Telemedicine Breaks Out Of Prisons to Widespread Use During Pandemic

 For Additional Information contact:

    Dave Scott 770/354-7228

Remote care providing fast, efficient treatment

ATLANTA (June 08, 2020) – Due to the coronavirus pandemic lockdown Americans are now taking advantage of telemedicine, an advanced form of medical care that was once a luxury commonly afforded to the most unlikely members of society – the U.S prison population.

Because of the virus pandemic— telemedicine — a term broadly used to describe any method of remotely accessing medical care, including over the phone, through email, or via video chat — has gone from a science fiction proposition to an increasingly ordinary part of general health care in little more than three months.

“Telemedicine flourished in correctional institutions out of necessity,” says Albert Woodard, CEO of Atlanta-based KaZee, Inc. a company that helped build the world’s largest telemedicine system and has been devoted to providing telemedicine systems for correctional institutions since 2002.

“The three major factors that led to the development of telemedicine for correctional institutions, were fast access to medical care, the cost of guarding and transporting prisoners to clinics or hospitals, and the safety of care givers and prison officials,” explains Woodard.

“Telemedicine plays an important role in enabling healthcare workers to quickly identify symptoms, aid patients, and lower costs,” says Woodard. “The severity and suddenness of the Covid-19 situation hastened changes to how care is delivered and ushered in a fast transition to telemedicine outside of prison walls.”

KaZee works with correctional institutions across the country, most recently winning a $27 million contract with The Illinois Department of Corrections (IODC) and its Department of Juvenile Justice (IDJJ) programs to assist with the implementation and support of a state-wide electronic system to automate the process of managing patient healthcare charts and records and supporting it in the delivery of cost-effective quality medical, dental, mental health, pharmacy, and other specialty care. The system it implemented for the Texas Department of Criminal Justice saved it nearly $1 billion over the past 10 years with cost per day, per inmate, reduced from about $19 to $9.67.

Woodard explains that telemedicine enables institutions to lower the costs of transportation by enabling the prisoners to be treated where they are, eliminating the need for guards to accompany them, thus reducing the spread of the virus and the cost of security. “Telemedicine increases efficiencies too because the presence of an electronic medical record provides the treating physician with the appropriate data at the point of care, thus enhancing the quality of care,” he says.

Electronic records enable physicians to quickly review pertinent information from anywhere. “The merging of all this information into one data base enables faster response times for treatment, more accurate documentation, reduced medication errors and lowers costs,” says Woodard.

During the pandemic Woodard said it became obvious that telemedicine’s benefits can extend from the prison cell block to the suburban or urban city block with its promise of both humanitarian benefits and cost savings.

“While prisons aren’t known for being on the cutting edge of technology, the harsh realities of prison health care — where many inmates have complicated medical needs and getting access to an offsite doctor can be a lengthy and even traumatic process — have acted a catalyst for health care practitioners to get creative about how people can access much-needed care,” Woodard says.

There are almost 1.5 million people in state and federal prisons throughout the United States and each one of them according to the U.S. Supreme Court has a constitutional right to health care, thus prompting the use of telemedicine in the prison system.

“Just like e-mail, Facebook, messaging, and ATM’s, where our information follows us around the globe, the medical sector is realizing that those same mobile and cloud-based technologies can help provide superior care at lower costs and the prison system was one of the first to pick up on it,” says Woodard.  

Woodard predicts that the healthcare industry will probably never return to the old visit-the-office type procedures. It’s safe to say that virus pandemic has accelerated the move of telemedicine out of the correctional facilities and pushed the healthcare industry into a new frontier and there’s no going back,” he says.

About KaZee, Inc.

KaZee, Inc., is a leading provider of high-quality information technology (IT) products and services to the healthcare industry. Within the healthcare industry, KaZee serves ambulatory and outpatient clinics, multispecialty physician practices, Federally Qualified Health Centers (FQHCs), county health departments, and currently focuses on correctional health facilities such as state, county, and local jails, prisons, and youth detention centers. KaZee supports customers within 40 states across the country. For more information about KaZee, go to www.KaZee.us.

KaZee’s Telemedicine Support Services

As we enter the 21st century, Telemedicine is becoming a widely  acceptable alternative to in-person doctor visits.  Viewed as an effective and efficient method of providing timely, quality health services, public and private insurance payors are recognizing the value of care delivered through Telemedicine systems and are quickly adjusting their payment models to cover  Telemedicine services.

As one of the pioneers of Telemedicine and Electronic Health Records Systems, KaZee stands ready to help its customers design, build and support Telemedicine systems that meet their individual needs and preferences while ensuring their patients always have universal access to quality healthcare.

Our telemedicine experts collaborate and consult with our customers to determine their specific requirements and how telemedicine can assist with addressing their healthcare delivery needs.  We assist in designing, developing and supporting all aspects of the system including purchasing, installing and supporting all equipment and software needed to ensure that the telemedicine technology is always robust and efficient and functions as expected.

To maximize the effective use of Telemedicine solutions, we employ implementation/training teams that are highly skilled and experienced in the use of Telemedicine technology.  We helped build one of the world’s largest Telemedicine systems and we have been developing and supporting these types of systems since 2002.  For convenience KaZee offers its customers training online or onsite at their facilities.   To ensure ongoing training over time all training sessions are recorded and made available locally or remotely via the cloud.

