Transcript State & Federal Prison Population by Offense

Denise DeShields, MD
Executive Medical Director
Texas Tech University HSC
1
Patient Advocacy:
Prison Healthcare and the Offender Patient
2
Vital Statistics
• No country incarcerates a higher
percentage of it’s population than the
United States.
• The U.S. incarceration rate is 716/100,000
population (according to the International
Center for Prison Studies).
3
Countries with the largest number of prisoners per 100,000 of the
national population, as of 2013
USA
St. Kitts and Nevis
Seychelles
Virgin Islands (U.S.)
Rwanda
Cuba
Russia
Anguila (U.K.)
Georgia
Virgin Islands (U.K.)
Belarus
El Salvador
Bermuda (U.K.)
Azerbaijan
Belize
Grenada
Antigua and Barbuda
Panama
St. Vincent and the Grenadines
Cayman Islands (U.K.)
716
649
641
539
527
510
490
487
473
460
438
425
417
407
407
402
395
392
389
382
4
International Rates of Incarceration, 2012/2013
U.S.
Rwanda
Russia
Brazil
Spain
Australia
China
Canada
Austria
France
Germany
Denmark
Sweden
India
716
492
475
274
147
130
121
118
98
98
79
73
67
Imprisonment Rate Per
100,000 People
30
0
100
200
300
400
500
600
700
800
5
U.S. State and Federal Prison Population , 1925-2012
1800000
1600000
1400000
1200000
1000000
800000
600000
400000
200000
0
1925
1928
1932
1936
1940
1944
1948
1952
1956
1960
1964
1968
1972
1976
1980
1984
1988
1992
1996
2000
2004
2008
2012
Number of People
2012: 1,570,400
6
State & Federal Prison Population by Offense
State (2011)
Federal (2012)
0.7%
1.4%
5.9%
36.9%
9.6%
15.3%
10.6%
Other
Weapons
18.3%
12.1%
Immigration
50.6%
16.8%
5.9%
Drug
Public Order
Violent
Property
Other
Violent
Property
Other
53.0%
Drug
Public Order
7
State Expenditures on Corrections, 1985-2012
60
53.3
Billions of Dollars
50
51.4
42.3
40
36.4
30
26.1
20
16.9
10
6.7
0
1985
1990
1995
2000
2005
2010
2012
8
People in State and Federal Prisons, by Race and
Ethnicity, 2012
8.4%
White: 500,604
33.1%
22.0%
Black: 551,154
Hispanic: 332,202
36.5%
Other: 127,521
9
United States Prison Statistics
In 2012 there were 6,937,600 offenders under the supervision of the
adult correctional system (i.e. parole, probation, or under the custody
of state, federal prisons and local jails). Of that, 1,571,013 were
incarcerated (22%).
 In 2012 the states with the highest incarceration rates:
Louisiana
Mississippi
Oklahoma
Texas
(893/100,000)
(717/100,000)
(684/100,000)
(601/100,000)
 In 2012 the states with the lowest incarceration rates:
Maine
Minnesota
Rhode Island
(145/100,000)
(184/100,000)
(190/100,000)
10
11
12
Lifetime Likelihood of Imprisonment
All Men: 1 in 9
White Men: 1 in 17
Black Men: 1 in 3
Latino Men: 1 in 6
All Women: 1 in 56
White Women: 1 in 111
Black Women: 1 in 18
Latina Women: 1 in 45
13
14
U.S. Offender Population Has Grown Every
Year Between 1978-2009
 The national imprisonment rate for males
is 14x that of females.
15
16
Number of People Serving Life Sentences, 1984-2012
180,000
160,000
140,000
120,000
100,000
80,000
60,000
40,000
20,000
0
1984
1992
2003
2005
2008
2012
17
Correctional Populations in the United States, 2012
 In 2012 about 1 in every 35 adults in the United States or 2.9% of adult
residents, was on probation or parole or incarcerated in prison or jail.
 The decrease during 2012 was the fourth consecutive year of decline in the
U.S. correctional population.
 Although the correctional population declined by 0.7% during 2012, this was
the slowest rate of decline observed since 2009.
 More than half (56%) of the decrease in the U.S. correctional population
during 2012 was attributed to a drop in California’s correctional population, a
decline driven by the state’s Public Safety Realignment Act of 2011.
18
Total population under the supervision of adult correctional systems and annual
percentage change, 2000-2012.
Population (in millions)
8
Annual percent change
Population-
2.5%
7
2.0%
6
1.5%
5
1.0%
4
0.5%
3
0.0%
2
-0.5%
1
-1.0%
0
-1.5%
'00
Note:
Annual percent change
'01
'02
'03
'04
'05
'06
'07
'08
'09
'10
'11
'12
See Methodology for information on the methods used to calculate annual change in the correctional population.
Sources: Bureau of Justice Statistics, Annual Probation Survey, Annual Parole Survey, Annual Survey of Jails, Census of Jails, and
19
National Prisoner Statistics Program, 2000-2012.
