Wednesday, April 06, 2011

Lege has few answers on how to cut prison health costs

The debate over proposed cuts to prison spending has so far seemed rather surreal, with the Governor and officials in both the House and Senate proposing massive, nine-figure cuts while the Legislative Budget Board predicts an expanding number of prisoners, with little public discussion of how to pragmatically reconcile the situation. Perhaps the most obvious example is prison health care, where cuts risk diminishing inmate medical care to unconstitutional levels. Mike Ward at the Austin Statesman has an article titled "Options running out for prison health funding," in which we learn that nobody really has a plan (surprise!) for how to implement proposed cuts to prison health care. "Right now, I don't have an answer," said Senate Finance Committee Chair Steve Ogden.
Prison health care officials said much of the mushrooming costs is being driven by the fast-growing number of older prisoners — about 23 percent of prison medical costs stem from care for convicts age 61 and older — and those with illnesses that are expensive to treat, such as HIV, AIDS, hepatitis C, kidney diseases and cancer.

Among some lawmakers, there remains hope that a number of budget amendments and separate bills could slow the costs — through a "healthy prisons" initiative designed to improve diets and exercise regimens that could save $13 million and by requiring convicts who can afford it to pay $100 a year for their care, among others.

A bill by state Rep. Senfronia Thompson, D-Houston, would speed up paroles of low-risk convicts who are terminally ill, require long-term care, are in a vegetative state or are immobile because of a medical condition. The bill is scheduled for a public hearing today in the House Corrections Committee.
The Governor wants to privatize, but vendors have said they'd be unwilling to perform such services at Medicaid rates, which is the level at which prison healthcare would be reimbursed under both proposed budget plans. To privatize, they'd have to keep prison health spending at or near current levels, which nobody seems willing to do, particularly after the state auditor criticized UTMB earlier this year for allegedly overcharging the state.

Texas' per-inmate medical costs are already among the lowest in the nation, while long sentences have boosted the number of more expensive, older prisoners. The best and arguably the only way to cut costs further is to reduce the number of inmates, particularly those older, Medicare-eligible inmates who require the most intensive services. None of the other suggestions I've seen tossed out on this question seem reasonable, or in most cases even remotely plausible.


Prison Doc said...

I think you have it summed up pretty accurately.

A "healthy prisons" initiative, if done right, could work in the long run but would do little for the here and now.

There's no getting around the simple truism that more prisons + more inmates = higher healthcare costs.

Texas Maverick said...

April 6, 2011 12:00 p.m. - 3:00 p.m. EST

“Reduce Costs, Lower Risks, Enhance Healthcare Services: The Promise of Effective Pharmaceutical Management” airs TODAY at 12:00 p.m. EST. It is the latest satellite/internet broadcast to be hosted by the National Institute of Corrections. Learn more about the costs and issues surrounding correctional pharmacy management.

For more information and registration, visit
One of the Consultants is
Joseph Penn, MD CCHP
Director, Mental Health Services, University of Texas Medical Branch, Correctional Managed Care

Grits I know you are too busy to watch but it will be archived. One of the suggestions at a hearing was to put more items into commissary and let inmates pay for them. I'm sure this will be presented.

Of course your suggestion, let those who aren't a risk come home is too simple.

Anonymous said...

So far it looks like the legislature is cutting education in Texas and keeping the prisons. After all we built them, they came and we'll keep um.

Anonymous said...

My son is at this moment on his way back to Estes unit from hospital Galveston. He had a minor surgery performed. He is eligible for parole in June of this year. He could have had his surgery when he got out, employed and insurance. OH well, our tax dollars at work.

Anonymous said...

"a "healthy prisons" initiative designed to improve diets and exercise regimens". Makes you wonder what happened to the days TDCJ use to grow their own food. And the exercise equiptment / free weights George Bush had removed from the Prisons.


Prison Doc said...

Ham2mtr, exercise equipment is still alive and well in prison and used by many...and even if it were not, aerobics and calisthenics require no equipment.

