Thursday, October 09, 2008

How will UTMB layoffs affect prison healthcare?

As Galveston Island continues to dig itself out from the refuse, has anyone heard what effect Hurricane Ike has had on medical care delivery in Texas prisons? Recent news of up to 4,000 proposed layoffs makes me think the University of Texas Medical Branch at Galveston must be struggling to meet its contractual obligations for providing prisoner healthcare after the big storm destroyed more than $700 million dollars worth of facilities.

By contract, essentially acting as a capitated HMO, UTMB-Galveston provides medical care for 80% of prisoners in the state, much of it via "telemedicine" where inmates are seen via teleconferencing link by doctors in Galveston. The Texas Tech medical school handles the other 20%. But with Galveston Island devastated and UT's facilities there in tatters, UTMB just announced widespread layoffs, reports the Houston Chronicle:
A day after elected officials claimed they had helped avert a planned layoff of thousands of employees at the University of Texas Medical Branch, the interim chancellor of the UT System said a "significant" portion of workers will lose their jobs.

The layoffs will come as a direct result of damage inflicted by Hurricane Ike, which cost the academic medical center about $710 million in building damage, ruined equipment, revenue losses, cleanup and evacuation. Insurance will cover about $100 million, said Kenneth Shine, the interim chancellor and executive vice chancellor for health affairs, in a story Thursday in the Austin American-Statesman.

"We recognize there have to be significant reductions in force on the island," Shine said. "It's a very challenging situation."

According to Shine, some of the 85 buildings on campus took on as much as 8 feet of water, and storm damage essentially destroyed the hospital's kitchen, blood bank and radiology department.

In addition, the center's main revenue source, a 500-bed hospital at the campus, is expected to return as a 200-bed hospital for the foreseeable future. With the hospital and other revenue generators out of commission or at reduced capacity, the medical branch will likely operate at a deficit beginning as soon as next month, Shine said.

This announcement raises many more questions, especially for the state prison system, than the article answers. How will these layoffs affect UTMB's contract with TDCJ, which already was an underfunded, understaffed hodge podge of services held together by "telemedicine" out of Galveston? Has TDCJ reduced medical services in the wake of Ike, one wonders? And if so, how is that playing out in the field? After all, Ike hit Galveston on Sept. 12, nearly a month ago. (Thank heavens the main pharmacy is located in Huntsville; if it had been destroyed, I'm not sure how the agency would operate.)

Prisoners at the hospital in Galveston were evacuated to Tyler, where the UT-Tyler Hospital continues to handle their care. But it's not designed as a prison hospital, nor is it likely equipped to act as the center of UTMB's telemedicine services. The Chronicle reported that the prison hospital "wasn't badly damaged, but many of the required auxiliary services, including a pharmacy, aren't yet available."

Certainly the system must be flexible and I have tremendous sympathy for those in Galveston who've lost their homes and in many cases, now, their livelihood. But the medical school is also the health care system for 106 prison units holding more than 150,000 prisoners (from UTMB's perspective, read: "patients"), about 40 of whom die every month regardless of the weather. (That's more than California even though their prison system is larger.) It's one thing to scale back services for a month or so in response to disaster, but if UTMB lays off most of their staff and their facilities in Galveston are out of commission, is UTMB even capable of fulfilling its TDCJ contract anymore? Quien sabe?

I'll poke around today and see what else I can discover on this topic; check back for updates at the end of this post. And anyone with first-hand knowledge of what's going on inside the prisons with UTMB-delivered healthcare services, please let us know in the comments.

UPDATE (10/10) I put out some feelers and am still waiting to hear back. Most UTMB buildings, though, are currently not open even for employees. Also, in addition to buildings and labs, many computers were damaged and heaven knows how long it will take to sort out their information systems. Certainly it will be a profound test of their backup systems, at the very least.


Anonymous said...

There has also been concerns about the healthcare of the youth committed to TYC with the closure of the UTMB branch in Galveston. At this time it seems that the impact will not be as great for them because the younger population tends to be healthier; however for surgical needs, there are concerns now at TYC about how these will be handled. The telemedicine for TYC did not operate out of Galveston prior to 09/01 (and it is unclear if it did after that point) but there are still concerns about how psychiatric services will be handled for those youth in West Texas. Hopefully the use of contract care beds will alleviate much of the need for UTMB's healthcare services. TYC has a few sick kids, but there has been no announcement or plan that has been put forth at least publicly about where these kids will go now.

Anonymous said...

Even though I worked there for many years, I now know nothing about the health care for the prisoners.

What I am primarily concerned about are the thousands upon thousands of poor Texans who traveled there from all over the state each year for their free or very reduced cost medical care. Very very sick people now with no medical care and no "contract" that covers their care.

Many of the medical students are serving in the medical facility in Temple (A & M facility I think).

Reporting about Galveston and the hurricane damage and aftermath seems to be a total big vacuum. There has not been near enough quality reporting by journalists on the situation there. I would characterize it is very very odd.

Anonymous said...

Just a word on UTMB and correctional health care -- All 86 medical units of the state prison system are fully operational, including a Texas City clinic damaged by Hurricane Ike, according to officials at the University of Texas Medical Branch at Galveston who manage the state’s correctional health services.

Hospital Galveston, which provides inpatient care and specialty services for critically ill offenders, received some flood damage in the storm but will reopen 32 beds in November, said John Allen, interim vice president and chief operating officer for UTMB correctional care.

The prison hospital is located on the flood-damaged UTMB campus in Galveston.

“We are recreating our health care delivery system using more free-world partners and services,” said Dr. Owen Murray, interim vice president and chief physician executive for UTMB’s correctional medical system.

“During this difficult time, UT Tyler and Hermann Memorial Hospital in Huntsville have stepped up to help us care for patients who needed cancer treatments and other kinds of emergency care,” Allen said.

UTMB medical specialists are providing most clinical services.

Of the 11 Texas Youth Commission health clinics managed by UTMB, only the TYC facility in Beaumont had service interrupted due to the storm. The unit, which has resumed normal operations, was closed for approximately two weeks before and after IKE.

The University of Texas Medical Branch provides medical care for about 120,000 offenders in the state prison system and provides medical care for all Texas Youth Commission facilities.

Anonymous said...

Take at look at the "Tx Faculty Association, UTMB - Galveston blog.