Nearly two percent of the general population of the United States is infected with Hepatitis C (HCV), a figure that is predicted to grow over the next decade.  And, with the majority of HCV-infected people being intravenous drug users, the prisons have become loci for the disease.

As the need to treat HCV in the nation's correctional settings becomes more crucial, many states are starting to take action.  One correctional system, however, is taking a unique approach to treating inmates with HCV.

Texas' HCV-infected inmates no longer need to trek across the nearly 262,000 square mile state to see a specialist who is qualified to treat them for the disease; instead they can communicate with their HCV doctors right from their own correctional facilities.

This technologically progressive form of treatment is known as telemedicine and has become a growing trend in correctional healthcare in recent years because of its practicality.  Treating incarcerated people without having to remove them from their facilities allows inmates to get the specialized care they need and simultaneously allows corrections systems to cut down on transportation and staffing costs.

With nearly 40,000 HCV-infected inmates throughout the state, the University of Texas Medical Branch at Galveston (UTMB), which is contracted by the Texas Department of Criminal Justice (TDCJ) to provide healthcare for 80 percent of the state's offenders, turned to telemedicine to deal with the heavy volume of patients.

"Overall our telemedicine [program] has been hugely helpful," said Dr. Owen Murray, Medical Director, Facilities Operations, UTMB Correctional Managed Care.  "If we had to rely on local care, we'd struggle to find qualified people to take care of these patients," he said about the lack of hepatologists near each of TDCJ's 100-plus facilities.

Bringing Treatment to the Inmates

Via telemedicine, inmates in every facility, no matter how remote, have access to a team of physicians in Galveston who can treat them for their HCV.

When HCV-positive patients are identified in the TDCJ system, either by symptoms or clinical suspicion, the medical staff of the inmate's unit first contacts HCV specialists in Galveston by telephone.  They discuss issues like the patient's medical history, any medications he or she is currently taking and the inmate's psychiatric condition.  The patient's medical records are readily accessible to both parties through UTMB's Electronic Medical Record system, which allows physicians and medical staff to add notes to records directly through the computer, rather than having to fax paper versions back and forth between facilities as they had in the past.

"It caused a lot of paperwork issues," Murray said about the old system.

After physicians in Galveston review the patient's case, they make a decision on how to treat the individual based upon UTMB, TDCJ and Texas Tech University's joint protocol for treating HCV.  Texas Tech is also contracted to provide healthcare to TDCJ inmates.

"From there, they're triaged into various groups," Murray said, pointing out that the route of treatment designated for a patient is dependent upon the type and severity of the case.  "Most of the time, they'll go on a routine telemedicine and follow-up schedule."

During telemedicine treatment visits, patients, their medical provider at their correctional facility and a member of the UTMB staff in Galveston all interface via monitors.  This face-to-face contact not only benefits the inmates, but it is also an advantage for the correctional medical staff.

When an inmate is not involved with a telemedicine program and needs to see a subspecialist, Murray typically doesn't go to that appointment with them, he said.  With telemedicine, he added, "I can sit in with patients."

Being part of a patient's visit with an HCV specialist helps everyone involved because healthcare providers in both locations can communicate their concerns and "it puts a name with a face," Murray said.  Plus, it educates the staff in terms of understanding the specialist's mechanisms for treating the disease.

Taking Offenders on the Road

Although most HCV-infected inmates can be treated using telemedicine, some do require a visit to Galveston, where they can meet with a specialist in person.

"When a diagnosis is potentially in question and treatment is potentially in question, [inmates are sent to Galveston]," said Murray about the trip that many inmates dislike and are not willing to make.

"It's not like they make the trip in a car in one day," said Murray.  "To go for a half hour or a 15-minute visit it may take them two or three days," he said.

When a trip takes a few days, inmates must stay at transient houses located at maximum- security facilities along the way and inmates from minimum-security facilities may be scared off by the prospect of doing that, Murray added.

Aside from the travel, inmates may also not want to leave for fear of losing their bed in a facility, Murray said.  "They can't save beds for offenders when they leave," he said. 

Also, offenders might have visits scheduled with family members or friends that they do not want to miss, said Murray.  And they can't be forced to go to treatment, he added. 

"[Telemedicine] reduces our moving those inmates around the system," Murray said.

Although telemedicine has only been used to treat HCV consistently since 2001, the practice has been in general use at UTMB since 1994 when, working in conjunction with TDCJ and Texas Tech, they developed the state's first correctional managed health care delivery system.

In six years, telemedicine has saved the state over $650 million.  And, in the last year alone, UTMB has treated over 10,000 people using telemedicine, some of those with HCV.

"We really have created a very workable telemedicine program within the state," Murray said.

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To learn more about Telemedicine at UTMB, contact the media hotline at (409) 772-6397