Monday, May 30, 2011

TDCJ 'Going California'?: Prison health under-funded by nine figures

The big news in the corrections field recently has been the US Supreme Court's order for California to de-incarcerate its overstuffed prisons because of a failure to provide adequate healthcare. But Texas is setting itself up for the same type of situation with recently announced cuts to the prison health budget. Universities providing prison healthcare said prior to the 82nd Legislature that they weren't compensated for $57 million in healthcare services in the last biennium. The Legislature covered last year's shortfall in House Bill 4, but then they slashed another $71.5 million from prison healthcare over the next two years.

So if the last biennial budget was $57 million short and budget writers cut another $71.5 million without reducing the number of prisoners, the shortfall in the next two years - assuming the same levels of care - would run to $126.5 million, or around $800 per prisoner - a smaller reduction than earlier drafts of the budget but still around a 14% cut. In response, Grits commenters who work at TDCJ say thousands of clinic visits have already been canceled and operating room schedules have been reduced. While some of these services may not have been medically necessary, it's hard to imagine those levels of reductions without impacting actually needed services. As one commenter declared, "The system is clearly going California."

Even taking into account allegations by the state auditor that UTMB overcharged the state $37 million in the last biennium for services not covered under their contract, that's still nearly $90 million short of the amount needed to provide services that state officials already considered barely constitutional. (And notably, the state reimbursed universities for all the alleged overcharges, siding with UTMB over the state auditor.) A new $100 annual fee will replace $3 copays for inmates, but if there's no money in their commissary account they don't have to pay and nobody thinks it will remotely cover the shortfall. (UPDATE/CORRECTION: The bill to revamp inmate copays died unexpectedly on the last day but has been revived in the special session, reports the Statesman's Mike Ward.)

As far back as 2005, UTMB officials said the system was near the brink of failing to provide constitutional levels of care: "'We can't go any farther,' said [Dr. Ben] Raimer, a physician and former chairman of the state's Correctional Managed Health Care Committee. 'I'm certainly not going to be involved with a system that is not constitutional. . . . We're at that line now. One step across it and we're there.'" Unfortunately, the state since then has taken several more steps across that line, culminating in this year's outright draconian cuts.

Regarding future shortfalls, the Galveston Daily News claimed that HB 4, "if it becomes law, will make the Texas Department of Criminal Justice — rather than the health care institutions — responsible for the bills for treating prisoners. When the prison system runs out of money, it will have to find new sources of money or stop sending prisoners for care." However I see no such provision in the bill, which definitely covered last year's shortfall but as far as I can tell did not transfer future obligations to TDCJ. (Perhaps it's in other legislation that passed, but I can't find/haven't seen it.) And as California's example demonstrates, it's simply not an option to "stop sending prisoners for care." Whoever wrote that (the story was attributed to "staff reports") has a slim understanding of the dynamics of prison health finance.

In any event, whoever must pay, the demographics of Texas' aging prison population mean costs will likely go up, not down, since the Lege failed to enact most proposed de-incarceration initiatives this year (with a few exceptions Grits will discuss soon). The Houston Chronicle reported recently that "Elderly inmates in Texas make up 8 percent of the state's prison population, yet they account for more than 30 percent of prison hospitalization costs." In FY 2010, the state "paid $4,853 per elderly offender for care compared with $795 for inmates under 55." In that environment, it's hard to imagine the prison health budget won't enter the next biennial budget cycle somewhere in the range of $100+ million short. Or else the state simply won't provide needed care, potentially leading to California-style litigation.

OTOH, since the California litigation took 20 years to reach the point where the feds imposed a solution, perhaps this move represents an accurate political calculation that legislators can kick this can down the road for now without risking federal intervention. The day of reckoning, however, is fast approaching.

16 comments:

  1. Thanks Grit's that answered a lot of my questions.

    ReplyDelete
  2. My lifetime -- 70 years-- in Texas, and I'm thinking it might be time to move somewhere else...

    These people aren't just crazy -- they're FOOLS...

    ReplyDelete
  3. hmm maybe UTMB needs to grow a pair and tell the state...


    BYE your on your own!