20
Texas Department of Criminal Justice
The mission of the Texas Department
of Criminal Justice is to provide public
safety, promote positive change in
offender behavior, reintegrate
offenders into society, and assist
victims of crime.
21
TDCJ History
• 1848 Texas Legislature passed an act establishing a State Penitentiary.
• The prison system began as a single institution in Huntsville. Over time, more
prisons were built primarily in the historic cotton/slavery belt of Texas (Stephen
F. Austin’s Colony).
• In 1921 George W. Dixon of The Prison Journal published a report on the Texas
Prison System facilities stating that it was one of the most "brutal" in the world.
He reported that “convicts” were subject to whippings, beatings, and isolation.
• Before 1972, there were 18 prisons, 16 for males, 2 for females with 25,000
offenders.
• In the 1980’s Texas embarked on a massive prison construction project. There are
now 109 TDCJ Units, that incarcerate over 150,000 offenders.
• In 1989, The Texas Department of Criminal Justice was created absorbing the
functions of The Texas Department of Corrections, The Texas Board of Pardons
and Paroles, and the Texas Adult Probation Commissions.
22
TDCJ Employees
Over 37,000 employees
Over 32,000 work in a confinement facility
Over 23,000 of those are Correctional Officers
Additionally, there are 3,900 contracted health
care staff serving 114 facilities (109 TDCJ
facilities, 5 private facilities)
23
24
Offender Population Trends in Texas
25
Census/Capacity
Texas currently operates the largest prison system in the United States.
Capacity:
162,057
Community Supervision Population as of August
31, 2013
Total Adults On Direct, Indirect, and Pretrial Supervision
401,093
Operational Capacity:
155,575
232,899
168,194
Current Census:
151,273
26
Census/Capacity – Cont’d
Offender Population as of
November 30, 2013
160,000
140,000
Prison 136,654
120,000
100,000
State Jail 11,024
80,000
60,000
Substance Abuse 3,595
40,000
20,000
0
Total Offender Population
151,273
27
Census Capacity
Capacity
162,057
Operating Capacity 155,575
Population
151,080
Percent of Capacity 93.34%
28
 TDCJ manages offenders in 109 state and 5 privately operated
facilities.
 56% of offenders have a violent offense of record
 Nearly 27,000 sex offenders
 Average IQ score is 90.7
 12,174 female offenders
 Average Educational Achievement score 8.2
 15,420 offenders are 55 years of age or older
 275 offenders on death row
 In fiscal Year 2013, 71,713 offenders received and 72,071 offenders
released.
29
Texas Department of Criminal Justice Offender Profile
FY 2014 1st Quarter – November 2013
Average Age of Offenders - 11/30/13
Death Row Offenders - 12/17/13 (last update)
Average Age Prison Offenders
Average Age State Jail
Confinees
38
Total (includes bench warrants)
35
Percent Black
40.7%
Average Age SAFP Offenders
34
Percent White
29.1%
Percent Hispanic
28.7%
Age 55 and over total
Age 55 and over female
15,420
749
Births in Custody - FY 13
Total Offenders Who Gave Birth
275
Female
9
Gang Affiliation - 11/30/13
185
Confirmed Gang Members
8,812
Suspected of Gang Association
1,968
30
Texas Department of Criminal Justice Offender Profile
FY 2014 1st Quarter – November 2013
Medical Condition - 11/30/13
AIDS
786
HIV 1
1,455
On Dialysis
228
Requiring Hospice Care
19
In Wheelchairs 2
434
Hepatitis B 3
716
Hepatitis C 3
17,416
Outpatient Mental Health Caseload4
23,297
Inpatient Mental Health Average Daily Census
1,911
Mentally Ill (Prior MHMR contacts)
54,397
Prior MHMR Contacts - Primary Diagnoses
18,506
Developmentally Disabled – Avg. Daily Census 5
698
1Does not include offenders with AIDS.
2Numbers include offenders in ADS program and offenders temporarily using wheelchairs.
3Estimated numbers using the Hepatitis Surveillance Database as of 8/31/2013.
4Includes dual diagnosed Developmentally Disabled Program Offenders
5Developmentally
Disabled was formally referred to as Mentally Retarded.
31
Texas Department of Criminal Justice Offender Profile
FY 2014 1st Quarter – November 2013
Offense of Record - 11/30/13
Number
Percent
Total* - Violent
84,089
55.6%
Total* - Property
23,810
15.7%
Total* - Drug
24,346
16.1%
Total* - Other
19,028
12.6%
Total - Black
52,884
35.0%
Total - White
47,648
31.5%
Total - Hispanic
49,971
33.0%
770
0.5%
32
*Total includes prison, State Jails and SAFPs.
Race - 11/30/13
Total - Other
Texas Department of Criminal Justice Offender Profile
FY 2014 1st Quarter – November 2013
Sentences and Time-Served - FY 13
Average Sentence - Prison Receives
Average Sentence - Prison On-Hand
7.7
19.3
Average Sentence - Prison Releases
Percent Served - Prison Releases
Years Served - Prison Releases
7.9
58.0%
4.3
Percent served is case based and cannot be calculated using aggregate totals.
