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With More Inmates on Dialysis, Officials Deal With Rising Costs

A small but expensive and ever-growing group of Texas inmates requires dialysis. Fewer than 230 inmates who receive dialysis treatment account for about 3 percent of the entire prison system's pharmaceutical budget.

Inmates Roberto Bisco and Robbie Robinson undergo dialysis in the medical center of the Estelle Unit in Huntsville, Texas.

Less than 1 percent of  the Texas prison population needs dialysis, a treatment that removes waste and water from the bloodstream.

But they are an expensive group — and their ranks are growing. Today, 228 inmates need dialysis three times a week. Their drug treatment costs taxpayers $1.25 million a year, accounting for about 3 percent of the prison system’s pharmaceutical budget.

By comparison, the pharmaceutical bill for the 1,800 inmates treated for HIV is about $17.8 million a year.

But with an additional 99 inmates expected to be placed on dialysis within the next year, the trend shows no signs of slowing, particularly among young and middle-age African-American men. And because inmates with liver failure are also being treated for other health problems — hypertension, diabetes, hepatitis C, for example — it is difficult for prison officials to calculate their total costs.

“They’ve got elevated blood pressure and have gone so long without treatment, they’ve made their kidneys work harder, to the point of needing dialysis,” said Dr. Owen Murray, the chief physician for the University of Texas Medical Branch’s correctional managed care program, the primary health care provider for inmates at 109 state prisons. Nearly one in three kidney failure patients in the United States is African-American. 

Several factors contribute to the high concentration of kidney disease in African-Americans, medical researchers say, including a higher rate of high blood pressure and hypertension, which tax the kidneys. About 35 percent of the 150,340 inmates in Texas are African-American.

“They’re more complicated to care for,” said Murray of prisoners with kidney disease. This week, he told lawmakers about the increasing costs of chronic kidney disease in prison.

State Rep. Sylvester Turner, D-Houston, said dialysis, along with expensive treatment for hepatitis C and HIV, are reasons to look to federal programs to help with the cost.

“We cannot ignore these cost drivers, and we also cannot ignore opportunities, like expanding Medicaid, which may offset these costs,” Turner said.

In 2013, there were 624 more inmates diagnosed with chronic kidney disease than there were in 2011. A total of 1,800 have the disease, and if treatment is not managed aggressively, could be on dialysis at some point.

Murray’s office on Texas’ Gulf Coast directs the management of dialysis machines at two prisons: the Carole Young Unit in Galveston County and the Estelle Unit in Huntsville, 120 miles away.

“We have three shifts a day to get everybody through,” Murray said.

State Rep. Tan Parker, the chairman of the Texas House Committee on Corrections, said more emphasis on preventive measures was needed.

Parker, R-Flower Mound, complained that inmates, who are locked in cells, are not much better than people outside of prison at taking their medication and that the lack of compliance is costing Texas taxpayers.

Murray and other state prison officials told Parker’s committee on Thursday that about 50 percent of people outside of prison take their medication as prescribed. In Texas prisons, that compliance is 55 percent.

“That’s very frustrating,” Parker said. “There’s a lot of money being left on the table.”

Disclosure: The University of Texas Medical Branch was a corporate sponsor of The Texas Tribune in 2012. A complete list of Texas Tribune donors and sponsors can be viewed here.

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