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Rick Scott, Governor
Florida Department of Corrections, Secretary Michael D. Crews

Florida Department of Corrections
Timothy H. Cannon, Interim Secretary

Health Services

Charles R. Mathews
Charles R. Mathews, M.D.,
C.C.H.P.

Assistant Secretary
John Burke
John G. Burke
Deputy Assistant Secretary
for Health Services Administration
David L. Thomas
David L. Thomas,
M.D., J.D.

Deputy Assistant Secretary
for 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))

From the
Assistant Secretary:

As you will see on the following pages, a great deal has been accomplished during fiscal year 1997-98 and I am, of course, extremely proud of these accomplishments by the Health Services team. These accomplishments include the development of a mini-residency with the University of Miami College of Medicine (that exemplifies public/private cooperation), seminars on HIV/AIDS and tuberculosis, the continued expansion and refinement of our Quality Management Program (which furthered our efforts to improve the utilization of nursing staff), the expanded use of both the Corrections Distance Learning Network (CDLN) and the Health Science Television Network (HSTN), and further development of an electronic medical records system. Also, through Correctional Quality Managerial Leadership we were able to further improve the efficiency and effectiveness of our delivery of health care services to Florida's inmates. If you have any questions or comments relative to this report, please contact us.

Charles R. Mathews, MD

The 2,700 health services staff members provide access to comprehensive medical, dental, and mental health services for male and female offenders Department-wide. This includes health education, preventative care, and chronic illness clinics at the minimum community standard of health care. During FY 1997-98, the department provided 2.8 million health care encounters. The scope of health services includes primary care, emergency care inpatient hospitalization, and specialty care, as required.

The annual per diem cost for health care for Florida inmates has increased from $8.63 in 1992-1993, to only $9.30 in 1997-1998, an increase of 1.3% per year. This is despite an increase in the average daily population and the fact that the department over the last six years has absorbed price level increases. In comparison, the Hospital and Related Services component of the Consumer Price Index has averaged 5.0% per year during the same period. The consolidation of health care delivery during this time period was instrumental in managing these costs.

The Office of Program Policy Analysis and Government Accountability (OPPAGA) stated that "While the department's annual cost of providing each inmate with health care services has increased over the last five years, these costs have increased at a slower rate than Florida's medical care inflation rate."

Comparison Average Daily Cost of Health Care for DC Inmate, US Citizen, and Medicaid Patient
Fiscal Year 1992-1998

Graph that shows a steady increase in average daily cost of health care for DC Inmates, US CItizens, and Medicaid patients.


Consolidating Health Care Services

There has been considerable focus on the consolidation of health services for improved quality, managed care, and, more specifically, cost effectiveness. The following are some examples.
  • The Office of Health Services (OHS) competed in the first annual Secretary's Quality Showcase competition in October and took first place in the Central Office with their presentation on Dental Consolidation. As a result, the Consolidate, Reduce and Improve (CRI) Team competed in the statewide competition in Ocala in October.
  • Dental Consolidation resulted in an annual $2.5 million cost avoidance and an increase in dental productivity of approximately 7.7% per dentist. This was accomplished while maintaining a high quality of care.
Medical Services

  • Another historic first: The Department of Corrections is the first state agency ever to apply to the Florida Medical Association to provide continuing medical education (CME) for its physicians. All other certified organizations that provide CME credits are hospitals. The department is expanding into the field because finding and keeping good physicians and keeping them abreast of medical changes is one of the department's continuing challenges. National research shows that one aspect of successful physician recruitment and retention is the quality and ease of acquiring continuing medical education.
  • Improvement in the quality of physician training, skills, and continuing education. This was accomplished through enhanced recruiting, credentials review and approval, and more recently the offering by the department of approved continuing medical education (CME) credits.
Dental Services

  • Completed Phase One of dental consolidation and the process is ongoing. Developed four new dental quality management indicators in concert with Quality Management staff. These indicators will be trended and evaluated during 1998.
  • Photo of dentist.
  • Working with the Bureau of Security Operations, dental services staff developed recommended guidelines for more secure toothpaste and toothbrushes.
Mental Health Services

