Friday, February 03, 2012

UTMB begins "transfer" of prison health services to TDCJ; are they up to it?

At the Galveston Daily News, Heber Taylor reports that, despite months of negotiation between the Texas Department of Criminal Justice and the UT Medical Branch (UTMB) over providing inmate health care:
there is no agreement.

Dr. David L. Callender, president of the medical branch, let the staff know that the transition has begun to transfer the health services to the corrections department.

The basic problem is money.

The University of Texas System has made it clear its not going to continue to subsidize care for prisoners from university funds.

The Texas Department of Criminal Justice didn’t get the money from the legislature to pay the full cost of the care.

This is not the kind of problem two state agencies can resolve.

Somebody with money simply has to pay the bill.

Ordinary taxpayers should be watching this because the state’s not going to save money by taking the Correctional Managed Care Contract away from the medical branch.

This arrangement is still a good fit in terms of controlling costs. Finding the money to pay for this contract would be cheaper than starting over again with new contractors. 
I don't necessarily believe TDCJ is prepared to take over prisoner healthcare, either from a financial nor a management perspective. Nor did I understand the failure of legislative leadership that allowed this festering problem to linger beyond last session, when it was already coming to a head. Taylor's right - this isn't an issue two state agencies can negotiate away.

In truth, after UTMB was basically told by Senate budget writers they shouldn't end the contract, I'm surprised the university feels they have the authority to back out. They're definitely thumbing their nose at Senate Finance Chairman Steve Ogden, perhaps because he's retiring from the Lege this term and won't be around to haunt them in 2013 for their defiance. (After all the Aggie senator did for UTMB after Hurricane Ike, it's particularly a slap in the face.)

Meanwhile, privatization isn't really an option, either, at current funding levels, even if that's the Governor's preferred option. Various companies (and UTMB, for that matter) want the hospital contract, which is more lucrative, but nobody really wants to contract for clinic-level care unless the Lege ponies up more money.

Bottom line: The Lege this year cut the prison health budget but failed to reduce incarceration levels, meaning demand for services wasn't commensurately cut. Texas already has among the lowest per-prisoner health expenses in the country and it's unlikely the budget can be lowered as long as we incarcerate nearly 160,000 people. The cost of overincarceration has finally caught up with Texas, and the expense is greater, even, than just TDCJ's budget.

This is a fish-or-cut-bait moment. Before next session, the state must decide how to deliver prison healthcare on a shortchanged budget. But when the Lege meets again in 2013, to avoid nine figures in additional expenditures at TDCJ, they must change policies to reduce the number of people incarcerated. Any other option will yield the same untenable result as the last budget, magnified several-fold.


Anonymous said...

This transfer does not necessarily mean that TDCJ will take over active administration of health care services.
At this point it simply states that UTMB is giving them the responsibility, thereby leaving the door open for TDCJ to possibly negotiate with another third party,
perhaps a major university with some health care ties, to take over the contract. Whatever happens, you can
be sure that the health care services provided are going to continue to be sub par, at best.

Gritsforbreakfast said...

If TDCJ doesn't take it over, I sure don't see that "third party" stepping up to the plate at current funding levels. Ditto for regional hospitals. And there is no other "major university" to turn to.

I agree with your conclusion, but IMO for at least some period between now and 2013, if UTMB really backs out TDCJ will be stuck holding the bag, so if they're not prepared to take on "active administration" they'd damn well better get ready.

Don said...

Texas Tech already does a small part of it, but I'm pretty sure they're not up to taking on any more of it.

Scott, I know you posted this somewhere but I can't find it. Could you tell me the total budget cut to TDCJ, percentage that was to probation, and percentage to health care? Just approximate will do. I'm a guest on a radio show to talk about some of this stuff. Thanks.

Gritsforbreakfast said...

Don, in the end the big cuts were to probation, food, the Windham School District and inmate healthcare. I don't know the percentages offhand. But the reality is, after TDCJ agreed to pay UTMB $5 million per month extra for health services, all supposed savings at TDCJ vanished. Despite closing the Central Unit, with the extra health costs by my back-of-the-napkin estimate their budget won't actually decline this biennium.

Anonymous said...

