Feb 15

    No Place for Old Men

    Texas prisons are filling up with the old and the ill — at enormous expense.

    Benito Alonzo is a short, 140-pound 80-year-old. His quiet-spoken manner, drooping jowls and gray hair, trimmed in a buzz, give him the appearance of a benevolent grandfather, and indeed, he is a grandfather. In thick-framed black eyeglasses, he bears a resemblance to the defanged and aging Henry Kissinger. But Alonzo is neither a celebrity nor a statesman. He’s a convict who has lately grown infirm.

    He says he’s been diagnosed with prostate cancer and he’s afflicted with Hepatitis C. For several years he’s been prescribed a drug called Lactulose, which Dr. Owen Murray, chief of medical affairs for the Texas penal system, says “we use for people whose livers are at the end of their lives.” In November, the University of Texas Medical Branch in Galveston told Alonzo’s son in a letter that during a recent medical examination, it also found “evidence of cirrhosis,” an often-fatal ailment.

    Read More Here.


    NOVEMBER 07, 2014

    TDCJ: Prison Healthcare Needs $174.8 Million More To Meet 'Minimum Standards'

    According to TDCJ's Legislative Appropriations Request for FY 2016-17 (large pdf), the agency needs an extra $174.8 million over the next biennium beyond current director Brad Livingston at the front of the budget:

    According to university providers, additional funding of $174.8 million is critical to maintain operations and ensure effective overall quality of care within the system and deliver the level of services required by minimum standards. Of this amount, an estimated $84.9 million is required to bring the FY 2016-17 funding to the projected level of expense incurred for the delivery of services currently provided.

    University providers are encountering significant difficulties in the ability to recruit and retain the professional staff necessary to provide care at TDCJ correctional facilities. Therefore, $59.4 million is included in this request to provide market level adjustments (5% in FY 2016 and an additional 5% in FY 2017) to the salaries of the direct offender health care delivery staff.

    The correctional health care system is also facing critical capital equipment needs for x-ray units, dialysis machines, dental chairs, hospital beds, and other equipment with estimated cost totaling $6.7 million. Other initiatives at a cost of $23.8 million will provide primarily for the hiring of nursing and key health care staff to increase coverage at targeted correctional units.


    Texas Has Nowhere But Prison For Most Mentally Ill Convicts

    July 6, 2014

    For every inmate, healthcare, including mental healthcare,
    must be provided by local jails. As long as the state
    provides nowhere else for mentally ill inmates to go,
    counties must provide what services they can with the
    limited resources available.

    On the top floor of the Liberty County courthouse, in the 75th District Court, Thursday morning, July 3, Assistant District Attorney Matthew Poston had the unhappy responsibility of performing some of the state’s dirty work.

    He represented the state on a motion to revoke the probation of a man for whom there may be no good place in this world, a man repeatedly in trouble with the law, whose mental illnesses leave him unable to function well on his own, but who, by the standards of the law, is not so mentally ill as to be free of culpability for his actions.

    The probationer sat at the defense table in his faded orange jailhouse scrubs and answered the questions put to him by Poston. The probationer explained he was first diagnosed as bipolar at the age of 9, that he was later diagnosed as schizophrenic, that he hears voices, and that he has been diagnosed with other disorders but could not remember them all.

    He could not say the number of his arrests.

    “Do you know how many times you’ve been arrested?” Poston asked.

    “Quite a few,” the defendant answered.

    In his 30s now, he thinks his first arrest was in his teens.

    According to Poston, the man has been arrested 24 times.

    Homeless and long unemployed, the man has for awhile lived under a tarp.

    He has served time before, found guilty of illegally harvesting oysters in a controlled area, a crime for which he has been arrested several times.

    The man has been arrested several times for theft, and also for public intoxication.

    Arrested again in December 2013 and charged with felony burglary of a building, he was given a two-year suspended sentence with a $1,000 fine, four years’ community supervision, and 100 hours of community service to complete.

    This was followed by incidents of criminal trespass, resisting search and transportation, and marijuana possession. Court documents indicate he failed to report to his supervising officer and failed to complete 98 of his 100 hours of community service.

    During his hearing on Thursday, the defendant indicated he was better when on his medications, that he took medications while he served his earlier sentence but did not stay on them outside of prison.

    Judge Mark Morefield granted the state’s motion and revoked probation. He sentenced the defendant to serve 18 months.

    “I really don’t give a damn what you have to say,” the man said in response to the judge’s pronouncing sentence. He let a few other words fly as the bailiff escorted him out of the courtroom, ending with “I hope somebody breaks that dude’s nose,” referring to the judge.

    A Texas Department of State Health Services (DSHS) 2010 report states, “Studies from around the country estimate that between 8 and 16 [percent] of all jail or prison inmates have a mental disorder such as Bipolar Disorder, Schizophrenia, or Major Depressive Disorder.”

    The 2010 report says that of the adults served by DSHS-funded community mental health centers, some 19 percent reported “contact with the criminal justice system” in the three years from 2007 through 2009.

    It goes on to say, “of the 620,250 persons in the TDCJ system, 140,959 had been registered in the DSHS system. In other words, 23 [percent] of adult offenders who were in a Texas state prison, on parole, or on probation were current or former consumers of the DSHS-funded mental health system.”

    According to the DSHS report, bipolar disorder was the most commonly reported diagnosis among those adult consumers of DSHS services who reported involvement with the criminal justice system over the three years studied, with major depressive disorder being the second most frequent and schizophrenia and related disorders third.

    Most “were male, white, between 22 and 50 years of age, Medically-Indigent, and had not been admitted to a state or community psychiatric hospital with the fiscal year,” the study says.

    “There is a void in the system,” District Attorney Logan Pickett said Thursday, after the hearing; there is just nowhere else to send them but prison. “We feel sorry for them, but there’s nothing else we can do,” said Pickett. “We have an obligation to protect the public.”

    As a result of there being nowhere else for the mentally ill who violate the law, the costs of their treatment, on top of the normal costs of housing an inmate, falls onto the Texas Department of Criminal Justice and local county jails.

    Houston Attorney Paul LaValle commented, “The Harris County jail is the largest unlicensed mental health facility in the state.”

    Texas Has Nowhere But Prison For Most Mentally Ill Convicts

    APRIL 10, 2014

    Report: Texas Jails and Prisons Warehousing Thousands of Mentally Ill

    The Treatment Advocacy Center has issued a new report titled "The Treatment of Persons with Mental Illness in Prisons and Jails: A State Survey." Here's a notable excerpt from their findings on Texas:

    The North Texas State Hospital, with 692 beds, is the largest remaining state psychiatric hospital. The Harris County Jail in Houston, where “25 percent of the prisoners receive psychotropic medication” (Bellaire Examiner, May 18, 2012), has over 8,000 inmates and thus is certainly the largest “mental institution” in the state. In Bexar County, “about 21 percent of the inmates suffer from mental illness” (San Antonio Express-News, Aug. 8, 2010). In both Bell and El Paso Counties, “about 40 percent of the inmates” are being treated with psychotropic medications “or need those medicines” (Texas Tribune, Dec. 16, 2010; KWTX, July 24, 2013).

    One of the most depressing aspects of the situation for prison and jail officials is to see the same people repeatedly cycling through their facilities. In Harris County, almost 600 mentally ill individuals “cycled through the jail at least five times in the past two years” (YourHoustonNews.com, May 22, 2013). They include Patricia George, 34 years old and diagnosed with schizophrenia; she has been charged with 31 misdemeanors and 12 felonies and has already spent nine years in jail (Houston Chronicle, July 21, 2008).

    Texas is among the states with the lowest number of public psychiatric beds and among the stingiest states in per capita mental health spending. Some of the jail overcrowding is directly attributable to having no available psychiatric beds. In 2010, the Bexar County Jail had 100 jail inmates waiting to be transferred to a state hospital, and the Dallas County Jail had 103; since then, the situation has only gotten worse (San Antonio Express-News, Aug. 8, 2010).

    The group's recommendations were to:

    Provide appropriate treatment for prison and jail inmates with serious mental illness

    Implement and promote jail diversion programs

    Promote the use of assisted outpatient treatment (AOT)

    Encourage cost studies

    Establish careful intake screening

    Mandate release planning

    See additional coverage from MSNBC.

    H/T: Sentencing Law and Policy.


    Mentally Ill Are Often Locked Up In Jails And Prisons That Can't Help

    January 20, 2014

    Over the past decade, thousands of mentally ill people have been funneling in and out of the nation's jails and prisons, landing in places that are ill-equipped to treat them. Illinois' Cook County Jail has some of the most innovative programs in the country, but staff say it's a far cry from actual treatment.

    Read this story HERE


    Irving Jail Staff Knew Diabetic Inmate Had No Insulin Before Death

    By AVI SELK Staff Writer aselk@dallasnews.com
    Published: 09 December 2013

    Sarah Tibbetts

    Irving jail staff knew that a diabetic inmate needed insulin hours, if not days, before she collapsed in her cell and died.

    Two jail supervisors have been placed on paid leave while the city and district attorney’s office investigate the Nov. 3 death of Sarah Tibbetts, 37.

    The medical examiner has not yet ruled on the cause of death. Nor have police responded to accounts from family and jail sources that Tibbetts, who took insulin daily to survive, did not get any during nearly 42 hours in custody.

    A grocery store baker before her life began to fall apart several years ago, Tibbetts often lived out of motel rooms and recently lost her 12-year-old son to child services, according to her family.

    The only convictions on her record were misdemeanors; trespassing and drug possession last year. But Irving police had arrested her several times before they found her Nov. 1 in a motel room — allegedly with someone else’s credit card and traces of marijuana on baggies in her purse.

    Family said that Tibbetts’ arrests usually ended with a minor charge being dropped and a trip to the hospital for insulin, which she either left behind or wasn’t allowed to use because it was improperly labeled.

    But this time, something went wrong.

    Rebecca Tibbetts, Sarah’s mother, said staff phoned her a day after the motel arrest and asked her to bring the medicine to jail.

    “I said I’m in California. I can’t bring it up,” said Rebecca Tibbetts, who lives in that state. “I said my daughter is insulin-dependent and she will die without her insulin. If you can’t provide it, she needs to be sent to a hospital.”

    The next morning, Sarah Tibbetts lay unconscious on the floor of her cell.

    Jack Pritchett, Tibbetts’ boyfriend for the last six years, said he watched her last minutes from a nearby cell.

    Pritchett was arrested with Tibbetts after jumping out the motel room window, police said, and held on old warrants. The two were put in a small cell block near the jail entrance, Pritchett said, directly in front of guards at the booking desk.

    “They knew we was together real hard, like Bonnie and Clyde. Like peanut butter and jelly,” he said, tears on his cheeks. “Twenty officers and every one of them knew me and her.”

    Pritchett said he could hear Tibbetts calling out to him before she collapsed, “Baby, baby.”

    When she fell silent, he knew something was wrong.

    “I screamed at her for five, maybe 10 minutes,” he said. “Screamed bloody murder until they finally got up. They all started rushing over there.”

    A guard pulled her into the hall and pumped her chest, briefly reviving her. “It was like a movie,” Pritchett said. “She looked right at me and closed her eyes.” He banged on his cell door as paramedics took Tibbetts to an ambulance. “I said, ‘Let me out and help her!’ Because I brought her back a few times over the years, you know. But then she couldn’t hear my voice no more.”

    Pritchett’s account of Tibbetts’ death matches the few details police have released: Jail staff attempted CPR before she was rushed to a hospital, where she was pronounced dead about half an hour later. Surveillance footage has not been released.

    Later that day, Rebecca Tibbetts got another call from the jail and learned her daughter was dead.

    She asked the officer on the phone if Sarah ever got her medicine. “He was kind of polite,” Rebecca Tibbetts recalled. “He said, ‘No, she did not have any insulin.’”

    A jail employee, speaking on the condition of anonymity, confirmed that staff knew Tibbetts needed insulin before her death. A police spokesman would not discuss the incident while the city investigates and the district attorney considers possible criminal charges — standard after an in-custody death.

    “We want to find out what happened,” spokesman John Argumaniz said. “Everyone wants to make sure that in no way, shape or form do we jeopardize the investigation of the grand jury.”

    Rebecca Tibbetts expects her daughter’s autopsy will link the death to diabetes and may file a wrongful death suit.

    “There was a lot of mistakes made, not completely purposefully,” she said. “Maybe they were thinking she’d make it through.”

    Pritchett recalled Tibbetts as a beautiful woman who loved baking cakes, solving crosswords and deserved better than she got.

    “She was never evil of any sorts,” he said. “It was straight up murder through negligence.”

    Irving jail staff knew diabetic inmate had no insulin before death

    Violence Behind Bars: A Tie to Mental Illness

    By Brandi Grissom
    September 22, 2013

    Major Michael Gruver in recreation area of Clements Unit (r)
    and a Guard tower near front gate of Clements Unit, Texas
    Department of Corrections (l). Photo by: David Bowser

    AMARILLO — The most violent prisons in the Texas state system share a common factor: They house a high proportion of mentally ill inmates.

    The Texas Tribune analyzed violent-incident data from 99 state prisons from 2006 to 2012, and found far more incident reports at facilities housing high numbers of mentally ill, violent offenders than at other prisons.

    It is not surprising that prisons with a greater proportion of mentally ill inmates would have more violence than others, said Michele Deitch, a prison conditions expert at the University of Texas at Austin’s Lyndon B. Johnson School of Public Affairs. But the volume of violent incident reports raises questions about the staff’s ability to manage inmates and keep prisoners and officers safe.

    “You can’t ignore those numbers,” Deitch said.

    Among the five units with the highest number of reports are the state’s three psychiatric facilities. In addition, the William P. Clements Unit, which is not a psychiatric facility, but houses 1,800 mentally ill inmates among a population of 3,500, is in that group, according to Texas Department of Criminal Justice data.

    Criminal justice reform advocates say the numbers show that the state’s approach to incarcerating the mentally ill is not working. But criminal justice department officials say the numbers do not tell the whole story. They say state facilities are safe, and programs aimed at helping mentally ill inmates are working.

    “I think we do a very good job taking care of what we do here,” said Barry Martin, the senior warden at Clements.

    From 2006 to 2012, Clements inmates and officers were involved in about 6,600 violent incidents — those in which an assault was alleged, force was used, a weapon was involved or a disturbance was reported — outpacing all other prisons.

    On average, there were more than 25 reports for every 100 prisoners each year.

    In those years, there were 77 allegations of sexual assaults at Clements and 264 incidents in which inmates lobbed bodily fluids. According to the reports, officers used chemical agents to subdue inmates more than 1,500 times, and offenders were found with weapons on 411 occasions.

    After dipping significantly from 2006 to 2007, the number of violent incidents at Clements rose to 1,093 in 2011 and more than 900 in 2012 from fewer than 800 in 2007.

    Deitch called the numbers “overwhelming.” But Clements is not the most violent per capita. Reports of violent incidents are more prevalent at smaller institutions that house only psychiatric patients. At the John Montford Psychiatric Unit in Lubbock, the average of violent incident reports was 43 per 100 inmates from 2006 to 2012. The Beauford H. Jester IV Unit near Richmond, which houses some of the most violent mentally ill inmates in the system, had 41 incident reports per 100 inmates during that time. The average for the 99 Texas prisons analyzed by the Tribune was less than 8 per 100.

    At Clements, officers were involved in a “major use of force” — reported whenever officers force inmates to do something against their will — more than 3,400 times during the six-year period. The Montford Unit, with a population less than one-third that of Clements, had more than 1,500 reports of major use of force during the same period. Officers at Jester, with about 500 inmates, reported major use of force 900 times.

    The state system is facing an increase in prisoners requiring psychiatric care, a trend seen in the criminal justice system nationwide in recent decades. The number of inmates treated for mental illness by the University of Texas Medical Branch, which provides most inmate care in Texas prisons, grew from about 14,500 in August 2008 to nearly 17,900 in August 2012. More than 15 percent of the more than 151,000 inmates have been given a diagnosis of some form of mental illness.

    Deitch and other proponents of prison reform said the rate of violence, particularly at facilities with mentally ill inmates, shows a need to reduce the prison population and improve staff training to cope with prisoners with psychiatric needs.

    “Something is happening that’s causing inmates to act out in quite serious and dangerous ways, and staff do not have that situation under control,” she said.

    Scott Medlock, director of the prisoners’ rights program at the Texas Civil Rights Project, said state officials should consider structural changes, including spreading mentally ill inmates among many units instead of concentrating them at a few.

    “Those people are entitled to accommodations that will help integrate them into the prison system and keep them safe,” he said.

    But leaders at Clements and department administrators say the statistics do not reflect the hundreds of times when officers have prevented violence. And they do not show the success of intensive programs that help mentally ill offenders.

    Martin, the warden at Clements, said that the unit houses not only mentally ill inmates but has a wing dedicated to G-5 offenders, those who are considered the most dangerous. The prison has 448 cells for solitary confinement; last week, 435 of them were occupied.

    Clements officers are given two and a half weeks of training in dealing with mentally ill inmates, and Martin said he planned to add more.

    “That’s the biggest job,” he said, “protecting them from one another and, here, from themselves.”

    At Clements, health care providers from Texas Tech University Health Sciences Center run the Program for Aggressive Mentally Ill Offenders. Inmates can participate voluntarily in the cognitive behavioral therapy program, and 175 are enrolled. Those who complete the program by taking medication, attending therapy sessions and modifying their behavior receive a certificate that prison and parole officials consider when making decisions about housing conditions and potential release dates.

    “It makes life easier for them and for us,” Martin said.

    The prison also has an involuntary program for about 200 chronically mentally ill inmates, which puts them in daily contact with mental health care providers.

    Marion Williams, the medical director at Clements, said she felt safer treating patients inside the prison than outside. Keeping a large population of mentally ill inmates in one facility, she said, allowed for continuity of care.

    As inmates shouted and banged on the steel doors in a solitary confinement wing at Clements, Maj. Michael Gruver, who oversees the isolation wing, said dealing with large numbers of inmates with mental health problems was difficult at times.

    “There are challenges,” he said, “but they’re not insurmountable.”

    Dan Hill contributed data analysis to this report.

    Violence Behind Bars: A Tie to Mental Illness

    March 24, 2013


    New Fight Brews Over Prison Health Care
    At Stake: Membership on the little-known Committee that oversees Prison Care

    By Mike Ward
    American-Statesman Staff

    Concerned that the quality of medical care for inmates is slipping as costs increase, some state legislators are hoping to entice more of Texas’ medical schools into helping manage prison health care.

    “It’s all about competition,” Senate Criminal Justice Committee Chairman John Whitmire, D-Houston, told the Austin American-Statesman. “The more medical schools we have involved, the better the price could be.”

    As part of legislation reauthorizing the Texas Department of Criminal Justice, Whitmire is proposing that the number of medical schools allowed to participate in the prison health care system’s management grow from two to eight.

    But some legislators and prison health officials worry Whitmire might be opening the door for private companies to move into prisoner health care for the first time.

    Private, for-profit vendors provide prison health care in other states, but those arrangements have been prone to litigation and complaints that the vendors keep costs down by rationing care.

    In Texas, public medical schools provide inmate health care, and the cost per person for all care in the largest states remains lowest in Texas — at just under $9 a day. The University of Texas Medical Branch at Galveston and Texas Tech University Health Sciences Center have been the primary health care providers for prisoners since 1993, though Texas Tech contracts with local hospitals for much of its care in the western third of the state.

    Whitmire’s bill would add six medical schools to the mix: the University of Texas health science centers in Houston, Dallas and San Antonio; the Baylor College of Medicine; the University of North Texas Health Science Center at Fort Worth and Texas A&M’s medical program.

    Representatives of those six schools could join UTMB and Texas Tech rotating through seats on the managed-health care committee that oversees prisoner health care, riding herd on contracts and costs. Only two schools at a time would have seats on the panel.

    Proponents of the change say privately that UTMB and Texas Tech, now full-time members of the committee, shouldn’t be overseeing their own contracts, and that involving the additional medical schools could increase competition and reduce costs.

    Opponents say that having competing universities making decisions could cost UTMB and Texas Tech money and affect their operations without giving them a voice.

    The Senate Criminal Justice Committee voted last week to approve the change, but not all legislators are convinced it is wise.

    “UTMB and Texas Tech have provided this care since the system was created, and it makes no sense to take them off,” said state Sen. Juan Hinojosa, D-McAllen, who said he will propose expanding the committee by two members to put those schools back on the panel full-time — rather than rotating on and off — when the bill comes up for a vote by the full Senate. “It makes more sense to have them there.”

    Health care for prisoners costs Texans more than $870 million every two years, about what the Legislature is proposing to spend on textbooks and instructional materials for Texas’ public schools. In recent years, prisoner health care has become one of the state’s fastest growing expenses.

    The cost of prison health care has increased from $338.6 million in 2004 to an estimated $434.9 million this year, even though the convict population has dropped from nearly 160,000 to 151,000.

    The remaining convicts, however, are older and have more expensive medical conditions. Case in point: Medical officials say that treating convicts for hepatitis C, which infects more than a third of the prison population, could jump to $13 million — a 380 percent increase — if a third new drug is adopted for treatment, as recommended by new medical guidelines.

    Under the U.S. Constitution, Texas prisons are required to provide appropriate care for the felons it keeps behind bars. In many instances, that means far better doctoring than they would receive at home.

    Amid negotiations over the so-called “sunset” re-authorization bill, behind-the-scenes lobbying over how Texas’ correctional health care system will operate — and who will oversee it — has been intense. In addition to a push for the involvement of more state medical schools, private vendors and their lobbyists have been clamoring to get contracts to care for prisoners.

    Two years ago, top aides to Gov. Rick Perry were involved in closed-door discussions with private companies interested in prison health care contracts. A bill to require privatization did not pass.

    The prison system’s governing board two years ago was given authority to contract with entities other than UTMB and Texas Tech, but it has since used the authority to sign only one deal, with a regional hospital in Huntsville.

    UTMB and Texas Tech have reported losing millions in recent years because of growing costs, and UTMB at one point in 2011 said it wanted to drastically scale back its involvement in prison health care, though it later renewed its contract to provide convict care in roughly the eastern two-thirds of Texas.

    UTMB officials said they want to maintain a presence on the managed health care committee and believe that Texas Tech should have one too.

    “We believe our experience and expertise in correctional care will continue to benefit the committee, and we are hopeful that the full Senate will agree,” UTMB spokesman Raul Reyes said in statement.

    Texas Tech officials didn’t respond to requests for comment, but they have said much the same in previous public comments, legislative leaders said.

    Whitmire said he didn’t write the wording on changing the board’s makeup, but that it came from the Sunset Advisory Commission staff. Staff members said the wording was part of recommendations drawn from their recent studies of the system and input from legislative and state leaders.

    Without elaboration, prison officials said they support the change. “We support the sunset recommendations applicable to TDCJ, and have no objections to any of the bill’s provisions,” agency spokesman John Hurt said.

    New Fight Brews Over Prison Health Care


    NOVEMBER 13, 2012

    TDCJ budget request: Nuther $141 million needed for prison healthcare next biennium

    Unless it reduces the number of prisoners to whom it provides healthcare, the Legislature must spend $141 million more on prisoner healthcare next biennium, the state prison system told the Lege in its budget request.

    To read more on this article, click Here

    Some Inmates Forego Health Care to Avoid Higher Fees

    • By Maurice Chammah
    • October 16, 2012

    Before a recent hearing, attorney Michelle Smith learned that her client, a Texas Department of Criminal Justice inmate, would not be arriving at the courtroom.

    Smith, who works on prisoners' rights with the Texas Civil Rights Project, later received word that the inmate, instead of attending his hearing, was lying in an emergency room. He had become sick, but decided not to see a doctor, because it would have cost him $100. In the past it had only cost $3, and he decided the higher price wasn’t worth his commissary money.

    “He thought he just had the flu and wasn't willing to pay a $100 to get it treated,” Smith said. “It turned out he had pneumonia."

    As a result of HB26, which took effect last year, TDCJ prisoners who seek medical care now pay a fee of $100 once a year, whether they see a doctor once or multiple times. But if they don't see a doctor at all, they can avoid the fee altogether. Critics of the new law, though, say the fee has had unintended consequences — including situations where inmates are refusing treatment and a complicated administrative process for inmates who say they have been charged incorrectly. The fee, these critics say, hasn't even met financial expectations.

    Lawmakers who supported the policy change say the goal is to take the burden off taxpayers to pay for inmate health care. “I believe it was the right thing to do at the time,” said state Rep. Jerry Madden, R-Plano, who wrote the bill. "I still think it's a reasonable thing to do."

    Madden explained that at the time the bill was passed he and other lawmakers considered the possibility that inmates would forego treatment. After a year of seeing the policy in action, he said, legislators may want to revisit the fee and make changes.

    The fee has not produced the predicted financial results. The $100 dollar copay was expected to raise $5.7 million in 2012. According to TDCJ, it generated about $2.5 million, while the $3 copay had generated roughly $500,000 each year.

    “Quite frankly, it doesn’t make much of a difference,” said Dr. Owen Murray, vice president for correctional managed care at the University of Texas Medical Branch, which along with Texas Tech University Health Sciences Center has administered health care to all TDCJ inmates since 1993. “The financial expectations for the program have not been met.”

    TDCJ spokesman Jason Clark said that the medical fee is charged to the offender's commissary, or trust fund, account. “If there is not enough money in the trust fund account, the law requires that 50 percent of each deposit to the offender’s trust fund account must be applied to the amount owed until the total amount is paid,” he said. That means when inmates get commissary money from their families, half is taken out if they have seen a doctor and haven't paid the entire fee.

    There are exceptions. Inmates with less than $5 in their commissary account are not charged. The fee does not apply to emergencies, to follow-up services on an initial treatment or to chronic care.

    Usually, inmates' money comes from relatives. Some family members worry that those who need treatment are forgoing a doctor’s visit to save money for other items — such as food, hygiene products and fans that can be purchased in commissary — said Jennifer Erschabek, head of the Texas Inmate Families Association’s Austin chapter. “Because they get so little commissary money, they try to avoid going to medical treatment at all costs,” said Erschabek, whose son is serving 33 years for murder in Navasota’s Luther Unit. When he got skin rashes recently, he chose not to visit a doctor.

    If many inmates make the same decision, Erschabek said, the results could be dangerous. Untreated contagious diseases could threaten other inmates, visitors and correctional officers.

    Smith, the attorney, said anecdotes like those of her client and Erschabek’s son worry her for both medical and fiscal reasons. "My big question is whether that copay is really saving any money,” she said, “because more serious complaints that develop from lack of early detection end up costing more in the long run.”

    Erschabek and Smith said they have also heard complaints that the copay implementation has been inconsistent.

    Murray said that initially the number of inmates requesting care dropped drastically, but eventually it grew back to prior rates as patients learned the system. Once they have paid the yearly fee, they “start to put in more sick-call requests,” he said.

    Most doctor visits requested by inmates are for chronic diseases or emergency events, he said, and they have not seen an increase in infectious diseases.

    Murray explained that the question of when to charge the copay is a matter of interpretation. “No matter how clear you are,” he said, “different doctors look at different things in different ways."

    Smith and others at the Texas Civil Rights Project said the best way to save money on prisoner health care would be to expand medical parole, or find other ways to release sick inmates who are deemed little threat to society so that they can be covered by Medicaid.

    Smith estimated that the 10 inmates with the highest medical expenses cost TDCJ $1.9 million every year. But Rissie Owens, chairwoman of the parole board, warned lawmakers last year that chronically ill inmates in the past have been paroled, then recovered and committed new crimes.

    Madden, the bill’s original author, said the current solution may not be the final answer for prison health care. “There is some tweaking that needs to be done,” he said.

    In addition, the new federal health care law may free up more Medicaid money for Texas prison inmates in 2014, according to comments by state officials last year. In 1997, the U.S. Department of Health and Human Services ruled that Medicaid could pay for treatment of prison inmates in hospitals.

    Erschabek said that the financial burden will ultimately rest with the families of inmates. Her son has asked her not to put money in his account until he absolutely needs it, but she made a deposit anyway.

    “Families who can pay will," she said, "because they'll do whatever it takes."

    Some Inmates Forego Health Care to Avoid Higher Fees

    SEPTEMBER 18, 2012

    Medicaid expansion and addresing severe mental illness through the justice system

    A friend forwarded me a handout being circulated at the Harris County Criminal Justice Coordinating Council detailing a pair of studies of "Kendra's Law" out of New York, which provides court-ordered outpatient mental health treatment to a small subset of probationers in the "most desperate need for psychiatric treatment."

    According to the handout, "Taken together, the two reports establish that assisted outpatient treatment (“AOT”) drastically reduces hospitalization, homelessness, arrest, and incarceration among people with severe psychiatric disorders, while increasing adherence to treatment and overall quality of life.

    The independent evaluation further indicates that the effectiveness of Kendra’s Law is not simply a product of systemic service enhancements, but is in part attributable to the value of AOT court orders in motivating treatment compliance." In particular:
    During the course of court-ordered treatment, when compared to the three years prior to participation in the program, AOT recipients experienced far fewer negative outcomes. Specifically, the OMH study found that for those in the AOT program:
    • 74 percent fewer experienced homelessness;
    • 77 percent fewer experienced psychiatric hospitalization;
    • 83 percent fewer experienced arrest; and
    • 87 percent fewer experienced incarceration.

    The related findings of the independent evaluation were also impressive. AOT was found to cut both the likelihood of being arrested over a one-month period and the likelihood of hospital admission over a six-month period by about half (from 3.7 percent to 1.9 percent for arrest, and from 74 percent to 36 percent for hospitalization).

    What's more:
    Kendra’s Law also resulted in dramatic reductions in the incidence of harmful behaviors. Comparing the experience of AOT recipients over the first six months of AOT to the same period immediately prior to AOT, the OMH study found: • 55 percent fewer recipients engaged in suicide attempts or physical harm to self;
    • 49 percent fewer abused alcohol;
    • 48 percent fewer abused drugs;
    • 47 percent fewer physically harmed others;
    • 46 percent fewer damaged or destroyed property; and
    • 43 percent fewer threatened physical harm to others.

    Even more encouraging, such improvements were to some extent sustainable beyond the time participants received intensive services. For those who spent more than six months in assisted outpatient treatment, increases in use of medications and reductions in hospitalization "were sustained in the post-AOT period, whether or not intensive services were continued."

    Who knows if these outcomes would be replicable in Texas, but these data - particularly the bit about outcomes sustained beyond the probation period - made me think once again about the proposed Medicaid expansion under the federal Affordable Care Act. And since we're on the subject, I should reference a recent report referenced at Sentencing Law and Policy titled, The Affordable Care Act: Implications for Public Safety and Corrections Populations. That analysis noted that "About half of all people in jails and prisons have mental health problems and about 65 percent meet medical criteria for alcohol or other drug abuse and addiction," so clearly Medicaid expansion would impact many people who cycle through the justice system. What's more, "Pre-release and reentry programs might also be better able to connect people who are leaving jail or prison with community-based intervention services," which would definitely have implications for folks mandated to receive intensive services under some version of Kendra's Law (not to mention folks receiving psychiatric meds leaving prisons and jails).

    The report concluded that:

    The ACA is not a panacea – it will not eradicate the societal factors that contribute to excessive poor health among African Americans and other minorities, nor will it eradicate other biases within the criminal justice system that contribute to disparate rates of incarceration. It does, however, pose an opportunity to level at least one dimension of the playing field – access to treatment for mental illness and addiction – two problems that increase the likelihood of arrest and recidivism. In doing so, it may help reduce racial/ethnic disparities in incarceration.

    Mandating mental health services for folks with the most severe psychiatric problems could reduce the frequency with which they cycle through the criminal justice system, as is depressingly common, and if the NY results are any indication, could also prevent a good deal of crime and substance abuse among those with the most severe mental health needs. And if Texas were to expand Medicaid eligibility in 2014, it would present an opportunity for financing such services that at the moment seem fiscally out of reach.

    And yes, I know Gov. Perry has said he opposes Texas expanding Medicaid eligibility, so maybe such musings are just a pipe dream. But these are recurring dilemmas and it's rare that an opportunity such as the ACA presents itself to plug such gaping holes in the system. In any event, it's worth a discussion.


    Private Prison Company’s New Profit Source: Mental Health

    SEPTEMBER 6, 2012

    The State of Texas may outsource management of a public psychiatric hospital to a company that’s made its fortunes in the business of private prisons.

    To save state dollars, the Texas legislature ordered the Texas Department of State Health Services to privatize one of its public psychiatric facilities to cut costs in the facility by ten percent without diminishing quality of care.

    Only one bidder responded: GEO Care, a branch of GEO Group, the country’s second largest private prison company. GEO Group’s prisons and immigrant detention centers have a track record of abuse, deaths, sexual violence and medical neglect of inmates and detainees. And more recently, GEO Care has proven to be made of precisely the same stuff.

    On its website, GEO Care, which currently operates six “residential treatment hospitals” in Florida, South Carolina, and Texas, GEO Care says it “provides government clients with turnkey solutions for medical and mental health rehabilitation facilities.”

    But reports from the company’s active psychiatric facilities suggest that it’s version of solutions look far more like institutionalized neglect.

    A Track Record of Abuse and Violence

    GEO Care is already facing $53,000 in fines from the State of Texas for violations of patient care standards in Montgomery County Mental Health Treatment Facility, a Texas mental health facility the company has operated for a year and a half. The Austin American-Statesman reports:

    Plans for a psychiatric hospital in Montgomery County publicly emerged three years ago, when Texas legislators signed off on the idea to help ease the growing number of forensic patients, mentally incompetent criminal defendants waiting in jails to be transferred to a state hospital.

    The 100-bed, $33 million hospital has a mock courtroom, a gymnasium, a library and other amenities. It brought 175 jobs to Conroe and saves the county from routinely having to drive inmate patients to Rusk State Hospital, more than 100 miles away.

    Since opening, a series of health and safety and compliance reviews by the Texas Department of State Health Services, found a GEO Care facility rife with patient neglect, forced seclusion, denial of patient’s access to phones and family visits and administering of medication without patient consent.

    In an internal Department of Health Services email obtained by Colorlines.com, State Hospitals Section employee Jo Ann Elliott wrote to her colleagues about a particularly troubling case of neglect in the facility. “While in seclusion for four hours, [a] patient banged his head on the seclusion room window and walls, causing lacerations to both eyes and a bruise to head. Patient threatened staff if door was opened.”

    In the email, Elliot added, “No physician assessment occurred during the 4 hour seclusion. This lack of action by staff would be a reportable incident to DFPS [Department of Family and Protective Services] in one of the state hospitals.”

    A separate internal email from Bill Race, also of the Departments’ Hospital Section, documents repeated failure of facility staff to properly secure patient consent before administering medications and treatment plans. In one case, the file of a 45-year-old HIV positive man who struggled with Schizoaffective Disorder included “No medical notes documenting plan for treatment of HIV, or other conditions…” The man’s “[t]reatment planning identified psychosis, SA,, but not HIV…”.

    Race noted that another patient, a Spanish speaking schizophrenic man, was treated with at least six psychiatric drugs but no consent was documented until a month after the regimen of drugs started.

    Texas mental health advocates are concerned about the GEO Care bid. Robin Peyson, the Director of the Texas branch of the National Alliance on Mental Illness, says that while her organization does not categorically reject the privatization of mental health facilities, GEO Group is an unacceptable choice of contractor.

    “Our concerns rest with GEO Care in particular because of the history of problems with GEO Care facilities— significant occurrences of abuse of neglect.”

    “I visited the Montgomery facility,” Peyson said. “Obviously it was an arranged scheduled visit but the facility was very nice compared to some state facilities. But my personal experience is overridden by the kinds of concerns that have been expressed through judicial venues and quality monitors.”

    Beyond abuses in the Montgomery facility, GEO has a sordid history in Texas. In 2007, for example, the GEO run Coke County Juvenile Justice Center was shuttered after reports of ramped sexual abuse of the young inmates and a number of suicides. And in 2009 at GEO’s Reeves County Detention Center, inmates rioted, in part because of poor health care.

    Elsewhere, the company has a similarly dismal record of care for psychiatric patients. In Florida, the Associated Press reported a series of brutal deaths inside a 355-bed Geo facility in Broward County that holds mentally ill patients:

    Three gruesome deaths at the privately run South Florida State Hospital triggered an investigation that revealed concerns that employees were overmedicating patients and failed to call the state abuse hotline after a patient died in a scalding bathtub, according to documents obtained by The Associated Press.

    The AP docuemnts three deaths:

    In August 2011, Loida Espina died after her head was perhaps slammed through a wall.

    In June 2011, Luis Santana, who was highly medicated, was found dead in a scalding bath with skin “sloughing” off his face after staff failed to check on him every 15 minutes as required, according to a November review by DCF.

    Also in June 2011, a patient with a history of suicide attempts by jumping died after leaping from an off-site building.

    Spending Priorities

    Data from the Kaiser Family Foundation shows that Texas has the lowest per capita spending on state mental health care services than any other state. The second lowest spender is Florida. Peyson says that cutting an additional ten percent off the top just doesn’t make sense.

    “When you’re cut to the bone already and then try to save 10 percent on top of that, I do wonder in what way a for profit company can realize ten percent savings.”

    While GEO Care is cutting costs at the expense of patient and inmate well-being, it’s spending lots of money elsewhere. And though advocates have formed a coalition to press the Texas Legislature and Governor Rick Perry to turn down the Geo Care—groups including Grassroots Leadership, The ACLU of Texas, The United Methodist Church, and the Texas Criminal Justice Coalition—they’re confronted with a company that pours tens of thousands of dollars into Texas political campaigns and even more into it’s lobbyists.

    According to the Texas Ethics Commission website, since 2008, GEO contributed to dozens of Texas political campaigns, including $11,000 to Gov. Rick Perry’s campaigns and $2000 to State Senator Tommy Williams, who theAustin American-Statesmen reported was “instrumental in gathering legislative support for the [Montgomery] county hospital in his district.” In July, Williams’s spokesperson told the paper, “He’s for whatever works, and he thinks privatization is working in Montgomery County to provide the most services to the most people. Yes, they’ve had hiccups, but the county is taking actions to address those.”

    “When private, for-profit companies bid on contracts to privatize public facilities like Kerrville State Hospital, they often promise to save the tax-payer money, which is enticing to a state like Texas that continues to face a serious budget crisis,” said Kymberlie Quong Charles of Grassroots Leadership. “But that promise is in conflict with their first priority of making a profit.

    They may be able to cut their operating budget, but at the cost of peoples’ jobs and patients’ safety.”

    In its profit seeking, GEO has found use for the politically connected. In the Kerrville bidding process, questions about a conflict of interest GEO Care’s bid have already emerged. According to reporting by several Texas newspapers, the bidding process appears tainted by insider maneuvering.

    The Austin American-Statesmen reports:

    Last month, questions surfaced over whether it was ethical for Stephen Anfinson — who headed Kerrville State Hospital until early 2011 — to participate in efforts by Geo Care to run the Kerrville hospital. Anfinson began working for Geo shortly after leaving the facility and now helps oversee the company’s psychiatric hospitals.

    Anfinson’s insider knowledge of the facility gave his employer an unfair competitive advantage and tainted the integrity of the process, said Tom “Smitty” Smith of Public Citizen, a government watchdog group.

    The company may also have made an underhanded attempt to silence potential opposition to their bid. Last year GEO Care donated to Peyson’s organization, NAMI Texas, which listed the company among its “Corporate Champions”. Peyson says the company donated $5,000 for NAMI Texas’s 2011 annual conference.

    “I’d think they won’t be donating again this year,” Peyson said, after opining that the state should turn down the bidder.

    The Department of Health Services is expected to decide this month whether to recommend the GEO bid to state leaders, including Governor Perry.

    This article was originally published by Colorlines.

    Private Prison Company’s New Profit Source: Mental Health

    JULY 19, 2012

    Texas' Decision To Reject Medicaid Expansion Quickens Trend Toward Using Justice System As Mental Health Substitute

    Grits has been further pondering the implications of recent national health care politics on the criminal justice system, now that Gov. Rick Perry and Lt. Governor David Dewhurst have both said they'll oppose expansion of the state Medicaid program to cover Texans with incomes up to 133% of federal poverty levels, even though the feds would pay 100% of costs for the first three years, and 90% of costs after 2019.

    Obviously this means the Texas prison system won't be taking advantage of possible state-budget savings from pawning off prisoner hospital costs on the feds. But the more I consider it, the implications for the justice system from this ill-considered political stance are profound and much more far reaching, particularly as it regards the use of jails and prisons as a substitute for funding a more robust community-based mental health system.

