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Telemedicine opens doors for the special care of inmates



When an inmate needs to see a specialist, getting this care can be complicated.

Prisons are often located in rural areas far from medical centers that have experts in cancer, heart and other disease treatment. Even if the visit involves only a trip through a hospital in the city, the inmate must be transported under guard, often in shackles.

The entire process is expensive for the correctional facility and time-consuming for the patient.


Given the challenges, it's no wonder many prisons have adopted telemedicine. They use videoconferencing to allow inmates to see specialists and psychiatrists without leaving the facility.

A survey conducted by the Federal Health Centers for Disease Control and Prevention in 201

1 found that 30 states out of 45 who have responded to used telemedicine for at least one type of specialty or diagnostic service. The participating States reported that telemedicine was most commonly used for psychiatry (62.2 percent) and cardiology (26.6 percent), according to the study published in 2016.

Among the correctional facilities offering these services, Rikers Island is home to nine prisons on an island near LaGuardia Airport in New York City. More recently, the company offers telemedicine for female inmates who depend on oncology, rheumatology and hematology. Further specialties are expected in the future.

Male inmates on Rikers have been receiving telemedicine services since 2016. Around 40 inmates each month have virtual visits with specialists in these areas as well as infectious diseases, urology, dermatology, pulmonology and gastroenterology

"First, we implemented [telehealth] for the efficiency part to avoid hours of transport," Dr. Ross MacDonald, senior medical officer at NYC Health + Hospitals / Correctional Health Services, who oversees the healthcare services at Rikers. "But what we've learned over time is that it really improves clinical care." Telehealth allows the referring physician in the prison to team up with the hospital specialist to work together to clarify information for the patient, MacDonald said. [19659002] Clinicians provide regular basic care in prison. When a medical problem is identified that requires the attention of a specialist, the patient visits the prison medical clinic with the provider who referred them, and the two go through the patient's history and symptoms with a specialist at NYC Health + Hospitals / Elmhurst in Queens, which is visible on the monitor. If vital signs need to be checked or other tests performed, the family doctor can handle it and forward the information to the specialist.

If a personal examination with the specialist is necessary after this meeting, this would be the case

"This is not intended to replace personal visits, it should complement them," he said.

Nevertheless, some supporters of the prisoners are worried about the increasing use of telemedicine. Khalil Cumberbatch said he was worried that the video visits could increase inmates' feelings of isolation. Cumberbatch spent nearly a year on Rikers Island, for the first time when he was awaiting trials for first-degree robbery in the early 2000s, and later, when he appealed against his conviction.

He now works as Deputy Vice President of Politics at the Fortune Society. a nonprofit organization that supports efforts to help prisoners return to society after detention.

"You are removing contact with the outside world," he said. "There is a level of engagement that can be lost when you do it on the screen."

But for sick prisoners, that may not be a priority, others say.

"Many of them do not want to" Dr. Edward Levine, Ohio State University's Wexner Medical Center medical director for prison care, who has been involved in telehealth with the Ohio Department of Rehabilitation and Correction since 1995. "These people are sick, they have to get on a bus, it's bumpy, and there are delays, and if they do not feel well, they do not like it. "

Levine estimates that he sees up to 150 gastroenterological patients a year in Ohio 29 prisons through telemedicine visits. "They develop a relationship with them just as you would if you saw them in a clinic," he said.

Although inmates may owe additional payments when they see a provider of everyday pain, they generally do not have to pay for specialty care, whether on-site or via telemedicine, Dr. Anne Spaulding, epidemiologist and associate professor at the public health school of Emory University in Atlanta, who has worked as a medical director of corrections. This is because a healthcare provider typically initiates a special care. Prisoners are being charged more frequently for medical visits they initiate, she said.

Telemedicine can improve the continuity of care and help patients control chronic diseases. In a study of HIV-infected adults detained in facilities of the Illinois Department of Correction, 91 percent of telemedicine patients achieved complete suppression of the virus during the first six visits, compared to 59 percent of patients who received standard care in the facilities , The study attributed the findings to the fact that specialists provide evidence-based, up-to-date telemedicine care rather than relying on family physicians in the correctional facilities.

"If we can see them in real time without having to go. The setup, we get better results," Dr. Jeremy Young, an infectious disease specialist and associate professor of medicine at the University of Illinois in Chicago, who was the lead author of the study.


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