  • Obtained provider status with the Boards of Psychology, and Social Work, Marriage and Family Therapy and Mental Health Counseling, allowing a continuing education program. As a result, the Office of Health Services has provided a number of training opportunities needed for doctoral and masters level practitioners to maintain and to improve clinical skills in areas of critical practice.
  • The Correctional Distance Learning Network (CDLN) has been used extensively to provide training for mental health staff statewide in a highly cost-effective manner. Four CDLN presentations focusing on clinical skills were developed to enable participants to earn continuing education credits, often without having to leave the institution.
  • Provided support to the Bureau of Substance Abuse Treatment Programs in the development and implementation of a joint substance abuse and mental health program to provide treatment for the dually diagnosed. This is the first program of this kind in a correctional setting. As a result, the modified therapeutic communities at Jefferson and Zephyrhills correctional institutions will soon be providing treatment for 120 offenders with a serious substance abuse disorder and co-occurring mental illness.
Nursing Services

  • Expanded training opportunities are being designed which will make continuing education credits available at the institutions, as well as through the distance learning network.
  • Developed an in-house training program for the unit treatment and rehabilitation specialist position, which was implemented at Corrections Mental Health Institution and Lake Correctional Institution.
Pharmaceutical Services

  • Pharmacy clusters re-allocated resources for improved shared services and pharmacy computer networking improved inventory control.
Electronic Medical Records System

  • The impetus for this effort comes from a legislative study recommending electronic medical records to improve data analysis for managed health care decisions, improve continuity of care throughout the system, and to reduce the amount of paper currently being devoted to inmate medical records. Initial steps included review of currently established electronic medical record systems both inside and outside the correction environment. A second phase is under way to evaluate Department of Corrections computer systems (OBIS-HS, CARP), along with a detailed analysis of specific health services job requirements at all institutions. The final phase includes an evaluation of medical record documentation needs throughout the corrections system.
Quality Management Services

  • Completed the Quality Management pilot project, which was initiated in the fall of 1996 to develop, test, and implement specific indicators that monitor patient care systems and processes and, over time, will identify opportunities for improvement. The project also incorporated concepts of Correctional Quality Managerial Leadership (CQML) as well as findings from the Correctional Medical Authority (CMA) surveys, quarterly surveys, and risk management reports. The project was designed to improve communication at and between the institutions, the regions and the central office. The pilot project and specific team accomplishments and processes were evaluated and the overall rating was positive.
  • Developed new guidelines related to infection control topics (e.g., chickenpox) and provided infection control education to departmental employees at all levels, institutional, regional, and Central Office, to allow more effective prevention and control of the spread of infection within DC facilities.
Health Services Corrections Action Team (CAT)

  • A corrections action team (CAT) was created to develop a statewide plan for continuity of care for HIV-infected inmates upon release. This CAT expands on the pilot project which is ongoing in Region IV
  • The tobacco use cessation CAT completed its primary task by producing a health services bulletin (HSB) to address smoking cessation. HSB 15.03.35 Tobacco Use Cessation Program became effective March 6, 1998.
Environmental Health Services

  • Developed safety and health guidelines for a melaleuca tree control program that addresses OSHA safety issues, training, personal protective equipment specification, herbicide utilization guidelines, administrative procedures, and ongoing program monitoring. Melaleuca trees are invasive pests in wetland areas. This program utilizes inmate labor to reclaim public lands that have been ecologically damaged by massive overgrowth of nonnative plant and tree species.
  • Developed guidelines for risk assessment and provision of Hepatitis B vaccination for inmate workers at landfill/waste recycling operations.
  • Implemented system-wide tracking of blood borne pathogen exposures.
Contract Health Services

  • The use of two cost-containment projects dramatically reduced both the cost and the potential risk to the public that occurs when transporting inmates to and from an institution to local hospitals for specialty care.
  • North Florida Reception Center's mobile surgery suite continues to conserve costs. Cost avoidance for the period of July 1997 through June 1998 totaled $1,154,046.
  • Chemotherapy treatment: North Florida Reception Center initiated an oncology program to provide on-site chemotherapy services. Results show a cost avoidance of $1,772,500 for fiscal year 1997-98.
Utilization Management (UM) Program