    At Monday's House County Affairs hearing, Chairman Garnet Coleman noted the irony in response to testimony by witnesses regarding the effectiveness of Veterans Courts, which are essentially mental-health courts aimed at current and former military members. Citing the example of a mentally ill veteran coming back from Afghanistan who, as a civilian, earned less than 133% of the poverty rate, Coleman noted such a person could essentially gain access to mental health services only by committing a crime. (The Department of Veterans Affairs provides some services, he noted, but nothing like those needed for someone with a chronic, serious mental illness.) By rejecting Medicaid funds, said Coleman, the state would strip away options for indigent veterans and everybody else below the 133% threshold to access treatment services outside the justice system.

    His comments got me thinking: The biggest implication for the criminal justice system from rejecting Medicaid funds really stems from the missed opportunity to attract billions (with a "b") in new funding for mental health services that would be delivered outside the criminal justice system.

    This would be huge. When discussing the problems posed by the criminalization of mental illness, there's bipartisan acknowledgement that the justice system isn't the best vehicle for providing mental health services. But it's all we've got for now, the fatalists lament, and if one wants to suggest expanding community-based mental-health services, the first response is always "show me the money." Heck, last session legislators even cut mental-health budgets in prison, much less community-based services. With the opportunity to expand Medicaid services on the table - and the feds paying for ALL of it for the first several years, 90% after 2019 - the money to pay for indigent mental services is now officially available. State leaders only need say "yes."

    Without such an influx of community-based mental health funds, indigent mental-health care costs will continue to plague county jails and local emergency rooms. Other testimony at Monday's House County Affairs hearing mentioned that, while the overall Bexar County jail populations is declining (as is happening to various degrees across the state), demand for mental-health beds is the one category that continues to increase, straining capacity. And their experience is a microcosm of what's happening statewide.

    The reasons are obvious. Texas has under-invested in mental-health care to the point that the state faces a court order declaring long wait times for forensic hospital beds unconstitutional. Mentally ill inmates in jails cost much more than the per-inmate average and pose unique procedural challenges resulting from the justice system's inability to constructively deal with them. The decision to reject billions in community-based mental health funds for the indigent only exacerbates the problem.


    Premature Baby Born At Dawson Jail Without Medically Trained Personnel

    July 10, 2012
    Reporting Ginger Allen

    DALLAS (CBS 11 NEWS) – CBS 11 has learned a baby was prematurely born last month at the Dawson Jail in downtown Dallas, apparently with no medically trained personnel in attendance.

    The baby lived four days.

    In an exclusive interview with CBS 11, Doctor Owen Murray, Vice President of Offender Health Services at the University of Texas Medical Branch at Galveston, said there is no state requirement to have medically trained personnel at Dawson between 5 p.m. and 5 a.m., which was the period in which Autumn Miller gave birth to her daughter, Gracie.

    It was the latest development in a series of stories CBS 11 has been investigating on the medical care provided to inmates at the privately-run prison facility.

    In our first report, a severely diabetic woman died after her family said she became ill in the jail. Her cries for help to guards went ignored, according to her family.

    In our next report, a young woman died of pneumonia after personnel at Dawson failed, according to her family, to furnish her with the antibiotics she needed.

    After our second story aired, Jean Burr contacted CBS 11. Burr is a grandmother with a dozen grandchildren. She called us the day after her family buried her newest granddaughter. It was a little girl, with a name that conveyed her brief life, Gracie.

    “She was here by the grace of God and gone the same way,” her grandmother said.

    Gracie came into the world in an unlikely place: Dawson State Jail. The facility holds non-violent criminals who commit minor crimes. Gracie’s mother, Autumn Miller, was convicted of a drug charge, violated her probation and got a year behind bars.

    Miller arrived at Dawson in January. She has three other children and knew what it felt like to be pregnant.

    “Three weeks before the baby was born, she had requested a pregnancy test and pap smear, because she had not had a period since she had been there and she was feeling unwell. She didn’t know what was wrong, but she was not feeling right,“ Burr said.

    Officials at Dawson will not tell CBS 11 News whether they have any records of Autumn Miller requesting a pregnancy test.

    Dawson State Jail is run by a private company called Corrections Corporation of America (CCA). CCA will not respond to our questions about what occurred inside the jail on June 14, 2012.

    But Burr says her daughter tells a chilling story of what happened during the early morning hours when she began to bleed and cramp inside the jail and had trouble walking.

    “They took her down to the medical unit on a stretcher. When she got there, there was a doctor on the screen,” Burr said.

    But Miller told her mother that the doctor, who was available through a teleconference, never had a chance to see her.

    “The lady that was down there in the medical unit in charge told the doctor they did not need him for this patient and they just turned this off … She was crying, complaining that she was feeling pressure, pain, bleeding and something was bad wrong. They needed to do something,” Burr told CBS 11.

    “One of the guards in there made the comment that, ‘Oh, it is probably the food, you probably need to go poo.’ They gave her a menstrual pad, locked her in a holding cell and closed the door. And then she went in there and pressure was so bad she went to the toilet…,” Gracie’s grandmother said.

    What happened next, according to Burr, has changed all of their lives forever. And, she says, it was something no one at the jail was prepared to handle at that time.

    After Miller went to the bathroom, “the baby came out and went into the toilet and she started screaming,” Burr said.

    Tiny Gracie was born premature on June 14 at just 26 weeks. She weighed a little more than a pound. Ambulances rushed Gracie and Miller to Parkland Hospital where doctors worked against the odds to save Gracie.

    Pictures from the hospital show Miller holding her newborn, snuggled in a pink blanket, near to her chest. Miller, still in handcuffs, holds the little girl’s hands. By day three, Miller, Burr and other family members had hope that Gracie had a fighting chance of surviving.

    But after four days, doctors told them Gracie was beyond all help.

    So she made the decision to let the baby go; Autumn held her while she took her last breath and heartbeats. And they pronounced her dead at 5:30.

    “And shortly after 6, (Autumn) was on her way back to Dawson,” Burr said.

    Once at the jail, Miller was placed in solitary confinement for two days, her mother, overwhelmed with emotions, said.

    “This is still a woman with the afterbirth and bleeding and stitches where she’d had a tubal … and they locked her in there for two days … and then they took her to see a psychiatrist and said, ‘Well, you’ve been on suicide watch,’ “ Burr said.

    Burr, grief stricken by the loss of her granddaughter, contacted CBS 11 after learning that the station had been investigating the medical care at Dawson, and the circumstances leading up to the deaths of other inmates at the facility.

    “I understand that their freedom and their rights have been taken because they have done things to cause that….(But) this could have been prevented,” Burr said, as tears welled up in her eyes. “No baby should be born in a toilet in prison.”

    Burr tells CBS 11 she believes that if Autumn had been given the pregnancy test that she requested, things would have turned out differently.

    “Then three weeks later they would have known she was having a baby,” Burr said. “She could have been in a medical unit. She could have had the treatment she should have been having. And maybe Gracie would still be with us,” the grandmother said.

    Fighting back tears and still devastated by the loss of her newest grandchild, she clings to an album of the pictures the hospital took of them all together over the four days Gracie lived.

    “It would have changed the outcome of what will be with Autumn for the rest of her life to live with. She’s going to see that baby being born in that toilet – and die — for the rest of her life … she didn’t deserve that,” Burr said.

    Miller’s lawyer told CBS 11 he did not want Miller speaking to us while she is still at Dawson. She is scheduled to be released in November.

    Neither CCA nor the Texas Department of Criminal Justice will answer our specific questions about the incident that occurred on June 14 or about the deaths of the other inmates.

    Steven Owen, spokesman for CCA, provided us the following statement:

    “Our dedicated, professional corrections staff is firmly committed to the health and safety of the inmates entrusted to our care. Inmates are provided a number of ways to communicate concerns about health care to facility management, CCA management, and the Texas Department of Criminal Justice (TDCJ). CCA is not the health care provider at the Dawson State Jail, so the company is not privy to medical-specific information about inmates. Health care services at this facility are provided by the University of Texas Medical Branch (UTMB) in contract with TDCJ. Our team works closely with our government partners to ensure inmates have access to the healthcare service providers at the facility.”

    Jason Clark, spokesman for TDCJ, referred us the same written statement he gave us several months ago when our investigation began:

    “The Texas Department of Criminal Justice oversees the confinement of approximately 156,000 offenders at 111 facilities across the state. In addition to operating its own units, the agency also contracts with private entities to operate secure facilities such as Dawson State Jail. There are five privately operated state jails. Corrections Corporation of America is the current contractor at Dawson State Jail. Through a competitive bidding process, CCA was awarded a contract for the operation and management of the facility beginning September 1, 2010 with options for renewal through August 31, 2017.

    While I cannot address offender Weatherby’s case specifically, the safety, security, and well- being of offenders is paramount to the agency. TDCJ goes to great lengths to ensure that the contractor is complying with the contract. Each privately operated state jail has a contract monitor that is assigned to the unit and is responsible for monitoring the contract between the agency and contractor. Monthly unannounced visits and specific area of compliance reviews are conducted each month throughout the year. If issues are found, the agency requires to contractor to remedy them within a specific time frame or the contract can ultimately be terminated.

    TDCJ is obligated to provide medical care for offenders. The agency partners with Texas Tech University Health Science Center and University of Texas Medical Branch to provide comprehensive healthcare to adult offenders incarcerated within state prisons and state jails. UTMB is the medical provider at Dawson State Jail. Specific questions about offender healthcare should be directed to them. TDCJ – Health Services Division works to ensure that offenders have access to care, monitor quality of care, investigate medical grievances, and conduct operational review audits of health care services at TDCJ facilities including Dawson State Jail.”

    Premature Baby Born At Dawson Jail Without Medically Trained Personnel

    JULY 10, 2012

    Health Clinic Hours Reduced 50% At Some Texas Prison Units Because Of Budget Cuts; Ogden Says Prison Health Budget Underfunded 15%

    Clinic hours at some Texas prison units were cut by up to 50% in the wake of recent budget cuts, Texas Tech officials told state senators on Monday.

    The Texas Senate Finance Committee met yesterday to address correctional managed health care. Go here to watch the hearing online. The only MSM coverage appears to be from Chris Tomlinson at AP. The money quote from that story: "Dr. Denise Deshields, the health director of Texas Tech University's prison health care system, said the new cut could lead to an unconstitutionally low level of care.

    'I don't know how we would possibly handle an additional 10 percent reduction in appropriations. We are really cut down to the bone as it is,' she said."

    Further, "The vice president for offender health services at the University of Texas Medical Branch, Dr. Owen Murray, said that because of staffing cuts guards are now expected to help make medical decisions that nurses and doctors once made."

    Grits listened to much of the hearing this morning. Here are a few tidbits the abbreviated AP story didn't pick up:

    Chairman Steve Ogden openly prefaced the hearing by declaring, "We did not last session appropriate all the money that we believed was going to be necessary to pay for correctional managed health care. There was a great deal of concern at UTMB that we might run short and they'd be left holding the bag." Grits readers knew that but I hadn't heard an elected official says so that openly before now.

    (One supposes it helps that Sen. Ogden is retiring and won't be back next year.)

    Ogden emphasized that there's a contract in place with UTMB through next session, but not through the end of the biennium. Right now it looks like the state may be short by $58 million, he said, which would have to be paid for with an emergency appropriations bill at the beginning of the 2013 session. There's "no crisis at the moment," he stressed.

    In fact, Ogden said that when the Lege adjourned, budget writers thought they'd shorted prison healthcare by "maybe $120 million" (Grits' calculation was $126.5 million), so if it's only $58 million, in some ways it's "good news," Ogden suggested pluckily (particularly if you like your good news written in red budget ink).

    Sen. John Whitmire wanted to know, if TDCJ now will be $58 million short instead of $120 million, how was the money saved? He worried that the state may have saved money by reducing services to the point that we have an unconstitutional system, might it cost more in the long run.

    Whitmire scoffed that UT comes up to him and says they're going to "walk it" (the contract"), their board says they're going to "walk it," but when the media asks him about it he replies, "Naw, they're not gong to walk it ... we have nothing to replace them with." At this point, though, negotiations are ongoing and the issue is unresolved. Senators Whitmire, Tommy Williams and Robert Duncan have all been closely involved with UTMB negotiations, said Sen. Duncan in his comments. (Texas Tech, it should be mentioned, is fine with continuing under their current contract: UTMB is the only one threatening to quit.)

    LBB staffer John Newton gave a rather dry, just-the-facts-ma'am, presentation. Sen. Royce West brought up a big sources of savings for TDCJ prison healthcare that no private provider could replicate: In particular, UTMB has access to so-called 340B pricing on its pharmacy services, which is pricing only available to institutions that operate a hospital eligible for "disproportionate share" funding for provision of indigent services. Indeed, even Texas Tech is not eligible for 340B pricing, the committee was later told. (It's one of the reasons Grits has been skeptical at claims privatization might lead to significant savings.)

    For a variety of reasons, healthcare for inmates is far cheaper than for state employees or under private insurance, LBB staff told the committee. Sen. Whitmire pointed out that part of the reason it's cheaper is they deliver fewer services. For example, "at 7 o'clock, [prison doctors] go home, to save money ... so if you get sick at 10 o'clock in the free world, you get health care. In prison, you wait" till the next morning, "or don't get it."

    Senators seemed amazed that California's cost per day was four times Texas', according to data provided by LBB, but they did not get good answers on what's happening in California vis a vis federal litigation over healthcare, so I should point out that it's a question Grits has addressed in some detail in the past. It's also worth noting California's baseline costs are higher: Prison guards make around twice what ours do, for example.

    Sen. Duncan asked several times if Texas is providing a constitutional level of care, but he didn't press for a preferred answer. He pointed out that Texas had been under a court order in the past, and said he wanted to know if the state was still providing a constitutional level of care now that the state is out from under federal oversight, implying the state risked additional federal intervention and by extension, California-style costs.

    Currently most of TDCJ population would not be eligible for Medicaid if not incarcerated except for pregnant women and certain blind and disabled inmates, said LBB's Newton. If the state chose to expand Medicaid, however, most of them would be eligible in FY 2014 once they're in the free world. Newton gave the best argument I've seen raised against the idea of extending Medicaid to cover prisoner hospital stays: That approach may be more appropriate in a fee for service setting than under a managed-care contract, undermining incentives to limit hospital costs. (The point became moot as elsewhere yesterday Gov. Rick Perry came out against expanding Medicaid at all.)

    Dr. Cynthia Jumper (associate dean, Tech) touted the benefits of telemedicine in reducing travel costs and access to specialists in facilities like Dalhart. Even so, she said, budget cuts last year resulted in reduced clinic operating hours at clinics managed by Texas Tech: Nine units operated by Tech cut operating hours by 50%, she said, and 11 others cut operating hours by 25%.(Emphasis added.) Tech already cut 77.39 FTEs (full-time equivalent staff positions) as a result of the 2011 budget cuts.

    Texas Tech's budget was reduced by $25 million over this session, noted Sen. Odgen, asking what they would do with that money if they got it back. Jumper answered, hire more staff and pay existing staff more money. A better answer (which Sen. Deuell tried to hand them) would have been to replace staff vacancies and expand clinic hours to past levels, thus reducing emergency room costs. After all, inmate patients go to local emergency rooms if they get sick after hours, according to testimony, and the state gets a bill for those services.

    Other reduced services under the Tech system included closed ICU beds at the Montford Unit and canceled after-hours services for certain special-needs inmates. Tech officials also testified as to the difficulty of getting hospitals to agree to Medicare rates because of extra security costs. Some providers have dropped out, the committee was told.

    Tech has a 17% vacancy among professional staff and already find it "difficult to recruit, difficult to retain." In particular, pay for nurses is already below market. Tech officials said they did not think they could provide constitutional levels of care if they took another 10% cut.

    UTMB was represented at the meeting by Dr. David Calendar and Owen Murray, VP of Offender Health Services. UTMB reduced its number of employees by 165 FTEs under new staffing plan negotiated with TDCJ, Dr. Murray told the committee. They also cut hours at on-site clinics - in particular it was mentioned that 14 UTMB-run clinics went to eight hours per day from 12 hours or more - but not as radically as at some Tech-run units. Instead, cuts on the UTMB side were mostly focused in management and mental health services, the committee was told. In addition, cuts to facility support personnel have resulted in noticeable declines in productivity. Murray said there were probably some "critical staffing needs" where the agency "cut too deep." When the Correctional Managed Healthcare Committee was created, Dr. Murray pointed out, clinics were open 24/7 at all units.

    Primarily, savings from last year's budget cuts occurred because of reductions in personnel and reduction of services, said UTMB officials. There were also some savings in reduced emergency room costs because hospitals including UTMB must now accept Medicare rates instead of the amount they charge insurance companies.

    Many of Senators Ogden and Dan Patrick's questions seemed aimed at prodding respondents to rebut the implications of Sen. Duncan's questioning to say affirmatively that the state provided constitutional levels of care. Ironically, the go-to answer they solicited from several officials (besides buck passing) was that Texas' level of care met American Correctional Association accreditation standards. Ironically, though, the state does not meet ACA standards when it comes to, for example, heat in prison units, according to a report over the weekend. The Statesman's Mike Ward cited "American Correctional Association standards that stipulate temperature and humidity inside prisons be kept at 'acceptable levels.' A state law mandates county jails be kept between 65 and 85 degrees, though it doesn't apply to state prisons," Ward reported.

    I'm not a lawyer, but if the state is going to claim compliance with ACA standards means their prison health care is constitutional, they may find themselves hoisted on their own petard if and when litigation goes forward regarding heat-related deaths at units that don't meet ACA standards. Grits reported in June on oral arguments at the 5th Circuit on whether federal litigation can go forward to decide if excessive heat violates civil rights.

    In any event, Murray told Sen. Dan Patrick that reducing clinic hours put non-medical personnel like guards in the position of making medical decisions. When medical personnel aren't there, the state incurs costs at local emergency rooms they wouldn't otherwise have to pay, resulting in more costly, excessive and inappropriate care overall.

    The private vendors hoping to take over TDCJ health services said they would likely hire on most existing employees but cut their benefits, especially pension and retirement services.

    Brad Livingston, TDCJ executive director, seemed hopeful if not sanguine that UTMB might continue to contract for services "in the long run." If prison health is privatized, he said, the Lege should plan to pay a significant amount for compliance monitoring in addition to the contract costs and demand strict compliance with staffing minimums at the units, particularly those in more remote areas.

    Sen. Ogden got LBB to acknowledge that quite bit of state spending on inmate health care and prisons generally - particularly employee benefits - are actually outside of TDCJ's budget. (The Vera Institute of Justice recently calculated that 23% of Texas prison costs are outside TDCJ's budget.) He asked for LBB to come up with a total calculation going forward that includes all those off-budget items, as well as UTMB's overruns, which will be interesting to see later on. Ogden offered his own opinion that, when such an analysis has been performed, the actual cost of prison healthcare will be about 15% above what the state has appropriated. I'll betcha he's pretty darn close. The question is, knowing that, how much longer can they kick the can down the road?

    Health Clinic Hours Reduced 50% At Some Texas Prison Units Because Of Budget Cuts

    Texas Lawmakers Consider Changes To Prison Care

    Associated Press
    Updated July 9, 2012

    AUSTIN, Texas (AP) — Proposed cuts to the health care provided to Texas prisoners could make the system unconstitutionally inadequate, experts warned lawmakers Monday.

    The Legislature has reduced funding for prison health care, prompting providers to cut clinic hours, vaccinations and spending on medical equipment while not raising employee salaries to keep up with the private sector, experts told the Senate Finance committee. The Texas prison service currently incarcerates 158,000 people.

    Gov. Rick Perry last month asked state agencies to prepare budget proposals to cut spending by an additional 10 percent next year. Dr. Denise Deshields, the health director of Texas Tech University's prison health care system, said the new cut could lead to an unconstitutionally low level of care.

    "I don't know how we would possibly handle an additional 10 percent reduction in appropriations. We are really cut down to the bone as it is," she said.

    The vice president for offender health services at the University of Texas Medical Branch, Dr. Owen Murray, said that because of staffing cuts guards are now expected to help make medical decisions that nurses and doctors once made.

    Lawmakers expressed concern that the state could face lawsuits if it does not provide adequate care to the prisoners. California's prison health care system was declared unconstitutional and is under federal receivership. California now spends about $13,300 per prisoner, compared to the more than $3,100 spent by Texas.

    The Texas committee is exploring new ways of providing and paying for prisoner health care.

    The state is considering contracting with private companies to provide the health care and looking into whether the state can collect federal funds to help pay for it. University medical programs and state funds currently are used for inmate health care.

    Sen. John Whitmire, D-Houston, pointed out that the state is spending millions of dollars each year on terminally ill, bedridden inmates who pose no threat to society. He recommended passing legislation that would allow the release of those prisoners so they would be eligible for federal Medicaid funding for their health care.

    Texas lawmakers are holding hearings on a variety of topics to be ready in January, when the Legislature will meet again and begin passing laws.

    Texas Lawmakers Consider Changes To Prison Care

    JUNE 28, 2012

    Will Texas expand Medicaid coverage under Obamacare to include prisoners' hospital costs?

    The Internet today, naturally, is abuzz with commentary about the US Supreme Court's ruling upholding most of "Obamacare" but giving states the right to opt out of the Medicaid-expansion piece without losing federal funds they already receive. Now that the court has ruled, Grits thought it worthwhile to iterate the questions raised implicating Texas criminal justice spending. Specifically, will the now-optional state Medicaid expansion happen in the Lone Star state, and will it include hospital care for Texas prison inmates?

    The answers could determine whether the Texas Lege can reduce the line item for prison health spending in the next biennium, or if they must increase it by a nine-figure sum. Here's how Stateline.org described the new option to cover state prisoners' hospital bills under the federal Affordable Care Act:
    Most state prisoners (currently) do not qualify for Medicaid. That's because all but a few states limit Medicaid to low-income juveniles, pregnant women, adults with disabilities and frail elders.

    The majority of people in lock-ups are able-bodied adults who do not qualify, even on the outside. In 2014, however, when Medicaid is slated to cover some 16 million more Americans, anyone with an income below 133 percent of the federal poverty line will become eligible. Since most people have little or no income once they are incarcerated, virtually all of the nation’s 1.4 million state inmates would qualify for Medicaid.

    As a bonus to state corrections agencies, most inmates would be considered new to Medicaid, making them eligible for 100 percent coverage by the federal government between 2014 and 2019. After that, states would be responsible for only 10 percent of their coverage. In addition, state health insurance exchanges—which are required to be functioning by 2014—would make it easier for corrections departments to sign inmates up for the program.

    So the question arises: Will the Texas Legislature expand Medicaid in 2014, or will the state thumb its nose at the new law and abstain from accepting additional federal healthcare money? Given that the feds would pay 100% of the costs until 2019, not to mention the fact that expanding Medicaid would allow the state to pawn off a great deal of prisoner healthcare costs on the feds, there will be terrific fiscal temptation to accept the subsidies. OTOH, Governor Rick Perry, Attorney General Greg Abbott, and many Republican legislators have staked out extremist positions against Obamacare, and the state could choose to reject the money on principle. That's a bit like cutting off one's nose to spite one's face, since Texas taxpayers would then be in the position of subsidizing healthcare in other states while failing to receive any of the benefits, not just in expanded coverage for free-world Texans but in reduced state prison health costs.

    Though the feds will substantially up their subsidies in 2014, covering inmate hospital care through Medicaid is something some states are already doing.

    Reported Stateline.org, "Dr. Gloria Perry, the chief medical officer for the Mississippi prison system, says her agency heard about the cost-cutting measure from a health care vendor looking for business in the state. The agency then verified the legality of the procedure with the state Medicaid office and quickly created a reimbursement program. No state laws or appropriations were required."

    Given the US Senate's filibuster rule, where 60 out of 100 votes are needed to pass legislation, I don't see the federal healthcare law being repealed even if Mitt Romney is elected President and Republicans reclaim the US Senate, despite a great deal of chest pounding to the contrary on the campaign trail. The battle over implementing federal healthcare legislation has now shifted inexorably to the states.

    Whether Texas will accept billions in federal subsidies to expand Medicaid as envisioned under Obamacare will be one of the biggest political debates of the 83rd Texas Legislature. And at the end of the day, Grits wonders whether the deciding factor won't be the new law's effect on prisoner health care costs.

    RELATED (6/29): In the Fort Worth Star-Telegram, columnist Bud Kennedy had some kind words to say about this item. "Of all the blog posts and blather Thursday on both sides of the Supreme Court case, one of the most incisive comments came from Austin criminal justice blogger Scott Henson," he wrote, concluding, "I give him credit for thinking before shouting."

    Regrettably, though, there was an error in Kennedy's recitation of the effect of Medicaid expansion on state prison healthcare costs. He declared that "the federal government would pick up 90 percent of the state's nearly $500-million-per-year prisoner healthcare costs." In fact, as Grits understands it, the Medicaid expansion would only cover hospital costs for prisoners, not in-prison clinics or other health services delivered on-site. That would still be a quite-large sum, but Medicaid would not cover all prisoner health costs.

    According to a State Auditor's Report (pdf) published in 2011, hospital services account for about $16% of Texas prison health costs - roughly $150 million per biennium.

    Also, Texas runs its prison pharmacy through UTMB-Galveston's hospital system, but Grits can't tell without more research whether pharmacy costs would be covered by Medicaid under that scenario: It's possible. Notably, Texas underfunded prison healthcare in the current biennium by more than $100 million, so while Medicaid wouldn't pay for all prison health costs, it would plug the state's short term prison health deficit. Otherwise, the only way to reduce prison health costs in the state budget is to reduce the number of people Texas incarcerates.


    Report: Texas prison health costs even higher than thought

    By Mike Ward
    May 6, 2012

    The cost of providing health care to Texas' 154,000 imprisoned criminals during the next two years will likely exceed the amounts allocated in both the Senate- and House-approved versions of the state budget, a new financial analysis shows.

    The report on the University of Texas Medical Branch at Galveston's costs appears to validate the university's earlier assertions that it was losing money on providing the care, and it projects that the prison care could cost $930 million over the next two years — far more than either legislative chamber has appropriated so far.

    A draft copy of the report summary by the Texas Medicaid & Healthcare Partnership was obtained Thursday by the American-Statesman.

    The analysis was conducted for the state Health and Human Services Commission after a January audit blasted UTMB's costs as too high, a report that triggered intense criticism of the medical school and has prompted a lobbying rush by private companies who contend they can do the job for much less.

    The report also likely promises to pose a new headache for budget-writers looking for ways to find savings as they try to combine the House budget with the Senate version, which spends $12 billion more.

    "The audit is the first independent verification of our current costs, which some people have thought were high," said House Corrections Committee Chairman Jerry Madden , who asked for the report four months ago and confirmed initial details Thursday.

    "While it's possible that some of the functions of this program could be done more cheaply, I don't think this (report) is going to help the rush by some to privatize the system.

    "Taxpayers are getting their money's worth right now, it appears."

    UTMB and prison officials declined to comment on the report, saying they had not yet been briefed on its details. Legislative leaders said they had not yet seen the report and could not comment.

    The House-passed version of the budget allocates prison health care about $725 million. The Senate budget plan approved Wednesday allocates almost $200 million more.

    Under current law, UTMB provides health care to convicts in roughly the eastern two-thirds of Texas and operates the prison hospital in Galveston.

    The Texas Tech University Health Sciences Center provides care at state prisons in the rest of Texas. It contracts with local hospitals for some of that care, whereas UTMB provides most of the care with its own staff and at its facilities.

    In recent years, UTMB and Texas Tech have claimed losses totaling more than $60 million for providing the care, requiring supplemental appropriations several times from the Legislature.

    The new financial review projects that the losses will continue for UTMB. Texas Tech costs were not examined.

    In 2010, the summary shows, UTMB lost as much as $26.8 million — with actual costs listed at $436.1 million, for which the university was paid only $409.3 million.

    During the 2012-13 budget period, the report estimates, the costs for UTMB to provide prison health care could range from $879.6 million to as much as $930 million — depending on whether costs for some physicians, interns and residents are included.

    Madden acknowledged that the numbers in the report are significant, "if they prove correct, which I think they will."

    Texas' system of managed correctional health care in its 112 state prisons was created in 1993, utilizing the two university medical schools as a way to better manage and control costs and to replace a medical care system operated by prison officials who had been plagued for years by lawsuits over poor and often inaccessible care.

    The managed care system, overseen by a committee of doctors, has faced increasing criticism for its spiraling costs.

    Allen Hightower, executive director of the Correctional Managed Health Care Committee, has said that the increasing age of convicts who have more medical problems and the rising costs of drugs to treat high-cost illnesses such as HIV, AIDS and hepatitis C are the cause.

    Aides to Gov. Rick Perry have been pushing for months to privatize some parts of Texas' prison health care system to save money. But legislative leaders and prison officials have so far not embraced the concept, citing past debacles with privatization in corrections programs that promised savings but led to higher costs and poor service.

    mward@statesman.com; 474-2791

    Texas prison health costs even higher than thought

    Dementia Behind Bars

    Published: March 25, 2012

    The get-tough-on-crime and mandatory sentencing policies that swept America beginning in the 1970s did more than drive up the inmate population and prison costs. They also ensured that inmates who once might have been seen as rehabilitated and given parole would grow old and even die behind bars. As a result, prisons are struggling to furnish costly, specialized care to ever more inmates who suffer from age-related infirmities, especially dementia.

    According to a report from Human Rights Watch, in 2010 roughly 125,000 of the nation’s 1.5 million inmates were 55 years of age and over. This represented a 282 percent increase between 1995 and 2010, compared with a 42 percent increase in the overall inmate population. If the elderly inmate population keeps growing at the current rate, as is likely, the prison system could soon find itself overwhelmed with chronic medical needs.

    There is no official count of how many inmates suffer from dementia. But some gerontologists say the current caseload represents the trickle before the deluge. They say the risk of the disease is higher behind bars because inmates are sicker to start with — with higher rates of depression, diabetes, hypertension, H.I.V./AIDS and head trauma. Given these risk factors, the dementia rate in prison could well grow at two or three times that of the world outside.

    This is a daunting prospect for prison officials whose difficulties in keeping pace with the present dementia caseload were underscored in a recent report by The Times’s Pam Belluck. The article portrayed officials in crowded, understaffed correctional facilities scrambling to care for ailing inmates who can no longer feed, dress or clean themselves and who create conflict and disorder because they can no longer follow simple commands.

    The Human Rights Watch study said the cost of providing medical care to elderly inmates is between three and nine times the cost for younger ones. Another study found that the annual average health care cost per prisoner is about $5,500; about $11,000 for inmates aged 55 to 59 and $40,000 for inmates 80 or older. A specialized unit for cognitively impaired inmates in the New York State system costs more than $90,000 per bed per year, more than twice the figure for general inmates.

    Many inmates, obviously, can never be released, and they will continue to require special care. But the states must pursue other avenues as well. They can foster partnerships between prisons and nursing homes to improve the quality of care; consider compassionate release programs for frail inmates who no longer present a threat to public safety; and, no less important, revisit the mandatory sentencing policies that did away with judicial discretion and filled the prisons to bursting in the first place.

    Dementia Behind Bars

    Guest Blog: The Logic of the $100 Offender Copay and the Unintended Consequences

    March 19th, 2012
    Posted in Criminal Law Reform, Prison Reform, Prisoners' Rights
    By Jennifer Erschabek
    Austin Chapter Chair, Texas Inmate Families Association (TIFA)

    Last session, a bill passed that requires the Texas Department of Criminal Justice (TDCJ) offenders to pay a $100 annual health care fee when initiating a medical visit. The new law also allows TDCJ to supply more over-the-counter (OTC) medications in the prison commissaries. This was passed as a way for the state to recover some of the medical costs of providing healthcare to inmates. Besides the obvious concern that families and friends of inmates (when they can afford it) are bearing an additional cost when it is the state’s responsibility to provide care for those the state chooses to incarcerate, this new practice might not even be that effective at saving taxpayer dollars.

    The state estimates that this prisoner co-pay will generate $10-$13 million over the next biennium.
    But, we wonder how realistic this number really is. Indigent prisoners (40-50 percent of the offender population) and those with chronic conditions are waived from the fee. This raises another concern about whether indigent inmates are correctly identified for exemption. Younger and healthier inmates will avoid using the medical system so they don’t have to pay the fee.

    But, to us, it isn’t only about the money for which our loved ones receive low quality health care. The new law allows for indigent inmates to receive free clinic visits and also free OTC medications. According to our family members within TDCJ, this has resulted in a black market for medications, where indigent inmates are trading their OTCs for commissary goods. In many cases, offenders who do have money on their accounts are refusing to go to the clinic, instead self-diagnosing and ‘trading’ for medications to avoid the $100 charge for a medical visit.

    The medical co-pay also impacts the health of the entire unit, offenders and guards. When offenders are not treated for contagious diseases such as scabies, mumps and staph infections, nobody wins. This is a real threat to public health – in and out of prison. Remember, many inmates are locked up for a short period of time, and then return to society. It benefits all of us to ensure that they return to society free of communicable illnesses.

    There has been one good result because of the co-pay. Now that more OTC medications are available to offenders through the commissary there are fewer medical visits. But, they could have done this before – you really don’t need to see a nurse or doctor just to get Lotrimin or Benadryl.

    Most important: It is the state’s responsibility to cover the medical costs of individuals who we choose to incarcerate. TIFA will continue to work to lower this unjust and unhelpful copay. Find out more about TIFA, and the work that we do.

    The Logic of the $100 Offender Copay and the Unintended Consequences

    Texas is seeking early release for more and more sick inmates

    Posted Feb. 29, 2012

    ROSHARON -- He's had a heart attack and two strokes, and he walks with a cane because of arthritis.

    Dan Austin Quinn is not the same person who stalked his estranged wife for months before confronting her in the parking lot of a Haltom City drugstore in 1985.

    He's not the same man, he says, who shot Carolyn Quinn three times in the head and then felt "relief."

    "The hate has gone out of my heart," Quinn said during a recent interview at the Terrell prison unit in Rosharon, south of Houston. "I'm no threat to nobody. I've made peace with God."

    Today, the 72-year-old Quinn is hoping for a different kind of relief from the state.

    Sentenced to 99 years in the shooting death of his wife, Quinn has been recommended by the state for early release from prison because of his medical problems.

    He's among a growing number of sick inmates for whom the state is seeking early medical release, known as medically recommended intensive supervision.

    The state says sick and elderly inmates are costly and can be better served by "free world" medical services, particularly when federal Medicaid or Medicare could help foot the bill.

    Some prosecutors and victims' rights advocates, however, contend that the state is trying to balance its budget on the backs of crime victims.

    "The state government through the Board of Pardons and Paroles appears to be playing a shell game or hot potato by shifting the cost of inmate care to the county and the federal government," said Kim Ogg, a former Harris County prosecutor in Houston and an advocate for crime victims.

    "It sounds like an austerity measure taken by the state at the expense of crime victims."

    Sent Home To Die

    Sick inmates are being sent home to their families, hospitals or nursing homes at record levels in Texas.

    The parole board approved 85 medical releases in fiscal 2011 -- the most in five years and more than double the 40 approved in 2009, according to the Texas Department of Criminal Justice.

    Most sick inmates are sent home to die, records show. Of the nearly 1,300 inmates released for medical reasons from 1991 to 2009, 65 percent are dead, while about 7.4 percent returned to state prison or absconded, according to the Legislative Budget Board in Austin.

    "We don't know what their crimes are; we just submit them based on their medical criteria," said Dr. Owen Murray, vice president for offender health services for the University of Texas Medical Branch, which oversees prison medical care.

    Murray said the aging population and long sentences being handed out by Texas juries mean that the prison population is getting older and sicker.

    "It's becoming an issue for the state and the [criminal justice] department," Murray said. "We have a shrinking number of available beds, so where do we put these patients?"

    The prison system has about 300 beds statewide for sick and mentally ill inmates, with the most serious treated at the UTMB hospital in Galveston.

    There are also two prison hospital facilities, in Texas City and Huntsville.

    "We have been very vigilant about doing everything we can to look after these patients," Murray said. "The parole board is in a difficult spot. [In addition to costs] they really have to look out for public safety. I don't envy their job, trying to balance those two things."

    Parole board Chairwoman Rissie Owens told the Star-Telegram that cost is not considered when officials decide whether to release sick inmates.

    "The medical care cost is not included in the information sent to the board," she said. "The [Board of Pardons and Paroles] makes a determination based on the inmate's medical condition and medical evaluation and if he will be a threat to public safety.

    "Along with the nature of the inmate's crimes and ability to carry out future criminal activity, the board looks at things like the prisoner's degree of mobility, assistance needed for daily living, cognitive condition and expected life expectancy," she said.

    The board denies far more requests than it approves -- typically rejecting about 2 in 3.

    If requests are approved, the inmates are released as if on parole, and the "intensive supervision" requirements vary case by case, officials said.

    Tarrant County Inmates

    Quinn is one of more than a half-dozen inmates sentenced in Tarrant County whose medical release the state has sought in the past few months.

    He is the only one of the group convicted of murder, but the list also includes thieves and drug dealers.

    The state has refused to disclose the inmates' medical problems, even to the district attorney's office, saying federal privacy laws prohibit the release of medical information.

    Tarrant County District Attorney Joe Shannon says he won't agree to the early release of Tarrant inmates unless he knows what's wrong with them, and he has sent letters opposing their release to the parole board.

    "Do they have a sore throat or a hangnail, or are they dying of cancer?" Shannon asked. "I'm not going to release someone for intensive medical treatment if I don't know why they're being treated.

    "I'm not going to overturn a jury verdict or plea of guilty without any information at all. ... I don't know what they need that cannot be provided inside the prison."

    The parole board considers letters of opposition from prosecutors and victims or their families, as well as letters written on the inmates' behalf.

    Shannon said the number of state requests for medical release has escalated sharply in the past few months.

    "It could be budget-driven, but I don't know," Shannon said. "With the increased age of our population in general, you're going to see this more and more."

    The parole board has denied the state's initial request for medical release for Quinn and the others. One inmate, Robert Munoz Romo, who was sentenced to two years in prison for theft, died before the board could act on the state's request.

    But a rejection doesn't mean that the requests end. Officials say the state routinely re-evaluates those cases every few months and could recommend medical release again.

    Quinn, meanwhile, is also eligible for regular parole, and is awaiting a decision.

    He said he wants to go home to his wife, Thelma, whom he married by proxy while in prison. She lives in Pearland, about a half-hour from the prison, and is being treated for cancer.

    She's also Quinn's ex-sister-in-law, having been married to his brother, who died in 1989.

    "I have no intent of ever going back to Fort Worth," Quinn said. "Back when all this happened, I didn't care about nothing. I wanted to die myself. All that has changed. I want to live, to get out and help Thelma."

    Stalking and Murder

    Quinn's two grown daughters have not seen their dad since the murder trial. They haven't been to visit him in prison, and they haven't written.

    They couldn't be reached for comment recently, but in 2001 they told the Star-Telegram that their mother believed that she would be killed for trying to leave him. Quinn says he doesn't blame them for cutting him out of their lives.

    "I love them very much," he said. "I never meant them no harm. ... But if somebody had killed my mother, I'd want to do the same thing."

    The relationship began to deteriorate in 1983, when Carolyn Quinn took a job with the Texas Longhorn Breeders Association of America, her family has said. Carolyn enjoyed her work and was learning computer skills. Dan Quinn didn't like it -- he didn't want his wife to work at all.

    The tensions escalated in October 1984. During an argument over the checkbook, he pulled a knife and held it to her throat. He left the house and told his wife and daughter that they should be there when he returned. Instead, they left.

    Quinn threatened and stalked Carolyn for months, despite a restraining order, and in January 1985, she filed for divorce.

    He began following her repeatedly whenever she left home, he wrote threats in blood on her windshield, and he left threatening notes on her car and doorstep.

    He also threatened to kill her relatives if they helped her, they have told the Star-Telegram.

    He said he followed her to a drugstore on East Belknap Street in the hope of talking to her but changed his mind when he realized she wouldn't talk.

    He shot her three times in the head and fled in his car, which was parked nearby.

    He was arrested the next day in Conroe trying to get cash at Western Union.

    He didn't put up a fight, police said.

    "I think about it every day," he said recently. "I cherish the memories of the good times. ... I didn't want to lose her. I could see that she wasn't going to come back. She didn't need the ol' redhead anymore. Satan was pulling my strings."

    Is he sorry for the shooting?

    "Sorry? There are a lot of words I could use. Remorseful. Ashamed. Stupid," he said. "I should have left them alone."

    Thelma, 79, said she's not afraid of Quinn. She said they married in 1990 after her first husband, David Quinn, died of heart trouble.

    She says she's known Dan Quinn since he was 9 and has always had a soft spot for him. She said God told her to communicate with him after his brother died.

    "He couldn't hurt nobody if he wanted to," she said recently. "He's absolutely no threat. ... He's very polite. He's a loving person."

    She added, "He says he's coming home to take care of me, but I'll probably be taking care of him."

    Treat or Release?

    The debate over whether to treat sick inmates in prisons or release them has exploded nationwide.

