Prison health study still on drawing board

One year later, UT chancellor hopes to start scaled-back review of medical care

5 October 2003
Austin American-Statesman

Last fall, Mark Yudof, chancellor of the University of Texas System, proposed a study of medical care in Texas prisons to see whether convicts' complaints were justified. But nearly a year later, the study has yet to begin, and UT officials are still developing plans for a study diminished in size and scope. Moreover, the study is not likely to be as independent of the University of Texas Medical Branch in Galveston as officials once pledged.

Yudof, who promised the study amid criticism of the prison health care network operated by UT's medical branch, acknowledged this week: "This is just about the most frustrating thing I've ever done as chancellor."

Yudof and Dr. James Guckian, interim vice chancellor over UT's medical schools, said they expect the study will begin soon. They said it will be conducted by the Texas Medical Foundation, an Austin- based group that conducts quality-of-care and other medical reviews for government agencies, hospitals and other health care providers.

Phil Dunne, the foundation's chief executive officer, appeared unaware Wednesday that the study might be about to begin. He said the foundation was still awaiting a response to a proposal it provided UT Medical Branch officials more than a month ago. Dunne said the study that the foundation suggested "is not equal to what I saw Chancellor Yudof propose. . . . This is like a really small, specifically focused thing."

Nonetheless, Yudof said he still has "high hopes" the oft- delayed study will accomplish the goal he set.

"This was a hot potato because there was so much public attention on it," he said of the delays.

History of obstacles

The succession of starts and stops began Oct. 12 when Yudof, just weeks into his job as chancellor, announced plans for an independent evaluation of UT Medical Branch's prison health care system. UT's medical branch provides health care to roughly 80 percent of the 148,000 inmates in Texas prisons. (Texas Tech cares for the rest.)

In December 2001, the American-Statesman detailed continuing problems and issues with medical care in Texas prisons. For months, convicts, their families and advocacy groups had complained of inadequate and improper care ranging from lack of treatment for cancer to mistakes in record keeping and diagnoses.

The inmates' families and advocates increased their calls for reform during summer 2002, when the federal court ended its monitoring of conditions in Texas prisons. They worried the quality of care was declining.

Yudof decided that a study should be done and that a three- member panel selected by Texas Health Commissioner Eduardo Sanchez should do the work. He said that the panel should include no more than two doctors and that none of its members should have ties to UT or UT's medical branch.

The study was to have included a review of inmates' medical case files, on-site inspections of prison clinics and a review of the methods and systems that other states use to ensure that prison health care is adequate and proper.

"We need to have people who are independent look at it," Yudof said at the time. "We need to know if we have the right oversight system." He pledged that the final report would be made public and would include "recommendations regarding any deficiencies" and "recommendations regarding future and ongoing assessments of quality care."

Yudof also wanted the study finished by the end of 2002.

Within days of Yudof's announcement, problems arose. Prison reform and government watchdog groups assailed UT officials for involving themselves in the process of selecting the panelists, charging the study's independence was being compromised.

Then, a month later, the American-Statesman disclosed that two of the seven doctors recommended as panelists had had their medical licenses revoked or suspended for sexual misconduct, and another had been cited for negligent care.

The other four candidates all were graduates of UT medical schools or had ties to Texas prison officials or the UT System.

When they learned of the problems with the candidates, UT System officials immediately dropped all but one candidate from the list and agreed to start over.

In late January, the Health Department's Sanchez bowed out, insisting that his agency was not the proper one to oversee such a study. Yudof began again.

"We then asked UTMB to contact the Correctional Managed Health Care Committee and have them contract directly with TMF (the medical foundation) -- so we wouldn't have UTMB involved," he said. The committee -- made up of representatives from UT Medical Branch and Texas Tech, plus other appointees -- contracts with the UT school and Texas Tech for prison health care and oversees their work.

Negotiations went on for about two months, Guckian said, "and then we began to realize what was happening to us in the legislative appropriations process -- and we had to focus our resources on that."

By the time the Legislature adjourned in May, Yudof said, the Correctional Managed Health Care Committee had decided to opt out as well.

"They told us the study was not needed because they had just finished a study of their own, and they were satisfied with the quality of care," Yudof said.

It was back to UT Medical Branch.

"We decided to do the contract under their auspices, and Ben Raimer was given the authority to develop a contract with the Texas Medical Foundation," Guckian said.

Raimer heads UT Medical Branch's prison health care program and leads the Correctional Managed Health Care Committee. Still more hurdles

Yudof and Guckian said contract negotiations have since been under way, with these hurdles: a new federal law governing confidentiality of medical records, various legal issues and the growing cost of completing the study Yudof first envisioned.

"It became very clear that that the cost would be prohibitive, . . . so we went back to TMF and said, 'What can we do for available funds?' " Guckian said.

UT officials originally expected to spend $30,000 to $40,000, but they learned it would cost much more to do all the work Yudof originally wanted. Yudof said the scaled-back study will now cost about $70,000 -- including an administrative review of the systems of care and a review of some medical records, probably just a few hundred of those prisoners with prevalent diseases and infections such as HIV, hypertension, hepatitis C, heart disease and diabetes.

Guckian said nurses will do much of the review work, although doctors may be involved in some parts.

And will those reviewers still have no ties to UT or UT Medical Branch? Yudof and Guckian said they want those involved in the study to be as far removed as possible, but there may be no way to eliminate everyone with UT ties since a Texas group will conduct the study. "We'll try to eliminate people with obvious conflicts," Guckian said.

Dunne said the medical foundation will comply with whatever stipulations UT includes in the contract, such as barring reviewers with ties to UT or the medical branch. Other stipulations could govern whether the public has access to any or all of the report. It's unclear what the stipulations will be because the contract isn't ready. Typically, medical confidentiality laws prohibit the release of any patient-identifying information, and most quality-of- care studies are conducted under peer review rules that also require confidentiality.

Dunne said that once UT Medical Branch signs a contract with the foundation, a study could be completed in 120 to 180 days.

Guckian said he expects a contract will be signed within a few days so the study can finally begin -- and be completed by the end of the year. Yudof was more cautious.

"Considering what's happened . . . I wouldn't bet the ranch on it," Yudof said.