Saturday, January 22, 2011

Whither Texas prison healthcare with 24% budget cuts?

Just about everybody who's looked at it thinks the 24% budget cut slated for prison healthcare in Texas proposed House budget is unworkable; now we learn it supposedly opens a path toward privatizing prison healthcare, reports Mike Ward at the Statesman:
Health care for inmates in Texas' 112 prisons costs taxpayers more than $929 million for two years. The House plan would cut that to just over $707 million.

Most of the proposed cuts would come from reduced treatment, a situation that prison officials worry might eventually cost more, as convicts whose health needs could have been addressed early on require more expensive hospital care.

In addition, drug costs are expected to continue to increase, and legal costs could go up significantly as inmates file lawsuits over reduced medical care.
In this post, Grits called the suggested the healthcare cuts "untenable" soon after they were published. They just make no sense except for Ward's observation, "Most of the proposed cuts would come from reduced treatment." Many voters may say they're happy with that, but particularly for offenders who the state is caring for long-term, the extra cost in the out-years from chronic, preventable ailments is substantial and ultimately, unavoidable.

The $64 Question: Will the Legislature force UTMB-Galveston to remain in its unwanted shotgun marriage with TDCJ at the new, reduced rates described in Ward's story, or will they be allowed to leave in pursuit of new suitors, perhaps opening the door to Geo Care or some other private prison health contractor? ¿Quien sabe? That's one of the may great unknowns facing the prison system during the 82nd Texas Legislature.

47 comments:

  1. Most of us expect the shotgun wedding to continue. Outside correctional health contractors large enough to take on the project would expect to make a tidy profit, not to accept a loss under threat of buckshot.

    Maybe I am just in denial.

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  2. Chase off UTMB, pay a premium for contracted health care. Yet another ridiculous suggestion from Mike Ward, for which the foundation has been laid by an entity that has no clue as to how correctional health care functions. I remain ashamed at the narrow-sightedness of those in control of the purse strings. This will shake out, for sure, but the real losers will be the people of Texas, who will pay one way or another. UTMB barely makes any profit on corrections. Who else will assume such?

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  3. UTMB barely makes any profit on corrections. Who else will assume such?

    For some reason, UTMB usually gets lumped in with the bad guys (cops, proscutors, etc.) by bloggers.

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  4. I really enjoyed hearing you on The Prison Show last night. David Babb directed me to your Blog. I am excited to read more. Thank You for the great information!

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  5. UTMB's group that operates prison healthcare has already reduced the rate as low as it can go. What many fail to realize is that cutting services further will make the state more susceptible to federal oversight. The reason prison healthcare in California is so expensive is because the state failed to provide its prison population with adequate care as defined by the federal government so the feds came in and took over. As a Texas taxpayer, I do not want the state budegt to increase any more than it already has. All parties, to include the legislature and UTMB need to realize the benefits that this contract provides. Low priced healthcare for the state and a steady flow of patients for UTMB, which needs these patients for their residency programs, are beneficial for Texas state taxpayers. The real issue is that there are too many new senior level executives at UTMB and too many new legislators in Texas legislature to remember the history of this relationship and how it originated. Pay the extra money it takes to care for this population and move on or we will all be paying 4-5 times as much for this group just like California.

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  6. 05:52 you are quite right about senior UTMB, Legislative, and TDCJ officials not seeming to understand the historical perspective of UTMB involvment.

    That being said, there's still a lot that UTMB CMC could do to improve the financial situation, starting with eliminating much of the administsrative bureaucracy. They could save money, but no where near $60M worth.

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  7. Anon 03:11:00 PM
    Where does Mike Ward suggest chasing off UTMB for contracted care ? Mike knows more about prison healthcare than anyone else. Read some of his previous articles before you make any more statements like this.

