Elizabeth A. Krupinski, PhD

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• Elizabeth A. Krupinski, PhD
• Arizona Telemedicine Program

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• 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 gt 10
  days if inmate has special medical needs or other
  special circumstances such as pending
  extradition.

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• 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.

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• 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.

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• 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.

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• 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.

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• 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.

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St. Marys Hospital

• Carondelet Health Network Southern AZs oldest
  largest non-profit HC provider.
• Heart and Vascular
• Neurology and Neurosurgery
• Womens 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

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St. Marys Hospital

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

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Type Type Type
Orthopedics 2830 Neurology 289 Plastic Surg 47
Renal 1868 Oral Surgery 287 Nephrology 32
GI 1419 Internal Med 231 Physical Therapy 19
Urology 1351 Dermatology 183 Dental Surgery 6
Cardiology 1219 Pulmonology 170 Oral 5
Surgery 1083 Hand Th/Surg 155 Podiatry 5
Hem/Onc 1007 Rheumatology 115 Cardiac Surgery 3
ENT 621 Infec Dis 94 Speech Therapy 3
Neurosurgery 403 Vascular Surgery 49 Thoracic Surgery 2
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• 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

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• 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

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Whats Being Done?
Site/ Program Site/Program Site/Program
California Johns Hopkins (MD) Kentucky
Georgia Carolinas (NC) Louisiana State
Northwest TH (Wash.) UC Davis (CA) Iowa
NSW TH (Sydney) Mountaineer (WV) Western Australia
Virginia Commonwlth UTMB (TX) TX Tech
Maine Crozer (PA) University VA
Wisconsin ECU (NC) University AZ
SUNY Buffalo (NY) FFACTS (TX)
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Whats Being Done?
Specialty Specialty Specialty Specialty
Derm 16 Ortho 7 Oncol 4 Burn 2
Infec Dis 14 Nephrol 7 Wound 3 Dental 2
MH 14 HH 6 Renal 3 Anesth 2
Neuro 12 Radiol 6 Spch th 3 Hand Surg 1
Card 10 Surg 6 Pulm 3 Forensic 1
Peds 8 Rheum 6 Urol 3 Audiol 1
Gastro 8 Pain 5 Path 2 ALS 1
Int Med 8 ObGyn 5 Nutrit 2 Post Surg 1
ER 7 Rehab 5 Pub Hlth 2 Plastic Surg 1
Endoc 7 Primary 5 Anesth 2 Pharm 1
Ophthal 7 ENT 4 Podiatry 2 Vasc Surg 1
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Ob/Gyn _at_ 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
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Ob/Gyn _at_ 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
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Derm _at_ Fletcher Allen (VT)

• Video based consulting
• 2002 2005
• 668 DoC consultations
• 78 new
• 244 Community based consultations
• 59 new

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Derm _at_ 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

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Derm _at_ Fletcher Allen (VT)
  Prior Diagnosis Change Diagnosis Prior Treatment Change Treatment
Corr 48 20 74 83
Comm 66 7 73 67
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• 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

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THANK YOU!