    ReplyDelete
  4. Texas politicians care only about themselves and their cronies.
    "[L]egislators can kick this can down the road for now" is the typical attitude. But it will bite Texas in the a**. As we move into third world status eventually people will not want to be here. There's no room for progressive ideas here within the current political climate. No normal person could ever hope to follow or have virtually any influence during this last legislative session.
    Maybe as the Tea Party matures, grows, splits, something will come of the populist undercurrent. I do not think anything will change unless "the people" rise up - another "spring."

    ReplyDelete
  5. rodsmith suggests that UTMB should tell the state "your on your own".

    Remember that UTMB is the state, at least they are a state agency that is 30% financed by the Legislature, so it is not what it seems when it comes down to the last blow in this battle. UTMB autonomy may not be what it seems.

    ReplyDelete
  6. Lots of providers do not want to spend the next few years defending themselves in court because UTMB is not providing enough staff, or even worse defending their licenses.
    You will soon see a mass exodus of professional staff, and no one willing to replace them. Their is a lot more to this than most people realize.

    ReplyDelete
  7. Let the lawsuits begin. Texas is the largest open air prison in the world. You can thats the elected officials, The Governor and all their cronies.

    ReplyDelete
  8. ahh but just think 11:24 if UTMB wasnt' going into the red trying to run the state's prison sytem medical sytem ...they might not need that 30% they get from the state!

    ReplyDelete
  9. UTMB needs to stop driving up the cost on healthcare. They charge TDCJ to conduct Interferon studies on inmates, while they take money from the drug companies to conduct these studies. The UTMB Director should step down conducting this type of fraud. TDCJ is the best thing that ever happened to UTMB. Who else is going to be guinea pigs for UTMB drug studies and new doctors. UTMB should be paying TDCJ for providing experimental guinea pigs.

    ReplyDelete
  10. If a guy is 60+, and he's determined to be non-violent, or no longer the violent young man that was full of piss and vinegar 30 or 40 years back, it's a no brainer. Get him out before he has a heart attack, stroke, or develops cancer.

    We simply can't afford to give the convicted elderly expensive healthcare when we don't seem to be able to even afford the same healthcare for non felons.

    On parole, his healthcare costs are not TDCJ's problem, and they can still keep their eyes on his behavior on parole via ankle monitor or other means.

    ReplyDelete
  11. Anonymous was right.
    I am quitting after many years as Doctor in system.
    I'm not willing to put my
    retirement on the line for
    UTMB not living up to it's contracts with TDCJ.
    Lots of friends considering same thing.
    System will be in big trouble soon, so will prisoners seeking healthcare.

    ReplyDelete
  12. William Carter6/02/2011 10:41:00 AM

    I'M NOT A PRISONER..I have never been even looked at by the cops for anything! I'm 56 years old and been a common laborer self employeed carpenter. I work about 50 hours a week and each job is different because I need and want the work, so some jobs pay a little more than others cause I have to flexable as to what the customer can afford.
    I pay my taxes and I pay into stinkin social security KNOWING its being paid out to someone else and will not be there when I need it.
    I have paid for 3 kids college and got them through without oweing anyone a dime...I'm not bragging, those are just the facts and I'm sure alot of other folks my age have done about the same.
    And here is the kicker on this little deal, economy is kind of bad and people are putting off a remodeling jobs or other non essential projects.
    I've got a damn toothache! had it for about 4 days now...can't afford right now to go it looked at cause if it needs much work that will be 600-1000$. And if I could afford it, it would several days before I could get an appiontment!
    But thats jusy my problem, can't lay in my cell and complain after each nice warm meal how my tooth hurts! And then file some BS grievance if I didnt get in to see the dentist within 48 hours of me telling them my tooth hurt!
    Why is prison full? Cause for a whole lot of deadbeats its better than working and paying your own way! Give them a few years of the real world and freedom might be something they would prefer!

    ReplyDelete
  13. Didn't HB 4 pass today?

    ReplyDelete
  14. Grits how can I email you some information.

    ReplyDelete
  15. If texas wants to keep Locking up and forgetting people with HUGE sentences, then they should BALANCE their damn checkbook and pay their damn bills! Now, I have to get $100 taken from my poor wife because the state couldnt balance their budget? And Rick Perry wants to be president now? HA! NO WAY ! This is ridiculous. So that means everytime they lose more money, they will have an open door to raid our poor peoples trust funds. Totally SICK!

    ReplyDelete
  16. Band Aides and Aspirin only until ALL non-felons can afford health care.

    ReplyDelete