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  8. It was a pleasure having you on the show Friday night. For those that don't know, THE PRISON SHOW can be heard every Friday night 9-11 PM central time on radio station KPFT 90.1 FM, (http://www.kpft.org). THE PRISON SHOW web site is http://www.theprisonshow.org. I have been with the show over 21 years now.I spent almost 5 years in the Texas Department Of Corup (oops) Corrections. I have been out since 1989.

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  9. From my experience, prison medical care, especially in the units is barely adequate. Perhaps that's acceptabe considering the user population. But we all know that the prison population is aging with age related medical issues. Maybe we should just stick them in a bed and let nature take its course. Would severely reduce costs to the worried taxpayer.

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  10. Medical care for inmates in TDCJ is already mediocre to poor- with many instances of care at 3rd world standards. But, then again, UTMB seems to scour every 3rd world nation in its search for the cheapest, least trained health care workers. Just having a nursing staff that spoke English would be a huge improvement.

    There are many ways UTMB could provide better care than its present arrangement. They could greatly increase use of mid-level practitioners, but ONLY if they rigorously hired very competent ones. At present, work in our prisons is too often the job of last resort for healthcare workers- or the entry job into the US market for that nurse from Ghana.

    Texas is infamous for its cruelty and barbarity in the prison system. The health statistics of inmate medical outcomes tell the tale. And this is just fine with most folks- until it concerns somebody they know. Then comes the outrage.
    Funny how that seems to always hold true. No new taxes, slash the "fat" from govt- but not MY school, not MY deserved govt service!

    Want to drastically reduce inmate medical costs? Quit using incarceration as the first choice of punishment! We lock up everybody, then gripe that we have to pay for their food, health care,etc. And when we go just too medieval, in come the federal courts to take over our systems, as they should. Texans need to learn that the sentence calls for incarceration- not rape, not beatings, not loss of life or limb to poor medical care. But no, we'll continue along the same path, never learning the lesson. You watch.

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  11. The Gatesville Gulag
    The medical services are inept, inhumane and a travesty to the good tax payers of Texas. How can they charge some a $5.00 co-payment when we the family is told 80K a year is being spent on prisoners? If for god’s sake you have to be shipped to hospital Galveston I will pray for you. No woman should be hogged tied and put on a bus for this travel and returned the next day after surgery shackled. This is inhumane to say the least. There have been instances where pregnant women have died down the in Gatesville with medical problems that easily could have been treated if there was any human compassion at all there. I was told a woman was written up for make too much noise one night right before she died in the dorms. The Tele medicine that UTMB charges the taxpayers is fraud. Tele medicine is supposed to provide onsite physician medical care without moving a prisoner across the state. That was the services that UTMB sold the state legislators as a money saving initiative to gain this lucrative contract. Most women will refuse medical treatment depending on who is giving this treatment. Some will forego OB/GYN services because the initial Pap smear is conducted by a Physician Assistance and not a doctor. I would urged anyone to avoid this examination completely now. One woman told me she did not believe her experience was unique. I have talked to several women, who have complained about the way their exams were done, who did them, just that issue in general. Women have talked about leaving the table bleeding because they have been treated so roughly: women who had abnormal results from Pap smears and other examinations aren’t treated properly. Women in prisons have a high risk for cervical cancer because they are exposed to multiple risk factors such as a diet low in fresh fruits and vegetables so my question is again where this so-called 80K a year being spent is. Also some women have said tests are provided in small, unclean rooms, without privacy, and that staff often inflicts pain while administering the tests. One woman stated “[physician] was cramming the speculum in like a Roto Rooter”. Some reported feeling sexually abused or violated during their Pap-smear examination. Many connect this feeling to previous histories of sexual or physical abuse. I have been told they would rather have a female care provider, who they believe would be more compassionate and understanding than male personal. Very few of the medical personal offer any explanations of the examinations, the results, or follow up care, including prescription drugs. When asked questions often times the medical personal are not receptive. As a result of these barriers, many people locked up avoid or refuse subsequent treatment by prison medical providers. One woman said terrified by her experience with a physician, said, “I would refuse another Pap smear by him. I just couldn’t do it, couldn’t go through it again. Many people in women’s prisons are aware of the potential health risks of refusing medical appointments but believe that this risk is outweighed by the value of avoiding violation by medical personal and maintaining their integrity, rights to privacy, and personal autonomy. In maintaining this system, TDCJ and UTMB blatantly violates the patients’ rights to family. Behind the prison walls, women are not allowed to show emotions, to simply put their arm around someone crying by lost of a family member. Their anger, pain and other feelings must be kept under tight control. To speak out or show their true feelings will lead to a guard writing up a case and then a kangaroo court where the house rarely loses. So exempt for tears they have nothing else or no one to turn to.

