Health Services

Charles R. Mathews, M.D. Assistant Secretary (904) 922-6645 SUNCOM 292-6645
John G. Burke Chief of Health Services Administration	David L. Thomas, M.D. Chief of Health Services

"The Assistant Secretary of Health Services...shall be responsible for the delivery of health services to offenders within the system and shall have direct professional authority over such services." (F.S. 20.315(3)(g))

The Office of Health Services is responsible for the physical and mental health of each of Florida's state prison inmates. Its specific areas of responsibility include inmate medical, dental and mental health issues; nursing staff for prison hospitals; infection control; elderly and impaired inmates; quality management, environmental health and health administration; health-related reports and statistics; health-related inmate grievances; inmate health education; and corrective action plans. During FY 1995-96, 3.1 million health care encounters were provided by the department.

The DC's cost containment efforts were recognized by the American College of Physician Executives National Awards Program "as an innovation and a significant advance in medical management." Consequently, the DC's medical cost containment strategies were included in the nationally distributed Innovations '96, a compilation of innovative health care initiatives published by the College each year. Kudos to John G. Burke, Chief of the DC's Health Services Administration.

Some examples of the Office of Health Services costs containment accomplishments include:

• Realizing a total cost avoidance of $11.5 million dollars through the use of hospital contracts.
• Implementing a dental services consolidation plan which is expected to provide a 15 percent cost avoidance in dental expenditures.
• Receiving a $6,000 National Institute of Corrections grant which provided training for 125 mental health staff.
• Reducing the number of pharmacies needed statewide by two thirds from 33 institutions with on-sight pharmacies to 11 pharmacies clustered in areas with several prisons nearby. This reduction in staff and pharmacies resulted in substantial savings to the department. At the end of FY 95-96, a cost avoidance of more than $315,000 was achieved through decreased staff, decreased equipment requirements and reduced drug inventories.
• Consolidating inmates into institutions based on their medical grade classification, resulting in a reduction in health care staff and improved continuity of care by outside providers.
• Increasing the use of telemedicine (which allows inmates to be seen and questioned by doctors via television) has reduced by 55% the trips officers and inmates make outside the prison for medical reasons. Other benefits of telemedicine include:
• Minimizing security risks of transporting inmates out of the institution
• Allowing inmates to be treated inside the institution without compromising the level of care
• Minimizing the incentive for inmates to feign illness in order to be sent to an outside consultant
• Facilitates the screening of inmates with emergencies or who require psychiatric evaluations

In accordance with Florida law, the Department of Corrections began charging a $3.00 copayment for inmate health care in January 1995. The charge is for inmate initiated, non-emergency visits only. Health services cannot be denied to those inmates lacking financial resources.

Exceptions: Inmate health emergencies are not charged copayment fees, and certain situations or medical requirements, which are non-emergency in nature, but may directly impact the health and welfare of the inmate population, such as voluntary HIV testing, do not incur the $3.00 copayment charge.

Visits Decrease, Appeals Increase: In the first year of copayment charges, monthly non-emergency clinic visits declined by 13 percent and the monthly number of clinic visits per inmate was 22 percent below the previous year's use rate. First year assessed copayments totaled $407,553 and of this amount, 72 percent or $293,515 had been collected by year's end. An additional impact of the copayment program was seen in the total number of health related appeals which increased 54 percent in 1995 compared to 1994. In a monthly average of 248 health related appeals, 21 percent were related to copayments.

Getting the Word Out: Information regarding the copayment program and attendant application procedures are required to be provided to the inmates during in-processing and are also required to be conspicuously posted. Medical personnel receive copayment training, and the program is included as an item of health services' inspection interest. The Office of Health Services monitors the number of copayment grievances recorded on a monthly basis.

The Office of Health Services is mandated to provide a standard level of health care. Within the scope of this standard of care, the inmate copayment program has reduced unnecessary utilization and generated additional revenue, while neither filtering nor otherwise discriminating in the provision of, or access to, required health services.

Total Deaths* in Prison

These figures represent inmate deaths at major institutions and under DC care only.

Unnatural Deaths, 1991-1995

AIDS Deaths in Prison, 1991-1995

Facts about AIDS in Prison

• Inmates may be tested for HIV at their request, or if they have been involved in an incident involving the exchange of body fluids.
• Inmates who are HIV positive or who have AIDS are not housed separately from other inmates.
• Inmates do have access to AZT and other drugs to combat their illness.
• Inmates could receive medical clemency under certain circumstances, and if their families agree to care for them upon release.