debt until the legislature belatedly appropriates the money to cover the bills.

From the state’s point of view, there are several reasons the medical branch should be saddled with that contract. It’s got a good record-keeping system. It’s a leader in telemedicine — and consulting with doctors using remote technologies is far, far less expensive than loading a prisoner in a van and paying guards to haul him halfway across the state.

But from the medical branch’s point of view, there’s no benefit.
Ironically, because of high transportation costs, keeping hospital services in Galveston probably only makes sense if they're providing medical care at the clinics. There's an odd Catch-22 going on here. (As an aside, I guess the whole "telemedicine" thing wasn't the terrific cost saver it was made out to be.)

Really, of course, the solution is for the Legislature to pay what it costs - $9.88 per inmate per day, according to a presentation to TDCJ's board yesterday - for inmate healthcare, which would amount to a $61 million bump in appropriations. But TDCJ has already been ordered to slash $75 million and will likely be subject to even greater cuts before the 82nd Legislature is complete. So how can this work? I'm not sure that the University of Texas just gets to walk away from this contract, but this certainly ups the ante.

I've said it before, but with Texas prisons essentially at capacity and the programming responsible for slowing the rate of increase in inmate numbers presently on the chopping block, it bears repeating at this moment: The only way to solve this nexus of problems is to do exactly what was done at the Texas Youth Commission: Reduce the number of incarcerated inmates by policy, close units, and divert a portion of the savings to diversion programs and in this case, paying the agency's healthcare bills.

These are tough problems facing the Legislature, and particularly all the new freshmen in the House, some of whom will inevitably populate the key committees governing these questions. But there are ways to solve overspending on incarceration while safely cutting the budget. Conservatives at the Lege need only ask themselves: What would Ronald Reagan do? And if they can't recall, one hopes Marc Levin will be around to remind them.

22 comments:

Anonymous said...

Or we could just stop furnishing convicted criminals such expensive healthcare when there are millions of law abiding citizens in this country who are desperate for medical care and insurance coverage. It's always struck me as an odd notion that somehow the state is obligated to provide anything other than rudimentary medical care to people who demonstrate that they cannot abide by the law or conform to societal norms. Why do prisoners deserve these precious resources when their are millions of innocent children who can't get care? This idea that state becomes somehow "obligated" because they assume custody of a criminal is complete bullsh!t in this day of increase budget deficits. It's an antiquated liberal notion which stems from the day when people like William Wayne Justice thought we could tax society into Utopia. It's not happening! We are about to have to make some painful choices in this country regarding the allegation of finite resources. Turning dangerous criminals back out onto the street is not a necessary choice just because we can't afford to give them top shelf health care. Let them suffer like millions of other people in this country! Alternatively, if criminals are concerned about the quality of health care in the prison system, perhaps they should just avoid getting sent there in the first place! Problem solved!

Prison Doc said...

While I am no apologist for the late Judge Justice, providing basic health care for inmates is now a well established requirement of Federal law. Under the UTMB-administered system, good basic health care is delivered, and yes, it is better than that available to most of the working poor, for example. Chronic diseases such as high blood pressure, diabetes, heart disease, seizures, and HIV generally receive "state-of-the art" care. Other uncomfortable problems such as non-urgent orthopedic injuries, hernias, minor skin disorders receive much less complete care.

I agree with Grits that using UTMB Galveston hospital makes little sense if UTMB is not providing the outpatient care as well. Galveston's location is an historical anomaly, and transportation from many prison units is a big deal.

Most of us working for UTMB in the units are praying for a continued "shotgun marriage" between UTMB and TDCJ forced by the lege. There are ample opportunities for cost savings and efficiency on the part of both but so far neither have demonstrated an interest in achieving that.

If the UTMB and TT administered medical care go away, the result will probably be multiple private prison healthcare contractors and a lot of inmate medical care will suffer.

Anonymous said...

