The Fix Is In

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

The wife of Frank Palo Jr. filed a lawsuit against the county in March, alleging the jail staff failed to provide her husband with the heart medicine he needed. According to the lawsuit, Palo "repeatedly asked nurses and officers for his heart medicine, but was either rebuffed or ignored." He was booked into jail on a Saturday. Five days later he was dead.

Another suit brought against the city tells the story of Clarence Lee Grant Jr., who had his medication confiscated by the nursing staff after he was transferred in from a mental hospital. Over the next month it was noted by various staff members that he appeared dehydrated and weak. But when family members called up to the jail, they were told he was "doing fine."

It became hard for Grant to speak.

When a jailer stopped at his cell, knocked on the glass and asked if he wanted to see a nurse, Grant jumped at the sound but did not answer. The jailer asked the nurse about the behavior and was told to record it as "a refusal to see the nurse."

Grant died in his cell later that day.

"From the beginning of the UTMB contract…difficulties with providing mental health and medical services to mentally ill inmates arose," the suit alleges.

Dallas County has since brought the Galveston-based system into one of those suits as a third party. When problems became too obvious to ignore, commissioners hired Health Management Associates to review UTMB's performance.

Those results, released in a February report, found ineffective screening that bordered on the chaotic, with only about one in four chronically ill inmates ever being seen by a health professional after intake. Tuberculosis screenings are "basically non-existent," investigator Dr. Michael Puisis wrote, noting UTMB had reduced the TB screening program staff from 13 to three. More than 35 percent of those with medical problems and up to 30 percent of the mentally ill are never even identified.

And you'd be out of luck if you got a toothache in lockup. UTMB's only treatment in Dallas County is to pull the tooth. And that is done the old-fashioned way: with hand tools only, in a dirty room. From the lone chair, inmates at this "dental clinic" find there aren't even sinks to spit out the mouthfuls of blood.

"My position is, they're still on a learning curve according to Dr. Puisis and the HMA study," Price says. "There's no way in two years…to say all of a sudden 'We've learned.' I don't think that's the case."

UTMB officials counter that they were brought into an ineffective system in Dallas County, one they weren't charged with fixing.

"They did not approach us to come in and redesign the jail health program," says John Allen, executive director of operations of UTMB's correctional health care.

And Allen rejects any "apples to apples" comparisons.

After all, Dallas County, with its 6,500-bed capacity is a far different program from Houston's mere 500-bed arrangement. Houston's two jails are more a detention turnstile where the most important health care concern is not long-term care (with average stays of presentenced detainees running only 23 hours, there is hardly the chance) but rather the critical initial screenings.

While Allen blames screening problems in Dallas County on the fact that jailers perform that step -- not UTMB staffers -- there are several reasons to be concerned about the Dallas experience.


UTMB launched itself into the prison health care business back in 1983, with the opening of a prison hospital on campus in Galveston. But it got a rocket boost ten years later when the Texas legislature, responding to an exploding jail population, turned health care services for one of the largest correctional systems in the Western world over to UTMB and Texas Tech.

High hopes were held out for UTMB, which at the time was developing an extensive telemedicine network, whereby rural doctors (and now, increasingly, prison nurses) could get specialized assistance from doctors in other parts of the state.

With its move into prison health, UTMB began treating one of the demographically sickest populations in the nation. A report by the U.S. Department of Justice found that the average offender coming into prison has a "95 percent chance of needing medical care" and 60 percent of the time the prison doctor or nurse is the inmate's first exposure to a health care professional.

With four million documented patient encounters per year, UTMB doctors, nurses and med school students get unlimited access to conditions they'd never dream of encountering in a typical suburban practice.

For some students, that's a thrill.

"I had the chance to see diseases that other medical students just read about," UTMB graduate Chad Conner was quoted as saying in one higher-education journal. (In an interesting bit of spin, the same article suggests that med school-run prison health care programs have "increased patient satisfaction by decreasing the time inmates spend away from their prison.")

Helga Dill has formed a different opinion of UTMB as she has worked to help her husband, a heart patient, survive a 20-year stint at the Michael W. Powledge Unit in Palestine, Texas.

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