Years ago, an Arizona inmate was transported to a hospital for an MRI. Officials removed the inmate's handcuffs so the scan could be completed, and stood back as he lay down on the table. Suddenly, the inmate shot up, grabbed an officer's gun, and fired shots at the officers and doctors in an attempt to escape.

This might sound like a scene from a dramatic television show, but it was a very real wake-up call for officials. In response, the Arizona Department of Corrections (ADOC) began implementing telemedicine stations at facilities across the state.

“We saw the MRI situation as an example of why we wanted to investigate telemedicine,” recalls Nurse Debbie Pangborn, Telemedicine Program Administrator for the ADOC. “Sometimes in corrections, you just do your job every day and you don't really remember that situations like this happen. It's a real danger. But there's no escaping telemedicine.”

Designed by the University of Arizona, telemedicine stations are roughly the size of a refrigerator and contain six different cameras. Hooked up to a T1 connection, the stations can transmit live images between an inmate and a specialist for consultation without the inmate having to leave the facility.

“We estimate that we have already saved 13,000 trips outside of the facility,” says Dr. James Baird, Medical Program Manager for the ADOC. “Those trips generally had two officers accompanying the inmate and often involved more than two days of travel.”

According to Pangborn, physician visits off-site cost the ADOC about $417; the use of telemedicine cuts that cost in half.

“There have been monetary savings with telemedicine,” says Pangborn. “But you cannot put a price on security and safety. That's the bottom line for us.”

Face-to-face effectiveness

Telemedicine is useful at state facilities in rural areas, like the ADOC, because it eliminates the hours and security risks usually involved in taking inmates to hospitals or clinics.

According to the ADOC, cameras hooked up to telemedicine stations also improve inmate care because physicians can review problems more immediately.

“We have a camera for ear, nose and throat issues,” says Pangborn. “We have a camera for dermatology issues, like rashes. There is also a face-to-face camera so the inmate can speak with the specialist. It's also helpful because our facility doctors can sit down to speak to the specialist if needed.”

Cameras used for issues like rashes can change light settings to highlight a particular body area.  They also freeze-frame images, which reduces shaky pictures and typically results in a better diagnosis for inmate patients.

According to a survey of ADOC inmates, 99% of offenders feel comfortable using telemedicine.

“Our inmates feel like they are part of something cool,” she says. “Beyond that, they no longer have to worry about leaving the facility. When an inmate visits a specialist, they have to roll up all of their belongings, and sometimes be held in other facilities overnight. They often lose their cell mates when they travel, and that is distressing to the offender population.”

Psychiatry and Education

When inmates request to speak with a psychiatrist, a telemedicine station can provide “face-to-face” sessions. Officials initially thought the system would not be conducive to therapy, but they found that inmates are comfortable with the new process.

“They like speaking with a therapist or psychiatrist over the telemedicine system because it's not so intimidating,” explains Pangborn. “For us, it's great because we can meet inmate needs without hiring a full-time psychiatrist.”

The University of Arizona has also been offering daily continuing education classes through a telemedicine network. Medical staff and physicians can “sit in” on the college classes and access video libraries too.

The ADOC has found telemedicine's multiple uses a cost-effective solution to many of its issues, and by this fall every ADOC facility will have a station.

“This system continues to make more options available for us. Right now, we're considering it for significant trauma cases that occur because of assaults,” Baird says. “The fact is, telemedicine is advancing daily.”