    In Texas, the average cost to house an inmate in state prison is $18,082 a year, according to budget board estimates based on 2009 data.

    An inmate who needs healthcare costs an additional $3,842 per year.

    In its budget request for fiscal 2012-13, the Criminal Justice Department noted that an average of 837 inmates are under medical care in state prisons and that the costs are expected to be higher in 2013.

    The department also asked for more than $17 million to renovate a prison hospital in Marlin and the hospital in Galveston, but that funding did not survive the legislative process.

    Marc Levin, director of the Center for Effective Justice at the Texas Public Policy Foundation, said medical release is not for everyone.

    "Parole is a privilege, not a right," he said in a statement.

    "An inmate's medical condition should be part of the overall risk assessment concerning whether the inmate currently poses a danger to public safety. ... However, there are some inmates who should simply not be released no matter what their medical condition."

    Shannon says taxpayers will foot the bill either way.

    "It may well be that they could save money by putting them into a Medicaid facility ... where a huge percentage of that Medicaid money is federal," he said.

    "But it's still taxpayer dollars."

    Read more Here

    Invest In Care For Our Aging Texas Inmates

    Editorial Board
    Feb. 14, 2012

    Texas politicians love to brag about how the state is tough on crime, but they are a little less boisterous about the price tag on that philosophy. Despite the "lock 'em up" rhetoric, the Legislature has been increasingly aggressive about pursuing alternatives to incarceration.

    It's not that Texas lawmakers have gone soft on crime, it's that they are staring at incarceration costs that keep jumping — especially the cost of providing health care.

    Last week, the Texas prison board agreed to a $46 million deal with Huntsville Memorial Hospital to serve inmates incarcerated in area units. As the American-Statesman's Mike Ward reported last week, the prison system might be looking at similar agreements with regional medical entities in areas where prison units are clustered.

    Up to now, the Texas Tech and University of Texas systems have provided inmate health care, but both systems are chafing at the rising costs. The University of Texas Medical Branch has provided care for two-thirds of the state's convicts locked up in East and South Texas, with Texas Tech providing the care for the rest of the state. The tab for treating sick inmates is $400 million a year.

    Obviously, it is too early to tell if the contract is going to deliver the savings prison officials anticipate, but it is equally obvious that doing nothing was a ride on a runaway train. Though the prison system might be closing units because of prison diversion programs, incarceration is still in the mix, and demographics indicate that treating ill inmates will continue to be an expensive proposition.

    According to a report released recently by Human Rights Watch, "Between 2007 and 2010, the number of state and federal prisoners age 65 or older increased by 63 percent while the overall population of prisoners grew only 0.7 percent in the same period." According to Texas statistics, older inmates are 7 percent of the 160,000 inmate population, but they account for nearly a third of hospitalization costs, according to a recent report in The Texas Tribune.

    As is the case with an aging free population, older inmates require more medical attention than younger ones. And the Human Rights Watch study notes that prisoners age faster than their counterparts on the outside. "Incarcerated men and women typically have physiological and mental health conditions that are associated with people at least a decade older in the community.

    This accelerated aging process is likely due to the high burden of disease common in people from poor backgrounds who comprise the majority of the prison population, coupled with unhealthy lifestyles prior to and during incarceration," the report notes.

    The Texas prison system recognized the aging phenomenon years ago and set up special geriatric units for offenders ages 60 and older. It was a wise move that looks wiser all the time given demographics.

    No rational person would argue that poor lifestyle choices, illness or age should be a ticket out of prison for dangerous offenders, but neither would a rational person ignore the responsibilities the state assumes when it incarcerates someone. Prisoners have to be fed, clothed and treated when they become ill.

    The prison board's action was both logical and practical. We should all hope it succeeds.

    Share this article: http://www.statesman.com/opinion/invest-in-care-for-our-aging-texas-inmates-2176086.html?cxtype=rss_opinion

    New Contract: $46.8 Million Contract For Prison Healthcare

    By Mike Ward
    February 10, 2012

    In a first step toward creating a new regional network of health care for Texas’ 156,000 convicts, the state prison board this afternoon approved a $46.8 million contract with Huntsville Memorial Hospital.

    The contract represents the first time in years that the state has contracted with entities other than state universities to provide prisoner health care.

    Under the 3.5-year deal, Huntsville Memorial will provide nine beds in a secure wing of the Walker County hospital plus emergency-room services, medical imaging and day surgeries for 13,900 convicts at seven Huntsville-area hospitals.

    Prison officials said the contract could cut costs by perhaps as much as 30 percent, some of that in savings from not having to transport convicts in need of medical care to a Galveston prison hospital that’s several hours away. The hospital is run by University of Texas Medical Branch.

    Brad Livingston, executive director of the Texas Department of Criminal Justice, said officials are looking at the possibility of similar contracts with other regional hospitals where state prisons are clustered, such as Palestine.

    For the past 18 years, UTMB has provided medical care for about two thirds of convicts, in east and south Texas, and Texas Tech University has provided care for those in the rest of the state.

    UTMB a year ago gave notice that it wanted out of its contract because of escalating costs. Since then, legislative leaders and prison officials have searched for ways to curb the costs of the $400 million-a-year health care system. The Legislature last spring authorized the prison agency to look at other partnerships besides the two universities, as a way to save money.

    Today’s board vote was unanimous. Board member J. David Nelson of Lubbock called it “a landmark step” in reducing health care costs to prisoners.

    “It makes great sense,” he said. “It saves money. It engages health care providers in much closer proximity to the offenders and it takes advantage of competitive influences. I would encourage the staff to bring more of these contracts to the board.”

    Jerry McGinty, the prison agency’s chief financial officer, said the contract is worth about $13.4 million a year. He said it will cover 10-15 percent of the state’s convicts now provided care by UTMB.

    Officials earlier said that a separate deal is under negotiation for the hospital to operate an emergency room and specialty care clinic inside the Estelle Unit east of Huntsville.

    New Contract: $46.8 Million Contract For Prison Healthcare

    Pulling This Plug Won't Save Money

    By Heber Taylor
    The Daily News
    Published February 2, 2012

    The University of Texas Medical Branch has begun the transition of shifting responsibility for providing medial care to prisoners to the Texas Department of Criminal Justice.

    The medical branch and the corrections department have been talking about the contract for correctional managed care for a long time.

    The two originally hoped to agree on a contract for fiscal 2013 by Dec. 31. The talks were extended to Jan. 31.

    The two sides still are talking. But 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.

    Pulling This Plug Won't Save Money

    Red ink flowing again in prisoner health care costs

    By Curt W.Olson

    Texas has a growing problem with Medicaid costs in the state budget.

    The state and federal health care program for the poor consumes 20 percent to 30 percent of the budget in state general revenue and all funds. This percentage will increase in the future.

    Texas lawmakers left a $4.8 billion shortfall in Medicaid they must address in 2013.

    Another state health care program has also had its share of red ink in recent years.

    Correctional managed care, which is the health care program for 156,000 state prison inmates, costs about $1 billion this biennium. University of Texas Medical Branch-Galveston cares for about 75 percent of the prisoners. The rest receive health care at the Texas Tech University Health Science Center.

    Officials at the Texas Department of Criminal Justice are racing to find other options for most or all of its prisoner health care. UT and UTMB leaders informed TDCJ officials in the fall that without adequate funding they intend to end correctional health services.

    The program has run a deficit for at least the past three bienniums and it’s off to another poor start, said State Rep. Jerry Madden. R-Richardson, who also is House Corrections Committee chairman.

    He said the program at UTMB already is running $45 million in the red and a request has been made to the Legislative Budget Board.

    “The $45 million is the projected shortfall estimated by UTMB for (fiscal year) 2012 and is based upon UTMB providing the care,” TDCJ spokesman Jason Clark said in an e-mail.

    LBB spokesman John Barton said the LBB has a deadline of the end of the month to decide whether to take $45 million from prisoner health care in 2013 and pay it in 2012. If that doesn’t happen, it will be part of a supplemental appropriations bill in 2013.

    Texas lawmakers already face a large supplemental appropriations bill in 2013.

    It has the Medicaid shortfall and the deferred payment to schools, a total of $7.1 billion. The good news came last week when State Comptroller Susan Combs improved revenue projections by $1.6 billion.

    UT expressed an interest in quitting prisoner health care in February after a state audit reported a large shortfall over a couple of years and was critical of billing methods. UT leaders relented on that at the request of lawmakers.

    The deficit in the program is bad enough, but TDCJ officials who oversee the 111-prison system must have options to replace UTMB.

    “All options are being discussed at this time. We signed an agreement with UTMB for FY 2012. The agreement contains language in the contract that allows for the ability to transition specific services.

    “We are diligently working with UTMB toward developing either a 2013 contract or a transition agreement by January 31st.

    “It’s uncertain at this time what the final delivery model will look like. The agency is looking at a heavier reliance on ‘free world’ providers and utilizing regional hospitals within the provider network,” Clark said in the e-mail response.

    Madden said there has been talk of splitting health care into specific categories, such as dental and immediate care with a provider or providers in regions of the state.

    State Sen. John Whitmire, D-Houston, and chairman of the Senate Criminal Justice Committee, did not respond to a request for an interview.

    “TDCJ has been in discussions with other state medical schools as well as hospital providers currently in the provider network,” Clark said in the e-mail.

    While officials seek options apart from UTMB, Texas Tech has signed a contract with TDCJ to continue to provide care there for the 2012-13 biennium.

    The state must provide prisoner health care because it has been mandated by federal court decisions, and any change will receive intense scrutiny as to whether it satisfies that mandate.

    Any hint of failure could result in litigation.

    Texas Budget Source is a non-profit journalism project of the Austin-based Texas Public Policy Foundation, with funding from the Franklin Center for Government and Public Integrity. Like Texas Budget Source on Facebook or follow TXBudgetSource on Twitter. Curt Olson’s Twitter name is olson_curt. His phone number is 512-472-2700.

    Red ink flowing again in prisoner health care costs


    UTMB gets $45 million to continue prison health care
    Agreement calls for in-depth review of contract

    By Mike Ward
    Dec. 1, 2011

    Temporarily resolving a deadlock over the University of Texas Medical Branch continuing to provide prison health care, officials announced Thursday that a deal has been reached to extend the Galveston medical school's involvement.

    For that, the university will get an additional $45 million to cover expected losses over the next year.

    UTMB and prison officials said that as part of the deal, negotiations will begin to possibly transition UTMB out of its nearly 18-year role as the primary medical provider for about two-thirds of Texas' 156,000 prisoners.

    In a separate deal announced Thursday, Texas Tech University's Health Sciences Center agreed to extend its contract for nearly two years, without any additional funding, according to officials.

    Twice in the past year, UTMB and its bosses at the University of Texas System had threatened to terminate the contract because of continuing multimillion-dollar losses — more than $50 million during the past two years.

    Prison officials had responded by developing plans to use a new network of regional hospitals across Texas at which convicts could get the secondary care that now is mostly provided at the UTMB-run prison hospital in Galveston and adjoining specialty care clinics.

    Senate Criminal Justice Committee Chairman John Whitmire, a Houston Democrat whose committee oversees prison operations, said the $45 million in additional funding will be advanced from the state's next budget, as promised by legislative budget leaders.

    Whitmire said he will initiate hearings in January to "look at all alternatives for prison medical care: regional hospitals, UTMB, private companies — all options will be on the table."

    That will include looking at perhaps opening a mothballed, 222-bed Veterans Administration hospital in Marlin that was transferred to the prison system four years ago.

    So far, prison officials have spent $1.2 million on the vacant facility — hoping to someday open it as a more centrally located treatment option than Galveston.

    UTMB "was prepared to walk and they still want out of everything except the care in Galveston," Whitmire said. "That wouldn't solve anything right now, except it might put the system into crisis."

    Added House Corrections Committee member Jerry Madden, a Richardson Republican who earlier warned that medical funding was short, "It's going to force some hard choices: Find additional sources of revenue, or spend less."

    For Texas lawmakers, Thursday's deal means that a solution to the continuing problems of spiraling prison health care costs has been delayed until much closer to the time when they begin their next legislative session in January 2012. And it puts them $45 million more in the hole going into what already promises to be an ugly budgetary session, thanks to the sluggish economy.

    For Texas taxpayers, that could heighten demands to increase fees or taxes to pay for a growing list of priority needs and prevent further cuts to items such as public school funding and social service programs. But unlike those priorities, prisoners are guaranteed appropriate health care under the U.S. Constitution.

    Raul Reyes, a UTMB spokesman, said that in all, UTMB will spend $430.5 million during the next year providing prison medical care — an amount that has been increasing annually as prisoners grow older and have more expensive medical conditions, and as health care costs rise.

    Prison health care is expected to cost about $450 million this year alone, one of the fastest-growing components of the state's corrections budget — and of the state budget.

    By several estimates, the amount of funding for medical care of convicts housed in the state's 111 state prisons during the next two years will fall about $100 million short.

    Reyes said UTMB lost $44.9 million during the past two years on prison health care, and projects to lose $45 million during the next years. To cover those past losses by UTMB and Texas Tech, the Legislature last spring approved an additional $57 million.

    Texas Tech, which provides care for about a third of Texas' convicts housed in prisons mostly in western Texas, did not have the issue of large losses that UTMB had, officials said.

    Jason Clark, a spokesman for the Texas Department of Criminal Justice, said Thursday's deal is contingent upon approval by the prison system's nine-member governing board and the two universities' regents. Other officials said that approval is expected.

    For UTMB's nearly 3,000 prison medical employees, the tentative agreement provides job security for almost another year, after months of uncertainty as negotiations dragged out and then became contentious.


    UTMB gets $45 million to continue prison health care

    UT officials extend prison medical deadline

    By Mike Ward
    October 31, 2011

    With a deadlock on the future of Texas’ prison medical network still not resolved, the University of Texas System regents voted this morning to extend negotiations for 30 days.

    But in a special telephone meeting, just a day before the current contract is to expire, UT officials made clear that their University of Texas Medical Branch at Galveston will continue to provide prison care only if they do not lose money.

    If no agreement can be reached in the next month, officials said, UTMB will plan to terminate its contract for prison care at the end of December — and transition its role to a new provider.

    By several estimates, the amount of funding for medical care of state prison convicts during the next two years will be about $100 million to little. UTMB provides care to about two-thirds of the state’s 112 prison units, and Texas Tech University serves the rest under a managed-care system that was created in 1994 to ensure quality care while keeping costs down.

    Even so, costs have spiraled in recent years as Texas’ prison prisoner population grows older and has more serious illnesses that are costly to treat.

    Prison health care is expected to cost about $450 million this year alone, one of the fastest-growing components of the state’s corrections budget. Unlike many other recipients of state health care, Texas is required by law to provide medical care for the people it keeps behind bars.

    The drama over the UTMB’s continued participation in the prison medical system has played out for nearly a year. In a Nov. 22, 2010 letter to state corrections chief Brad Livingston, UTMB proposed cutting back its services because of continuing losses.

    More recently, UTMB officials said they wanted to provide only services at the prison hospital in Galveston and did not want to continue operating prison clinics — tagged in the past as money-losers. The acute-care hospital is considered a more lucrative part of the system.

    Earlier this month, TDCJ officials said they were negotiating with regional hospitals to take over most of the prison care, and were working on a plan that would not include UTMB.

    TDCJ officials had no immediate comment on the UT regents’ action, but said they were continuing to negotiate with both UTMB and Texas Tech. UTMB had extended its contract for prison care only for 60 days past Sept. 1, and Texas Tech had extended its contract for 90 days, prison officials said earlier.

    “We’re continuing to work with both universities, Texas Tech on a long term agreement and UTMB on a short term extension of current contract,” said Jason Clark, a spokesman for the Texas Department of Criminal Justice.

    UT officials extend prison medical deadline

    Regents extend UTMB medical contract

    October 31, 2011

    GALVESTON - The failure of the University of Texas Medical Branch to reach a contract agreement for prison medical services led University of Texas regents Monday to extend the contract by 30 days to give negotiations another chance.

    After adjourning from a telephone conference executive session, the regents said that if negotiations with the Texas Department of Criminal Justice failed, the board wanted to phase out UTMB's medical care for prisoners over a period ending Dec. 31, 2012, according to a UT system spokesman.

    UTMB and UT system officials have complained for at least two years that the medical school on Galveston Island has been losing money on its medical services contract with TDCJ.

    Officials said UTMB was forced to pay out of pocket for prison medical care over the amount budgeted by the Legislature and then wait as long as two years for an appropriation.

    UTMB officials sent a letter two weeks before the end of the contract, which expired Monday, to TDCJ seeking emergency negotiations because previous contract negotiations had failed.

    TDCJ officials said at the time that they were in discussion with other hospitals about providing services if contract negotiations with UTMB founder.

    UTMB provides about 80 percent of the prison system's medical care.

    Regents extend UTMB medical contract

    OCTOBER 21, 2011

    Obamacare provision a boon to budget writers on state prison health costs but complicates UTMB negotiations

    Via Sentencing Law and Policy, I was fascinated to see an article from Stateline.org about how "Obamacare" may soon actually provide hospital coverage for state-level prisoners, which is an aspect of federal healthcare reform I was definitely unaware of.

    Reported Stateline.org:
    The federal health law’s controversial Medicaid expansion is expected to add billions to states’ already overburdened Medicaid budgets. But it also offers a rarely discussed cost-cutting opportunity for state corrections agencies. Starting in 2014, virtually all state prison inmates could be eligible for Medicaid coverage of hospital stays—at the expense of the federal government.

    In most states, Medicaid is not an option for prison inmates. But a little known federal rule allows coverage for Medicaid-eligible inmates who leave a prison and check into a private or community hospital. Technically, those who stay in the hospital for 24 hours or more are no longer considered prison inmates for the duration of their stay.

    Here’s how it works:

    Under the 1965 law that created Medicaid, anyone entering a state prison lost Medicaid eligibility. The same went for people who entered local jails, juvenile lock-ups and state mental institutions. The reasoning was that states and local governments had historically taken responsibility for inmate health care so the federal-state Medicaid plan was not needed.

    But an exception to that general rule opened up in 1997 when the U.S. Department of Health and Human Services wrote to state Medicaid directors saying inmates who leave state or local facilities for treatment in local hospitals can get their bills paid by Medicaid, if they are otherwise eligible. In addition to the incarcerated, those on probation or parole or under house arrest were among those who could participate.

    Still, most state prisoners do not qualify for Medicaid. That's because all but a few states limit Medicaid to low-income juveniles, pregnant women, adults with disabilities and frail elders. The majority of people in lock-ups are able-bodied adults who do not qualify, even on the outside. In 2014, however, when Medicaid is slated to cover some 16 million more Americans, anyone with an income below 133 percent of the federal poverty line will become eligible. Since most people have little or no income once they are incarcerated, virtually all of the nation’s 1.4 million state inmates would qualify for Medicaid.

    As a bonus to state corrections agencies, most inmates would be considered new to Medicaid, making them eligible for 100 percent coverage by the federal government between 2014 and 2019. After that, states would be responsible for only 10 percent of their coverage. In addition, state health insurance exchanges—which are required to be functioning by 2014—would make it easier for corrections departments to sign inmates up for the program.

    I find this report fascinating in the context of the ongoing negotiations between university health systems in Texas and the state prison system over provision of inmate care. Hospital care is considered the "plum" of Texas inmate healthcare, while the money losing part is the frontline clinics inside prison facilities. So UTMB has been pushing to keep the hospital care and dump in-prison healthcare, while the Department of Criminal Justice has threatened to farm out inmate healthcare to local hospitals if UTMB won't agree to continue operating the prison clinics.

    This news, though - while welcome from the perspective of Texas taxpayers who will see state costs for inmate healthcare decline - seemingly throws a monkey wrench into everyone's plans. Presently, UTMB charges more than Medicaid rates for hospital care, so once inmates are covered by Medicaid, that part of the contract would cease to be the "plum" they consider it now. Similarly, local hospitals may be less likely to seek out contracts with the prison system if they must accept Medicaid rates, and it's a virtual certainty that private prison health contractors won't want the job at the low rates Medicaid pays.

    At the same time, the state would be foolish NOT to sign inmates up for Medicaid, where the feds would pay 100% of hospital costs between 2014 and 2019 and 90% after that. Given recent cuts to Texas' prison healthcare budgets, the state has virtually no choice but to go that route. Right now, 100% of hospital costs come from the state budget.

    I've no idea whether the parties to negotiations are aware of these changes to federal law, but signing up prisoners for Medicaid would alter the incentives for everyone involved, making hospital care less lucrative and attractive for UTMB, local hospitals, and private prison health providers alike. Indeed, finding providers willing to take Medicaid rates is already a challenge in the free world, so it remains to be seen how all this will play out.

    In any event, this is good news in the medium term for Texas budget writers, even if it's an especially complicating factor for TDCJ's ability to contract for hospital care, with UTMB or anybody else, in the short run.



    UTMB proposes transferring prison health care to corrections agency
    Letter says university would retain hospital and specialty care but give up prison clinics

    By Mike Ward
    Oct. 13, 2011

    Officials with the University of Texas Medical Branch at Galveston proposed Thursday to put the state prison system back in the health care business for the first time in 18 years as a way to exit what they claim is a money-losing program that UTMB cannot afford.

    Declaring an impasse in negotiations on a new contract, UTMB President David Callender told its correctional health care employees in a letter that unless a deal can be reached, UTMB plans to "begin transitioning to (the Texas Department of Criminal Justice) a number of the services we currently provide."

    But the university wants to continue operating the prison hospital in Galveston and providing specialty care at its clinics there — the most lucrative parts of the prison medical network, prison officials have said.

    Should UTMB get its way, prison officials said that costs could rise by perhaps tens of millions of dollars because medical employees would get hazardous-duty pay required for prison employees, a new bureaucracy would have to be established to oversee medical care, drug prices could soar because a discount program might no longer be available and the prison system would likely be susceptible to increased litigation over poor care.

    "That may be what UTMB wants to do, but I'm sure it's not TDCJ's plan," said House Corrections Committee Chairman Jerry Madden, R-Richardson. "I don't want to go back to the old days when the prison system oversaw care. The risk of that is that the courts would get involved, which is where we were before 1993."

    UTMB provides contract care to roughly two-thirds of Texas' 153,000 convicts.

    Texas Tech University provides care for the other third, under a managed-care system created in 1993 to get prison officials out of the business of overseeing medical care and to limit spiraling costs of medical care and litigation.

    Although costs were limited for a time, an aging and sicker prison population has caused health care costs to soar in recent years. UTMB projects it could lose $2 million a month if the contract is extended because the Legislature did not appropriate enough money for prison health care.

    "A preliminary proposal for this transition of services does not seek to eliminate jobs. Rather, it will recommend transferring some UTMB (correctional managed care) personnel to TDCJ," Callender said in the letter.

    In all, about 2,700 UTMB employees provide medical care to convicts at the state's 111 prisons, prison system statistics show.

    At the same time, Callender said UTMB intends to continue operating the prison hospital in Galveston and would continue to provide specialty treatment there.

    "Under this proposal, our academic programs would continue to benefit from their access to this important patient population," Callender said.

    "It will also ensure that offenders have continued access to outstanding specialty care. We must, however, have an agreement where TDCJ will pay UTMB the cost of providing this care."

    TDCJ spokeswoman Michelle Lyons said her agency had not seen the letter and had no comment.

    She said UTMB officials have not yet provided prison officials with their proposed transition plan.


    UTMB proposes transferring prison health care to corrections agency

    More medical school help for prison health care examined by state

    By Mike Ward
    Published: Aug. 19, 2011

    Facing a $130 million cut in funding and no fewer patients, officials who operate the network of medical care for state prisoners say they are considering a plan to expand providers to include five additional public medical schools to help those at the University of Texas Medical Branch and Texas Tech University.

    The move could fundamentally change the current system.

    "We're going to explore every possible combination within our statutory authority that is fiscally sustainable," Brad Livingston, executive director of the Texas Department of Criminal Justice, said Friday. "Our plan is to have a meaningful discussion with any potential providers."

    For years, UTMB and Texas Tech have provided health care to Texas' state prisoners in a system that now includes seven hospitals and more than 100 medical clinics at Texas' 112 state prisons.

    But for several years, UTMB and Texas Tech have been increasingly strapped by spiraling costs to provide that care. UTMB months ago gave notice that it no longer could afford to provide care at prisons.

    Both universities, facing budget cuts of their own from the legislative session that ended in May, have been faced with a dilemma of providing the care without sustaining large losses.

    When the Legislature approved funding for prison health care in May, leaders said they were confident the amounts would be enough to cover all the costs — if prison and medical officials worked to make the system more efficient.

    The issue is significant for Texas taxpayers because under the law, prison officials must provide medical care to all convicts behind bars, at whatever the cost. In recent years, the system has gobbled more and more money as convicts grew older and their illnesses became more expensive to treat.

    Asked why the five other public medical schools would want to take on a care system that UTMB and Texas Tech have struggled with financially, Livingston and other prison officials said they hope new efficiencies can be found.

    "Even though there is less money, there is opportunity," said Oliver Bell of Horseshoe Bay, chairman of the Texas prison system's nine-member governing board. "But it's absolutely a challenge."

    This year, after an audit criticized UTMB's prison health care operations and expenses, and top aides to Gov. Rick Perry pushed to privatize some parts of the health care system, legislative leaders ordered the system to live within its means.

    "Hospital care is 28 percent lower (in the new budget), and that's the biggest challenge," Livingston said. "We will have to be very creative to get this done, and will be exploring new partnerships — including looking at other universities — along with other things. We will turn over every stone necessary to make this work."

    Bell said that though UTMB and Texas Tech have provided convict health care since the current managed-care system was established more than 15 years ago, other public medical schools — including UT-Tyler, UT-Southwestern in Dallas, UT-San Antonio, Texas A&M University and the University of North Texas Health Science Center in Fort Worth — will probably be approached.

    The difficulties facing the prison health care system are even more pronounced because the Legislature changed the management structure this year, according to several officials familiar with the discussions but who asked not to be quoted by name because they are not authorized to speak publicly.

    Previously, the health care system was coordinated by the Correctional Managed Health Care Committee, created in 1993 to oversee care by UTMB and Tech. The idea was to have a committee with a majority of doctors who could focus on access to care and the quality of care, not prison officials or prison board members, who were not medical professionals.

    Now, the Legislature has returned the management to the Texas Department of Criminal Justice, and prison officials are in charge. The committee is shrinking from nine to five members, and the prison board will sign and manage the contracts for care, instead of the committee.

    On Friday, the prison board took the first step to take charge, approving a six-month extension of the contracts with UTMB and Texas Tech to allow for new contracts to be negotiated. UTMB and Texas Tech officials were not available for comment.

    In the past year, both universities have downsized the hours and staffing at prison clinics to try to stay within the budget. But with drug costs and other expenses rising, they have been hard-pressed to keep up — triggering increasing complaints about slow access to care at many prisons.

    Bell said there is no plan to allow private vendors to replace state medical schools in providing the majority of the care, although the universities subcontract some services to outside vendors. The Legislature last spring blocked attempts to privatize large parts of the system.

    House Corrections Committee Chairman Jerry Madden, R-Richardson , who helped craft the changes in state law last spring, said the Legislature fully intended for prison officials and the universities to look for savings when they reduced funding.

    "While we think there are efficiencies that may be realized in the current system, we don't think they should reduce services below what is required," Madden said. "I'm sure if they need additional funding, they will come discuss it with us."


    More medical school help for prison health care examined by state

    UTMB to cut jobs

    From staff reports
    The Daily News
    Published July 20, 2011

    GALVESTON — The University of Texas Medical Branch told employees Tuesday that it will cut about 120 jobs and an additional 130 positions in its program to provide care to state prisoners.

    The job cuts were a direct response to state budget cuts. The Legislature cut funding to the medical branch by $114 million in the next two years.

    About 130 employees in the Correctional Managed Care program were given 60 days’ notice Tuesday. The employees were told their positions were being eliminated or they would be reassigned effective Sept. 16.

    Those employees will have 48 hours to ask to be reassigned to other positions in the program. It was not clear Tuesday afternoon how many would take that option.

    The 2,900 employees in the program work at prisons throughout the state, including the hospital in Galveston.

    State funding for the prison contract was cut by about $10 million, which eliminated about 250 jobs. However, administrators, anticipating cuts in funding, had left positions unfilled.

    The cuts in positions in the academic, health system and institutional support areas will be from a workforce of about 8,000.

    It was not clear Tuesday which positions would be cut or whether faculty positions would be affected. Different areas of the institution have received budget targets. The decisions will be made as the medical branch tries to complete its operating budget for fiscal 2012 by the middle of August.

    UTMB to cut jobs

    July 10, 2011

    On June 21, the Associated Press reported: "The Texas House has approved legislation meant to tamp down rising health care costs for the state's prisoners. Passed by a vote of 124-14, the bill requires inmates who initiate a doctor's visit to pay a $100 annual fee, unless they are indigent.

    It also requires the Texas Department of Criminal Justice to house inmates with similar health conditions in the same units, so as to help reduce costs. The measure additionally directs the department to provide some over-the-counter medications and at no cost to indigent inmates. It now heads to the Senate. Opponents say the bill is too much of an increase from the current, $3 prisoner co-pay per doctor's visit. But a budget analysis predicts it will save Texas nearly $10 million over the next two years."

    It was shared on "Grits for Breakfast," an online blog on criminal justice matters in Texas. Grits blog owner responded with the following points: "Two points: First, the state doesn't "save" money under this plan, it just generates more revenue from taxing inmate families by seizing money from commissary accounts. Referring to a new tax as "savings" is downright Orwellian. Second, in past Grits comment strings, medical professionals working at Texas prisons have questioned whether this policy will *increase*demand for services thanks to changed economic incentives.

    Presently, many younger, relatively healthy inmates use relatively few medical services. But if they think they're already paying for it, anyway, they may be more likely to ask to see a doctor or nurse for relatively minor complaints. Of course, the $100 doesn't come close to paying for the true cost of their medical services, but from the inmates' perspective, folks who previously paid nothing will now pay $100, and those who previously factored in the cost of a $3 copay now will think to themselves, "Well, I've already paid for the services, I may as well use them." Time will tell, but there's a real risk this move will boost overall medical costs significantly more than the $10 million raised from new taxes on inmate families."

    I'm not that knowledgeable on law enactment to know if it died in session without being passed, but the bill was HB 26. Here is the link to the House bill analysis - Click HERE and the link to the Texas Legislature Online, where you can follow the bill, click HERE

    See also information on the Legislative Process, click HERE

    Prison health care privatization, again

    By Mike Ward
    June 16, 2011

    A bill to start charging Texas prison convicts up to $100 a year for their medical care this afternoon sparked the latest skirmish over a continuing push to allow private companies to provide prison medical care in the state’s 112 prisons.

    The move surfaced in an amendment to House Bill 26 that would have required the state committee that oversees prison medical care to initiate a competitive bidding process for the $900 million health care network.

    State Rep. Fred Brown, R-College Station, said he offered the plan — the second attempt during the special legislative session to privatize prison clinics, and at least the fourth since last January — “because I think private companies can provide the service for $40-50 million less.”

    A top aide to Gov. Rick Perry for months has been pressing for privatization, in the belief it could save millions. But prison and medical officials have countered that they already are providing care at perhaps the lowest per-inmate cost in the nation, and said the costs are rising because of the numbers of sick felons Texas has behind bars.

    “This is about competitiveness,” Brown said. “If we can save money by doing this, why are we waiting?”

    Under current law, the University of Texas Medical Branch at Galveston and the Texas Tech University Health Sciences Center provide health care in prisons, in a system whose costs have mushroomed in recent years and drawn criticism from legislative leaders.

    House Corrections Committee Chairman Jerry Madden, R-Richardson, the author of HB 26, immediately objected. While the issue is ripe to be studied, Madden said to mandate privatization without any proof that it can save money makes no sense.

    “We don;t need to take that step before we have information,” he told the House, seeking to kill Brown’s amendment. “It’s a bad idea at this time.”

    Rep. Sylvester Turner, D-Houston, said he opposes charging convicts more for their medical care, “but if we’re going to open the door on that, as we apparently are, then I’m for opening up the discussion about privatization and a lot of other things.”

    “I’m not sold on privatization, but let’s study it,” he said.

    Brown’s amendment was adopted after it was rewritten to say that the state’s Correctional Managed Health Care Committee can competitively bid the medical contracts, replacing the word “shall” with “may.”

    While Madden said he thinks the wording change makes the amendment optional, and Brown said he fears it will not prod the committee to change anything, prison officials said privately late today that it could provide enough of a push to get competitive bidding of the health care contracts up for active discussion.

    Madden conceded the issue keeps coming back again and again.

    “Someone is continuing to push privatization and I’m continuing to push back,” he said, noting that just a week ago another House member tried to tack on an amendment to a fiscal matters bill to give Perry control of the health care committee, a move seen as a first step to bringing in private vendors.

    That amendment was removed before the bill was finally approved.

    Two unsuccessful attempts were made to tack a similar amendment onto other bills during the regular legislative session that ended in May, after a bill to allow privatization failed to be approved in Madden’s committee.

    Like Madden, other House and Senate leaders have said they support studying the feasibility of private vendors providing all or part of Texas’ prison health care, but they oppose mandating privatization without knowing whether there will be any savings.

    Prison health care privatization, again

    House Tentatively Approves Prisoner Healthcare Fee

    • by Ioanna Makris
    June 16, 2011

    The House today gave early approval to a bill that would require Texas prisoners to pay $100 a year for health care.

    Current law requires inmates to make a copayment of $3 per doctor visit. HB 26, by state Rep. Jerry Madden, R-Plano, seeks to offset some of the prison healthcare costs that taxpayers now absorb by requiring inmates in the Texas Department of Criminal Justiceto pay an annual fee of $100 if they use prison medical services.

    For inmates who are unable to pay the fee, 50 percent of money deposited into their trust fund would be removed until the fee is covered. For indigent inmates, those with $5 or less in their trust fund, no money would be taken out.

    Now, taxpayers pay for a large portion of inmate healthcare, Madden said. Lawmakers budgeted $900 million for prisoner health care during the current biennium, but actual costs were $50 million to $70 million higher, he said.

    State budget writers estimate the annual fee would raise more than $9.9 million in the 2012-2013 biennium. TDCJ would oversee the allocation of those funds.

    Under the bill, Texas Tech University Health Sciences Center and The University of Texas Medical Branch at Galveston would also develop and implement a program to train others to administer over-the-counter medications to the inmates.

    Allen Hightower, director of the Correctional Managed Health Care Committee, which oversees prison health care, said the issue of who should dispense those pills has been a matter of contention because of the cost of having a doctor administer simple medications.

    Madden said training nurses to administer simple medications would be a big savings.

    House Tentatively Approves Prisoner Healthcare Fee

    Prisoner health care bill gets panel's OK

    Published: June 7, 2011

    Inmate health care bill moves ahead

    A House committee approved legislation Tuesday meant to cut down on soaring health care costs for prisoners in Texas.

    The House Corrections Committee voted unanimously for a bill that would require inmates who initiate a visit to the doctor to pay a $100 annual fee unless they are indigent. It also requires the Texas Department of Criminal Justice to house inmates with similar health conditions in the same units to reduce costs.

    The legislation requires the department to provide certain over-the-counter medications at no cost to indigent inmates.

    A budget analysis predicts that the bill will save the state nearly $10 million over the next two years.

    The author of House Bill 26, Rep. Jerry Madden, R-Richardson, said he will try to add the measure onto a Senate fiscal matters bill Thursday.

    What's ahead...

    The House returns at 1 p.m. today. The Senate is back at 2 p.m. Thursday.

    Prisoner health care bill gets panel's OK

    Prison health care mistake could cost $13.4 million

    By Mike Ward
    May 31, 2011

    A last-minute blunder in the Texas House has killed a bill that was designed to save taxpayers $13.4 million by requiring imprisoned felons to pay more for their own health care, officials said this morning.

    The issue has quietly emerged as a new sleeper topic — the third one — for the special session that began today, a topic that may not need gubernatorial permission to be addressed.

    The reason: It’s a cost-cutting measure, and Gov. Rick Perry already listed cost-cutting as a permitted issue for lawmakers to address.

    House Corrections Committee Chairman Jerry Madden, R-Richardson, said House Bill 3459 that would have changed state law to achieve the savings had been agreed to on Sunday, and was to have been approved late Sunday.

    “It got caught up in the chubbing and delays that night, and was not approved,” Madden said. “We couldn’t get it approved on Monday, so it died.”

    On Monday, House officials discussed the problem that the death of the measure would cause — it would leave prison health care programs with $13.4 million during the next two years, and could have required additional layoffs without a supplemental appropriation of additional money in 2013.

    By mid-morning, a new bill to address the problem had been filed — House Bill 26 — and House officials were preparing to move ahead to pass it into law.

    Madden said Perry’s agenda for the special session specifies that the Legislature can address bills that involve “containment of costs, and that’s what the caption of this new bill says.”

    Madden said the bill is to be referred later today to a House committee for a hearing, a prelude to getting before the full House for debate and passage.

    Under the new bill, convicts would be required to pay a new $100 annual “health care services fee” if they visit a prison clinic, instead of the $3-per-visit fee they are now charged.

    Only those convicts who could pay the fee would be charged. No inmates can be denied access to health care because they can’t pay, Madden said.

    The measure also allows prison commissaries to sell additional over-the-counter medications, a move that could further reduce prison health care costs that have been spiraling in recent years.

    Special aides to help prison clinics pass out medications would also be permitted under the bill, to stretch manpower requirements of prison medical professionals.

    Senate Criminal Justice Committee Chairman John Whitmire, D-Houston, said the issue needs corrected during the special session. He noted that the original bill passed both houses during the regular session.

    Senate Finance Committee Chairman Steve Ogden, R-Bryan, said he favors increasing the co-pay. “I’m for co-pay,” he said. “Anything that helps (with the budget), I’m for,” he added.

    Prison health care mistake could cost $13.4 million

    Vendors push for prison health care privatization

    © 2011 The Associated Press
    May 1, 2011

    AUSTIN, Texas — Private companies are lining up to grab a piece of the action of the nearly $1 billion health care system for Texas prison inmates, according to a newspaper report published Sunday.

    Lawmakers say the idea of privatizing the system has still not been fully studied. Rather, they say outside companies are pushing the idea even though the Legislature has yet to embrace it, the Austin American-Statesman reported in Sunday's edition.

    Last week, the chairman of the Texas House Corrections Committee rejected wording that would encourage farming inmate health care out to private vendors. The proposal would have given Gov. Rick Perry control of the prison system's Correctional Managed Health Care Committee.

    "There is a push on to change the system we have, a system that is cost-effective and is a national model, even before we know whether there will be any real savings," said the House Corrections Chairman Jerry Madden, R-Richardson.

    But privatization backers inserted the same wording into legislation not assigned to Madden's committee. No action has been taken on that bill.

    The American-Statesman has reported that top Perry aides have been involved in meetings with vendors and lobbyists.

    Presently, state law places the responsibility for the health care of 154,000 state inmates with the University of Texas Medical Branch at Galveston and the Texas Tech University Health Sciences Center.

    Consumer watchdogs such as Tom "Smitty" Smith, Texas director of Public Citizen, warn that privatization could mean skyrocketing costs for taxpayers and poorer care for inmates. Smith listed the state's most recent privatization failures: the outsourcing of human services benefits enrollment, the consolidation of data and information systems and the private leasing of state office space.

    "A change this large should be vetted completely in the open, not in a back room," Smith said. "Certainly, if this were vetted in public, it would probably get a big thumbs down."

    Aides to Perry say only that the governor will review any legislation on privatized prison health care carefully before signing it, the American-Statesman reports.

    On several occasions, the Texas Department of Criminal Justice has hired private companies to provide substance-abuse treatment programs, only to face rising costs because the companies had underestimated them and could not provide services at the promised price.

    "Many times when you hire private vendors, you find the only way they can provide the services cheaper is by paying their people less or providing less service," Madden said. "With medical care, that's exactly what we don't want to get into."

    Two members of the Texas Board of Criminal Justice, which operates the prison system, say the idea was still worth exploring. Tom Mechler (MEHK'-lur) of Amarillo and David Nelson of Lubbock say the ongoing losses at the two university health care providers and the state's tight budget make seeking alternatives urgent.

    Vendors push for prison health care privatization

    FEBRUARY 16, 2011

    Draft budgets reduce prison healthcare reimbursements to match Medicaid rates

    In the wake of a recent audit alleging that the University of Texas Medical Branch overcharged for prison health services, I was interested to note that both the House and Senate budgets would university medical providers to get written permission from LBB to charge TDCJ more for services than would be allowable under Medicaid.

    Rider 58 in the proposed Senate budget (large pdf, p. 599) declares that TDCJ "shall not pay rates to health care providers for hospital services provided to offenders in its custody that exceed the rates that would be paid for same services according to the Medicaid reimbursement methodology adopted by the Health and Human Services Commission in Texas Administrative Code, Chapter 355."

