Problem: 125/150 inmates on medication before telepsychiatry
Outcomes: With proper pharamcology via telepsychiatry, this number was reduced to only 30 inmates on medication.
Conclusions: Proper pharamcology with appropriate care and medication solves problems of over or under treating inmates. It also reduces number of inmates who try to “work the system” and saves tax payer dollars.
Problem: High cost of medication for inmates before telepsychiatry
Outcomes: With telepsychiatry and proper formulary adherence they were able to reduce pharmacy costs by almost 2/3 per month and nearly $480,000 annually.
Conclusions: Having access via telepsychiatry to psychiatric prescribers who are well-versed in correctional psychiatry and pharmaceutical options leads to major savings on psychiatric medication.
Telepsychiatry has proven efficient and effective, as is evident by case studies of Array's customers and other clinical research data.
Prisoners with psychiatric emergencies are treated expeditiously reducing liability to the arresting agency. More importantly police officers are spending less time at health care facilities guarding prisoners and are available to protect and serve civilians.
Telepsychiatry also represents access to corrections- specific psychiatrists who are sensitive to the nuances of treating offenders while maintaining adherence to a strict formulary.
Direct Cost Benefits of Telepsychiatry for Jails:
- Lower transportation cost
- Reduce custody & overtime expense
- Reduce offsite (ED) expense
- Lower call obligation expense
- Improve formulary adherence
- Provider suicide watch release
Indirect Cost Benefits of Telepsychiatry in Jails:
- Reduce flight risk
- Improve public safety
- Improve relationships with community providers
- Provide proper inmate care and safety
By: Chief Raymond J. Hayducka, MS, CPM, South Brunswick Police Department
The New Jersey Police Chief
Published: July/August 2009
Most law enforcement agencies throughout New Jersey and the United States are feeling the effects of the economy. This has compelled agencies to reduce costs and do more with less. Through a shared service program law enforcement officials in Middlesex County were able to find a cost effective solution to a problem that has impacted most agencies at one time.
Problem: Police Officers in Middlesex County are required to transport and guard prisoners that are experiencing a psychiatric emergency or threatening suicide prior to being lodged in the county jail on criminal charges.
The prisoner would have to be medically cleared because the correctional facility is not set up to care for prisoners with psychiatric emergencies. Quite often police officers would end up guarding these prisoners at local hospitals for long periods of time due to mental health professionals being unavailable during off hours and weekends to diagnose them.
During a monthly meeting of the Middlesex County Association of Chiefs of Police the issue of guarding prisoners with psychiatric emergencies was discussed.
Middlesex Borough Chief James Benson brought forth the problem after a particularly frustrating experience his agency recently dealt with.
Middlesex Borough Officers were required to spend the entire weekend guarding a prisoner that had a psychiatric emergency.
They had to assign two officers to guard the prisoner for a 48 hour period because of a delay in the psychiatric screening. Most of the time spent by the officers was on overtime. The cost was thousands of dollars from the police department budget.
Many Chiefs in attendance agreed they had experienced the same problem in the past and just one prolonged incident could strain an agency’s budget. During the meeting the Chiefs turned to Middlesex County Prosecutor Bruce Kaplan to help find a solution to this costly problem. Prosecutor Kaplan advised the County Chiefs he would discuss the issue with Middlesex County Jail Warden Edmund Chicci and see if a cost effective solution could be found.
At the next meeting Prosecutor Kaplan and Warden Chicci presented the idea of telepsychiatry. Telepsychiatry is a process that screens prisoners through a video conference. If the program could be implemented law enforcement agencies in Middlesex County would have the ability to have a prisoner with a psychiatric emergency examined by a psychiatric clinician 24 hours per day / 7 days a week / 365 days a year.
CFG Health Systems (sister company of Array), the current provider of medical services for the Middlesex County Jail, and numerous correctional facilities throughout New Jersey and Pennsylvania, was willing to work with the association and run a test pilot program for six months. A committee was formed consisting of law enforcement executives from the Middlesex County Chiefs of Police Association and county officials to study the possibility of implementing a telepsychiatry program.
All the law enforcement executives on the committee agreed that in order for the program to succeed it would be important to minimize the number of trips to local hospitals for the purpose of having a prisoner evaluated.
It is common knowledge among criminals in Middlesex County that you could avoid or delay entry into the county jail by claiming you are suicidal or you are experiencing psychological issues.
