Friday, November 07, 2014

Solitary confinement down 34% in Texas prisons since 2006; elderly, Hep C driving inmate health costs

The number of Texas prisoners in solitary confinement (known in bureaucratic lingo as "administrative segregation," or "ad seg") has declined by 34 percent since 2006, from 9,600 to about 6,300 today, TDCJ chief Brad Livingston told a Texas Senate Criminal Justice Committee meeting on October 28 (see video). New programs created in the last few months aim to begin transitioning prisoners out of ad seg before they're released, he said, so fewer will be released directly from ad seg to the streets, he said.

Roughly 4,500 offenders have completed TDCJ gang renunciation program and been transitioned to the general population, said Livingston. Chairman John Whitmire cautioned Livingston to continue in that direction or else federal litigation could force them to take even stronger steps.

The hearing focused particularly on cost drivers in the prison health care system.

Sen. Charles Schwertner, who is a medical doctor, took umbrage at UTMB receiving fee for service reimbursement while private providers must (mostly) accept Medicare reimbursement rates. TDCJ contracts with 140 hospitals besides UTMB, the committee was told. About 25 hospitals have received a waiver from LBB based on a TDCJ request to go above Medicare rates. Schwertner said he'd been chewing on this issue for four years since hearing a sharp exchange with a private provider about disparate rates in a Senate Finance Committee hearing.

Dr. Owen Murray told Sen. Schwertner the reimbursement was different because UTMB is a teaching hospital and is a "mixed mission facility, both a prison and a hospital." So, for example, they can't make discharge decisions based purely on medical judgments but also consider when TDCJ can pick someone up, whether beds with the appropriate classification are available, etc.. That explanation seemed to modestly placate the senator, but I won't be surprised if the committee revisits the question.

Sen. Whitmire suggested TDCJ needs an additional hospital to UTMB Galveston, maybe in Marlin.

Dr. Lanette Linthicum, the medical director in charge of correctional managed care, told the committee about 30% of incoming offenders have Hep C, the main cause being IV drug use. Only 188 are currently receiving active treatment with Sovaldi, a new drug that costs in the neighborhood of $80K per patient. A virologist at UTMB decides who gets therapy. They're presently waiting for new policy to be developed, perhaps before the end of the year, for Hep C treatment protocols. Linthicum added tha end-stage liver disease from Hep C is an emerging problem among geriatric inmates.

Dr. Linthicum said that, out of TDCJ's network of 600 infirmary beds, three quarters are assigned to permanent residents who will parole from there or die there. Ninety percent of those, she estimated, are sex offenders and thus not eligible for medical parole. And even if they were released, there's little support for them when they get out. Linthicum believes there are quite a few geriatric inmates with serious medical needs who could be released without compromising public safety. But to make medical parole work, TDCJ needs "community partners" for elderly offenders, particularly sex offenders.

On mental health, about one in six inmates has a serious mental health diagnosis, which contributes significantly to the agency's pharmacy bill. According to Brad Livingston, 74 of Texas' 109 facilities have some level of mental health presence. Four units holding 2,000 inmates provide inpatient mental health care for the sickest; 23,000 more are treated on an outpatient basis in general population or ad seg in other units.

Whitmire said that, sometime at beginning of session (assuming he's still chair), the committee will have a hearing on successes of Texas' treatment and diversion programs with an aim toward doubling down on those investments to further reduce incarceration levels.

MORE: Here's TDCJ's full budget request (large pdf) for FY 2016-17, for those interested.

RELATED: From Governing magazine: Aging prisoners shackle state budgets.


Anonymous said...

It will cost the tax payers the same wether they are in prison or out. They don't have jobs or insurance and never will for most of them. All sex offenders need to stay locked up for life. I can't believe we even consider sex offenders in trying to balance the budget. Think of the next little kids that person will victimize. It won't be worth it. We do hope for someone besides Whitmire. He has worn out his welcome. We need someone who knows what the heck they are doing and is not a bully. It would be nice that it would be someone who does not have a conflict of interest in who they are in a romantic realtionship with. Whitemire does not pass that test.

sunray's wench said...

Yes anon, because we all know that all sex offenders are predators of children... *sigh*

There are plenty of families who could financially support the inmates if they were paroled, rather than the whole state supporting them while they are incarcerated.

Anonymous said...

Dr. Linthicum never stated the Hep C offenders were on Sovaldi. She just said 100 on UTMB side and 88 on Texas Tech side were receiving "active therapy".

sunray's wench said...

Perhaps there should be a separate Medical Parole Board, consisting of doctors and senior lew enforcement individuals, who have the experience, understanding and knowledge to make informed decisions, rather than the current BPP of political pawns.

He's Innocent said...

I fail to understand how folks such as the first commenter can be so closed minded about sex offenders.

Sir or Ma'am, please educate yourself! You look like a moron! Sex offenders, and in particular, the oldest amongst them are the least likely of any class of offense to re-offend again with the same type offense as first convicted. Sex offenders often get charged again with Failure to Register (classified as another sex crime) when they forget to change their vehicle's plates with the authorities, when they grow a beard, or their shoe size changes. No, I am not kidding! All in all, the only class of offenders who re-offends less is capital murders.

Here, educate yourself. All of you. Or continue to encourage legislation based upon emotion, not facts. I promise, one day, that choice of yours will come around to bite you in the ass. I know, I am living this with my spouse.

"Post Release Recidivism...."

"High Risk Offenders May Not be High Risk Forever"

"Sex Offenders Not High Risk of Repeat..",d.aWw

Anonymous said...

Only a group of bigoted, insensitive, medieval-minded, cruel, bastards would place a human being in a cage with sensory deprivation, lack of human contact, uselessly punitive, filthy, rusted, or inhumanely sterile cells where, in reality, one is buried alive. As to the picture: the cells are not that clean. The Skyview unit (which is supposed to be a hospital) in some areas and in ad seg is a cesspool, feces all over the place, from people gone mad over the years and from lack of sanitary standards; Ferguson in the 80's and now is a roach and rat infested dungeon. Michael's is cleaner, but still old and rusty with mildew. Allred is dirty and rusty.
As to "people want to be placed in adm. seg.": yes, when their lives areat stake,they may ask, having to choose between death or life, but they don't want to languish day after day in an hopeless and senseless gray cell deprived of human contact and anything that would remind them that they are human beings. Inmates sometimes resort to catching roaches and to try to keep them as pets - impossible to do. Those who "serve" in such an inhumane establishment and try to justify its existence, are insensitive, delusional, ignorant baboons, and, as far as I am concerned, I pray for them to someday rot in hell, in the hope that there is a hell in which they - as good "Christians" - believe.
Guards want to have respect as they are often not respected in their own community by anyone except their peers. You don't get respect when you participate in an inhumane, oppressive, unjustifiable, cruel system such as solitary confinement and super-max prisons.
While we are engaging in probably a useless discussions, those kept in these hellish places are suffering needlessly. They are, in effect, being subject to a form of slow torture that it is worse than death itself. Guards and wardens: be proud participants! And if you can look yourself in the mirror, I hope you don't see what I see when I think of your faces: a spiritually bankrupt, lost bunch of souls who don't have enough sense to just say "no" and move where they can find more humane jobs.
Thanks GFB for letting me rant.