Wednesday, August 29, 2007

UTMB: Mental health care quality declining at TYC

More from today's TYC hearing:

Ben Raimer from UTMB told the joint legislative committee that they're having a difficult time recruiting healthcare workers to staff Texas Youth Commission facilities because of deteriorating safety conditions at TYC units. Raimer said mental health care at TYC in particular, was certainly no better and probably worse at TYC than it was a year ago, almost solely because of the significant loss of quality staff. It's extremely difficult, he said, to recruit good people into a "chaotic" work situation. Due to "overcrowding" or "understaffing," he said, TYC healthcare workers had to operate in a "situation that's out of control."

Unfortunately, I've got bad news for Mr. Raimer: TYC won't even begin to solve its understaffing problems anytime soon, so I'm not sure what he thinks will reverse this troublesome trend of losing quality medical staff?

Whaddya wanna bet they wind up using telemedicine and telepsychiatry instead?


Anonymous said...

Already using it on a weekly basis

Anonymous said...

For anyone who has a license (nurses, counselors, psychologists, psychiatrists), TYC is to be avoided like the plague. One only needs to be accused of wrongdoing to spend thousands of dollars defending one's license. In the current environment, everyone is being accused of something and you're guilty until proven innocent.

Frankly, if I knew a licensed professional WILLINGLY put him or herself in a position of such professional danger, I would question his or her intelligence and judgment.

Anonymous said...

Problem may be solved: it is reported one of the sticking points in the contract with UTMB is that if they are going to provide psychiatry, they want to provide psychology too. (Note: with TDCJ, if the warden wants to get rid of a shrink, he just won't allow on campus, effectivel terminating the persons job.) Contracted hours could mean just one more group of professional juvenile corrections personnel traded out.

Anonymous said...

The use of telepsychiatry has been UTMB's plan all along. What was so distressing about Raimer's testimony is that UTMB has had difficulty providing quality care to youth all along. There have been serious health issues in youth that have gone long untreated despite youth being seen in the infirmary. And the nurses are not involved in the treatment team at all. They have been adamantly against crushing meds and would prefer to take kids off meds entirely if they are non compliant or cheek the meds. They do not do patient education - teach the kids about their illnesses or medications. Dr. Raimer tout's the team approach, but the UTMB staff has historically been against involving themselves in a kid's care or in planning for the youth's release. Someone should request copies of TYC's internal monitoring reports of the quality of the medical care and a copy of the report by the ACA consultants. There have been major problems with the provision of care by UTMB.

Anonymous said...

What a waste!

My ex-wife was a dentist for UTMB in East Texas. She thought that iy was cute that TYC staff called the nursing staff at CRTC "angels of death".

Mercy certainly isn't in this plan.

Anonymous said...

9:11, Wardens do not deal with any Campus; they are prison facilities.

A warden must have a valid reason for not allowing any person on the facility (I do remember the days when the medical folks had to be sent to another unit to work because of unit "infractions").

I also remember "translating" on more than one occasion, for a Vietnamese medical professional and East Texas Inmates. A Vietnamese Doctor trying to speak English and East Texas Inmates trying to understand. So much for the medical confidentiality. I spent two years in Vietnam and I had a difficult time understanding him. I was really happy to see Dr. L.L. arrive; she was a breath of fresh air!

Anonymous said...

There was a time when the nursing and medical staff were part of the TYC team. They were involved. They cared about the kids. Whenever a youth was restrained, he would be checked by a nurse, whether he claimed to be hurt or not. Not under UTMB. Result: kids sit in a cell and self-inflict injury and then claim it was done during the restraint. Or, worse for the kid, he decides to be macho and claim no injury when, in fact, he is injured. Both scenarios play out all the time since UTMB took over medical care.

One reason he has trouble recruiting psychiatrists is because they don't want to work for UTMB. The contract psychiatrists were already chafing under the contraints put on them by the UTMB formulary.

Now UTMB wants to take over psychology as well. That'll be a treat! If they have the psychiatrists and psychologists, the next thing they'll want is the caseworkers, too.