  • Generated an approximate $10 million cost avoidance in FY 1997-98. Centralized at North Florida Reception Center (NFRC), staff of this program closely managed the appropriate movement of inmate patients to contract hospitals, NFRC hospital, and institutional infirmaries. Delays in providing consultations and surgery were identified, enabling the Office of Health Services to further improve the timeliness and quality of care.
Health Education Services

  • Held statewide workshop entitled Put Prevention into Practice, focusing on the role of clinical preventive services. It used a national model developed by the Department of Health and Human Services with numerous collaborating agencies/organizations. Keynote speakers from the Department of Human Services, the Federal Bureau of Prisons, and Columbia University made presentations related to the theme of the conference. Additionally, education on triage, trauma, and clinical scenarios for nursing and physician staff was provided. This highly successful OHS workshop allowed health services staff statewide to receive timely training and personally interact with colleagues.
  • Used Health Sciences Television Network (HSTN) educational programs to provide health care staff at the institutions, regions, and central office with the most current health care practices to ensure quality health care for inmates while containing training costs. HSTN continues to be a convenient, cost-effective means of allowing staff around the state to receive timely, quality training to maintain current licensure through viewing continuing education programs without leaving the institution.
  • Obtained provider status for continuing education from nursing, mental health, dental, and pharmacy boards. As a result, the Office of Health Services is able to offer continuing education credits to licensed health care providers employed by the Department of Corrections at substantial cost savings.
Health Services Recruiting

  • Centralized application processing which has contributed to an average 7.5% vacancy rate statewide, even with an increased number of institutions during the last five years.
  • Implemented national and statewide advertising for all health service disciplines.
  • Participated in career fairs and interactions with colleges and universities for health services candidates.
HIV and AIDS

AIDS Facility
  Inmates with AIDS - This facility was specifically designed for inmates who are seriously ill with AIDS.
 
  • In December 1997, the department opened a special care facility for terminally ill AIDS patients and those with complications from AIDS at Central Florida Reception Center south unit. This facility houses up to 100 of the most seriously ill AIDS patients. Through economies of scale, on-site specialty care, reduced hospitalization, and security costs, this facility reduces the cost of AIDS treatment and provides a more consistent quality of care for these very seriously ill patients.
  • At the University of Miami College of Medicine, several studies are currently under way for FDA-approved drugs administered to volunteer inmates with HIV and AIDS. A world renowned AIDS specialist, Dr. Margaret Fischl, the principal investigator for these studies, serves as a consultant physician to the department and sees many inmates with infectious diseases at no cost to the state.
Partnerships

  • Received a $150,000 annual grant from the Department of Health to provide clinical and epidemiological oversight of inmates and inmate contacts who are infected with tuberculosis and who have or are suspected of having active tuberculosis disease. The program goal is to ensure the timely identification and effective treatment of these inmates.
  • Received a $40,000 grant for the development of a coordinated plan to eliminate tuberculosis that encompasses the contributions of county and state correctional entities and public health staff. The principle objective is to enhance the control of tuberculosis infection in correctional facilities at all levels as part of a statewide tuberculosis program.
  • Received three $50,000 federal grants for inmate peer HIV/AIDS education programs at Lawtey Correctional Institution, Dade and Florida CI. These programs are in partnership with the Department of Health (DOH) and the Centers for Disease Control (CDC). Their goal is to reduce the incidence of HIV/AIDS through education of inmates and staff. The focus is an enhanced counseling/peer education project on a voluntary basis with the aim of referring inmate graduates from the peer educator project to the appropriate DOH community office or organization at the time of the inmate's release.
  • Received a $25,000 Merck educational grant to improve and enhance the health services library.
  • Through the department's affiliation with the University of Miami College of Medicine, many medical students and residents will be rotating through our institutions. Some faculty will volunteer in our facilities and some departmental physicians will be serving as volunteer medical school faculty.