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  12. I have seen better medical care in a third world jungle and desert prisons. Shame on TDCJ, UTMB and the state's elected leaders. But TDCJ has no shame it is proud of it's human rights abuse records.

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  13. All that was said about Gatesville is true. I have seen it myself. Other areas of concern are when coming into Diagnostics all those with asthma have their inhalers taken away. And at some point (a month or two later (maybe)) there is a respiratory therapist who does an evaluation....recommends several inhalers and still the inmate is not given the inhalers, so asthma patients are at a great risk of having an attack and losing their life. In addition, I saw many people have seizures as a result of the heat (must be over 120 degrees in those metal buildings) and these people have seizure after seizure with heat the trigger...they just keep putting them back in the oven which is causing the seizures. Always a risk of brain damage or losing life. Others get hurt at work, need stitches, antibiotics, etc. but won't seek medical because they receive a case for the accident...cases prevent parole releases. Its an abomination....being the property of Texas. So one could say...that is all the reason to be a good citizen and not break laws...well, many are in there who are innocent or for the craziest little things. I was shocked to see how my tax dollars were being spent. Gross mismangement.

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  14. While I do not believe in inhumane treatment, have you ever asked yourself the question as to how much priority these inamtes were giving to their health before they got arrested? Do they have better healthcare as a result of being arrested and imprisoned or was their healthcare better in the free world?

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  15. Unfortunately those holding the purse strings do not hold the purse strings down the road. Less spent now will equal more spent down the road not only financilly but in increased crime and then the merry go round begins to increase in speed. Failing to step back an look at the entire picture which also includes coming on further federal regulations is making choices with the head buried in the sand

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  16. 1:13 you should be careful about making blanket assumptions about those who are incarcerated. They actually come from a wide variety of backgrounds and are there for a variety of reasons.

    I know of one who is there only because she has a mental illness. And, yes, she got good health care prior to her incarceration. On second thought, that's not quite true. She got good health care for physical issues but did not get adequate treatment from the state mental health services. Unfortunately, in many cases private psychiatric services are too expensive for most people and state services are pitiful. She did receive some good treatment from a private psychiatric facility just prior to her incarceration but, unfortunately, it was too late. Had she gotten better treatment from the state system a few years earlier, I suspect she would not be incarcerated. So, instead of spending a few dollars to provide decent mental health treatment now, we'll just spend a lot of dollars to incarcerate them later as their illness progresses.

    The state hospitals should be shut down. I say that not because they are not needed but because the level of treatment they provide is so inadequate they are a waste of taxpayer money. There is actually a state law that says they are to provide the highest standard of care. Yet, they actually provide the lowest.

    If we spent a little more on mental health treatment, we'd save money in the long run on prisons.

    How will Texans answer if they ever find themselves having to explain to God how they treated the least of these.

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  17. What difference does it make “what kind of health care did they have before they got incarcerated”. That shows how ignorant you are. NO HUMAN BEING SHOULD BE DISABLED BEHIND BARS LIKE THEY DO IN GATESVILLE AKA CRAIN UNIT!!!!
    People go in there healthy and leave physically and emotionally broken. Who has to pick up the pieces the families and government programs that do not work and most people do not like unless THEY need them. The prison employees down there take great pride in torturing, tormenting and violating human rights down there in the valley of evil.