    Presently, said the state auditor, "the UTMB-CMC Division's reimbursement amount for physician billing services is, on average, 135 percent of the Medicare reimbursement amount. Additionally, UTMB-CMC Division reimbursement amounts exceeded standard Medicare reimbursement amounts for each type of hospital service, including inpatient and outpatient services." Medicaid rates are even lower than Medicare, so if they were charging 135% of Medicare rates, UTMB billings are about to take a serious haircut.

    Further, the bill creates a rather elaborate process for exceptions in order to charge more than Medicaid would pay:

    In order to pay a rate that exceeds the rate that would be paid for same services according to the Medicaid reimbursement methodology ... the Department of Criminal Justice must receive prior written approval from the Legislative Budget Board. To request authorization to increase a rate, the Executive Director of the Department of Criminal Justice shall submit a written request to the Health and Human Services Commission and the Legislative Budget Board. The Health and Human Services Commission shall determine if the requested rate is reasonable and shall notify the Legislative Budget Board in writing of its finding. The Legislative Budget Board may consider the Health and Human Services Commission's finding in determining whether to approve the requested rate. The request shall include, but is not limited to, the previous rate; the requested rate; the reason for the request to exceed the previous rate; and the estimated fiscal impact of the increased rate. The request shall not be submitted for approval if such approval would cause expenditures to exceed appropriations.

    Given that, it's almost certain that exceptions for higher rates would be few and far between, and even if individual rates are increased, the total aggregate amount providers can receive is capped at appropriated levels.

    UTMB has complained for years that the state pays them too little for the healthcare they provide at Texas prisons, even threatening (read: Bluffing) to cancel their contract if the state didn't fork over more money. But given the audit and draft budgets released recently, clearly the tables have now turned.

    Not only won't they get more money, prison healthcare now faces a whopping 24% aggregate budget cut, and there's nothing in this budget (nor that I've heard from anyone else) that makes me think anyone at the Lege plans to let UTMB out of this shotgun marriage anytime soon.


    Second audit on UTMB expenses authorized

    By Mike Ward
    February 8, 2011

    Reacting to a state audit that blasted the University of Texas Medical Branch for how it spent funding for prisoner health care in Texas, University of Texas System Chancellor Francisco Cigarroa late this afternoon moved to audit the audit.

    In a statement, Cigarroa characterized the state auditor’s findings as “serious” and said “they must be reviewed carefully.”

    “After a comprehensive look at the state auditor’s report, UTMB respectfully believes that the primary findings are not correct,” Cigarroa said. “Subject to the approval of the state auditor, I have authorized the hiring of an independent auditor to expedite a review of the state audit findings and to report to me and to the Board of Regents its findings and recommendations.

    “The UT System and UTMB pledge to take swift and appropriate corrective measures, if necessary, to ensure that the financial aspects of the CMC (correctional managed care) contract are appropriate and in line with federal guidelines.”

    When the audit was made public last week, UTMB officials challenged the findings that it may have overcharged for care. They had suggested that an independent review of the state audit would validate that it did nothing wrong.

    The audit alleged that the University of Texas Medical Branch at Galveston charged the state’s prison health care program for more than $16.2 million in costs not directly related to prisoner care, spent more than $6.6 million in two years for items that were not allowed under the prison contract and handed out $14.1 million in pay increases over three years while reporting that the program had a $95.1 million deficit.

    In one case, the audit disclosed that 40 employees of the prison medical division of UTMB received bonuses last November for which they were not supposed to be eligible — one receiving a payout of $125,460 — at a time when state agencies had been ordered to cut spending by 15 percent to staunch a predicted $27 billion budget shortfall.

    According to the audit, UTMB’s prison health care division charges the prison system more for reimbursements for physician services, inpatient hospital services and outpatient services than it does for Medicare, Medicaid and at least one major private insurer’s reimbursements.

    The reimbursement amount for physician billing is, “on average, 135 percent of the Medicare reimbursement amount,” the audit states.

    Second audit on UTMB expenses authorized


    HPD Practices On Prisoners For Drawing Blood From Drunk Driving Suspects

    By Stephen Dean
    June 17, 2010

    HOUSTON -- Houston City Hall has nixed a plan to have HPD officers draw blood themselves from drunken drivers, and Local 2 Investigates found they practiced on state prison inmates in a psychiatric ward.

    "This type of behavior on psychiatric inmates is very, very unethical," said Houston civil rights attorney Randall Kallinen.

    Local 2 Investigates first uncovered last year that HPD officers would begin training to become certified phlebotomists. That would allow them to draw blood from suspected drunken drivers without having to rely on hospitals or nurses.

    The first seven officers started training, first using artificial limbs and then sticking needles into each other's arms. From there, they started sticking needles into the arms of convicts at the Jester IV Prison, a psychiatric ward off Highway 99 near Richmond.

    One officer involved in the training said the inmates were having blood drawn under a doctor's orders as part of "intake" into the prison system. The officer said, "They were not stuck just for us."

    In a statement, University of Texas Medical Branch (UTMB), which administers the medical program in Texas prisons said:

    "UTMB’s Correctional Managed Care program has an agreement with Lone Star College involving its Law Enforcement Phlebotomy Program. The participating Houston police officers at the units were there as part of the Lone Star College course they were taking. Having blood drawn is part of the standard intake process at TDCJ and offenders were given the option of having a police officer or a staff phlebotomist perform the procedure. All of the offenders involved chose to allow the police officers to do the procedure."

    At HPD headquarters, Executive Assistant Chief Tim Oettmeier said it was a "validated, certified training program."

    When asked about the ethics of HPD officers practicing needle prods on inmates, he said, "We looked at it as students involved with a protocol, as opposed to police officers involved in a protocol."

    Kallinen said it raises many questions since the officers were not trained or certified medical professionals.

    "Are they going to perform the right procedures? Are they going to cause an infection? Are they going to stab the wrong thing to practice medical procedures on inmates, and especially psychiatric inmates?" Kallinen said.

    He said those inmates may not be able to understand or provide a meaningful consent to be used for training exercises.

    "What you have there is sort of a group of people who can be very easily coerced into doing things that aren't good for them," said Kallinen. "They want to please their captors."

    The program was hatched last year under the prior mayor and police chief.

    Mayor Annise Parker has now scrapped the entire program, but not because inmates were used as test subjects.

    In a statement, Mayor Parker said:

    "Chief (Charles) McClelland and I have agreed to halt this program. While I applaud the out-of-the-box thinking that led to this idea, I believe it went too far. I cannot support taking our officers off the street either to draw blood or for deployment in this matter. Of course, drunk driving is a serious problem that we must work together to eradicate, but there are already mechanisms in place to determine whether a motorist is driving under the influence. Additionally, if we choose, there is the option of contracting with civilian professionals to draw the blood."

    Oettmeier said the city lost $4,000 by scrapping the program. Those where the costs of giving hepatitis shots and other vaccinations required for the seven officers to begin phlebotomist training.

    One officer said, "I just spent five days at TDC drawing blood for nothing."

    That officer said blood was drawn from at least 50 inmates at Jester IV and another lockup in Dayton before the program was halted in mid April.

    HPD Practices On Prisoners For Drawing Blood From Drunk Driving Suspects

    Prison drug-test tab: $278,000

    By Mike Ward
    June 17, 2010

    The expected price tag to administer random drug tests to state prison employees under a new program to curb contraband and improve security will be more than $278,000 a year, new figures showed today.

    The estimate comes at a time when Texas state government is facing a possible $18 billion shortfall, and as Texas’ massive prison system is raising concerns about public safety if it has to cut an additional 10 percent from its proposed budget in 2011-12, as state leaders have asked.

    A briefing document to be presented today to the prison system’s governing board shows the proposed drug-testing program would test 9,600 employees a year, or about 800 a month.

    The employees would be among 39,995 — most all of them in prison, parole and administrative jobs that have regular contact with convicts, including most of the top brass — that could be tested, according to the document. The rest of the agency’s administrative staff would be exempt.

    Michelle Lyons, the prison agency’s spokeswomen, said the tests will cost $29 each.

    “Our goal is to test about a quarter of the employees each year,” she said.

    “Everyone in that group would be tested in the next four years.”

    Prison officials proposed the new program at the urging of House leaders as a way to curb a chronic flow of contraband into the state’s 112 prisons, and as a way to keep drug-impaired employees from working in prisons.

    While officials insist the new program closely parallels ones used successfully in other states, a growing chorus of corrections officers and union leaders have challenged the details of the initiative, saying the proposed rules do not properly protect employees’ rights and that testing procedures need to be revised to make them fair and workable.

    House Corrections Committee Chairman Jim McReynolds, a Lufkin Democrat who proposed the testing months ago, said he is not sure the proposed plan tests enough workers. And he questioned the high costs of the tests “at a time when the state is so far in the hole financially.”

    “They’re not doing all the employees, and the proposed rules leave open a lot of questions — like what happens if there’s a false positive on a test,” he said. “This is America. You don’t start out guilty. Your innocence is presumed until its proven otherwise.

    “The intent of the program is good, but there are a lot of details that still need work. There are a lot of questions that have to be answered.”

    Prison officials earlier said they planned to implement the new program by sometime in August, and intended to brief the Texas Board of Criminal Justice today as a prelude to implementing new administrative guidelines to allow for the tests.

    Prison drug-test tab: $278,000


    By Nathan Bernier
    Austin, TX

    The people who run the health care system for Texas inmates are trying to cut costs without lowering care to a level that could prompt federal intervention.

    Texas has about 154,000 prison inmates. And for the past sixteen years, their medical needs have been outsourced to a pair of universities.

    The University of Texas Medical Branch in Galveston handles about 80 percent of inmate patients. Texas Tech University handles the rest.

    As Nathan Bernier reports, the goal of these programs has been to cut costs � but some critics argue that you only get what you pay for.

    Most of the people who run the Texas prison health care system are quite proud of how little money they spend on it. Doctor Owen Murray is in charge of UTMB’s prison health care program.

    “From a delivery system, it really is a well conceived model, and has really worked out well for the state and as well for our offender patients,” Murray said during an interview at KUT studios.

    “The fact that we have one prison hospital for the most part, that allows us to centralize our hospital and subspecialty care, really has kind of advantaged us to be able to improve our care but also be really cognizant of our costs,” Murray said.

    Those costs are now among the lowest in the nation. Texas spends about $9 per inmate per day on health care. That’s close a fourth of what California spends by comparison. One way they save that money is through telemedicine, where medical specialists can examine a patient hundreds of miles away though an audio-video link.

    “Another way is the 340 B prescription pricing, which is the lowest prescription drug pricing in the country that anybody can get,” said Marc Levin with the Austin-based free market think tank called the Texas Public Policy Foundation.

    “So I think there’s a lot of factors to where it’s more efficient to have inmates that are really ill to go to Galveston or Lubbock, but there are some clinics or so forth within the units, and there’s telemedicine, so you’re not trying to replicate the expertise of a big medical center at every prison, because we have 112 prisons,” Levin said.

    But even with the cost savings, UTMB is struggling to pay for prison health care. The cost to Texans each year is more than $400 million. Mainly because of an aging prison population with chronic disease, Dr. Owen says his university’s program is facing a loss of $82 million.

    “Well that is true, but historically the way that has worked is the legislature has come back in the next session and through a supplemental appropriation, allowed the university to be paid for those health care costs,” Owen said.

    That may be the case. But this time around, Texas lawmakers are staring down the barrel of a budget gap that could reach $18 billion. So last month, UTMB sent layoff notices to more than three-hundred employees. And that raises a question: Can UTMB can still provide a legally required level of prison health care when 12 percent workforce has been laid off. Allen Hightower is executive director of the state’s Correctional Managed Healthcare Committee.

    “I can assure you that the last thing any of us want to do is to breach what a reasonable person would think is a constitutional level of healthcare,” Hightower said in a telephone interview.

    “In some ways, it’s a game of chicken because the feds can always come in and do what they did in California and say, you know you can’t scale back that much,” said Scott Henson, a a career political consultant who also writes about criminal justice at his blog Grits for Breakfast.

    Some activists say Texas has already crossed the line and is no longer providing a constitutionally mandated level of care to its inmates. Helga Dill runs a prisoners’ rights group called Texas CURE.

    “They just cut the medication in half. They turn patients away because they don’t feel like they need to be treated. I get 20 to 30 letters a day. So I don’t care what these officials say,” Dill said.

    Almost everyone admits, providing prisoners with health care is not getting any cheaper. For example, “geriatric inmates” make up about seven-percent of the prison population. But they already account for one-third of the system’s hospital costs. This population is just one of the areas that UTMB officials are targeting to cut costs.


    Texas prison system doctor punished for writing prescriptions away from work

    June 12, 2010
    Houston Examiner
    By Stephen Dean

    (Austin) -- The Texas Medical Board has imposed restrictions on a Texas prison system doctor for writing prescriptions outside the scope of his prison work.

    Dr. Walid Hamad Hamoudi was caught by state investigators writing prescriptions for 'pain management patients' that the state says were not medically necessary.

    Pain management prescriptions are a massive problem in Texas and other states, allowing doctors to make significant money on the side by signing prescriptions for those who are addicted the hydrocodone, Xanax and other pain pills.

    Dr. Hamoudi is a physician at the University of Texas Medical Branch in Galveston, which serves the Texas Department of Corrections prisons in the region.

    As part of a "mediated agreed order," Dr. Hamoudi agreed to pay a $5,000 fine and he is no longer allowed to write any prescriptions outside his TDC work at UTMB hospital.

    Part of the punishment also requires him to submit peer review records four times a year to the Texas Medical Board so they can monitor what other doctors are saying about his care.

    A new Texas law requires doctors to formally document all hydrocodone, Xanax and Soma prescriptions they write, and this punishment requires Dr. Hamoudi to submit his monthly controlled substances prescribing records to the Texas Medical Board for examination.

    The order, filed this week in Austin, also specifically bars Hamoudi from writing any prescriptions for patients above the usual "therapeutic doses" and only when medically necessary.

    Within 6-months, the order requires Dr. Hamoudi to complete a medical jurisprudence exam, which shows he understands the law on prescribing pills to patients, and he is also required to complete 10 hours of education in prescribing for pain management patients. He has to take another 10 hours worth of classes for keeping the proper records for those prescriptions.

    The board accused Dr. Hamoudi of failing to practice medicine in an 'acceptable, professional manner consistent with health and welfare.

    The restrictions on his medical license will last for three years. He can only practice medicine outside his prison job after that time expires, and when he requests and gets permission from the medical board to expand his practice beyond his prison work. The board pointed out that he will only be granted that permission if he provides sufficient evidence that his practice is consistent with state law.

    He is among a handful of Texas doctors punished this week for their prescriptions of pain pills, including one who prescribed himself the pain pills.

    Dr. Joseph J. Patrick of Houston admitted to the board that he had not acted diligently in his role as the medical director at several clinics where over 21,000 presciptions were written for controlled substances, including 900 prescriptions through an ambulance service where he worked. His license has been restricted so that he cannot write prescriptions beyond what a patient may need for only 72 hours and he was ordered to restrict his practice to his hospital emergency room duties.

    Dr. Charles Mahoor Moradi of Coppell was referred to a drug abuse class and psychiatric exams as part of his punishment.

    Dr. Christina Clardy of Houston had her license suspended after her arrest on organized crime charges in a 'pill mill' operation that handed out prescriptions to addicts.

    Dr. Don Martin O'Neal of Sulphur Springs had his license suspended after the DEA reported he was prescribing significant quantities of narcotics to numerous patients. A physician colleague discovered that he had been using the colleague's signature stamp to write some of the prescriptions, which meant the colleague's DEA authorization was used for those pills. He was indicted on 55 felony charges.

    Dr. Wasim Mohammad Khan of Lufkin was fined $2,000 and ordered to have another doctor watch over his care because of his prescribing pills to a pain patient who ended up dying of an overdose. Dr. Grady Carlton Shaw of Corsicana was placed on restrictions for 3-years and barred from prescribing to some pain management patients because the board says one of his patients became addicted to Methadone.

    One doctor, Day Pattison McNeel, Jr. of Canyon Lake was forced to surrender his license to practice medicine for prescribing controlled substances in 2008 and 2009 even though his prescription writing license had been cancelled.

    Other disciplinary decisions handed down this week include Dr. Robert Dyson Healing of Jasper, who was required to take classes because he failed to immediately report to the bedside of a patient who was in respiratory distress while he was on call.

    Finally, Dr. Lundy Eldridge Cavender of Burleson had his license suspended after two suicide attempts. The medical board says he admitted himself into a psychiatric ward after exposing himself and masturbating in view of female employees in the public areas of his clinic.

    Texas prison system doctor punished for writing prescriptions away from work

    UTMB to lay off 363 prison health workers

    May 18, 2010

    GALVESTON — UTMB on Wednesday will begin notifying 363 medical employees working in state prisons that they will be laid off July 21 in order to stem $82 million in loses projected for 2010-11, UTMB President David Callender said in a message to employees today.

    A spokesman for the University of Texas Medical Branch at Galveston confirmed the layoffs and said that Callender was not immediately available for comment.

    The message said the medical school would begin trimming its 3,418-strong correctional managed care work force with layoffs at 86 outpatient units throughout central, coastal and east Texas.

    “We have reached the point financially where we have no other choice but to reduce the number of (correctional managed care) positions to address a growing deficit in state funding for correctional care costs,” Callender said in the message.

    UTMB and Texas Tech University provide medical care for the state prison system and are reimbursed by the Legislature. Callender said this means that UTMB must pay for the medical costs from its own resources while waiting for the reimbursement. He said the costs typically exceed the amount provided by the Legislature and are rising as the prison population ages and requires increasing care.


    UTMB to lay off 363 prison health workers

    UT System threatens to drop prison care contract

    By Laura Elder
    The Daily News
    Published May 14, 2010

    GALVESTON — Officials of the system that oversees the University of Texas Medical Branch are threatening not to renew a contract to provide health care to more than 120,000 state prison inmates unless lawmakers agree to cover a projected $82 million budget shortfall in the program.

    But local officials at the medical branch, which employs about 3,000 people to fulfill the contract at John Sealy Hospital and at prison infirmaries around the state, have said they hope such a drastic measure won’t be necessary.

    Officials in previous interviews have said they would seek a restructuring of how prison care is delivered. Doing so could shift a large part of the correctional care work force from the medical branch to the Texas Department of Criminal Justice payroll.

    Delicate Issue

    The issue is delicate. UT System officials are careful not to offend lawmakers, who in the last legislative session appropriated $566.5 million in general revenue funding for the medical branch, which was reeling from Hurricane Ike.

    That was an increase of almost $109 million over the previous biennium.

    Meanwhile, Texas’ top budget-writers are projecting an $18 billion budget shortfall and will expect state agencies to make cuts.

    Chronic Underfunding, Soaring Costs

    But insufficient state appropriations have for years shown up on the balance sheet of the medical branch, which has a $1.5 billion budget.

    The medical branch long has been expected to cover correctional care costs until lawmakers appropriate supplemental funding.

    “It’s not UT’s job to, in essence, loan money to the prison system for prisoner health care,” state Rep. Craig Eiland, D-Galveston, said. “But this is what has been happening for many years.”

    The inmate patient population is important to the academic mission at the hospital by providing a variety of cases for medical students, Eiland said. But costs to treat convicts are soaring. As the prison population ages, health care costs for chronic diseases such as hepatitis C, diabetes, cancer and HIV are climbing, officials have said.

    Serious Turn

    The issue took a serious turn with a May 10 letter by Dr. Kenneth I. Shine, executive vice chancellor for health at the University of Texas System, and Dr. Scott C. Kelley, executive vice chancellor for business affairs, to state Sen. Steve Ogden, chairman of the Senate Finance Committee, and state Rep. Jim Pitts, chairman of the House Appropriations Committee.

    “In the face of this ongoing burden, we cannot continue the contractual arrangement in its current form, and, unless changed, anticipate that we would not desire to renew the contract at the end of its term in August 2011,” Shine and Kelley said in the letter.

    Impeding Progress

    Last month, William R. Elger, executive vice president and chief business and finance officer for the medical branch, warned that while the institution was in the black for the first time in recent memory, its financial progress was limited by the correctional care contract.

    The medical branch asked lawmakers in the last session for $131.5 million to cover the program’s cost but got only $72.4 million, leaving it underfunded by $59.1 million, Elger said.

    Without legislative intervention, the medical branch expects to lose about $82 million through the correctional managed care program for 2010-11, officials said.

    “It’s not working for us, and it’s not working for the state,” Elger said in an interview last month.

    Making Cuts

    The UT System, which oversees the medical branch, is altering operations and reducing expenses, which would cut the $82 million shortfall for the biennium to about $50 million, Shine and Kelley said in the letter. The medical branch was prepared to produce that $30 million in savings, they wrote.

    “Yet, even with these actions, UTMB again is being put in the position to absorb significant shortfalls at an extremely critical time when the campus is focusing to fund the reconstruction of the university after the devastation from Hurricane Ike,” they said.

    Hurricane Ike, which struck in September 2008, flooded the first floor of the hospital and other buildings and inflicted about $1 billion in damage and lost revenues.

    Shifting Work Force

    Medical branch and UT System officials have proposed lawmakers help to develop a different structure that would allow the institution to continue treating prisoners through the contract without carrying significant deficits.

    One proposal is that the medical branch continue to operate the prison ward at John Sealy Hospital and provide physician and senior-level nursing expertise, while the Texas Department of Criminal Justice employed the vast majority of nurses and other staff in various units.

    “The state could base its appropriation and reimbursement on a mechanism aligned with ‘free world’ Medicaid rates,” Shine and Kelley wrote.

    “Such a mechanism might include a combination of fee-for-service and incentive payments to ensure cost-effective care.”

    Only 28 Percent Work Here

    Only about 28 percent of prison care personnel work on the island. The remaining 72 percent work at prisons and should be the responsibility of the Texas Department of Criminal Justice, Eiland said.

    Because the appropriations process for the 2012-13 biennium will begin soon, the medical branch is seeking to renegotiate its contract now.

    “The intention would be to have finalized those negotiations by the time the Legislature convenes in January 2011 so that the new structure and the resulting funding needs of TDCJ can be taken into account,” Shine and Kelley wrote.

    Ogden and Pitts could not immediately be reached for comment Thursday.

    The medical branch has had a correctional care contract since 1993.

    UT System threatens to drop prison care contract

    The Torrey Smith story

    July 3, 2010
    Re: June 27 article "Mistakes in inmate's death."

    Anyone who has ever had a son, wife or friend in a local jail probably got chills reading this story.

    It chronicles the slow and painful death of 31-year old Torrey Smith, who was accused of faking his illness by incompetent staff.

    Reporter Patrick George helps us see exactly what happens when jail officers fail to take responsibility for the lives of the human beings in their care.

    I often read brief accounts of deaths due to medical neglect in jails across Texas, but most papers don't bother to analyze.

    Without good media coverage, the public is unlikely to grasp the magnitude of this problem, and families will continue to lose loved ones.

    A question for Hays County: Why weren't medical and supervisory staff held accountable? After Smith died alone in his cell, all that happened was one officer was fired and another resigned.

    Diana Claitor
    Director of the Texas Jail Program

    The Torrey Smith story

    MAY 20, 2010

    Which prison health employees getting the axe at UTMB?

    Here's a little more detail from a FAQ on UTMB's home page explaining which medical staff at Texas prisons are getting the axe:

    • What is the breakdown of the reduction in force by position types? Jobs affected: 133 registered nurses; 56 medical assistants; 47 facility clinical associates; 43 administrative staff; 33 dentists; 19 dental assistants; 15 dental hygienists; 5 human development consultants; 4 vocational nurses; 3 patient care technicians; 2 physicians; 1 optometrist; 1 mid‐level practitioner; and 1 clinical associate. Of the 363 employees affected, 306 are female and 57 are male. The ethnic breakdown is: 240 White; 71 African‐American; 42 Hispanic; 9 Asian; 1 Native American.

    • What units/cities will be affected? The reduction in force will affect CMC employees at all 86 outpatient units that UTMB staffs in central, coastal and east Texas. These units are organized into nine geographic regions. Reductions per region follow:

    • Galveston, 12
    • Beeville, 30
    • San Antonio, 28
    • Gatesville, 33
    • Dallas, 24
    • Palestine, 64
    • Huntsville, 76
    • Houston, 51
    • Beaumont, 45

    Especially noteworthy and potentially problematic are the reduction in the number of R.N.s. UTMB is also eliminating roughly half the dentists they presently employ. "UTMB estimates that the reduction in force will save approximately $22 million over the 14‐month period between July 21, 2010, and Aug. 31, 2011."

    Relatedly, see this "white paper" (pdf) from UTMB's Ben Raimer titles "Healthcare in the prison system: A looming fiscal crisis." Major cost drivers for the system identified by Raimer were:

    • Aging offenders
    • HIV infection
    • Serious mental illness
    • Hepatitis C virus
    • Cardiovascular diseases
    • Kidney failure and dialysis
    • Asthma
    • Diabetes

    One particularly astonishing fact bite jumped out at me: "Approximately 19,700 offenders incarcerated in a TDCJ facility in April of 2010 had a diagnosis of HCV infection." That's an enormous number. In addition, "In FY 2009, nearly 9,200 TDCJ offenders in the UTMB-CMC sector were diagnosed with a serious mental illness, compared with only about 5,600 in FY 2004. This increase in the prevalence of serious mental illness among TDCJ offenders has significantly strained the personnel resources of the mental health program."

    UTMB was already skirting the borderline regarding provision of acceptable levels of inmate healthcare; these cuts may set the state up for litigation down the line of the type that's driven California's health costs through the roof.

    Which prison health employees getting the axe at UTMB


    Health officials: Prisoners won't get H1N1 vaccine before the general public

    Prison system has requested vaccine to inoculate prisoners most at risk for swine flu.

    By Mike Ward
    October 29, 2009

    Facing public criticism over plans that some convicts might get swine flu shots before law-abiding citizens, state health officials clarified Wednesday that no widespread inoculations are expected to take place in Texas prisons any time soon.

    At the same time, they said that pregnant women who are incarcerated could get shots "to help protect their unborn children." In a statement, the Department of State Health Services said "a limited supply will be going to the prison system to vaccinate those most at risk." It provided no additional details.

    The American-Statesman, quoting prison officials, had reported that thousands of prisoners could get swine flu inoculations before many law-abiding Texans because they fit the criteria for priority inoculations. Those officials said more than 45,000 convicts considered to be at high risk of developing the flu have been targeted to receive vaccinations, which they said they had been told could start arriving as soon as next week.

    Officials also said they planned to inoculate more than 40,000 correctional officers and medical personnel who work with those prisoners and also are considered to be high-risk.

    On talk shows, blogs and Internet postings, critics blasted the plans, which prison officials said were designed to prevent an H1N1 outbreak inside Texas' prison system, which is the second largest in the United States and houses more than 150,000 convicts.

    Health officials had been asked Tuesday about allocations of the vaccine and said they could not immediately provide details.

    "Texas has not allocated any swine flu vaccine to prisons at this time," the health agency said in a statement Wednesday. "Prisoners are not a priority group to receive the vaccine and will not be vaccinated ahead of the general public."

    A few sentences later, the statement continued: "A limited supply will be going to the prison system to vaccinate those most at risk."

    Texas had expected to receive 3.4 million doses of the vaccine by mid- October, according to the initial projections from the U.S. Centers for Disease Control and Prevention.

    However, the state has been allocated less than 1.7 million doses so far.

    Carrie Williams, a spokeswoman for the Department of State Health Services, said she has no estimate of how many doses will be provided to the state prison system.

    There is no date for when those doses might start arriving, she said.

    Williams said prison officials have requested about 203,000 doses — the same number that prison officials earlier confirmed.

    Prison system spokeswoman Michelle Lyons reiterated that the agency expects to receive its vaccine shipments "at the same time they are distributed to the public for administration to the identified priority groups and high risk patients."

    She said most prisoners will not receive inoculations ahead of the public.

    Among the state prisons listed by officials as having high-risk prisoners who would be considered a priority for inoculations is the Polunsky Unit, which houses the state's death row.

    Asked Wednesday whether death-row prisoners would be eligible for shots, should enough doses become available, prison officials responded: "The administration of vaccines is based on an offender's medical status — not custody level. Any inmate who is part of the priority groups identified by the CDC would be among the initial groups to receive the vaccine."

    Prison and health officials have cautioned that withholding the vaccine from prisoners until after it's distributed to other people would be a mistake, especially in state prisons where thousands of people live in close quarters, where an outbreak could quickly spread — and quickly jump into the general public as guards and staff members became ill.

    "Not allocating any swine flu vaccine to prisons at this time doesn't seem like a good answer," said House Corrections Committee Chairman Jim McReynolds, a Lufkin Democrat who also serves on the House Public Health Committee.

    "Like it or not, we have a large number of people incarcerated in Texas — in (the Texas Department of Criminal Justice), in (the Texas Youth Commission), in various mental health facilities. We have a responsibility to take care of the people there, the ones who are vulnerable to this illness, the ones who are medically fragile."


    Prisoners won't get H1N1 vaccine before the general public

    Some prisoners in front of line for swine flu shot

    Oct. 27, 2009

    Thousands of prisoners could get vaccinations for swine flu before law-abiding Texans because they fit the criteria for priority inoculations, officials said Tuesday.

    Michelle Lyons, spokeswoman for the Texas Department of Criminal Justice, said more than 45,000 convicts considered to be high-risk have been targeted to receive vaccines, which could start arriving as soon as next week.

    Officials also plan to inoculate more than 40,000 correctional officers and medical personnel who work with those prisoners and also are considered to be at high risk of developing the flu.

    In all, Lyons said the prison system has asked for more than 158,000 doses of vaccine to inoculate all convicts in state prisons and state- contracted private prisons against the H1N1 virus.

    “We have been told that we will start receiving doses by around the first of November in lots of 25,000,” Lyons said.

    If that holds true, prisoners in some parts of Texas could get their shots before members of the public who might need them, a situation that triggered an outcry in Massachusetts. A lawmaker there called for the vaccines to be given to the public first.

    Texas officials say that's off point.

    Allocating resources

    Lyons and Department of State Health Services officials said the decision on who gets the vaccines is set by a distribution policy from the U.S. Centers for Disease Control and Prevention. Under that policy, the initial target groups to receive the shots when the vaccine is first available are: pregnant women, people between 6 months and 24 years old, health care providers and emergency services personnel, people between 25 and 64 years old with medical conditions that put then at higher risk for complications of flu, and people who live with or provide care for infants younger than 6 months.

    “We have a number of the high-risk groups in prisons: pregnant women, people with immune deficiencies, with other serious health issues,” Lyons said. “In some respects, we're like a nursing home or a college dorm. If the flu were to get started in this environment, it could spread quickly.

    “Introducing just one person with the flu into that environment could cause major problems,” she said.

    State Sen. John Whitmire, who heads a legislative committee that oversees state prisons, said enough vaccine should be made available for both public and prison high-risk populations.

    “I can appreciate that people in the free world who are waiting for a shot may not understand why people who are incarcerated are (a) priority, but that doesn't mean we should allow a catastrophic epidemic inside the very enclosed high-risk populations in prison,” said Whitmire, a Houston Democrat.

    “We have a responsibility to take care of high-risk people wherever they are. This shouldn't be an either/or situation.”

    Some prisoners in front of line for swine flu shot


    October 18, 2009

    Months to Live: Fellow Inmates Ease Pain of Dying in Jail


    American prisons house a growing geriatric population. About 75 prisons have started hospice programs; half use inmate volunteers...

    [Read to the complete article, please click on the Title above.]

    Harris Co. jail inmate died from swine flu

    Copyright 2009 HOUSTON CHRONICLE
    Oct. 7, 2009

    A Harris County Jail inmate who was taken to Ben Taub General Hospital died last month as a result of the swine flu virus, Houston health officials confirmed today.

    Kenneth Lane Beckett, 27, was complaining of flu-like symptoms, including a high temperature and elevated pulse, on Sept. 21 when jail medical officials ordered him transferred to the hospital.

    Beckett remained there until his death three days later. While at the hospital, he tested positive for H1N1, better known as swine flu.

    Harris County sheriff's officials said Beckett also had other medical conditions in addition to the swine flu virus.

    “That is the only (H1N1) death within our jurisdiction of a City of Houston resident,“ said Kathy Barton, with Houston's Department of Health and Human Services.

    A Mexico City toddler who died late April at Texas Children's Hospital is no longer being considered a local H1N1 case because the child was not from Houston, Barton said.

    “We have had no pediatric (swine flu) deaths in our jurisdiction in the City of Houston,” Barton said.

    In late September, jail medical officials sent a letter to the Texas Department of State Health Services, asking to be placed on a priority list for the H1N1 vaccine.

    A spokesman for the sheriff's office said the request was not connected to Beckett's death, but because the Harris County Jail processes about 130,000 inmates annually.


    Harris Co. jail inmate died from swine flu

    Swine flu found in jail inmate who died

    Sept. 26, 2009

    A Harris County jail inmate who died on Thursday tested positive for swine flu but his cause of death has not yet been confirmed, officials said Friday.

    Kenneth Lane Beckett became ill on Monday, complaining of flu-like symptoms. He had a high temperature and an elevated pulse when jail medical staff ordered him transferred to Ben Taub General Hospital, officials said.

    He remained there until his death. Ben Taub officials told the sheriff's department they tested Beckett and confirmed that he had the H1N1 virus, commonly known as swine flu.

    “He had underlying serious medical conditions along with the H1N1,“ said Deputy Thomas Gilliland, a Harris County sheriff's spokesman.

    Gilliland said hospital officials declined to tell him the full details of Beckett's other health problems, citing patient privacy rules.

    Earlier this week, jail medical officials sent a letter to the Texas Department of State Health Services, asking to be placed on a priority list for the H1N1 vaccine. Gilliland said the request was not connected to Beckett's death but because the Harris County Jail processes about 130,000 inmates every year.

    As of Aug. 26, there have been 447 reported cases of H1N1 in Houston, according to the city's Department of Health and Human Services. A Mexican toddler who died at Texas Children's Hospital in late April after being transferred from Brownsville remains the sole swine flu death in the Houston area, officials said.

    Beckett had been in the jail for more than two years. He was arrested and charged with murder in the April 19, 2007, fatal shooting of Albert Devon Jones, 34, at an apartment complex in the 10500 block of Beechnut.


    Swine flu found in jail inmate who died

    Hospital prison’s security to be reviewed

    By Chris Paschenko
    The Daily News
    Published September 22, 2009

    GALVESTON — State prison officials plan an extensive review of how Joshua Duane Barnes escaped from the seventh floor of a prison hospital on the University of Texas Medical Branch campus, a prison spokeswoman said Monday.

    City of Galveston officials also are reviewing notification policies after a communication breakdown that thwarted a public alert, a city spokeswoman said.

    “Whenever we have a major incident, we compile a team of prison administrators throughout the state, and they will conduct a review,” Texas Department of Criminal Justice spokeswoman Michelle Lyons said.

    “They’re going to look at security if something needs to be done differently.”

    Both prison and UTMB officials said policies and procedures were followed; however, there are discrepancies in details about who was notified of the escape and when.

    Lyons said initial reports from the prison revealed Barnes escaped at 9:50 p.m., but a mistake was made entering the event in military time. Prison officers discovered Barnes missing at 8:50 p.m., Lyons said.

    Prison guards called 911 from inside the seven-story tower within 10 minutes of the 8:50 p.m. discovery that Barnes was gone, Lyons said.

    Galveston police researched the logs and didn’t find the call.

    Galveston Police Chief Charles Wiley and Barry Cook, a Galveston County Sheriff’s Office spokesman, said state prison officials notified their offices shortly before midnight via a Teletype, a statewide law enforcement database exchange of information.

    It was UTMB police who first called the sheriff’s office at 9:06 p.m. and Galveston police at 9:13 p.m., Wiley and Cook said.

    Galveston police arrived at the medical branch at 9:20 p.m., Wiley said.

    “TDCJ has informed me that their policy is to contact UTMB police, the Department of Public Safety, Galveston County Sheriff’s Office and Galveston police in that order,” Wiley said.

    Wiley asked prison officials to change that policy and notify Galveston police immediately after first contacting campus police, Wiley said.

    “They have agreed to do that,” Wiley said. “I think their policy about notifications delayed our response.”

    Lyons, however, said guards followed policy, which requires them to immediately dial 911.

    A 911 call from Galveston would have reached Galveston police dispatchers; however, Lyons said she didn’t know what agency a prison guard spoke with. Galveston police could find no record of a 911 call.

    The city of Galveston would have used its emergency notification system, to either call, text or e-mail those signed up for notices with information about the escape, Alicia Cahill, a spokeswoman for the city of Galveston, said.

    “The police department took immediate action by saturating the area with officers,” Cahill said. “In their haste to react, they failed to notify their upper command and, unfortunately, this prevented the city from sending an alert through its mass notification system.”

    The city will take quick action to ensure important notices and emergency information are appropriately dispatched in the future, Cahill said.

    A hospital administrator told charge nurses of the escape shortly before 10 p.m., Raul Reyes, a spokesman with the medical branch, said.

    The hospital, however, didn’t send its version of an e-mail, text or phone blast to staff, students and faculty until 7:30 a.m. Sunday, Reyes said.

    That decision was made to allow those students and staff members coming to the campus in the morning to be aware of the situation, Reyes said.

    Only those affiliated with the medical branch, however, are allowed to sign up for those notifications, Reyes said.

    The medical branch relied on state prison officials to notify the public, but medical branch officials will review policies and procedures regarding the incident, Reyes said.

    Hospital prison’s security to be reviewed

    September 22, 2009

    Mental Illness, Human Rights, and US Prisons

    Human Rights Watch Statement for the Record to the Senate Judiciary
    Committee Subcommittee on Human Rights and the Law

    Prisons and Prisoners with Mental Illness: Overview

    Supermaximum Security Prisons and Isolation


    Mental Health and American Prisons: A Human Rights Framework

    Right to Humane Treatment and Rehabilitation

    Right to be Free from Abuse

    Right to Health

    Convention on the Rights of Persons with Disabilities

    Human Rights and Supermax Prisons


    Human Rights Watch appreciates the opportunity to present this statement on mental illness in US prisons to the Senate Judiciary Committee Subcommittee on Human Rights and the Law. We commend the Subcommittee for recognizing the importance of securing respect for human rights here in the United States as well as overseas. The specific focus on the rights of persons who have a mental illness and who are incarcerated in the United States is particularly welcome.

    Human Rights Watch has worked for many years to improve protection for the rights of US prisoners, including those with mental illnesses, and we stand ready to assist the Subcommittee with its efforts in any way we can. In this statement we will present a brief overview of the problems faced by mentally ill persons who are incarcerated and the human rights that are implicated.[1] We will also offer several recommendations for Congressional action that we hope the Subcommittee will consider.

    Prisons and Prisoners with Mental Illness: Overview

    Prisons were never designed as facilities for the mentally ill, yet that is one of their primary roles today. Many of the men and women who cannot get mental health treatment in the community are swept into the criminal justice system after they commit a crime. According to the Bureau of Justice Statistics, 56 percent of state prisoners and 45 percent of federal prisoners have symptoms or a recent history of mental health problems.[2] Prisoners have rates of mental illness- including such serious disorders as schizophrenia, bipolar disorder, and major depression-that are two to four times higher than members of the general public. Studies and clinical experience consistently indicate that 8 to 19 percent of prisoners have psychiatric disorders that result in significant functional dis abilities, and another 15 to 20 percent will require some form of psychiatric inter vention during their incarceration.

    Mental health treatment can help some prisoners recover from their illness and for many others it can alleviate its painful symptoms, prevent deterioration, and protect them from suicide. It can enhance independent functioning and encourage the development of more effective internal controls. By helping individual prisoners regain health and improve coping skills, mental health treatment promotes safety and order within the prison environment and enhances community safety when prisoners are ultimately released.

    Unfortunately, prisons are ill-equipped to respond appropriately to the needs of prisoners with mental illness. Prison mental health services are all too frequently woefully deficient, crippled by understaffing, insufficient facilities, and limited programs. Many seriously ill prisoners receive little or no meaningful treatment.

    Although there are many conscientious and committed mental health professionals working in corrections, they face daunting if not insurmountable challenges to meeting the needs of their patients: impossibly large caseloads, physically unpleasant facilities, and institutional cultures that are unsympathetic to the importance of mental health services. Gains in mental health staffing, programs, and physical resources that were made in recent years have all too frequently since been swamped by the tsunami of prisoners with serious mental health needs. Overburdened staff are hard pressed to respond even to psychiatric emergencies, much less to promote recovery from serious illness and the enhancement of coping skills.