It's commissary food that does 'em in.

Don said...

Wonder how healthful of a diet you can get for 60 cents a day? Where's Bush's buddy with all the, what was it, Vita-Pro or something like that?

Nurseypooh said...

Prison doc, it's not just commisary food doing them in, it's all the pork, commodity butter, carbs and saltttt they feed them. What happened to them growing their own food? Good question? Well it takes a field squad to supervise them out there and they're short staffed, also the inmates can't work if it's to cold, to hot, or the humidity to high! Not to mention a lot of the offenders have lead very unhealthy lifestyles before they got locked up resulting in a lot of their current health conditions. How about they put OTC meds in the commisary for them to buy and then they can stop submitting sick calls for ibu, tao, coldbusters, hydrocortisone cream, etc........
We give them Ibu for chronic pain conditions, then it ruins their stomach, GERD and now their on Prilosec which is very expensive even if it is OTC. We have so many offenders on it, we may as well stand at the door of the chow hall passing it out like candy!
It might also help if they changed the policies related to threats of suicide. Females are the worse, they come to medical laughing and smiling claiming they are suicidal just so they can go to crisis mgmt. so they can holler at their friends who are there, manpower and nice van ride thru the countryside, sometimes 5 hours etc.
What a waste of money! Then they are back in a day or two! It's a shame because there are offenders who are truly suicidal, sick and need our care but a lot of our time is spent on fake pych, someone trying to get out of work etc.
Why does hospital Galveston repair a dislocated elbow, finger and toe that has been dislocated for 3-5 yrs due to a gangbanger getting shot, it was not impairing any of his activities in the world so why when he gets to prison he wants all that fixed and they fixed it!!!! My rant for the day.

Anonymous said...

Finally someone has the idea to put some of the burden of paying for prisoners on the consumers....THE PRISONERS!!!!

I think that they could even take it a step further by making prisoners pay full price for healthcare, education, etc. if they can afford it.

By affording it I mean if they have money in thier commissary account use that to defray the cost of thier confinement needs.

There are some that do not have the means to do this, and I understand that, but there are some that could and should pay for it.

I also think that the State could release the low risk prisoners that have healthcare needs, but then again we are in the same boat when they get out.

We would still be paying for it even though they would not be confined in prison anymore.

Anonymous said...

Anon 10:04

I guess we could gather them all up and take them to Austin so Grits and his cronies could treat them......

Gritsforbreakfast said...

10:04: Commissary account money comes from families, not inmates. Take that money for incarceration costs and what family in their right mind would ever deposit money there again? The theory of "make them pay" sounds good, but you have to deal with the practical realities.

10:06: Get a life, troll.

Prison Doc said...

Illegitimati non carborundum, Grits!

Anonymous said...

I know that the money in the commissary accounts comes from friends and families moron...

Why can't they put that money towards healthcare, education, etc.

Is it more important that the prisoners have candy and cokes?

Or....maybe towards the overall health and mind expansion of thier dear loved ones?

Anonymous said...

Maybe it is better that they come out of prison with a gut, and diabetes....

Gritsforbreakfast said...

11:18, why would families put money in the commissary account if the state is going to seize it? It just doesn't make sense. Who would do that?

DeathBreath said...

It is really quite simple. Raise taxes, idiots.

Anonymous said...

I can tell you that I, as a mother of a son incarcerated would not put another dime on his account if the state thought they were going to use the funds for anything else than what I intended it to go for. My son would love to work for some kind of salary. He could use that money to send to his son. He is an experienced diesel mechanic, a certified generator tech and can work on gas engines as well. He applied for a diesel mechanic position and never heard a word. His dad (my husband) inquired about the position because my son really wanted to do the job. We were told that there was a freeze on all jobs. Oh well, so we keep paying for those folks that are incarcerated. Bryans mom

Anonymous said...