Let me be very clear to Anon 0906, healthcare provided by UTMB is definitely not "sub par". Since when can you see your doctor on a whim? When the offenders get to prison they want all sorts of things operated on, examined, medicated, treated, etc that they never even considered a priority in the free world. My grandmother in the nursing home doesn't get faster and more comprehensive medical care that the Texas offender population. I'm not upset about the care that is provided to the offenders; I'm proud of it. I'm disgusted about the care that is not provided to our elderly and very sick in the free world. For example, Michael Hospice Unit is immaculate and the care and compassion given there is like none I have ever seen. There are special units all over the state that cater to certain types of sick offender populations or disease types. I won't lie and say that all medical staff with UTMB have their hearts in the right place, but I will tell you that the majority do and that is the God's honest truth.

I seriously doubt the lege will allow UTMB to move down the road. The state gets a lot of bang for their buck and Texas Prison Healthcare costs are the among the cheapest in the nation. Approx $9 per member per month vs up to $45 in other states. The lege cut UTMB back to around $7 and as we all know, there were no mass releases to match those cuts. Good luck trying to find cheaper healthcare because when you do, that is when you will also find increase costs in litigation.

Prison Doc said...
This comment has been removed by the author.
Anonymous said...

To Anonymous 2/03/2012 08:25:00 PM You're a liar! You must be a member of TDCJ staff, or you would not write the nonsense you just wrote!
Inmates DO NOT receive "on-demand medical services"; my husband has been on the list (was removed when he transferred units and started again!) since May 2010 to have his eyes examined and get glasses-- the glasses he was incarcerated in are in real bad shape and he has risked cases for using tape (he gets off of envelopes and wherever) just to hold them together! He has put in I-60's trying to get medical care. He was given substandard medication for his bipolar condition that made him even more depressed! He has been seen more often by a PM than a doctor with UTMB and he says (and I can validate) the staff for UTMB in the prison system are rude and not very nice! I can say that your statement "When the offenders get to prison they want all sorts of things operated on, examined, medicated, treated, etc that they never even considered a priority in the free world." is pretty accurate, but the care is subpar, compared to the level of medical care we receive in the 'free world'. Talk to an inmate before you make your comments; research your subject!


UTMB has for years have been looking out for themselves and not looking after the best interest of the tax payers and patients of the State of Texas. Having work on both the TDCJ side and UTMB side of Health Services TDCJ can clearly take over this with little problem. Dr. Linthicum has done a good job with what she has to work with and has the resources to to do the job more effectively and effeciently.

PRISONDOC is correct on his assesment.

Crain Watcher said...

To Anonymous 2/03/2012 08:25:00, You have no clue and Inmate wife is right. The Gatesville units are not even at constitutional level and have never been. I have seen people offer to pay for eye exams and their love one glasses only to sit in property rooms for months just to mess with the inmates. An inmate died down there a few years ago one night and the guard would not even call medical and even wrote the inmate a case, then the guard gets promoted to Sergeant. The medical staff down there are mean and cruel and everyone is faking to hear them tell it. This is interesting TDCJ say's women will recieve one razor every week to shave with but on the Crain unit they get one very CHEAP RAZOR PER MONTH and it lasts one week. They want these women to be deprived, negelcted and lower their self-esteem. Why does this unit refuse to follow TDCJ rules. Some razors came into the commissary and the warden made them send them back. They are not trying to rehabilitate these women. They want them to go back to society broken. This is unacceptable to bill the tax payers for these razors by the month only to short change them. Lat time I checked this is called tax payer fraud this unit is doing. These same attitudes can be seen in the medical down there and the inmates are not charged their love ones were this year $100.00 fee, even though the Constitutional level health care should be free. YOU LOCKED THEM UP, YOU PAY FOR THEM. Tuff on Crime remember.

Anonymous said...

If courts in the state of Texas continue with handing out long sentences and rehabilitation is such that TDCJ see a high return rate of prisoners then Texas needs to pony up money for Health care

Phillip Baker said...

