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Slide 1: Elizabeth A. Krupinski, PhD Arizona Telemedicine Program
Slide 2:   Reception center staff evaluates each inmate on substance abuse, education, mental health, and medical. Initial classification for placement in state institution conducted and finalized prior to movement. Inmate may be held at reception center for > 10 days if inmate has special medical needs or other special circumstances such as pending extradition.
Slide 3:    1 to 5 scoring system. Most important factors that determine final score & placement are public risk, institutional risk & medical needs. Scores establish custody level & need for specific services such as medical, mental health, substance abuse or sex offense treatment, and program needs including education, vocation training & work skills. Relocation based on bed availability in appropriate custody level & medical rating of inmate and facility.
Slide 4:    Comprehensive medical, dental, & mental health services considered medically necessary. Ongoing treatment by licensed professional (physicians, PAs, NPs) plus nurses, lab technicians, pharmacists, radiology techs. All phases dentistry including oral surg & restorative. Mental health assessment, crisis management, & therapy. Emergencies facilitated through area hospitals. Specialty services provided through contracts with B oard eligible or Board certified specialists in community
Slide 5:   If inmate requests medical attention may submit written Health Needs Request (HNR) to Medical Unit. Request reviewed & inmate scheduled if necessary. If request urgent or life threatening, inmate seen immediately. All medical information is considered privileged and highly confidential.
Slide 6:   Health care recommended & provided at local facility level by local providers. If specialty services/consultation recommended, request forwarded to Health Services Central Office. Only procedures/treatments considered absolutely medically necessary considered for approval. Cosmetic or elective in nature will not be approved. Final determination for any treatment plan decision of AZ DoC medical staff.
Slide 7:   Charge up to $5.00 when scheduled after submitting HNR, or on emergency basis. Appointments requested by a health care provider there is no charge. Chronic serious medical conditions (diabetes or hypertension) followed on routine schedule without HNR & no charge. Prescription medications supplied as necessary. Certain OTC medications (ibuprofen or multi-vitamins) available at inmate store.
Slide 8:  Carondelet Healt h Network Southern AZ’ s oldes t & lar gest non-profit HC provider. ◦ ◦ ◦ ◦ ◦ ◦ ◦ ◦ ◦ ◦ ◦ ◦ Heart and Vasc ular Neuro logy and Neuro surgery Wo m en’s C are S ervices Ortho pedics and Rehabilitatio n Burn and Wo und American D iabetes As so ciatio n Reco gnized Diabetes Care Centers Ho sp ic e and Palliative Care Diagno stic and S urgic al Services Outp atient Services Lifeline Emergency Respo nse H elic op ter Pro gram Co ntracted S ervices fo r Co rrec tio nal Care Long- term C are Facility in Nogales, Ariz o na
Slide 9:  March 1998 ATP provided TM services St. Mary’s started March 2000 ◦ Main refer ring site both IP & TM ◦ Continues to present (~ 120 consultations)        SF = 649 RT = 12,847 Total = 13,496 Mental Health services not included (> 7000) Tandberg Healthcare System 3 codec 5000 Transitioning to Second Opinion
Slide 12: Type & # Orthopedics = 2830 Renal = 1868 GI = 1419 Urology = 1351 Cardiology = 1219 Surgery = 1083 Hem/Onc = 1007 ENT = 621 Neurosurgery = 403 Type & # Neurology = 289 Oral Surgery = 287 Internal Med = 231 Type & # Plastic Surg = 47 Nephrology = 32 Physical Therapy = 19 Dermatology = 183 Dental Surgery = 6 Pulmonology = 170 Oral = 5 Hand Th/Surg = 155 Rheumatology = 115 Infec Dis = 94 Vascular Surgery = 49 Podiatry = 5 Cardiac Surgery = 3 Speech Therapy = 3 Thoracic Surgery = 2
Slide 13: Scenario #1 - Medical Center Visit Average cost per case $849.90 Scenario #2 - Telemedicine Visit Average cost per case $467.25 Savings per case $382.65
Slide 14:    US Department of Justice 2002 Implementing Telemedicine in Correctional Facilities www.ncjrs.gov/pdffiles1/nij/190310.pdf ◦ ◦ ◦ ◦ ◦ ◦ Executive Summary Introduction Implementation Decis ion & Planning Technology Evaluation Cost Es timation Model 8 Appendices with workshee ts
Slide 15: Site/ Program California Georgia Northwest TH (Wash.) NSW TH (Sydney) Virginia Commonwlth Maine Wisconsin SUNY Buffalo (NY) Site/Program Johns Hopkins (MD) Carolinas (NC) UC Davis (CA) Mountaineer (WV) UTMB (TX) Crozer (PA) ECU (NC) FFACTS (TX) Site/Program Kentucky Louisiana State Iowa Western Australia TX Tech University VA University AZ
Slide 16: Specialty Derm = 16 Infec Dis = 14 MH = 14 Neuro = 12 Card = 10 Peds = 8 Gastro = 8 Int Med = 8 ER = 7 Endoc = 7 Ophthal = 7 Specialty Ortho = 7 Nephrol = 7 HH = 6 Radiol = 6 Surg = 6 Rheum = 6 Pain = 5 ObGyn = 5 Rehab = 5 Primary = 5 ENT = 4 Specialty Oncol = 4 Wound = 3 Renal = 3 Spch th = 3 Pulm = 3 Urol = 3 Path = 2 Nutrit = 2 Pub Hlth = 2 Anesth = 2 Podiatry = 2 Specialty Burn = 2 Dental = 2 Anesth = 2 Hand Surg = 1 Forensic = 1 Audiol = 1 ALS = 1 Post Surg = 1 Plastic Surg = 1 Pharm = 1 Vasc Surg = 1
Slide 17:     6% incarcerated women are pregnant Often at high risk (drugs, alcohol, smoking) 1.4 Mbit T1 with 512 Kb video capability Multi-disciplinary ◦ ◦ ◦ ◦ ◦ Gener alist Ob/Gyn Maternal-Fetal Medicine Specialist Genetic Couns elor Sub-Specialists (r adiology) Gordon Labor & delivery Low “Pregnant & Incarcerated” ATA 2008
Slide 18:       High patient & clinician satisfaction 41 pregnant patients served 224 patient visits 20 deliveries 56 triage calls 14 transport calls Gordon Low “Pregnant & Incarcerated” ATA 2008
Slide 19:     Video based consulting 2002 – 2005 668 DoC consultations ◦ 78% new 244 Community based consultations ◦ 59% new
Slide 20:  Most common diagnoses both groups ◦ Acne ◦ Psoriasis ◦ Dermatitis  Next most common non-TM services Only 0.4% for TM groups ◦ Basal Cell Car cinoma ◦ Actinic Ker atoses 
Slide 21: Prior Change Diagnosis Diagnosis Prior Treatment Change Treatment Corr Comm 48% 66% 20% 7% 74% 73% 83% 67%
Slide 22:    TM has clear & significant role in corrections Likely are programs without documented descriptions or outcomes Numerous clinical specialties can be covered Cost-benefit analyses generally show savings ◦ Clear ly some mor e common than others  ◦ Mainly due to r educed trans por tation costs ◦ Secondar ily to reduced physician travel costs 
Slide 23: THANK YOU!