Our highly skilled and experienced technical staff continues to provide our customers with operations support and maintenance services after implementation to ensure our Customer’s system continues to perform at a high level as environments change and evolve over time.  We provide 24×7 help desk support globally to minimize any downtown or business interruptions.

Our long-term goal is to help our customers achieve their organization’s mission in the most efficient way possible in order to facilitate access to quality healthcare for their patients.

For additional information about KaZee’s Telemedicine offering please visit us a KaZee.us or call us at 706-279-4141.

A Message From KaZee’s Chairman and CEO

A Message from the Chairman and CEO

KaZee is concerned about the safety and well-being of our staff, as well as, those of our Customers and business partners.  We are implementing measures to help minimize our exposure to infectious diseases in the short and long terms.

KaZee has long been an advocate of having its employees and staff working from home.  We will continue to encourage our staff to work from home as much as possible and provide cost reimbursement for the equipment and services needed to help facilitate working from home.  KaZee will continue to invest in being a fully virtualized company and will do the things necessary to reduce our physical facility footprints, such as investing in cloud computing and reducing the number and size of our offices and data centers.

KaZee will ensure that hand sanitizer, soap and hot water is plentiful at all of our physical facilities and offices.  We will make sure that door knobs, desk tops and other places where people contact are thoroughly cleaned each day.  We will encourage our staff to minimize handshakes and embraces, but to greet and depart from others professionally and with respect.

We will encourage the use of teleconferencing and tele-training and other support services as much as possible.  We will encourage board members to participate in board meetings via teleconferencing also.  We will continue to invest in Video and Audio conferencing infrastructure to reduce our exposure to large gatherings of people whenever possible.  For the time being we will encourage our staff to not travel out of the country and to avoid airports and other mass transit facilities as much as possible.  We will temporarily suspend any participation in conferences in person.

We will follow the recommendations of the CDC, NIH and other local health departments and organizations and will make our staff, employees, customers and business partners aware of any new critical developments and KaZee’s protective actions to be taken.

If you have other suggestions that you think would better help protect us from infectious diseases like colds, the flu or harmful viruses, please feel free to make those recommendations via our website http://www.Kazee.us.

Best luck to you and your family

Albert Woodard | Chairman and CEO |

Atlanta’s KaZee Turns To Small TN Bank For Cash Infusion to Fuel Rapid Growth

In just two weeks Memphis-based Paragon approved a million-dollar line of credit

ATLANTA, GA (October 30, 2019) – In mid-2019 Atlanta-based KaZee, a minority-owned healthcare information technology company, experienced a massive growth spurt requiring a quick injection of capital to invest in additional employees, suppliers, equipment, and facilities.

KaZee, a Tennessee company, turned to Memphis-based Paragon Bank, a regional community bank, which KaZee management says immediately understood their situation and need for an immediate and ongoing cash infusion.

“When we searched for a financial partner to help us deal with our rapid growth we settled on Paragon for two key reasons,” explained KaZee CEO and Chairman, Albert Woodard. “First, the bankers at Paragon were by far the most understanding of our needs, and secondly they understood our sense of urgency and were willing to make quick decisions that enabled us to immediately begin performing on the large contracts we had recently been awarded.”

Woodard said he and his management team did thorough due diligence when searching for a banking partner. “We settled on Paragon because it fully understands how today’s robust economy has generated more and more demand for our products and services and instantly recognized our need for capital to continue meeting that demand.”

“Working with Paragon is like having a financial partner just down the hall,” said Woodard. “Two weeks after contacting Paragon we had the capital we needed.”

That’s how paragon planned it when it was founded 15 years ago according to bank First Vice President of Commercial Lending Bill Freeman. “Being a smaller bank enables us to make fast decisions because our CEO is just down the hall from my office,” says Freeman.

“Just like KaZee did its due diligence on us, we also have a department at the bank that handles small and minority businesses, women, African-Americans. etc. We also have a set of criteria called the five C’s – Credit, Character, Collateral, Cash Flow, Capital and Conditions – that we look for in a client. KaZee met them all.”

“Our representative in Atlanta said he had a program that would work for the African-American owned KaZee called “Profit Stars,” explains Freeman. “With this program we buy the invoices from the customer and then give them the capital based on those invoices charging a small front end-fee and then a 2.4 percent of the initial invoice.”  

Despite its Memphis headquarters Paragon says serving clients in Atlanta isn’t unusual, particularly small business organizations. “Business owners don’t select a bank because its name is on a sports stadium,” says Freeman.  “Ads for community banks never claim they operate like large megabanks. On the other hand in their ads large banks talk about themselves as a community bank, because they know people prefer a personal touch and speedy decisions handled locally, that can only be performed by locally owned institutions.

Freeman explained that Paragon mostly does business out of its offices in Oxford, Mississippi, Atlanta, and, of course, Memphis.

In July KaZee was awarded a $27 million contract with the Department of Corrections in Illinois to streamline and improve the electronic healthcare system of the more than 39,000 adults and juveniles incarcerated in its prisons and detention centers.

