Telemedicine’s Unusual Applications: Prisoner Health

Telemedicine has obvious potential to revolutionize how Joe the Plumber (and his cousin, Mike the Systems Analyst) interact with their doctors and other healthcare providers. But what about the more institutional uses for this field of technology? It turns out that prisons have been using telemedicine technology for decades, and they’re anxiously waiting for more of it to go mainstream.

Why? Simple: one of the biggest expenses in dealing with prisoner health issues is the danger involved in bringing a medical team into a prison — or a violent inmate out into a medical facility. According to a study in North Carolina, the most basic prisoner transport (which still requires two guards and a State vehicle) costs $700 each way. And while every prison has a small medical ward, they’re often woefully inadequate to any but the most basic healthcare tasks.

Enter Telemedicine

Many states are looking into providing telemedical consultation services for prisoners, hoping that by giving them the chance to talk to a doctor — be it to discuss preventative health or get a diagnosis or discuss side effects of medicines — they can reduce costs in time, money, and lives. Colorado, North Carolina, and Texas already have state-wide medical teleconferencing in their public prison system; some dozen other states are watching carefully to see if the programs deliver the expected results.

Private Prisons, Private Practices

It was the private sector, however, that first adopted telemedicine for prison populations as the primary method of dealing with prisoner health. The Corrections Corporation of America, owners of the Leavenworth Detention Center, has instituted a ‘tele-first’ policy and claims that it takes only 16 successful telemedicine interactions per month for their program to pay for itself and start saving the prison money with each successive diagnosis or consultation. They have contracted with a variety of private practices to acquire the services of more than 31 doctors across 15 specializations for their prison population.

Prisoner’s and Practitioner’s Preference

Perhaps unsurprisingly, the CCA also reports that their prisoners prefer telemedicine visits to being handcuffed and transported to a facility under constant watch by nervous armed guards. Similarly, doctors — even those accustomed to working in adverse conditions — would much rather be on the opposite side of a hundred-mile gap from a violent criminal if conditions allow.

The Quality Question

Prison Legal News managing editor Alex Friedmann posed the all-important question at a national healthcare conference in late 2013: “The vast majority of medical consults outside the prison setting are face to face, in-person examinations. If that is the community standard of care, to what extent does telemedicine applied specifically to prisoners represent a deviation from the standard of care?”

Currently, the law requires that prisoners be given the opportunity to decline telemedical services in favor of traditional face-to-face medicine — so long as that remains true, any deviation is at the discretion of the prisoner… an acceptable scenario, one must believe, for all involved.