A TEXAS CIVIL RIGHTS PROJECT HUMAN RIGHTS REPORT 2011 “A THIN LINE” The Texas Prison Healthcare Crisis and The Secret Death Penalty “Right now the [health care] system is constitutional… but we’re on a thin line.”1 – Dr. Ben Raimer, Former Chief Physician Executive for UTMB Correctional Managed Care Special thanks to Lindsey Smith, Joseph P. Berra, Kelly Burns, Lauren Conner, Serine Consolino, James C. Harrington, Andrew Johnson, Christopher Johnston, Scott Medlock, Christina Muniz, Lauren Pitts, Zaida Riquelme, Erica Surprenant, Lonnie Williams, and Vinson & Elkins, LLP. Texas Civil Rights Project The Michael Tigar Human Rights Center 1405 Montopolis Drive Austin, TX 78741 Texas Civil Rights Project Board of Directors Pablo Almaguér, Roxann Chargois, Ouisa Davis, Leona Diener, David A. Grenardo, Chuck Herring, and Renato Ramirez www.texascivilrightsproject.org (512) 474 5073 (phone) (512) 474 0726 (fax) © Texas Civil Rights Project, 2011 All Rights Reserved TABLE OF CONTENTS EXECUTIVE SUMMARY ...............................................................................................................1 METHODOLOGY ............................................................................................................................2 INTRODUCTION .............................................................................................................................3 Medical horror story: David West .........................................................................................3 LEGAL HISTORY OF PRISON HEALTHCARE IN TEXAS ........................................................6 Historical Overview of Medical Care in Texas Prisons.........................................................6 Prisoners’ Right to Medical Care under the U.S. Constitution ..............................................6 Managed Health Care in Prisons and Potential Violations of the U.S. Constitution .............9 Conclusion .............................................................................................................................9 CURRENT MEDICAL CARE IN TEXAS PRISONS .....................................................................11 Prisoners’ Rights to Medical Care under Texas Government Code ......................................11 Contractual problems .................................................................................................12 QUALITY OF CARE ........................................................................................................................15 Medical horror story: Larry Louis Cox ..................................................................................15 Accountability ........................................................................................................................15 Provider attitudes ...................................................................................................................17 Infrastructure ..........................................................................................................................17 Telemedicine: a partial solution .............................................................................................18 Recommendations: .................................................................................................................19 ACCESS TO CARE ..........................................................................................................................20 Medical horror story: Adam Whitford ...................................................................................20 i Distribution of medication .....................................................................................................20 Communication breakdown ...................................................................................................21 Treatment delays ....................................................................................................................21 Recommendations: .................................................................................................................22 PROBLEM AREAS...........................................................................................................................23 OVERCROWDING IN TEXAS PRISONS ......................................................................................23 Overview ................................................................................................................................23 Overly harsh sentencing laws ................................................................................................24 Dishonest fiscal notes ............................................................................................................25 Chronic failure of the Board of Pardons and Paroles ............................................................26 An aging prison population ....................................................................................................28 Recommendations ..................................................................................................................29 MENTAL HEALTH ..........................................................................................................................30 Medical horror story: Josh Dillard .........................................................................................30 Overview of mentally ill prisoners ........................................................................................31 Available mental healthcare ...................................................................................................32 Negative effects of prison ......................................................................................................33 Recommendations ..................................................................................................................34 INFECTIOUS DISEASE ...................................................................................................................35 Medical horror stories: H1N1 and norovirus .........................................................................35 Hepatitis .................................................................................................................................36 Tuberculosis ...........................................................................................................................37 ii HIV/AIDS ..............................................................................................................................37 Staphylococcus ......................................................................................................................38 Preventative methods .............................................................................................................39 Recommendations: .................................................................................................................39 CONCLUSION ..................................................................................................................................41 APPENDIX ........................................................................................................................................42 Medical Horror Stories ..........................................................................................................42 Micah Burrell .............................................................................................................42 Donald Novel .............................................................................................................42 Juan Palote .................................................................................................................44 ABOUT THE TEXAS CIVIL RIGHTS PROJECT ..........................................................................45 NOTES ...............................................................................................................................................47 iii EXECUTIVE SUMMARY Texas is well known for executing more prisoners than any other state. Executions are the public death penalty—they take place with transparency. Texas, however, also practices a “secret” death penalty. Prisoners are killed and maimed in Texas by appalling medical care. Texas incarcerates approximately 154,000 people in 112 Texas Department of Criminal Justice (TDCJ) prisons around the state. The Federal Constitution requires Texas to provide basic medical care for prisoners’ serious medical conditions. In the past, federal courts have had to monitor Texas prisons for grossly failing to meet this basic humane obligation. Texas is now facing a return to the “bad old days” when the courts had to intervene in prison health care. Texas pays just $9.88 per prisoner per day for health care, compared with $28.55 per prisoner per day in California—which is already under judicial supervision and has been ordered to release over 40,000 prisoners so the remaining inmates can receive constitutional care. In this legislative session, the Governor has asked all state agencies to make significant cuts to their budgets. Prison health care will be a tempting target—prisoners have no powerful lobby, and are an easy political punching bag. Indeed, legislators have proposed slashing the prison health care budget by almost 25 percent. Texas would pay $6.00 a day, or less, per prisoner on health care. This would be disastrous. Balancing budgets on prisoners’