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  18. Better health care? Veterinarians provide better health care to animal than what the women in Gatesville receive. Why don’t you go down there and see for yourself. The only problem is no private citizen the actual taxpayer being defrauded can see it. They will not let you in there to see this inhumane place. The state lawmakers does not have the integrity or the internal fortitude to send a real fact seeking commission in there either because they are afraid of what will be revealed to the public. They do take great pride in torture.

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  19. Being the property of the state of Texas? You mean SLAVERY!!!

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  20. @ 1:35 & 1:57....I speak of things like sharing needles, trading sex for money and drugs, multiple sex partners, etc; you know high risk behavior as it relates to prioritizing your health.

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  21. Some of us have loved ones down there who are being tortured as we speak and been denied health care all together. They are not prostitutes, drug users or trash but human beings. I challenge you go see for yourself but you will never see anything or get in period. TDCJ keeps their torture chambers under strict secrecy. So some of us do not like at all what you implied and even if those “HUMAN BEINGS” we those things why did we the people not give them help and treatment instead of torture and slavery?

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  22. This thread has gone off the rails. Shut 'er down, Grits!

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  23. Don't act like you are in charge Doc-of prisoners abuse. And those locked up get better care than most Texasns.

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  24. What about all the women who have not in jail that cannot afford a papsmear or health care. How about all the families that do not have health insurance. The one's who needs inhalers but can't get them because of money to see the doctor or get an inhaler!
    So we have to go to jail to get health care and some one notice we are not getting what we really need. I am so sorry I feel this way but if your in jail, so be it, should not have raped, murdered, stole from hard working people or whatever you did to get there. Your not special! The people you hurt should get your part of your health care!
    Texas is needs to take notice for the good people of this state and not these people.
    All of those rights is why the prison system is not working.

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  25. Your right prisons are not working because of there are more non-violent people locked up in Texas than the entire country of Iran due to corrupt law enforcement, prosecutors, judges and politicians like Tom Delay. You want free health care go to your County Health Department. But the Texas Gulags are in violation of International treaties this country signed and refuse to honor. Just wait after the 82nd Legislation ends a traffic ticket will get you a free ride to TDCJ. Maybe law enforcement will just shoot you on the spot because the people running the state will probably get kick backs for that too.

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  26. Prison DOC you must work for TDCJ. The land where there are no 1st amendment rights, where everything is hushed up, where breaking the law is the norm. Where no one has any basic human rights. Where you do not like what you see or hear you shut it down. I wonder how many people you abused?

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  27. I agree with PrisonDoc ... This discussion has gotten way off track. Inmates are treated with great care NOW, but if the "powers that be" have their way, that will change very soon. They want to take away the present healthcare and they really don't care what happens after that. Don't waste your breath on what WAS, and concentrate on what IS. Contact your legislators now.

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  28. "WHAT IS" "CURRENT" IS THE MOST INHUMANE HEALTH CARE OR LACK OF IT ON ONE UNIT I KNOW IS GATESVILLE!!
    Maybe if you had a love one down there and actually witness this with your on two eyes you would not make that "stupid" comment inmates are treated with great care. They are treated worst than animals! GREAT CARE MY YOU KNOW WHAT!!

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  29. LOL!!! That must be a state senator with the "inmates are treated with great care". Somebody must have paid them a bribe to post that comment. Lol

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  30. OMGosh, if you think the inmates are treated "worse than animals" now, you ain't seen nothing yet!! The care they are getting now is PREMIUM compared to what they will get after the wonderful, caring politicians from Ft. Bend County get the correctional healthcare cuts they are proposing. Don't get angry at the postings here, get MAD at what is being proposed! You have NO idea how bad it will get compared to what it is now. No idea.

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  31. They are getting nothing now. All that money is going into peoples pockets at TDCJ, UTMB and our elected leaders. What everyone wants is for those in prison die slow painful deaths.

