State prisons turn to telemedicine to improve health and save money

This article originally appeared in Stateline, an initiative of the Pew Charitable Trusts.

CONROE, Texas — Texas prison psychiatrist Pradan Nathan recalls an unsettling face-to-face session with a dissatisfied patient about a dozen years ago at a maximum security prison in East Texas. The large man, a member of a notorious prison gang, insisted Nathan prescribe him a particular medication. Nathan said he didn’t need it.

“I’m going to stab you to death the next time you come in here,” the prisoner growled.

Nathan feels a lot safer these days. He sees up to 16 patients a day from a suburban Houston office here, using an audio console, a camera and a monitor to treat inmates at two state prisons -- including one with a death row -- at least 30 miles from where he sits. He’s still threatened occasionally, but now it’s from a comforting distance. Needless to say, he’s a big fan of telemedicine.

He’s not the only one. Most states have turned to telemedicine to some extent for treating prisoners -- often in remote areas, where many prisons are located -- because it allows doctors to examine them from a safe distance. It enables corrections officers keep potentially dangerous inmates behind bars for treatment rather than bearing the cost and security risk of transporting them to hospitals. And because more doctors are willing to participate, it makes health care more available for inmates.

Though some prisons used telemedicine as early as the 1980s, its use has dramatically increased with the arrival of vastly improved technology, electronic medical records and pressure to control ever rising medical costs.

“Telemedicine is perfectly designed for prisons,” said Marc Stern, a former assistant secretary for health services for the Washington State Department of Corrections who now consults with corrections systems on telemedicine.

How much telemedicine saves states is hard to tell because it’s difficult to calculate the costs of transportation and extra security if prisoners have to be sent outside prison walls for medical care.

But Owen Murray, vice president of correctional managed care for the University of Texas Medical Branch (UTMB), which handles health care for approximately 80 percent of the state’s prison population, is convinced telemedicine contributes to Texas’s relatively low per-capita spending on prisoner health.

Texas has the nation’s largest prison population, with about 153,000 inmates, and, according to a Pew Charitable Trusts report, spent $3,805 per prisoner on medical care in 2011, compared to a national average $6,047. (Pew also funds Stateline.)

And few states use telemedicine as much as Texas. UTMB’s prisoner health operation conducts 127,000 telemedicine visits a year with inmates in the 83 Texas correctional facilities it tends to. About three-quarters of the visits are for mental health or primary care. (All behavioral health care is handled via telemedicine, as is about 20 percent of primary care appointments, and between 5 and 10 percent of specialist visits.)

Texas lawmakers support telemedicine in prisons, Murray said, even though the financial savings are hard to pinpoint. In addition to adding to public safety, he said, telemedicine speeds inmates’ care, which in turn helps improve their health. It also helps apply the same standard of care over a wide geographic expanse.

Despite its growth, telemedicine faces the same hurdle to widespread use in prisons as it does in the general population: All states still require that doctors treating a patient in a particular state be licensed in that state, including those practicing digitally from elsewhere.

Advocates for prisoners have mixed views of the use of telemedicine in corrections. Bradley Brockman, director of the nonprofit Center for Prisoner Health and Human Rights, called it “a godsend and a real gift because prisoners are getting care from providers or specialists that they would have far less chance of getting otherwise.”

But David Fathi, director of the American Civil Liberties Union’s National Prison Project, said that while telemedicine can improve health access, too often it is used to cover over inadequate medical staffing in prisons. “Because telemedicine is less expensive, there is a tendency to use it excessively and inappropriately,” Fathi said. “It is used not as a supplement for on-site staff but as a substitute for on-site staff.”

Telemedicine in Texas prisons

Florida was the first to experiment with telemedicine in prison, introducing it in state prisons in the late 1980s. But the technology was primitive.

When Texas started using it in prisons in the early 1990s, for example, the audiovisual equipment and slow frame speeds produced poor visuals that doctors found insufficient for diagnosis and treatment. Ear, nose and throat doctors would say, “I can’t see anything; just send the patient to the hospital,” Murray recalled.