State expands use of telemedicine for prison inmates

Dr. Sean Weiss is ready to see patients. Nurse Darcey Miller stands ready to assist.

Weiss is in New Orleans. Miller in St. Gabriel.

It is a doctor’s appointment via modern telemedicine, and it’s bringing medical care to more and more prisoners in the Louisiana corrections system.

Four years ago, about 1,500 prisoners were seen and their medical problems diagnosed via remote hook-up. Last fiscal year, the numbers were twice that, and appointments continue to grow.

Telemedicine involves the exchange of medical information from one site to another via electronic communications. The doctor can talk to and see the patient, and vice versa. Special equipment on both ends allows the doctor to examine the patient.

At Elayn Hunt Correctional Center at St. Gabriel, nurse Miller checks the prison inmates’ vital signs, pulls files that reflect a convict’s medical history and operates the equipment that captures images seen by the physician on the other end. Weiss files the images in patient medical records.

“I kind of fill in the gaps at both ends,” said Miller as she supplements medical information the prisoner tells the doctor and acts as the long-distance hands of the physician.

Corrections is relying more on telemedicine to fill gaps created when the LSU Earl K. Long Medical Center in Baton Rouge, where many state inmates had been sent for care, was closed in April.

“We have completely redesigned the health care system in the Department of Corrections,” Hunt Deputy Warden Seth Smith said. “We have brought specialists to the offender, where physicians physically come here ... We do telemedicine for specialists we don’t bring on-site.”

Telemedicine is safer for the public — inmates remain within secured facilities and don’t have to be transferred on public streets — more efficient for the department and better for the inmates.

“We can get the guys in and out more quickly,” Smith said. “We are applying the community standard (of medical care) with minimal risk to the public.”

Telemedicine clinics started in July 1997 with pulmonary, orthopedics, diabetic, and dermatology offerings.

“Three years ago, it expanded a lot,” said Dr. Raman Singh, who is the medical and mental health director for the state’s prison system. “This year the Department of Corrections got the money and we expanded more clinics.”

Currently, Corrections provides 17 telemedicine clinics in dermatology, orthopedics, general surgery, infectious disease, ophthalmology, cardiology, oncology, rheumatology, ear, nose and throat, endocrinology, pulmonary, neurosurgery, urology, neurology, gastroenterology, HIV and Hepatitis C.

For the current fiscal year, the state Department of Corrections has allocated $1.3 million for LSU to provide services to the agency’s south Louisiana facilities, where most of the inmate population is assigned and $560,000 for U.S. Telehealth to provide services to its north Louisiana prison facilities.

“Telemedicine is a supplement. It’s a very effective triage for select groups of patients where we know it works,” said Singh. “It supplements. It improves access to care.”

The triage system of care is at work at the LSU clinic, where assessments dictate the level of care needed.

Weiss is a facial plastic surgeon and an assistant professor with the LSU Department of Otolaryngology-Head and Neck Surgery.

On this day he is doing head and neck examinations. Weiss’ first patient of the day, David Jones, complains of chronic ear problems.

“My ears are full of fluids and they irritate me all day,” Jones tells the doctor.

“How long as that been going on?” Weiss asks.

“Since 2007,” Jones replies.

After a few more questions Miller steps in as Weiss directs her to insert a small camera into Jones left ear, then right so he can assess what’s going on. Then, Weiss directs her do the same thing in Jones’ nostrils. She then switches to another camera to check the back of his throat.

“Both ears look like they have fluid behind the eardrums and some infected material,” Weiss told Jones.

Weiss prescribed medicine.

Later, inmate Edwin Savoy complained to Weiss of hoarseness that started a year-and-a-half ago.

“I’ve been a heavy smoker and kind of abused my body all my life,” Savoy confessed.

“Any pain or discomfort in the throat?” Weiss asked.

“No, sir,” Savoy responded.

“Any history of cancer in the family?” Weiss continued.

“Yes, sir,” Savoy said, then proceeded to describe each instance.

Weiss put Savoy through the same ear, nose and throat exams as Jones.

“I don’t see anything today that is very concerning. However, any time we have a patient who has had hoarseness as long as you, there’s more evaluation we would like to do,” Weiss said.

Weiss said an appointment in the New Orleans clinic needed to be scheduled. At the clinic there’s a special camera that can look at the voice box to see what Savoy’s vocal cords look like “ to make sure there’s not any growth or anything else we need to pay attention to,” he said.

In the meantime, Weiss told Savoy to drink plenty of fluids.

In Savoy’s case, the telemedicine visit triggered a trip off prison grounds. In Jones’ case a trip was avoided and care delivered, saving the expense of a road trip when one was not warranted.

Telemedicine is a key part of an integrated health care system for inmates, Singh said.