Oh, when my husband checke on the diesel mechanic job for my son the lady told him that my sons application was on her desk and was being reviewed. That was over 6 months ago. I don't understand why tdcj won't allow the folks incarcerated to work for some kind of monies. Bryans mom again.

Donna said...

Pity that there can't be some sort of collaboration with markets like Whole Foods that throw out thousands of dollars of food every day. Maybe a tax break?

Eliminate prisoners and you cut out the need for health care costs. How to do this?

First, acknowledge the root cause, that prison is big BUSINESS. Private prisons are run for profit; justice has little to do with it. Bonds on prisoners are traded on Wall St. With the rug pulled out of the real estate market, and the fiat dollar going into hyperinflation, what's left but to warehouse the goods and keep the market afloat? If the public only knew the scam!

Second, eliminate the black market on drugs that sends a majority of them there in the first place. Either let hemp save the economy with its 1000s of uses, or let the prison bond market keep the economy going (see above).

And Prison Doc, could you talk more about the commissary food? A book by probation officer Barbara Stitt, Food and Behavior, proved the case that food can make criminals. As a health writer, it grieves me to see so many crazy-making chemicals in the so-called food. It is bad in the grocery store; it must be horrid in the prisons.

Anonymous said...

If you only knew of the bogus medical appointments that UTMB make and the amount of offenders that are scheduled to come to HG everyday you would be astonished. That includes elective surgeries. ( and for that,) they have to have a heart study to make sure they aren't going to die in the operating room. A heart study consists of a stress test and if it is inconclusive(most of the time it will be) they need a nuclear medicine stress echo. And an x-ray then a CT scan and after those they need an MRI. If an offender has a pre-existing condition then it should not be corrected if not causing a problem.
MRI cost avg. 1000-3000
CT scan avg. 500.-1500
Nuclear med. stress test approx. 3000-4000
Exercise stress 3000-4000
Dr. visit aprox.(avg.5-8 visits) 300-500
Operating Room approx. 1600-2000 per Hr.
(This doesn’t include dr. nursing, & support staff or equipment and supplies used during surgery). This might be for nothing more then a bunion or perhaps an old war injury while selling crack he might have fell and broke his arm and it looks crooked. Also pre-existing conditions that you and I are not covered thru our insurance
This also includes all new female offenders that are received by TDCJ they get an automatic mammogram and are worked up for a well woman check up. (Something most mothers and or daughters can’t afford if you are a free tax paying citizen.) This is a sham of the biggest proportions that has been going on for years. UTMB is saying TDCJ owes them more then 62 million more dollars and have threaten to not renew their contract. The last time TDCJ had extra money left over in the budget TDCJ gave it to UTMB and in turn they gave their nursing staff a raise. This year after all the threats of not renewing because UTMB was so much in the hole they decided to give all of their staff a 500.00 bonus for good team work. (This don’t sound like an agency that wants to be called a state office when its appropriation time and a private employer after they get the check).Well do the state of Texas a favor and please don't renew the contract.
None of the figures includes the transportation cost and the cost of security that is the burden of TDCJ.
All this while needing transportation to the hospital daily. This is nothing more than thievery by the medical community.

Anonymous said...

Hello moron....

Who do you think gets the money from the commissary account when they purchase candy and cokes?

Anonymous said...


I say you are right!!!

Elimnate the prisoners!!

Just give them all a dose of the expired lethal injections...

Gritsforbreakfast said...

I call BS on 12:18 claiming inmates are getting "elective surgery." That's just silly.

8:31, excellent point about the commissary profits. That's exactly right.

Anonymous said...

Inmates were receiving elective surgery when I retired in 2004.

Retired 2004

Anonymous said...

I would be more than happy to pay for my love ones medical; however, the medical she recieves from the GATESVILLE GULAG is criminal at best. I have watched this for over six years and I have not been able to find one medical provider or staff down there who could get themselves out of a wet paper sack muchless provide compentent care. I am a firm believer after witness this for many years none of these people could practice for very long any where but TDCJ/UTMB. I will just be blint here they are too stupid to practice any where else. Release my non-violent love one and I will take care of all her needs. Where are the Feds when you need them. Gatesville Women's prison is a disgraced and is run by war criminals.

