Doctors treat inmates without leaving their offices

CLEVELAND, OH (WOIO) - The Cuyahoga County jail has implemented a telemedicine program for inmates. Officials tell us that it saves taxpayer money and provides early detection and prevention, but there are detractors who question the program. 

We sat in on a telemedicine consultation, where a patient who had a seizure disorder before he was placed behind bars, had a consultation with a cardiologist. 
 
The cardiologist, a specialist from Metro Health, was able to hear heart sounds, see and speak to the patient, and see heart rhythms printed out on a page.  Two nurses, and doctor Thomas Tallman, the medical director at the jail were also present for the consultation. The personnel present would do things like physically move the stethoscope around for the doctor on the other end of the video call. 

"It really has the capability of anything you might want to do face to face other than them reaching through with their hands and grabbing the patient," said Tallman.  "We keep it pretty comprehensive," Tallman said of each telehealth consultation. "By the time they're done I think it matches the experience of being directly in the office pretty closely." 

Tallman said the high-tech machine has an excellent camera that's able to clearly show doctors what's on the other end of the video. He said that the technology has advanced so significantly to be able to provide a high level of care remotely. 

In fact, Tallman said it's even better in some ways than an in-person visit, "there's a stethoscope on, the heart sounds that are transmitted through this are probably better than that I hear through my stethoscope." 

He also said that inmates are able to see specialists a lot more quickly through the telemedicine program which is critical in a jail setting where inmates may be behind bars for only a relatively short period of time.
 
"Get things started in here and maintain on the outside and you can prevent a lot of the problems that we sometimes deal with in here," said Tallman. 

Tallman also told us that the jail and MetroHealth have been able to reduce the number of hospital transports by more than half as a result of initiatives like the telemedicine program. 

MetroHealth's website cites a variety of things like the '"virtual visit" telemedicine program, on-site chronic disease program (CDP), expanded in-house x-ray/ultrasound imaging and laboratory support, and ongoing skills training (e.g., wound care, orthopedics, suturing)." 
 
Tallman provided us information showing that hospital transports decreased this year from a high of 122 transports in the month of January to 17 hospital transports in June. 

"It saves money and the time with having two deputies have to go with them stay for hours typically to get a visit completed to and from the hospital, so we can do this and then decide if that is necessary," said Tallman.

He stressed that if there is an emergency or a need to go to the hospital patients will still be sent there. 

Reducing the number of transports saves taxpayer dollars. MetroHealth gave us numbers for the costs of average hospital visits broken down by month in 2016, and the average cost of a hospital transport was more than $800. 

Studies nationwide are showing a lot of cost savings as a direct result of telemedicine behind bars.

A report put out by the Pew Charitable Trust and the John D and Catherine T MacArthur Foundation found that in Georgia telehealth saved about five hundred bucks per digital visit behind bars.  In California, the state's Legislative Analyst's Office estimated the telehealth savings for inmates were roughly $2000 per inmate. That report estimated the cost to guard and transport one inmate to the hospital costs $2000 or more per day.  A Texas study published by the University of Texas Medical Branch estimated telehealth programs behind bars saved the state $780 million from 1994 to 2008. 

There are detractors to the program. Mike Brickner, a local representative of the ACLU told us that they acknowledge that the jail has some "special challenges" in dealing with the medical care of inmates, and that "anywhere you go, whether you're dealing with telemedicine or in person, our prisons and jails are under resourced and over taxed with people."
 
Brickner said he recognizes that inmates might receive medical attention quicker, but he did question the quality of that care. He said he thinks that by conducting a medical exam via video call, that doctor might miss some things about the patient.

"Telemedicine could be effective in some cases – but it's also possible that telemedicine could miss something or lead to a prisoner being misdiagnosed," said Brickner. 

MetroHealth said they take the responsibility of caring for inmates very seriously, and look at telemedicine as just another way of doing that.

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