Youthful Offenders - 11/30/13
Fourteen year-olds
Fifteen year-olds
Sixteen year-olds
Seventeen year-olds
Total Offenders Under Eighteen
Prison Offenders Only Under Eighteen
0
0
5
67
72
58
33
Recidivism
49.1% For prison offenders
released in 1992
22.6% For prison offenders
released in 2009
34
Fiscal Year 2013
Total TDCJ Budget
$3.071 billion
Cost of Incarceration:
$18,314.64 offender/year
$50.04 offender/day
35
Fiscal Year 2013
TDCJ Health Care Budget
$429 million
Cost of Health Care
$9.26 offender/day
36
Fiscal Year 2012
Health Care Costs Affected By Age
Offenders 55 years-old and older
comprise 9.6% of the population
but account for 39.1% of
hospital costs in TDCJ
37
Fiscal Year 2012
Health Care Costs Affected By Dialysis
 Average number of offenders requiring
dialysis at any given time in 2012 was 213
(0.14% of the offender population).
 Dialysis accounts for 1.11% of the annual
budget
 This approx 8 fold increase in costs does not
include hospitalizations and clinic services
not directly related to dialysis that are also
more frequent in this population.
38
Fiscal Year 2012
Health Care Costs Affected By HIV
Approx 1.6% of offenders are HIV (+)
48.24% of the pharmacy budget
was spent on antiretroviral
medication.
39
Fiscal Year 2012
Health Care Costs Affected By Mental Health
The second largest categorical
pharmacy cost in 2012 was psychiatric
medications.
6.31% of pharmacy budget is spent on
psychoactive medication.
40
41
Prison Healthcare in Texas
42
Ruiz vs. Estelle
(June 1972)
TDCJ inmate and prison
reform activist David
Ruiz leaving court in
1978 (with briefcase)
Photo By Alan Pogue
43
 Overcrowding – particularly the placement of two and even
three inmates in cells designed for a single inmate
 Inadequate security – claimed to be the result of too few
guards, sometimes resulting in the handing over of
supervision of whole sections of prisons to inmates (known
as “building tenders”) who assisted guards
 Inadequate healthcare – an insufficient number of
professional medical personnel for the number of prisoners,
the use of non-professional personnel to deliver professional
medical care, and limited therapy for psychiatric patients
 Unsafe working conditions – exposure of prisoners to
unsafe conditions and lax enforcement of safety procedures
 Severe and arbitrary disciplinary procedures
Full Footnote: “PRISON SYSTEM.” The Handbook of Texas Online.
http://www.tsha.utexas.edu/handbook/online/articles/view/PP/jjp3.html, accessed Tue Sep 7 15:01:51
US/Central 2004
44
 December 1992 – Judge Justice signed Final Judgment in Ruiz. With regard to
health care and psychiatric services, the Final Judgment imposed a series of
additional reporting requirements in the short term, and in the long term imposed
the following mandates:
1) maintain NCCHC accreditation of all unit and regional health care
facilities;
2) Ensure that no prisoner is assigned to do work that is medically
contraindicated;
3) Ensure full access to health care for all prisoners;
4) Ensure that nonmedical staff cannot countermand medical orders; and
5) Maintain medical, dental, rehabilitation and psychiatric staffing and
facilities that enable timely delivery of health care to all prisoners,
consistent with contemporary professional standards for correctional
health care, vigorously recruit the required staff, and stay
competitive in the recruitment of staff.
TDCJ was not liberated from this Federal requirement until 2003!
(1972-2003)
45
Constitutional Right to Health Care
“having custody of the prisoner’s body
and control of the prisoner’s access to
medical treatment, the prison authorities
have a duty to provide needed medical
attention”.
Ramsey v. Ciccone,. 310 F.Supp. 600 (W.D.Mo., 1970)
46
Constitutional Right to Health Care – Cont’d
As early as 1970, the US Supreme Court
first recognized the need for health care
for those in prison. Since then through a
series of decisions including Estelle v.
Gamble (1976), access to adequate
medical care has been held to be a
constitutional right for inmates in
correctional facilities.
47
Constitutional Right to Health Care – Cont’d
The “intentional denial to a prisoner of
needed medical treatment is cruel and unusual
punishment and violates the Eighth (8th)
Amendment to the United States.”.
Ramsey v. Ciccone,. 310 F.Supp. 600 (W.D.Mo., 1970)
48
Constitutional Right to Health Care – Cont’d
The courts have found a right to medical
treatment for prisoners in the due process
clause of the Fourteenth (14th) Amendment
and held that “Under totality of the
circumstances, adequate medical treatment
must be administered when and where there is
reason to believe it is needed.”
Mills v. Oliver, 367 F.Supp. 77,79 (E.D.Va., 1973)
Fitzke v. Shappell, 468 F.2d 1072 (6th Cir. 1972).