About KaZee, Inc. KaZee, Inc., is a leading provider of high-quality information technology (IT) products and services to the healthcare industry. Working with the University of Texas Medical Branch and the Texas Department of Criminal Justice, KaZee helped develop and implement one of the first Electronic Health Records Systems in the Country and one of the largest Telemedicine Operations in the World outside of the U.S. Department of Defense.  KaZee works with Parkland Hospital today to help support Parkland’s contract with Dallas County to provide quality healthcare to the County’s inmate populations.  Both programs have received high recognition for the quality and cost effectiveness of the healthcare they provide their inmates. KaZee is a national firm that supports its customers all across the country. For more information about KaZee visit www.KaZee.us.

About Paragon Bank: Alarmed that the number of mergers and acquisitions were eliminating home-grown independent banks from the local landscape veteran Memphis banker Robert Shaw assembled a financial team to create a bank designed to help local area businesses grow and contribute to improving the community, founding Paragon National Bank. Paragon’s philosophy is to deliver friendly, personalized service and state-of-the-art solutions to help businesses grow. This neighborly, civic-minded quality succeeded by attracting legions of loyal customers, resulting in four banking center locations and numerous awards for being the area’s best community bank and a best place to work over the past 15 years. Headquartered in Memphis, Paragon’s success with small and mid-size business customers has enabled its Small Business Capital Group to flourish and serve businesses around the country. For more information about Paragon visit www.bankparagon.com

 

Increasing Safety Measures for the Treatment of Incarcerated Transgender Individuals

Author: Shijuade Kadree, Esq., MPH, Founder and Principal of Compass Strategies Consulting

The ABCs of the LGBT Community

There is an increasing prevalence and frequency of discourse about the lesbian, gay, bisexual, and transgender (LGBT) community, including discussion of the community’s basic needs and treatment, as well as ways to engage, serve, and affirm community members. It is important to ground oneself in the appropriate terminology when discussing the LGBT community. Broadly speaking, every person has a sexual orientation and a gender identity. Sexual orientation refers to who is someone physically, emotionally or romantically attracted to.[1] Some examples of a sexual orientations are lesbian, gay, and bisexual (LGB)l individuals. Gender identity describes how an individual identifies along the gender spectrum of “male, female, a blend of both or neither.”[2] The latter group of community members is collectively often referred to as the transgender or gender non-conforming (TGNC) community. The community of LGBT individuals is vast and cross-sectional, and has intersections with every other demographic, such as race, ethnicity, class, mental health status, political affiliation, and disability. Consequently, it is important to note that the LGBT community is not monolithic, and individuals within the community may describe themselves or their beliefs, very differently from each other

As it pertains to incarcerated individuals, based on the National Inmate Survey of 2011-12, data show that LGB individuals are incarcerated at three times the rate of the general public.[3] However, studies have also shown that approximately 16% of people who identify as transgender, or 1 in 6 TGNC individuals, has been incarcerated.[4] Given those stark rates, this article will specifically focus on incarcerated individuals who identify as transgender, that is individuals whose gender identity does not match their sex assigned at birth,[5] and their interaction with correctional facilities.

Challenges presented to TGNC incarcerated individuals

Being an incarcerated TGNC individual means they are likely subjected to daily humiliation, misgendering and experience a significantly increased risk of physical and sexual abuse. A study in California determined that TGNC people were up to 13 times more likely to be the survivors of sexual assault while incarcerated, when compared to their non-TGNC counterparts.[6]  According to the National Center for Transgender Equality, the trauma, and physical and emotional harm experienced by sexually assaulted inmates not only hurts the assault victim and their family, but there are detrimental impacts and costs to the criminal justice system as well.[7] In addition, TGNC people may also face increased hardships trying to receive medically-necessary, gender affirming healthcare services while incarcerated.

These hardships are compounded by laws, ordinances, and regulations governing the respective department of corrections, which may or may not have guidance about how to best treat TGNC people. For example, many jurisdictions lack best practices about whether or not TGNC individuals should be housed in sex-segregated facilities. Often times correctional officials in sex-segregated facilities, inappropriately using the Prison Rape Elimination Act as justification, will remove the TGNC individuals from the general population and place them in protective custody or solitary confinement. This is often considered punishment based on someone’s identity and the vulnerability of attack risk that this identity poses. Doing so can have long-term, damaging psychological effects on the incarcerated individual.[8] This segregation can even increase the likelihood that the person will not receive appropriate care in an emergency, such as the case with Layleen Polanco, a transgender woman who died from complications of epilepsy, while in punitive segregation on Rikers Island in New York.[9]

What you can do about it

As noted above, there is no consistent guidance from the National Institute of Corrections on how to best care for and protect LGBTQ inmates. However, this void provides an opportunity for leaders and administrators in correctional systems to put in place proactive measures and policies to ensure the affirming and safe treatment of incarcerated TGNC individuals. Suggested recommendations include:

  • Providing cultural competency or sensitivity training for facility staff to learn more about the LGBT community, including the needs of TGNC individuals, understanding basic language, terminology, and identity.
  • While TGNC individuals in sex-segregated facilities are often placed in solitary confinement for their safety, and individualized risk assessment should be conducted on a case by case basis. Where possible, these individuals who must ultimately be placed in protective custody for their safety should still have access to the same educational, employment, fellowship, and recreational activities as individuals in the general population.
  • Work with the local corrections agency to determine if housing individuals according to their gender identity, rather than their sex assigned at birth, or if segregated housing solely for LGBT individuals, is feasible. Examples of facilities where there has been successful are in Illinois, Maine and Washington, D.C.
  • Review the appropriate use and application of the Prison Rape Elimination Act as it pertains to housing TGNC individuals. The Act’s regulations prohibit placement of TGNC individuals in sex-segregated facilities (rather than in one that aligns with the individual’s gender identity), only based on biological traits, without a consideration of additional factors. A review of your facility’s policies on this alone might significantly reduce some of the emotional, physical, and mental trauma incarcerated TGNC individuals face by being in sex-segregated settings. 
  • Ensure that your facility has an explicit nondiscrimination policy that prohibits the maltreatment of any incarcerated person based on the real or perceived status of their sexual orientation or gender identity.
  • Institute a “gender-neutral commissary list,” which means that a variety of grooming and personal care products that might typically be considered appropriate for one sex, are available. Doing so provides a simple, but impactful way, for TGNC individuals to feel safe and seen while incarcerated.[10]

In brief, correctional facilities may not be able to address the larger issues of societal discrimination against TGNC individuals, but they can provide safe, humane and affirming settings, which can support long-term rehabilitation for them while incarcerated. While laws, ordinances, and regulations lag, there are numerous intermediary steps that can be taken by prison officials to implement practices that will decrease the violence, harassment, and abuse that many TGNC individuals face while incarcerated.


[1] “Sexual Orientation and Gender Identity Definitions,” The Human Rights Campaign. https://www.hrc.org/resources/sexual-orientation-and-gender-identity-terminology-and-definitions. Last accessed: September 13, 2019.

[2] Ibid.

[3] “Incarceration Rate of LGB People Three Times the Rate of General Population,” The Williams Institute. https://williamsinstitute.law.ucla.edu/williams-in-the-news/incarceration-rate-of-lesbian-gay-bisexual-people-three-times-the-general-population/. Last accessed: September 23, 2019.

[4] “Transgender Incarcerated People in Crisis,” Lambda Legal. https://www.lambdalegal.org/know-your-rights/article/trans-incarcerated-people. Last accessed: September 14, 2019.

[5] Right now, when a child is born, they are classified as male or female based on their biological traits. This is commonly referred to as “sex assigned at birth.”; see also, “Transgender FAQ,” GLAAD, https://www.glaad.org/transgender/transfaq. Last accessed: September 13, 2019.

[6] Supra, note 4.  

[7] “LGBTQ People Behind Bars: A Guide to Understanding Transgender Prisoners and their Legal Rights.” The National Center for Transgender Equality. https://transequality.org/sites/default/files/docs/resources/TransgenderPeopleBehindBars.pdf. Last accessed: September 9, 2019.

[8] “FAQ: Answers to Common Questions About Mistreatment of TGNC Incarcerated People,” Lambda Legal. https://www.lambdalegal.org/know-your-rights/article/trans-in-prison-faq. Last accessed: September 11, 2019.

[9] “Cause of Death Revealed for Transgender Woman who Died at Rikers Island,” CNN. https://www.cnn.com/2019/07/31/us/layleen-polanco-rikers-island-autopsy/index.html. Last Accessed: September 11, 2019.

[10]Policies to Increase Safety and Respect for Transgender Prisoners: A guide for agencies and advocactes,” The National Center for Transgender Equality. https://transequality.org/sites/default/files/docs/resources/PoliciestoIncreaseSafetyandRespectforTransgenderPrisoners.pdf. Last accessed: September 21, 2019.

THE OPIOID CRISIS

THE OPIOID CRISIS

By: Margaret Kadree, MD

Chief Medical Officer, Johnson Health Center

The opioid crisis has risen to such proportions that it has had to be addressed at a national level. Historically, the overuse of opioids is not a novel situation, it can be traced back to prior to the American revolutionary war1. Opioids were introduced to the American colonies by European settlers and was effective in treating pain related to a variety of common ailments. With the advent of injectable morphine, which provided soldiers substantial pain relief during the civil war, a documented wave of morphine overuse occurred1.  Because morphine appeared to be effective for a wide array of illnesses, it was indiscriminately included in a significant number of medications, including medicines for children.  Death of infants from this type of usage prompted the FDA to introduce the Pure Food and Drug Act of 1906 which mandated oversight and labeling of the contents of medications – and subsequently – the Harrison Drug Act of 1914, which limited the ability of physicians to prescribe opioids1.  These laws helped to reduce the widespread use of opioids at that time and by so doing stemmed that epidemic. Since then there have been several waves of opioid overuse – however, these were related to primarily non- prescription drug use. In the 1990s, with the push to make patients suffering from pain, “pain-free”, potent oral opioid agents became available. These agents were promoted as being safe for patients and having a low risk of addiction1,2. Concomitantly, the National Academy of Medicine encouraged physicians to prescribe opioids more liberally for their patients with pain. The Joint commission for Accreditation of Hospitals, a major accrediting body, even had as a quality marker whether patients’ providers were managing their pain adequately1. All of these conditions coming together at the same time have contributed substantially to the current opioid epidemic. With the increased availability of opioids through legitimate channels, opioids can now be found in the medicine cabinets at home, making it available to individuals who have not been directly prescribed these medications – and unfortunately – this includes children – so that our current epidemic is not just one that affects adults but also our pediatric population1,4. This is an entirely new phenomenon.

