TUESDAY, July 27, 2004 (HealthDayNews) -- A health-care experiment in Texas prisons has produced unusual results -- decreased costs coupled with increased quality.
That, at least, is the opinion of those conducting the experiment.
"It's real," said Dr. Ben Raimer, lead author of the study in the July 28 issue of the Journal of the American Medical Association and chief physician executive and vice president of correctional managed healthcare at the University of Texas Medical Branch (UTMB) in Galveston.
Others aren't so sure.
"In prisons generally, rosy statements are made generally about the state of things," said Donna Brorby, a San Francisco attorney who was counsel from 1978 to 2002 for a group of Texas prisoners who sued on the grounds that the quality of care was so bad it violated the Eighth Amendment prohibiting cruel and unusual punishment.
Health care in U.S. prisons was largely ignored until the 1970s when the American Public Health Association published the first comprehensive national health care standards for correctional facilities. The American Medical Association also came up with standards while a number of court decisions forced reform.
"Stories of health-care problems [in the prison system] are legion and staggering with people dying from tragically silly minor things," said Jamie Fellner, director of the U.S. Program at Human Rights Watch in New York City. "One guy died in Mississippi of bed sores. They got so bad that nobody would deal with them."
About a decade ago, the Texas Department of Criminal Justice contracted with UTMB to provide 78 percent of care for inmates statewide, with the remaining 22 percent going to Texas Tech University Health Sciences Center.
With 145,000 inmates, Texas has one of the largest correctional systems in the Western world and one in which inmate health was not good to begin with. According to one study of inmates incarcerated between August 1997 and July 1998, 60 percent of the prisoners were diagnosed with at least one medical condition, including asthma, diabetes, hepatitis, HIV and various psychiatric conditions.
Under the new system, several levels of care are provided, including primary ambulatory care clinics on site at the prisons; 16 infirmaries throughout the state; regional medical facilities; and a prison hospital at UTMB, built in 1983 -- the first prison hospital to be located on an academic medical center campus. There are also specialized treatment programs at different units and extensive use of telemedicine, including teleconferencing with specialists.
According to the study, the arrangement has resulted in higher overall compliance with standards of care, from 40.1 percent in 1994 to 96.8 percent in 2003. In addition, the mean blood glucose level for patients with type 1 diabetes decreased, as did cholesterol levels and the proportion of patients with high blood pressure. Furthermore, the rate of AIDS-related deaths decreased from a high of 1.5 deaths per 1,000 inmates in 1995 to 0.24 deaths per 1,000 in 2002. And the rate for asthma-related deaths went from a high of 3.3 per 100,000 prisoners in 1995 to zero in 2002.
Finally, the program has resulted in savings of about $750 million over 10 years, according to one estimate cited in the study. The Texas correctional system spends a relatively paltry $315 million a year on health care, versus $1 billion in California, which houses about 160,000 inmates, according to the study.
However, Brorby said the article was thin on detailing the specific steps taken by the program to improve health care in the prison system.
"I don't think the article gives us enough information to say whether compliance has increased," said Brorby. "It sounds like quite an astounding reduction in asthma death rates but there's a real question when you have that kind of dramatic result. It could have been a change in how they coded deaths."
In the course of her lawsuit, Brorby said she discovered that excellent care at the UTMB hospital facility was not necessarily being continued back at the prisons. "There was a failure to supervise," she said.
Still, the study authors, along with the author of an accompanying editorial, Dr. Newton Kendig of the federal Bureau of Prisons, suggested the model be used for other underserved populations, such as Medicaid, Medicare and the Children's Health Insurance Program. Other prison systems, including California's, are also looking at this program as something to emulate.
More information
For more general information on prison and prisoners' rights, visit the American Civil Liberties Union.
