Telemedicine in Jefferson County Jail, Washington

Jennifer Yopp
CNA
Overview
Geographic isolation, understaffing and budget constraints limit correctional facilities’ access to health services for inmates. Small, rural, tribal and border (SRTB) communities often suffer from insufficient healthcare options; the special considerations associated with providing such care to inmates in those areas only compound the challenge.

A lack of preventative medical care or qualified personnel on staff to deal with acute medical issues and a lack of primary care providers in the local area—who are also willing to work with a corrections population—means jails have to rely on emergency room care, taking more inmates on more frequent trips to the hospital. To access routine care, jails might have to make long trips to a provider willing to work with a corrections population.

Transporting inmates can place a large burden on jails: transportation requires dedicated staff; extra security measures, including placing restraints on an inmate; and often a significant amount of time for the trip itself and the office visit. Telemedicine services bring healthcare to inmates by enabling healthcare providers to conduct office visits remotely using audiovisual equipment. Telemedicine has the potential to alleviate many of the medical-related burdens on jail facilities.

Challenge
Jefferson County is a small border county in Washington State. Jefferson County Jail, built in 1986, has 57 beds and an average daily population of 48 inmates. In addition to its correctional duties, the 20-person jail staff, including 12 corrections officers, is responsible for providing mandated civil services, courthouse and courtroom security, and animal control services.

The jail does not have medical or mental health staff on premises 24/7. Jail staff had difficulty identifying local providers willing to provide medical or mental health services to the jail population. A private contractor two hours away was the closest option for face-to-face medical and mental health services. The lack of local care options pointed them to a telemedicine solution.

Technology and Operations Solutions

The jail has used videoconference services for many years, primarily for video court appearances. It now uses the same audiovisual equipment for telemedicine purposes—connecting inmates with medical care providers on a regular basis. The use of an existing system means that no additional costs have been incurred, and the training time was minimal. Initial startup instructions on how to set up the video equipment and log into the system took less than 30 minutes for both corrections officers and healthcare providers. In addition, because the jail used the same healthcare provider for telemedicine that was contracted for in-person medical care, the provider was already using the jail’s medical records system.

Medical services are now provided on a regular basis, twice per week—once in person and once via telemedicine. Each session is schedule for an hour, with the ability to last longer if not all inmates can be seen in the course of an hour. A contractor provides the medical services, and subcontracts with a psychiatric advanced registered nurse practitioner (ANRP) for mental health services. The psychiatric ANRP is available twice per month—once in person and once via telemedicine, with each session lasting several hours.

Before a telemedicine session, inmates are informed that the medical session will be conducted via video and have the option to participate or wait for an in-person appointment. To conduct the sessions, a video camera was set up in the jail’s medical room. The remote healthcare provider logs into the jail’s electronic medical records system and can see inmates’ medical files. For safety and security, a corrections officer is always present during telemedicine appointments. The inmate and healthcare provider then conducts the medical appointment over the Internet with full audio-visual capability. 

Perhaps even more importantly, telemedicine support is also available around the clock for medical crises. Staff can initiate a telemedicine session at any hour—even in the middle of the night or on weekends—to help treat an inmate in crisis or determine whether in-person medical treatment is needed. Thanks to telemedicine, this triage process can happen without having to transport the inmate to the emergency room as the first course of action. “The ability to triage inmates after hours is a huge savings for a small, remote facility,” says the Jail Superintendent Steve Richmond.

Outcomes and advice

Jefferson County Jail’s correction staff has fully supported the use of telemedicine because it enables the jail to offer a higher level of both physical and mental health care and reduces the burden of inmate transportation, inmate medical care and mental health crises on staff and inmates. In Jefferson County, where the trip to the contracted provider can take two hours one way, using telemedicine also eliminates a four-hour round-trip drive for routine healthcare. This means more time is available for inmates to spend with a healthcare provider, and under less stressful conditions (not having just been restrained and transported two hours for care).

When dealing with highly sensitive information such as healthcare records, system security is always a major concern. Although the Jefferson County Jail staff  are not aware of any breaches of the telemedicine or electronic medical records systems, they remain vigilant, constantly monitoring and maintaining their IT security. The county IT Department is responsible for security and advises the jail staff on IT matters. According to Richmond, “having knowledgeable IT people close by that are also stakeholders in our operation makes everything run just a little smoother.”

Finally, using existing equipment has minimized the financial impact of implementing a telemedicine program. For the lean staffing and funding situations often found in small facilities, telemedicine makes it possible to provide significant healthcare services to inmates.

For more information: Steve Richmond, Jail Superintendent, srichmond@co.jefferson.wa.us