Do you have asthma?  Do you have high blood pressure?  Do you use drugs?  At the booking station in Mesa, Arizona, if you answer yes to any of these, you're going downtown.

All people who enter the Maricopa County jail system must first be screened for medical problems.  If they report any health issues, like those mentioned above, then they are required to see a nurse for a medical evaluation.  For people who are booked into the system at the booking station in Mesa, seeing a nurse requires a 22-mile trek downtown, to the main jail in Phoenix, where healthcare staff is on hand to perform medical evaluations. 

The trip takes time, it takes money, and, more alarmingly, it takes law enforcement officers off the street.

The path from Mesa to Phoenix will see a lot less travel in coming months, however, when Maricopa County launches its new telemedicine program, which will link the Mesa booking station to the Madison Street Jail in Phoenix and enable nurses there to conduct inmate medical evaluations via videoconferencing.  Through telemedicine technology, nurses will be able to see inmates, take their vital signs and examine their wounds from a distance.

"It's easier if you can bring the services to the inmates rather than bring the inmates to the services," said Marge Levine, Jail Transition Coordinator for Correctional Health Services (CHS), the county's inmate healthcare provider.  "It's not like [inmates are] somebody just going to the doctor.  You have to have them escorted.  You have to make sure that security is appropriate and available." 

And, in a county with such a large jail population, transporting inmates to other jails to receive health services can be a cumbersome task.

"We have roughly 8,300 inmates in this system on any given day," said Levine.  "With that large a population, we need to be able to provide more effective and more efficient treatment to the inmates.  This is a good way of doing it."

Teaming Up to Bring Telemedicine to Maricopa County

With the help of the Arizona Telemedicine Program, which is run by the University of Arizona College of Medicine, the county has been able to create its own telemedicine program to avoid the public safety risks that accompany transporting inmates from jail to jail.

"[The Arizona Telemedicine Program] has been invaluable to us," said Connie Ahlman, Telemedicine Coordinator for CHS.  "They have all the resources of the University of Arizona and the medical school behind them."

The Arizona Telemedicine Program, which began in 1996, provides telemedicine services to many state agencies, including the Arizona Department of Corrections (DOC). 

"We have a lot of experience working with [the Arizona DOC] and getting them the connections they need," said Richard McNeely, Co-Director of the Arizona Telemedicine Program.

Given the it's extensive background in telemedicine, Maricopa County partnered with  the university's program when it received a $940,000 grant in 2002 from the U.S. Department of Health and Human Services to begin a telemedicine program in its jails system.

"It's a wide variety of things we're getting from the Arizona Telemedicine Program.  [It] gives us a tremendous background and assistance level," Ahlman said.  "We pay a fee on each [telemedicine] site to the program to hook up that site and [the program] provides us with a certain amount of maintenance to the system."

Getting Telemedicine Going in Mesa

The first site that Maricopa County plans to equip with telemedicine technology is the Mesa booking station, where Lieutenant Ed Shepherd is looking forward to inmates and officers making fewer trips to Phoenix.

"Nobody wants to take that trip downtown," said Shepherd.  "We want to book people here."

According to Shepherd, about four or five people each day are not accepted into the jail system at the Mesa station for medical reasons and each requires an officer to escort them to Phoenix.

"There's a lot of rejects over minor medical deals," Shepherd said.  "There's a whole slew of folks that just need to have their vital [signs] checked."

As soon as the CHS Telemedicine Program is up-and-running, employees at the Mesa booking station will be able to check those inmates' vital signs, while a nurse in Phoenix guides them through the process.

"We're going to have, at any time, live communication with medical staff that we don't have now," Shepherd said.

Training for Telemedicine

With the equipment that will be installed at the Mesa booking station, the staff there will be able to check more than just inmates' vital signs.  In addition to a vital signs monitor, the machine also has a blood pressure cuff, a finger pulse monitor, an oral temperature probe, a remote stethoscope, a hand-held camera and a remote otoscope to examine inmates' ears.

"[The machine] is pretty automated," Levine said.  "We will train the Sheriff's staff to use the system so that they will be able to do the screening."

According to Shepherd, all of the 60 employees who rotate shifts at the Mesa booking station will be trained in how to use the equipment.  Although an exact training model has not yet been developed, it is in the works.

"We'll have to set up two or three training sessions so we'll probably go right to the facility with the equipment.  It will be an on-site training," Ahlman said.  "I think we'll probably do something on video as well.  Training is going to be a constant thing."

To supplement the training the booking station staff initially receives, CHS plans to hang posters near the equipment so employees can refer to operating procedures at a glance, Ahlman said.

Treating Inmates Through Telemedicine

Once the equipment arrives at the Mesa booking station and the Sheriff's staff is trained to use it, both physical and mental health services will be provided to inmates via telemedicine.

"We are using the videoconferencing capabilities to have inmates speak with a psychiatrist or a psychologist," said Ahlman.

Also, Ahlman pointed out, follow-up visits for medical problems like broken bones will be conducted via telemedicine as well as some consultations with specialists.

"We haven't always had the opportunity to do that," Ahlman said.  "[Even] if the specialists aren't locally available, we'll be able to get second opinions and follow-ups [through telemedicine]."

Setting up the Staff

Not all medical problems can be effectively treated through telemedicine; CHS staff will decide which cases require an actual visit to a nurse or doctor.  But, most inmate health issues at the Mesa booking station can be addressed by using the new technology.  Inmates aren't the only ones who will receive services through this new program, though.  The staff will gain something, too.

Staff will be able to pursue continuing education credits by attending conferences and classes via the new videoconferencing equipment that will soon be installed in the Madison Street Jail and the Mesa booking station.

"It's the same principle as bringing services to the inmates," Levine said.  "We're bringing services to the staff."

While both the inmates and the staff wait for the equipment to be delivered to the Mesa booking station to get the CHS telemedicine program started, planning has already begun to expand the program to Maricopa County's other remote booking station and two new jail facilities that are currently under construction.

"Our long range goal is to have all of our clinics in all of the jail systems tied in in some way to telemedicine," Ahlman said.

Resources:

To contact CHS, call (602) 506-4926

To contact the Arizona Telemedicine Program, call (520) 626-4785 or go to www.telemedicine.arizona.edu