According to a report from NIDA updated in January of 20193:       

Every day more than 130 people die from opioid overdose

In 2017 more than 47,000 died as a result of opioid overdose [ including prescription drugs]

1.7 million people suffered from substance use disorder related to prescribed opioids

Roughly 21 to 29 percent of patients prescribed opioids for chronic pain misuse them

Between 8 and 12 percent develop an opioid use disorder

An estimated 4 to 6 percent who misuse prescription opioids transition to heroin

.

About 80 percent of people who use heroin first misused prescription opioids

Opioid overdoses increased 30 percent from July 2016 through September 2017 in 52 areas in 45 states.

Opioid overdoses in large cities increased by 54 percent in 16 states.

With regards to the pediatric population, neonates and adolescents between the ages of 12 to 17 are the most adversely affected. The incidence of neonatal abstinence syndrome [NAS] increased five-fold between 2004 and 20144 – in spite of the fact that treatment of opioid use disorder [OUD] during pregnancy has been the standard of care since 1998. According to the 2016 National Survey on Drug Use and Health, the most current data available, 798,000 12-17 year olds had an illicit drug use disorder, of these 153,000 were opioids5. The majority of opioid use was due to prescription pain medications – only 1000 or so were related to a heroin use disorder.

In response to the opioid crisis, the U.S. Department of Health and Human Services (HHS)has put in place “five major priorities”3:

1. improving access to treatment and recovery services

2. promoting use of overdose-reversing drugs

3. strengthening our knowledge of the epidemic through better public health surveillance

4. providing support for cutting-edge research on pain and addiction

5. advancing better practices for pain management

Individual states have also developed agendas to contain and ameliorate the situation6. In spite of the excellent HHS plans, it can be predicted that certain populations may not be able to reap the full benefits of such interventions. In addition, the perspective, until recently, that substance use disorder is of necessity associated with criminal activities as opposed to being a medical condition, has hampered the development of comprehensive healthcare mechanisms to manage it. While OUD crosses all socioeconomic strata, not surprisingly, the most adversely affected segments of the population are those with limited financial or economic resources – especially the homeless or those who find themselves in an unstable housing situation7,8, as well as individuals in the criminal justice population8,12. These populations are further encumbered by a high rate of behavioral health disorders and the cyclical relationship between opioid use disorder and homelessness [opioid use can precipitate homelessness and homelessness in and of itself can fuel or exacerbate a proclivity for opioid use]. The disparities are further aggravated by the often unrecognized fact that OUD is akin to a chronic disease, in that there are two components to therapy – short-term management and maintenance therapy. Individuals who were diagnosed with OUD, even when they become “drug-free” and even when they are strongly committed to remaining “drug-free” remain at risk for relapse. In other words, maintenance therapy is essential to minimize the incidence of relapse.

For a homeless or “near” homeless individual whose OUD may have started with the use of prescription drugs, but who, because of his or her dire financial condition, is no longer able to afford the prescription drugs – he or she may resort to using street heroin7 – which may be combined with other sedatives, thus increasing the likelihood of overdose. Some states have documented an increased rate of overdose-related deaths in the homeless population when compared to the population at large8,9. Even homeless veterans have not been spared in this statistic. In a 2019 article on the opioid epidemic, in veterans who were homeless or “near” homeless, it was noted that such veterans had an almost 2-fold increased risk of fatal drug overdose when compared to the general population10. This has occurred in spite of the Veteran Health Administration’s Opioid Safety Initiative program which expanded access to naloxone [a drug which can be used to reverse opioid intoxication emergently] as well increased access to its medication-assisted treatment program [MAT}. The confounding factor precipitating this outcome applies to both homeless veterans and the general homeless population – namely, limited or no access to the programs that can help such individuals – naloxone, medication-assisted treatment and behavioral health – directly due to the intricacies and limitations precipitated by the homeless condition. So much so, the Substance Abuse and Mental Health Services Administration [SAMHSA] has been encouraging homeless and housing service providers to make naloxone available to the homeless and “near” homeless populations7. In addition, they have requested that friends, family members, potential responders and providers be trained to administer naloxone emergently. SAMHSA developed an Opioid Overdose Prevention toolkit which has been available since 2013. SAMHSA has also developed guides – specifically for managing the homeless- which, among others, addresses MAT resources as well as Behavioral Health resources7.

