More medical school help for prison health care examined by state

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."