Perhaps it's time that we start reconsidering these "well established requirement(s) of Federal law" before the federal government and the state's become bankrupt. I just read within the last week where the State of Arizona is not denying certain organ transplants to Medicaid patients due to lack of funding. Health care expenditures now make up nearly a third of the Texas budget. We're making life and death decisions regarding end of life care for honest and decent taxpaying, productive members of society on a daily basis for purely economic reasons and yet here we are discussing whether a bunch of convicted criminals are receiving "constitutionally adequate" healthcare at taxpayer expense. Does anyone else see the irony in this? This is insanity! And I'm sorry, but returning convicted criminals to the street to save money is not the answer. Give them an aspirin and a bandaid and tell them to suck it up and get better. There were lots of captured American soldiers who were POW's in WWII who survived on a helluva lot less!

Anonymous said...

There's programs within TDCJ to get offenders out of prison that are sucking the system dry with their medical needs. The idiots in austin at tcoommi are too busy with figuring out who's panties are in a wad today to get anything done and get these offenders out..

Gritsforbreakfast said...

12:17, it's not tcommi - the Board of Pardons and Paroles has to approve medical parole and they deny most of them or else routinely delay them until the inmate had died.

Anonymous said...

For one grits, it's tcoommi, not tcommi. The program is called MRIS(look it up), not just medical parole. Proving once again that you don't know everything about the criminal justice system...

Gritsforbreakfast said...

12:48, take comfort in a blog comment typo, if that's what you need to make yourself feel smart. Otherwise, I think my point was clear, and also accurate. You don't seem to dispute its substance. Here's some data on the numbers approved by the BPP compared to those recommended.

Don said...

12:48---no, Grits doesn't know nearly as much about CJ as you apparently know about playing idiotic "gotcha" games.

Prison Doc said...

Yes, and MRIS is another joke too...I've filled out that paperwork a jillion times and nothing ever came of it....

Anonymous said...

Prison doc, thats my point exactly, the idiots in charge of TCOOMMI are too worried about their makeup and who is not the fattest one of the bunch. There are so many "programs" that nobody has the balls to actually make work to get medical leaches out of prison. Grits apparently overlooked the original comment..

Gritsforbreakfast said...

1:18, you seem to be missing the point, it's not "the idiots in charge of TCOOMMI [who] are too worried about their makeup and who is not the fattest one of the bunch." It's the parole board that turns down the great majority of their recommendations. And if the BPP accepted more, TCOOMMI would process more. I just disagree with you it's exclusively their fault when it's the BPP that's turning most of the MRIS candidates down.

Snoopy said...

Anonymous, you're pretty brazen for someone who's......anonymous. Wonder if you care to share your name and source?

Devil's Advocate said...

Anonymous sound to me like someone who got released from TDCJ in one form or another and has an axe to grind?

Do you have anything of substance or facts or is this just a personal attack on state employees?

Anonymous said...

It is an absolute fact that the BPP is responsible for keeping prisoners who need extensive care instead of releasing them to Medicare or VA treatment. I see them on a weekly basis when they are brought to visitation at RMF ( Regional Medical Facility)at Estelle. They are wheeled in on hospital beds, wheelchairs and guided by guards because they are blind ! The secret is, they are "sexoffenders" and deemed "dangerous"! Check out the law and see they are only released on MRIS when in a coma or vegetative state. When has a blind person or one w/o legs hurt anyone? If Legislators had enough guts and education about the subject, maybe they would change the law. There are over 10,000 prisoners over the age of 55 who are draining the system. The politicians are afraid of losing an election if they make a law to release those"dangerous" sexoffenders. They are not concerned about the tax payer's money that goes into this insanity.

Anonymous said...

You suggest that the Texas Youth Commission should "reduce the number of incarcerated inmates."

With the 700.000 gang-bangers in Texas, I'm sure there are not 1,700 juveniles in this state who deserve to be incarcerated. Why not return the most dangerous 1,700 back to the streets and let them do their thing? That's the permissive thing to do.

Gritsforbreakfast said...

2:08, when TYC released inmates, the juvie crime rate continued to drop. Do you have reason to believe (that you can document) that reducing incarceration rates for adults will have a different result? What if you released the "least dangerous" 1,700 out of the 155,000 adults incarcerated instead of the "most dangerous"? After all, the state releases more than 70,000 per year, anyway.

DeathBreath said...

