Friday, January 18, 2019

#txlege budget writers in denial on prisoner health care

In its Legislative Appropriations Request, the Texas Department of Criminal Justice said it needs an additional $247 million in order to continue delivering inmate healthcare at current levels, and ideally would like tens of millions more to make salaries more competitive. In response, the initial Texas House budget authorized an additional $160 million, and the Senate budget cut medical care by $1.3 million, reported the Texas Tribune.

The House clearly came up with the $160 million number because that's the amount they're having to pay in TDCJ's "supplemental" budget, meaning the amount the Lege under-funded services during the last biennium. But that ignores to the extent to which under-funding led to denied services, and it also doesn't account for medical inflation. Bottom line: The Senate number is pure fantasy, and even the House budget under-funds medical services for prisoners, ensuring the Lege will face another large supplemental appropriations request in 2021 if they don't increase the appropriation before May.

This has been going on for so long, budget writers have run out of options. Every biennium, they must start by writing a nine-figure check to cover un-funded costs in TDCJ's healthcare budget. A few years ago, the Legislature tried to make prisoners' families pay for inmate healthcare, extracting money from their commissary accounts. But the fees didn't raise as much as projected, while prisoners deferring doctor visits for financial reasons led to higher overall costs because of a lack of preventive care. So we've been there, done that, got the t-shirt.

At this point, Texas prisons already operate on a bare-bones budget. It's a non-controversial fact of life that healthcare costs will continue to rise by nine-figure amounts every biennium without significant policy changes to reduce incarceration.

Whether or not legislative budget writers want to acknowledge it, the only reliable way to lower the medical-services line item at TDCJ beyond current, rock-bottom levels is to reduce the number of prisoners for whom the state must provide health care. If Texas wants to lock up more people than any other state in the union, state government must pay for medical care while those folks are incarcerated.


Steven Michael Seys said...

My own health deteriorated to such an extent in the last decade of my incarceration that once I was released the VA has been scrambling to restore my health. Texas taxpayers are paying part of that cost too. The bottom line is that unless you want to simply kill all prisoners you are going to pay for their health care either before or after their release.

Anonymous said...

Steven Seyes, you just went from the frying pan to the fire. Bad health care in prison to, in my opinion, even worse health care at the VA. They will try to kill you. Be careful and good luck.

Unknown said...

This is relating to mental healthcare, but in the same important ballpark. I hit TDCJ in 1991 when Gov. Ann Richards, a recovered alcoholic, told the system to have substance abuse programs on every unit. She also demanded that counselors be added on each unit in the psych departments. Having a drug addiction and suffering from life-long depression and a dissociative disorder, i reaped the benefits of these expanded programs, as did many others.
As you would expect of dear ol' TDCJ, as soon as Gov. Richards left office, the substance abuse programs and access to mental healthcare quickly diminished. After a few short years the access to counseling was cut to 15 minutes per month, and that only for the ones such as myself who were on the psych case load and taking psych meds. I can tell you in no uncertain terms that my physical health and emotion health affect each other. When you have depression, free-floating fears and anxieties, they affect the person physically, sometimes in severe ways, and at times with deadly consequences. Sarcastically speaking, we are, in their eyes, the dregs of society, so why should they care if we are suffering (or dying) as long as they can save a bunch of bucks to put into all those ear-marks they slip into the major bills.
But, that is what we contend with in a society that is hell-bent on punitive justice rather than a restorative justice.

Anonymous said...

Grits, you probably remember, California's prison costs were so high, they had to release a bunch of inmates and then went under federal oversight, I believe. They finally realized they can't incarcerate everyone. When is Texas going to learn? As long as those Republicans are in power, I'm afraid Texas prisons are going to be kept filled. It's time to legalize marijuana -- not a Class C misdemeanor, idiots! It's time for the BPP to actually start letting some of the inmates with good behavior be released, not get a set off after set off! It's time to close some of the prisons where TDCJ can't hire Correctional Officers, not send Correctional Officers from OTHER UNITS to cover. It's time to hold these politicians accountable. Vote these bums out of office people, please!

Unknown said...

It seems to me that we have two problems when it comes to criminals and the old oxymoron "criminal justice". First, we are in the Bible Belt. I grew up Christian, still am, so i am well aware of their mindset- throw away the key; eye for an eye, all that retributive garbage. There are still many in that community who, in a broad sense, forget about the love for EVERYONE that is conveyed in the New Testament. It's almost a superiority complex. They are, almost as if it were a rule, none-forgiving, if you commit a crime there is only ONE thing to do: prosecute and with as much time as possible. I have seen it the whole of my 70 years - the criminals crossed a non-existent line to unredeemability( is that a word?). Lock 'em up and we'll go on to the next poor 'ol lost soul.
I belong to a large Baptist church here in Denton, and when i hooked up with Mike Barber prison ministry i was derided by many for my compassion and non-judgemental attitude toward all those horrible criminals.
Second is what we all know exists: the good ol' boy system.
It just occurred to me there is a third reason - leges trying to garner votes for the next election by making a bunch of new, costly, and useless laws. It reminds me of the late '70s book, "The Peter Principle". They have reached their highest level of incompetency and come up with useless stuff to justify their jobs. I have personally aproached legislators and city counsel members with the question, "There were statistics, facts, and testimony regarding the fact that these laws do nothing but placate the public and look tough on crime. Why did you still pass the (law, ordinance)?" Many were honest in their replies, "To get the votes". Scary stuff.

Gary Packwood said...

While nearly everyone is in agreement that health care costs will increase as we continue to increase the number of prisoners who are locked up, we also need to check what the charges are year by year from The University of Texas Medical Branch (UTMB) or any other medical provider.

We certainly don't need the name of the offender but we do need to know the number of offenders who need multiple visits year by year and whether or not that number is decreasing or increasing.

Multiple visits from one prisoner can blow the top off any budget and give the appearance of very busy health care providers.

Please let's audit outcomes while we advocate for fewer prisoners.

Unknown said...

Brings up a good point! I was on 4 units during my 20 years in there. The infirmary waiting areas were always packed, and due to medical and psych meds, i was there at least once per week. I also made trips to John Seely(sp?) and the Montford Medical/Psych unit. Those 2 are packed with doctors, nurses, and other staff. That is not to imply they do not need them, but those two hospitals seemed to be almost overflowing.
We all know about anticdotal reports from inmates when it comes to their problems, but I'm sure that many of the horror stories about the surgical and other medical screw-ups are fairly close to the truth. Those self-reports included one that I personally knew who i saw lose over 60 lbs. after a botched surgery, then a succession of surgeries to correct it. Several others i witnessed, returned in what looked like worse shape than before they went there.
The pill lines were always very long, and i watched most inmates take literally handsful of pills. I, myself was taking 17 pills per day for 4 years. On the Allred unit there were many, many who, like myself, were medically unassigned.
Not sure what my point is, except to say that from my viewpoint TDCJs medical/psych costs must be enormous. Between UTMB and Texas Tech Medical Branch, TTMB seemed to be a bad option for medical care. The competency of medical personel in the southern region (think UTMB) was much greater than the northern region (TTMB). I had racked up around 21 semester hours each of pharmacology and neurobiology at NTSU, now University of North Texas, in the late 80s and caught a multitude of prescribing errors by both PAs and doctors just with my meds.
Again, not sure what my point is, but all that has to be at an enormous cost.

Gadfly said...

The feds have a different solution. Boot you out of prison at 65 and let you go on Medicare.