PRISON HEALTH COSTS TO SOAR, PANEL TOLD

Aging inmate population, longer sentences, better HIV treatment cited

AUSTIN - The graying of Texas' prison population will cause health-care
costs behind bars to rise dramatically over the next few years, state
legislators were told Tuesday.

As more criminals get longer sentences, fewer are paroled and treatments
improve for HIV-infected inmates, "we're going to have health-care costs
just skyrocket," said Sen. Florence Shapiro, R-Plano, a member of the
Senate Committee on Criminal Justice.

The committee met Tuesday to discuss medical treatment of prison inmates.
The panel is responsible with examining various prison-related issues to
determine what changes in state law should be considered. The Legislature
next meets in January 1999.

Senates were told Tuesday that it costs more to keep older inmates healthy
than young ones and that there are more older inmates now than ever before.

On Jan. 1, Texas had 9,130 prisoners 50 or older - a 15 percent increase
from a year earlier and more than double the number of inmates in that age
group four years ago. Overall, the prison population is around 140,000.

Most experts attribute the aging of the population to:

* Longer sentences.

* Revisions in the state criminal code that require many inmates,
especially violent offenders, to serve more years before they're eligible
for parole.

* A state Board of Pardons and Paroles that has been increasingly reluctant
to grant parole and increasingly quick to send freed convicts back to
prison for violating terms of parole or probation.

"All indications across the board are that the graying of the prison
population is going to go on," said Jim Riley, director of correctional
managed health care.

Under the "managed care" system established for prisoners - essentially
like the health maintenance organizations that many Americans on the
outside belong to - the average payment to a doctor who sees an inmate is
about $5.20, said Jim Riley, director of the prison managed health system.

But for "elderly" inmates, those 55 or older, the cost per visit shoots up
to about $14.50, he said.

As more inmates reach the geriatric stage, "I think it's going to go even
higher," Mr. Riley told the senators.

To get a handle on what those increases might amount to in the long run,
prison officials may need the services of an actuarial consultant, said Dr.
David R. Smith, president of the Texas Tech University Health Science
Center and chairman of the prison system's managed health-care advisory
committee.

"Right now, we don't know the answer. Beyond a couple of years, we're
really just guessing," Dr. Smith said.

Texas Tech is one of two university hospitals that administer the prison
health-care system. The other is the University of Texas Medical Branch at
Galveston.

Another factor driving up costs is the high price of new and successful
drug therapies for inmates with HIV. Dr. Smith said those costs are
projected to rise to more than $18 per patient per day by the end of the
current fiscal year. Two years ago, before the new drug therapies came into
common use, each HIV patient's daily medicine cost $4.24, he said.

About 2,000 prison inmates have been identified as HIV-infected.

Many patients being kept alive by these new drugs would have died at much
younger ages a few years ago, he said.

Sen. John Whitmire, D-Houston, chairman of the Criminal Justice Committee,
said elderly prisoners with terminal illnesses who pose no risk to society
should be allowed to leave prison to die at home with their families.

He and Dr. Smith questioned the wisdom of keeping such people in costly,
needed prison beds.

"I've seen some of these patients," the doctor said. "You're talking about
people who can't even get out of bed, who can't lift their arms or heads.
Some of them are blind with diabetes."

The senator said, "We should let them go home to die in dignity. It's the
humane thing to do, and it would save dollars."

Currently, such inmates must apply for a "special-needs parole" to be sent home.

They can apply only if they are not classified as among the system's most
violent offenders. Last year, 114 such special-needs paroles were granted,
officials said.