Wednesday, March 30, 2011

Privatization of prison healthcare pushed in secret meetings

At the beginning of the session, Gov. Rick Perry tossed out the idea of privatizing prison healthcare, but after the House and Senate budgets slashed reimbursement rates to the same, low levels as the Medicaid program, in my own mind I'd set aside the possibility as a non-starter. I just didn't think anyone would want the business at those payment levels. And I was right, sort of.

Mike Ward at the Austin Statesman, though, reports that secret meetings promoted by the Governor between legislative leaders and private prison companies (with the current university health providers not in the room) have been exploring more seriously the possibility of privatizing Texas prison healthcare. House Corrections Chairman Jerry "Madden said that though vendors and their lobbyists have been pressing in recent weeks for privatization to be considered as an option," though he also added, "I don't know that there's any great move in the Legislature to see things redone."

One pitfall: Privatizing wouldn't actually save money, and in fact would cost more than legislators have said they're otherwise willing to spend. Ward obtained a copy of a "report circulating among legislative leaders  ... which appears to be a draft and has no mark of authorship" promoting the privatization option. (Regrettably, the Statesman did not post it online.) He quotes a critical provision from that document which to me seems virtually to preclude the option: "'Opportunities for the private sector to deliver certain segments of inmate healthcare may be possible if funding levels remain close to the current appropriation levels.' That said, the report notes that funding levels proposed in the initial Senate and House budget drafts 'will not be adequate to satisfy the legal requirements for inmate healthcare and meet the minimum manpower needs.'"

In other words, though legislators intend to slash reimbursement rates by up to 24% after a state auditor's report criticized UTMB for overcharging, privatization only makes sense economically for private companies if funding remains at current, much higher levels. That reality makes the prospect seem unlikely.

It was already an open question whether the levels of funding in the state budget are adequate to provide constitutional levels of healthcare at TDCJ. Ward adds ominously that "During the past 10 years, more than 900 medical positions have been eliminated from prison clinics. Doctors and some prison officials have warned privately that further cuts would be likely to trigger lawsuits over too little care." In that context, I fail to see how it would help maters to add a middleman taking a slice of profit out of the budget pie. The Lege has a lot more control over the situation and a greater ability to demand cost concessions if UTMB and Texas Tech continue to provide care.

MORE: The headline to the AP story on this says "Texas may have to privatize prison medical care."  But there's no "have to" here; this is all about "want to." As mentioned above, privatization as a practical matter may be more expensive because outside vendors won't be willing to provide services at Medicaid rates as envisioned in initial budget drafts.

AND MORE: From the Austin Statesman (3/31): "Idea of private healthcare for inmates meets skepticism."

See related Grits posts:


Texas Maverick said...

MTC, private operator selected after GEO lost several contracts offers medical care. So I would suspect they would be in the running. I would hope Madden would be knowledgeable enough to know this is a recipe for lawsuits.

Prison Doc said...

My "contacts" in the private correctional medical world don't know anything about this (FWIW) but I see it as a non-starter. The lege can get away with paying UTMB less than they need, but private vendors won't be so charitable.

UTMB needs a top-to-bottom review of their operation to decrease costs. UTMB is supposed to save money through "managed care" but nobody seems to be managing.

My money is still on the continued "shotgun wedding" option.

Arce said...

I don't think TDCJ is providing constitutional levels of health care now. Within the last year, an inmate died from internal bleeding and coughing up blood after repeatedly complaining and going to the infirmary, and being promised a trip to the hospital which did not materialize in the WEEKS before he died.

Prison Doc said...

Bad outcomes do not equal unconstitutional care...people can do poorly and even die although the i's may be dotted and the t's crossed.

rodsmith said...

your right prison doc!

BUT once you have been dumb enough to see the individul and promise to do something then DONT'


your LIABLE!

Hook Em Horns said...

No point in splitting hairs. If there is money to be made, prison health-care will be privatized at some point. Follow the money. The over-riding value in privatization has nothing to do with inmate care and nothing to do with the cost to taxpayers, it is about enriching private industry and expanding the Texas prison machine.

ckikerintulia said...

Do this secret meetings with legislators violate the open meetings act?

Unknown said...

I was thinking the same as I read this article.Health Clinic

David RD said...

Follow the money - it'll probably lead to one of Rick's buddies or maybe even a legislator that plans to have a second career after they're out of office. I agree, UTMB's mishandling of the system deserves an INDEPENDENT outside audit - but, will most likely never happen. With most "privatization" schemes, they usually end up costing much more than if we keep the duties "in house" - rewarding past, current, and/or future campaign contributors with "privatization" contracts is definitely not the way to go. Knowing several people within the TDCJ system the healthcare given is already inadequate. If you lock a man or woman up in a State institution the State is effectively taking sole custody of that individual and should be held liable and accountable for that individual's care and life...even if he's a so called "criminal".

David RD said...

Forgot to mention..."Secret meetings" promoted by the Governor between TDCJ officials and private companies??? Man, if that doesn't sound crooked - especially when arranged and prompted by Perry - you'd have to be REEEAAALLLY stupid!! Good Ole Boy Texas Politics!!!! Just as Perry ordered..right into his buddies pockets! Someone needs to jump on that one!

Anonymous said...

Hook Em and others are right on the mark. Perry does not represent the people but the lobbyists who represent industry and the Republican party line. (I guess everyone knows that Perry is Chairman of the Republican Governors Association?) "Crony Capitalism" is a term that crops up these days.

Grits, I appreciate your always thoughtful and informative analysis, but maybe hanging in the "liberal oasis of Austin" contributes to a naiveté?

Anonymous said...

Regardless of what TDCJ does, IMO they are on a one-way track to renewed federal oversight. Health care has been slashed and burned to the point it's a joke.

Check out the Jester IV Psych Unit. One inmate recently sent there for mental health problems turned out to have a brain tumor. A psychiatrist had to fight the clinical director to get appropriate care for the inmate.

The previous Clinical Director was fired for trying to alter medical records after the suicide death of an inmate.

Due to cuts in CO staff, medical staff has trouble getting inmates brought to the clinic. Instead they have to be seen cellside under obviously less than ideal conditions.

And this is just the tip of the iceberg.