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  32. There's just too much inflated costs. Too many unnecessary runs to emergency rooms because on-call doctors don't want to be bothered. There's just no quality care given even at these over the roof prices.

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  33. Simply BS that they are getting "nothing now." Again, just wait. Just wait.

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  34. How do you know what they are getting? Have you ever had a love one denied medical care or had some one do a medical procedure on them that was not needed or done wrong or laugh at them while they cry in pain? I have and I can thank UTMB for the inhumane treatment and the sadistic guards who would not lift a finger to contact medical. I know for a fact if it was your family member it would not be BS as you say.

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  35. I bet Texas has federal court supervision of inmate health care in its future.

    A lot of people criticized William Wayne Justice for taking over the prison system. But, he did the right thing. The blame belonged with the Texas legislature which failed to do its job in overseeing the system. If the people of Texas don't want the federal courts intervening again they better start electing legislatures that have a clue. That ain't going to happen because most Texas voters are clueless. So, its just a matter of time before there is court intervention.

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  36. A Federal take over of the entire prison system here in Texas again would be the only humanitarian thing to do and then maybe try some of the prsion officials for crimes against humanity.

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  37. I bet our elected leaders are going to try to file bankrupcy and default on all the state retirement, pensions and everything morally and legally speaking because we have elect a bunch of criminals who have neither ehtics or morals. I think we have locked up the wrong people. Maybe we should lock up the prison officials and the elected leaders.

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  38. "I think we have locked up the wrong people. Maybe we should lock up the prison officials and the elected leaders."

    Is that the manifesto for Grits for Breakfast?

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  39. Now there's an idea.

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  40. Yes, leave it to the Texas legislature & Pretty Boy Perry to come up with such a brilliant plan. But, instead of standing up & be a man, something outside the scope of his behavior, Pretty Boy Perry succumbed to the forces that put him in office. In that sense, he is a cheap whore.

    UTMB has nobody to blame but themselves. Initially, they pocketed the 30 million instead of returning it to Texas or TDCJ. In the beginning, UTMB thought they'd found a cash cow. But, it bit them in the arse, didn't it?

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  41. People that work for TCJD are folks that liken to criminals themselves. It only blossoms the problems for the state.

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  42. TDCJ employees are a bunch of criminals. For most it's generational and it is in their genes now Sugarland, Huntsville and the Gatesville Gulag. Most of the criminal activities are conducted by the employees outside the walls and our elected leaders sit back and rubber stamp these actions because Prison and incarceration is their private play grounds. That is why Texas leads the free world in making new laws and locking people up. But wait Texas is not part of the free world or the demacratic society. This state fought two wars count them two wars for slavery and when that did not work for them they elect a bunch of redneck trash to build prisons to replace slavery. Sounds like China to me.

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  43. Wow- I can understand the pain these family members are feeling. My son got his arm dislocated and broke in two places at his growthplate at a very young age. Then was cuffed like that. And was told by a nurse stop crying you arms not broke for hours, Then nurse two comes along, tells him all you kids cry just to get off campus. After hours of pleeding to see the Doc 17 house to be exact.UTMB just popped it in place and splinted it. But it hung 17 hours out of socket. And was pulled out by a staff.And he was not even 14. And was there for two minor misdemeanor's, under 500$ in damage a year of his life. Every time he ask nurse for headache medicine she would reply get the F**k away from my station. So the ignorance for any one to say there is good health care in the prisons. Is just simply amazing to me!! Let somebody treat your Momma,Daddy,Son are Daughter this way.

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  44. Look into the mirror and you can see your son's problem first hand. Grow up and be a responsible parent.

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  45. Why don't you look in the mirror!!! NO ONE HAS THE RIGHT TO HURT ANYONE PERIOD!!! BUT EVERYONE HAS THE RIGHT TO DEFEND THEMSELVES. What would you do if it was your child? Then again maybe you abuse your kids.

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  46. At least no one has called anyone a Nazi...yet.

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  47. That is because we are in the communist country of Texas.

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