Correctional Managed Care operates fourth largest center in Texas

For immediate release: May 1, 2007

GALVESTON, Texas - Operating the fourth largest dialysis center in Texas would seem challenge enough. Add the fact that the patients are inmates housed by the Texas Department of Criminal Justice and the complexities increase dramatically as Correctional Managed Care staff not only must provide high quality dialysis services but must do so under the restrictions imposed by tight security.

And it doesn't get easier when inmate patients are released since their treatment doesn't end when they're paroled. Placing men and women with a criminal record in a "free world" dialysis center presents its own array of problems.

With a capacity of 163 patients, with 156 under treatment, the dialysis center at the Estelle Unit in Huntsville is a busy place.

The Estelle dialysis center's 29 dialysis stations accommodate three patient shifts six days a week. The center operates from 5 a.m. to 11 p.m. In addition to CMC medical personnel, security personnel from the TDCJ are always there to move the patients in and out.

Nearer to Galveston, the Texas City unit for female offenders at the Carol Young Medical Facility can handle up to 12 dialysis patients, with 10 patients now. The Estelle/Texas City facilities are the only correctional dialysis units in Texas, although a private company operates a small unit at the Montford trustee camp.

Denise Box, the district practice manager for the Estelle Unit, said the dialysis unit has approximately 45 staff, including physicians, registered nurses and licensed vocational nurses, patient care technicians, social workers, a dietician, and technical, administrative and clerical staff. UTMB began operating the unit in 2000, following its operation by private companies.

TDCJ inmates who are dialysis patients are younger than similar patients in the general population with average ages in the 40s, while free world patients tend to be in their late 50s and early 60s.

"There are a lot of theories about why our patients are younger, but there has not been any real research on it," said Jennifer Elmore, dialysis nurse manager. She noted that diabetes and hypertension are the leading causes of kidney failure.

UTMB social workers at the dialysis unit have an important role to play in patient discharge, she said. Finding a clinic may be part of someone's parole plan. At times, parole may wait one or two months before a social worker finds a unit to take someone who is being discharged. This provides the least disruption in care, Elmore noted.

Sometimes a delay is not possible because an inmate must be released. In the case of a mandatory release, when a dialysis facility has not been found, the patient is given a copy of his or her medical records to take to a free world hospital for admission to dialysis in an emergency situation.
The University of Texas Medical Branch at Galveston
Public Affairs Office
301 University Boulevard, Suite 3.102
Galveston, Texas 77555-0144