Elizabeth A. Krupinski, PhD Arizona Telemedicine Program

1. Elizabeth A. Krupinski, PhD Arizona Telemedicine Program

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.

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.

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 Board eligible or Board certified specialists in community by direct contact or video conferencing & telemedicine.

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.

6. Health care recommended & provided at local facility levelby 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.

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.

8. St. Mary’s Hospital • Carondelet Health Network Southern AZ’s oldest & largest non-profit HC provider. • Heart and Vascular • Neurology and Neurosurgery • Women’s Care Services • Orthopedics and Rehabilitation • Burn and Wound • American Diabetes Association Recognized Diabetes Care Centers • Hospice and Palliative Care • Diagnostic and Surgical Services • Outpatient Services • Lifeline Emergency Response Helicopter Program • Contracted Services for Correctional Care • Long-term Care Facility in Nogales, Arizona

9. St. Mary’s Hospital • March 1998 ATP provided TM services • Continues to present (~ 120 consultations) • St. Mary’s started March 2000 • Main referring site both IP & TM • SF = 649 • RT = 12,847 • Total = 13,496 • Mental Health services not included (> 7000) • Tandberg Healthcare System 3 codec 5000 • Transitioning to Second Opinion

13. Scenario #1 - Medical Center Visit Average cost per case $849.90 Scenario #2 - Telemedicine VisitAverage cost per case $467.25 Savings per case$382.65

14. US Department of Justice 2002 • Implementing Telemedicine in Correctional Facilities • www.ncjrs.gov/pdffiles1/nij/190310.pdf • Executive Summary • Introduction • Implementation Decision & Planning • Technology Evaluation • Cost Estimation Model • 8 Appendices with worksheets

15. What’s Being Done?

16. What’s Being Done?

17. Ob/Gyn @ Univ Arkansas • 6% incarcerated women are pregnant • Often at high risk (drugs, alcohol, smoking) • 1.4 Mbit T1 with 512 Kb video capability • Multi-disciplinary • Generalist Ob/Gyn • Maternal-Fetal Medicine Specialist • Genetic Counselor • Sub-Specialists (radiology) • Labor & delivery Gordon Low “Pregnant & Incarcerated” ATA 2008

18. Ob/Gyn @ Univ Arkansas • 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

19. Derm @ Fletcher Allen (VT) • Video based consulting • 2002 – 2005 • 668 DoC consultations • 78% new • 244 Community based consultations • 59% new

20. Derm @ Fletcher Allen (VT) • Most common diagnoses both groups • Acne • Psoriasis • Dermatitis • Next most common non-TM services • Basal Cell Carcinoma • Actinic Keratoses • Only 0.4% for TM groups

21. Derm @ Fletcher Allen (VT)

22. TM has clear & significant role in corrections • Likely are programs without documented descriptions or outcomes • Numerous clinical specialties can be covered • Clearly some more common than others • Cost-benefit analyses generally show savings • Mainly due to reduced transportation costs • Secondarily to reduced physician travel costs • Outcomes data are scarce but likely positive

23. THANK YOU!