    Mindful of budget constraints and scant public support for investments in the treatment (as opposed to punishment) of prisoners, elected officials have been reluctant to provide the funds and leadership needed to ensure prisons have sufficient mental health resources. Twenty-two out of forty state correctional systems reported in a recent survey that they did not have an adequate number of mental health staff.[3]

    Without the necessary care, mentally ill prisoners suffer painful symptoms and their conditions can deteriorate. They are afflicted with delusions and hallucinations, debilitating fears, or extreme mood swings. They huddle silently in their cells, mumble incoherently, or yell incessantly. They refuse to obey orders or lash out without apparent provocation. They beat their heads against cell walls, smear themselves with feces, self-mutilate, and commit suicide.

    Doing time in prison is hard for everyone. Prisoners struggle to maintain their self-respect and emotional equilibrium in facilities that are typically tense, overcrowded, fraught with the potential for violence, cut off from families and communities, and devoid of opportunities for meaningful education, work, or other productive activities. But life in prison is particularly difficult for prisoners with mental illnesses that impair their thinking, emotional responses, and ability to cope. They are more likely to be exploited and victimized by other prisoners. They are less likely to be able to adhere to the countless formal and informal rules of a strictly regimented life and often have higher rates of rule-breaking than other prisoners.

    Supermaximum Security Prisons and Isolation

    When mentally ill prisoners break the rules, officials punish them as they would any other prisoner, even when their conduct reflects the impact of mental illness.[4] If lesser sanctions do not curb the behavior, officials "segregate" the prisoners from the general prison population, placing them in supermaximum security ("supermax") prisons or in segregation units within regular prisons. Once isolated, continued misconduct-often connected to mental illness-can keep them there indefinitely. A disproportionate number of the prisoners in segregation are mentally ill.[5]

    Prison officials across the country have increasingly embraced long- term segregation to manage and/or to discipline prisoners who are perceived to be dangerous, but also those who are seen as difficult or disturbing. Supermax prisons such as Tamms Correctional Center in Illinois or segregation units in other prisons constitute the modern day variant of solitary confinement. Prisoners are confined 23 to 24 hours a day in small cells that frequently have solid steel doors.

    They live with extensive surveillance and security controls, the absence of ordinary social interaction, abnormal environmental stimulus, a few hours a week of "recreation" alone in caged enclosures, and little, if any, educational, vocational, or other purposeful activities. They are handcuffed and frequently shackled every time they leave their cells.

    Prolonged confinement under such conditions can be psychologically harmful to any prisoner, with the nature and severity of the impact depending on the individual, the duration, and the specific conditions (for example, access to natural light, radio, or books).

    It can provoke anxiety, depression, anger, cognitive disturbances, perceptual distortions, obsessive thoughts, paranoia, and psychosis.

    [6] But the risk of harm is particularly grave for prisoners who already have serious mental illnesses. The stress, lack of meaningful social contact, and unstructured days can exacerbate symptoms of illness or provoke a reoccurrence. Suicides occur proportionately more often in segregation units than elsewhere in prison. All too frequently, mentally ill prisoners decompensate in isolation, requiring crisis care or psychiatric hospitalization. Many simply will not get better as long as they are isolated. According to one federal judge, putting mentally ill prisoners in isolated confinement "is the mental equivalent of putting an asthmatic in a place with little air...."[7] A recent story in the Belleville News- Democrat about Tamms profiled one prisoner with a well-documented history of paranoid schizophrenia who was held in solitary for nearly six years, mutilating himself and smearing feces.[8] Other Tamms prisoners reportedly cut themselves, eat their own flesh, attempt suicide, and engage in other behaviors consistent with suffering from serious and untreated or poorly treated mental illness.

    The psychological harm of supermaximum security confinement is exacerbated because mental health professionals are not permitted to provide a full range of mental health treatment services to the prisoners. Mental health services are typically limited to psychotropic medication, a health care clinician stopping at the cell front to ask how the prisoner is doing (that is, "mental health rounds"), and occasional meetings in private with a clinician.[9] Individual therapy, group therapy, structured educational, recreational, or life-skill enhancing activities, and other therapeutic interventions are usually not available because of insufficient resources and clashes with prison rules-for example, insufficient numbers of custodial staff to take prisoners to and from their cells to private meetings with clinicians, and rules requiring prisoners to remain in their cells and prohibiting contact with other prisoners.[10]

    In every class action challenging the placement of mentally ill prisoners in supermax confinement, plaintiffs have either won a court order or obtained a settlement prohibiting or greatly limiting such confinement.[11] As a result, in prisons covered by the litigation, mentally ill prisoners are given more time out of their cells and greater access to mental health professionals and programs. Improved clinical responses of prisoners with mental illness in these prisons have been achieved without compromising safety or security.

    Unfortunately, except in the small number of prisons covered by this litigation, mentally ill prisoners continue to be sent to segregation; indeed, they are often disproportionately represented in segregation units.


    There is increasing awareness among public officials of the importance of providing re-entry services to prisoners leaving prison as an effective means of increasing the likelihood they will successfully make the transition back to the community. Men and women with mental illness have unique needs for discharge planning and re- entry services. In addition to support for housing, employment, and income, they also need links to appropriate mental health treatment and access to public assistance. According to the Council of State Governments:

    individuals with mental illnesses leaving prison without sufficient supplies of medication, connections to mental health and other support services, and housing are almost certain to decompensate, which in turn will likely result in behavior that constitutes a technical violation of release conditions or a new crime.[12]

    Unfortunately, the need for re-entry services far exceeds the supply.

    All too many mentally ill prisoners leave prison without arrangements to ensure they will continue to receive an appropriate level of mental health treatment, without ready access to public assistance, and without assistance to navigate the difficult waters of life after prison, in which the stigma of being a felon now accompanies all the problems that existed before incarceration.

    Mental Health and American Prisons: A Human Rights Framework

    Human rights standards acknowledge the unique vulnerability of prisoners to abuse and afford special protections to them. The UN Human Rights Committee has affirmed the "positive obligation" of states to protect the rights of those whose vulnerability arises from their status as persons deprived of their liberty.[13]

    Several discrete but inter-related human rights concepts are particularly relevant to the treatment of prisoners with mental illness: human dignity, the right to rehabilitation, the right to the highest attainable standard of health, and the right to freedom from torture or cruel, inhuman or degrading treatment or punishment. A prison operated within a human rights framework would provide a full range of mental health services with the staffing, resources, and facilities needed to serve the prison's population. Custodial policies and practices would be adjusted to ensure security and safety needs do not compromise mental health treatment. Staff would no longer constantly find themselves forced to choose between what they know they "should" be doing in terms of standards of care and sound principles of treatment, and what is feasible in the circumstances.

    Respect for human rights of prisoners not only underpins and protects the fundamental values agreed on by the international community, it promotes safe and effective prison management. Unfortunately, human rights standards are all too often honored in the breach in US prisons. They are little known and almost never directly applied.

    Right to Humane Treatment and Rehabilitation

    All human rights are grounded in the inherent dignity of all persons, as affirmed in 1948 by the Universal Declaration of Human Rights. Recognizing the temptation to ignore the human dignity of persons who are confined in prisons, article 10(1) of the International Covenant on Civil and Political Rights (ICCPR), to which the United States is a party, expressly requires all prisoners to be treated, by all officials and anyone else, "with humanity and with respect for the inherent dignity of the human person." Compliance with article 10 requires prison management to ensure mental health treatment for prisoners with mental disabilities as well as humane conditions of confinement. The failure to provide adequate mental health services in prison cannot be excused by the cost of ensuring adequate numbers of qualified staff or sufficient facilities for responding to mental health needs. The Human Rights Committee has affirmed that the application of article 10, promoting the right to humane treatment, "cannot be dependent on the material resources available."[14]

    Respect for the human dignity of prisoners also requires operating prisons in ways that will enhance the likelihood of their successful re-entry into the community upon release. Article 10 of the ICCPR requires the "essential aim" of imprisonment to be "reformation and social rehabilitation." It thus mandates a positive goal for corrections, something beyond mere punishment through deprivation of liberty. As stated in the UN-approved Standard Minimum Rules for the Treatment of Prisoners ("SMR"), imprisonment should be "used to ensure, so far as possible, that upon his return to society the offender is not only willing but able to lead a law-abiding and self- supporting life...."[15] Mental health treatment obviously has an important role in rehabilitation for prisoners who have or are at risk of developing mental disorders. As the SMR states:

    The medical services of the institution shall seek to detect and shall treat any physical or mental illnesses or defects which may hamper a prisoner's rehabilitation. All necessary medical, surgical and psychiatric services shall be provided to that end.[16]

    The SMR also sets forth different regimes that are appropriate depending on the severity of the mental illness. According to the SMR, persons found to be "insane" should not be kept in prisons but should instead be transferred to appropriate medical institutions; prisoners who are "mentally abnormal" should be "observed and treated in specialized institutions under medical management."[17] For prisoners with mental disabilities who remain in their care, all prisons should provide health services that are "organized in close relationship to the general health administration of the community or nation" and which include "a psychiatric service for the diagnosis and, in proper cases, the treatment of states of mental abnormality."[18]

    A human rights approach to mental health treatment for prisoners further recognizes the importance of continuity of care to ensure that individuals have access to treatment once released. The SMR notes that correctional facilities should work with the appropriate agencies to determine what after-care services are necessary and can be arranged so that individuals will have necessary treatment, care, and support when they return to the community.[19]

    Right to be Free from Abuse

    Article 7 of the ICCPR states that no one "shall be subjected to torture or to other cruel, inhuman or degrading treatment or punishment,"[20] a prohibition that is further developed by the Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (CAT) , to which the United States is also a party.[21] The Human Rights Committee has confirmed that "[n]o justification or extenuating circumstances may be invoked to excuse a violation of Article 7 for any reason."[22] Under CAT, torture is defined as an act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person for a specific purpose (for example, to obtain a confession or as punishment) and with the involvement of a public official.[23] The infliction, or in many cases, the toleration of suffering that does not constitute torture-for example, because it is less severe or because it is not intentionally inflicted-constitutes cruel, inhuman, or degrading treatment. Neglecting to provide needed treatment to alleviate mental suffering may violate article 7 as may deliberately withholding such treatment. The prohibition should be interpreted to extend the widest possible protection against abuses, whether physical or mental.

    The UN Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment points out that persons with disabilities "are often segregated from society in institutions, including prisons ... [in which they] are frequently subjected to unspeakable indignities, neglect, severe forms of restraint and seclusion, as well as physical, mental and sexual violence."[24] In determining whether a person with disabilities has been subjected to torture or other prohibited cruel treatment, the Special Rapporteur notes that "assessing the level of suffering or pain, relative in its nature, requires considering the circumstances of the case, including the existence of a disability, as well as looking at the acquisition or deterioration of impairment as a result of the treatment or conditions of detention in the victim."[25]

    If prisoners' mental health deteriorates and they endure serious psychological suffering because they have not been provided the mental health treatment that is needed, their right to be free of cruel or inhuman treatment may have been violated. Article 7 may also be violated if prisoners are confined under conditions that put them at high risk of psychological harm, such as solitary confinement.

    Right to Health

    The Universal Declaration of Human Rights (UDHR) affirms a person's right to health, irrespective of legal status.[26] Under the International Covenant on Economic, Social and Cultural Rights (ICESCR), to which the United States is a signatory, states must ensure "the right of everyone to the enjoyment of the highest attainable standard of physical and mental health" and, in furtherance of this goal, must create "conditions which would assure to all medical service and medical attention in the event of sickness."[27] The Committee on Economic, Social and Cultural Rights interprets the right to health under article 12 of the ICESCR to place states "under the obligation to respect the right to health by, inter alia, refraining from denying or limiting equal access for all persons, including prisoners or detainees, minorities, asylum seekers and illegal immigrants, to preventive, curative and palliative health services."[28] Although the United States has yet to ratify the Covenant, it is bound to honor its responsibilities as a signatory.

    Principle 9 of the UN Basic Principles for the Treatment of Prisoners states, "Prisoners shall have access to the health services available in the country without discrimination on the grounds of their legal situation."[29] Similarly, principle 20 of the UN Principles for the Protection of Persons with Mental Illnesses and the Improvement of Mental Health Care states that all persons serving sentences "should receive the best available mental health care" with treatment and care consistent with that outlined for individuals who are not incarcerated.[30]

    Convention on the Rights of Persons with Disabilities

    On July 24, 2009, President Obama announced that the United States would sign the Convention on the Rights of Persons with Disabilities, which was then signed on July 30. Introducing this decision, President Obama stated, "Disability rights aren't just civil rights to be enforced here at home; they're universal rights to be recognized and promoted around the world."[31] The Convention makes clear that attention to disability-including mental disability-is not only an issue of treatment and welfare but is essential to the proper administration of justice.[32] As a signatory to the Convention, the United States has an opportunity and an obligation to expand its protection of people with disabilities, including those with mental disabilities who are incarcerated.

    Many of the provisions of the Convention have unique relevance for prisoners with mental disabilities. The Convention in article 5, for example, prohibits discrimination on the basis of disability, and requires states to provide "reasonable accommodation" to persons with disabilities. The Special Rapporteur on Torture has pointed out that the lack of reasonable accommodation in detention facilities may increase the risk of exposure to neglect, violence, abuse, torture, and ill-treatment.[33] In addition, article 15 of the Convention affirms the right to be free of torture or cruel, inhuman or degrading treatment or punishment, article 16 prohibits violence, abuse, and exploitation of persons with disabilities, and article 17 recognizes the right of every person with disabilities to respect for his or her physical and mental integrity. In addition to violating other rights, placing prisoners with mental disabilities in solitary confinement may constitute a violation of the Convention on the Rights of Persons with Disabilities.

    Human Rights and Supermax Prisons

    Human rights experts have long criticized prolonged solitary confinement, understood as physical isolation in a cell for 22 to 24 hours a day, such as exists in US supermax prisons. In 2008, the Special Rapporteur on Torture concluded that "the prolonged isolation of detainees may amount to cruel, inhuman or degrading treatment or punishment, and, in certain instances, may amount to torture."[34] Based on his research, he found that "the key adverse factor of solitary confinement is that socially and psychologically meaningful contact is reduced to the absolute minimum, to a point that is insufficient for most detainees to remain mentally well functioning."[35] He stated that solitary confinement should only be used "in very exceptional cases" and "only as a last resort";[36] the Special Rapporteur further noted that holding persons with mental illness in solitary confinement "cannot be justified for therapeutic reasons, or as a form of punishment."[37] In 2007, the Special Rapporteur participated in the Fifth International Psychological Trauma Symposium held in Istanbul, Turkey, and with other prominent international experts produced a document titled the Istanbul Statement on the Use and Effects of Solitary Confinement. Noting that solitary confinement "harms prisoners who were not previously mentally ill and tends to worsen the mental health of those who are," the Istanbul Statement concludes that "solitary confinement should only be used in very exceptional cases, for as short a time as possible and only as a last resort."[38] It should be "absolutely prohibited ... for mentally ill prisoners."[39]

    In 2006, the Human Rights Committee, reviewing US compliance with the ICCPR, stated that it:

    reiterates its concern that conditions in some maximum security prisons are incompatible with the obligation contained in article 10 (1) of the Covenant to treat detainees with humanity and respect for the inherent dignity of the human person. It is particularly concerned by the practice in some such institutions to hold detainees in prolonged cellular confinement, and to allow them out-of-cell recreation for only five hours per week, in general conditions of strict regimentation in a depersonalized environment. It is also concerned that such treatment cannot be reconciled with the requirement in article 10 (3) that the penitentiary system shall comprise treatment the essential aim of which shall be the reformation and social rehabilitation of prisoners. It also expresses concern about the reported high numbers of severely mentally ill persons in these prisons, as well as in regular in U.S. jails.[40]

    Similarly, the Committee against Torture on reviewing US compliance with CAT also expressed concern "about the extremely harsh regime imposed on detainees in ‘supermaximum prisons'. The Committee is concerned about the prolonged isolation periods detainees are subjected to, the effect such treatment has on their mental health, and that its purpose may be retribution, in which case it would constitute cruel, inhuman or degrading treatment or punishment."[41]


    Prescriptions for mental health care in prisons are plentiful. They are found in the standards and guidelines of the American Correctional Association and the National Commission on Correctional Health Care, in court rulings, expert reports, and in a voluminous professional literature. What is lacking in prison mental health services is not knowledge about what to do, but the resources and commitment to do it. We hope the work of the Subcommittee will help marshal those resources and that commitment. Compassion, common sense, fiscal prudence, and respect for human rights dictate a better approach to the treatment of persons with mental illness in US prisons than is evident today.

    The recommendations that follow focus on several key steps we believe Congress should take.

    •1. Amend the Prison Litigation Reform Act (PLRA)

    The Prison Litigation Reform Act of 1996 has placed serious obstacles in the path of prisoners seeking to protect their rights while incarcerated, including their rights to mental health treatment and services.[42] One PLRA provision requires federal courts to dismiss prisoner lawsuits if prisoners have not exhausted the prison or jail grievance system. Prisoners with mental illness can find it impossible to comply with all the deadlines and technical rules in a grievance system, and may then find themselves forever barred from vindicating their rights in court. On the other hand, correctional agencies legitimately want a reasonable opportunity to respond to prisoners' complaints before having to defend themselves in court.

    Congress should amend the PLRA to remove the current exhaustion requirement and substitute a provision allowing courts to stay lawsuits temporarily to allow prisoners to take their complaints through the grievance system. Congress should also repeal the PLRA provision that denies compensation for "mental or emotional injury" absent a prior showing of physical injury. Although isolated confinement and deficient mental health care can cause serious suffering and catastrophic injury to a prisoner's psychiatric condition, the PLRA's "physical injury" requirement bars a remedy for such injuries if the prisoner has not been physically injured as well. The Committee Against Torture called for repeal of the "physical injury" requirement when it last reviewed US compliance with the Convention Against Torture in 2006.[43]

    •2. Reduce High Incarceration Rates

    The United States has the highest rate of incarceration in the world because it puts so many people behind bars for low-level, nonviolent offenses and for lengthy periods of time. Prison should be reserved for dangerous or violent prisoners who must be securely confined; alternative sanctions should be used for low-level, nonviolent offenders. If prison populations were reduced there would be fewer persons with mental illness behind bars and more resources available for those who must be incarcerated. Congress should enact incentives to encourage states to reduce their prison populations and it should review federal laws to ensure federal prisons are not needlessly incarcerating low-level prisoners, including low-level drug offenders.

    •3. Increase Funding for Mental Health Treatment in Prison

    Through the Mentally Ill Offender Treatment and Crime Reduction Act of 2004, which was reauthorized and extended for an additional five years in 2008, Congress has provided resources to state and local governments to design and implement collaborative initiatives between criminal justice and mental health systems that will improve access to effective treatment for people with mental illnesses involved with the justice system. To date, however, most of the funding awarded by the Bureau of Justice Assistance under the Act has gone to either pre- trial or post-release initiatives. Congress should ensure that federal funds are also used to improve the provision of mental health services to persons with mental disorders while they are incarcerated.

    •4. Eliminate Prolonged Isolation of Mentally Ill Prisoners

    Congress should use its powers to protect prisoners with mental illness from being confined in the harsh isolation conditions typical of supermax prisons and other segregation or isolation units. It should directly instruct the Bureau of Prisons (BoP) to end this harmful practice. It should also pass legislation precluding the awarding of federal funds for the construction or operation of any state prison or local jail if the jurisdiction has not instituted policies and practices to ensure mentally ill prisoners are not placed or kept in supermax prisons or other segregation units.

    Prisoners with mental illness who require extreme security precautions should be confined in specialized units that ensure human interaction and purposeful activities in addition to a full panoply of mental health services.

    •5. Improve Correctional Mental Health Services

    In addition to increasing the flow of federal funds to support correctional mental health services provided by state and local jurisdictions, there are a number of other steps Congress could take to improve the treatment and conditions of confinement of prisoners with mental illness. We suggest only a few here.

    a) With regard to the BoP, it should ensure periodic performance reviews of its mental health services by independent and qualified experts. The results of those evaluations should be public (with the names of prisoners kept confidential).

    b) It should provide funds to states and localities to evaluate their mental health services and to develop corrective action plans.

    c) It should ensure that the Special Litigation Section of the Civil Rights Division of the Department of Justice has sufficient staff and resources to investigate and where necessary litigate violations of the Eighth Amendment that result from deficient mental health treatment of prisoners and from their placement in supermax prisons or segregation units.

    •6. Improve Ex-prisoner Access to Public Benefits Covering Mental Health Services

    Congress should secure changes to current law and regulations in federal programs that fund mental health services that lead to delays in the restoration of eligibility for benefits for prisoners released from prison. Enabling ex-prisoners to receive Medicaid, Supplemental Security Income, and Social Security Disability Insurance immediately upon leaving prison would enable them to pay for needed medication and mental health services in the community and to ensure continuity of care. Rapid restoration of benefits to released prisoners helps them manage their illness and reduces their risk of re-involvement with the criminal justice system.

    [1] Our research, findings, and recommendations on this issue are fully developed in our report, Human Rights Watch, Ill-Equipped: US Prisons and Offenders with Mental Illness, October 2003, http:// www.hrw.org/en/reports/2003/10/21/ill-equipped-0.

    [2] Doris J. James and Lauren E. Glaze, "Mental Health Problems of Prison and Jail Inmates," Bureau of Justice Statistics, September 2006, http://www.ojp.usdoj.gov/bjs/abstract/mhppji.htm (accessed September 21, 2009).

    [3] Cece Hill, "Inmate mental health care," Corrections Compendium, vol. 29, no. 5, 2004, pp.15-31.

    [4] Jamie Fellner, "A Corrections Quandary," Harvard Civil Rights- Civil Liberties Law Review, vol. 41, 2006, pp. 391-412.

    [5] David Lovell, "Patterns of disturbed behavior in a supermax prison," Criminal Justice and Behavior, vol. 35, no. 8, 2008, pp. 985-1004; Maureen L. O'Keefe and Marissa J. Schnell, "Offenders with mental illness in the correctional system," Journal of Offender Rehabilitation, vol. 45, no. 1, 2007, pp. 81-104.

    [6] Jeffrey Metzner and Joel Dvoskin, "An overview of correctional psychiatry," Psychiatric Clinics of North America, vol. 29, no. 3, September 2006, pp. 761-772.

    [7] Madrid v. Gomez, 889 F. Supp. 1146, 1265 (N.D. Cal. 1995).

    [8] Beth Hundsdorfer and George Pawlaczyk, "Trapped in Tamms: Inmates in Illinois' Only Supermax Prison Face Battle Proving Mistreatment," Belleville News-Democrat, August 4, 2009, http://www.bnd.com/600/ story/865378.html (accessed September 16, 2009).

    [9] See, for example, Madrid v. Gomez.

    [10] Jeffrey Metzner and Joel Dvoskin, "An overview of correctional psychiatry," Psychiatric Clinics of North America.

    [11] See David C. Fathi, "The Common Law of Supermax Litigation," Pace Law Review, vol. 24, 2004, 681-682.

    [12] Council of State Governments, "Criminal Justice/Mental Health Consensus Project Report, Chapter IV: Incarceration and Reentry, Policy Statement 21: Development of Transition Plan," June 2002, http://consensusproject.org/the_report/ch-IV/ps21-transition-plan (accessed September 21, 2009).

    [13] Human Rights Committee, General Comment 21, article 10 (Forty- fourth session, 1992), replaces general comment 9 concerning humane treatment of persons deprived of liberty, U.N. Doc. HRI/GEN/1/Rev.1 at 33 (1994), http://www.unhchr.ch/tbs/doc.nsf/ 0/3327552b9511fb98c12563ed004cbe59?Open... (accessed September 21, 2009).

    [14] Ibid.

    [15] Standard Minimum Rules for the Treatment of Prisoners (SMR), adopted by the First United Nations Congress on the Prevention of Crime and the Treatment of Offenders, held at Geneva in 1955, and approved by the Economic and Social Council by its resolutions 663 C (XXIV) of 31 July 1957 and 2076 (LXII) of May 13, 1977, http:// www2.ohchr.org/english/law/treatmentprisoners.htm (accessed September 21, 2009), art. 58.

    [16] SMR, art. 62.

    [17] SMR, art. 82.

    [18] SMR, art. 22.1.

    [19] SMR, art. 81.

    [20] International Covenant on Civil and Political Rights (ICCPR), adopted December 16, 1966, G.A. Res. 2200A (XXI), 21 U.N. GAOR Supp. (No. 16) at 52, U.N. Doc. A/6316 (1966), 999 U.N.T.S. 171, entered into force March 23, 1976, ratified by the United States on June 8, 1992, http://www.hrweb.org/legal/cpr.html (accessed September 21, 2009).

    [21] Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (Convention against Torture), adopted December 10, 1984, G.A. res. 39/46, annex, 39 U.N. GAOR Supp. (No. 51) at 197, U.N. Doc. A/39/51 (1984), entered into force June 26, 1987, ratified by the Unites States on October 21, 1994, http:// www.hrweb.org/legal/cat.html (accessed September 21, 2009).

    [22] Human Rights Committee, General Comment 20, article 7 (Forty- fourth session, 1992), replaces general comment 7 concerning prohibition of torture, or other cruel, inhuman or degrading treatment or punishment, U.N. Doc. HRI/GEN/1/Rev.1 at 30 (1994), http://www.unhchr.ch/tbs/doc.nsf/0/6924291970754969c12563ed004c8ae5? Open... (accessed September 21, 2009).

    [23] "The prohibition in article 7 [of the ICCPR] relates not only to acts that cause physical pain but also to acts that cause mental suffering to the victim." Human Rights Committee, General Comment 20. For a recent discussion of psychological torture, see Hernan Reyes, "The worst scars are in the mind: psychological torture," The International Review of the Red Cross, vol. 89, no. 867, September 2007.

    [24] UN General Assembly, Interim report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, Manfred Nowak, A/63/175, July 28, 2008, http:// daccessdds.un.org/doc/UNDOC/GEN/N08/440/75/PDF/N0844075.pdf?OpenE... (accessed September 21, 2009), pp. 10-11.

    [25] Ibid.

    [26] Article 25.1 of the Universal Declaration of Human Rights (UDHR) states, "Everyone has the right to a standard of living adequate for the health and wellbeing of himself and of his family, including food, clothing, housing and medical care..." UDHR, adopted December 10, 1948, G.A. Res. 217A(III), U.N. Doc. A/810 at 71 (1948), art. 25.1, http://www.udhr.org/UDHR/default.htm (accessed September 17, 2009).

    [27] International Covenant on Economic, Social and Cultural Rights (ICESCR), adopted December 16, 1966, G.A. Res. 2200A (XXI), 21 U.N. GAOR Supp. (No. 16) at 49, U.N. Doc. A/6316 (1966), 993 U.N.T.S. 3, entered into force January 3, 1976, http://www.un-documents.net/ icescr.htm (accessed September 17, 2009), art. 12.

    [28] CESCR, General Comment No. 14, The right to the highest attainable standard of health, E/C.12/2000/4 (2000), http:// www.unhchr.ch/tbs/doc.nsf/(Symbol)/40d009901358b0e2c1256915005090be? Opendocument (accessed September 17, 2009).

    [29] UN Basic Principles for the Treatment of Prisoners, G.A. res. 45/111, annex, 45 U.N. GAOR Supp. (No. 49A) at 200, U.N. Doc. A/45/49 (1990), http://www.un.org/documents/ga/res/45/a45r111.htm (accessed September 17, 2009).

    [30] UN General Assembly, UN Principles for the Protection of Persons with Mental Illnesses and the Improvement of Mental Health Care, Principle 20, GA Resolution 46/119 (1991), principles 4.2, 4.3, 13.1 (d), available at http://www.un.org/documents/ga/res/46/a46r119.htm (accessed September 17, 2009).

    [31] "Remarks by the President on the Signing of the Convention on the Rights of Persons with Disabilities Proclamation," The White House Press Release, July 24, 2009, http://www.whitehouse.gov/ the_press_office/Remarks-by-the-President-on-R... (accessed September 17, 2009).

    [32] Article 13 of the Convention emphasizes that prison staff need training "to ensure effective access to justice for persons with disabilities." UN General Assembly, Convention on the Rights of Persons with Disabilities, adopted January 24, 2007, A/RES/61/106, entered into force May 3, 2008, signed by the United States on July 30, 2009, http://www.unhcr.org/refworld/docid/45f973632.html (accessed September 17, 2009).

    [33] UN General Assembly, Interim report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, Manfred Nowak, July 28, 2008, pp. 10-11.

    [34] Ibid., p. 18.

    [35] Ibid., p. 21.

    [36] Ibid.

    [37] Ibid., p. 13.

    [38] Istanbul Statement on the Use and Effects of Solitary Confinement, adopted on December 9, 2007 at the International Psychological Trauma Symposium, Istanbul, available at: http:// solitaryconfinement.org/uploads/Istanbul_expert_statement_on_sc.p... (accessed September 21, 2009), pp. 80-81.

    [39] Ibid.

    [40] United Nations Human Rights Committee, "Consideration of reports submitted by States parties under Article 40 of the Covenant, Concluding Observations of the Human Rights Committee, United States of America," U.N. Doc. CCPR/C/USA/CO/3 (2006), http://www.unhchr.ch/ tbs/doc.nsf/%28Symbol%29/CCPR.C.USA.CO.3.En?Opendoc... (accessed September 21, 2009).

    [41] United Nations Committee Against Torture, "Consideration of reports submitted by States parties under Article 19 of the Convention, Conclusions and Recommendations of the Committee against Torture, United States of America," U.N. Doc. CAT/C/USA/CO/2 (2006), http://www1.umn.edu/humanrts/cat/observations/usa2006.html (accessed September 21, 2009), art. 36.

    [42] See Human Rights Watch, No Equal Justice: The Prison Litigation Reform Act in the United States, June 2009, http://www.hrw.org/en/ reports/2009/06/16/no-equal-justice-0.

    [43] United Nations Committee Against Torture, "Consideration of reports submitted by States parties under Article 19 of the Convention, Conclusions and Recommendations of the Committee against Torture, United States of America," U.N. Doc. CAT/C/USA/CO/2 (2006), http://www1.umn.edu/humanrts/cat/observations/usa2006.html (accessed September 21, 2009), art. 29.

    Mental Illness, Human Rights, and US Prisons

    September 02, 2009

    Older offenders driving TDCJ healthcare costs

    Texas' Correctional Managed Health Care Committee meets in Dallas next week and they've posted the backup material related to their agenda online. (Large file - 169-page pdf.)

    Here are a few highlights that jumped out at me from that lengthy document:

    Correctional managed care in Texas lost a total of $24.2 million in the first three quarters of FY 2009, with losses of $5-7 million per month throughout the spring. One of the attachments describes $48 million the Lege approved in supplemental funding to UTMB and Texas Tech to cover these shortfalls. Who knows, however, if they've accurately budgeted going forward?

    In the most recent quarter, vacancy rates for psychiatrists at TDCJ topped 35%. The vacancy rate for physicians was 15% - a little higher for nurses and dentists.

    Even though the overall inmate population is declining slightly, the older, sicker inmate population continues to increase, according to the minutes from the committee's last meeting:

    Mr. McNutt ... reported that the offender population slightly decreased to 150,225 at the end of the second quarter FY 2009 compared to 151,723 for the same time period a year ago.

    The aging offenders continue to rise at a steady rate and Mr. McNutt reported that the number of offenders 55+ at the end of second quarter FY2008 was 10,211 compared to 10,824 this second quarter FY 2009 which is an increase of about 5.9%.

    More on why older offenders are more expensive:

    the older offenders access the health care delivery system at a much higher acuity and frequency than younger offenders. Hospital costs received to date this fiscal year for older offenders averaged approximately $1,634 per offender vs. $260 for younger offenders.

    While comprising only about 7.2% of the overall service population, older offenders account for 32.7% of the hospitalization costs. Older offenders are represented four times more often in the dialysis population averaging about $20.8K per patient per year.

    Providing dialysis treatment for an average of 188 patients through this quarter cost $1,961,176.

    In the next biennium, the Legislature budgeted $97.8 million for psychiatric care and $836.7 million for acute care - that's nearly a billion dollars per biennium for Texas inmate healthcare, with the number of older, high-cost inmates growing.

    Of inmates recommended by TDCJ as good candidates for "Medically Recommened Intensive Supervision," the parole board refused to consider 76% of them in 2008. Of those they agree to consider, 90% were approved.

    At UTMB, which provides care for about four-fifths of Texas inmates, nurses account for 77% of inmate encounters with health care providers; physicians just 9.3%, mental health providers 5.5%, dentists 4.7%. For inmates covered by Texas Tech, only 74% of encounters were with nurses and just 5.7% were with physicians.

    Finally, when money is tight, prevention gets cut. Another attachment says only 3,350 inmates participated in peer education in March 2009 systemwide compared to 7,334 in March 2008; peer education numbers were also lower in April and May.

    There's a lot more information in this lengthy document, but those are the items that stood out upon initial perusal.

    Posted by Gritsforbreakfast

    Labels: Health, TDCJ

    Troubled prison firm's deal for new psychiatric hospital raises questions

    July 10, 2009
    The Dallas Morning News eramshaw@dallasnews.com

    AUSTIN – A private prison company's history of filthy conditions, sexual abuse, suicides and riots in some of its Texas lockups isn't stopping the state from paying it $7.5 million to run a new psychiatric hospital near Houston.

    Lawmakers inserted an earmark into the state budget to fund the future Montgomery County facility starting in 2011. But they said they didn't know until this week that the county had selected the GEO Group to operate it, although GEO lobbyists were pushing for it as early as February.

    The new facility came as a post-session shock to mental health advocates, who acknowledge the need for it. But they say they weren't informed about it and never would have signed off if they knew Florida-based GEO was operating it.

    "Why would we want to use an entity that hasn't had a stellar reputation?" asked Monica Thyssen, children's mental health policy specialist with Advocacy Inc. "If the process had been more transparent, there probably would have been other state officials who would've said, 'I don't know if GEO is the best use of state dollars.'"

    GEO officials, who run more than 50 facilities in the United States, including five mental health facilities in Florida, declined to comment, saying in an e-mail that they don't discuss "specific business development efforts and/or contracts."

    But state lawmakers say the psychiatric facility, which by 2011 is expected to house more than 100 criminal offenders awaiting trials or competency findings, will solve a major backlog. The Montgomery County jail has hundreds of inmates awaiting mental health treatment.

    The nearest state forensic mental hospital is more than 100 miles away, and when a bed opens up, it takes at least two deputies to take an offender there.

    "It's a problem we sorely need to address, instead of leaving people who need mental health care in prison," said Sen. Bob Deuell, R- Greenville, one of the Senate's budget writers.

    But the budgeting process and the choice of contractor have raised some eyebrows.

    Department of State Health Services officials, who oversee psychiatric care in Texas, say the Montgomery County facility was not something they requested funding for in the budget. It was added to the budget in conference committee.

    Mental health advocates, who track psychiatric hospital legislation closely, say they never heard any public discussion about it. And neither Deuell nor Sen. Tommy Williams, who represents Montgomery County, knew until a reporter's phone call that county officials had selected GEO subsidiary GEO Care to run the facility – though legislative documents indicate the company was pushing for it as early as February.

    "I know [GEO] has had problems," said Williams, R-The Woodlands. "Certainly I would expect them to run it in accordance with our state guidelines. I'll insist on that."

    GEO's track record in Texas has been rocky.

    In the midst of the Texas Youth Commission's 2007 sexual abuse scandal, agency officials shuttered the company's Coke County Juvenile Justice Center, saying they had found atrocious conditions – including feces on the walls – at the facility. They also fired a GEO prison worker after learning he was a convicted sex offender.

    Earlier that year, an inmate in isolation at GEO's Dickens County facility slashed his throat, leaving letters complaining of blood- coated blankets and pillows, and floors and walls covered in mold.

    And in 2006, a woman committed suicide at a GEO jail in Val Verde County, after complaining that she had been raped by another inmate and sexually harassed by a guard.

    As recently as this winter, inmates at GEO's Reeves County Detention Center rioted, starting fires and taking hostages, to demand better health care. And in April, a Texas appeals court upheld a $42.5 million verdict against the company for the 2001 death of an inmate who was four days from finishing his sentence at a Willacy County facility. The man was beaten to death by other inmates using padlocks stuffed in socks.

    Montgomery County officials, who selected GEO to operate the psychiatric facility late last month, say that the company has a good track record with its other mental health hospitals and that they're not "overly concerned" with the problems that have been documented in a few of Texas' 17 GEO lockups.

    A presentation that GEO prepared for Texas lawmakers in February boasts of improved clinical programming, shortened waiting lists, and the elimination of the use of restraints and seclusion in its Florida psychiatric facilities. Company executives say they won the support of wary mental health advocates in that state.

    The GEO prison incidents "obviously shouldn't have happened," Montgomery County Commissioner Ed Chance said. "But when you're dealing with inmates, you're going to have problems. You're going to have some headlines."

    After the 2007 TYC scandal, lawmakers on both sides of the aisle raised serious concerns with GEO. Sen. Juan "Chuy" Hinojosa, D- McAllen, said "a simple Internet search" should have made GEO a bad contractor choice for the state. And Rep. Jerry Madden, R-Plano, told lobbyists for the firm it was best if they didn't contribute to his campaign at that time.

    But GEO has continued its full-court press in Texas. Within months, these lawmakers and 13 others had accepted campaign contributions from the company.

    "Some of their facilities are pretty darn good, and some are not as good as the others," Madden said. "But that's the exact same problem we have with the state-run facilities."

    Troubled prison firm's deal for new psychiatric hospital raises questions

    Doc puts inmates' mental health first

    July 5, 2009
    By Melissa Fletcher Stoeltje

    It's become a given among mental health professionals that jails are now the largest psychiatric hospitals in the country. In Bexar County, as in others around the nation, roughly one out of four inmates suffers from some kind of mental illness.

    That translates into some 800 inmates at the county jail being treated for a psychiatric disorder — hundreds more than patients being cared for at the San Antonio State Hospital.

    Dr. Sally Taylor, administrator of psychiatric services at Bexar County Jail, has been on the front lines of the struggle to treat and rehabilitate mentally ill prisoners.

    Before that, she was the medical director of the psychiatric emergency room at University Hospital for 17 years, dealing with some of the most disturbed and violent patients and training scores of medical students and other health professionals.

    But she's done more than that. By all accounts, Taylor has been a tireless advocate for the mentally ill in San Antonio, working with local advocacy groups to reduce stigma about mental illness, encourage churches to address mental disorders and promote education and community awareness about mental disease.

    Recently, she worked with other mental health groups on legislation to compel mentally ill prisoners to take their medication.

    This is important for those who have been found incompetent to stand trail and are in jail awaiting transfer to an inpatient competency restoration program.

    This will allow treatment for those with severe mental illness who are a danger to self or others or who lack the capacity to understand the risk of refusing treatment, and who have been excluded from court ordered treatment simply because they are located in jail.

    It might even help some inmates enough that they could enter outpatient competency restoration.

    The bill was signed into law by Gov. Rick Perry.

    Because of her work, Taylor was recently one of 41 psychiatrists around the country to be given the prestigious 2009 Exemplary Psychiatrist award by the National Alliance on Mental Illness, for which she was nominated by the local NAMI chapter.

    “Psychiatrists who are honored have really gone the extra mile,” said Michael Fitzpatrick, executive director for NAMI. “We awarded Dr. Taylor not only for her work in (University Hospital's psychiatric ER) but for her engagement with us on policy, corrections and faith- based initiatives. She's just outstanding.”

    Yolanda Alvarado, chairwoman of the Bexar County Mental Health Task Force, said Taylor was the driving force behind the compelled medication legislation.

    “I know that it came from her brain,” Alvarado said. “She got the judges involved, too. She actually went to testify. Because she's a doctor, she carries such credibility.”

    Speaking from her office inside the jail, Taylor, who earned her medical degree from the University of Texas Health Science Center, said mentally ill people off their medication often commit petty crimes — criminal mischief and the like — then wind up in jail.

    Before the legislation she worked on became law, they couldn't be compelled to take medication in jail, unlike in mental health facilities. They would be judged incompetent to stand trial.

    “And then what happens is they end up languishing in jail for two or three months because there are no open beds at the state hospitals,” she said.

    “And for all that time they're deteriorating and getting worse. I worry that some of these people might never be restored because the brain stays sick for so long.”

    Sometimes an inmate goes into the state hospital for competency restoration, then comes back to the jail and again refuses medication — which sends him or her back to the hospital. It's becomes a cycle.

    Taylor, to appease advocacy groups that resist the idea of compelled medication, helped craft the legislation to apply only to those inmates who are deemed a danger to themselves or others.

    But her goal is not just to help restore sick inmates to competency.

    In 2008 she advocated for more than 100 inmates who had committed misdemeanor crimes to have their charges dropped so they could then enter treatment programs, rather than incarceration.

