Monday, October 17, 2011

Can regional health providers replace UTMB prisoner healthcare?

If Mike Ward at the Austin Statesman ever retires or is laid off, there won't be a single professional journalist in the state closely monitoring the Texas Department of Criminal Justice. Most recently he reported on Saturday that:
In a surprise move, state prison officials revealed Friday that they are exploring a plan to run their convict health care program without any participation from the University of Texas Medical Branch at Galveston for the first time in 18 years.

Instead, officials said they are devising a network that would rely on regional hospitals across Texas to provide the care.

"We have very well-developed plans on what this new regional care network would look like and are moving forward to whatever transition may be necessary," said Brad Livingston, the prison system's executive director.

"We are working to finalize contracts containing the necessary provisions and prepare for a transition, if necessary, that ends UTMB's role in the delivery of offender health care."

Friday's development came after UTMB officials declared that talks to extend their managed care contract for prisons were at an impasse and proposed to stop providing care at prisons but continue operating the prison hospital in Galveston.

The hospital, and the specialty clinics associated with it, generally are considered the financial plums of prison health care, while the prison-based clinics are much less lucrative.
This news raises for Grits many related thoughts and unanswered questions:

First, this may be somewhat of a bluff, just like the suggestion that other university medical schools might be willing to do the job. UTMB and TDCJ are in the middle of negotiations, and UTMB thought they held all the cards, offering to bow out of the part of the program that's losing money but aiming to keep what Ward calls "the financial plums of prison healthcare." These are the portions that private providers hoped to cherrypick from the state earlier this year, though none were willing to take on the money-losing prison clinics in addition to the "plum" parts. So TDCJ appears to be calling UTMB's bluff, but it remains to be seen whether they could actually pull off the project by contracting with regional hospitals.

I also found it remarkable that "Prison officials said that in addition to the savings of cheaper rates they hope to negotiate with the regional hospitals, they could save transportation costs to Galveston. On an average day, about 2,000 convicts are being bused to Galveston for treatment." For many years we've been told by officials that prison healthcare in Texas is a "model" that's cheaper than in most other states primarily because of UTMB's "telemedicine" program, which supposedly cuts costs by letting providers in Galveston consult with patients over a videoconferencing system. But now, when UTMB threatens to pull out, there would be "savings" from "cheaper rates" and lower transportation costs from switching to regional providers? That may be true, but it makes one wonder if officials were misrepresenting the situation then, or now?

Third, I doubt regional hospitals are set up to handle inmates security-wise. The University Medical Center in Lubbock ended its contract with Texas Tech to handle prisoner care after an inmate took two nurses hostage and raped them. Most hospitals aren't prepared for the security measures required to replace UTMB services, and I suspect many won't be willing to enact them.

In addition, there's the issue of cost. The state auditor earlier this year found that "UTMB's prison health care division charges more for reimbursement for physician services, inpatient hospital services and outpatient services than it does for Medicare, Medicaid and at least one major private insurer's reimbursements." But will other hospitals be willing to take these patients at cheaper rates? I suspect their fees will be a major sticking point. It's unlikely prison healthcare will be cheaper under any alternative system.

Fifth, how does UTMB have the authority to end the contract when the Legislature basically ordered them to stay on during the legislative session? It strikes me as outright bizarre that one state agency is refusing to contract with another one when the Legislature explicitly told them to. What other agency gets to ignore legislative directives like that, and why does UTMB have so much autonomy that they can tell the state prison system to go take a hike? I don't get it. UTMB complains that they're being used as a bank to float interest-free loans to TDCJ, but in the big picture that's just the state loaning money to the state. When UTMB raised the issue of dropping out of the contract earlier this year, Senate Finance Chairman Steve Ogden dismissed their suggestion as "not helpful." One notices UTMB didn't follow through on their threat to end the contract until AFTER Ogden had secured a billion dollars in recovery money for them following Hurricane Ike and announced his retirement. I wish the Lege or the Governor had insisted on tying that recovery money to UTMB continuing to provide prisoner healthcare. Before they spent the recovery money, they had lots of leverage; now they appear to have little at all.

Sixth, this development re-raises the issue of privatization, and whether private prison health firms will be willing to perform Texas prison health services for the amount the Lege budgeted for UTMB and Texas Tech to do the job. Reading between the lines from news coverage (mostly from Ward) this spring, farming out the more lucrative parts of prison healthcare was really all private firms were interested in, but they only could do the job if prison health budgets stayed at last biennium's levels, not for nine-figures less. At current funding levels, I'm not sure who will be willing to do the job.

Finally, while most of the discussion presently seems to center around hospital care, the frontline work at the prison clinics still must get done, though nobody seems to be publicly suggesting a plan to accomplish that. Presumably TDCJ would resume direct employment of workers in prison clinics, but nobody's said so and I suspect an array of unresolved issues would accompany such a move. At a minimum, TDCJ isn't staffed up to provide supervision over prison health workers, and probably doesn't have the expertise on staff to do so. Further, I don't know if TDCJ employee benefit and retirement packages are comparable to UTMB's and suspect frontline employees may take a hit if that actually happens unless the Legislative Budget Board can somehow find more money. That's the part of the system that's actually bleeding red ink, but it appears from public discussions that the main focus of negotiations and TDCJ planning has been on provision of hospital care.

Maybe the threat of taking away the "plum" parts of prison healthcare will slow down UTMB's rush to get out of its contract with TDCJ, but it seems like they're dead set on leaving the deal one way or another. What a mess: An utterly predictable, and in fact predicted, management failure by the Lege and the governor's appointees on TDCJ's board. Thanks to the Statesman's Mike Ward, at least it's now a public failure instead of a secret, unacknowledged one.

