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Aging Inmates Squeeze Corrections’ Health-Care Budgets

As prisoners get older and develop expensive health problems, states are looking for ways to cut costs.
BY: David Levine | March 2011

Prison, it’s been said, is a microcosm of society. In the case of health care, that is certainly true. Just like the rest of us, the prison population is getting older and, as a result, sicker. They need more -- and more expensive -- health care, which they have a right to receive under the 8th Amendment’s ban on cruel and unusual punishment. That’s putting a tight squeeze on corrections budgets across the country.

According to the Bureau of Justice Statistics, the number of federal prisoners 55 and older nearly doubled over the last decade, from 8,221 in 2000 to 15,323 in 2009. That’s due in large part to the more Draconian drug sentencing laws of the 1970s and 1980s, which sent baby boomers away for longer stretches.

Today, those prisoners are in their 50s and 60s, and are developing age-related health conditions like heart disease, cancer and complications from diabetes. With years of hard living behind most of them, they have higher odds of carrying hepatitis C or HIV, of having AIDS, liver or kidney disease, substance abuse damage and mental illnesses.

Correctional health-care costs reached $9.9 billion in 2009, according to Prison Health Services, a private company that provides health care to inmates. When HIV treatments alone cost $2,000 a month, you can see why costs are so high. They fall entirely on states, too, since prisoners aren’t eligible for Medicaid or Medicare. “When I started in this field in 1978, health care was on average about 10 percent of the correctional budget,” says Jacqueline Moore, a Colorado-based correctional health-care consultant. “Now, it’s about 20 percent.”

Given the current budget conditions, states are looking for ways to cut costs. The Kansas Department of Corrections (KDOC) has found one with a managed-care contractor called Correct Care Solutions. Among that company’s care solutions was establishing clinics to treat chronic illnesses within prison walls. Inmates with kidney disease are housed at sites that have dialysis machines, while inmates with other medical problems are moved to facilities that specialize in those diseases. The solution saves on the cost of hospital visits and related high fees, such as security guards and transportation.

Since inmates are closer to care, they now receive better preventive care, which lowers the risk of more serious and costly health problems. These and other changes have been a success, according to Viola Riggin, director of health-care services for KDOC. The state expects 2012 costs to actually go down to $45.5 million from $46.1 million in 2010, even though the prison population has grown. When the contract is renewed in 2013, Riggin expects an increased cost of less than 4 percent, compared to the industry average of 6.9 percent.

Within the next year or so, the corrections department plans to open an Activities of Daily Living unit for the 474 inmates who are considered significantly disabled and/or frail due to age or disability. “Geriatric inmates are usually our highest users of services such as offsite dialysis, oncology and hospice,” Riggin says, noting that this category of patient costs $22.55 per day to treat, compared to just $9.18 per day for inmates in the lowest level of care.

Moore, the corrections health-care consultant, recommends that states partner with local universities to stay on top of research (KDOC is affiliated with the University of Kansas), have access to nonprofit administrative oversight and obtain better pharmacy prices under the 340B Drug Pricing Program, which provides outpatient drugs to eligible safety-net health organizations at a reduced price. Those states that self-administer their correctional care should negotiate better prices with providers and create a preferred provider network, just as outside managed-care companies do.

Of course, these inmates are only going to get older, and health-care costs are only going to rise. The problem isn’t going away. States like Kansas, which has been aggressively attacking the issue for a decade or more, stand the best chance of keeping their heads above water. “We don’t know what the future holds,” Riggin says, “but we won’t be waiting to find out.”

David Levine
David Levine is a GOVERNING contributor.

Twitter: @governing



February 9, 2012

Former TDCJ officer indicted

By PAUL STONE Palestine Herald-Press The Palestine Herald-Press Thu Feb 09, 2012, 06:15 AM CST

PALESTINE — A former Texas Department of Criminal Justice correctional officer has been indicted on multiple counts of sexual misconduct by an Anderson County grand jury.

David Wayne Green, 39, of Palestine was indicted by the grand jury on Jan. 19 on three counts of sexual assault of a child and a single count of continuous aggravated sexual assault of a child, according to Anderson County District Attorney Doug Lowe.

Prior to his arrest on the charges, Green worked as a correctional officer at the TDCJ’s Coffield Unit in Tennessee Colony, according to the district attorney.

The female victim was under the age of 14 during the period of time alleging the continuous aggravated sexual assault of a child and 14 or older at the time of the three counts of sexual assault of a child, Lowe said.

Continuous aggravated sexual assault of a child is a relatively new charge, going into effect on Sept. 1, 2007.

“If you (sexually) assault a child for a period of time over 30 days and the child is under 14, it constitutes continuous aggravated sexual assault,” Lowe explained. “The significance of that is it puts a floor of 25 years (minimum sentence).”

Also, sexual assault of a child is typically a second-degree felony in the state of Texas, but the counts against Green have been enhanced by one degree and were indicted as first-degree felonies, according to the district attorney

Lowe said the enhancement was based on the so-called “Warren Jeffs Law” passed by the Texas Legislature in 2009.