Anon 8:25 clearly either has no first hand experience with TDCJ's health care or he chooses to ignore truth. I'm always amazed at the guards and general public who genuinely think that inmates get "better care than I do". Yeah? Wanna trade places? You have to send a lot of I-60's to get that first contact- with some nurse from Ghana who barely speaks English and could care less. Then there's all the I-60's to get past the nurse's bandaid approach and see a real medical professional. There's an actual reason why prison healthcare workers get so little respect. Not deserved by all for sure, but how about the doc at JIII who video'd himself holding up a full tube of toothpaste from the property of a Type 1 diabetic the good doctor almost killed within 6 weeks of arrival and never got under control in 10 mos under his "care". He claimed the guy was eating his toothpaste to "manipulate his disease"! Seriously. No, healthcare in TDCJ is definitely NOT up to community standards, as required by law. See that article (Tx Tribune? Here? I forget) about the relative costs of the rising geriatric population vs the majority of offenders? Yet do we release these old guys back home? Oh no, we are "tough on crime".

Anonymous said...

Crain Watcher, what a hater!! You write as if you believe TDCJ is running around the state locking up innocent folks just so UTMB and TDCJ can torture them. What a joke! Inmates make bad decisions and most of them will tell you they made bad choices. Get over yourself. If you or anyone else doesn't like the prison atmosphere them I suggest you Don't Mess With Texas!!

Crain Watcher said...

Thank you, Thank you very much!!! I am a hater because of TDCJ employees break the law too, so be it. Just charge those guards with felon crimes and put them in TDC whites along with the other inmates. You are probably one of those sorry guards. The U.S. Constitution still covers Texas too. Hater? No I am no hater but Texas does lead the way in locking up innocent folks that is proven and what happens next the TDCJ guards abuse them. Prison is the punishmnet not some guard giving you a STD after you get there or humiliating the inmates in front of there family members. Why is it so important to yell at and abuse their visitors also. You wonder why people return to the community worst off, well just look in the mirror. Was it right to abuse those boys for almost 100 years by back water inbreeds in Gatesville. Is it right for guards to force inmates to have sex? You are probably knee deep in this abuse. Thank you, Thank you very much!!!! Anon, I mean Crain Unit Prison guard.

Anonymous said...

I can tell you there is an officer on the Terrace unit that writes inmates up for walking down the sidewalk and will always call the dorms to have them stripe searched for a third time just to mess with them. I guess Anon thinks it is right for a guard to take the time write a dying woman up for making too much nosey but not take the time to call medical. Was it you that promted this guard to Sergeant?

Anonymous said...

Did ya;ll lose the purpose of this post or what? Get back to the subject at hand! Stop bellyaching.

Anonymous said...

Anon 0906 replies that I worked in the system for a long time in a position of great responsibility as a provider of health care. Patients who have appointments at Hospital Galveston can wait up to a year, if not longer, for the care they could get outside
by calling for an appointment, and suffer in the interlude. Many security officers are concerned, but many are not. Many of the medical staff are good, many don't really care. I speak from experience. Access to health care is definitely sub par, and often the care given is also. Believe me, I have been there, done that.

Usis said...

Mr. Heber Taylor is leaving out some key words from Dr. Callendar's announcement.

The most notable is that 'we will begin the early phases of PLANNING for a transition of correctional health services to TDCJ.'

NO transitions have begun. They are beginning to PLAN transitions, according to Dr. Callender's email.

To me, this is still political posturing. As pointed out by other folks in this commentary, UTMB provides healthcare at an extremely low cost that no one can begin to match. Outside companies have come in and given bids at over $20/inmate/month, over double what UTMB charges.

Also keep in mind that UTMB has the telemedicine and electronic medical record infrastructure in place that will be hard to replace, and certainly not cheap to replace.

I know that politics is not rational or even fair, but it will be fairly hard to pull a fast one on the public for the cost to transition alone.

In summary: I don't think that UTMB is going to leave. They provide a service at the lowest price possible. TDCJ will end up paying the piper in the end.

Here's the email announcement from Dr. Callender in full:


Status Update on CMC Contract

In early December, I wrote to let you know that the negotiation period for UTMB’s correctional care contract had been extended until January 31, 2012, to allow time for UTMB and TDCJ to reach a mutually acceptable agreement for fiscal year 2013. Unfortunately, despite everyone’s best efforts, we have not yet been able to do so.

Discussions are continuing. In the meantime, consistent with the current agreement, we will begin the early phases of planning for a transition of correctional health services to TDCJ. The transition is designed to avoid disruptions in patient care, and UTMB will continue providing unit and hospital care as previously agreed. We will provide further information as it becomes available over the coming weeks.

We thank everyone for their patience and support as we continue to work through the process of creating a new model for correctional health care that will provide appropriate services for the offender population at a reasonable cost for our state.