49
Estelle vs. Gamble
“We therefore conclude that deliberate
indifference to serious medical needs of
prisoners constitutes the ‘unnecessary and
wanton infliction of pain’ proscribed by the
English (8th) Amendment.
U.S. Supreme Court in Estelle vs. Gamble, 429 U.S. 98, 97 S.Ct. 285 (1976)
50
Deliberate Indifference
 Right to Access Care: Access to care must be
provided for any condition be it medical, dental, or
psychological, if the denial of care might result in
pain, suffering, deterioration or degeneration.
 Right to a Professional Judgment: A prisoner must
receive appropriate attention required for the
condition.
 Right to Care that is Ordered: A constitutional
violation is present when needed prescribed care is
denied or delayed to an inmate.
51
Professional Judgment
Federal courts are reluctant to “second guess” the
adequacy of treatment rendered except in egregious
cases:
 “The medical attention rendered is so woefully
inadequate as to amount to no treatment at all.”
Westlake v. Lucas, 537 F2d 857, 860 n., 5 (6th Cir. 1976)
 “Treatment so cursory as to amount to no
treatment at all, may in the case of serious medical
problems violate the Fourteenth Amendment.”
Tolbert v. Eyman, 437 F.2d 625, 626 (9th Cir. 1970).
52
53
54
Correctional Managed Health Care
Correctional managed health care (CMHC) was established by the Texas
Legislature in 1993. Key provisions of the legislation included statutory
requirements as follows:
 Establish the Managed Health Care Advisory Committee to TDCJ;
 Develop a managed health care plan for TDCJ inmates;
 Establish a managed care network of physicians and hospitals to serve
TDCJ inmates:
 Integrate, to the extent possible, Texas public medical schools into the
established managed care network;
 Initiate a competitive bidding process for contracts with other medical
care providers for services the public medical schools cannot provide;
and
 Develop a managed health care plan that reduced the cost for state
inmate medical services.
55
What is Correctional Managed Health Care?
A Strategic Partnership between:
 The Texas Department of Criminal Justice
 The University of Texas Medical Branch at
Galveston
 Texas Tech University Health Science Center
Focused upon a shared Mission:
 To develop a statewide health care network that provides TDCJ
offenders with timely access to quality health care while also
controlling costs
56
Main Duties of the CMHC
 Establish offender Health Services Plan
 Establish Policies and Procedures related to the
provision of health care within TDCJ
 Provide a forum to resolve any disputes between
TDCJ and the university providers
57
Health Care and Medical Necessity
 Health Care: Health related actions taken, both preventive and medically
necessary, to provide for the physical and mental well-being of the
offender populations.
 Medically Necessary: Services, equipment or supplies furnished by a
health care provider which are determined to be:
Appropriate and necessary for the symptoms, diagnosis or
treatment of the medical condition; and
Provide for diagnosis or direct care and treatment of the medical
condition; and
Within standards of good medical practice within the organized
medical community; and
Not primarily for the convenience of the TDCJ Offender Patient,
the physician or another provider, or the TDCJ Offender Patient’s
legal counsel; and
The most appropriate provision or level of service which can
safely be provided.
58
Classification of Levels of Care
Level I Medically Mandatory: Care that is essential to life
Level III Medically Acceptable: Care for non-fatal
and health and without which rapid deterioration is expected. The
recommended treatment intervention is expected to make a
significant difference or is very cost effective. Examples include:
appendectomy, repair of deep wounds, burn treatment, heart
attacks, treatment of severe head injury, and prenatal care.
Examples of mental health services in this classification include:
schizophrenia, other psychotic disorders, delirium, bipolar disorder,
suicide risk, or any psychiatric condition requiring hospitalization.


Care at Level I is authorized and provided to all
inmates.
Level II Medically Necessary: Care that is not immediately
life threatening, but without which the patient could not be
maintained without significant risk of serious deterioration or
where there is a significant reduction in the possibility or repair
later without treatment. Examples include: diabetes, asthma,
hypertension, heart disease, treatable cancers, immunizations, and
comfort care such as end stage care of terminal illness. Examples of
mental health include: dementia, major depression, anxiety
disorders, adjustment disorder, and severe personality disorder.

Care and treatment of conditions at Level II is
provided to all inmates but evolving community
standard and practice guidelines controls the extent
of service.
conditions where treatment may improve the quality of life but will
not in general affect the length of life. Examples include treatment
of non-cancerous skin lesions, cataract removal, hip replacement,
and routine hernia repair. Examples of mental health include:
mental retardation, dysthymic disorder, and moderate personality
disorder.
Level III conditions are considered on a
case-by-case basis by a review process.
Level IV Limited Medical Value: These are treatments that
may be valuable to certain individuals but are significantly less cost
effective or produce no long-term gain. This category includes
treatment of minor conditions where treatment merely speeds
recovery or offers minimal reduction in symptoms or is for the
convenience of the individual. Examples include tattoo removal,
nasal reconstruction, cosmetic or plastic surgery and treatment of
diseases that resolve on their own such as the common cold.