For persons who find themselves within the criminal justice system, according to the US Department of Justice, approximately 50 percent of state and federal prisoners meet criteria for substance use disorder [SUD]11. Opioid use disorder [OUD] is not usually treated during imprisonment. The risk of death of a former prisoner, within 2 weeks of release, is 12 times that of the general population11.  The leading cause of death is opioid overdose. This phenomenon is in part related to the individual’s body having become re-sensitized to the respiratory depression and sedative effects of the opioid. During chronic use of opioids, the body develops a tolerance to the analgesic as well as respiratory depression effects of the opioid. Thus an individual who has been on opiates for a long time is able to take increasingly larger doses of opiates without experiencing a fatal outcome. However, when that same individual goes through a period of abstinence from opioids the body loses its ability to tolerate high doses of opioids, hence the increased likelihood of a fatal outcome. It is well documented that individuals who have OUD, and who do not receive any treatment for same during imprisonment, have a high probability of returning to drug use and so are at increased risk for overdosing. Furthermore, untreated opioid disorders also contribute to an increased rate of return to criminal activities and return to prison. Individuals with OUD who participate in methadone treatment and counseling while in prison are less likely to test positive for illicit opioids at one month following release. In addition, prisoners who receive MAT are more likely to follow through with therapy following their release from prison11.

A survey of community correction agents’ view on MAT showed that understanding of OUD as a medical disorder and validation of the effectiveness of the medications used in treating the disorder, resulted in greater acceptance of such practices in the correctional setting11. The World Health Organization has recommended that prisoners should not be denied adequate health care because of their imprisonment11 – which intrinsically includes therapy for OUD, a defined medical diagnosis.  Because of the potential for diversion, the criminal justice system will of course have to have measures in place to minimize opportunities for diversion, such as directly observed therapy.

Can individuals, employers, organizations also have a positive impact on the opioid crisis? Absolutely. An ounce of prevention is said to be worth a pound of cure! A critical first step is increasing awareness of the dangers of opioids. This can be done through self-education, education in the home and among family and friends – as well as informal or more structured education programs in the workplace, churches or any place where people tend to gather. People also need to be apprised of the fact that while OUD has been previously intimately linked with criminal activities, that this is not necessarily the case for every individual who suffers from this disorder. Education about non-opioid and non-pharmaceutical methods of pain control is also equally critical.

Available data shows that between 40-50 percent of individuals who develop opioid substance use disorder were first exposed to prescription opioids through a relative or friend. Family exposure is particularly commonplace with adolescents. Therefore, a useful measure is not to share opioid prescriptions with others – no matter how well-intentioned, and further – one should place opioid prescriptions in a secure place – so that they will not be readily accessible.

When a person is identified as being addicted to opioids, connecting them with organizations who manage these problems is very important. This should be done in a non-judgmental fashion. The stigma associated with substance use disorder is great enough to deter those who need care – from seeking same.

We are indeed in the midst of yet another opioid crisis – the resolution of which can be expedited if all hands are on deck. It is not just up to governmental bodies and healthcare organizations to resolve the problem – so I challenge each individual and each organization who reads this article to choose to do at least one intervention which will move the needle towards minimizing – if not eliminating the inappropriate use of opioids.

REFERENCES

1.Levy S. Youth and the opioid epidemic. Pediatrics 2019; 143[2] e20182752

2. US department of health and Human Services; What is the US Opioid Epidemic?  http://www.hhs.gov/opioids/about-the-epidemic/index.html. Accessed August 2019

3. National Institute of Drug Abuse. US Dept of Health and Human Services. Opioid Overdose Crises. https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis; last updated January 2019. Accessed July 2019

4. Honein et al. Pediatrics 2019; Winkelman et al. Pediatrics 2018 . Dramatic increases in Maternal Opioid Use and Neonatal Abstinence Syndrome. Source: National Institute on Drug Abuse; National Institutes of Health; U.S.Department of Health and Human Services. https://www.drugabuse.gov/related-topics/trends-statistics/infographics/dramatic-increases-in-maternal-opioid-use-neonatal-abstinence-syndrome; Accessed August 2019

5.Substance Abuse and Mental Health Services Administration. (2017). Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health (HHS Publication No. SMA 17-5044, NSDUH Series H-52). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www. samhsa.gov/data/  Accessed July 2019

6. National Alliance for Model State Drug Laws; https://www.nasmdl.org/topics [prevention-intervention; treatment; recovery support; PDMP/PMP] Accessed August 2019

7. Substance Abuse and Mental Health Services Administration. Homeless and Housing Service Providers Confront the Opioid Epidemic. https://www.samhsa.gov/homelessness-programs-resources/hpr-resources/homeless-housing-services-providers-confront-opioid. Accessed August 2019

8. Bauer LK, Brody JK, León C, Baggett TP. Characteristics of homeless adults who died of drug overdose: a retrospective record review. J Health Care Poor Underserved.2016;27(2):846–59.

9. Massachusetts Executive Office of Health and Human Services, Department of Public Health. An assessment of fatal and nonfatal opioid overdoses in Massachusetts Boston (MA): The Department; 2017 Aug – accessed august 2019 https://www.mass.gov/files/documents/2017/08/31/legislative-reportchapter-55-aug-2017.pdf

10. Amanda M. Midboe, Thomas Byrne, David Smelson, Guneet Jasuja, Keith McInnes, and Lara K. Troszak: The Opioid Epidemic In Veterans Who Were Homeless Or Unstably Housed; HEALTH AFFAIRS 2019.00281 38, NO. 8 (2019): 1289–1297 ©2019 Project HOPE—The People-to-People

Health Foundation, Inc.

