Texas Prison Health Care: On the Brink of Unconstitutionality, Again

by Matt Clarke

According to Texas prison healthcare officials, medical care in the state?s 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 healthcare. '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 healthcare 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 healthcare system, an eight-story hospital located in Galveston that was built 24 years ago. Now, just as the prison healthcare 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 healthcare system, the fix will be neither so easy nor so cheap.

The two forces driving the prison healthcare 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 healthcare 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 healthcare 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 healthcare 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 healthcare 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 healthcare 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 healthcare 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 healthcare 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 - lost the date on this article but was about 2007, Flo, PAPA