Sandra Bland Act Mandates Telemental Health Access
By Julie Anderson
The 85th Texas Legislature’s mandate requiring telemental health access in county jails may seem daunting at first. However, correctional care experts say that while finding providers may be a challenge, the setup itself is not so difficult; after all, telehealth has been well used in prisons for decades.
Correctional Health Care and Telemedicine
The Correctional Managed Health Care Committee (CMHCC), authorized by Chapter 501, Subchapter E of the Texas Government Code, was originally established by the 73rd Texas Legislature in 1993 to address the rising costs and operational challenges involved in providing health care to prisoners confined in the Texas Department of Criminal Justice (TDCJ).
The CMHCC oversees a health care partnership between the TDCJ, Texas Tech University Health Sciences Center (TTUHSC) and the University of Texas Medical Branch at Galveston (UTMB).
The original mission of the committee was to develop a statewide managed health care plan that provides TDCJ offenders with timely access to quality health care while also controlling costs. Both TTUHSC and UTMB have utilized telemedicine to help fulfill this purpose.
TTUHSC Correctional Managed Health Care (CMHC) provides health services to offender patients in state prisons, jails and transfer facilities throughout the West Texas region, reported Will Rodriguez, senior managing director for TTUHSC CMHC. This region includes 21 units at 17 geographic locations, and all are telehealth enabled.
“We’ve found our telehealth program maximizes provider resources and mitigates some of the innate challenges of the correctional environment,” Rodriguez shared.
UTMB’s Correctional Managed Care (CMC) program provides complete medical care, psychiatric care, and dental services to approximately 118,000 offenders within the TDCJ at approximately 83 facilities throughout the state, said Dr. Owen Murray, executive director of clinical services and chief physician executive for the UTMB-CMC program. With the addition of several Texas juvenile facilities and four county jails, the total number served is about 122,000. The telemedicine component of each program is a supplement to what the correctional facilities already have on-site.
“Telemedicine service is very amenable to delivering a wide spectrum of health care services,” Murray offered. “The technology is expanding so rapidly with the frame speed increasing to basically ‘real’ time, so there is no gap in being able to see the patient and talk effectively,” he continued. “The improved technology has been accompanied by a decrease in equipment cost, making telemedicine effective in a gamut of clinical settings.”
Equally important to the success of telemedicine is the availability of electronic health records.
“I may be in Galveston seeing a patient from Beeville, and I have access to the patient’s medical records as if I am sitting right there with the patient,” Murray explained. “The ability to review the electronic chart has helped improve the efficiency and quality, whereas before users had to pick pieces out of charts and fax them back and forth.”
When it comes to correctional telemedicine, one of the primary benefits is the public safety component, Murray emphasized, as taking an offender off the prison premises increases the risk of incident.
“Often, when you hear of escapes the occurrence has involved health care,” he noted.
UTMB also provides correctional telemedicine for four counties: Burnet, Comal, El Paso and Victoria. In addition, UTMB has contracts with Victoria County and University Health Systems (Bexar County Jail) for psychiatric services.
New County Mandate
On June 15, 2017, Gov. Greg Abbott signed Senate Bill 1849, known as the Sandra Bland Act, into law. Among other requirements, the new law mandates that county jails:
- give prisoners the ability to access a mental health professional at the jail through a telemental health service 24 hours a day; and
- give prisoners the ability to access a health professional at the jail or through a telehealth service 24 hours a day, or if a health professional is unavailable at the jail or through a telehealth service, provide for a prisoner to be transported to access a health professional.
The deadline for the Texas Commission on Jail Standards (TCJS) to adopt rules and procedures regarding these new requirements is Sept. 1, 2018. The county must comply with these new requirements by Sept. 1, 2020.
The Sandra Bland Act also created an account titled the Prisoner Safety Fund. Counties that operate a jail that is 96 beds or less may apply for grants to assist in paying for capital improvement upgrades to county jails, specifically newly required cameras and sensors, another component of the legislation. Depending on the level of funding, leftover money could possibly go toward the telehealth equipment, but not ongoing costs. The grant program is currently in development. (To read about the Sandra Bland Act in full, see the December 2017 issue of County Progress.)
