Post by SoulTrainOz on Jul 26, 2006 23:17:37 GMT -5
Millions more will be need to keep inmate clinics constitutional, top state officials warn.
By Mike Ward, Austin American-Statesman
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.
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)
Source : Austin American-Statesman
www.statesman.com/news/content/news/stories/local/07/24prison.html
By Mike Ward, Austin American-Statesman
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.
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)
Source : Austin American-Statesman
www.statesman.com/news/content/news/stories/local/07/24prison.html