Examples of mental health include: pedophilia, sleep disorder, and
conduct disorder.

Treatment of Level IV conditions is not generally
authorized; however, a review process may consider
exceptional individual cases.
59
Our Mission
Manage the health care partnership and the overall
delivery system in a constitutional manner that:
 Insures Access to Care
Access
 Maintains Quality of Care
 Manages the Cost of Care
Quality
Cost
Correctional Health Care’s
Balancing Act
60
Roles and Responsibilities
CMHCC
 Clinical Policy
Oversight
 Resource Allocation
 Legislative/Legal
Coordination
 Contract Coordination
 Liaison Activities
 Dispute Resolution
 Quality of Care
Monitoring Oversight
University Providers
 Onsite Services
 Offsite Services
-Specialty Clinics
-Hospitalization
 Pharmacy Services
 Mental Health Services
 Utilization
Management
 Provider Network
Management
 Quality of Care
Monitoring
 TDCJ Employee
Health Services
TDCJ Health Services
 Monitoring
-Access to Care
-Quality of Care
-Operational Reviews
-Grievances
 Public Health/Infection
Control
 Health Services Liaison
 Professional Standards
 Administrative
Functions
61
CMHCC Organizational Relationships
Committee includes five Members
appointed as follows:

Two Physicians appointed by the
Governor

A representative from TDCJ
appointed by TDCJ Executive
Director

A Physician from the University of
Texas Medical Branch appointed
by the President of the University.

A Physician from the Texas Tech
Health Sciences Center appointed
by the President of Health
Sciences Center
TDCJ Health Services
Division
Governor Legislature
Correctional Managed
Health Care Committee
CMHCC
Executive Director
UTMB Correctional
Managed Care
TTUHSC Correctional
Health Care
62
Geographical Areas of
Responsibility
Dalhart
Pampa
Amarillo
Tulia
TTUHSC
Sector
Plainvie
w
Lubbock
Childres
s
Brownfield
Wichita Falls
Jacksbor
o
Breckenridge
Lamesa
Bonham
Snyder
Winnsboro
Dallas
Abilene
Colorado City
Venus
El Paso
New Boston
Bridgeport
Gatesville
Brownwood
Overton
Palestine
Henderson
Teague
Rusk
Diboll
Marlin
Midway
Fort Stockton
UTMB
Sector
Jasper
Lovelady
Bartlett
Burnet
Austi
n
Dayton
Navasota
Housto
n
Lockhart Sugarland
Kyle
San Antonio
Richmond
Rosharon
Hondo
Cuero
Kenedy
Dilley
Livingston
Woodville
Huntsville
Cleveland
Angleton
Brazoria
Beeville
Cotulla
San Diego
Raymondville
Edinburg
63
Offender Population – Cont’d
Provider
Census
UTMB
119,290
TTUHSC
30,805
PRIVATE
985
TOTAL:
151,080
64
65
Health Services Mission
 It is the mission of the Health Services Division
to work with the Correctional Managed Health
Care Committee and its contracting entities to
ensure that quality health care is provided to
incarcerated offenders in the custody of the
Texas Department of Criminal Justice as well as
monitor the delivery of all health care services.
66
Health Services Division
The TDCJ Health Services Division is divided into six
clinical departments:






Health Services Liaison
Office Health Services Monitoring
Office of Mental Health Monitoring and Liaison
Office of Professional Standards
Office of Public Health
Office of Special Monitoring
67
Health Services Liaison
 Provide TDCJ Bureau of Classification and the Transportation
Department with technical expertise regarding offenders with
special medical and mental health needs.
 Coordinate intra-system unit offender assignments
 Inter-system transfers from counties admitting offenders to TDCJ
 Assist TCOOMMI (Texas Correctional Office on Offenders with
Medical or Mental Impairments) in coordinating continuity of
medical/psychiatric care for offenders prior to their release from
TDCJ
 Monitor discharges from hospitals and infirmaries
68
Office of Health Services Monitoring
 Perform Operational Review Audits to ensure
compliance
- Accreditation Standards
- System Policies and Procedures
- Applicable State and Federal Law
 Oversee Quality Improvement/Quality Monitoring
Program
 Perform Onsite Quality Assessments
69
Office of Mental Health Monitoring and Liaison
 Provide the Agency with technical expertise regarding
mental health to ensure access to quality mental health
care.
 Conduct operational reviews of mental health services.
 Conduct mental health services quality of care audits.
 Liaison with Texas Correctional Office on Offenders with
Medical or Mental Impairments (TCOOMMI) to improve
continuity of mental health care.
70
The Office of Professional Standards
 Patient Liaison Program
- Investigates and responds to medical concerns/complaints
from third parties (Offender families, advocates, lawyers,
governmental officials, etc.)