The ship of fools, the Texas Legislature, needs to be gutted. Self-serving pigs are occupying this legislative body. So, now, after turning a profit, the profiteers are wanting out? Several years ago, UTMB was so full of themselves. They bragged about their state of the art medical care. What a joke. It was all smoke and mirrors. Yes, Galveston is known for piracy. I find it rather ironic that UTMB shares a street with Jean Lafitte. Yes, Maison Rouge, the dwelling of Jean Lafitte is right down the street from UTMB. Both have profited at the expense of others. Oink, oink, oink.

Anonymous said...

Well I will be! After all that I believed would be, will be. One must really search the history of UTMB taking over Healthcare from TDCJ. I have stated before that Correctional Managed Care is rottened from Despotism and Nepotism that is finally catching up with those responsible. It appears that David Callendar, President of UTMB, is not buying the same "old story" from the likes of "Lannemous" Lithicum, "Good Ole Boy" Owen Murray and the multitude of "lesser minuets" that were the same individuals who were responsible for Prison Healthcare when under TDCJ that only shifted to being paid by UTMB. It has been quite a "scandal" that seems to be coming to an end. I saw it coming years ago and I opted out with "early retirement" before the "boom came down". Way to go UTMB (proper, not UTMB/CMC)! More to come, I am sure!

Anonymous said...

I so agree with the obvious disparity in giving "more than adequate" Healthcare to Prisoners and the Working Poor being basically SOL. I was there, part of it all! The other day I was informed (after being retired) that an Inmate filed a law suit because he had to work in the Kitchen because "they" (ie, all those he was suing) would not "honor his restrictions". Now I believe that the Unit (Ellis) was notorius for "questionable" judgement in assigning jobs based on restrictions, but this Inmate wanted everyone that he ever saw to "pay". I know one thing, and the day that he came to me I properly took care of him based on his medical complaint. But what has been created here is a "monster" and the Inmates know it (not all of them but alot of them). When "Constitutional Healtcare" came into being it was only a matter of time before those that "break the law" become those that "use the law" for their advantage. In fact it has a name; it is Hegelian Dialectilism. I offer that for now for those that would like to think about it. But for the "Working Poor", think about the Republicans that do not want you to have healthcare. Maybe they should champion against "Constitutional Healthcare".

Anonymous said...

Another comment ref TYC and Healthcare. Did you know that Crockett State School with about 150 "little inmates" have 15 Registered Nurses to take care of them, and they still have trouble making simple decisions without a "Provider" being responsible (This is in contrast to say Eastham Unit that has 2000+ "adult inmates" and only maybe two RNs and four LVNs). And the same people that worked for TYC just transferred over to UTMB to build this "empire" (eg, "Shady" Sandra Ferrara). This is talk about wasting taxpayers dollars on some scale (large or small).

Anonymous said...

When I first started working in the Prison 12 years ago, I came to the conclusion that if you lock someone up for life they are going to get old (and sick). And I have seen alot of old (and not so old) sick Inmates. And I did three "tours of duty" at Estelle. I have seen bed-ridden, paraplegic Inmates (that were sex-offenders) that will spend the rest of their lifes in an in-patient cell. I had an idea once (that I shared with CMC management, "Good Ole Boy" Owen Murray to be exact) to clean-up and open-up and old VA hospital in Marlin for these old and sick Inmates; because he admitted that day many years ago that there was no long-term care plan for these Inmates that would never get out of Prison. Last I heard a few years ago this was going to be done and that it would be 2012 before they even got the hospital cleaned up (let alone stocked and outfitted). I have been "out of the net" for the last four months so I am not privy to new information. But the point is where do they go, what do they do, until they die. No conclusion, no solution. And David Callendar, UTMB President, is not interested in waiting to find out. I do not want to start in on our "elected politicians" because they are "constitutionally allowed" to lie (ie, not to tell the truth).

Anonymous said...

If they would decrimminalize drugs the prisons would empty out and our streets would be . After all according to the Supreme Court Roe vs Wade decision a person has the right to their own body, so this should include the right to ingest whatever substance they want to ingest in their body as least it is only their body unlike Roe vs Wade abortion decision.Locking people away for up to 15 years for using a drug is rediclious and denies people their right to their own bodies and to free choice.The laws against drugs are doing more harm than the drugs. Before drugs were made illegal it was safe to walk the streets.