caledinsider.org: The Budget Literacy Project

***I’ve been playing phone tag with California Department of Corrections and Rehabilitation (CDCR) throughout the week. Once I get a chance to talk to a representative I will post their comment.***

With the state of California facing a deficit in the tens of billions and the University of California down hundreds of millions, a partnership that saves the state money and potentially redistributes it to education sounds fantastic.

According to a report by the telemedicine company NuPhysicia, Governor Arnold Schwarzenegger’s proposal that UC take over California’s prison health care could save the state up to $16 billion over the next 10 years– money which UC officials said could be redistributed back to the state general fund and from there to education.

But the idea is far from simple and hardly novel.

While the UC Board of Regents discussed the possibility of university-run prison health care during their March meeting, the idea was first brought up before the board in 2005.

In its 2005-06 analysis of the state budget bill, California’s Legislative Analyst’s Office said a health care partnership between the California Department of Corrections and the University “has merit, but the proposal is not fully developed.”

“Some of the potential benefits include (1) continued learning for prison health care staff; (2) opportunities for clinical research in a unique health care environment; and (3) more cost-effective health care delivery,” the analysis states.

Because no specifics as to how University involvement in California state prison health care would work were finalized at that time, the office declined to make any recommendations.

The office has yet to take an official position this time around for the same reasons.

“The governor hasn’t put forward a concrete proposal,” said Aaron Edwards, a fiscal and policy analyst for the office. “He has just outlined in concept of what could happen.”

The report is only one factor in the web of “maybes” and “mights” that comprise the debate and has infuriated the Union of American Physicians and Dentists, which is affiliated with the American Federation of State, County and Municipal Employees.

First presented at the March UC Regents meeting, the report suggests that UC manage California’s prison health care system, including supplying UC health care professionals and hiring other staff to run the system and using telemedicine, i.e. having doctors meet with patients via teleconference.

According to NuPhysicia, its recommendations could save the state $4.3 billion over the first five years of their implementation and between $12 and $16 billion over the next decade. California currently spends $2.4 billion a year on prison health care, or $41.25 per inmate each day.

The first point of contention the union has voiced against the proposal is that there is a conflict of interest at its base– UC President Mark Yudof was president of UT from 2002-08 and John Stobo, who is currently senior vice president for health sciences for UC, was President of the UT Medical Branch at Galveston. In 1997, the same year NuPhysicia was founded as part of the branch, Stobo began his tenure. NuPhysicia is used in Texas’s UT-run prison health care system.
Union members have also said that the report’s recommendations won’t provide adequate health care for inmates and in the end, the recommendations will cost the UC money.

The recommendations could cost jobs. UC spokesperson Lynn Tierney said that the proposal could lead to layoffs of current prison medical personnel about five years after its implementation as a result of consolidating UC health care and California state prison health care positions. At present, California has 73.5 medical personnel per 1,000 inmates compared to 29 medical personnel in Texas.*

At the May regents meeting, Stuart A. Bussey, the union’s president, said the medical cases in prison are more difficult than UC health care professionals might expect. Among other problems, 40 percent of prisoners have Hepatitus C and HIV is rampant.

“These are very complicated pharmaceutical patients,” he said.

He also warned against the use of telemedicine, saying it can lead to doctors not noticing patients’ health problems such as heart murmers and making false diagnoses as a result of not being in direct physical contact with patients.

“It’s kind of a dicier situation when you don’t have your five senses,” he said.

But Stobo stressed that telemedicine would not replace the traditional patient-doctor relationship.

“Telemedicine is an enabler, it’s a factor,” he said. “It’s not a solution, it enables solutions.”

Safety is also an issue according to Scott Anderson, a physician in the department of mental health with the California Department of Corrections and clinical professor at UC Davis, who said inmates can behave more aggressively than other patients. After the regents’ session on prison health care at their May meeting, he shared a cautionary tale about a prisoner slashing a nurse’s face with a razor. When he shared the anecdote during a two-hour discussion held by the regents later that day, he said the prisoner had slashed the nurse’s neck.

Anderson went on to say that prisoners are more likely to file lawsuits against health care professionals than other patients. He added that it was only after he entered prison health care that he was sued for malpractice–twice, in fact. Ultimately he concluded at the meeting that the costs of such liabilities could trickle down onto the backs of UC students who have already experienced a 32 percent fee hike this year.

Regent Sherry Lansing, who chairs the Committee on Health Care in California State Prisons established by the regents at their March meeting, said the UC would not consider the plan unless it were cost effective, adding that the committee’s purpose is to decide whether UC will enter prison health care and, if so, how. NuPhysicia’s model is just one option, she said.

If UC takes over prison health care, Texas, the birthplace of NuPhysicia, is the most analogous example to how such a relationship might play out.

Texas and California have similarly sized prison populations– 168,105 inmates in Texas and 166,556 in California,  according to theinmatelocator.com. Likewise, the UT and UC systems are close in size with 141,134 and 159,000 undergraduate students, respectively.

Both states’ prison health care systems have, at one time, been in federal receivership, meaning they have been managed by a federally-appointed official for not meeting constitutionally-mandated health standards. California’s prison health care system has been under such oversight since 2006. Such a problem can be fixed according to Tierney, who said the 1993 university take-over of the Texas system led to the quality of prison medicine meeting constitutional standards.

A similar arrangement could be fruitful in California, Edwards remarked.

“According to an internal study (the University of Texas) has done, they’ve decreased costs,” he said, before adding that the office has not been able to independently verify the findings of the study.

Texas may be the most relevant example for California, but it is not the only one. At least five states currently have university-run prison healthcare: Louisiana, Florida, Georgia, Texas and New Jersey. The last three all do their prison health care through NuPhysicia.

Despite the prevalence of university-run prison health care, the regents are emphatically shrinking away from taking any official position. Still, they seem to have crossed-over from opposing such a plan to being more interested in following through.

“My first thought was just no way is this gonna happen,” said Regent Norman Pattiz who is a member of the committee. “Except now that I’ve gotten more information about it, I’m feeling a little less no-way.”

In addition to considering having UC manage California prison health care, the regents say they are open to options such as the UC serving as a consultant for state prison health care and starting a fellowship program through which UC doctors would become involved in state prison medicine.

The timing of the final decision is as up-in-the-air as the decision itself. Lansing said there will not be a decision within weeks, nor will the regents take years to come to a conclusion.

“I don’t know where this is heading. We are committed to looking at this in a very thorough way,” she said. “I don’t want to be held to a time line.”

* The Statesman reports that in Texas, 363 prison health care workers were recently laid-off as a result of state budget cuts–not necessarily because of UT’s involvement in Texas state prison health care.