- Operate a family hotline
- Public Awareness Corrections Today (PACT) Conference
 Step Two Offender Medical Grievances
- Conducts an appellate process for medically-related
grievances not resolved to the offender’s satisfaction at
the Step One Level.
71
Offender Medical Grievance Program
The top five complaints registered
with the Step II Offender Medical
Grievance program were as follows:
1. Treatment Issues,
2. Staff Related Complaints,
3. Medication Issues, Access
to Care Issues, and
4. Concerns about the
legislatively mandated
Annual Health Care
Service Fee.
The top five complaints, not in order
of priority, registered with the Patient
Liaison Program in fiscal year 2013
were:
1.
2.
3.
4.
5.
Treatment Issues,
Medication Issues,
Access to Care Issues,
Mental Health Issues, and
Medical Classification
Issues.
In fiscal year 2013, Step II and Patient Liaison combined offender Medical Grievance
Program investigated and responded to a total of 7,132 offender medical grievances.
72
Office of Public Health
 Disease surveillance and reporting
 Coordinate Infection Control Policy and provide
consultation
 TDCJ Employee Health
 Peer Education related to Health Care
 Safe Prisons Program (PREA)
73
Disease Surveillance






HIV
Tuberculosis
Syphilis and other STDs
Hepatitis
Staph Infections
Isolation Outbreaks
- Norovirus
- Chicken Pox
- Scabies
- Mumps
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S.A.N.E.
 Sexual Assault Nurse Examiner
 Component of Safe Prisons Program
 Purpose
– Raise awareness and sensitivity to sexual assault
– Train medical staff in proper chain of custody
collection and handling of physical examination
evidence
– Audit quality of sexual assault examinations
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Joint Committees
 System Leadership Council
 Policy and Procedure Committee
 Infection Control Committee
 Pharmacy and Therapeutics Committee
 Morbidity and Mortality Committee
 Peer Review
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Health Services Philosophy
Values Toward Offenders
 Believe all offenders are entitled to receive quality
health care that is timely, appropriate, and consistent
with policies and procedures.
 Believe offenders are to be treated as patients and are to
be provided access to treatment regardless of past
behavior, race, color, gender, national origin, religious
preference, or handicap.
 Believe offenders should be provided educational
opportunities to learn about wellness,
self care, and disease prevention.
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Health Services Philosophy
Values Toward Offenders (Cont’d)
 Believe offenders should be housed in a safe and healthy
environment.
 Believe offenders should be given opportunities to
achieve improved levels of mental and physical health.
 Believe offenders are entitled to know about the
condition of their health and that such information
should be treated confidentially.
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TTUHSC Correctional Managed Health Care
Mission: Provision of quality, comprehensive, cost efficient health care to 31,000 TDCJ
offenders in West Texas.
TTUHSC Services:
- 25 TDCJ facilities in 18 West Texas locations west of I-35
-
(3) 17 bed infirmaries, Montford RMF
-
Inpatient, outpatient, hospitalization, ER and Telemedicine Services via onsite and offsite
providers, Montford (WRMF) and contractual agreement with community hospitals.
-
TTUHSC manages over 352 health care provider contracts for services to TDCJ offenders
-
TTUHSC CMHC has 932 employees and over $100M budget
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TTUHSC Telemedicine
Telemedicine is available at 15 TDCJ units. With shared access, telemedicine is
available to 92% of our offenders.

Telemedicine has been available in CMHC for nearly two decades. We conduct
approximately 10,000 telehealth visits per year.
Advantages: - Instant access to offender patients
- enhance public safety
- convenience
-rural locations have enhanced access to specialty care
- reduces provider travel thereby increasing access to care
- feasible venue to conduct extender supervision in remote locations
.
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TTUHSC CMHC Mental Health Program
 Services include psychology, psychiatry services and psychopharmaceuticals.
 Services are provided on site at 23 TTUHSC affiliated TDCJ facilities
in West Texas:
 Inpatient providers at Montford cover outpatient mental health via 40
telepsych clinics per month.
 TTUHSC Manages current mental health inpatient census of 970
offender patients, 550 at the Montford Psychiatric Hospital in
Lubbock and 420 at the PAMIO (Program for Aggressive Mentally Ill
Offenders) In Amarillo.
 These 970 inpatient beds comprise nearly 50% of total TDCJ inpatient
caseload.
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Special Psychiatric Programs
Montford In-patient Psych
 Co-located with RMF, established in 1995
 550 bed forensic inpatient unit
 Provides specialty social work psychology, and psychiatry
services in addition to inpatient services.
 Globally CMHC psych services manages over 6,300
mental health outpatient encounters/yr, 100 crisis
management admissions/month and 825 telepsych
eval/month
PAMIO: Program for Aggressive Mentally Ill Offenders Clements Facility (Amarillo) PAMIO (established in 1990).
 208 bed capacity
 Innovative behavioral program offering structured Mental
Health Services to a unique sub set of offender patients
whose mental illness is compounded by aggressive and
assaultive behavior.
