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D-3C  The Basics: What Does Facility Administration Need to Know About Correctional Health Care ( CE/CME) (Healthcare/ Security ). Basic Issues in Correctional Healthcare. Jim Sokol , BSN, RN Regional VP, Mid-Atlantic Conmed. Dean Rieger , MD, MPH Chief Medical Officer

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D-3C  The Basics: What Does Facility Administration Need to Know About Correctional Health Care (CE/CME) (Healthcare/ Security)

basic issues in correctional healthcare

Basic Issues in Correctional Healthcare

Jim Sokol, BSN, RN

Regional VP, Mid-Atlantic

Conmed

Dean Rieger, MD, MPH

Chief Medical Officer

Correct Care Solutions

presentation goals
Presentation Goals

Discuss Constitutional underpinnings for care inside the walls

Differentiate between federal and state issues

Expose novice custodial administrators to the basics of correctional health care

case study 1
Case Study #1
  • James, 30 y.o. w/ life sentence
  • Chief Complaint: rash from weight bench
  • Observation: rash consists of a slightly whitened area; there is no infection, no weeping, no itch…just the discoloration

He wants medication to make the rash go away

Do you send him to the dermatologist for diagnosis and advice regarding treatment?

case study 2
Case Study #2
  • Ginny, 25 y.o. – has four month sentence for meth possession
  • Observation: teeth are severely ground down and those remaining are brown with deep caries; her gums are painful, bleeding, and swollen

She wants her remaining teeth extracted and to receive dentures while she is with you

Do you need to extract the teeth? Do you provide her with dentures?

case study 3
Case Study #3
  • Jane, 66 y.o. w/ 2 yrs left on 18 yr imprisonment
  • Chief Complaint: requesting a new wheelchair
  • Observation: arthritis in both hips, and recently developed a stomach ulcer thought to be related to her use of ibuprofen to help relieve hip pain
  • Health services personnel want to refer her to an orthopedic surgeon

Will you give her a wheelchair? Will you send her to the orthopedic surgeon? Will you support hip replacement surgery?

case study 4
Case Study #4
  • Mark, 55 y.o. ex-smoker, leaving prison in 3 months
  • Chief Complaint: coughing a small amount of blood-flecked phlegm
  • Observation: no other symptoms
  • Health services staff want to work him up for possible lung cancer

Should you proceed to expend these resources now, at the end of his confinement, or should you defer this work up until after release from prison?

foundational issues
Foundational Issues
  • Deliberate Indifference
  • State laws, regulations, other
  • Malpractice
  • Accreditation
deliberate indifference
Deliberate Indifference

Case from Texas hit the Supreme Court in 1976; decision cited the Eighth Amendment to the Constitution

  • Serious medical condition
  • Deliberate indifference

What do these terms mean

What is included?

deliberate indifference ii
Deliberate Indifference II

Inmates complain that they have a right to…

Do they?

You must understand deliberate indifference better than the inmate

Inmate claim that they have lots of rights…that they do not.

malpractice
Malpractice

Your clinical personnel have to worry about malpractice

What is malpractice?

Four elements:

  • Patient provider relationship
  • Care provided in a negligent manner
  • Patient has been damaged
  • The negligence caused the damage

Custody can be deliberately indifferent but cannot commit malpractice

accreditation
Accreditation

Accreditation makes it easy

  • Create the context for Constitutional care
  • Helps insure that you address all aspects
  • Reassures outside agencies that you are doing the right things

Without accreditation questions arise

  • What is wrong in the facility?
  • What is not being provided to the inmates?
  • Is something being hidden?
inmates rights
Inmates Rights

Deliberate indifference is a civil right accorded to inmates

  • Access to care
  • Access care from an appropriate provider
  • Receive care that has been ordered by a provider

Courts assume that care ordered has been ordered because it addresses a serious medical condition. This default assumption may be wrong.

no right to
No Right To

Just because inmates want something does not mean they have a right to it:

  • No right to choose provider at any level
  • No right to determine where care will be provided
  • No right to distinguish between serious and nonserious care (this is reserved to the health care professional
no right to1
No Right To

Just because inmates want something does not mean they have a right to it:

  • No right to care irrespective of cost
  • No right to care irrespective of remaining confinement time
pause
Pause

.

Questions on

deliberate indifference?

conservation of resources
Conservation of Resources

Provide good care efficiently

Implications of Deliberate Indifference towards resource preservation. You and your staff control the care process.

Short stay facilities may mitigate costs by ROR or other legal means

service components
Service Components

Physical health needs

Mental health needs

Dental health needs

It is not necessary to provide every imaginable type of care but it is necessary to address mainstream care expectations. Think family practice not herbology.

physical plant
Physical Plant

Appropriate space

  • Exam
  • Office
  • Storage
  • Pharmaceuticals and sharps
  • Waiting room
support
Support

Utilities

  • Water, light, electricity
  • Internet

Supplies and equipment

personnel
Personnel

Health care practitioners

Mental health practitioners and professionals

Nurses and other professional support personnel

General support staff

Don’t forget appropriate current credentials!

clearance process
Clearance Process

Arresting officers and use of hospital emergency departments

Assessment at your front door prior to acceptance in

  • By officers
  • By nurses
front door processes
Front Door Processes

Receiving screening

Disposition for housing, diet, special needs

Health Assessment (general intake physical exam)

Necessary lab and/or diagnostic screening

Referral for care identified in front door processes

ongoing care
Ongoing Care

Identification and initiation of care for chronic

diseases

Access to care for routine

needs (sick call)

Access to care for urgent

needs

Access to care for needs

identified by “others”

care that cannot be provided on site
Care That Cannot Be Provided On Site

Think:

  • Complex machinery
    • MRI, CT,
    • X-ray and Ultrasound – mobile?
  • Emergency Room
  • Hospital
  • Nursing Home
  • Specialist
pharmaceutical services
Pharmaceutical Services

Commissary

Prescription

Keep on Person (May Carry)

One Dose at a Time (DOT)

No-miss medications

Essential medications

Discontinuing community prescriptions

Release medications?

return to community
Return To Community

Community Interface usually uncontrolled

Serious medical condition untreated may mean return to confinement

  • Mental Illness and nuisance violations
  • Substance abuse

Costly necessary treatment-”Come and get me”

health record
Health Record

“Permanent” record of care delivered

Tells the story in forms and language

Explains clinical decisions made during confinement

Protects the facility and staff

Facilitates continuous care upon release or return to confinement

continuous quality improvement
Continuous Quality Improvement

CQI Cycle:

  • How are we doing?
  • Is it good enough?
  • What can we do better?
  • How do we implement it?
  • Did it work?
  • No? Then come up with another way.
  • Yes? Then look at something else.
cqi elements
CQI Elements

Structure

Process

Outcome

cqi elements1
CQI Elements

Structure

Process

Outcome

cqi elements2
CQI Elements

Structure

Process

Outcome

the future
The Future

Affordable Care Act will affect hospital pricing and payments and may even provide care in certain types of outpatient circumstances, much still TBD and varying in “opt-in” and “opt out” (Medicaid expansion) states

thank you
Thank You

Questions?

James Sokol BSN RN Dean Rieger MD MPH

Conmed Correct Care Solutions