Inmate Health - Reducing The Cost And Improving Theavailability Of Treatment
telemedicine medical consultations federal
Telecommunications links make it possible for physicians and other health care specialists to evaluate and treat patients who are hundreds or thousands of miles away. This technology, called telemedicine, offers the prospect of providing prisoners with cost-effective health care. For example, telemedicine makes it possible for
|Percent of inmates who reported an injury since admission|
|Total||Injured in an accident||Injured in a fight|
|Time since admission||State||Federal||State||Federal||State||Federal|
|Less than 12 months||13.2%||17.0%||10.2%||15.6%||2.9%||0.8%|
|72 months or more||45.9||31.6||31.7||26.3||19.7||5.3|
physicians to examine prisoners without the inconvenience of traveling to prison facilities, often located in remote or isolated areas. Likewise, the cost and security concerns of transporting prisoners to physicians are also eliminated.
In "Can Telemedicine Reduce Spending and Improve Health Care?" (National Institute of Justice Journal, April 1999), authors Douglas McDonald, Andrea Hassol, and Kenneth Carlson reported on a demonstration program to evaluate a telemedicine system in prison. The pilot project was conducted jointly at four federal prisons:
- U.S. Penitentiary, Lewisburg, PA. Maximum security. Houses an average of 1,300 male prisoners
- U.S. Penitentiary, Allenwood, PA. Maximum security. Houses an average of 1,000 male prisoners
- Federal Correction Institution, Allenwood, PA. Low and medium security. Houses an average of 1,100 male prisoners
- Federal Medical Center, Lexington, KY. Medium and minimum security. Houses an average of 1,450 mostly male prisoners with chronic illnesses
The pilot program was conducted from September 1996 to December 1997. It did not replace routine medical care provided by prison staff. As reported, the goal of the telemedicine test program was to reduce three types of care:
- Consultations with specialty physicians who would normally visit the prison
- Prisoner trips to hospitals or off-site physicians
- Transfers of prisoners to federal medical centers for intensive or long-term treatment
At each prison a dedicated telemedicine room was equipped with interactive video-conferencing equipment, specialized medical cameras, an electronic stethoscope, and a computer workstation with appropriate software. For most examinations a medical staff member from the prison (usually a physician's assistant) presented the inmate patient to an off-site specialist linked via video-conferencing and equipped with remote controls that enabled the specialist to manipulate cameras located in the patient examination room.
During the fifteen months of the demonstration project, physicians made approximately one hundred telemedicine consultations each month, for a total of 1,321 consultations. About 58% of the telemedicine "visits" were for psychiatric consultations, followed by dermatology (13.3%), orthopedics (10.7%), dietary (6.4%), and podiatry (4.7%). The remaining 6.5% of telemedicine consultations were with specialists from other disciplines, including infectious diseases, cardiology, and neurology.
Four specialties were selected for purposes of comparing conventional medical care in prisons with telemedicine consultations—psychiatry, orthopedics, dermatology, and cardiology. Specialists in these four fields were among the most frequently consulted prior to the pilot project, and that frequently increased with the implementation of telemedicine.
During the pilot program, the cost of in-prison consultations decreased from approximately $108 per conventional consultation to $71 per telemedicine consultation, a savings of $37 per consultation. However, because there was not a one-for-one substitution of regular consultations and telemedicine consultations, the total number of consultations increased with the addition of telemedicine.
Some thirty-five trips for inmates to visit specialists outside of prison were eliminated through telemedicine for a total savings of about $27,500. Some trips were unavoidable when inmates required invasive tests, surgery, or intensive trauma care. The Bureau of Prisons estimated that it saved an additional $59,134 because, in certain cases, telemedicine eliminated the need for air transfers of inmates to federal medical centers. Most of the averted air transfers were for psychiatric patients who required intensive monitoring that was made possible through telemedicine consultations.
There were other nonfinancial benefits to the implementation of telemedicine consultations. Waiting time to see specialists decreased and new services became available, including more specialized HIV/AIDS care. Also, inmate patients reported feeling that the quality of care improved with telemedicine.
As a result of the success of this pilot program, the National Institute of Justice (NIJ) began studies using telemedicine in jails. It also funds a program to inform corrections staff of the benefits of telemedicine and to help prison administrators decide if telemedicine will succeed at their facilities. Some of the points to consider are space constraints and access to nearby medical centers. In addition, the program suggests ways to develop and launch prison telemedicine systems. Designing such systems is discussed in Implementing Telemedicine in Correctional Facilities by Peter L. Nacci and others (Washington, DC: U.S. Department of Justice and U.S. Department of Defense, May 2002).
One of the new systems implemented in 2003 involves the University of Texas Medical Branch (UTMB) and the Federal Medical Center in Lexington, Kentucky. Under the telemedicine agreement, medical specialists in Galveston treat inmates in Lexington nearly 1,000 miles away. Among the specialties offered are orthopedics and urology.