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By Todd Stein
April 20, 2000
Photo: Texas Tech Telemedicine

When the Texas state prison system launched a joint venture with two top state universities to bring telemedicine to inmates in 1993, it seemed like the future had arrived. Now, the University of Texas Medical Branch at Galveston has embarked on a plan that promises to lead telemedicine into the 21st century – and offer correctional nurses a sophisticated new educational tool.

A suite of computerized components, dubbed "Cyber-Care" by the university researchers who invented them, allows physicians at the UTMB/Texas Department of Criminal Justice Hospital in Galveston to access an inmate’s electronic medical records, view digital X-rays and EKGs, listen with computer-enhanced scopes, and feed the data into a software program that determines the best treatment plan for the inmate.

"It’s a big step from the old days of waiting for a [prison] nurse to read the medical record page by page over the phone," said Owen Murray, MD, the university’s associate medical director for correctional health care. "This is no longer just telemedicine."

Growing numbers

Inmates are the only U.S. residents with a constitutional right to health care. According to the latest statistics, Texas has the largest prison population per 100,000 residents – 636 – compared to the national average of 387. In response to Texas’ large prison population, the university has instituted the most comprehensive electronic medical records program in the nation and includes all 150,000 inmates in Texas state prisons.

So far, the university has installed portable Cyber-Care modules in five of the 97 East Texas prison infirmaries that it operates under a state contract. Another seven Cyber-Care units will be installed each week until all inmates can be electronically linked to primary care physicians and specialists at university medical centers. That marks a significant increase in the state’s ability to offer inmate telemedicine, which until recently was available at just 13 university-run prison facilities and 14 of the 26 West Texas prison clinics operated by the Texas Tech University Health Sciences Center in Lubbock.

Hands-on training

With the growth of inmate telemedicine comes the opportunity for more correctional nurses to supplement their education by working in telemedicine.

"I can’t tell you all the things I’ve learned working in telemedicine," said Arenda McAlpine, LVN, a telemedicine presenter at the Clements prison facility near Amarillo. "It is just amazing the detailed knowledge you can get from talking to specialists every day."

Texas Tech and UTMB provide their telemedicine nurses with specialized training that extends far beyond learning how to operate the machinery. Telemedicine nurses receive at least three days of training in subspecialties, ranging from neurology to dermatology, so they will know how to present patients to the video camera and which tests physicians are most likely to request before a consultation.

Allan Sapp, assistant director of the state’s Correctional Managed Healthcare Committee, recalls a recent Texas Tech telemedicine nurses seminar led by the university’s chief of orthopedics. "He showed them which way to turn a patient’s knee and which tests he’d want done. We have better mid-level providers now because of that kind of communication and the daily face-to-face consultations," Sapp said. "It’s an undocumented benefit, but I really think it has helped us improve the quality of care provided at the [prisons]."

Better care

By at least one measure, the quality of care has improved. Inmate deaths at state prisons have declined 34 percent since 1997 in all the major disease categories, said Leon Clements, UTMB’s chief administrative officer for correctional managed care. Clements attributed the drop to the telemedicine program, which speeds response to outbreaks of tuberculosis and other infectious diseases, and makes it easier for specialists to manage the treatment of patients with HIV.

Alyce Poteet, an RN who runs the telemedicine studio at a women’s facility near Waco, said the growing number of telemedicine consultations on infectious disease has radically reduced the number of 350-mile bus trips inmates must make to Galveston. This has reduced the likelihood of an outbreak going unnoticed long enough for an inmate to infect others.

Telemedicine programs also have saved taxpayers money, but how much is unclear. A typical telemedicine consultation lasts 15 minutes and costs about $100, which Clements said saves UTMB between $200 and $1,000, depending on the distance between the prison and the Galveston hospital. With about 11,000 consultations conducted last year alone in all state prisons, that’s a savings of between $2.2 million and $11 million, but those figures may underestimate the savings. A recent study estimated that federal prisons saved $5,000 each time they used telemedicine instead of a trip outside the prison.

Human touch

Despite the potential savings, some critics question whether providing health care over a video screen threatens the quality of care. Concern runs deeper when it comes to psychiatric care, a new element of both UTMB and Texas Tech’s telemedicine programs. Yet Sapp says seven out of 10 inmates prefer the video exams to face-to-face physician visits because they spend less time chained and riding in buses for up to 12 hours to reach distant hospitals. "To be quite honest, we are dealing with folks who’ve grown up watching a lot of television," Sapp said. "And the idea of carrying on a conversation with a doctor over a television is not a problem for them at all."