BILL ANALYSIS
By: Coleman
BACKGROUND AND PURPOSE
Due to the lack of access to health care coverage and services, preventable and communicable diseases tend to disproportionately affect the poorest groups in society. A significant proportion of the poor and underserved population spends time incarcerated. According to a 2007 report in the New England Journal of Medicine by Dr. Susan Okie, 25% of people with HIV and 33% of people with hepatitis C will spend time in a correctional facility. Additionally, because of their close interactions with inmates, staff members in correctional institutions have a higher risk of contracting many of these communicable conditions. Inmates may be physically isolated from society, but they are not "isolated" in terms of the spread of communicable diseases (e.g., meningococcal infections, influenza, pneumococcal infections, tuberculosis, hepatitis B/D and C, HIV, and other STDs).
Correctional environments provide an important venue for screening, surveillance, vaccination, treatment, and prevention. An effective way of reducing the incidence of new disease is through the diffusion of prevention knowledge from inmates to the community at large. Inmates comprise "a captive audience" as they are bored, sober and usually motivated to obtain useful health-related information. Given the high correctional population turnover in Texas, inmates can learn prevention strategies for their benefit, and in turn, relay that information back into their communities upon their release. In addition, teaching inmates about prevention and disease maintenance will reduce the spread of diseases such as HIV and other STDs within the penal system.
House Bill 2526 creates a Center for Correctional Public Health and Health Promotion that, in consultation with correctional health facilities, will be responsible for designing and implementing interventions appropriate for correctional settings. The center would evaluate the process, impact, outcome, and cost-effectiveness of interventions such as sexual assault prevention, condom programs, HIV/STD prevention, the importance of adherence to medication (e.g., HIV, tuberculosis, antibiotics), reducing unsafe sharps use (e.g., injection, tattoos), and how to access health care outside of the correctional system. In addition, the center will educate correctional staff across the state about public health issues unique to the correctional system and provide continuing education.
RULEMAKING AUTHORITY
It is the committee's opinion that this bill does not expressly grant any additional rulemaking authority to a state officer, department, agency, or institution.
ANALYSIS
House Bill 2526 creates a Center for Correctional Public Health and Health Promotion ("Center") and subjects the Center the Texas Sunset Act. Unless continued in existence as provided by Chapter 325, Government Code, the Center is abolished and Chapter 115, as added by this Act, expires September 1, 2019.
This bill provides that the governing board of the Center will include the administrative head (or that person's designee) of the Department of State Health Services (DSHS) and the Texas Department of Criminal Justice (TDCJ). Additionally, the governor will appoint the following board members no later than December 1, 2007: a representative of a county correctional department, a correctional health care worker, a representative of an organization that represents inmates, and a representative from the institution of higher education where the Center is located. The members appointed by the governor will serve staggered, two-year terms, with the terms of two members expiring on February 1 of each year. In making the initial appointments, the Governor shall designate two members for terms expiring February 1, 2008 and two members for terms expiring February 1, 2009.
The bill provides that the Center must be based at an institution of higher education selected by DSHS. The selected institution must offer a master's of public health degree program or have a health science center, be involved in issues relating to health care of inmates at correctional facilities in this state, and be an institution of higher education that offers a criminal justice degree program.
HB 2526 requires the Center to focus its efforts at preventing and reducing communicable diseases in inmate populations at correctional facilities and in those populations that are most likely to come in contact with inmates in a correctional environment. The bill also requires the Center to emphasize preventative programs that emphasize risk situations and risk behaviors.
The bill provides that in developing and implementing programs under Chapter 115, Health and Safety Code, the Center shall work with state and local correctional health agencies, including providers of correctional health care and the public health section of the TDCJ health services division, and may work with the American Correctional Association, the American Correctional Health Services Association, the Centers for Disease Control and Prevention, and organizations representing inmates.
HB 2526 enumerates the following duties that the Center must carry out: develop and implement preventative education and risk reduction programs; perform behavioral interventions and health screenings; provide early intervention or care; provide immunizations where available; assess the cost-effectiveness of interventions and demonstration projects; asses the impact of correctional programs on community health; provide graduate and continuing education in correctional public health and infectious diseases; and carry out joint research projects with correctional administrations. Additionally, this bill requires the Center to carry out research and training, with specific funded fellowship positions being available for correctional staff to spend a semester or longer or to undertake graduate education in the area within the center.
The bill requires the Center to employ full-time and part-time faculty members of the institution of higher education in which the Center is based. The faculty members must have research interests relating to public health and disease prevention in correctional institutions, including: (1) HIV, sexually transmitted diseases, hepatitis B and C, and tuberculosis; (2) substance abuse; (3) health promotion and health education; (4) program evaluation; (5) health policy; (6) criminology and criminal justice; (7) correctional health care and treatment; or (8) other relevant areas.
EFFECTIVE DATE
September 1, 2007.