TMC PULSE

t m c » p u l s e | a p r i l 2 0 1 7 23 Before, caring for Texas inmates took as much as 14 percent of the prison system's operating costs. One-on-one treatment was delivered by prison system employees and through fee-for-service arrangements with local hospitals, which generated little incentive to control spending. Staffing challenges at rural hospitals and rising rates of HIV and hepatitis C also burdened the system. Today, through the Correctional Managed Care program, complete medical services are provided by the partnering universities, with UTMB treating close to 126,000 patients, or 80 percent of the state's offenders. The univer- sities also manage the recruitment and hiring of all health care personnel, pharmaceutical operations, outpatient and ancillary services, and inpatient hospital encounters. "We get the value of a health care entity providing health care services versus the cor- rectional system, plus we have a better aligned compensation system in place because hospi- tals and universities are running the program," explained Owen Murray, D.O., MBA, executive director of clinical services and chief physician executive for the UTMB Correctional Managed Care program. "It's a win-win situation." Comprehensive care Entry to the W.J. "Jim" Estelle Unit involves passing through multiple checkpoints akin to post-9/11 airport security and prison guards unlocking cell blocks with extra-large brass keys. Offenders are dressed in head-to-toe white and instructed to walk alongside the walls between thick yellow lines painted on the polished concrete in the main hall. This is their entrée to their everything—the mail room, commissary, barbershop, law library, medical clinic, pill line, rec rooms and classrooms. It is a city unto itself, fostering self-sufficiency and accountability. Medical care is available here 24 hours a day, seven days a week. The clinic inside the main building functions like a typical doctor's office and minor emergency room. Those with more serious health concerns are transported to the Regional Medical Facility (RMF) on campus, where patriotic murals painted by inmates cover the walls. Like the geriatric unit, offenders residing in the RMF must meet specific medical criteria. Many require an inpatient setting for ongoing nursing and IV care. "They're not sick enough to be in the free world, but not well enough to be anywhere else inside," explained Shelly Hanson, director of nursing. All told, Estelle's comprehensive medical capabilities range from primary care to UV therapy for skin conditions to dental services. The regional laboratory for the prison system is also on-site, as well as an ambulance service for offenders on other campuses or emergencies at the RMF. For highly specialized care, prison- ers are transported to a free world hospital or a prison hospital in Galveston managed by UTMB. Delivering services on-site reins in millions in otherwise necessary expenditures. According to Laura King, nurse supervisor, the RMF's dialy- sis unit alone saves the state $6 million a month. "We have a lot of individuals who are not going to be getting out, so we are going to be dialyzing a long time," King explained. "It's unbelievable the amount of money this facility saves the state when you look at the ancillary staff and security required to send them out to a free world hospital." According to Murray, that $6 million in sav- ings translates to a cost that is seven times less than other states, most of which contract with an outside company for dialysis treatment. "It just makes sense to do it ourselves," he said. Aging population Only a small portion of the prison population needs dialysis—a process that takes on the natural work of kidneys and eliminates waste and water from the blood—but it is an expensive procedure most commonly required for older patients. And as the prison population continues to age, the cost of caring for older inmates will rise. The number of state and federal prisoners age 55 or older increased 204 percent—from 43,300 to 131,500—between 1999 and 2012, while the number of inmates under 55 increased by just 9 percent over the same time period, according to a recent report from the Pew Charitable Trusts and the John D. and Catherine T. MacArthur Foundation. Pew cites a National Institute of Corrections study that pegs the annual cost of incarcerating prisoners 55 and older with chronic and terminal illnesses at, on average, two to three times that of the expense for other inmates. (continued) THROUGH THE CORRECTIONAL MANAGED CARE PROGRAM. TEXAS TECH UNIVERSITY TREATS THE REMAINING 20%. 80% of texas offenders UTMB TREATS CLOSE TO 126,000 PATIENTS, OR A patient on his cot in the geriatric wing of the Estelle Unit. They're not sick enough to be in the free world, but not well enough to be anywhere else inside. — SHELLY HANSON Director of nursing at the Estelle Unit

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