UTMB gets $45 million to continue prison health care
Agreement calls for in-depth review of contract
By Mike Ward
AMERICAN-STATESMAN STAFF
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.
mward@statesman.com
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
By HARVEY RICE
HOUSTON CHRONICLE
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.
POSTED BY GRITSFORBREAKFAST
LABELS: HEALTH, MEDICAID, TDCJ, UTMB
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
AMERICAN-STATESMAN STAFF
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.
mward@statesman.com
UTMB proposes transferring prison health care to corrections agency
More medical school help for prison health care examined by state
By Mike Ward
AMERICAN-STATESMAN STAFF
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."
mward@statesman.com
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.
POSTED BY GRITSFORBREAKFAST
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
2010:
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
PAYING FOR HEALTH CARE IN TEXAS PRISONS
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.
PAYING FOR HEALTH CARE IN TEXAS PRISONS
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
By HARVEY RICE
HOUSTON CHRONICLE
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.
harvey.rice@chron.com
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
diana@texasjailproject.org
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
2009:
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
AMERICAN-STATESMAN STAFF
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."
mward@statesman.com
Prisoners won't get H1N1 vaccine before the general public
Some prisoners in front of line for swine flu shot
By MIKE WARD
AUSTIN AMERICAN-STATESMAN
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
HEALTH
October 18, 2009
Months to Live: Fellow Inmates Ease Pain of Dying in Jail
By JOHN LELAND
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
By MIKE GLENN
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.
mike.glenn@chron.com
Harris Co. jail inmate died from swine flu
Swine flu found in jail inmate who died
By MIKE GLENN
HOUSTON CHRONICLE
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.
mike.glenn@chron.com
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
Re-entry
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
Recommendations
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.
Re-entry
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]
Recommendations
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
By EMILY RAMSHAW
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
Express-News
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
By STEVEN B. SCHNEE
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
By MARC A. LEVIN
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
UT MEDICAL BRANCH
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
ASSOCIATED PRESS
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."
baltimoresun.com
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?
2008
Months after Ike, care for prison inmates still ailing
Storm's impact on hospital in Galveston costing state $18 million
By LISA SANDBERG and MATT STILES
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.
lsandberg@express-news.net
matt.stiles@chron.com
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
AMERICAN-STATESMAN STAFF
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
By ROMA KHANNA
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.
roma.khanna@chron.com
Injured Inmate spent two days on cell floor
EDITORIAL
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
AMERICAN-STATESMAN STAFF
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
By ROMA KHANNA
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."
roma.khanna@chron.com
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
By POLLY ROSS HUGHES
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
UTMB
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
By DAN CHILDS
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)
kaisernetwork.org
Health Experts Urge Distribute
Condoms to TX Prisons
Should all new convicts get HIV tests?
Houston senator asks AG to rule
By Mike Ward
AMERICAN-STATESMAN STAFF
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
AMERICAN-STATESMAN STAFF
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
Total
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
EDITORIAL
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.
AIDS
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.
Research
Prisons, jails urged to target TB
By Joyce Howard Price
THE WASHINGTON TIMES
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.
TB
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.
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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.
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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.
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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.
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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."
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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?"
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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.
Texas
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."
National:
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
EDITORIAL BOARD
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