Often prisoners would threaten suicide so they could spend time in the hospital instead of the jail. These trips are costly and present security risks. If the trips could be minimized the officers would be available to patrol the streets and the cost to guard these prisoners would be greatly reduced. This was the main goal of the program.
The committee worked with County Jail officials to set up a procedure to have the prisoners screened. A prisoner experiencing a psychiatric emergency or threatening suicide that was set to be lodged in the county jail would be transported similar to a prisoner being lodged under normal conditions.
The only difference would be that the agency transporting the prisoner would be required to notify the jail prior to transport the need for a psychiatric screening. This would give the jail staff time to contact the on-call psychiatric technician and set up the video conference monitor. The officers transporting the prisoners would have to stay with the prisoner throughout the screening until the prisoner has been cleared for lodging at the county jail.
The psychiatric clinician could determine the prisoner is medically cleared to be lodged at the jail and recommend strategies to the jail staff to safely secure the prisoner. The clinician could also determine if the prisoner needed to be transported to a psychiatric hospital.
During the six month test period the average waiting time the police officer has had to spend with the prisoner during the screening was 65 minutes. The time saved transporting the prisoner and waiting for treatment was drastically reduced.
Dunellen Police Chief Gerard Cappella stated “in my 23 years of law enforcement I have never seen a psychiatric screening at a hospital conducted in less than six hours. The time saved is worth participating in the program.”
The main goal of the program was achieved immediately. The amount of time local law enforcement officers were guarding prisoners at hospitals for psychiatric emergencies is almost non-existent.
Police officers can return to the streets faster to perform their normal patrol functions.
It is estimated that in less than six months the savings in overtime expenditures was approximately $75,000. The cost of the program is divided among 26 law enforcement agencies in the county. Each agency is charged per capita based on the population they serve.
The program is considered by many law enforcement executives a great insurance policy. If you use it one time you can recoup your cost by not paying officers overtime to guard prisoners at local hospitals. The total cost for the program will be $36,000 per year.
Monroe Township Police Department was the first agency to use the program. Their cost to participate in the program is $1,383 per year.
The officers brought the prisoner to the county jail on a Friday night. After the prisoner was assessed by the psychiatric clinician she was approved for clearance at the jail. The clinician recommended that the jail conduct a suicide watch for 24 hours which they are equipped and trained to do.
Monroe Police Chief John Kraviec stated “if this situation occurred prior to the implementation of the program my officers would have been stuck at the hospital all weekend guarding the prisoner. It would have cost thousands of dollars in overtime. The program pays for itself the first time you utilize it. My officers came back and told everyone how smooth the system ran. It’s a benefit to the taxpayer by reducing cost and it makes your agency more effective.”
There have been other benefits for law enforcement since the program has been implemented. Officer morale has improved because they now know what to expect when they have a prisoner with psychiatric issues.
Prior to the program being implemented the police officer did not know if they would be stuck guarding the prisoner for an hour or days on end.
This has also led to a better relationship with the jail staff. It is very clear now what the role of the police officer is and at what point the prisoner will become the responsibility of the jail staff.
The prisoner is assessed much sooner and the liability for everyone is reduced because of the faster diagnosis and prescribed treatment. Middlesex County Freeholder Mildred Scott, chair of the county Law and Public Safety Committee, a 28 year veteran and retired Chief Sheriff’s Officer of the Middlesex County Sheriff’s Department recalls being tied up for hours in hospitals with prisoners. “This program improves officer safety and saves the taxpayers money.”
Middlesex County Deputy Freeholder Director Christopher Rafano, who was part of the committee and instrumental in implementing the telepsychiatry program, stated “there will be no reduction in treatment for the prisoner. In fact the treatment would be better because the prisoner will be evaluated faster than if brought to a hospital.”
Les Paschall, CEO of CFG Health Systems emphasized that the program is designed to comply with the Standards for Healthcare Services in Correctional Facilities issued by the National Commission Correctional Healthcare.
It is also designed to meet all constitutional and regulatory requirements as well as the local community standards of healthcare. This innovative solution is an example of a shared service that has proven efficient and effective which is imperative
in these difficult economic times.
Prisoners with psychiatric emergencies are treated expeditiously reducing liability to the arresting agency. More importantly police officers are spending less time at health care facilities guarding prisoners and are available to protect and serve the residents of Middlesex County.
Ray Hayducka is Chief of Police in South Brunswick Township. He currently serves as the 3rd Vice President of the NJ State Association of Chiefs of Police.
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