Telemedicine Used to Treat Inmates Creates Efficiencies, Improves Care

By Ben Boulden

UAMS orthopaedic hand surgeons at clinics on Shackleford Road and Autumn Road in Little Rock couldn’t see the inmates at those locations because of security requirements that couldn’t be met at those facilities.

And having Arkansas Department of Correction prisoners brought to the main campus often meant they had to wait long periods under guard until an orthopaedist could see them between performing surgical operations.

“We had to come up with a better way to see those patients,” said Terri Imus, R.N., trauma telemedicine coordinator at the UAMS Center for Distance Health. “What spurred the interest in orthopaedics telemedicine is the physicians were not going to be able to see the patients from the prisons in manner that was time efficient.”

The Center for Distance Health already was operating a telemedicine program to screen and treat infectious diseases among inmates who were at the intake unit where inmates are first processed.  Using a high-definition, live video connection, a physician  assistant at UAMS would consult with the inmate patients and a Correct Care Solutions nurse at the unit.

Headquartered in Nashville, Tennessee, Correct Care Solutions provides medical and behavioral health services for nearly 250,000 patients in state hospitals as well as local, state and federal correctional facilities. Also, a hand trauma telemedicine program connecting hand physicians with all of Arkansas’ emergency departments statewide has been up and running for several years. Taking it into the prison system seemed like a good idea, and the first few months in operation seem to have proven it.

The prison orthopaedics telemedicine program began in July 2017, and four UAMS hand surgeons provide on average about 20 consultations a week. Hand surgeons are in special demand because of injuries inmates may have suffered prior to incarceration or disease processes of aging such as arthritis.

Sometimes inmate patients would be transferred to a hospital when all they really needed was to be splinted or get a hand or arm cast until they can get to a clinic, Imus said.  The facilities use a mobile x-ray company that can take x-rays at any of the locations and the hand surgeons can access those images and make recommendations to the attending physician at the prison unit.

With that in mind, UAMS has trained three nurses working for the Arkansas Department of Correction on splinting and casting a patient’s hand or lower arm under the direction of a physician via telemedicine. A physician on-site also has to approve the new cast or splint that’s used.

The program has created efficiencies within the correction system, too.

“The prisons love it,” Imus said. “For an inmate to go out to an appointment somewhere, the prison has to do all this paperwork. They have to make sure there are correctional officers and transportation. When they come back, they have to be processed back in and transferred back to their assigned unit”

Processing can take as much as 90 minutes for one inmate and even longer for a group of inmates leaving or returning from a correctional facility. Safety of all personnel is of utmost important as is providing access to care for this population. With a weekly average of 20 inmates needing in-person visits before the new program was implemented and with two correctional officers together paid as much as $50 an hour along with mileage of 42 cents per mile, the financial cost to the correction system was a considerable expense.

Imus would like to see the prison program extend even further as the Center for Distance Health builds relationships with physicians in other specialties who are willing to perform consultations via telemedicine.

“Our goal is to provide any type of care to the prison population and that is possible with telemedicine,” Imus said. “Correction officials already know it works.”