Wednesday, September 02, 2009

Older offenders driving TDCJ healthcare costs

Texas' Correctional Managed Health Care Committee meets in Dallas next week and they've posted the backup material related to their agenda online. (Large file - 169-page pdf.) Here are a few highlights that jumped out at me from that lengthy document:

Correctional managed care in Texas lost a total of $24.2 million in the first three quarters of FY 2009, with losses of $5-7 million per month throughout the spring. One of the attachments describes $48 million the Lege approved in supplemental funding to UTMB and Texas Tech to cover these shortfalls. Who knows, however, if they've accurately budgeted going forward?

In the most recent quarter, vacancy rates for psychiatrists at TDCJ topped 35%. The vacancy rate for physicians was 15% - a little higher for nurses and dentists.

Even though the overall inmate population is declining slightly, the older, sicker inmate population continues to increase, according to the minutes from the committee's last meeting:
Mr. McNutt ... reported that the offender population slightly decreased to 150,225 at the end of the second quarter FY 2009 compared to 151,723 for the same time period a year ago.

The aging offenders continue to rise at a steady rate and Mr. McNutt reported that the number of offenders 55+ at the end of second quarter FY2008 was 10,211 compared to 10,824 this second quarter FY 2009 which is an increase of about 5.9%.
More on why older offenders are more expensive:
the older offenders access the health care delivery system at a much higher acuity and frequency than younger offenders. Hospital costs received to date this fiscal year for older offenders averaged approximately $1,634 per offender vs. $260 for younger offenders. While comprising only about 7.2% of the overall service population, older offenders account for 32.7% of the hospitalization costs. Older offenders are represented four times more often in the dialysis population averaging about $20.8K per patient per year. Providing dialysis treatment for an average of 188 patients through this quarter cost $1,961,176.
In the next biennium, the Legislature budgeted $97.8 million for psychiatric care and $836.7 million for acute care - that's nearly a billion dollars per biennium for Texas inmate healthcare, with the number of older, high-cost inmates growing.

Of inmates recommended by TDCJ as good candidates for "Medically Recommened Intensive Supervision," the parole board refused to consider 76% of them in 2008. Of those they agree to consider, 90% were approved.

At UTMB, which provides care for about four-fifths of Texas inmates, nurses account for 77% of inmate encounters with health care providers; physicians just 9.3%, mental health providers 5.5%, dentists 4.7%. For inmates covered by Texas Tech, only 74% of encounters were with nurses and just 5.7% were with physicians.

Finally, when money is tight, prevention gets cut. Another attachment says only 3,350 inmates participated in peer education in March 2009 systemwide compared to 7,334 in March 2008; peer education numbers were also lower in April and May.

There's a lot more information in this lengthy document, but those are the items that stood out upon initial perusal.


editor said...

It will be interesting to see the statistics for the Medically Recommended Intensive Supervisions for FY2010. Beginning shortly, the inmates will be responsible for completing these instead of dedicated staff. (kinda hard to do if you're in a coma)

PirateFriedman said...

I can live with releasing elderly criminals, but it would be nice if Medicare would go bankrupt before they get out.

Anonymous said...

i thank God that for whatever reason my son was confined in a unit that housed older and in many cases infirm inmates...nothing drives home making something of your life better than being 21-26
surrounded by 40 + and often a mess...tdcj , warts and all, has truly saved my wayward boy's life

sunray's wench said...

TDCJ is one of the few corrections agencies in the US that actually recognise "elderly" inmates as a distinct catagory. It is also one of the few that has dedicated beds for elderly and infirm inmates.

What concerns me is by releasing the younger inmates, those left behind will have their services squeezed even more because it is not glamorous to spend on elderly inmates. It makes more sense financially and socially to release the elderly over the young, when they have family support willing to take them in.

Anonymous said...

I think I read on this blog that 30% of Harris County Jail inmates have mental health problems. I wonder what that percentage is for TDCJ.

I was surprised to see that only 5 or 6% of encounters were with psychiatrists. There are certainly long lines at the pill windows and no real treatment available for the mentally ill in prison.

The State of Texas is ignoring a real chance to do something that would improve the public safety when these folks are released.

I would love to see Texas provide some real leadership in this area.

Texas Maverick said...

Page 142-143 of report: MRIA Comparison- Prison vs. State Jail YTD May 2009
PRISON MRIS presented to BPP 303 Denied consideration*(threat) 83% Approved 15%
presented to Judge 21 Approved 82%. Someone who passes MRIS for referred to BPP has to be nearly on their deathbed, how can they be a threat to society?

Anonymous said...

Psychiatric care in TDCJ is a joke. They are putting people on older medications that have high risks of causing serious long term side effects just because they are cheaper than newer, safer medications.

When you inquire about an inmate's medical care it's like pulling teeth to get straight answers to simple questions.

DEWEY said...

TDCJID has health care? News to me, and I help do THE PRISON SHOW on radio station KPFT. I did almost 5 years there. Ask the lady (who shall remain nameless) whose brother died of cancer because of lack of treatment. Ask almost anyone that has served time there. DEWEY

sunray's wench said...

Texas Maverick ~ just another reason why the BPP has to go

Charlie O said...

Dewey, Mr. Pirate Rothbard would say that your friend's brother dying from lack of treatment was a sum gain for Texas and not an indication of abysmal policies and healthcare. His comment about Medicare going broke before elderly inmates are released is indicative of what a souless a-hole he is.

PirateFriedman said...

souless a-hole he is

Charlie, good to hear from you.

You should try marrying a woman in the free world, it will make much less angry and crazy. Or did that happen to you in the military?

Anonymous said...

Good let the older prisoners bankrupt the system. I am serious about that. I have always thought then when you have a broken, corrupt anything, you allow it to die of its own accord. In this case, by overcrowded rolls of the older folks.

Anonymous said...

Pirate Rothbard, I agree with charlie. ALMA DE LA GENTE

Anonymous said...

High costs for geriatric inmates is a natural outcome of increasing sentence lengths over the last 3 decades at the expense of community supervision and the tax payer. Being "tough on crime" is mostly an ideological foundation for counterproductive (often stupid and destructive) policy.

We are now reaping the adverse rewards of poor policy driven by ideological slogans that do little to advance public safety. But, being "tough" does feel good and is politically advantageous.

Maybe it is time we tried to be "smart" not just "tough".

Charlie O said...


You wish for the demise of Medicare so that elderly ex-inmates cannot get health care and you have the gall to call me angry? Methinks you need to take a long look in a mirror. If, of course, that's possible, since I've heard that the walking dead have no reflection.

Anonymous said...

You wish for the demise of Medicare so that elderly ex-inmates cannot get health care and you have the gall to call me angry?

Not angry, just a believer in the potential of the free market which has served us so well. Aren't you glad you have a computer built by the capitalist system instead of a Dubna 48K?

PirateFriedman said...

And have a good labor day weekend Charlie. Again I'm really sorry that you've demonstrated again and again that you're a really angry person who lives in a world of blaming other people for his own problems. I know you feel morally superior to anyone who doesn't want to throw an excessive amount of taxpayer funded services at criminals, whatever helps you get through the day.

male masturbation toys said...

I think this information is true, many times the cost of good health is very high and not everyone can have access to good health insurance

Anonymous said...

Texas wants to show the world that they are so rough and tough, well fine, let the state pay their bills to show this and stop whining about it. Ante up cowboys, or shut the H--- up.

Jim Harrison