    “In coordination with the district attorney's office, the probate court, the jail staff and the Center for Health Care Services, we were able to get civil commitments sending them to the state hospital,” she said. “That may not sound like a lot of people, but for us it was a brand new process, and it became a well-oiled process.”

    Taylor applauds the city's award-winning jail diversion program, which trains police officers to recognize mentally ill law-breakers and take them to ERs and other treatment facilities instead of jail.

    But she said much more needs to be done with regard to the long-term needs of mentally ill lawbreakers.

    “We do a great job recognizing the (mentally ill) at the front door, but the problem is the back door,” she said. “Bexar County is one of the lowest counties in per capita funding for mental health in Texas, and Texas is 48th or 49th out of the 50 states in terms of funding for mental health.

    “You can do all the screening and all the jail diversion that is possible, and I'm completely in favor of that, but you've got to have services for people when you send them out in the world.”

    Too often, she said, released mentally ill inmates confront a host of obstacles on the outside that hobble them in being compliant with their medical care. And then they re-offend.

    “If somebody comes to the jail because it's a place to sleep and eat, you want to be able to provide that on the outside,” she said. “We don't have enough residential units, we don't have enough housing, we don't have enough supported employment, we don't have support services, we don't have intensive case management. So we drop the ball.”

    Taylor, who swims and makes jewelry to de-compress from her high- pressure job, said she is drawn to working with the prison population because she is able to help give voice to the voiceless.

    “I like helping people that the rest of society shuns,” she said.

    Doc puts inmates mental health first

    Mental illness deluging local jail facilities

    Copyright 2009 Houston Chronicle
    June 27, 2009

    It is said that coal miners used to take a canary in a cage down into the underground mine each day. The canary was sensitive to the presence of natural gas, which is odorless and could seep into the mine shafts without the miners knowing. If this occurred, the miners’ lives would be in danger, either from asphyxiation or explosion. The canary was the early-warning mechanism to trigger a rapid, safe evacuation of the miners — a sensible, prudent approach — an early- warning system to a truly risky situation.

    So, you ask, why is he writing about this early-warning system? Because we need to learn from the miners. I suggest that there is another canary — another warning about a significant risk — in this case to our very community. I am talking about the Harris County Jail and the increasing number of people with mental illness ending up in jail. The Harris County Jail is now the largest mental health facility in Texas. Approximately 2,400 inmates a day are now diagnosed with a psychiatric illness that medically justifies the provision of psychiatric medications. There are almost as many psychiatrically ill inmates in the jail on psychiatric medications as there are patients in all of the Department of State Health Services hospital beds across the entire state.

    Let that reality sink in.

    How is this occurring? Several critical factors contribute to this disturbing trend. First, many individuals with a serious mental illness need early access to appropriate professional diagnosis and treatment and, often, supports to achieve and maintain stability in their psychiatric condition.

    These conditions aren’t, as a general rule, cured by medication. Stabilized, yes — cured, no. These individuals need education about the condition, available treatment options, impact on personal capabilities, stability and maintenance over time, etc. — all of which are made more difficult by the nature of these disorders affecting the information-processing organ of the body — the brain. These are neuro-chemical — disorders of the brain.

    And, if one throws into the mix that many untreated or undertreated folks with mental illness self-medicate with street substances, alcohol or both to ease the internal pain, one has a recipe for people recycling in and out of the criminal justice system because their behaviors run afoul of the law.

    The discrepancy between the funded treatment capacity (8,500 per month) for only the three eligible diagnoses of schizophrenia, bipolar disorder and major depression (let alone all the other serious psychiatric conditions for which people end up in jail) is huge.

    A conservative estimate of the incidence/prevalence of these three diagnoses in Harris County is 170,000.

    There is a growing awareness among our key county officials that the county simply can’t afford to continue housing this growing population in the jail.

    More cost-effective options for certain misdemeanor offenses by people with mental illness are under active consideration. This will require literally building out an array of services and supports that don’t currently exist in the form or quantity necessary to effectively impact this subpopulation.

    The just completed legislative appropriations process may provide some new resources to assist in building out the needed service and support configuration. However, because the state has not gradually been expanding its DSHS mental health system as the population has grown, we are in a very deep hole that will take a significant financial investment and a number of years to escape.

    The county can’t build out the entire delivery system on its own. The state must participate. And many of our elected officials in Washington are now recognizing there is a critical federal role in more adequately addressing the medically uninsured and underinsured, including those with mental illness and substance abuse.

    The risks to our society at multiple levels are huge. Economically, socially, to compete on the world stage, we can’t afford to continue the incredible loss and waste of human potential. And though the focus of this article is on the adult justice system, a similar reality is unfolding within the juvenile justice system.

    Keep an eye on the jail — it is truly a barometer of the health of our community.

    Schnee is executive director of the Mental Health and Mental Retardation Authority of Harris County.

    Mental illness deluging local jail facilities

    MAY 12, 2009

    States expand videoconferencing in prisons

    By John Gramlich
    Stateline.org Staff Writer

    Faced with the high costs of transporting and escorting sick inmates to the doctor, states are expanding their use of videoconferencing to provide health consultations to prisoners without resorting to costly — and sometimes dangerous — off-site trips.

    Illinois is considering joining at least 26 other states that use “telemedicine” to help sick prisoners get advice from doctors, according to Derek Schnapp, a spokesman with the state Department of Corrections. State prison officials recently met with their counterparts from Texas — which has been using telemedicine for years and is considered a national leader — to discuss whether it should be introduced in Illinois, Schnapp said.

    Elsewhere, videoconferencing in prisons and jails is replacing inmates’ in-person trips to the courtroom or parole board, and even the way family members visit.

    Supporters say the technology saves money when few states have funds to spare; Arizona, for instance, saved $237,000 in 2008 by using telemedicine at nine correctional facilities, according to the state Department of Corrections. But some have criticized the expansion of videoconferencing.

    Relying on technology to keep inmates behind bars makes them “disappear more and more from the public consciousness, and I think there’s a (negative) long-term consequence of that,” said Nancy Stoller, a professor at the University of California-Santa Cruz and the coordinator of a jail and prison task force at the American Public Health Association.

    Telemedicine is not a new invention, but experts say the recession could drive more states to consider it. Many of those that already rely on telemedicine, meanwhile, are using it for a wider range of purposes.

    In Georgia, about 700 of the state prison system’s 1,000 monthly videoconference consultations between doctors and inmates are for psychiatric — not physical — problems, said Alan Adams, director of the Office of Health Services for the Georgia Department of Corrections.

    Adams said he is surprised at how popular “telepsychiatry” — as the practice is called — has proven among doctors and inmates alike. Prisoners who might otherwise have reservations about face-to-face psychiatric evaluations, Adams said, tend to speak more openly when they are connected to doctors through a video link.

    “It takes some of the personal nature of the contact away and allows the inmate to be more open and free,” Adams said, predicting that more states will use telepsychiatry.

    Telemedicine and telepsychiatry work by letting inmates and doctors communicate with each other using interactive, real-time audio and video links.

    The practice — which has been praised by the U.S. Department of Justice and the National Commission on Correctional Health Care — is most often used for consultation, not treatment. Doctors, for example, can check up on inmates after they have had surgery and recommend further action. On-site nurses usually assist the doctors by employing stethoscopes, taking inmates’ blood pressure and carrying out other in-person tasks.

    Cost savings can be especially significant when inmates are located in rural prisons that can be hundreds of miles away from specialists.

    A 2006 California legislative audit, meanwhile, noted that telemedicine also can save taxpayer money because it allows a larger pool of medical providers — not just those in the vicinity of a state prison — to compete for state contracts.

    Many states also are using videoconferencing to avoid transporting prisoners to court for arraignments and other initial appearances, according to Greg Hurley, an analyst with the National Center for State Courts, which researches court trends across the nation.

    Parole hearings also can be conducted by videoconference.

    Connecticut last year finished installing videoconferencing equipment at all 18 of its state correctional facilities and the state’s court system is studying ways to expand the practice. The state’s corrections commissioner, Theresa Lantz, noted that videoconferencing saves the state money it would otherwise have to spend on vehicles, gasoline, correctional officers and overtime.

    Illinois and other states also are looking at videoconferencing to let prisoners talk with family members who might not be able to make the trip to visit them in person.

    Four states — Florida, Texas, Utah and Wisconsin — recently have changed their laws to allow so-called “virtual visitation” as an option in family court, allowing some divorced parents to “visit” their children using Skype and other video communications programs.

    Now, there is a growing push among prisoner advocates to allow virtual visitation for those behind bars as well.

    The Pennsylvania Prison Society, a nonprofit advocacy group, has partnered with the state Department of Corrections since 2001 to allow inmates’ families to come to the organization’s offices and speak on a video link with their loved ones serving time. A 55-minute session costs the family $20, according to the group’s Web site.

    While virtual visitation has primarily been hailed for making visitations between inmates and their families easier, some state officials see savings for the taxpayer as well.

    When family members don’t come to visit inmates in prison, “that’s one less person that has to be searched. That’s one less person you need to use full-time staff to keep an eye on during visitation,” said Michael Nail, deputy director of the corrections division for the Georgia Department of Corrections. In addition, Nail said, videoconferencing reduces the possibility that contraband material — such as drugs or weapons — will find its way into prison.

    Indeed, concerns about public safety have played a major role in the expansion of videoconferencing behind bars. That is particularly true in states that have seen correctional officers, medical professionals or others assaulted — or even killed — during inmate trips away from prison.

    In June 2007, for example, a 27-year-old white supremacist doing time at the Utah State Prison stole a gun from a 60-year-old correctional officer who was overseeing him during a trip to a Salt Lake City medical center for an MRI. The inmate, Curtis Allgier, killed the officer before being tracked down and arrested by the authorities at a city fast-food restaurant.

    The incident — which rocked Utah and made national headlines — resulted in a series of changes in the Utah’s correctional facilities, said Angie Welling, a spokeswoman with the state corrections department. Utah State Prison now offers MRIs and dialysis on site, and the state has expanded its use of telemedicine to cover specialized areas of medicine: cardiology, dermatology, obstetrics and orthopedics. The aim is to cut down on potentially deadly trips to the hospital.

    “It’s sad to think that something of that tragic nature is necessary to kick-start some of these initiatives,” Welling said.

    But the proliferation of videoconferencing equipment in prisons and jails has not come without criticism.

    The American Federation of State, County and Municipal Employees, a state workers’ union, has criticized Illinois officials for considering using telemedicine — which may cut down on the need for correctional officers in some settings. “At face value, we don’t believe telemedicine in prison settings is a good idea,” an AFSCME spokesman told the Quad-City Times.

    Others have questioned the long-term implications of using videoconferencing for health care and other purposes. Stoller, the University of California-Santa Cruz professor, questioned whether the quality of care offered through telemedicine consultations compares to seeing a doctor in person.

    Expanded videoconferencing could have long-term consequences on prisoners’ mental health and their ability to interact effectively with others, she said.

    Contact John Gramlich at jgramlich@stateline.org.

    States expand videoconferencing in prisons

    Expand program to divert mentally ill from prisons

    April 22, 2009

    Mental illness is a key factor in driving up correctional costs in Texas.

    There are 42,556 offenders with a mental health diagnosis in prison, 55,276 on probation and 21,345 on parole. Additionally, some 170,000 mentally ill inmates are admitted into Texas county jails every year.

    Mentally ill inmates cost more to house and they stay longer. They are also more likely to recidivate.

    Fortunately, there are policies that can reduce both the recidivism and cost associated with the mentally ill in the criminal justice system.

    First, counties can divert mentally ill offenders from jail through programs that protect public safety while saving taxpayer dollars.

    Bexar County has established a successful three-pronged jail diversion program that can serve as a model for other Texas counties.

    First, it employs specially trained law enforcement personnel called Crisis Intervention Teams (CIT). These teams are often able to defuse incidents involving the mentally ill without an arrest. Participants in CIT programs spent on average two more months out of jail than non- diverted individuals, resulting in significant jail cost savings.

    While the largest Texas metropolitan police departments have CIT personnel, smaller police departments can create a CIT program through cooperatives with other nearby departments.

    With Bexar County’s second prong, arrested offenders are screened for mental illness and, if not a threat to public safety, released on a mental health bond or to a treatment center. Screenings are conducted at the Crisis Care Center, a 24-hour facility that provides significantly quicker service at a lower cost than the emergency room.

    Once stabilized, offenders are released on a mental health bond. Because the wait for a trial date can be as long as six months, outpatient monitoring significantly reduces the utilization of county jail space.

    Finally, Bexar County diverts such misdemeanants from jail through an initiative called MANOS, which includes intensive case management that consists of outpatient medication management and counseling.

    Of the 371 offenders admitted to the MANOS Program, only 6.2 percent were re-incarcerated. This compares to a re-incarceration rate of 67 percent for mentally ill offenders without the intensive case management services offered by the jail diversion program.

    Savings from Bexar County’s jail diversion program are estimated at between $3.8 million and $5 million per year.

    The state can also take steps to address the impact of mental illness on the criminal justice system. About 2,500 probationers and 800 parolees participate in a state-funded initiative involving intensive case management and a smaller case load with a specially trained officer.

    The three-year re-incarceration rate is 15.1 percent for participating probationers and 16 percent for parolees.

    In contrast, there is a 52 percent re-incarceration rate for mentally ill probationers and parolees who do not receive treatment.

    Increasing the number of probationers and parolees in this program could more than pay for itself through lower recidivism.

    Another way to address mental illness in the criminal justice system is through mental health courts.

    Several Texas counties — including Bexar, El Paso, Tarrant and Dallas — have established mental health courts in which a judge orders the defendant to obtain treatment and supervises his progress.

    Harris County’s criminal district judges voted in January to designate a full-time felony mental health court.

    The court is not yet in operation.

    A RAND Institute study found significant cost savings from mental health courts due to lower jail utilization.

    Finally, defendants who are mentally incompetent to stand trial can be diverted from a state hospital.

    In 2008, the state launched outpatient competency restoration pilot programs.

    Taking Travis, Tarrant, Bexar and Dallas counties together, some 427 offenders are projected to be served in 2009. The total cost of these four programs is $2.16 million compared with the state hospital cost of $14.95 million based on an average cost of $35,000 per offender. Accordingly, it makes sense to expand these pilot programs to additional sites.

    Mentally ill offenders will always pose a substantial challenge in the criminal justice system.

    But through initiatives like these, we can achieve our goals of enhanced public safety and reduced costs to taxpayers.

    Levin is director of the Center for Effective Justice at the Texas Public Policy Foundation, a nonprofit, free-market research institute based in Austin.

    Expand program to divert mentally ill from prisons

    March 01, 2009

    What strategies work to keep HIV+ ex-prisoners on their meds?

    From the abstract to an article in the Journal of the American Medical Association, we get a bit more information about the shockingly high rates of HIV positive inmates who stop receiving anti-retroviral drugs when they leave prison. Researchers fear such inmates could become the source of drug-resistant HIV strains, which would be a grave outcome indeed.

    Reuters reported that just 5.4% of former HIV+ inmates filled their prescriptions after ten days. Only 17.7% had done so within 30 days, and 30.0% after 60 days - still a strikingly low figure with 70% still off their antiretroviral medication two months after they leave prison.

    There's a practical, public safety aspect to this that can't be ignored: The creation of drug-resistant HIV would be a very, very bad thing.

    On the bright side, the study identified two variables that improve the chances HIV+ ex-prisoners get back on their meds after leaving confinement.

    First, according to the abstract "Inmates released on parole were more likely to fill a prescription within 30 days ... and 60 days" by significant margins.

    Even higher compliance rates, though, came because: "Inmates who received assistance completing a Texas AIDS Drug Assistance Program application were more likely to fill a prescription within 10 days," 30 days and 60 days. (See "Results" at the bottom of this page for the statistical details.)

    In other words, HIV+ inmates on parole were slightly more likely to get their medication, presumably because they're under supervision, but they were much more likely to do so, especially in the short-term, if they're told where they can get help paying for the (quite expensive) drugs.

    That makes a lot of sense, and it points to possible legislative solutions.

    Perhaps there's some way to leverage stimulus funds designated for law enforcement or health services to go into the (already strapped) AIDS Drug Assistance Program, designating additional money to pay for indigent ex-prisoners to get that compliance rate somewhere closer to 100%? We're talking about a relatively small number of folks - an average of 700 or so people per year; that's a small price to pay for TDCJ to avoid becoming the source of some terrible, new medical scourge.

    Once TDCJ has started an HIV+ prisoner on antiretroviral medications, making sure they're signed up to get their meds on the outside seems like as important a public safety function as locking prisoners up in the first place.

    The same could be said for mentally ill prisoners, for whom I'd like to see a similar study performed. More attention should be paid to that transition.

    This is one of those moments when "an ounce of prevention is worth a pound of cure." I could make that argument for quite a few other reentry services, but in this instance it's particularly true.

    Posted by; Gritsforbreakfast
    Labels: Health, HIV, Parole, prescription drugs

    February 26, 2009

    Drug interruptions upon leaving prison could create drug-resistant HIV strains

    HIV/AIDS is the number one killer of Texas prison inmates, and TDCJ spends about half its pharmacy budget on HIV medications, but many ex-prisoners don't keep taking the drugs once they get out, according to a new study from UTMB.

    Reported Reuters:

    Results of a new study show that major interruptions in HIV drug treatment occur after release from prison.

    Within 60 days of release from prison, just 30 percent of HIV-infected inmates in the Texas Department of Criminal Justice system filled a prescription for antiretroviral drug therapy, researchers report in Wednesday's issue of the Journal of the American Medical Association.

    Moreover, 90 percent or more of inmates did not fill a prescription soon enough to avoid an interruption in their antiretroviral therapy, according to the report.

    "These remarkably high rates of lengthy HIV treatment interruptions are troublesome from a public health perspective," study investigator Dr. Jacques Baillargeon, from the University of Texas Medical Branch, Galveston, noted in a written statement.

    "Several studies suggest that many released inmates who discontinue antiretroviral therapy also resume high-risk behaviors such as injection drug use or unsafe sex," Baillargeon added, "and this combination may result not only in poor clinical outcomes for these individuals but also in the creation of drug-resistant HIV reservoirs in the general community."

    The study involved 2115 HIV-infected inmates who were receiving antiretroviral therapy prior to their release from prison between January 2004 and December 2007.

    Just 5.4 percent of inmates filled an antiretroviral prescription within 10 days of release, the researchers found.

    HIV drugs are expensive so for prisoners with no access to health insurance it's not surprising if most stop taking them. But that also sets the stage for a significant public health crisis.

    It's easy to say we shouldn't care about prisoners healthcare, but surely everybody should care about the possible "creation of drug-resistant HIV reservoirs in the general community."

    I don't know if the solution is to provide meds to parolees with HIV or how this situation might be addressed, but it'd be a catastrophe of enormous proportions if Texas prisons became the breeding ground for some scary, new drug-resistant HIV strain.

    Posted by; Gritsforbreakfast
    Labels: prescription drugs, TDCJ, UTMB


    Regents asked to keep UTMB on Galveston Island

    At hearing, the public asked regents to reject recommendations to move all patient beds to the mainland.

    By Juan A. Lozano
    February 20, 2009

    GALVESTON — The message at a public hearing today on the future of Galveston's hurricane-damaged public hospital and medical school was clear: Rebuild it and keep it in this island city. Doctors, medical students, residents and local and state officials implored the UT System Board of Regents to reject a report it commissioned that recommends all patient beds be moved to the mainland from the University of Texas Medical Branch in Galveston.

    The public meeting came after Atlanta-based Kurt Salmon Associates recommended this month moving the beds as the best hope for securing the financial future of UTMB, which suffered more than $1 billion in damage when Hurricane Ike came ashore Sept. 13.

    Only about $100 million of that was covered by insurance. "While you may feel you need to support the consultant's report, we urge you to set aside the findings and proceed with the restoration of Galveston before more damage is done to the future of UTMB, Galveston and Galveston County," said Sally Prill, a Galveston resident. "Hurricane Ike damaged UTMB. Only you can restore UTMB."

    UTMB — Galveston County's largest employer — laid off 3,000 employees and reduced the number of beds at its public hospital from 550 to 200 after the hurricane.

    The regents commissioned the report from the consulting firm as they and state lawmakers consider the future of UTMB, the state's oldest medical school.

    The firm's report recommended splitting hospital beds between the island and mainland as the second best option. Repairing UTMB and keeping all beds on Galveston — which all people who spoke at today's public meeting advocated — was deemed the least affordable option.

    The report said an inland location would be closer to the more heavily populated outskirts of Houston, which has a greater proportion of patients with commercial and government insurance.

    Under the option of moving to the mainland, the only patients who would remain on the island would be inmates who are treated at a Texas prison hospital at UTMB.

    Even before the hurricane, UTMB had been in financial trouble, losing millions of dollars due to its underfunded indigent health care program.

    The facility has been a provider of indigent care in Southeast Texas for many years.

    Brian Masel, a second-year medical student, criticized the consulting firm's report, saying it focused on money and not patient care. "What's so unique about UTMB? Faculty, the patients and the system. Many of the proposals outlined in this report do not take these pillars into consideration. The quality of care of patients will suffer," he said.

    Mayor Lyda Ann Thomas told the four regents at the meeting that they had an opportunity to carry on UTMB's "grand traditions" of medical care, research, and care of citizens, whether rich or poor, insured or uninsured. "I ask you to bring compassion to your deliberations," Thomas said. "As a city, Galveston needs and has counted on UTMB for 118 years. Our physical, mental, cultural and economic health has and still depends upon the University of Texas Medical Branch at Galveston."

    Regents asked to keep UTMB on Galveston Island

    Faculty group criticizes now-canceled UTMB bonuses

    By Ralph K.M. Haurwitz
    February 9, 2009

    The University of Texas Medical Branch at Galveston, which is reeling from financial losses as a result of Hurricane Ike, had planned to pay $3 million in bonuses to staff members until a faculty group got wind of the plan, leaders of the group said today.

    “They tried to sneak them through. They pulled it back because they got caught,” said Tom Johnson, executive director of the Texas Faculty Association, an advocacy group with more than 1,000 members on 85 college and university campuses in the state.

    E-mails obtained by the faculty association under the Texas Public Information Act show that UTMB announced Dec. 5 that bonus payments were being canceled.

    That was 2½ weeks after the association requested information on the plan, said George Reamy, a blogger for the association’s Web site.

    Cancellation of the “staff incentive plan” came nearly three months after the hurricane, nearly two months after Gov. Rick Perry urged state agencies to tighten their belts and a month after 2,450 UTMB employees were laid off.

    The faculty association isn’t exactly on the friendliest terms with UTMB and the UT System.

    The association has a pending lawsuit against the UT System Board of Regents, contending that the regents violated the state’s Open Meetings Act by discussing layoff plans behind closed doors. The regents’ lawyers say the closed meetings complied with the law. According to UTMB documents obtained by the faculty association, the staff members who had been scheduled to receive bonuses for the fiscal year that ended Aug. 31 included Garland Anderson, executive vice president, provost and dean of medicine. He had been in line for $122,233, up 3 percent from the $118,673 bonus he got the previous year.

    Karen Sexton, executive vice president and CEO of the schools’ health system, had been scheduled for a $107,500 bonus, and Ben Raimer, senior vice president for health policy and legislative affairs, was due to get a $100,000 bonus, the documents show. Kathy Shingleton, UTMB’s vice president for human resources and employee services, said in the Dec. 5 e-mail to staff members that “it is with sincere regret that I must inform you that in light of the financial crisis brought about by Hurricane Ike, we simply are not able to support the approximately $3 million in SIP payouts.

    With regards to the FY09 SIP program, it has been suspended at the current time with the hope to restore it in FY10, depending upon UTMB financial conditions.” Marsha Canright, a spokeswoman for UTMB, said today that bonuses are never guaranteed.

    “Staff incentive plans were put in place some time ago because they improve productivity and performance,” Canright said. “As far as I know, these bonuses hinge on two items. Did the individual/group reach a ‘super’ goal above and beyond their expected performance? And second, did the institution meet its financial goals? I think at UTMB you can opt to do incentive goals or merit increases but not both.

    This is a program that is blessed by the state. “For example, if a development officer raised a million dollars in excess of their target goal, they would receive a bonus if the institution met its financial goals.

    For UTMB, that’s a big if.”

    Categories: UT Medical Branch at Galveston

    Faculty group criticizes now-canceled UTMB bonuses

    No prison guinea pigs

    President Obama should act now to ensure incarcerated Americans aren't used for medical research

    By Allen M. Hornblum and Jeffrey Ian Ross
    February 3, 2009

    We keep hearing that President Barack Obama is intent on correcting the excesses of the previous administration, whether it's waterboarding or dirty air or international relations. But how about this: There exists the possibility that prisoners in American jails could be used for "voluntary" experiments - clinical trials for drugs, new surgical procedures and the like. It's a troubling piece of Bush-era business that the president could correct with the stroke of a pen.

    For more than two years, we, as members of a liaison panel advising the Institute of Medicine, have been waiting for an answer from the secretary of health and human services concerning the troubling potential for inmates in American prisons to be used for experiments.

    In 2006, the formal IOM committee recommended that convicts be made available for human subject research - a possible return to the mindset that gave us horrors such as the Tuskegee Syphilis Study. Fortunately, the Bush administration did not act on the recommendation, but the lack of a decision has not given us any comfort. This country's leaders should firmly reject the proposal.

    Our panel, focused on former prisoners and prisoner advocates, tried to convince the IOM committee that loosening restrictions on the already weakened protections for incarcerated Americans would take us back to a time when vulnerable populations were grist for the research mill and ethical abuses were tolerated. Prisoners were used as the guinea pigs of choice for researchers and pharmaceutical companies well into postwar America, and prisons have been a convenient storehouse of cheap and available research subjects. Physicians with pet medical theories and budding careers, or drug companies in the financial straits of product development, aggressively sought access to walled institutions as perfect places for testing.

    Incorporated in everything from testicular transplant and irradiation experiments to studies subjecting them to radioactive isotopes, dioxin and chemical warfare agents, prisoners were a key pillar of American medical and pharmaceutical research.

    This, from the same country that led the prosecution of Nazi doctors for their barbaric medical experiments on concentration camp prisoners. And this, from the country that served as a principal author of the Nuremberg Code, which ardently proclaimed that people "unable to exercise free power of choice" or subject to "constraint or coercion" should not be included as subjects in medical experimentation. Regrettably, the research community back at home continued to mine our mental institutions, orphanages and prisons for research subjects. Only during the great ethical enlightenment of the 1970s and the aftermath of the Tuskegee "studies" did American researchers condemn this practice.

    The IOM's 2006 report, "Ethical Considerations for Research Involving Prisoners," called prisoners "an especially vulnerable class ... who historically have been exploited by physicians and researchers. " This turned out to be lip service, though: The group decided that the use of prisoners for experiments could be rationalized because this population is also vulnerable to diseases such as AIDS, hepatitis C and tuberculosis, and therefore could benefit from new treatments, even if they are experimental in nature. Develop an "ethical framework" for research, the committee urged, and the potential for abuse would be eliminated.

    We're skeptical, given the lack of choice that convicts have in their daily lives. Couple that with the notoriously poor health care available in American cellblocks, and you have a potential disaster.

    President Obama and his nominee for secretary of health and human services, Tom Daschle, have an opportunity to clarify our nation's stance toward those whom we have declared unfit to live free among us. They can demonstrate, by rejecting the IOM's recommendation, that the prison abuses condoned or ignored by previous administrations will stop. While steps are being taken to close the notorious prison at Guantanamo, let's do what we can closer to home to ensure civil treatment for the incarcerated.

    Allen M. Hornblum, author of "Acres of Skin" and "Sentenced to Science," frequently lectures on medical ethics. Jeffrey Ian Ross, a University of Baltimore professor and a fellow in UB's Center for International and Comparative Law, is author of "Special Problems in Corrections" and co-editor of "Convict Criminology."


    No prison guinea pigs

    Many inmates sick, access to care poor: study

    Jan 15, 2009

    CHICAGO (Reuters) - Inmates in U.S. prisons and jails have rates of serious illness that far exceed those of the general population and many lack access to healthcare, researchers said on Thursday.

    They found that 800,000 inmates -- about 40 percent of the U.S. prison population -- have a chronic medical problem such as diabetes, asthma or heart or kidney problems.

    And more than 20 percent of sick inmates in state prisons and 13.9 percent in federal prisons had not seen a doctor or a nurse since their incarceration began.

    "A substantial percentage of inmates have serious medical needs. Yet many of them don't get even minimal care medical care," said Dr. Andrew Wilper of the University of Washington School of Medicine in Seattle, whose study appears in the American Journal of Public Health.

    Wilper did the research while at the Cambridge Health Alliance and Harvard Medical School in Massachusetts. He and colleagues analyzed data from a 2002 survey of inmates in local jails and a 2004 survey of prison inmates.

    They found a far higher incidence of chronic disease among inmates. Compared to other Americans of the same age, state prison inmates were 31 percent more likely to have asthma, 55 percent more likely to have diabetes, and 90 percent more likely to have suffered a heart attack.

    Access to care was worst in local jails and best in federal prisons.

    One-quarter of jail inmates who had suffered severe injuries had received no medical attention, versus 12 percent in state prisons and 8 percent in federal prisons.

    The researchers also looked at mental illness. While about a quarter of inmates had a history of chronic mental illness like schizophrenia, bipolar disorder, depression or anxiety, two-thirds of them were off treatment at the time of their arrest.

    Only after their imprisonment did most of these inmates receive treatment.

    A study this week in the Journal of the American Medical Association found inmates with drug problems are not getting adequate treatment.

    The study by researchers at the National Institute on Drug Abuse, part of the National Institutes of Health, found about half of all prisoners -- including some guilty of non-drug offenses -- are dependent on drugs. Yet less than 20 percent of inmates suffering from drug abuse or dependence get formal treatment.

    They said the criminal justice system was in a position to encourage drug abusers to enter and remain in treatment, disrupting the cycle of drug use and crime.

    (Reporting by Julie Steenhuysen; Editing by Will Dunham and Xavier Briand)

    Many inmates sick, access to care poor: study

    Troubled inside: mental health care in prison

    Mental health policy on care in the community has disintegrated into a lack of practical support and neglect. Prisons have had to fill up with petty offenders with complex mental health needs to take up the slack. There are many men, women and children in prison who need healthcare above all else.

    Proper investment in court diversion, mental health and drug treatment in the community and secure health provision for those who need it, would lift the burden off untrained prison staff and put a stop to the cruel and unnecessary punishment of jailing vulnerable people."

    The use of prison to warehouse people for their mental illness is a criminal use of our justice system, it makes ill people worse and disrupts the rehabilitative work of prisons. If you had to invent a way to deepen mental health problems and create a health crisis, an overcrowded prison, and particularly the bleak isolation of its segregation unit, would be it.

    On the wing there was plenty of evidence of behaviour brought on by mental distress… one young man only ever wore the same pair of jeans and a green nylon cagoule. He never wore shoes or socks, never went out on exercise, hardly ever spoke to anyone and was understood to have been taken advantage of sexually by predatory prisoners. He was in his early 20s with many years in prison still ahead of him. Another had a habit of inserting objects into his body: a pencil in an arm, matchsticks in his ankles.

    (Erwin James, foreword to Troubled Inside: the Mental Health Needs of Men in Prison.)

    Many prisoners have mental health problems. 72% of male and 70% of female sentenced prisoners suffer from two or more mental health disorders. One in five prisoners have four of the five major mental health disorders.

    A significant number of prisoners suffer from a psychotic disorder. 7% of male and 14% of female sentenced prisoners have a psychotic disorder; 14 and 23 times the level in the general population.

    Revised figures, collected by the Prison Service in 2005 show that 597 out of every 1,000 women and 50 out of every 1,000 men harm themselves while in prison.

    Research suggests that prisoners are twice as likely to be refused treatment for mental health problems inside prison than outside.

    In 2002 there were 39,000 admissions to prison health care centres.

    The Department of Health estimates that about 30% of these, approximately 11,800, were for mental health reasons.

    Prison regimes do little to address the mental health needs of prisoners. Research has found that 28% of male sentenced prisoners with evidence of psychosis reported spending 23 or more hours a day in their cells - over twice the proportion of those without mental health problems.

    Mental health issues amongst prisoners are often linked to previous experiences of violence at home and sexual abuse. About half of women and about a quarter of men in prison have suffered from violence at home while about one in three women report having suffered sexual abuse compared with just under one in 10 men.

    Half of all those sentenced to custody are not registered with a GP prior to being sent to prison.

    *Figures are done by the Nation's scale.

    JANUARY 02, 2009

    What happens with prison healthcare if UTMB fails to rebuild?

    According to an article titled "Emergency!" by Mimi Swartz at Texas Monthly, the University of Texas System may decide not to rebuild the UT Medical Branch at Galveston after Hurricane Ike, facilities which include the hospital responsible for most of the state prison system and "telemedicine" infrastructure that serves 80% of Texas prisoners.

    Cheering state Sen. Steve Ogden's efforts to insist UTMB be rebuilt, Swartz predicts that:
    unless Ogden prevails, UTMB will face inevitable death. Ogden is keenly aware that as an Aggie challenging the most powerful teasips, he’s vulnerable to criticism that he has it in for A&M’s longtime rival. Even so, he’s persisted. He understands that the proposed reduction in the number of hospital beds means a reduction in the number of patients needed to support a viable medical school; in order to become the best doctors, students need patients with a variety of illnesses and injuries. Victims of local emergencies, from car accidents to refinery explosions, would no longer have a Level I trauma center at their disposal; they’d have to depend on an ambulance or a helicopter to get them to Houston. Certainly Galveston’s residents would suffer financially and medically with a reduced UTMB, but so too would all the overcrowded public hospitals in Texas that would then have to take in more uninsured patients, or simply turn them away without treatment. “The longer the hospital stays out of commission the more people forget,” one longtime Island resident told me.

    Maybe that’s just what the regents are hoping for.

    To be fair, Swartz's article and Sen. Ogden understate the enormous problems with investing so much in infrastructure on a hurricane- prone barrier island. It's possible that's just an untenable idea that must be fundamentally reconsidered. But if UTMB isn't going to rebuild its medical infrastructure in Galveston, that leaves as an open question what happens to prison health care UTMB was previously providing through that facility.

    What happens with prison healthcare if UTMB fails to rebuild?


    Months after Ike, care for prison inmates still ailing

    Storm's impact on hospital in Galveston costing state $18 million

    Copyright 2008 Houston Chronicle
    Dec. 5, 2008

    AUSTIN — Nearly three months after Hurricane Ike forced the near- closure of the state's main prison hospital in Galveston, roughly 100 inmates remain scattered at hospitals around the state, sharply raising the cost of inmate medical care and exacerbating the shortage of prison correctional staff, who are sent to guard inmates in free- world settings.

    The prison hospital's almost complete closure has cost the state some $18 million, according to estimates released Friday by the Texas Department of Criminal Justice.

    That figure is expected to rise, with the full reopening of University of Texas Medical Branch at Galveston's prison hospital still weeks away. The hospital's outpatient services have largely resumed.

    "This has been hugely disruptive and hugely expensive," said Sen. Kel Seliger, R-Amarillo, vice chair of the Senate Criminal Justice Committee.

    Owen Murray, UTMB's chief physician executive for correctional managed health care, said his staff was working to reopen the hospital.

    He said he hoped it would return to normal by February, with inmates filling its 108 or so acute-care beds.

    In the meantime, roughly 100 sick inmates have been sent to several hospitals, where care generally is more expensive. To ensure the safety of others, each inmate patient is assigned two to three prison correctional staff, who are posted outside their hospital rooms.

    With the prison system short at least 2,600 correctional officers, the diversion of guards to hospitals "creates a real challenge for us," prison spokesman Jason Clark said.

    Rep. Jerry Madden, R-Plano, chair of the House Corrections Committee, said he was unsure how the $18 million estimated shortfall would be resolved.

    "There is federal money coming. But we might have to do an emergency appropriation, as well," he said.

    This year's total inmate prison health care budget is $422 million. Location questioned

    Having the state's main prison hospital along the coast, vulnerable to hurricanes, gives some lawmakers pause. Seliger and Madden said some are questioning whether it makes sense to concentrate prison medical care there.

    "I think we've got to look seriously at having some services relocated elsewhere," Madden said.

    Murray said the biggest problem for his staff is finding community hospitals willing to treat convicts.

    "Most local hospitals have had minimal exposure to treating inmates and they're not crazy about it," he said. "When people see two officers or more posted outside a hospital room ... it creates a PR problem for the hospital."

    The University of Texas Health Science Center at Tyler, Huntsville Memorial Hospital and Conroe Regional Medical Center have been more willing than others to receive the sick convicts.

    Texas contracts with UTMB at Galveston to treat roughly 80 percent of its state inmates needing care.

    Hospital Galveston, as the facility is known, is a secure medical facility that, until Hurricane Ike devastated the island, held an average of 250 inmate patients, said Allen Hightower, executive director of the Correctional Managed Health Care Committee, which coordinates health care for the prison system.

    The prison hospital is connected by an underground tunnel to the civilian John Sealy Hospital.

    Unlike John Sealy, the prison hospital suffered little damage during the storm. It cannot function at full capacity, however, because it depends on the civilian hospital for support services, such as records, food and blood. Two of the prison hospital's four elevators were damaged by the storm, and the facility's operating rooms are out of service. Repairs to the ventilation system also are under way.


    Months after Ike, care for prison inmates still ailing

    Study: Mental illnesses predict repeat offenders

    From staff reports
    The Daily News
    Published December 2, 2008

    GALVESTON — Inmates with a major mental illness are more likely to be incarcerated repeatedly, according to a study by Jacques Baillargeon, an epidemiologist and associate professor at the University of Texas Medical Branch.

    The findings are the result of a yearlong study of 79,000 offenders within the Texas Department of Criminal Justice, one of the nation’s largest state prison systems.

    Baillargeon said about 8,000 offenders were diagnosed with major psychiatric disorders, such as depression, bipolar disorder, schizophrenia or nonschizophrenia psychotic. In almost all cases, the odds of multiple incarcerations increased. Inmates with bipolar disorder were more than three times as likely to have had four or more prior incarcerations since 2000, compared to inmates with no mental illness.

    “To reduce the cycle of repeat imprisonment for people with severe mental illness, we should consider a number of interventions, including alternative correctional facilities with appropriate clinical care for psychiatric illness,” Baillargeon said.

    The findings will be published in December’s American Journal of Psychiatry, http://ajp.psychiatryonline.org/pap.dtl.

    Other authors include Ingrid Binswanger, J.V. Penn, B.A. Williams and Dr. Owen Murray.

    Mental illnesses predict repeat offenders

    After Ike damaged Galveston hospital, prisoners shipped elsewhere in Texas

    By Mike Ward
    November 14, 2008

    Damage from Hurricane Ike could keep much of the Texas prison system's primary hospital in Galveston closed for months, increasing security risks as more than 100 convicts have to be treated in public hospitals, officials said Thursday.

    Brad Livingston, the prison system's executive director, said administrators at the University of Texas Medical Branch at Galveston have promised to reopen some of the prison hospital's 365 beds later this month, but a full reopening is indefinite. Currently, a limited number of inmates are going to the facility for clinic visits, not overnight stays.

    "It creates a real challenge," Livingston said. "It goes without saying that security risks go up."

    Instead of sending convicts to Galveston for treatment, prison officials for weeks have been housing the bulk of them in public hospitals at the University of Texas at Tyler, Huntsville Memorial Hospital and a hospital in Conroe, among others. It wasn't clear Thursday whether any were in the Austin area.

    In other parts of Texas, convicts are being transported to local hospitals for treatment or they are being treated at prison infirmaries — normally reserved for minor care.

    In addition to extra costs of treatment at local hospitals, officials said convict-patients also require around-the-clock security. "There will be additional costs. How much, we don't know at this point," said Dr. Lanette Linthicum, the prison system's medical director.

    Livingston and UTMB officials, who on Wednesday got orders to lay off 3,800 UTMB employees as a result of an estimated $710 million in hurricane-related damage to the Galveston complex of hospitals and labs, said they also do not know the final cost of the alternate care.

    "(UTMB) has promised us they will eventually return Hospital Galveston to pre-Ike conditions," Livingston said. "We're not thinking about moving the (prison) hospital out of Galveston."

    Members of the Senate Criminal Justice Committee, who quizzed prison officials about the hurricane damage and cost estimates during a Capitol hearing Thursday, expressed concerns about the cost of having the primary prison hospital out of service for so long.

    "I also have a concern about having many violent inmates in public hospitals around the state," said Sen. John Whitmire, D-Houston, chairman of the committee. "It's a very unhealthy situation."

    Although the seven-story prison hospital escaped with minimal damage, partly because it was built on higher ground, it sits next to UTMB's John Sealy Hospital complex and related facilities that were heavily damaged.