Dr. David L. Callender


I hope this helps connect some dots for folks. And in the future, please read Heber Taylor's stories with a grain of salt, as he clearly ascribes to the age old newspaperman practice of sensationalism and exaggeration to sell his product.

Anonymous said...

I was trying to help sick inmates for a long time.The main problem I saw was UTMB would order things for the inmates and when they got back on their units all the "recommendations" from UTMB specialists were denied. When you questioned the unit as to why, they would state those are only recommendations and it isup to the unit doctors to decide if those recommendations should be followed , which in most cases never were. That was their main scam to deny medications, wheelchairs, diabetic footwear etc.. etc..The main reason one is sent to a specialists is to get those recommendations. Then they would give the inmates family a run around- TDCJ blaming and telling them to contact UTMB and UTMB blaming TDCJ, like they are seperate enities when they all work for UTMB

PAPA said...

when the long ago lost DRUG WAR was declared it was not taken into consideration the need for extra court system to have more judges, DA's, courtrooms,bailiffs,law enforcers,jails,prisons,to clean out the users of illegal drugs...oh forgot to mention most of the Inmates in TDCJ there for drug offenses,guess what most of them have major medical issues and problems due to the drugs not to mention the lack of medical care while out on the streets doing the drugs and alcohol which will not even go into the mental needs for medical care for depression, bipolar, etc...WHAT do you expect people,"GET REAL",release the non violent,many of the Inmates are Veterans,can qualify for VA care if they were able to be released,"GET REAL" people what do you expect.Galveston needs that entire hospital rebuilt from the hurricanes, it is still so contanminated with mold they can't really do major medical care,so UTMB need TDCJ to rebuilt or finish rebuilding that hospital to care for the Inmates. Guess WHAT!!!if you lock them up you have to house,cloth,feed,medically care for them,if TDCJ can't do that then they need to be releasing those that are long past due to be released including the non violent offenders,get them off the Taxpayers Payroll,plus it is against the law to abuse, torture, neglect the sick...the Monster is broken,when broken what do you do? FIX IT or Change it

Anonymous said...

I work in the system, I see officers that are on power trips, that abuse their power on the weak and ones that have suffered strokes, brain injuries, and are not the criminals they once were when they entered the system. I see nurses that are lazy, and if they worked in the free world would be fired for neglect and face the BON. I see PA's treat inmates like lab rats, not really treating the inmate but guess what! Nobody is watching. Nobody cares. Do you think tdcj cares! Ha, do you think the BON that's a state agency will investigate a nurse who works in a prison that's a state agency?! Ha! 1 in maybe 20 nurses actually follow their oath. And that 1 takes a beating verbally and emoitionally from the ones that don't give a rats ass. It's disgusting. And anyone that tries to say different is part of the problem. The problem is there is not an agency to investigate that's not involved with back room politics and the buddy system!!!! I have yet to see anyone talk about the funds waisted because of neglect from a nurse or provider, neglect that causes an inmate to be placed on a vent, that cost thousands a day. Nothing will change til the bad apples are removed. But bad apples are in charge!!!!

Anonymous said...

Actully anominious if you havednt been a patient in the TDCJ system you wouldmt know that the healthcare is very subpar , matter fact third world nations get better care. My brother was in their for two years and now is dieing with cancer they gave him horrible care and he isnt a criminal got screwed by courts over bs. and now he is dying . tell you what they use those guys like guiena pigs have no passion for their profession they all should be in prisoned(UTMB) personnel.

Anonymous said...

First of all I can truly say since I have worked in the medical department of tdcj and it's not as what you expect.When we go to school we are taught to be caring and compassionate but when you get there and you truly care for the human you are treated like crap. First of all you get called names told you are to friendly all because you are doing your job,you are accused of been an inmate lover and everything else. When it actuallity if you treated people the way you treat inmates you would get fired in a heartbeat and possibly loose your license. I don't mean to be cruel but UTMB solution to good workers is transfer them to other units or make there life miserable and last of all make them quit there jobs with no real valuable reason, So I would say to all the folks in the Medical departments at the Units especially in Huntsville lets pray to God that one day your loved ones don't end up locked up becuase you would not want them treated the way you treat the inmates. Because even though they are criminals they are still humans!!! Lets not forget that.