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Two U.S. Supreme Court Prison Decisions Puts Heat on US Prisons & Inmate Health Care
By Albert Woodard , Chairman, CEO and President of Business Computer Applications (BCA)
Published: 10/10/2011

Gavel healthcare Two Supreme Court decisions – one 35 years ago and another this past May – are having profound impacts on how the states provide health care to their prison populations.

In 1976 the U.S. Supreme Court (Estelle vs. Gamble) established a constitutional standard for inmate healthcare guaranteeing a prisoner’s medical treatment thus making prison inmates the only Americans with a right to healthcare? To do otherwise the high court said would constitute cruel and unusual punishment under the Eight Amendment.

And a May 23 U.S. Supreme Court decision to order California to release tens of thousands of prison inmates (Plata v Brown) is having a sobering impact on these prison systems.

The California decision represents one of the largest prison releases in U.S. history and was driven the court majority said by “overcrowding, which has caused suffering and death.” A federal overseer said earlier that California’s prison system should consider freeing the sickest inmates to cut costs.

Faced with these realities and a rapidly growing and aging prison population, many states are scrambling for ways to provide economical and quality healthcare services that are currently eating up 10 percent of their correctional budgets and rising. The Supreme Court’s California decision makes this a priority.

Texas may have dodged that judicial bullet due to its pioneering health care IT prison program.

For example, the Texas Department of Criminal Justice has deployed one of the country’s first and most successful health care information technology programs in a correctional system. The Texas system combined a statewide Electronic Medical Records (EMR) system and has saved the Texas taxpayers nearly $1 billion dollars over the last 10 years according to the Gartner Group.

Under the program the quality of health care also improved dramtically. The Texas’ system is recognized as being the second highest provider in quality healthcare in a correctional setting, second only to US government hospitals. The Texas system has also been called a national model for the way it taps into university resources with oversight from a state committee controlled by doctors.

The EMR system is used across the board by UTMB and Texas Tech which provide the medical care in the Texas Department of Criminal Justice prison system. The system is used in providing medical, dental, mental health and pharmacy services not only in the state prisons, but also in county jails and the Texas Youth Commission (TYC).

The statewide system serves some 120 state, 15 youth and three federal prisons and has been recognized for helping the state of Texas recognize a 45 percent reduction in medical tests deemed to be unnecessary. A past study indicated the program has resulted in a 70 percent reduction in the number of transfers from prison facilities to physician offices and a 38 percent reduction in transfers from inmate housing to emergency rooms.

The Texas adult inmate population currently stands at approximately 150,000 inmates and costs the state of Texas excess of $3 billion a year to operate. The EMR system covers 145 locations and handles 19 million interactions a month.

As a result of the EMR program the inmate medical cost per day compared to other states has been drastically reduced to $9.67.This compares to $41.25 for California, the only state with a higher incarceration rate than Texas.

Information Technology systems such as EMR, telemedicine and managed care applications enable correctional facilities to diagnose and treat inmates in-house, thereby reducing the need for costly transportation and security to transfer them to outside medical facilities. It enables healthcare providers to better document patient care and to have access to their charts from anywhere in the world, allowing them to easily and cost effectively prepare, review, plan and treat inmate medical, dental and mental health problems. In addition it reduces doctor and nurse time, offers supply and overhead savings and virtually eliminates medical errors and unfavorable outcomes of inmate lawsuits.

States are increasingly turning to these IT solutions as they anticipate health care expenditures to continue to increase rapidly as prison populations swell due to aging, tougher sentencing laws, longer prison sentences, as well as increases in chronic illnesses diabetes and heart disease, infectious diseases such as AIDS and hepatitis and mentally ill and homeless patients being housed in prisons and jails. From 1988 to 1998 the US prison population doubled according to the U.S. Justice Department making the U.S. the number one incarcerator worldwide. In 1978 the U.S. inmate population was approximately 750,000 people, today that number is reported to be in excess of over 2.3 million individuals.

EMR, telemedicine and other IT systems are not the only answer, but they are rapidly proving to be a remedy to improve correctional health care while lowering costs.

Albert Woodard is CEO of Atlanta-based Business Computer Applications, Inc. a major provider of emedical systems to federal, state and local government health organizations as well as private clinics and practices nationwide.

Other articles by Woodard:


  1. gbeck on 10/15/2011:

    I don't mind the required healthcare to the inmates. But, I think that alot of inmates don't need it, they are just trying to break up their bordom by playing sick so they can see the nurse which inturn causes the costs to go up. I must hand out a bottle of tylonol aday to avoid the inmate seeing the doctor or nurse.

  2. Ray Hill on 10/10/2011:

    I think the superlative estimation of Texas prison healthcare is like subjective on the part of the reporter, but after more than 30 years covering that beat as a journalist, it is my opinion that Texas may well ahve others fooled but the health care delivery in Texas prisons is about equal to other Southern prison systems.

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