RELATED: 'State funding doesn't cover costs of prison healthcare, officials say.'


Prison Doc said...

Fascinating article. We all wait with bated breath to see what will really happen. Who is bluffing now? Perhaps everybody.

We need Nostradamus, or at any rate someone smarter than I to predict what is going to happen.

DeathBreath said...

Based on my experienced opinion having worked in said environment, I can assure you that the buffoons making these decisions don't fully realize what they are doing. I seriously doubt whether they care about what happens to correctional staff. Yes, they talk a good game, but they are basically inept when it comes to correctional dynamics.

For instance, John Whitmire seems to wake up in a new world every day. After his utopian life was interrupted by a death row call, everything changed. Please, someone tell me, how does a chairperson of TDCJ know so little about adult corrections?

Yes, I can see how regional hospitals might provide medical services for more serious conditions, but are you going to tie up TDCJ personnel for each visit? How stupid. Sometimes, it takes two officers to escort a patient to a regional facility. If they officers have to stay longer than 24 hours, the hospital stay gets quite expensive.

Oh, and let's not forget the front line workers. These individuals are the most critical operatives in the system. They initiate the medical decisions required to send an offender for regional medical treatment.

TDCJ officers cannot make medical decisions.

Typically, mental health services deals with most of the behavior problems. Self-injurious behavior occurs at a very high frequency on most of these units. Someone has to determine whether these threats are consistent with secondary gain or legitimate auto-lethality.

I seriously doubt this plan will work. Once offenders see the weaknesses present, they will exploit the situation, particularly for those who work outside of adult corrections. Also, the chance of escape increases when security gaps are present.

What really needs to happen is an abortion of the current prison board. These cretins have made an entire mess of things.

Nurseypooh said...

There is not enough security officers to go with offenders to the hospitals as it is now. 2 officers have to go and stay. Hmmm will they find money to hire more security?

This is another wait and see thing for us.

Anonymous said...

Guaranteed: It won't improve medical care for inmates where the word "care" and "medical" are oxymorons.

Anonymous said...

Can't imagine TDCJ could make up literally millions in savings that UTMB provides the state in drug costs with the 340b pricing. If TDCJ believes it can save millions by contracting to regional hospitals, I would sure love to see the math on that one. Texas Tech contracts out some of their prison healthcare to hospitals that are located close to their prisons in rural and remote areas but their patients are generally very healthy. The sickest patients end up on the UTMB side by design because UTMB is able to better care for the sicker population. Will be interesting to see how this all plays out.

Anonymous said...

Nursey Pooh is right. There isn't enough security staff to care for each patient that we send off the unit for medical treatment in the local hospitals. If we have just one or two patients in a local hospital, the Warden is hounding the Nurse Manager to see what he/she can do to get the patient transferred to Galveston because Hospital Galveston is staffed with their own security and medical/nursing staff. I have spent many a day helping my Nurse Manager on the phone with UR trying to get a bed at HG for a patient to transfer from a local hospital or checking to see when they are stable for transfer.

So now TDCJ wants to utilize regional hospitals to house sick offenders on a constant basis and jeopardize the public's safety to save a few bucks? Unbelievable! Didn't they learn their lesson with the incident that occurred several years back at a hospital in West Texas? History does and will repeat itself under this scenario. How soon we forget.

I am all for taking good care of the offender population when they are sick and need medical attention. Most offenders don't abuse the system in medical, but there are some that are psychopaths and have no conscience and this is an ideal situation to be taken to a free world hospital with no iron gates, no razor wire, and free public access from their family and friends to supply them with a means and a way to escape. Sure hoping the decision makers rethink all options and weigh them carefully.

Prison Doc said...

For the uninitiated, 340B pricing mentioned above is a federal statute that sets extremely low prices on's available to public health entities and the UTMB program qualifies. Private hospitals and vendors have to pay closer to "full list price" so UTMB is able to pass on vastly lower costs on medication than could the private sector.

rick stanfield said...

TDCJ-ERS benefits are better than UTMB-TRS, trust me. One need only look at the packages as well as how time off is constructed. Pay might be the issue on this, but not benefits.

Lance said...

This is just setting TDCJ up for privitization. I'm sure ALEC (American Legislative Exchange Council) has model legislation for this to happen this next session.

The taxpayers, employees, and offenders will be the losers on this deal. Maybe taxpayers can fund this massive privitization of Texas Prisons with a state income tax????? The managed care system needs to continue with UTMB holding the contract. This keeps TDCJ out of the Federal Court House. Brad and the boys have failed to take a serious look at what happened in California.

The solution for TDCJ's health care cost is medical parole for the elderly offenders. Why the F--- are we keeping 80 year old men in maximum security prisons???? The State of Texas needs to make use of civil commitments for these old perverts. Make use of probation for these old sex offenders... Place a sign in grandpa's yard letting the kids in the neighbor know grandpa is a pervert and to stay 500 feet away from his house.

Coroplast Sign - $20.00

TDCJ Imprisonment with medical cost - $250,000.00

Maybe this cost savings can fund my kids school and they grow up in a country with other educated kids and not CRACK HEADS.

Anonymous said...

Dekenya Nelson seems to be typical of a lot of Texas inmates.

Nelson, 25, of Tyler is accused of brandishing a fake gun and barricading himself and two women inside a treatment room. This was at the University Medical Center in Lubbock.

The women told police that during the standoff, Nelson restrained them with handcuffs and repeatedly raped them.

Nelson is serving 140 years for sexual assault, burglary and car theft, including the rape of a female civilian prison employee.

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