Telemedicine Behind Bars

Providing healthcare to prisoners is difficult and expensive. Many correctional facilities are located in remote areas where healthcare professionals, particularly specialists, are scarce. Add to that the challenge of finding doctors willing to work in a prison setting and treat potentially dangerous criminals in person. Yet transporting inmates for treatment at hospitals and other healthcare facilities is very costly and presents public safety risks.

A growing number of correctional systems see telemedicine as a cost-effective solution to these challenges, according to an article in the Pew Charitable Trusts’ publication Stateline. State and federal prisons began experimenting with telemedicine in the late 1980s and early 1990s, but the technology then available was limiting. Dramatic improvements in technology, the introduction of electronic medical records, and pressure to control rising healthcare costs have paved the way for greatly expanded use of telemedicine in prisons. Today, most states use telemedicine to help meet the healthcare needs of inmates, Stateline reports.

“Telemedicine is perfectly designed for prisons,” according to Marc Stern, a former assistant secretary for health services for the Washington State Department of Corrections who now consults with corrections systems on telemedicine.

Even local correctional facilities in urban settings are turning to telemedicine to improve inmates’ access to quality healthcare. An article published last week in Modern Healthcare reports that Rikers Island, New York City’s main jail complex, introduced the use of telemedicine earlier this year.

Dr. Vinh Pham has treated patients from Rikers Island with hepatitis C and other infectious diseases for the last eight years. He has seen, first-hand, inmates’ frustration with the traditional process for accessing specialist care. Prisoners sometimes only have five minutes to meet with a doctor after spending 6-8 hours shackled in holding pens and sitting in traffic on the way to NYC Health & Hospital’s Bellevue campus.

“That was frustrating for the patient because they went through this tremendous effort to get there, and they could only have this very, very limited time to get their concerns addressed,” Pham said.

In May, NYC Health & Hospitals and Rikers began a pilot telemedicine program with $650,000 in funding. So far, about a dozen doctors and patient coordinators engage in virtual visits, which are limited to infectious disease, gastroenterology and urology specialists.

The inmates “just palpably seem more relaxed and satisfied with the entire encounter and experience than they used to,” Pham said. “It used to be a very negative experience.”

Although Rikers’ telemedicine program has started small, administrators hope to expand its reach. “We have a broad aspiration to do more of this across services,” said Dr. Homer Venters, chief medical officer of Correctional Health Services, a division of NYC Health & Hospitals.

The trend for correctional facilities to incorporate telemedicine into their healthcare programs is likely to continue. Stateline reports that states spent nearly $8 billion, nearly a fifth of their entire corrections budgets, on inmate healthcare in 2011. The graying of the U.S. prison population in recent years has brought increased pressures on prison healthcare budgets and programs, and this demographic trend shows no signs of abating.

Between 1999 and 2013, the number of state and federal prisoners 55 or older increased 234 percent, while the number of younger prisoners only rose by 9 percent, according to the Pew Charitable Trust. These older prisoners, like seniors in the general population, are more likely to have chronic medical and mental conditions and require significantly higher healthcare expenditures.

Many believe that using telemedicine to help meet the healthcare needs of inmates can save states money and improve inmate access to healthcare. Stateline notes that Texas has the largest prison population in the US and uses telemedicine more extensively than most states. The University of Texas Medical Branch (UTMB), which provides healthcare for around 80 percent of Texas prisoners, conducts 127,000 telemedicine visits a year. All behavioral health care, around 20 percent of primary care appointments, and between 5 and 10 percent of specialist visits are handled via telemedicine.

Texas spent just $3,805 per prisoner on medical care in 2011, compared to a national average of $6,047. Owen Murray, vice president of correctional managed care for UTMB, is convinced telemedicine contributes to Texas’s relatively low per-capita spending on prisoner health, although it is difficult to calculate just how much telemedicine saves the state.

According to the Stateline article, prisoner advocates have mixed views on the use of telemedicine in corrections. Some see it as improving inmates’ access to healthcare, while others caution that telemedicine’s cost-savings features tempt prison systems to use it excessively and inappropriately.

And Marc Stern, who strongly supports the use of telemedicine in correctional facilities, believes all doctors providing care to inmates through telemedicine should make occasional visits to prisons so they understand the unique world occupied by their patients.

 

Click here to read the Stateline article “State Prisons Turn to Telemedicine to Improve Health and Save Money.”

Click here to read the Modern Healthcare article “Putting Telemedicine Behind Bars.”

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