Gritsforbreakfast said...

What are you defining as elective surgery, Retired?

Nurseypooh said...

Have you ever met any of your loved ones providers? I have to disagree the nurses, and providers are ignorant and can't get a job anywhere else, since I'm a nurse for UTMB.
The system is far from perfect but what co.'s is in the free world?
Gatesville female offenders, example?
There is plenty of junk food to be bought out of commisary but very few healthY alternatives. A new health initiative might work if they didn't buy the junk from commisary. I see the diabetics come in everyday and some of them think it's a joke when they're blood sugars are high, we educate, educate, educate to no avail. Some cultural groups come from families who cheat and compromise their healths as a way of life and habit, it is very hard to change learned behaviors from infancy. If we don't watch some very closely a few will manipulate their b/s and insulin so they can got back and eat pastries etc.
UTMB medical staff are held to the same stringent accountability all other medical professionals are, we are licensed, recieve very good education during orientation and during employment there. I personally work there for the state benefits, having worked for tdcj prior to becoming a nurse I have state time already and want to continue there until retirement.

If you suspect your family member's health needs have not been addressed properly there are steps to take to complain, investigate, and resolved etc. and it does work and get the attention of the higher ups. It's sad you have lumped all us healthcare workers who work in the prison system and put up with being cursed, at risk for violence every day we step thru those gates, lumped us all together as stupid. I enjoy my patients for the most part and try to educate them as much as possible so they can better care for themselves while incarcerated and when they get out. I have little tolerance for those who come to medical playing games and/or expecting superior care for minor medical conditions that if in the free world they would never seek treatment for it. They get frustrated waiting and hour or two for appointments and fuss how it's not like that in the freeworld. Thats a joke! Some of them feel very entitled.

Anonymous said...

As a matter of fact I have met and talked to health care providers in the Gatesville Gulag and they are stupid plain and simple. I am glad some one who works for UTMB has finally admitted that the gulags medical care is substandard. I have had them investigated and they lie together also. They reason why people wait hours for appointments is because they schedule so many at the same time. I am asking the same question that Grits ask and I am calling this person on elected procedures also. I find it hard to believe that when an offender can not even get in to see a medical person for an infection and has to wait two weeks while the infection festers and almost kills them. Women have died down there due to incompentent providers and it can be proven also. Why do you think they wait until something gets worst to begin with you ask? Because the guards and staff writes them up and it effects their parole if the get hurt and report it from the free slave labor they provide for the slave master warden down there. I have met war criminals that have more compassion than the medical, staff and warden has in the Gatesville Gulag. Elected procedures is a lie and I will call you a LIAR to your face also.

Anonymous said...

Would you please be so kind as to inform me as to what proper procedure is for filing a medical complaint. My son recently had surgery a the hospital in Galveston. As a healthcare professional myself I am concerned with post op problems since his return back to the unit. My email is Thank you for what you do.

NurseyPooh said...

Dear anom.

1st start by calling the unit and ask to speak to the nurse mgr. to inquire about your son. Your son has to sign a form giving them permission to discuss his health chart with you if he hasn't already done so you can ask one of the medical clerks how he can do that. Next you can call and or write the practice manager (new name for this position) this person is in charge off all admin. duties including grievances, complaints, access to care etc. You may also write the warden with your concerns, the warden then contacts the medical dept. concerning the concern.
This is a good place to start and you should get some kind of results, be persistant but not rude. Once your son signs the form, they can talk to you more freely. Your son can request to only release certain info to you though like he may allow you to know about his recent surgery but not which infectious diseases he has.
Good Luck to you.

Anonymous said...

Scott: Elective surgery=Removing tattoos.

Retired 2004