The Fix Is In

UTMB is under fire in Dallas for its jail health care. So why is Houston ready to install it here?

It wasn't all because of Tommy Mae Flakes Ames's colostomy bag -- which jailers routinely refused to allow her to clean.

It wasn't only the shit and blood found on cell bars, mattresses, floors and ceilings. Or the beatings, the cockroaches and obvious fire hazards.

But the civil rights case that started with Ames more than 25 years ago exposed such abominable conditions at the city of Houston's work farm on Mykawa Road that it forced city officials to enact drastic changes.

The work farm was shut down and a new jail built. A director of hygiene was appointed and regular health screenings implemented. The last significant lawsuit over jail health care came a decade ago.

As last month's review of health care services at the two city jails confirms, things have improved drastically in city lockup.

But the mayor's office isn't satisfied and hopes to farm out jail health care operations this year. City attorneys are busily writing a draft of a three-year contract to entrust jail health services with the University of Texas Medical Branch at Galveston. The contract is expected to be presented to councilmembers this month.

However, a recent report of UTMB's handling of Dallas County jail operations suggests turning it over to the group could be a step back for the city. According to that report, health screenings are ineffective; services are understaffed; few of the inmates who need doctors ever see one; and negligence is likely to blame for some inmate deaths. And of deaths, there have been plenty. There were 12 in Dallas County jails last year, 13 the year before. And though UTMB didn't come into the system until October, 2002 saw 15 inmates die, according to the state attorney general's office.

"It got to where every time I looked up at my computer screen there was something about another custodial death," says Dallas County Commissioner John Wiley Price.

With that kind of record, why are we doing this?


Houston Councilmember Adrian Garcia says the city has been interested in getting out of the "jail business" for years. It's not so much a concern about medical practice as it is an interest of turning the program over to an expert, he says. That expert, ultimately, will most likely be Harris County. On-again, off-again conversations with the county could see city jail operations assumed by Harris County in three years, according to several sources.

Touted as a populist, Houston Mayor Bill White is not averse to more Republican affections like privatization. He had the city's building department turned over to private industry in his first year of service. City department heads got the message early on: White was seeking ways to either improve services or save the city money -- or both. It didn't take long for conversations to turn to jail health care.

While the police and health departments have been happy with the services as they exist, the mayor's office started to push for change. It didn't advertise for bids on the contract. Instead, quiet conversations began last summer that led to interviews with officials from the University of Texas, Baylor and UTMB.

Two of the three were quickly weeded out. UT, which operates some county jail programs around the state, didn't want to expand. And although Baylor was interested, it has no experience providing jail health care services.

That left UTMB.

Manuel Perez, chief of jail services for the health department, says he has "no idea" why the city is farming out the duties. Though he doesn't criticize the move, he defends his staff, saying: "They're providing medical care that inmates need at the time they need it." And though a city spokesperson says the department will try to find other jobs for these employees, one jail worker says staffers already have been informed they will soon be out of work.

"It was all of a sudden. That ax that cut down the jailers has fallen on us," the assistant says, referring to last year's mass firing of more than 200 civilian jailers.

Critics of the change say it is going to cost the city up to $1 million more per year, which Mayor White's health liaison Elena Marks denies. The actual cost -- something she can't pinpoint, saying only that it is being treated in continually changing "draft" contracts -- is expected to be "cost neutral."

"It's just a broader, deeper program," Marks says of UTMB's offerings. "We just have this one small program. They have about half of the inmates and jails and prisons in the state."

Actually, UTMB cares for 80 percent of those locked up in Texas prisons and jails. And it doesn't take much digging to find the bodies.

Up in Dallas County, where the county's decision to privatize was based on the bottom line, things haven't turned out well.

"My colleagues said it would save us some millions of dollars," says Price, who voted against the contract back in 2002. "In fact, it's done quite the opposite: It's going to cost us millions of dollars."

A number of lawsuits have been brought against the county because of the poor care provided inmates under UTMB's watch, Price says.

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