11. NIDA. [2018, June 8]. Medications to treat Opioid Use Disorder. https://www.drugabuse.gov/publications/research-reports/medications-to-treat-opioid-use-disorder. Accessed August 2019

12. By Noa Krawczyk, Caroline E. Picher, Kenneth A. Feder, and Brendan Saloner. Only One In Twenty Justice-Referred Adults In Specialty Treatment For Opioid Use Receive Methadone Or Buprenorphine. 10.1377/hlthaff.2017.0890 HEALTH AFFAIRS 36,NO. 12 (2017): 2046–2053 ©2017 Project HOPE—The People-to-People Health Foundation, Inc.

Bridging the Mental Health Care Gap in Prisons with Telepsychiatry

The problem is significant, long-standing, and well-recognized:  our jails and prisons are overcrowded with people with mental illness. Jails and prisons have replaced state psychiatric hospitals as the location where the largest number of people with mental illness reside. Jails in New York, Los Angeles and Chicago are now the three largest institutions providing psychiatric care in the U.S.(1) 

According to the U.S. Department of Justice,  

  • About 37% of prisoners and 44% of jail inmates have been diagnosed with a mental illness
  • About 14% of state and federal prisoners and 26% of jail inmates reported experiences that met the threshold for serious psychological distress.  These rates are about 3 to 5 times the rates in the general population.(2)

Numerous factors contribute to the high rates of incarceration, especially among people with mental illness. Lack of accessible mental health services and unmet mental health needs make people vulnerable to arrest and incarceration. Untreated mental illness, which can lead some people to self-medicate with alcohol and illicit substances, has been a trigger for arrest. There is a risk that behaviors associated with mental illness will be misinterpreted as criminal behavior, especially in communities in with high concentrations of poverty and where policing is particularly aggressive.

Lack of Mental Health Care in the Correctional System

People with mental illness who are incarcerated often have limited access to mental health services and inadequate care.  In a Department of Justice study, among prisoners with serious psychological distress, only about 36% of prisoners and 30% of jail inmates were receiving treatment. Prescription medication was the most common treatment among these prisoners and jail inmates.

Several states are being compelled to make improvements because of court actions. Alabama is currently under court order to improve mental health care for inmates. Last year a federal court ruled that the mental health care in Alabama prisons violates the U.S. Constitutions’ ban on cruel and unusual punishment. In March, Alabama approved an $85 million increase for the state’s prison system. The Illinois Department of Corrections is currently under a consent decree to improve services to its 20,000 inmates with mental illness.

Factors contributing to Lack of Mental Health Care in Correctional System and Judicial Action

Among the reasons for inadequate care of prison inmates are the lack of identification of mental health needs, overcrowding of inmates, and lack of psychiatrists and other mental health professional personnel. Dr. William Puga, Chief of Psychiatry for the Illinois Department of Corrections sees the lack of providers as the biggest obstacle to mental health care in the Illinois correctional system.

Many factors contribute to the provider shortage. There is a national shortage of psychiatrists and the shortage of psychiatrists is particularly acute in prison settings. The rural location of many prisons and psychiatrists’ concerns about safety in prison setting contribute to difficulties recruiting psychiatrists. Mardoche Sidor, M.D., President of the Sweet Institute and former director of a special unit working with individuals with challenging mental health conditions at Ryker’s Island Correctional Facility, notes, “One of the biggest challenges facing mental health care in corrections is that it is very hard to make meaningful change when people don’t feel safe:  both the individuals who are incarcerated as well as individual mental health clinicians.”   

Stigma is also a major barrier to mental health care in the correctional system, notes Otis Anderson III, M.D., a psychiatrist working in Mississippi correctional institutions: “Stigma is evident inmate to inmate, as well as between correctional officers and inmates. Inmates shy away from mental health care because they get castigated by other inmates and correctional officers if it is known that they are receiving mental health services in prison.”

Bridging the Gap with Telepsychiatry

Among the possible ways to help meet the mental health needs of people in prison is telepsychiatry. Telepsychiatry permits psychiatrists and other mental health professionals to evaluate and treat inmates remotely. Research has found telepsychiatry as an effective means of delivering treatment, comparable to in-person treatment, and it improves access to mental health services for inmates.

While telepsychiatry offers many advantages in the community, it especially has the potential to address barriers to care in correctional settings. Because providers do not need to be in the prison or jail, the significant travel time to often remote facilities is eliminated. Less time traveling and dealing with security issues means more time treating patients. Working remotely can also alleviate safety concerns and minimize the potential tensions and pressures among custody staff, healthcare staff and inmates (e.g., intimidation, prison culture). Some patients may actually prefer working with a remote provider.

While the use of telemedicine and telepsychiatry has been increasing in recent years, it has been used for many years in several correction systems. For example, the University of Texas Medical Branch in Galveston, TX has been providing mental health care to inmates in Texas through telepsychiatry since the 1990s. (3) In Georgia five prisons receive telemedicine care from the Augusta Correctional and Medical Institute. In Ohio, more than 4,000 inmates in the correctional system are served each year through telepsychiatry and other telemedicine provided by the Ohio State University Medical Center in Columbus, Ohio. (4)

Access to patient information through electronic health records (EHRs) is a necessary component of effective telepsychiatry. EHRs help facilitate continuity of care and quality of care. They allow consistent access to records and can also help reduce potential errors from legibility problems with paper records.  Dr. Puga notes that without digital records, it’s often difficult to access old records, charts are often illegible or incomplete, it slows us down, and “some things end up falling through the cracks.”

