UTMB wants out of prison healthcare contract thanks to $61 million out-of-pocket costs

Might universities cease providing health care in the Texas prison system, reverting to TDCJ-employed doctors at the agency's 85 in-prison health clinics? Mike Ward at the Austin Statesman reports:

Making good on an earlier threat, officials at the University of Texas Medical Branch in Galveston are seeking to stop providing medical care to the state's 154,000 convicts at in-prison clinics it now runs.

Prison officials said Thursday the move could trigger a complete restructuring of how Texas provides health care to its prison convicts at a time when mushrooming costs are expected to leave the Galveston school and Texas Tech University tens of millions of dollars in the red.

"This is a fundamental shift they are proposing," said Brad Livingston, executive director of the Texas Department of Criminal Justice.

In a Nov. 22 letter to Livingston, UTMB proposed ending its 16-year contract with the Correctional Managed Health Care Committee , a state agency created to oversee and monitor prisoners' care, and contracting directly with the prison system.

Dr. David Callender, UTMB's president, said in the letter that the university "is principally interested in continuing to provide offender health care services at UTMB facilities on Galveston Island."

The acute care at the prison hospital is the most lucrative part of the prison health care system; the 85 in-prison clinics have been tagged in the past as money-losers.

UTMB said recently it will be carrying $61 million in debt outside its budget by the end of FY 2011 (next August) to care for Texas prisoners. A recent column in the Galveston Daily News, forwarded to me by an alert reader, argued for exactly this approach, claiming the university should continue to provide hospital services in Galveston but that:

The other 76 percent of the contract makes no sense. That money is spent at the prisons. There is no academic interest there. Doctors are not trained there. Neither are nurses.

The services the medical branch provides are on a contract basis, and the state resolutely has declined to pay for the costs. That leaves the medical branch to cover the debt until the legislature belatedly appropriates the money to cover the bills.

From the state’s point of view, there are several reasons the medical branch should be saddled with that contract. It’s got a good record-keeping system. It’s a leader in telemedicine — and consulting with doctors using remote technologies is far, far less expensive than loading a prisoner in a van and paying guards to haul him halfway across the state.

But from the medical branch’s point of view, there’s no benefit.

Ironically, because of high transportation costs, keeping hospital services in Galveston probably only makes sense if they're providing medical care at the clinics. There's an odd Catch-22 going on here. (As an aside, I guess the whole "telemedicine" thing wasn't the terrific cost saver it was made out to be.)

Really, of course, the solution is for the Legislature to pay what it costs - $9.88 per inmate per day, according to a presentation to TDCJ's board yesterday - for inmate healthcare, which would amount to a $61 million bump in appropriations. But TDCJ has already been ordered to slash $75 million and will likely be subject to even greater cuts before the 82nd Legislature is complete. So how can this work? I'm not sure that the University of Texas just gets to walk away from this contract, but this certainly ups the ante.

I've said it before, but with Texas prisons essentially at capacity and the programming responsible for slowing the rate of increase in inmate numbers presently on the chopping block, it bears repeating at this moment: The only way to solve this nexus of problems is to do exactly what was done at the Texas Youth Commission: Reduce the number of incarcerated inmates by policy, close units, and divert a portion of the savings to diversion programs and in this case, paying the agency's healthcare bills.

These are tough problems facing the Legislature, and particularly all the new freshmen in the House, some of whom will inevitably populate the key committees governing these questions. But there are ways to solve overspending on incarceration while safely cutting the budget. Conservatives at the Lege need only ask themselves: What would Ronald Reagan do? And if they can't recall, one hopes Marc Levin will be around to remind them.