Coordinating Effective and Efficient Care of Incarcerated Patients

October 26, 2011

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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 facilitiesNew 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 Director

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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– 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• 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• 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• 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)

– 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• 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

– 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– Intramuscular– Intravenous– Trans-dermal– Topical

• Wound care/wound vacuum care

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Long Term Care Unit• 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

– 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• 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

– 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

– 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

Panel

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How Corrections is Different• Missed appointments• Canceled appointments for subspecialty care or

procedures• Medical necessity versus medically indicated

Pre-existing conditionsExpected sequela of disease processEstimated date of release

Do Not ResucitateFamily VisitationNotification 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

Coordinating Effective and Efficient Care of Incarcerated Patients

October 26, 2011