Telemedicine in prisons, past present and future

1. Telemedicine in prisons, past present and future Debbie Justis, RN, MSHA Virginia Commonwealth University Health System

2. 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 1970’s • Cost • Reappeared in the 1990’s with advanced technology • improved cameras, software, and compression-decompression (CODEC) technology.

3. 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."

4. 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.

5. 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

6. 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

7. 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)

8. 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

9. 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

10. 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

11. 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.

12. 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

13. Two year growth