Telemedicine in prisons, past present and future

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Telemedicine in prisons, past present and future

• Debbie Justis, RN, MSHA
• Virginia Commonwealth University Health System

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Beginnings of prison telemedicine

• Began in 1974
• University of Miami connected physicians with
  prisoners at three area facilities using a
  microwave link.
• Initiatives in correctional facilities
  essentially ended in the late 1970s
• Cost
• Reappeared in the 1990s with advanced technology
• improved cameras, software, and
  compression-decompression (CODEC) technology.

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Eighth Amendment

• The Eighth Amendment of the U.S. Constitution
  mandates accessibility to health care for
  inmates. Lack of access to appropriate medical
  care was deemed "cruel and unusual punishment" in
  Estelle v. Gamble (429 U.S. 97 97S. Ct. 285
  SOL. Ed. 2d 251, 1976).
• "In Estelle, the Supreme Court established that,
  when prison officials are deliberately
  indifferent to the serious medical needs of
  prisoners, the prisoners' Eighth Amendment right
  to be free from cruel and unusual punishment has
  been violated."

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Eighth Amendment

• Since this court decision, many prison systems
  have found themselves under court supervision to
  provide appropriate care.
• Factors applying pressure on correctional health
  include
• increase in the numbers of inmates due to longer
  sentences
• increasing age of the general population.

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Benefits of telemedicine in prisons

• Reduce security threats
• Reduce cost by reducing travel expense
• Accessibility to specialists and disease
  management (many prisons rural)
• Offers opportunity to discuss consultation with
  caregivers
• Opportunities for Residents and medical students
• Reduction in medical malpractice litigation
• Satisfaction survey

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Barriers to prison telemedicine

• Prison medical and nursing staff acceptance
• Hospital physician acceptance
• Joint decisions between staff with different
  perspectives
• Hidden costs of training
• Support from administration
• Cost of equipment

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Financial analysis

• Prison cost savings by reduced security and
  transportation costs
• Disease management reducing hospital admission
  rates
• Reduced costs for tests performed in the prison
  site
• Reduced transportation to emergency departments
  (New York)

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Sustainability of prison telemedicine programs

• Cost reduction on transportation and security
  costs including overtime
• Improved quality and accessibility to specialty
  care with reduced wait times for appointments
• Decreases risk of escape
• Reduces threat of communicable diseases

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History of VCUHS prison telemed program

• Telemedicine at VCUHS began in 1996, funded by
  the VA legislature
• Telemedicine at VCUHS halted in June 2001
• With a new contract the program began again in
  November 2002 with 1 prison, 3 services (ID,
  GS,and OS) and 7 sessions

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Summer 2001 - Fall, 2002 (changes)

• Changed approach to reimbursement
• Contracts written on a per prison per month
  reimbursement scale.
• Monthly invoices are sent from VCUHS to DOC based
  on contractual rates and number of prisons on
  line. Covers cost of telemedicine clinic
  exclusive to the inmates.
• Practitioners continue to submit claims for their
  professional services

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Latest approach

• 2002-2003 Legislature suggested DOC find a way
  to purchase less costly medication.
• Corrections and VCUHS contracted services to
  provide medication within the regulations of the
  340B pricing rules.

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Newest contract

• 340B pricing is only allowed when providers from
  the hospital are the provider of care, and
  prescriber of medications
• HIV patients were again seen over telemedicine.
• After successes seen, even PHS has begun
  encouraging the use of telemed

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Two year growth
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