Hey, everyone's worried about TDCJ taking over TYC, looks like UTMB is taking a strong run at it! Old Salty

Anonymous said...

Dr. Raimer's testimony was almost as disgusting as Whitmire's performance. Raimer may be a pediatrician, but he certainly is no expert in adolescent psychology, psychiatry, or chemical dependency treatment.

His testimony was essentially a subtle endorsement of use of pepper spray, suggesting that "control" was what was needed before any treatment could take place, and that the youth need a sharp, sudden indication of when they have crossed a line to change (hmm, like what, Doc?), "if indeed they can be changed." Nice.

Is that why you didn't come forward about the broken bones of youth in TYC custody earlier, Dr. Raimer? Because abuse is really the best way to shock these kids out of their behavior? How about electro-shock therapy while we're at it?

Quit pandering to Whitmire and pretending like you know what you're talking about, Dr. Raimer. Next time you want to diagnose the entire population of youth in TYC at one fell swoop in a public hearing, why don't you bring in a real adolescent psychiatrist? Unless of course your goal is not actually to provide medically accurate information (as you claimed tearfully during the session), but to keep your cushy job while continuing to provide sub-par medical care to incarcerated Texans.

Anonymous said...

Lots of troubling information in these posts. I could write a whole guest blog about the historical problems with medicine and psychiatric services at TYC.

One of the big problems in the pre-Morales era was the use of part-time (at best) psychologists and psychiatrists who visited the facilities once a week or even once a month. In the case of the Gatesville facility, the part-time staff psychiatrist was a sibling to the Gatesville state rep (who went on to serve as a state attorney who defended TYC in the Morales case).

This led to a lot of undiagnosed or misdiagnosed mental illness.

You had guards "diagnosing" boys as "homosexual" using half-baked language on the basis of a boy's size, outward mannerisms, etc. Same with girls.

You also had a very haphazard and even lethal use of medications. Some pregnant girl inmates were given mysterious pills that induced abortions. Boys were doped up on sedatives during daytime hours when they were prohibited from falling asleep.

In 1949, when TYC was created, the agency's inability to provide adequate medical and psychiatric care was blamed on the remoteness of rural facilities, uncompetitive salaries, and the risk to one's professional reputation.

It astounds me to read nearly the exact same complaints today.

Bill Bush, UNLV

Anonymous said...

A guest blog on the topic would be excellent, Dr. Bush!

Anonymous said...

It's all about money and power. To the long tenured TYC staff who remember SJS; remember what motivates the LS youth? Money, Power and Excitement. What is the strategy for change with LS youth?
Set firm limits. I say we set some firm term limits on these politicians and vote them out of office! Guv Goodhair is considering a run for another term, Whitmire has an apparent lock on his present position, but the mike picked up some interesting side comments that he made disparaging Harris county - he may be vulnerable.

Has anyone else noted the similarity of the way Whitmire acts at hearings and the way our more predatory youth wield their power?

Anonymous said...

Anon 11:16 - I am certainly no fan of either UTMB or Dr. Raimer, and I wholeheartedly agree with most of what you posted. However, to be fair, Dr. Raimer did raise the issue of broken bones earlier. Of course, he did it in a very self-serving way, and without consulting the investigation results. All of those broken bone cases were thoroughly investigated.

The fact is, that UTMB staff are very reluctant to provide any more care than they are absolutely forced to provide. I worked for TYC long before UTMB took over, and I can certainly affirm that the TYC nursing staff and medical staff took much better care of the kids than UTMB do now. Old Salty

Anonymous said...

Yeah, but they cost too much money. Having UTMB provide the care was one of Whitmire's cost-saving gems!

Anonymous said...

Remeber when Kimbrough made the mistake of saying something just slightly critical of UTMB? Whitmire came unglued. He kept referring to UTMB as "UT" and saying that UT was a fine institution and he was not going to stand for anyone to say anything bad about UT. The Aggie, Kimbrough, got the point and apologized.

Anonymous said...

Yep, the fix is in!

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