CMI Program: Clements Amarillo
 234 beds, established in June 2013
 Program for the chronically mentally ill
 Program designed to decompress inpatient beds across the state that were occupied by chronically mentally
ill offenders
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Special Medical Programs
Montford Regional Medical Facility (RMF) – Lubbock, TX (est. 1995)
 The most complex TDCJ medical unit in the State of Texas
 50 ward beds, 4 step down ICU beds (with ventilator capacity), 44 LTC beds,
30 holding beds, onsite dialysis capacity for 48 patients.
 (2) surgical suites
 CT, ultrasound and MRI diagnostic capability
 Physical, occupational and respiratory therapy
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NO WEAPONS BEYOND THIS POINT
NO HOSTAGE WILL PASS THROUGH THIS GATE
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CMHC Workforce Racial Demographics
Workforce Ethnicity - Females
Workforce Ethnicity - Males
Mexican
American: 1
Mexican
American: 0
160
500
White: 334
White: 118
140
400
120
Hispanic: 16
Hispanic: 97
100
300
480
146
Black: 41
80
Black: 8
200
60
Asian: 5
40
Asian: 3
100
20
0
American
Indian/Native
American: 3
0
American
Indian/Native
American: 0
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TTUHSC CMHC Workforce Longevity
Years of Service
350
Number of Employees
300
250
200
150
100
50
0
0
-50
5
10
15
20
25
30
35
40
N u m b e r o f Ye a r s E m p l o y e d
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The Correctional Nurse
We start our shift with the slamming of a gate; we enter a place where most would hate
We don’t call our patient’s sweetie or Hun, for this is prison, safety is 1 st.
We put up a wall that can’t be let down, for our private lives are hidden in this locked up
little town.
Our patients have been convicted of murder and rape, yet we treat their medical needs,
no matter their case.
The world of nursing doesn’t understand why we do what we do, but this is our choice, just
as your job suits you.
We can’t have our children stop by and say “Hi”, or check our text messages for a reply
We must cut up our fruit and unwrap our candy, trust me things are not handy.
We have met gangsters, some family and even freaks; we assess cuts, wounds piercings,
and leaks (haha)
We get threatened and cussed out, even when doing our best
We must visit some patients, while wearing a protective vest, but we are nurses and a
Great job we do.
I am so very proud of each one of you.
You are amongst the few that can actually say, “You looked eye to eye with a killer and
were not afraid”
We’ve grown used to inmates in cuffs and the smell of pepper spray; we’ve seen a
thousand of tattoos
and piercings along the way.
WE are the family with experience high in wealth; we are nurses of Correctional Health
Happy Nurses Week 2012
Jaye Escobar, RN
Nurse Manager -John Middleton Unit
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CMHC
Challenges
Offender Patients
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Offender Population Age 55 and Older
1.2
18,000
15,661
1
12,342
13,355
14,198
16,000
14,000
11,565
0.8
9,373
10,131
10,761
12,000
10,000
0.6
8,000
0.4
6,000
4,000
0.2
2,000
0
0
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TREATMENT PROGRAMS
The Rehabilitation Programs Division manages activities related to offender programs and is
responsible for ensuring that all programs operate with consistent quality. The Windham School
District was established by the Texas Legislature as an entity separate and distinct from the Texas
Department of Criminal Justice and provides academic, as well as career and technology education,
to eligible offenders incarcerated within the TDCJ.
The Texas Department of Criminal Justice and the Windham School District offer the following
programs as well as many other volunteer led initiatives:
•Baby and Mother Bonding Initiative
•COURAGE Program for Youthful Offenders
•In-Prison Driving While Intoxicated Recovery Program
•In-Prison Therapeutic Community
•"Innerchange" Faith-Based Pre-Release Program
•Post-Secondary Education Program (Academic &
Vocational)
•Pre-Release Substance Abuse Program
•Pre-Release Therapeutic Community
•Serious and Violent Offender Reentry Initiative
•Sex Offender Education Program
•Sex Offender Treatment Program
•Substance Abuse Felony Punishment
•Administrative Segregation Pre-Release Program
•State Jail Substance Abuse Program
•Academic
•CHANGES/Pre-Release
•Cognitive Intervention
•English as a Second Language
•Literacy
•Parenting
•Perspectives and Solutions
•Special Education
•Vocational
•Voyager Faith Based Pre-Release
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DIVERSION PROGRAMS
The Texas Legislature has strengthened community supervision and parole by
reducing caseloads, increasing availability of substance abuse treatment options,
and providing sufficient funding to implement a progressive sanctions model.
