Presentation on DPSCS proactive health & mental health delivered at ACA Winter Conference 2013

Public Health

Topics At A Glance

Since FY08, DPSCS has taken a proactive, surveillance-backed managed health care approach to caring for Maryland’s inmate population. Inmate health can mirror the general public, but generally with higher instances of chronic and infectious health care issues because of drug use or other poor lifestyle choices, making it a public health issue for the state. During FY13:

  • The department had 133 infectious disease hospital admissions, a 59%drop from FY08.
Infectious diesease admissions image

Proactive Health Care

Through surveillance, constant education and outreach for both staff and inmates to increase awareness, the Department continues to be aggressive in diagnosing and treating HIV and other infectious diseases. Prevention and control is key to reducing both medical costs and affecting public health by stopping their spread. During FY13:

  • 15,739 inmates were tested for HIV (both voluntary and secondary to symptoms) compared to 3,774 in FY07,
    over four times as many.hiv voluntary testing
  • Indicative of successful treatment through anti-viral medications, 90 percent of incarcerated inmates being treated for HIV are currently at undetectable virus levels as defined by the CDC (viral loads less than 75). That number is up from 79 percent in FY09.

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Continuity of Services

In March of FY12 DPSCS began daily electronic sharing of Baltimore City arrest records with the Department of Health and Mental Hygiene (DHMH). During FY13:

  • Over 90,000 people were reviewed by the Department of Health and Mental Hygiene (DHMH) to determine if they had previously received services through the Public Mental Health System.
  • An average of 23 percent of all records sent during that time were matched with Public Mental Health Authorization records, allowing medical staff in the correctional facility to provide continuity of mental health care and, therefore, more effective treatment.

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Reduced Emergency Room VisitsEmergency room visits image

These proactive health care approaches have helped reduce offender emergency room (ER) visits. During FY13:

  • DPSCS reduced emergency room visits by 49.5 percent since FY07 and by 20 percent over FY12.
  • Thanks to reduced assaults and better training of staff in performing in-house sutures and X-rays when able, DPSCS has also reduced trauma-related emergency room visits by 64 percent since FY08 and 28 percent over FY12
  • DPSCS was well below the national correctional average of 100 visits per 1,000 inmates with just 40 per 1,000 in Maryland. The department experienced an 18 percent drop over FY12.

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Telemedicine

In FY13, DPSCS partnered with Wexford Healthcare Inc., and our acute care designated hospital, Bon Secours, to introduce 18 state of the art telemedicine units. Paired with special medical equipment, the units allow many routine and some specialty medical exams to be performed remotely, without the need to pay extra security and transportation for inmates to outside facilities.

High definition cameras, EKGs, stethoscopes, audioscopes and other specialty equipment allow on-site staff to perform accurate and comprehensive specialty exams in DPSCS facilities. Current telemedicine clinics include: cardiology, urology, oncology, gastroenterology, HIV and HVC. DPSCS hopes to expand the use of telemedicine to include emergency medicine and orthopedics, among other clinics.

In FY13, 284 inmates had telemedicine consultations. Each of these patients would have otherwise been transported off-site to see a doctor.  In its first four months, telemedicine saved DPSCS about $100,000, a rate that could recoup the $1.1 million cost in about 3.5 years.

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Quick Facts

Proactive Health Care

HIV Detection/Counseling

  • 15,739 inmates tested for HIV
  • 89% of infected inmates at undetectable viral load levels

Infectious Disease Admissions

  • a 59% drop in hospital admissions from FY08

Continuity of Services

  • 90,000 detainee/inmate records reviewed by DHMH
  • 23 percent matched DHMH records to better treat detainees/inmates

Reducing ER Visits

  • 49.5 % drop since FY07
  • reduced trauma-related emergency room visits by 64% since FY08
  • below national average of 100 visits per 1,000 inmates with 40 per 1,000