    Linthicum said 33 beds have been temporarily upgraded for hospital care at the Young Unit near Dickinson, on the mainland just north of Galveston, until the UTMB facility fully reopens. Doctors who would normally practice in Galveston are now working there, she said.

    When it was fully operational, the 25-year-old prison hospital saw between 250 and 300 convict-patients daily for appointments at specialty clinics and had a listed capacity of 365 in-patient convicts.

    It services prisons in Texas' eastern two-thirds, which UTMB cares for under contract with the prison agency.

    mward@statesman.com; 445-1712

    3,800 UTMB employees to be laid off

    By Ralph K.M. Haurwitz
    November 12, 2008

    University of Texas System regents today ordered layoffs of about 3,800 employees at the UT Medical Branch in Galveston, declaring that financial losses stemming from Hurricane Ike make that painful action essential.

    At the same time, the regents affirmed their commitment to the future of UTMB.

    “That school is going nowhere,” said Regent Colleen McHugh. “We are going to keep UTMB on Galveston Island.”

    The campus employs more than 12,000 people, who have been carried on the payroll since Ike wracked Galveston and other parts of the Gulf Coast as a Category 2 hurricane on Sept. 13.

    But with the institution’s hospital largely shut down, UTMB’s expenses have exceed revenues by $40 million a month and reserves will be exhausted shortly, said Kenneth Shine, the system’s interim chancellor and executive vice chancellor.

    “We simply cannot allow this institution to go bankrupt. I believe the regents have no choice but to make a painful decision,” Shine said shortly before the regents’ unanimous vote to commence layoffs.

    Shine said the employees to be dismissed would learn their fate in the next few days or early next week, adding that they would be carried on the payroll until mid-January.

    3,800 UTMB employees to be laid off

    August 04, 2008

    Texas Prison Health Care: On the Brink of Unconstitutionality, Again

    by Matt Clarke

    According to Texas prison health care officials, medical care in the states prison system is teetering on the brink of becoming unconstitutional.

    "We're toed up to the line. No doubt about it," proclaimed Dr. Ben Raimer, University of Texas Medical Branch (UTMB) vice president for correctional health care. "Right now, the system is constitutional but we're on a thin line."

    This ominous statement harkens back to 1993 when, in the closing days of the landmark Ruiz prison-reform civil rights lawsuit, federal District Court Judge William Wayne Justice declared that the Texas prison health care system was constitutional, but just barely. [see PLN, July 1994, p.14].

    UTMB is responsible for the operation of infirmaries in two-thirds of the state's 112 prisons; Texas Tech University runs the rest. UTMB also operates the flagship of the prison health care system, an eight- story hospital located in Galveston that was built 24 years ago. Now, just as the prison health care system is crumbling, the brick facade of the hospital building is coming down. A lack of funding has made it impossible to repair either the building or the system.

    For the hospital, the fix was to erect fences around the parts of the building's exterior where pedestrians were endangered by falling bricks. For the prison health care system, the fix will be neither so easy nor so cheap.

    The two forces driving the prison health care system's demise are a crumbling infrastructure and rising private sector salaries, which have led to a loss of prison medical personnel at the same time that an aging prison population has placed more demands on the system.

    Prison officials complain that requests for additional health care staff have been ignored by UTMB and Texas Tech. During a January 24, 2008 hearing before the state legislature's Senate Criminal Justice Committee, Dr. Raimer said the vacancy level for doctors at prison clinics was around 15%. "The biggest issue is recruiting.. .. We'll have to increase salaries," he stated. Some prisons have only part- time medical coverage.

    If recruiting is the biggest problem, failing infrastructure is a close second. In addition to the UTMB hospital's crumbling exterior, the equipment inside the facility, and equipment used at prison clinics, is failing as well. Dental and dialysis machines are in such poor condition that no reputable free world dentist or physician would consider using them.

    "Much of the equipment we are now using was purchased before UTMB became the care provider in 1993, and we continually have to scavenge parts and equipment," said Dr. Raimer. "Less than half the X-ray equipment is now functional ... I know of one dentist working part time in San Antonio who had to bring in equipment from his [private] office."

    The minimum cost to replace or repair UTMB's broken radiology, dialysis, dental, transportation and computer equipment is estimated at $6.3 million. But UTMB won't be providing that kind of funding anytime soon. Why? Because the university is losing money on prison medical services. The prison health care budget deficit in fiscal year 2006 was $6.5 million for UTMB and $1.8 million for Texas Tech.

    Perhaps this is the legacy of the praise heaped upon the Texas prison medical system following the termination of the Ruiz suit in 1993. At that time it was called a model of efficiency and cost savings, and one of the least expensive prison health care systems in the country.

    Even now, at an average cost of $7.42 per prisoner per day, Texas spends less than half of what California does on prisoner medical needs.

    Following the Ruiz settlement, UTMB and Texas Tech were given a fixed annual budget for prison health care and told they could keep as profit what they didn't spend. Prison physicians were given bonuses for saving money, and thus rewarded for denying prisoners needed care.

    There was little oversight; the Texas State Auditor's office concluded in a November 2004 report that the state's Correctional Managed Health Care Committee was plagued with conflicts of interest. [see: PLN, Jan. 2006, p.22].

    As a result, surgery and treatment were postponed and cheaper drugs were used instead of the best and most effective ones. Maintenance was neglected while equipment and physical facilities deteriorated.

    UTMB and Texas Tech made big bucks. Those years of profit have come at a cost and are now at a close. It has become critical that long- delayed medical procedures and maintenance be done.

    The UTMB hospital alone needs $10.4 million in repairs; it is estimated that the system as a whole requires $16.6 million in equipment and facility upgrades. That's on top of the $375.8 million budgeted for prison health care in fiscal year 2007-2008.

    The same system that generated large profits is now subjecting UTMB and Texas Tech to losses due to the costs associated with Texas, graying prison population (with 152,000 prisoners), plus rising drug prices and a hepatitis C epidemic.

    Around 20,000 Texas state prisoners are infected with hepatitis C; of those, 800 receive drug treatment costing about $10,000 a year each.

    Overall, it is estimated that the Texas prison system health care budget will have to grow by $122.1 million. That includes $47 million to cover ongoing cost increases, $21.8 million to retain medical staff, $23.7 million in increased hospital and specialty care expenses, $7.1 million in additional pharmacy costs, $6.3 million in critical equipment replacement, $5.8 million for increased supply and services expenses, and $10.4 million to repair the hospital in Galveston.

    Since Texas plans to continue expanding its prison system, these cost estimates can only rise.

    As previously reported in PLN following the termination of the Ruiz suit, "seven years after its implementation, the managed health care plan [through UTMB and Texas Tech] was providing Texas prisoners at best sub-par medical care at great expense to the Texas taxpayer, a situation that continues to this day." [see: PLN, Jan. 2006, p.22].

    Little has changed, apparently.

    Source: Austin American-Statesman

    Jan. 23, 2008

    Injured inmate spent two days on cell floor

    Medical staff withheld drug because dying prisoner couldn't come to get it

    Copyright 2008 Houston Chronicle

    Texas inmate Larry Louis Cox's 2007 death was ruled a homicide stemming from medical neglect.

    • Jan. 23: Cox is injured in a confrontation with guards. He is unable to stand to accept medication.

    • Jan. 24: Prison medical staff reports that Cox "refused" medication because he could not stand to accept it.

    • Jan. 25: Medical staff twice more reports Cox refusing medicine. • Jan. 26: In critical condition, Cox is transferred to a Galveston hospital.

    • Jan. 27: Doctors discover Cox's spine is fractured. His condition deteriorates.

    • Feb. 6: Cox dies.

    For two days after a physical confrontation with Texas prison guards, inmate Larry Louis Cox lay on a mattress on his cell floor, in his waste, with medical staff reporting he "refused" medication because he could not stand and come to the door to receive it.

    According to records obtained by the Chronicle, Cox complained that he was paralyzed. But only after he worsened and was transferred to a hospital did doctors determine he had suffered two broken vertebrae, undetected by medical staff. He died Feb. 6, two weeks after the scrap with guards.

    Recently released investigative reports and interviews with investigators and prosecutors provide new details about Cox's death at a Huntsville prison — an incident that prompted state Sen. John Whitmire, D-Houston, to set a hearing in Austin today of the Senate Criminal Justice Committee. Senators plan to examine Cox's treatment, the alleged negligence on the part of medical staff and the state of health care in all Texas prisons.

    A medical examiner ruled Cox's death a homicide by "medical neglect complicating blunt force trauma."

    Reports from the state Office of Inspector General show that on four occasions prison medical staff did not administer Cox's prescribed medication because he could not get up to receive it. Instead, it was a concerned prison guard who once hand-fed Cox painkillers and another who finally alerted medical supervisors that the 48-year-old convict needed to be transferred to a hospital.

    Walker County prosecutors acknowledged to the Chronicle that they twice refused to pursue charges against medical staff, despite state investigators' recommendations

    Interviews and reports also suggest that hot-button Texas prison issues, such as the shortage of guards and medical personnel, may have affected Cox's treatment.

    Convicted of prison killing

    Cox, a Houston man, entered the Texas prison system in 1990, after he was convicted of burglary with intent to commit sexual assault. While in prison, he was convicted of murder in the death of another inmate.

    He was incarcerated at the Estelle Unit in Huntsville on Jan. 23 last year when he scuffled with guards as they attempted to return him to his cell after a fumigation. Restrained, with his hands cuffed behind his back, Cox became combative, kicking guards who forced him to the floor. As Cox went down, he hit his head on his metal bunk and locker and began bleeding profusely.

    Medical staff, employees of the University of Texas Medical Branch assigned to the prison, examined Cox and decided to transfer him to Huntsville Memorial Hospital. There he received stitches for cuts on his face and a CT scan on his neck and head, but doctors found no fractures. A hospital spokeswoman declined to comment.

    Cox was returned to his cell.

    Six hours later, Cox "told (a guard) he hurt too bad to get up or move," according to reports. He said he was paralyzed. A guard offered him Tylenol, which Cox could not get up and receive.

    A nurse told the guard "that Cox would have to get up and accept the medication if he wanted it," according to investigators' records.

    "Cox did not receive any medication at that time."

    That interaction was repeated three times over the next couple of days, as Cox lay in his own blood and waste on his cell floor, complaining of pain.

    One guard, worried that Cox would die if he did not receive medical attention, contacted a supervisor with UTMB at the prison. Within 12 hours, Cox was taken to UTMB's John Sealy Hospital in Galveston, where doctors discovered his spinal fractures.

    For the next 11 days, Cox remained at John Sealy, declining until his death, according to reports. The Galveston County medical examiner ruled his death a homicide.

    The death prompted an investigation by the Office of Inspector General, an independent agency that monitors prisons, which was completed in July. Inspector General John Moriarty forwarded the case to prosecutors with the recommendation that charges be pursued against five of the medical staff at the Estelle Unit who treated Cox.

    "I have the obligation to make sure the rights of the inmates are protected," Moriarty said. "I am the last voice for that person and I believe there was a criminal violation in this horrendous case."

    UTMB officials described Cox's case as "unfortunate," not criminal, and said steps are being taken to "ensure that any mistakes made by our people are understood and not repeated," according to Dr. Ben Raimer, who directs the UTMB prison health care system.

    Prosecutor Philip Hall, a 14-year veteran assigned to the state's prison prosecution unit, reviewed the file, characterizing a prosecutor's opinion as the "only one that counts." Hall said he found no criminal conduct.

    "We had a guy who died under not normal circumstances and (OIG) wanted people charged," Hall said. "But just because the autopsy said medical negligence does not mean there was a crime."

    Jurors were satisfied

    He consulted with his boss, Gina Debottis, chief of the prison prosecution unit, and Walker County District Attorney David Weeks, who both agreed. The prosecutors said the medical staff's action could be explained by Huntsville Memorial Hospital's conclusion that Cox had no major injuries.

    Hall presented the case to a Walker County grand jury in October and recommended that no one be charged. Jurors declined to investigate further. The case appeared closed.

    But investigators from the Office of Inspector General appealed to Weeks, asking that he again review the case file and re-evaluate the decision not to pursue charges.

    Weeks again declined, saying Cox's case is more emblematic of systemic problems in prisons — guard shortages, funding for medical care — than individual criminal wrongdoing.

    "When you look at everything you can see how it happened," Weeks said. "It is a sad situation, but that doesn't make it criminal. I am here to prosecute cases that are valid and this one did not get to that threshold."

    About the time Weeks re-examined the case, Cox's brother, also in a state prison, appealed to Whitmire. The senator began investigating and scheduled a hearing of the Senate Criminal Justice Committee for today.


    Injured Inmate spent two days on cell floor


    Improving prison medical care depends on all of us

    January 20, 2008

    Medical care in Texas prisons seems as much as ever to be an oxymoron. For many years, the medicine practiced behind prison walls too often has been afflicted by a lack of care.

    There are many reasons for that — too little money, a shortage of professionals, decrepit equipment, an aging inmate population. These problems have plagued the sprawling Texas prison system for decades.

    It appears that a widespread disregard for the inmates' health and well-being permeates the prison system. Not in every prison and not with every inmate. But nearly 2,000 inmates died over a recent four- year span, the most in any state in the country — even California, with its larger prison population.

    It should be of great concern across Texas that, as the American- Statesman's Mike Ward has reported, prison inmates die in agony, their injuries ignored. Or hang themselves with guards watching and die because attempts at resuscitation were delayed. But it isn't. In both of those cases reported by Ward, no one was punished.

    Beyond the inmates and their families, too few people are outraged at the wanting medical care in Texas prisons. Because inmates are convicted criminals, and often unpleasant ones at that, sympathy is in short supply.

    It should matter, though. We are distinguished as a people and as a state by the way we treat the least among us, including those who have broken the law.

    Texas prison inmates are still human, and how we regard them determines the content of our character.

    We ignore prisons and inmate care at our peril, both moral and physical. Those prisoners are fathers and sons, mothers and daughters, brothers and sisters. We should care enough about them to guarantee decent treatment no matter what their crimes.

    And the vast majority of them will walk among us again, will return to their hometowns and the big cities. Their attitudes will depend in no small part on how they were treated in prison.

    When Texas contracted with two university medical schools to provide health care to prisoners, it was praised as an inexpensive way to provide quality care. But even under care of the University of Texas Medical Branch and Texas Tech University, inmate health care has been spotty, even dismal at times.

    Some Texas lawmakers have shown concern because so many deaths could be signs of deeper troubles. And lawmakers want to avoid another court ruling that the prison system is unconstitutional. That could be cumbersome and costly.

    State Sen. John Whitmire, D-Houston, chairman of the Senate Criminal Justice committee, has scheduled a committee hearing this week to examine prison health care. Shining a bright light on the problems that have surfaced could be the beginning of better health care.

    Punishing neglect helps avoid similar problems in the future.

    In the end, though, proper medical care in state prisons is a matter of our own self-respect. Arizona Sen. John McCain, a former prisoner of war and now Republican presidential hopeful, said it best when discussing torture: It's not about them, it's about us.

    Find this article at:
    Improving prison medical care

    Texas medical neglect cases stir concerns about prison health care

    Two deaths came after possible mistakes by staff; lawmaker asks for investigation.

    By Mike Ward

    January 16, 2008

    Eleven months ago, convicted murderer Larry Louis Cox died of injuries after scuffling with guards at a Huntsville prison and receiving limited medical care for more than a week as he lay in his cell. A medical examiner ruled his death a homicide due to medical neglect.

    No one was prosecuted or disciplined.

    In June 2003, a convicted sex offender hanged himself in front of guards at a prison near Wichita Falls, and, even though they immediately cut him down, he died after medical treatment was delayed.

    No one was prosecuted or disciplined.

    John Whitmire, chairman of the Texas Senate Criminal Justice Committee, said he fears that those deaths could be the tip of an iceberg amid a growing list of disturbing trends: Belt-tightening has left many prisons without medical staff at night. Other prisons operate with greatly reduced medical staffs. A shortage of prison guards could be further limiting access to medical care.

    "It's what I don't know that scares me," Whitmire said Tuesday as he asked the Texas Department of Public Safety and the FBI to investigate Cox's death at the Huntsville prison unit. "We need to get to the bottom of this."

    From 2001 to 2005, federal statistics show, 1,933 convicts died in Texas prisons, more than in any other state including California, which had 1,672 deaths and has a larger prison system than Texas. California had 175,115 prisoners and Texas 172,889 as of June 30, 2006, according to the federal Bureau of Statistics.

    Whitmire, D-Houston, has scheduled a Jan. 24 hearing of the Criminal Justice Committee to examine prison health care, which is provided by the University of Texas Medical Branch in Galveston and Texas Tech University. Both universities declined to comment Tuesday.

    In Cox's case, internal prison system investigation reports reveal, prison guards at times did more to aid the critically injured convict than did the medical staff.

    On Jan. 23, 2007, the reports show, Cox, 48, began kicking at two guards at the Estelle high-security unit as he was being placed back in his cell. As they "forcefully placed Cox on the floor," he hit his head on the edge of his bunk and on a footlocker. He was handcuffed at the time.

    A nurse and prison medic examined him, and he was taken to Huntsville Memorial Hospital, where a CT scan of his head and neck showed no fractures. He was taken back to prison, where, within hours, Cox told guards he was paralyzed.

    Because the prison clinic is closed at night, a guard gave him Tylenol, according to an investigative report. He went to the clinic the next morning and was given two oral prescriptions and sent back to his cell.

    When a medic tried to give him his pills hours later, the report said, "Cox could not rise to accept it so (the patient care assistant) noted the attempt as 'refused.' " A correctional officer "hand fed" him medicine a short time later.

    The next morning, Cox could not rise to take the medicine, which the medic again noted as a refusal. By this point, Cox was defecating on himself and could barely move. Another exam at the prison clinic was followed by medications listed as "refused."

    Concerned that Cox appeared to be dying, a correctional officer ignored prison rules to alert his own stepmother — a nurse manager for UTMB — who arranged for a medic from another unit to examine Cox at night.

    Cox was sent to UTMB's John Sealy Hospital in Galveston, where his condition deteriorated steadily. By Feb. 6, 2007, two weeks after he was hurt, Cox was dead.

    In an autopsy, Dr. Stephen Pustilnik, Galveston County's medical examiner, ruled the death a homicide. "Medical neglect complicating blunt force trauma," the report states.

    "That's the first time I remember that ever being listed as the cause of death," said John Moriarty, the prison system's independent inspector general. "Because of that, we felt this was a case we had to take all the way."

    However, a Walker County grand jury in Huntsville took no action after reviewing the details, said Gina DeBottis, chief prosecutor for the Special Prison Prosecution Unit that handles prison crimes.

    Other state agencies and the FBI subsequently decided not to pursue the case, prison officials said.

    Events were similar in the June 19, 2003, case at the Allred unit prison near Wichita Falls, where investigative reports show that Richard McAtee, serving 12 years for aggravated sexual assault of a child, hanged himself about 6:30 p.m. After delays at the prison infirmary, McAtee was rushed to a local hospital, where doctors pronounced him dead at 7:39 p.m.

    Investigators criticized the prison medical staff for their inability to respond quickly. Cardiopulmonary resuscitation was not immediately administered because one nurse forgot her medical bag, one report shows. At the prison infirmary, seven minutes elapsed before CPR was started because the nurse "was unable to locate a one-way breathing apparatus or ambulatory bag."

    Prison investigators referred a complaint over the delays to the state Board of Nursing Examiners. Moriarty said no one was disciplined.

    UTMB medical neglect

    Jan. 15, 2008

    Closer look sought into prisoner's death

    Houston Democrat demands answers in Huntsville case, examination of prison health care

    Copyright 2008 Houston Chronicle

    A Huntsville prisoner's death, ruled a homicide stemming from medical neglect of injuries he suffered in a scuffle with guards last year, prompted a state senator Monday to call for federal and local investigations into the death and an examination of the quality of health care for all Texas inmates.

    Larry Louis Cox, a 48-year-old Houston man serving time in the Texas Department of Criminal Justice's Estelle Unit, died Feb. 6, 2007, two weeks after a confrontation with guards left him with two broken vertebrae that went undetected for weeks, according to state prosecutors who investigated the death. No one was prosecuted or punished over the incident.

    The case came to the attention of Sen. John Whitmire, D-Houston, in December after the dead man's brother wrote the legislator.

    "The death certificate says that this was a homicide and I want to know who is being held accountable, " Whitmire said Monday. "More than anything, I want to know what are the conditions that allowed something like this to happen in the first place."

    Whitmire on Monday sent letters to the Houston office of the Federal Bureau of Investigation and the Department of Public Safety's Texas Rangers requesting that both entities probe the death. He also scheduled a Jan. 24 hearing of the Senate Criminal Justice Committee to examine protocols for prisoners' health care, the process of examining in-custody deaths and whether a chronic shortage of prison guards creates circumstances ripe for such incidents.

    Fell during struggle

    Cox entered the Texas prison system in 1990 after he pleaded guilty to burglary of a habitation with intent to commit sexual assault, and a Harris County judge sentenced him to 20 years in prison. Ten years later, while in prison, Cox was convicted of murder and sentenced to 15 years. Details of that crime were not available.

    He was incarcerated in Huntsville's Estelle Unit on Jan. 23, 2007, when two guards, clearing an area for fumigation, approached Cox's cell, according to Gina DeBottis, the attorney in charge of the state's special prosecution unit, which prosecutes crimes that occur in prisons.

    Cox refused to leave his cell. He kicked one of the guards, prompting the other and a sergeant to attempt to physically restrain him. Cox, whose hands were behind his back, fell during the struggle and struck his face on the edge of a metal bunk and a metal foot locker beneath it, according to the prosecutor's investigation.

    Guards took Cox to the prison infirmary, where he complained of neck pain and was transferred to Huntsville Memorial Hospital. There, he underwent a CT scan, which doctors reported was "unremarkable with no sign of fracture," DeBottis said.

    A Huntsville Memorial spokeswoman, Karen Bilsing, said she was unable to comment on the incident.

    The hospital discharged Cox and he returned to the prison. There, he remained for more than two days, complaining of serious pain, some guards told prosecutors. One guard became so concerned about Cox's condition that he contacted a nurse at the University of Texas Medical Branch at Galveston, which provides health care for prison inmates.

    "By January 26 his condition had tremendously deteriorated and he was taken by ambulance to Galveston," DeBottis said.

    Doctors there classified Cox's condition as critical and ordered two MRIs, which revealed two broken vertebrae and a spinal fracture. Cox continued to decline and he died Feb. 6.

    The Galveston Medical Examiner's Office ruled his death a homicide caused by "medical neglect complicating blunt force trauma," according to the autopsy report.

    A prison spokesman referred questions to UTMB. A UTMB spokeswoman declined to comment Monday.

    Presented to grand jury

    Cox's death was investigated on several levels at the time.

    The Texas Board of Criminal Justice's office of inspector general studied his death and passed its findings onto DeBottis' team of prosecutors. They presented the case in October to a Walker County grand jury, which cleared those involved in Cox's treatment.

    For Whitmire, the probes have been insufficient.

    "I am alarmed at the fact that we have had a homicide in our prison system and nothing has happened," Whitmire said. "This is a clear sign that we have problems that must be addressed and I hope the authorities I have appealed to will investigate."


    Democrat demands answers in Huntsville case

    Oct. 11, 2007

    Whitmire takes UTMB to task for lockup conditions

    Health officials say they didn't see problem

    Copyright 2007 Houston Chronicle Austin Bureau

    UTMB at Galveston is paid by the state to provide health care for juveniles incarcerated by the Texas Youth Commission. Some figures:

    • $19.9 million: Biennial contract cost beginning Sept. 1.

    • $412,000: Annual contract for Coke County health services before troubled detention center closed by state.

    Source: The University of Texas Medical Branch at Galveston

    AUSTIN — The University of Texas Medical Branch at Galveston should be held accountable for failing to report wretched health conditions at a juvenile prison in West Texas, a Houston state senator said Thursday.

    A top correctional health official at UTMB, however, said its 11 medical staffers at the privately operated Coke County Juvenile Justice Center say they never witnessed those conditions.

    The Texas Youth Commission shuttered the youth lockup in the West Texas town of Bronte earlier this month, saying up to 196 juvenile offenders at the center lived amid squalid conditions, including feces-covered cells, insect-infested food and inmates denied the ability to brush their teeth for days.

    "I think the health provider should be challenged and held accountable. The horrible conditions were certainly a health issue," said Democratic Sen. John Whitmire, chairman of the Senate Criminal Justice Committee. "I think (juvenile offenders) were just in a generally poor health environment."

    Dr. Owen Murray, UTMB's associate vice president for correctional managed care, countered that the youths showed no signs of abuse, neglect or infection when examined after their transfer to a state- run detention center.

    Whitmire, who begins a broad inquiry today into monitoring safeguards at state and local criminal justice lockups, said the Coke County offenders were locked in cells with no sanitation with many standing in their own waste.

    He said he plans to address the issues internally with UTMB officials sometime after the Friday hearing.

    "I'm concerned about their conduct in the quality of care provided. But, worse than that," Whitmire said, "they should have been whistle- blowers as well."

    'Deplorable' conditions

    UTMB provides medical care statewide for offenders incarcerated by the youth commission under a two-year contract worth nearly $20 million.

    It began offering medical services in Coke County on Sept. 1, a month before TYC officials made a surprise visit to the youth prison based on inmate complaints.

    TYC acting executive director Dimitria D. Pope described "deplorable" conditions, including the stench of human waste, stopped-up plumbing, malfunctioning fire alarms, poor sanitary conditions for laundry and improperly chained doors.

    She immediately canceled the state's contract with the private prison contractor, Florida-based Geo Group Inc., and transferred the inmates to a state-run facility.

    "Our staff never saw anything that TYC reported," Murray said in an interview.

    On Tuesday, however, a top Geo executive sent a letter to TYC's Pope supporting the state's decision to close the Coke County facility and expressing regret that it had failed to meet expectations.

    "It is a notable exception to Geo's history of successfully meeting client needs. Accordingly, it is an experience that we will carefully evaluate in order to prevent a future recurrence," wrote George C.

    Zoley, Geo's chairman and founder, adding he applauded Whitmire's efforts and will fully cooperate to improve oversight.

    Murray said UTMB had 11 medical staffers who served inmates at the Coke County facility, and most of them, especially the eight nurses, had worked under a contract previously held by Texas Tech University.

    Along with the nurses, one secretary, a part-time doctor and a part- time dentist saw ill inmates at the detention center.

    "We actually inherited the staff from Texas Tech," Murray said, with the exception of the dentist and physician.

    The medical team did not go into the dormitories housing general population offenders, he said. Instead, offenders were brought to a separate medical area.

    The medical team did see a few dozen inmates, cell to cell, in the high-security area, Murray said, where they reported finding no poor health conditions.

    "There was nothing, at least in the areas where they were going cell to cell, to make them think there was any kind of problem or issue," he said.

    Medics saw nothing odd

    UTMB's medical team at the West Texas detention center also said offenders did not complain to them about filth, human waste or not being allowed to brush their teeth, Murray said, and inmates normally do lodge such complaints to prison health providers.

    The youth commission's inspector general and the Travis County District Attorney's Office, meanwhile, have launched criminal investigations focusing on TYC employees who filed quality assurance reports that never mentioned health and safety violations at the Coke County facility, said TYC spokesman Jim Hurley.

    Whitmire said officials at the private prison company told him they had been let down by their own internal monitors in West Texas.

    "There's a whole range of possibilities, " to explain the lax oversight, Whitmire said, "from criminal to ... a culture of being in a remote location in West Texas and confining minority kids from urban areas — San Antonio, Dallas and Houston — and not reporting the bad operations of your relatives and friends."

    polly.hughes@ chron.com

    University Of Texas medical branch and TDCJ, is a seperation in the works?

    April 10, 2007

    Texas Prison medical facilitator accused of mismanagement, possible negligence.
    BY: Tonya Peters, Backgate Reporter

    With prison health care the topic of discussion in several other states right now, to include larger prison systems like California, the state of Texas may also be shopping for a new prison health care system soon. Rumors from within high levels of TDCJ staff have said that the days of UTMB as the Texas prison system's health care facilitator may be numbered.

    The Backgate website has had an ongoing investigation of UTMB policies and procedures regarding TDCJ health care for months, and it may be coming to a head in Austin soon. With the levels of complaints against UTMB within the walls of Texas prisons heading sky high, is UTMB actually placing offenders and staff in danger?

    Our report some months back concluded that the facts where as follows; UTMB staff regularly mis handle medications that are passed out to offenders, sometimes handing out lethal doses of drugs that were not ordered for those offenders. We have had staff witness pill techs hand out someone else's meds to another offender, who caught the mistake, and corrected the pill tech who changed the dosage, and type of drug. There have been numerous near misses. And we have to believe many instances where offenders have been affected.

    UTMB also creates such hostility between security and inmates that tensions often flair due to resolvable medical issues that could be easily corrected on the spot , but are not. I myself have seen nurses turn away offenders that are in need of urgent care, and are turned away , to later get worse and require a hospital stay costing thousands of dollars. Although being in corrections, we see the other side of the coin where inmates take advantage of the medical system of TDCJ , we have seen more times than not, the mismanagement of UTMB at the unit level, that seems to go unchecked.

    The rumors that UTMB may no longer be the health care provider for TDCJ come at a time when prison health care is in the news media all over America.

    Several state correctional systems are looking for answers on how to fulfill a growing need for inmates. In Texas for example, a growing number of incarcerated felons are over the age of 65. This means that more advanced health care will have to be available for those inmates, as well the need for medications. There is also a noted growth in HIV positive offenders, this in itself poses a special medical need for TDCJ.

    According to UTwatch, a prison medical watchdog organization, "Prison health care has become a 7 million per year business for the universities, paid for with public money, but without meaningful public scrutiny." They go on to describe;

    "In July of 1997, the Department of Health inspected the dialysis office at the Estelle prison. Conditions were so bad, the dialysis facility was closed.

    We may never know exactly what was wrong because, like so much of this information, these facts are kept secret by law." We will report more on this story at a future date.

    Free Condoms for Prisoners?

    Barrier Contraception Could Stem High Levels of HIV Infection in Correctional Facilities, Experts Say

    ABC News Medical Unit
    Dec. 14, 2006

    Behind high prison walls,
    the concept of safe sex
    may be as foreign as that of freedom.

    But some say this situation must change, especially because studies suggest that the prevalence of HIV infection in U.S. prisons and jails is six to 10 times higher than that seen in the general free population.

    Recently, the National Minority AIDS Council, an AIDS advocacy group, recommended that prisons curb the spread of the virus by distributing condoms to prisoners.

    The idea is not a new one.

    According to the not-for-profit organization Human Rights Watch, prisons in Mississippi and Vermont, and jails in New York, Philadelphia, Washington D.C., San Francisco and Los Angeles already distribute condoms to inmates.

    Several countries, including Canada, Australia, and most countries in the EU, also distribute condoms to prisoners.

    "Whether legal or not, sex between inmates is occurring, and we must do what we can to provide vehicles for responsible sexual behavior, including the use of condoms," said Eli Coleman, professor and director of the Program in Human Sexuality at the University of Minnesota Medical School.

    "These measures should be adopted worldwide as a means of promoting safety in our prisons. This is sound public health policy," Coleman said.

    Some prisons, however, are reluctant to provide condoms to prisoners.

    "In our system, engaging in sex in prison or sodomy is a Class 1 misconduct," said Sheila Moore, deputy press secretary for the Pennsylvania Department of Corrections in Harrisburg, Pa. "It's against the rules. Passing out condoms in prisons is also a security issue. Things such as drugs can be smuggled in."

    Despite Rules, Sex in Prison Continues

    It is difficult to pin down an exact statistic on how many prisoners are having sex. Various studies have arrived at figures ranging from 2 percent to 30 percent.

    But research also shows that prison sex is risky sex.

    One study in 2002 estimated that about one-quarter of the U.S. population infected with HIV had spent some time each year in a prison or jail.

    Hence, a certain number of prisoners who go in HIV negative come out HIV positive. Health experts say distributing condoms to these prisoners would be a wise approach to the problem.

    Some say that distributing condoms in prisons and jails may also prevent taxpayers from eventually having to pay to care for HIV- infected inmates.

    "If prisoners transmit [sexually transmitted infections] or HIV/AIDS to each other, the public will have to spend the money to take care of them," said Dr. June Reinisch, director emeritus of the Kinsey Institute for Research in Sex, Gender and Reproduction.

    "Whether you are on the side of caring about their health or are against their having sexual interactions -- which we are unlikely to influence one way or another by providing condoms or not -- we may be saving the public millions of dollars in health-care costs for taking care of the sick prisoners," Reinisch said.

    The pros and cons of distributing condoms in prison must be weighed before decisions are made.

    "I think that this approach is worth a try," said Dr. Fred Berlin, associate professor of psychiatry at the Johns Hopkins University School of Medicine. "The reality is that individuals do have sex in prison. However, good data should be maintained documenting both the perceived benefits, as well as any problems that might develop."

    Condoms a Security Concern

    Some prisons argue, though, that passing out condoms could create a host of unexpected problems.

    In short, they say that behind bars, a condom is more than just a condom.

    "We recognize the public health benefit, but a lot of people who do not work in the prison system cannot completely appreciate what inmates do with foreign objects," said Bill Sessa, spokesman for the Department of Corrections and Rehabilitation for the state of California in Sacramento. "They can make a lethal weapon out of dental floss."

    In October, California Gov. Arnold Schwarzenegger vetoed a piece of legislation that would have allowed condoms to be distributed in the state's correctional facilities.

    Sessa says the vetoed bill was not the first time the issue had come up.

    "[Condoms] can also easily be used to hide drugs, or smuggle contraband around the prison," he said.

    There is also the concern that condoms do nothing to prevent the incidence of nonconsensual sex among inmates.

    "It's terrible that prisons cannot protect inmates from nonconsensual sex, but frequently they cannot, and it's even worse when a raped prisoner becomes HIV positive," said Julia Ericksen, professor and chair of the department of sociology at Temple University in Philadelphia. "So, even here, condoms make sense."

    Many Alternatives Costly, Not Feasible

    Proponents of condom distribution in prisons say the measure would cost only pennies per inmate.

    Condom distribution is more preferable than more direct intervention to prevent sex among inmates, such as additional monitoring or isolation.

    "More stringent monitoring, well you could do that," said Dr. Rebecca Finn, director of HIV services for the New York City Department of Corrections.

    "But you'd need more people. It would be more expensive. And I'm not sure it would really do anything. If people are going to be sexually active, they're going to find out ways to do it whether they're being monitored or not," Finn said.

    Finn adds that because many prisons are so large -- Riker's Island, for example, holds between 10,000 and 12,000 inmates -- isolation would not be a feasible alternative.

    "Isolation is just not healthy," she said. "People end up getting mentally very unstable if you isolate them."

    Sex education is another option currently used by many prisons.

    "Our inmate- and employee-education programs for treatment and counseling of infected inmates is in line with state-of-the- art recommendations and consistent with or ahead of usual community practice," said Harrisburg's Moore. "We might not be able to prevent inmates from engaging in sex, but we feel that we need to continue to educate them."

    But Finn says education can go only so far -- particularly when inmates don't have the resources available to ensure their sexual encounters are as safe as possible.

    "Whether we think it's appropriate or not for inmates to have sex with each other, they do," Finn said. "If we refuse to accept the fact that when you put all these inmates together in a dormitory setting that they're going to be sexually active, then I think we are inviting new disease to occur."

    Despite their crimes, some observers say, prisoners do not deserve extra punishment while incarcerated.

    "No matter what, no prisoner deserves to get HIV as part of his punishment," Ericksen said.

    Copyright © 2006 ABC News Internet Ventures

    Free Condoms

    This Is Care?
    Inmate's death casts new shadow on UTMB

    November 24, 2006

    It took a grotesque discovery – rigor mortis – to finally prove to Texas prison medical personnel that young inmate Charles Billops Jr. wasn't faking illness.

    A prison guard picked up the ailing teenager's arm, and it remained frozen – in midair. The 17-year-old had died as he was being shuttled from cell to infirmary to psych unit, and his body had become rigid.

    No inmate in Texas prisons should have to pay such a terrible price as a result of falling ill behind bars.

    Mr. Billops' fatal spiral began with a mere sinus infection. That led to an undiagnosed brain abscess, which ultimately claimed the life of the Cedar Hill teen.

    It's hard to argue on the face of it that medical personnel were not guilty of the "deliberate indifference" alleged in a lawsuit brought by the family. The state has settled the family's claim for $250,000, which certainly is scant comfort for an irreplaceable loss.

    The state maintains that Mr. Billops' condition was rare and difficult to diagnose. Our response: You have to try – and try vigorously. That's something that medical personnel didn't appear to do as Mr. Billops lost more than 50 pounds in his first three months of prison before seeing a doctor.

    He never completed the fourth month of his two-year sentence in a youthful-offender program for petty thievery.

    The episode goes to the question of quality of care provided by the University of Texas Medical Branch, holder of a health-care contract for state prisons. UTMB formerly provided the same function for the Dallas County Jail and was under heavy fire for a litany of serious, life-threatening deficiencies. UTMB did not renew its contract with the county, and the two parted ways earlier this year.

    The Billops case shows that the standard of care on the state level also bears close watching.

    This teenager was sent to prison to pay a debt for stealing a PlayStation and some DVDs. It's beyond outrageous that the price was his life.

    This Is Care?

    November 14, 2006

    Texas underspends on prison healthcare

    Texas is "very close" to not providing a "constitutional level" of healthcare because we're spending the same amount today on healthcare we spent in 2002, said a rep from the Correctional Managed Healthcare Committee.

    The state's having a huge problem finding doctors and especially nurses to work at prisons - private practice pays more, and some hospitals are paying $5,000 signing bonuses for nurses. Given those options, what RN would choose to work in a prison?

    Thanks to longer sentences, the Sunset Advisory Commission was told that the number of inmates over 50 years old in Texas prisons is increasing 10% per year. Inmates over 50 access healthcare three times as often as younger inmates, and cost five times as much per inmate in health expenses. A few inmates incur huge costs. Last year, said Chairman Whitmire, two inmates cost Texas more than $1 million.

    Healthcare costs for Texas inmates are $7.65 per inmate per day, or around $1.2 million a day. Here are some daily per-inmate costs cited by staff from several other states:

    California: $16.60
    New York: $14.16
    Florida: $10.60
    Pennsylvania: $12.02
    New Jersey: $13.87
    Georgia: $9.31
    Oklahoma: $7.20

    More from the TDCJ Sunset hearing:
    TX Underspends

    Kaiser Daily
    HIV/AIDS Report: Across The Nation
    Friday, September 22, 2006

    Health Experts Urge Texas To Distribute Condoms to Prison Health Experts Urge Texas To Distribute Condoms to Prison Inmates [Sep 22, 2006] Health experts have urged Texas to distribute condoms at no cost to prison inmates to combat the spread of HIV, the Houston Press reports (Malisow, Houston Press, 9/21).

    July statistics show that of 154,000 prisoners in the state, 2,627 are HIV-positive. The state prison system in August proposed a change to its HIV testing policy from saying new inmates "should be tested" upon entering prison to saying they "shall be tested" unless they refuse the test.

    About 80% of inmates have agreed to take an HIV test upon entering prison since the state began its testing program, and prison system statistics show more than 38,700 inmates received HIV tests in 2005, 372 of whom tested HIV-positive.

    Texas law mandates that results of HIV tests are confidential and that HIV-positive inmates are not separated from HIV-negative inmates (Kaiser Daily HIV/AIDS Report, 8/24).

    Heather Mitchell, a member of ACT UP Austin, said that distributing condoms to inmates would be an inexpensive method of reducing HIV transmission.

    According to ACT UP, distributing condoms in state prisons would cost the Texas Department of Criminal Justice less than $300,000 annually.

    In addition, it is likely that federal, state and local HIV prevention funding would cover most of the program's costs, according to ACT UP. "Prisoners are engaging in sex, and condoms are a proven HIV prevention tool, so it just makes sense that providing condoms is going to decrease the number of infections," Mitchell said, adding, "And from a public health standpoint, anything that decreases HIV infection is a good idea."

    According to TDCJ officials, condom distribution is not allowed in state prisons because it would violate the department's zero- tolerance policy on sexual activity. TDCJ spokesperson Michelle Lyons said that the department is not ignoring the issue and is addressing it through programs that do not violate the zero- tolerance policy.

    According to the Press, the TDCJ and AIDS Foundation Houston have launched "Wall Talk" and "Safe Prisons," two peer-education programs that aim to combat the spread of HIV among inmates.

    (Houston Press, 9/21)

    Health Experts Urge Distribute
    Condoms to TX Prisons

    Should all new convicts get HIV tests?

    Houston senator asks AG to rule

    By Mike Ward
    Wednesday, August 23, 2006

    For years, prison officials have asked all convicts coming into the state prison system to be tested for HIV. About 80 percent have consented.