Jeffs, the former president of the Fundamentalist Church of Jesus Christ of Latter-Day Saints, was sentenced to life in prison by a Texas jury in August of last year after being found guilty of aggravated sexual assault of a child and sexual assault of a child.

“If you have a legal impediment to marrying the person,” the district attorney stated, “it enhances the penalty one step.”

Lowe said the alleged sexual assaults committed by Green occurred at an Anderson County residence, beginning in April 2009 and continuing over a period of two years ending last April.

The district attorney said the case was investigated by Kevin Hanes of the TDCJ’s Office of the Inspector General.

“He (Hanes) did a real good job investigating the case,” Lowe said. “We should be able to move pretty quickly.”

Lowe said Green’s trial will likely be held this year, possibly some time during the summer.

As of late Wednesday afternoon, Green remained in the Anderson County Jail in lieu of bonds totaling $500,000.


Paul Stone may be contacted via e-mail at





By KELI RABON / KVUE NEWS and photojournalist JOHN GIBSON

Posted on February 7, 2012 at 10:28 PM

At first glace, it looks like a hospital -- white hallways filled with wheelchairs, walkers, and dialysis machines, but the people in the building are not your average patients.

The Estelle Prison Unit in Huntsville houses the most medically-challenged inmates in the state. Some inmates suffer from chronic diseases, while others are undergoing intensive rehabilitation.

"I wasn't able to walk, move, move my hands, or nothing for about the last three months," inmate David Graves said.

He suffered a heatstroke while playing basketball at another prison facility and has just begun to regain control of his legs.

With each surgery, prescription, and treatment, inmates at the Estelle Unit and throughout the Texas prison system are racking up millions of dollars in medicals bills.

Dr. Owen Murray with the University of Texas Medical Branch oversees the prison health care system.

"Hypertension, HIV, Hepatitis C, diabetes, any patient that comes in with that as a diagnosis, or that we diagnose them with that while they're here with us, we obviously provide all the care associated," Dr. Murray said.

Dr. Murray says treatment isn't optional. Inmates are the only population with a constitutional right to health care, no matter the complexity or the cost.

"Whether you're a death row guy or you're just in for 12 months, if you have that cancer diagnosis, I don't have the option to choose to not treat you. So you're going to get that treatment," Dr. Murray said.

In 2011, medical care for Texas inmates cost taxpayers $494 million. That's $30 million more than in 2010.

The KVUE Defenders took a closer look at the treatments inmates receive. KVUE Defenders found medications like anti-depressants, sleeping pills, and generic Viagra, which Dr. Murray says was prescribed for pulmonary hypertension and not erectile dysfunction.

The most expensive was $24 million spent on HIV medication for about 1,800 inmates.

"As our patient population gets older, as they get sicker, using more medication is smart way to treat disease. It keeps people healthy and keeps them from the hospital, but there's costs associated with it," Dr. Murray said.

Then there are treatments a bit more controversial. Some inmates have received tattoo removal while others received cosmetic surgery.

"There may have been a case where someone might have had a facial lesion that was really contributing to their mental health issues and how they saw themselves. There may have been a case where we might have granted the opportunity for that lesion to be removed just because it was in the best interest of their mental health treatment," Dr. Murray said.

KVUE Defenders also uncovered TDCJ policy allows for sex change surgery for hermaphrodites, and hormone replacement therapy for transsexual inmates.

"If you're in the process of going to get the surgery, and you're going to be here for a period of time, we may continue that therapy so that when you get out, you can continue down the road," Dr. Murray said.

Sen. John Whitmire hadn't heard about that policy. He's served on the Senate's Criminal Justice Committee for 20 years.

"I don't think we ought to have any cosmetic surgery or elective surgery," Whitmire said.

Whitmire says a growing number of aging inmates is putting the largest strain on health care spending. The "Over 55" prison population has jumped from three percent to eight percent in the last 10 years. Whitmire has his own strategy for cutting costs.

"I think there's some inmates we're wasting millions of dollars on," Sen. Whitmire said. "You don't need 80-year-old, worn out, bed-fastened inmates locked up in a secure, maximum security prison. I would put them in a less secure, but secure facility. You lower your costs, and if you got them totally out of a confined correction facility, the federal government would pay for their care."

Inmates like 61-year-old John Williams have applied for TDCJ's "medically recommended intensive supervision" program.

"I've had 10 heart attacks and five stints. I've had bilateral lower limb amputations," Williams said.

Lester Starnes, an 84-year-old inmate with severe Parkinson's disease, said he'd like to be released too.

Both men are convicted sex offenders with numerous health problems, but due to their crime, they don't qualify for supervised medical release.

"You might as well say I've got a life sentence without any hope," Starnes said.

What is certain -- inmates will continue to receive every prescription, treatment and surgery needed to keep them alive courtesy of Texas taxpayers.




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