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.