EHRs can provide real time mental health status and treatment information at the time a patient comes in from or is released to outside mental health providers. Electronic patient discharge summaries can facilitate quality mental health care for patients released from prison or jail. Efficient coordination of all related resources such as patient side clinical presenter, patient, equipment, exam rooms, etc., is also important to effective care in prison settings.

Advances in technology and systems continue to improve the efficiency and effectiveness of services provided via telepsychiatry.  The telemedicine market overall is advancing and growing and hopefully, telemedicine will increasingly be applied to meet the growing needs for quality mental health care in prisons and jails.

References

  1. Alisa Roth. Insane: America’s Criminal Treatment of Mental Illness. 2018. National Public Radio.  https://www.npr.org/sections/health-shots/2018/04/25/605666107/insane-americas-3-largest-psychiatric-facilities-are-jails
  2. Bronson J, Berzofsky M. Indicators of Mental health Problems Reported by Prisoners and Jail Inmates, 2011-2012. U.S. Department of Justice, Bureau of Justice Statistics. Special Report.
  3. UTMB. Impact Newsletter. May 17, 2016. A Day in the Life of a CMC Telepsychiatrist
  4. Deslich, SA, et al. Telepsychiatry in the 21st Century: Transforming Healthcare with Technology. American Health Information Management Association

Illinois Department of Corrections and Juvenile Justice Signs an Electronic Health Records Contract with KaZee, Inc.

To help improve the mental and physical health of those persons its custody

SPRINGFIELD, IL (June, 2019) The State of Illinois is taking action to streamline and improve the health and healthcare of those persons incarcerated in the State’s prisons and detention centers.  The State also intends to reign in the soaring costs of providing quality healthcare to its more than 40,000 adult and juvenile incarcerated persons.

The IDOC / IDJJ programs are part of an agreement with the federal government to upgrade the State’s prison system to help advance the quality of healthcare provided inmates and improve healthcare outcomes.  As part of this program, the State has agreed to expand and upgrade its healthcare facilities and equipment, and hire staff dedicated to implementing and overseeing stringent quality assurance and disease control programs and electronic health records systems.

The State of Illinois, through IDOC and IDJJ, contracted with KaZee, Inc, an Atlanta based healthcare IT company, to assist with the implementation and support of a state-wide electronic heath records system.  KaZee is charged with assisting the State of Illinois automate the process of managing patient healthcare charts and records and supporting the State in the delivery of cost-effective quality medical, dental, mental health, pharmacy and other specialty care.

“Improving access to quality healthcare and specialists along with continuity and follow-up care should greatly improve healthcare outcomes and improve the overall physical and mental health of the persons in the custody of the Illinois Departments of Corrections and Juvenile Justice” says Tina Neely, IDOC EHR System Implementation Project Manager.  “In addition to improving the overall health of the State’s inmate population these programs will help assist inmates re-enter society, decrease recidivism rates and help improve public safety.” She adds.

KaZee is intimately familiar with the Illinois Department of Corrections having help automate health record systems for IDOC’s female inmate facilities over the past 6 years.

 “While the cost of providing healthcare continues to increase rapidly, States are under severe pressure to improve the quality of the healthcare they provide to the people in their custody.” says Albert Woodard, Chairman and CEO, KaZee, Inc. “As a result, they are increasingly turning to information technology systems and solutions.”

From 1988 to 1998 the US prison population doubled according to the U.S. Justice Department making the U.S. the number one incarcerator worldwide. In 1978 the U.S. inmate population was approximately 750,000 people. Today that number is reported to be in excess of over 2.2 million individuals. “Increasing prison populations are due to aging, tougher sentencing laws, longer prison sentences, as well as increases in chronic illnesses diabetes and heart disease, infectious diseases such as AIDS and hepatitis and mentally ill and homeless patients now being housed in prisons and jails.” says Woodard. 

Illinois is no exception; its prison population has grown eight percent since 2000. Illinois has the 22nd lowest incarceration rate in the country, with a rate of 341 per 100,000 people sentenced to a year or more behind bars in 2016, slightly below the national average. Currently, Illinois has a total of 43,657 people in state prisons.

About KaZee, Inc.

KaZee, Inc., is a leading provider of high-quality information technology (IT) products and services to the healthcare industry. Working with the University of Texas Medical Branch and the Texas Department of Criminal Justice, KaZee helped develop and implement one of the first Electronic Health Records Systems in the Country and one of the largest Telemedicine Operations in the World outside of the U.S. Department of Defense.  KaZee works with Parkland Hospital today to help support Parkland’s contract with Dallas County to provide quality healthcare to the County’s inmate populations.  Both programs have received high recognition for the quality and cost effectiveness of the healthcare they provide their inmates.  KaZee is a national firm that supports its customers all across the country. For more information about KaZee visit www.KaZee.us.

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