Diversion programs available through local CSCDs and the TDCJ Parole Division
include:
•Adult Education Programs
•Batterers Intervention and
Prevention Programs
•Cognitive Programs
•Court Residential Treatments Centers
•Programs for the Mentally Impaired
•Sex Offender Surveillance and
treatment
•Substance Abuse Treatment Facilities
•Victim Services Programs
•Vocational/Employment and Life
Skills Training
•Community Opportunity Programs
in Education
•District Reentry Centers
•Electronic Monitoring
•Halfway Houses
•Intermediate Sanction Facilities
•Sex Offender Program
•Special Needs Offender Program
•Substance Abuse Counseling
Program
•Therapeutic Community Substance
Abuse Aftercare
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TCOOMMI Overview
• Mission Statement: To provide a formal structure of criminal justice, health
and human service and other affected organizations to communicate and
coordinate on policy, legislative, and programmatic issues affecting
offenders with special needs (i.e., special needs include offenders with
serious mental illnesses, intellectual disabilities, terminal or serious medical
conditions, physical disabilities and those who are elderly).
– One of three states with a statutorily mandated coordinating body for
offender with special needs.
– The only state with continuity of care legislation.
– One of a few state with targeted funds for juveniles and adult offenders
with special needs.
– One of a few states with specialized juvenile and adult probation/parole
caseloads.
– The most proactive state in regulatory, statutory, procedural and
programmatic practices for offenders with special needs.
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TCOOMMI Overview – Cont’d
• Continuity of Care (Mental Health and Medical): A
program designed to provide a responsive system for
individuals discharging from TDCJ, local referrals from
parole, jail, family and other related agencies. Components
include, but are not limited to:
– Liaison with community resources, community
supervision and parole offices, provide technical
assistance to medical service providers caring for
offenders and work with the Wrongfully Convicted
Program.
– Screening and linkage to appropriate services, including
medically appropriate residential plans.
– Federal entitlement application services
– Jail screening
– Court intervention
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TCOOMMI Overview – Cont’d
• Adult Intensive Case Management: Clients must have a
high criminogenic risk and high clinical need. Risk is
determined by the criminal justice partners Risk
Assessment. Services includes, but are not limited to:
– Case Management
– Rehabilitation/Psychological Services
– Substance Abuse Treatment
– Psychiatric Services/Medication Monitoring
– Linkage to Hospice and Medical Services
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TCOOMMI Overview – Cont’d
• Adult Transitional Case Management: A program that
provides transitional mental health services to offenders
with severe and persistent mental illness who have been
served in Adult Intensive Case Management caseload, and
require ongoing services to reduce risk of recidivism,
reduce or stabilize symptoms while linking the offender to
natural and/or alternative supports. Additionally, this
program may be provided to offenders with a severe and
persistent mental illness who present with very little risk
of harm and a level of functioning that requires less
intensive levels of care to maintain community tenure.
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TCOOMMI Overview – Cont’d
• Juvenile Case Management/Special Needs Diversionary
Program: A program that provides community-based
mental health treatment and specialized supervision to
juveniles (i.e., age 10-18) who have received deferred
prosecution, juvenile court-ordered probation or who have
been released under court ordered conditions of release
and are being supervised in the community, and who have
a serious emotional disturbance. The Special Needs
Diversionary Program is administered in a collaborative
model by the Texas Juvenile Justice Department (TJJD)
and the Texas Correctional Office on Offenders with
Medical and Mental Impairments (TCOOMMI).
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TCOOMMI Overview – Cont’d
• HIV/AIDS Continuity of Care: A program designed to
provide a responsive system for individuals with HIV/AIDS
discharging from TDCJ with discharge planning (i.e.,
linkage to appropriate services), and post-discharge followup re ensure engagement in services.
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TCOOMMI Overview – Cont’d
• Medically Recommended Intensive Supervision
(MRIS): To provide early release from incarceration for
offenders who suffer from mental illness or intellectual
disabilities, or who are elderly, physically handicapped,
terminally ill, or require long-term care, and who pose
minimal public safety risk. This program provides
immediate linkage to appropriate services, including
medically appropriate residential plans.
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Winston Churchill on Prisons
“The mood and temper of the public in regard to the treatment of crime
and criminals is one of the most unfailing tests of the civilisation of any
country. A calm and dispassionate recognition of the rights of the accused
against the state and even of convicted criminals against the state, a constant
heart-searching by all charged with the duty of punishment, a desire and
eagerness to rehabilitate in the world of industry of all those who have paid
their dues in the hard coinage of punishment, tireless efforts towards the
discovery of curative and regenerating processes and an unfaltering faith that
there is a treasure, if only you can find it in the heart of every person – these
are the symbols which in the treatment of crime and criminals mark and
measure the stored up strength of a nation, and are the sign and proof of the
living virtue in it.”
The Magistrate’s Blog (2005-2012)
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U.S. Attorney General Eric Holder
“We need to ensure that incarceration
is used to punish, deter and rehabilitate
– not merely to convict, warehouse and
forget,” Holder said in remarks to the
American Bar Association in San
Francisco. “Although incarceration has
a role to play in our justice system,
widespread incarceration at the federal,
state and local levels is both ineffective
and unsustainable. … It imposes a
significant economic burden – totaling
$80 billion in 2010 alone – and it
comes with human and moral costs
that are impossible to calculate.”
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