Tuesday, August 28, 2007

UTMB should make telemedicine work better in Texas prisons before exporting it

"Telemedicine" is the physicians' version of fast food, a cheap, industrial, low-quality product that promotes dehumanized social relations for both health workers and customers. And to judge by the results UTMB has had in Texas, health outcomes under telemedicine are quite poor.

But that won't stop UTMB from subsidizing a private start-up firm to market the idea to other prison systems and the private sector. The Houston Chronicle reported over the weekend ("Virtual care, real profit," Aug. 25):

The group that helped pioneer remote medical treatment of prison inmates in Texas hopes to commercialize that technology and market it beyond government contracts.

The University of Texas Medical Branch in Galveston is expanding part of its telemedicine group as a for-profit startup, dubbed NuPhysicia, with $5 million in funding from Houston-based private equity group Sanders Morris Harris.

Being Texas, it's not enough that we develop some of the worst corrections policies on the planet, our taxpayers subsidize the export of those bad ideas to other places and the private sector.

That's what's happening here. UTMB is responsible for most inmates' care, but rather than adequately staff prison medical facilities, they've relied on this gimmick they've dubbed "telemedicine" to give medical care through video conferencing systems.

The result: UTMB's Ben Raimer testified to the Texas Legislature last year that they were "very close" to providing unconstitutionally poor levels of health care. Legislative hearings on the subject pinned blame on the telemedicine system, as Grits reported in November:
Prison doctors see 60 patients in eight hours using telemedicine systems, sometimes from 4 a.m. to noon, witnesses told the commission.

So let's think about that. At most, assuming docs take no bathroom or meal breaks, and with zero time between prisoners, that would mean prison docs using telemedicine systems spend 8 minutes per patient. Since all that is unrealistic, with 15 minutes per hour for restroom breaks, meal breaks, and time transferring from one to another prisoner, medical visits are likely to be more like 7 minutes long. And your workday, for the doc, starts at 4 a.m.?! Who would want that job?

Sen. Bob Deuell from East Texas, who is a medical doctor, sounded skeptical of the telemedicine system. He questioned during the Sunset hearing how high the quality of care could be for patients who only saw their doctor that short a time and only over a video feed.
UTMB hasn't fixed problems with Texas prisoner health systems, but they're now planning to export those systems to other locales for profit. How much sense does that make? Ironically, UTMB cited low spending on Texas prisoner healthcare in the article as a selling point for its program, but the writer doesn't mention that the state suffers poor health outcomes to go with its low spending. The Chronicle reported:

Half of UTMB's telemedicine patients are prison inmates.

Texas spends 46 percent of what California does per prisoner for health care, in part because telemedicine has driven down costs.

Texas spent $7.66 per inmate per day for health-related expenses in 2006 while California spent $16.60 per inmate per day, according to figures compiled by the Texas State Auditor's Office.

Electronic Health Network will continue to exist and treat Texas inmates.

NuPhysicia will pay UTMB to use its technology and some of its staff for governmental and private telemedicine contracts outside of Texas.

Texas' low spending on healthcare should be no selling point when UTMB publicly admits to being "very close" to providing care so poor it violates patients rights! In fact, it's odd to see UTMB citing that $7.66 figure as a positive - they told the Legislature that number needed to increase substantially, and said it could go as high as California's costs if the courts ever required UTMB to provide similar levels of care.

I must admit, part of me doesn't like the idea of a public university subsidizing for profit private investments. I don't see why UTMB should get legislative appropriations if they're going to spend millions to start private businesses. Hell, I'd like a few million in legislative appropriations to start a small business, if you don't mind!

But beyond those public policy concerns, UTMB shouldn't be selling its telemedicine program to the public as some big, cost saving success when the truth is, judging from prisoner outcomes, it produces a poor product.


Anonymous said...

Scott, Scott, Scott; With all your exposure to the Lege process and you don't know how to get a few million to start up a business like UTMB Managed Care did?

The process is so basic. UTMB has the Lege appropriate funding for a TDC Hospital at UTMB Galveston (This makes perfect sense do to the central location of Galveston Island). Of course UTMB actually has the building built and controls everything except security (and they attempt to insure all wardens assigned to their domain are UTMB team players).

You hire a silver-tongued spokeperson to convince everyone that transporting inmates from all over Texas to Galveston Island is a sound business decision (Yes it does cost millions to transport them and do not mention the security vulnerability). The spokesperson does not tell about the inmates not going to their appointments due to the travel requirements (in some cases six days on the road with overnights at several hub units).
I'll fast forward and skip a lot. You hire a former state Rep who, by coincidence, headed the Corrections Committee and had a position with TDCJ when his term was over. You double his salary and have him explain to the public that he could not take the TDCJ position as it just wouldn't look right; him being over the Corrections Committee and all.

You also hire former TDCJ executives and any TDCJ doctors that voice their objections about questionable inmate medical care.Oh I almost forgot about hiring a Medical Insurance Exec to oversee the operation.

You introduce telemedicine in response to the inmates complaining about all that travel time just to see a doctor.

I could go on Scott but I know you already have the big picture.

I'll just throw in this little tidbit. Some of the UTMB past Warden Team players: Ed Owens, Pam Williams, Gary Johnson. Their careers blossomed didn't they? Ed is TYC whatever; Gary retired as the TDCJ Executive Director, Pam is the Director of Clssification I believe.
One reccomendation Scott; Don't start a small business, you must go for the big bucks!

Unknown said...

Has anyone seen the ABC news piece about "prisoner copays" for health care. The payment is to be deducted from prisoner monies held before incarceration or from family members for treatment in prison. Sounds good for taxpayers. Wouldn't want to "coddle" any prisoners. However, it's not like there's a waiting list of people wanting to go to prison. Even with the free health care [well worth the price?], most people deliberately elude capture. In fact, if you discount the crimes involving drug use, commission of crimes to pay for black market drugs and crimes involving eluding capture and gang warfare - all due to drug prohibition - we would have at least two thirds fewer prisoners. But then we would have higher unemployment among minorities and that would look bad. More family wage jobs would crimp the profit margins of corporate freeloaders.

Anonymous said...

UTMB gives the worst care in the world and if it is an Inmate you can bet they could care less. The telepromter physician is worthless. A physician can not see the color of a wound or the pain in the eyes or the color of an anemic patient. This is one of the biggest wastes of taxpayors money ever. UTMB needs to be replaced by the counties where the prisons are located and they should be paid a fair amount for the care they give each Inmate. Again UTMB is horrible!!

Anonymous said...

"UTMB gives the worst care in the world ..." says the previous author. Highly reecommend taking a tour of just about any country, and keeping your eyes open at the same time. I am terribly sorry, but you might then want to take your words back!