Transcript Coordinating Effective and Efficient Care of Incarcerated

Coordinating Effective and Efficient Care of
Incarcerated Patients
October 26, 2011
New Mexico Contract
• Ten statewide facilities
• Six facilities are state operated
SCC, PNM, CNMCF, WNMCF, SNMCF and RCC
• Four privately contracted facilities
– NENMDF, GCCF and LCCF are GEO facilities
– NMWCF and WNMCF are women’s facilities (NMWCF is
CCA facility and WNMCF is state facility)
Corizon provides medical, dental, nursing and psychiatry
services at all eight 24 hour facilities
New Mexico Corrections Department provides Mental Health
at six state facilities and private facilities provide Mental
Health at the remainder
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Medical Services New Mexico
NMCD Health Services Bureau
• Stephen A. Vaughn, MD,
PhD; Bureau Chief
• Dan Collins, MD; Statewide
Director of Psychiatry
• Jerry Roark; Director of
Adult Prisons
• Vacant; Secretary of
Corrections
• Susana Martinez; Governor
Corizon New Mexico
• Bill Steiger, Vice President of
Operations
• Paul Torrez, Regional
Director
• Royanne Schissel, RN;
Regional Director of Nursing
• Leonel Urdaneta, MD;
Regional Psychiatry Director
• Patrick H. Arnold, MD;
Regional Medical Director
• Winfred Williams, MD;
Associate Regional Medical
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Director
Intake Facilities
• Central New Mexico Correctional Facility
– Los Lunas, New Mexico
– Male intake facility
– 300-600 intakes per month
• New Mexico Women’s Correctional Facility
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Grants, New Mexico
Operated by Corrections Corporation of America (CCA)
Dual purpose facility
60-100 intakes per month
• Age appropriate intake process including medical,
psychiatry and dental conditions
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New Mexico Contract
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Average daily population 6500
Males: 5800-5900 in 9 facilities
Females: 580-640 in 2 facilities
Physician providers
– 14 primary care
– 15 psychiatry
• Mid-level providers
– 5 Nurse practitioners
– 6 Physician assistants
– 1 Psychiatric Nurse Practitioner
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Organization
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Vice President of Operations
Regional Director
Regional Medical Director
Associate Regional Medical Director
Regional Director of Psychiatry
Regional Director of Nursing
Regional CQI Coordinator
Regional Infection Control Nurse
Tele-Health Coordinator
Regional Data Clerk
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Organization
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Health Services Administrator
Site Director of Nursing
Site Medical Director
Associate Site Medical Director
Off-Site Coordinator
LTCU Case Manager
Physical Therapist
Site Infection Control Nurse
Statewide Consulting Pharmacist
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Infirmary/Observation
• Central New Mexico Correctional Facility (CNMCF)
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Long Term Care Unit (LTCU)
Mental Health Treatment Center (MHTC)
Geriatric Treatment Unit (GTCU)
Alternate Placement (APA)
Penitentiary of New Mexico (PNM)
North East New Mexico Detention Facility (NENMDF)
Guadalupe County Correctional Facility (GCCF)
Lea County Correctional Facility (LCCF)
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Long Term Care Unit
• Housed within CNMCF in Los Lunas, New Mexico
• Provides acute care, housing, monitored and hospice
care
• Not a licensed hospital
• 24 hour nursing care
• 7 day a week provider rounds
• 24 hour a day provider coverage with after hours
coverage being telephone call
• Full time physical therapist
• On site dialysis unit
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Long Term Care Unit
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Administration of intravenous antibiotics
Routine PICC Line and Central Line Care
Provision of wound care with pumps as indicated
On site ultrasound through a sub-contractor
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Lower extremity duplex scans
Carotid duplex scans
Echocardiograms
PICC Line placement
• On site radiology suite with part-time radiology
technician
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Long Term Care Unit
• Management of PEG tubes
• Provision of hyper-alimentation through a
subcontractor
– On site dietician
• Provision of analgesia
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Intramuscular
Intravenous
Trans-dermal
Topical
• Wound care/wound vacuum care
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Long Term Care Unit
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Pastoral Care
Case Management
Discharge Planning
Mental Health Services
Psychiatry Services
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On Site Services
• Nephrology with Renal Medicine Associates
• Podiatry
• Prosthetic and Orthotics
– Center for Prosthetic and Orthotic Design
• Telemedicine for PT to other sites
• Future
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Gastroenterology
Cardiology
Orthopedic Surgery
Urology
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Utilization Management
• Utilization Management Nurse Reviewer
– Sondra Stricklan- Inpatient
– Patra Leara- Outpatient
• Regional Medical Director/Associate Regional
Medical Director
• Vice President of Medical Affairs
– Sylvia McQueen, MD
• Corporate Medical Director for Utilization
Management
– Pablo Viteri, MD
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Communication
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Primary contact is RMD/ARMD
LTCU Medical Director
LTCU Director of Nursing
Health Service Administrator for CNMCF
Security Officers at hospital who accompany inmates
Coordinate discharge planning
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Necessary equipment
Necessary meds
Required follow up appointment
Ambulance transport as needed
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How Corrections Is Different
• Inmate transport places community/facility at risk for
escape and violation
• Medical necessity minimizes this risk
• Inmates are guaranteed medical care by United
States Constitution
• Captive population
• Minimize missed appointments
• LTCU is available for step down care which allows for
decreased length of stay in hospitals
• NMCD costs for security: $1000 per day for inpatient
stays and $564 per emergency room visit
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How Corrections is Different
• Every inmate death requires notification of OMI
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Expected
Unexpected
Homicide
Suicide
• Organ donation
– Inmates are wards of the state
– Contact Bureau Chief for HSB
• Stephen A. Vaughn, MD PhD
– 505-301-2297
• Informed consent
– Can accept or refuse medical care
– Needs excellent documentation or consult with Ethics
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How Corrections is Different
• Missed appointments
• Canceled appointments for subspecialty care or
procedures
• Medical necessity versus medically indicated
Pre-existing conditions
Expected sequela of disease process
Estimated date of release
Do Not Resucitate
Family Visitation
Notification of Family
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How Corrections is Different
• When in doubt, please call us
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Mission
• Provide the best possible care which mirrors the
community standard
• Utilize evidence based guidelines at all times
– Medically necessary
– Guardians of taxpayer dollars
• Limit risk to community, facility and staff
• Work collaboratively with UNM-HSC to establish long
term networks
• Become partners in providing excellent care
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Coordinating Effective and Efficient Care of
Incarcerated Patients
October 26, 2011