    Now, a state senator wants to know whether they can make such tests mandatory.

    "It's a public safety issue," said Sen. Rodney Ellis, D-Houston. "We're very concerned about the rapidly increasing infection rates."

    Current prison system policy states that all incoming nmates "should be tested at intake," and under a proposed change to take effect next week, that would become "shall be tested" — unless the inmates refuse. At the same time, mandatory testing is done at intake for tuberculosis and syphilis.

    Upon release, every inmate is tested for HIV as part of a mandatory DNA blood test.

    Were prison officials able to test all incoming convicts, advocates of the testing say, they could know with certainty who was HIV- positive — information that would assist them in properly treating early infections. It could also provide statistical data on how many convicts are becoming infected or testing positive for the infection after they come into the prison system.

    Inmates who test HIV-positive are not isolated from other inmates.

    For some time, some medical experts have called for such mandatory testing in prisons, citing prisons as perfect incubators for a number of deadly diseases, including HIV and AIDS, and arguing that the nation's 1.4 million prison inmates have an infection rate five times that of the general public.

    Diseases in prison return to society when the infected inmates are released, the experts say.

    By state law, the results of HIV tests are confidential except to the individual inmate and medical staff.

    To underscore his concern on the issue, Ellis on Aug. 2 asked Attorney General Greg Abbott to rule on whether the testing can be mandatory under current state law — a law that was changed about a year ago to require the mandatory HIV testing for all convicts departing prison. Ellis and Rep. Yvonne Davis, D-Dallas, were the authors of that change.

    "If (Abbott) says the mandatory tests at intake are not mandatory, I'm going to put in legislation to require them," Ellis said.

    According to prison system statistics, more than 38,700 Texas convicts were tested for HIV last year. Of those, 372 were diagnosed as HIV-positive, according to the statistics.

    Texas' prison system holds about 154,000 convicts. Of those, 2,627 were HIV-positive in July, official statistics show.

    "We encourage incoming inmates to submit to the test so we can get them the treatment they need," said Michelle Lyons, spokeswoman for the Texas Department of Criminal Justice.

    mward@statesman.com; 445-1712

    Find this article at:
    HIV Testing

    Texas prison health care system on critical list

    Millions more will be need to keep inmate clinics constitutional, top state officials warn.

    By Mike Ward
    Monday, July 24, 2006

    Bricks falling off the eight-story hospital's crumbling facade have forced officials to fence it off, to keep passers-by out of harm's way.

    Less than half of the aged X-ray machines are working, and derelict machines must be continually cannibalized to keep others in service.

    Shabby dental and dialysis equipment that no private doctor would touch remains in use.

    Many clinics now operate with skeleton staffs, if they're open at all.

    Simply put, Texas' prison health care system is facing a growing crisis — so serious that top officials, for the first time, are warning that unless more money is allocated, the quality of Texas' prison health care could once again become unconstitutional, as it was three decades ago.

    "We're toed up to the line. No doubt about it," said Dr. Ben Raimer, vice president for correctional health care for the University of Texas Medical Branch at Galveston.

    "Right now, the system is constitutional . . . but we're on a thin line," Raimer said.

    UTMB operates prison clinics in about two-thirds of the state's 112 prison units under a contract with the corrections system. Texas Tech University runs the other third, mostly in West Texas.

    In addition to an estimated $16.6 million in upgrades to equipment and buildings, Raimer and other officials plan to ask lawmakers for an additional $32 million or more in taxpayer money just to make ends meet for everyday operations through August 2007.

    That's on top of the $375.8 million for prisoner health care in the state's current two-year budget.

    State officials say the problem is simple: skyrocketing costs of providing health care to an aging population of inmates who are afflicted with serious, expensive diseases.

    The crisis comes at a difficult time for state budget writers.

    Six months before the Legislature convenes again in January, lawmakers already are facing demands for hundreds of millions more for indigent health care programs, schools and even prisons.

    Gov. Rick Perry has asked almost every state agency to start the budget-writing process by submitting budget requests that are 10 percent less than their current budget.

    With the corrections system now near capacity with 152,000 prisoners, new prisons alone could cost upwards of $400 million, by some estimates.

    Projections compiled for House and Senate leaders show that UTMB expects a $24 million deficit from providing prison health care through August 2007 and that the Texas Tech University Health Sciences Center expects to lose $7.8 million.

    In addition, Raimer said, UTMB spent $9.5 million more than it was paid last year to provide prisoner health care.

    "If we don't get more money, in good faith, I can't see my president, our regents continuing the contract" when it ends in September 2007, he said. "I would expect the recommendation that we exit the contract."

    "You can't expect doctors to provide substandard care."

    Added Allen Hightower, executive director of the state's Correctional Managed Health Care Committee that oversees the prison health care system: "You can only squeeze so much juice out of an orange, and then there just isn't any more. We're there."

    Treatment rights

    For more than a year, inmates and their families have voiced increasing complaints and concerns that the quality of care is declining. Prison and medical officials have repeatedly denied those assertions, though acknowledging that increasing costs are a concern.

    They say their new warnings are designed to alert legislative leaders about the need for additional funding to avoid problems other states are experiencing.

    California's prison medical system is under court receivership, and systems in New York and New Jersey are verging of the same fate because of escalating costs and inadequate funding.

    "The system is a mess," said Helga Dill, on the board of Texas CURE,a prisoner advocacy group. "More money will help, but they also need to fix the problems with access to care, whether inmates receive the care they are supposed to get."

    The benchmark for prison health care in Texas is a 30-year-old U.S. Supreme Court decision — Estelle v. Gamble — that gives inmates the right to access medical care, the right to professional medical judgment and the right to receive the medical care called for by that medical professional.

    The separate, landmark Ruiz lawsuit that forced sweeping reforms in prison operations during the 1980s and 1990s also mandated additional changes in medical care and eventually led to the decision by prison officials to contract the health care programs to the two universities.

    Since that was done in 1993, the system has been praised as one of the least expensive in the country — a model of efficiency and cost saving, officials say — despite lingering complaints about the quality of care.

    Now, Texas officials acknowledge that the crisis is growing on several fronts, though they stress that the quality of care has not suffered.

    Medical staff costs are steadily increasing, driven by market demand for professionals such as nurses.

    Current vacancy rates in key provider positions such as doctors and nurses range as high as 17 percent at some prisons, according to details supplied to a House committee.

    In recent months, prison officials have complained that their demands for additional medical staff at some prisons have been denied by UTMB and Texas Tech officials.

    "The biggest issue is recruiting. . . . We'll have to increase salaries," Raimer said.

    Other officials noted that recruiting has become harder because the work is in a prison clinic and pay levels there often cannot compete with those in private hospitals, where signing bonuses and more pay for some shifts are commonplace. Prison clinics cannot offer those perks.

    Failing equipment

    In addition, the number of older prisoners has been growing at 10 percent a year.

    Because prisoners older than 55 tend to have more chronic illnesses that are more expensive to treat, costs are escalating almost as fast: Just 5.4 percent of the prison population accounted for 25 percent of hospitalization costs last year, officials said.

    Pharmacy costs are expected to increase 4 percent next year because of higher drug prices and the increased need for newer and more expensive drugs to treat hepatitis C and HIV, among other diseases.

    And because there will be more geriatric patients to treat, "we will have more offender patients with chronic illnesses and increased medication needs," according to a UTMB-Texas Tech report provided to legislative leaders.

    The hepatitis C epidemic highlights the size of that problem.

    An estimated 20,000 convicts in Texas are infected with hepatitis C, and 800 are receiving drug treatments that can cost $10,000 or more a year, double the number two years ago; 28 percent of the inmates arriving in state prisons from county jails test positive, officials said.

    In West Texas, where Texas Tech officials outsource some prison health care services, local providers have become increasingly unwilling to do the work because the state payment rates are too low.

    Coupled with the increasing costs is a rapidly deteriorating infrastructure.

    Most needed: $6.3 million in new radiology equipment, dialysis and dental chairs, computer equipment and buses and vans to take sick inmates to hospitals.

    "Much of the equipment we are now using was purchased before UTMB became the care provider in 1993, and we continually have to scavenge parts and equipment," Raimer said.

    "Less than half of the X-ray equipment is not functional.... I know of one dentist working part time in San Antonio who had to bring in equipment from his (private) office," he said.

    Even the prison system's flagship hospital in Galveston — now 23 years old — needs $10.4 million in repairs, from the bricks falling off its exterior to malfunctioning security gates and worn-out interior fixtures.

    The falling bricks, now officially characterized as a serious safety issue, have prompted officials to erect protective fences around parts of the exterior.

    "Something has to change for the better," Raimer said.

    mward@statesman.com; 445-1712

    How Texas compares

    Per-day costs of prison health care

    Texas $7.42

    California $14.96

    Ohio $11.64

    Florida $10.83

    Note: Figures are for 2004, except California. Those figures are for 2003, the latest available.

    Source: Council of Governments

    Losing money

    Estimated losses through the end of August this year and next for providing prison health care

    Fiscal year 2006

    UTMB $6.5 million

    Texas Tech $1.8 million

    Fiscal year 2007

    UTMB $17.5 million

    Texas Tech $6 million


    UTMB $24 million

    Texas Tech $7.8 million

    Sources: UTMB, Texas Tech

    Growing costs, growing needs

    Anticipated requests for additional money from the Legislature for prison health care in the next two-year budget cycle.

    Description Total

    Increase to cover ongoing costs $47 million

    Increase to retain health care staff $21.8 million

    Increased hospital/specialty care costs $23.7 million

    Increased pharmacy costs $7.1 million

    Critical equipment replacement $6.3 million

    Other increased operating costs for supplies and services $5.8 million

    Galveston hospital repairs $10.4 million

    Total $122.1 million

    Sources: UTMB, Texas Tech

    Find this article at:
    Critical List

    July 24, 2006

    A Warning About AIDS in Prison

    The American prison system houses 1.4 million inmates — in cramped, unsanitary conditions, with little medical care to speak of — and has an H.I.V. infection rate nearly five times that of the general, nonprison population. With inmates who participate in unprotected sex or share needles while using illicit drugs, the prisons are perfect incubators for deadly diseases, including AIDS.

    Foreign governments and international health organizations have long recognized the need to use the same AIDS prevention programs within the prisons as on the outside. At the very least, that means providing inmates information about AIDS and access to condoms. The situation is quite different in the United States, where the vast majority of corrections systems either decline to distribute condoms or bar them outright, on the grounds that sex behind bars is against prison rules.

    Discomfort with the idea of men having sex with men has led a few prison officials to suggest that sex between prisoners behind bars doesn’t happen all that often. The danger of this denial-based approach to public health was recently underscored in a bulletin from the Centers for Disease Control and Prevention. A study of the state prison system in Georgia, covering the years between 1992 and 2005, focused on 88 inmates who tested negative when they entered prison but who became H.I.V. positive while incarcerated.

    Despite denials to the contrary, the C.D.C. reports, “sex among inmates occurs,’’ and laws or policies prohibiting it have been “difficult to implement or enforce.’’

    The Bush administration’s hostility toward condom distribution — and toward straight talk about sex in general — has had a chilling effect at the C.D.C. Nonetheless, the bulletin urges state corrections systems that don’t have condom distribution programs to investigate the feasibility of adding them. The states need to take this advice seriously. Diseases that fester in prison spill over into society as a whole when the infected inmates return to the streets.


    This story was written in 2003 and nothing has changed...

    United States: Mentally Ill Mistreated in Prison More Mentally Ill in Prison Than in Hospitals

    (New York, October 22, 2003)

    Mentally ill offenders face mistreatment and neglect in many U.S. prisons, Human Rights Watch charged in a report released today.

    Prisons have become the nation’s primary mental health facilities. But for those with serious illnesses, prison can be the worst place to be.

    Jamie Fellner Director, U.S. Program of Human Rights Watch One in six U.S. prisoners is mentally ill. Many of them suffer from serious illnesses such as schizophrenia, bipolar disorder, and major depression. There are three times as many men and women with mental illness in U.S. prisons as in mental health hospitals.

    The rate of mental illness in the prison population is three times higher than in the general population.

    According to the 215-page report, Ill-Equipped: U.S. Prisons and Offenders with Mental Illness, prisons are dangerous and damaging places for mentally ill people. Other prisoners victimize and exploit them. Prison staff often punish mentally ill offenders for symptoms of their illness – such as being noisy or refusing orders, or even self-mutilation and attempted suicide. Mentally ill prisoners are more likely than others to end up housed in especially harsh conditions, such as isolation, that can push them over the edge into acute psychosis.

    “Prisons have become the nation’s primary mental health facilities,” said Jamie Fellner, director of Human Rights Watch’s U.S. Program and a co-author of the report. “But for those with serious illnesses, prison can be the worst place to be.”

    Woefully deficient mental health services in many prisons leave prisoners undertreated – or not treated at all. Across the country, prisoners cannot get appropriate care because of a shortage of qualified staff, lack of facilities, and prison rules that interfere with treatment.

    According to Human Rights Watch, the high rate of incarceration of the mentally ill is a consequence of underfunded, disorganized, and fragmented community mental health services. State and local governments have shut down mental health hospitals across the United States, but failed to provide adequate alternatives. Many people with mental illness – particularly those who are poor, homeless, or struggling with substance abuse problems – cannot get mental health treatment. If they commit a crime, even low-level nonviolent offenses, punitive sentencing laws mandate imprisonment.

    “Unless you are wealthy, it can be next to impossible to receive mental health services in the community,” said Fellner. “Many prisoners might never have ended up behind bars if publicly funded treatment had been available.”

    The Human Rights Watch report is based on more than two years of research and hundreds of interviews with prisoners, corrections officials, mental health experts and attorneys.

    It describes prisoners who, because of their illness, rant and rave, babble incoherently, or huddle silently in their cells. They talk to invisible companions, living in worlds constructed of hallucinations. They lash out without provocation, beat their heads against cell walls, cover themselves with feces, mutilate themselves until their bodies are riddled with scars, and attempt suicide.

    The Human Rights Watch report documents how prisoners with mental illness are likely to be picked on, physically or sexually abused, and manipulated by other inmates, who call them “bugs.” For example, a prisoner in Georgia, who is both mentally ill and mildly retarded, has been raped repeatedly and exchanges sex for commissary items such as cigarettes and coffee.

    Mentally ill prisoners can find it difficult if not impossible to comply with prison rules, and end up with higher than average rates of disciplinary infractions. Security staff – who usually lack training in mental illness – do not distinguish between the prisoner who is disruptive or fails to obey an order because of illness and a prisoner who causes problems for other reasons.

    Mentally ill prisoners have been punished for self-mutilating (“destroying state property”); attempting suicide with a torn sheet (“destroying state property”); for yelling and kicking cell doors because of hearing voices (“creating a disturbance”); for throwing papers at a guard while delusional (“battery”); and for smearing feces on the cell door (“being untidy”).

    Untrained staff escalate confrontations with mentally ill prisoners, sometimes using excessive force. Several mentally ill prisoners have died from asphyxiation after struggling with guards who used improper methods to control them.

    Over the past two decades, prison mental health services in the United States have improved – usually because of prisoner litigation. But the surging number of mentally ill men and women entering prison has outrun the availability of services. Public officials have been unwilling to provide the funds necessary to ensure adequate treatment for all the mentally ill offenders who need it.

    “Prison officials are being asked to do something they aren’t equipped to do,” said Fellner. “Prisons are designed for punishment, not as places to provide comprehensive mental health treatment. If people with mental illness must be incarcerated, they should be housed in facilities designed and funded to meet their mental health needs.”

    Human Rights Watch urged the U.S. Congress to enact legislation proposed by Senator Mike DeWine (R-Ohio) and Congressman Ted Strickland (D-Ohio) that would provide federal grants to divert mentally ill offenders into treatment programs rather than jail or prison, and to improve the quality of mental health services provided to jail and prison inmates.

    Human Rights Watch also recommended the use of independent mental health experts to assess mental health services in each prison system, urged elected officials and the heads of correctional agencies to ensure that mentally ill prisoners receive mental health services consistent with community standards of care, and called for rules to prevent housing prisoners with mental illness in isolated confinement or super maximum security prisons.

    The Mentally-Illed in Prison

    U.S. government wants to begin
    using prisoners for medical experiments

    Thu Jul 13, 2006 4:18 pm (PST)

    U.S. government wants to begin using prisoners for medical experiments (NewsTarget) A new report by the Institute of Medicine recommends easing current restrictions on the use of prisoners in medical experiments to allow inmates to "benefit" from clinical trials.

    Critics of the plan cite past abuses of prisoners by pharmaceutical companies and medical researchers as reasons to keep rigid restrictions on medical experimentation in place. About 300 former inmates have sued Penn drug researcher Albert Kligman for allegedly experimenting on them in 1964 with infectious agents, dioxin, radioactive isotopes and psychotropic drugs. Inmates were told the chemicals they were testing were harmless.

    Following the Holmesburg scandal, the federal government placed strict limitations on performing medical experiments.

    Experiments on prisoners,
    but the new Institute of Medicine.

    Medicine report suggests prisoners should once again be used to test therapies in the final phase of FDA approval, as long as the trials do not involve cosmetic toxicity testing, and half the trial members are not inmates.

    However, the Holmesburg prisoners represent only one of many cases of government-sponsored abuse at the hands of medical researchers
    Researchers .

    According to extensive NewsTarget.com
    research; Abuse, prisoners have been experimented on with everything from malaria and hepatitis Hepatitis to cancer and cholera.

    Cases of performing vivisections on live prisoners have even been reported.

    Ernest D. Prentice, chair of the Institute of Medicine's advisory board, says the current regulations "were written in an era of protectionism -- that taking part in research was bad and (prisoners) needed to be protected. We don't have that same view anymore."

    Temple University professor Allen M. Hornblum, author of "Acres of Skin," which details the experiments performed at Holmesburg, says prisoners should not be used in medical experiments, and that the new report "is like putting (on) the Good Housekeeping seal, saying it's now okay to do some of these things."

    However, the Institute's committee members say past mistakes in medical experimentation must be learned from and moved past. The report also says that with the prison population booming, prisoners are in need of new medicines that could help treat diseases from hepatitis to AIDS.

    Pharmaceutical companies typically recruit poor people for medical experiments, but with the number of drug experiments on the rise, and with fewer people willing to voluntarily participate in such trials, opening the prison population to medical experimentation would allow drug companies access to a huge population of low-cost guinea pigs.

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    Group urges research rules for prisoners

    By RANDOLPH E. SCHMID, AP Science Writer
    (Updated Wednesday, July 12, 2006, 1:04 PM)

    WASHINGTON (AP) - Federal rules protecting people who are subjects of scientific research should be extended to include prisoners, the Institute of Medicine said in a report released Wednesday.

    The U.S. Office for Human Research Protections oversees many federally funded studies involving human volunteers. But it does not have jurisdiction over research funded by the Bureau of Prisons and other federal, state or private organizations that support studies with prisoners.

    That is unjustified, a panel convened by the Institute concluded. It said all research involving prisoners - whether in jail or on probation or parole - should be governed by uniform ethical standards and guidelines.

    Just how many prisoners are participating in research programs was not known, however, since there is no database of research involving them, according to the Institute, a branch of the National Academy of Sciences. Such a database should be established, the report said.

    "Humane, respectful treatment of all prisoners is a hallmark of decent society," said Lawrence Gostin, associate dean and professor of law at Georgetown University Law Center in Washington and chairman of the committee that wrote the report.

    "Our goal should be to promote rigorous, responsible research that has the potential to improve the well-being of prisoners and the general public, while taking great care to protect the health and human rights of study participants, " Gostin said in a statement.

    Of concern were prisoners' limited privacy, their inherently coercive living arrangements and often inadequate health care.

    "They are among the most vulnerable human subjects of research," he said.

    Currently, prisoners taking part in medical studies are covered by rules enacted in the 1970s, the report noted.

    Since those rules were adopted, the number of people in correctional institutions has increased nearly five times to almost seven million, the report said. That has increased crowding while access to programs, services and health care that might be needed by prisoners in experiments has not kept pace.

    Also, the report said, the prison population includes an increasingly large number of people from racial minorities and people who have mental illnesses and communicable diseases.

    For research to be ethical it must offer prisoners potential benefits that outweigh risks, the committee said.

    It has long been questioned whether prisoners can make a free choice about participating in research programs. Voluntary, informed consent is a prerequisite and human research protection programs must ensure it, the report concluded.


    Prisons, jails urged to target TB

    By Joyce Howard Price
    July 10, 2006

    Tuberculosis is "particularly problematic" in U.S. correctional and detention facilities, say federal health officials, who have updated guidelines for preventing the spread of TB in jails and prisons.

    "Effective TB prevention and control measures in correctional facilities are needed to reduce TB rates among inmates and the general U.S. population," say authors of a report published in the current issue of the federal Centers for Disease Control and Prevention's (CDC) Morbidity & Mortality Weekly Report.

    "Inmates with undiagnosed TB disease place other inmates and correctional staff at risk for TB, and when released, these persons also can infect persons living in surrounding communities, " the researchers said.

    In the report, G. Scott Earnest and other CDC epidemiologists point out that the number of U.S. prison inmates quadrupled from 500,000 in 1980 to about 2 million in 2003.

    "A disproportionately high percentage of TB cases" occur among prison inmates, they said. In 2003, 0.7 percent of the total U.S. population was confined in jails and prisons, yet 3.2 percent of all TB cases nationwide that year "occurred among residents of correctional facilities."

    The researchers said the TB rates of inmates in prisons in California and New York are 10 to 15 times greater than the general populations of those states. Studies show the prevalence of LTBI -- or latent TB infection, which is asymptomatic -- "to be as high as 25 percent" in prisons, they said. Like TB disease, LTBI can be detected by screening and can be treated.

    The authors say the key reasons that prison inmates are at higher risk for the airborne infection are their diverse backgrounds, overcrowded facilities and poor ventilation.

    In addition, they say, "disparate numbers of incarcerated persons are at high risk for TB," because they have HIV, use injection drugs and have "low socioeconomic status" so may not have had access to proper medical care.

    In the United States, TB tends to be concentrated among immigrants. "Detained immigrants are arriving largely from countries with a high prevalence of TB" -- including Mexico, the Philippines and Vietnam -- "and therefore present unique challenges in the elimination of TB in the United States," the authors said.

    They note that testing and treating undocumented aliens can be difficult and that these people sometimes are resistant to "first- line anti-TB drugs because of interrupted treatment received in their countries of origin."

    The good news, the researchers said, is that illegals who wind up in American prisons "have an opportunity to receive TB screening and begin treatment for TB disease."

    The CDC's recommendations for prevention and control of TB in jails and prisons is the first update since 1996.


    Society Should be Concerned about Prisoners' Health

    By Gail C. Christopher, NNPA
    July 10, 2006

    The fight to end health disparities in the United States won't succeed unless local, state and federal leaders place more emphasis on improving the healthcare available to inmates in the nation's jails and correctional facilities.

    The current situation is appalling. There are nearly 1 million African Americans in jails and prisons today, comprising 44 percent of the 2.2 million prison population.

    The inadequate healthcare that they receive while incarcerated contributes to the health disparities that are causing African- American men, women and children around the country to be disproportionately diagnosed with a wide range of diseases.

    How does the health of prisoners impact our communities?

    Data recently released by the Commission on Safety and Abuse in America's Prisons shows that experts conservatively estimate that between 300,000 and 400,000 inmates across the country suffer from some mental illness. They get little treatment while incarcerated, thus they are returned to their communities with mental conditions that are likely to contribute to undesirable behavior.

    Moreover, the Commission's report also found that 1.5 million prisoners are released each year with life threatening, infectious diseases. That means people with HIV, tuberculosis, staph infections and Hepatitis are also returned to their communities where contagious diseases are passed on.

    Clearly, our nation has turned its back on the healthcare of prisoners, failing to recognize that most inmates eventually get released, and then bring their health issues back to their families and communities. There are a series of policies in place that are a major hindrance to allowing prisoners to receive proper healthcare.

    For instance, it is counterproductive for inmates to lose their Medicare and Medicaid benefits after they are incarcerated. A major hurdle for prison wardens is that even if jails and prisons want to vastly improve healthcare services for prisoners, most lack the resources to do so. The federal government exasperates the problem by taking away Medicare and Medicaid benefits, reimbursements that could be used by jails and prisons to bolster their healthcare services.

    Furthermore, this is a shortsighted policy by the government. In many instances, if prisoners received treatment for some of these diseases while they are incarcerated, it would actually reduce the costs associated with their health once they are released. Take Hepatitis C, for instance.

    Many prisoners don't receive any treatments for this disease. Years later when they are back in their communities, they may need liver transplants, which will cost the government far more than the treatments.

    The Commission's extensive report also noted another source of healthcare problems. Many prisons have adopted inmate co-payment systems. The inmates must pay between $2 and $15 to visit the doctor. Such plans were implemented to curtail inmates from making unnecessary doctor requests. But it also has another impact: those who need to see a doctor often don't because they have no funds in their prisoner accounts.

    This type of system doesn't seem fair when inmates have little control over whether they get chosen for wage paying jobs while incarcerated. Some have to depend on their families to deposit money in their prison accounts. But many inmates come from low income environments where that is not possible, so they go without healthcare.

    Another indication of how our society feels about inmate healthcare is demonstrated by states that issue special licenses for physicians who can only work in jails or prisons. These doctors have failed to display a level of skill and competence that would allow them to treat the general public, yet they are allowed to work on inmates. The Commission report notes that every six or seven days last year, a prisoner died in a California correctional facility from malpractice or inadequate healthcare.

    The Commission report discloses evidence of gross neglect regarding healthcare for prisoners. African Americans must realize that with nearly one million blacks behind bars we must advocate for prison reform. Building new correctional facilities should not be a priority; providing humane conditions, including adequate healthcare, should be at the top of the public policy agenda for prisons.

    Gail C. Christopher is vice president for health, women and families at the Joint Center for Political and Economic Studies, and director of the Joint Center Health Policy Institute.

    Copyright 2005, Louisiana Weekly Publishing Company

    Health Care

    Hundreds of HIV-positive inmates released

    By Greg Barr
    The Daily News
    Published June 25, 2006

    During the first five months of 2006, 480 inmates who were released from Texas prisons took more than just their hopes and dreams of starting a new life as they rejoined society. They also carried the virus that causes AIDS.

    As HIV infection rates continue to rise in the United States, medical professionals who care for the prisoners the population with the country's highest rate of infection say more emphasis on prevention and education is needed to curb the epidemic of infection.

    Some men knowingly infect their spouses or girlfriends with HIV because they are unwilling to admit they had high-risk sex in prison.

    Anne De Groot, director of the HIV/TB research lab at Brown University in Rhode Island, keynote speaker at a recent Galveston conference on HIV and prisoners, said 20 percent of the nation's HIV- infected population passes through the prison system.

    "And we are the revolving door. They go in and out," she said.

    In Texas, prisoners are required to have HIV testing before their release, if they have not already tested positive through voluntary testing.

    The Texas Legislature passed a bill in May 2005 requiring that mandatory screening, citing the "genuine threat to public health" caused by the increasing number of inmates with HIV in prison who return to the community. Only 20 states require mandatory HIV testing.

    "We need to overcome our discomfort and attack the problem, because it is costing lives inside and outside prisons," said the bill's sponsor, Sen. Rodney Ellis (D-Houston).

    About 80 percent of incoming prisoners submit to voluntary HIV tests, said TDCJ spokeswoman Michelle Lyons.

    At the end of May, there were 154,367 prisoners in the Texas prison system, of which 2,598 were infected with HIV. As of December 2005, 894 Texas prisoners had AIDS. Of the state's total HIV prison population as of that month, 1,494 were black, 628 white and 273 Hispanic.

    During 2005, 1,215 inmates with HIV were released by the state, down slightly from the 1,307 released in 2004.

    The medical branch has a managed care contract to provide medical services to the state correctional department, covering about 80 percent of inmates. Texas Tech University covers the remaining prison units. The state correctional system pays about $375 million a year for that managed care contract.

    During the first four months of 2006, the medical branch processed 48,942 HIV tests for the Texas prison system, of which 778 turned up positive. When a prisoner's test is positive, it is run two more times for confirmation, followed by a more sophisticated final test. Medical branch officials said they expected to handle more than 73,000 prison HIV tests this year, and spend about $500,000 annually providing that testing service.

    De Groot suggests that HIV infections in and outside prisons could be prevented if condoms were distributed to U.S. prisoners. A study of Georgia inmates published in April reported that, among those prisoners reporting consensual male-with-male sex in prison, only 30 percent used barrier protection, such as plastic food wrapping or rubber gloves.

    TDCJ's Lyons said supplying condoms to inmates is not something that the state would consider.

    "We don't encourage any kind of sexual activity in the prisons, be it consensual or otherwise," said Lyons. "There is some kind of misconception that prisons are this hotbed of infection, but most cases (of HIV) are already contracted before the prisoners get here."

    HIV-positive inmates released

    Female inmates have higher HIV infection rate

    By Greg Barr
    The Daily News
    Published June 25, 2006

    'He shot my dog Ziggy for barking too much. I knew he would go after my son next.' Victoria could rarely recall a time her boyfriend was not waving a gun in her face. One day, she shot him, six times.

    Being sexually abused by her brother, and later in life, by an uncle, turned Pam's world upside down. Moving into a women's shelter was the happiest day of her life.

    Mary's husband, a high-risk drug user, was the skeleton in her closet. If she asked him to use a condom, he beat her.

    After what Sue Coe has seen and heard the past two weeks, the fact that it has driven her to start smoking again seems inconsequential.

    The acclaimed New York artist and author, along with Eric Avery, a University of Texas Medical Branch psychiatrist, has been listening to heart-rending stories told by six female inmates infected with HIV, the virus that causes AIDS, at Texas City's Young Medical Facility prison infirmary on Attwater Avenue.


    Frightening Lives
    The British-born Coe, who studied at the Royal College of Art before moving to the United States in 1972, specializes in a form of artistic activism.

    She captured the Texas City inmates' caricatures on her canvas and turned their shattered lives into detailed illustrations for a book to be titled "Through Her Own Eyes" to be published later this year and distributed to medical and correctional staff at prisons and hospitals.

    "Going in, I thought (the prisoners) would be frightening. But it was their lives that were frightening, not them," said Coe, whose work has appeared in the New Yorker, Rolling Stone and Time magazines. "Some of these people could be my friends. I know they're criminals, and I'm not understating what they have done. But society has helped to create their situation. They're as angry and vulnerable as a human being can get."

    This is the second time Coe has visited the area for a project. In 1994, she did a series of drawings, first published in the Village Voice, of AIDS patients nearing the end of their lives at a University of Texas Medical Branch hospital.


    Beyond The Walls
    David Paar, director of HIV care for the Texas Department of Criminal Justice, who is coordinating the latest book project, said medical professionals are taught to avoid asking about prisoners' past transgressions.

    He hopes the book will open that door, because many prisoners, upon release, return to the only life they know.

    "All medical and correctional facility workers should be more aware of the extenuating circumstances that got these people into prison," said Paar, an associate professor of medicine at the medical branch. "If we're more aware, we can provide more effective health care that can extend beyond the prison walls."

    This suggested emphasis on linking past high-risk behaviors to causes for HIV infection among prisoners cannot come too soon for some medical experts, who gathered at a June 16 conference in Galveston to discuss the situation.


    Unprecedented Rise
    They heard presentations about the unprecedented rise of HIV infections among those behind bars - and how women prisoners, two-thirds of whom are African Americans, now have a higher infection rate than men. What's more, women are now being incarcerated at a higher rate than men - between 1995-2004 the number of women in prison grew by 48 percent, compared to 29 percent for men.

    The incidence of HIV infection among the prison population is nearly five times higher than the general population. Some 23,659 state and federal prisoners were HIV-positive in 2003.

    But despite popular cultural notions that male prisoners would have higher infection rates due to male-with-male sex, intravenous drug use or tattoos while incarcerated, more women than men in the prison system are HIV-positive.

    About 3 percent of all female inmates in the country and 2 percent of male inmates were HIV-positive in 2003.


    Danger Outside
    Yet the most important factor in helping curb the spread of HIV, said Paar - who treats about 60 HIV-positive prisoners weekly around the state using a computer video teleconferencing system at his Galveston office - is what happens to these inmates before or after they leave prison.

    "We have good care in the prisons. It's important that we focus on discharge planning to allow (HIV-positive inmates) to continue care," Paar said. Local social service agencies, such as the AIDS Coalition of Coastal Texas, which manages the cases of HIV/AIDS patients in Galveston County, are contacted if an inmate plans to return to that area.

    "We know that if this happens, and they have access to those services in the community, it reduces the chances of them returning to prison by 50 percent within the first six months or a year."

    Still, he said there are hurdles to overcome.

    "Identifying where the inmate goes (after release) is not as easy as you might think," Paar said. Although the state can provide a 30-day supply of HIV medications free of charge for inmates upon release, making sure that happens is a challenge.

    In her presentation, Coe recounted horror stories from inmates who described the scene at the Houston bus station, where some state inmates are dropped off after release, with about $50 in their pockets. Scores of crack dealers and prostitutes congregate in that area, knowing they may have a captive audience.

    "The missing link is obviously being able to hold the prisoner's hand, to get past that mess at the bus station and get the inmates home," said Paar. "Smaller states such as Rhode Island, with only 40 HIV-positive inmates being released a year, can provide that service but we can't replicate that in Texas."


    Hardest Hit
    Considering overwhelming evidence indicating that HIV infections are rising at an alarming rate among the African-American population - which also makes up the largest percentage of prisoners - Anne De Groot, director of the HIV/TB research lab at Brown University in Rhode Island, said she thought more emphasis should be placed on social and medical programs that target the risk factors for those most likely to become infected with HIV.

    "We have to know how to identify these people (at risk) ahead of time before they fall into the lifestyle that leads to prison. We have to be able to say that race, poverty and sexual abuse are the real issues we face," said De Groot, who has published numerous papers on women prisoners and HIV.

    Women's physiology leaves them more susceptible to HIV infection, De Groot said. And if they suffer post-traumatic stress disorder from sexual abuse, they face an even greater risk of infection due to that extra vulnerability.

    "The behaviors that land women in prison also put them at more risk of getting HIV," she said. "It's a game of Russian Roulette."

    One study of the prison population presented at the Galveston conference showed that in 1999, 16 percent of the total prison population suffered from mental disorders. And nearly 30 percent of female prisoners were in that category.

    Another prison study said that of the inmates questioned, 50 percent had been out of work for more than a year prior to incarceration. For 20 percent of the inmates, selling drugs - or their bodies - was their main source of income.

    Asked De Groot: "One study showed that, in the month before their incarceration, the average monthly income for women was $135. Could you live on that?"


    Copyright © 2006 The Galveston County Daily News

    Prisons Kill
    First posted 2/21/06

    Over the past six months, there has been reason to reflect on the history of medical neglect as a form of cruel and unusual punishment in US prisons, with major exposes, lawsuits settled or recalled in California, Texas, Ohio, and Delaware.

    If prisons are killing people, as federal judge Thelton Henderson recently suggested in California, then prisons are doing what they're intended to do, argues Dylan Rodriguez in his new book, Forced Passages: Imprisoned Radical Intellectuals and the U.S. Prison Regime --liquidating communities of color and oppressed peoples.

    According to this 2004 survey of prisoner rights, litigation, and prison law "by 1983, eight states had their prison systems declared unconstitutional, and twenty-two other states had facilities operating under either a court order or consent decree. By 1985, forty-two states had their correctional systems or facilities encumbered by the courts in some way. To say that [the United States of] America experienced a correctional 'litigation explosion' in those years would be an understatement, and in many ways, America [is] still in such a crisis." If some of the states with the largest prison systems in the U.S. are violating the Constitution, what does that say about prisons and their legality under U.S. and international law?

    PARC will maintain this page and periodically update it with stories of the crisis in prison health care, and stories of how prisons kill. PARC welcomes your submissions of stories with links to info [at] prisonactivist [dot] org with "prisons kill" in the subject line.

    On November 14, 2005, David Ruiz died. He was the lead Texas prisoner in the landmark 1972 federal lawsuit, Ruiz vs. Estelle. The Austin-American Statesman wrote: Ruiz vs. Estelle "brought the state's prison system under federal court supervision for more than 20 years and brought sweeping court-ordered changes: outlawing the brutal and violent system where convict 'building tenders' supervised other convicts because of a shortage of guards; where medical care was dangerously substandard; where rapes, beatings, and long stints in solitary confinement were meted out as punishment; where convicts were harassed by prison officials for exercising their legal rights; and where prisons were run like plantations and officials were not held accountable. Once the state remedied the illegal conditions that triggered the suit, the Ruiz case was closed in 2002...At the time the case was settled, the gray-haired Ruiz warned that though it was time for the case to end, the improved conditions in Texas prisons were slowly deteriorating."

    The National Commission on Correctional Health Care writes its origins date to the early 1970s, "when an American Medical Association study of jails found inadequate, disorganized health services and a lack of national standards. In collaboration with other organizations, the AMA established a program that in the early 1980s became the NCCHC."

    In 2002, the NCCHC reported the results of a 3 year-long study to Congress. The report on "The Health Status of Soon-to-be Released Inmates" found that "indisputably tens of thousands of inmates are being released into the community every year with undiagnosed or untreated communicable disease, chronic disease, and mental illness."

    PARC 02/22/2006 -
    Prisons Kill

    Prison health committee's failures
    are clear in audit

    Tuesday, November 23, 2004
    Austin American Statesman, TX

    Austin politicos 'be they state or local' often embrace process eagerly and enthusiastically and it's not difficult to understand why. If you keep the discussion focused on process, you divert attention from performance.

    Evidence of the assertion showed itself in the quarrel over an audit of a state committee and its spending habits and priorities. As reported last week by the American-Statesman's Mike Ward, the state auditor found that nearly $16 million in state money helped two public medical schools cover losses that were never properly documented and more than $30,000 intended for prison medical care went to pay for food, gifts, flowers and employee moving expenses.

    The alarming 'not to mention unflattering' findings were included in an audit of the Correctional Managed Health Care Committee. The auditor even questioned whether the plug shouldn't be pulled on the committee.

    So, what was the committee response?

    You can't treat us like a state agency. We're a committee, so there.

    The committee was created in 1993 to oversee health care services for Texas' 151,000 convicts. The prison system's abysmal health care delivery was detailed in a 2001 American-Statesman series entitled "Sick in Secret."

    The committee was touted as a fix by state officials, but browsing through the audit report, it is difficult to understand how anything was fixed.

    The committee contracted with Texas Tech and the University of Texas Medical Branch to provide inmate health services. Auditors found, however, that the contracts failed to clearly define performance measures, methods of evaluating contractor performance, penalties for non-performance, financial reporting requirements and right-to audit provisions required by state law.

    According to the audit, the committee paid the universities a total of $15.7 million more than their agreed-upon rates "without reviewing sufficient documentation to determine whether the universities had actually incurred financial losses" from 2001 to 2003. The committee held onto unspent money '$31.8 million one year' instead of turning it back into the state treasury as state agencies are required to do.

    So what about that?

    Dr. Ben Raimer of UTMB, and until recently chairman of the committee, replied that the audit appears to hold the committee to the standards applied to state agencies. "The Correctional Managed Health Care Committee is not a state agency," he said.

    Ah, process. If we can talk about what the committee is or isn't in the bureaucratic food chain, we can steal the focus from its performance.

    Obviously, this "fix" needs fixing and, fortunately, Sen. John Whitmire, D-Houston, sees that pretty clearly. Whitmire, chairman of the Senate Criminal Justice Committee, which oversees the state prison system, said, "I've asked a lot of questions myself about this over the years and have not always been satisfied with the answers."

    Translation: We'll get some answers during the session. Good, and remember to focus on performance rather than process.

    Some inmates to receive flu vaccine

    10:34 PM CDT on Friday, October 15, 2004 Austin Bureau Denton Record Chronicle, TX

    A small number of high-risk Texas prison inmates will receive flu vaccinations over the next two weeks, prison officials said Friday.

    The Texas Department of Criminal Justice has 1,100 vaccines reserved for inmates with chronic heart disease, kidney disease, HIV or AIDS. Doctors also will administer the vaccines to inmates over age 65 and to pregnant women, department spokeswoman Michelle Lyons said.

    Ms. Lyons said the University of Texas Medical Branch, which provides medical treatment to inmates, receives some flu vaccines every year. The number of inmates who will receive the vaccine this year is less than 1 percent of the system's 150,775 inmates. "This population is incarcerated, but at the same time it is our duty to make sure their health needs are taken care of," Ms. Lyons said. "You are talking about a prison where you have a number of people living close together. This is not the type of epidemic we want to break out."

    Sick in Secret
    A four-part series that takes a look at the hidden world of the Texas prison health care;
    News Report By The Austin American Statesman

    Texas Prison Watch


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