Murray does not view setup cost as the most challenging aspect of the telemental health mandate. After all, the mental exam is mostly conversational. In fact, Murray said, telemental health could be as simple as Skype, which is a form of telecommunications software that facilitates video chat. Of course, the connection must be secure and guarantee privacy.
“On the mental health side, there are a lot of inexpensive vehicles that can be used to meet the intent of the law,” Murray observed. However, the difficulty may be in finding providers.
“It will be a challenge to staff,” he surmised. There are approximately 45,000 psychiatrists in the United States, and that number is “staggeringly small.” With that said, the legislation references access to “mental health professionals.” Once that definition is clarified, as to who qualifies as a professional, and other rules are established, it will be easier to proceed with a delivery model, Murray said.
With regard to telemedicine and physical health, the initial costs could range from $3,000-$5,000 for equipment, depending on the sophistication level, Murray stated. Ongoing costs would depend on the spectrum of services and arrangement with the provider.
Counties interested in telehealth services are welcome to contact UTMB and request a mock run and view current contracts and business plans, said Steve Smock, associate vice president Comprehensive Health Care for UTMB CMC, firstname.lastname@example.org.
“We would be able to discuss various telemedicine delivery systems from very basic to rather elaborate,” Smock detailed. Or, the county could request a site visit at the jail facility.
“Currently, we don’t have a set-fee basis,” he explained. “The cost would depend upon the elaborateness of the telemedicine equipment they desired, the level of care they required, and the volume of care they required. We have discussed both a subscription account with a set number of authorized visits, or a fee-for-service basis.”
Burnet County hired UTMB to provide medical and dental services in November 2015, including telehealth. Four “presenters” – all UTMB employees – work at the jail and facilitate the telemedicine exams.
Victoria County contracted with UTMB one year ago for medical, dental and mental health services, including telemedicine and telemental health provisions.
The telehealth options are a supplement to what the county has on-site, Murray noted.
“This arrangement with UTMB was a step in the right direction,” shared Victoria County Judge Ben Zeller. “Aside from providing much-needed health care specialties, including psychiatry, UTMB now assumes the liability for medical actions performed in our county jail.”
The UTMB partnership gives Victoria County inmates access to 26 physician subspecialties through telemedicine.
“Appointments conducted through telemedicine eliminate costs associated with escorted, offsite transports and related security matters,” said Roy Boyd, chief deputy with the Victoria County Sheriff’s Office “This allows the detention division to keep the inmates within the security of the facility. It is also cost effective and provides access to diverse medical expertise.”
The telemental health arrangement includes four hours of scheduled mental health consults. Once the telemental rules have been set and the effective date of the Sandra Bland Act approaches, adjustments will be made to telemental health access, Smock shared.
“At any given time, between 60 percent and 70 percent of Victoria County inmates are on psychotropic medications,” Boyd reported. “It was key for us to get some sort of mental health component with our medical care.”
There was no initial cost to Victoria County for the setup during the transition, Boyd specified. The ongoing cost is a monthly fee as dictated in the UTMB contract to provide medical services.
When it comes to providing professional health care to inmates – whether it be physical or mental health care – Boyd operates from a purposeful premise.
First, whereas before the jail staff was assisting in the health process, the jail staff is now free to do more of what they are meant to do, which is keep watch over the inmates and ensure the jail is safe and secure.
Second in this “win-win” arrangement is taking proper care of the inmates, who are innocent until proven guilty, Boyd emphasized.
“Part of ensuring that we are doing the right thing for these prisoners is giving them the care they need,” Boyd maintained. “If they wish to be productive members of society when they are released, then we want to try and do the best for them while they are here. That’s how we see it.”
Counties wishing to learn more about Victoria County correctional care including telehealth services are welcome to contact Boyd at 361-574-8002.