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's been a long time since the Ames case. First filed in 1976, the complaint gathered plaintiffs until Houston officials finally agreed in 1989 to provide 24-hour medical screening services and a pharmacy at the city jails. It now spends $2 million a year maintaining about 40 full- and part-time medical staff.

To meet the terms of a federal consent decree, the work farm was shut down long ago. But one obvious lapse occurred in 1993, when a dying South Texas resident was arrested after being booted off an Amtrak train. The 19-year-old had stripped down on the train after crapping and pissing his pants. Booked in as a drunk, Max Perez was carried to jail on a stretcher. He died about ten hours later.

Brian Stauffer
Brian Stauffer

The family got $500,000; the city got a black eye.

And though complaints continue as they do at jails everywhere (these are, for good reason, unpopular places to spend one's time), and despite 14 custodial deaths in Houston's jails since 1995, the city has not had to shell out money to settle legal claims since the Perez case.

But screenings seem to continue to cause the city challenges.

New city inmates are supposed to be asked 14 questions before they are released into the general prison population. Do they have diabetes or hypertension? Are they pregnant? Do they want to die? The idea is to weed out those with conditions that need to be treated elsewhere, like a drunk tank, hospital or mental ward.

One particularly busy night, "the medical screener came out to the prisoner line, held brief interviews with each prisoner and asked only one or two questions," wrote Gordon Kamka, a Looneyville, West Virginia-based auditor who has reviewed jail operations since the consent decree went into effect. "This does not suffice for a true medical interview. Improvement is needed in this area. All questions need to be asked."

But this sort of mismanagement, though pregnant with the potential for problems, falls limp when laid alongside the stories Dill has collected from inmates under UTMB's care.

Take, for instance, the tearful pleas expressed last year by a Jester III inmate housed in Richmond. Though it is unclear when Arnulfo Ramirez Sr. died, a recent letter makes it clear he died a Texas inmate living with an intense amount of pain.

A veteran of several heart operations and colon cancer treatments, Ramirez wrote Dill after being given six months to live and having his request for special-needs parole denied.

If the prospect of dying in prison wasn't bad enough, sloppy medical care and a lack of pain medication suggest other reasons Ramirez may have been eager to beat the Jester.

After one cancer surgery, Ramirez said, UTMB nurses at John Sealy Hospital were irritated because he kept sliding off his pillow. He complained of intense pain in his back, which was ignored. Finally, one nurse noticed that doctors had left the spinal tap in his back. When they tried to remove it, the needle broke off inside his spine. "Well," one doctor reportedly told him, "as long as it doesn't go into one of your lungs or your heart, you will be all right."

"All right," Ramirez quickly found, is a subjective state. The needle was never removed. And each day the pain increased. After he got back to Jester, his pain medication was taken away and he was given Tylenol instead. "I have not been taking anything to adequately control pain for two years," he wrote Dill on January 11, 2004. "I am always with chest pain." Numbness took over his left arm, and the pain in his spine quickened. He began to bleed from his mouth and rectum. A walking cane was the only aid the Jester staff offered.

A convicted sex offender, who apparently protested his innocence to the very end, Ramirez was hoping to die at home surrounded by his remaining family. He had lost both a son and a daughter during his time in lockup. He wanted "so much not to die in TDCJ," he said. "I do have a home to go to once released and medical care. Please help me go home to die."

It's budget season at City Hall. And the direction on jail health seems to be set. In the health department, the refrain is "We're not the bad guys." At the PD, no one seems to have been asked for an opinion in the first place. The police administrator says they are happy with city health services but would welcome UTMB just as well.

Draft contracts shuttling between city and UTMB offices are already nearing that middle ground where ink gets spilled, and techies from both camps have worked out which computer systems can be rigged up to make the hospital system's telemedicine practical here. Marks says such upgrades would be paid for by UTMB and that two more controversial elements in the draft contract -- a 90-day fee renegotiation and a monthly cap on intake screenings, either of which easily could have soaked the city for extra bills -- have been stripped.

Kamka, who did not return e-mail or phone calls, talked up the university system in his April report on city jail operations. "Privatizing health services at the Houston City Jail seems to make sense," he wrote. "UTMB is obviously qualified to provide these services." Whether he was aware of HMA's report on Dallas County or the fact that jail had been flunked by the Texas Commission on Jail standards for two years in a row is unclear. Marks said in two interviews on May 5 and 6 that not only did she not know about the Dallas County story -- despite heavy coverage by The Dallas Morning News -- but that it had never come up in staff discussions.

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