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Dec. 12, 2011
LANSING A year after building a new health clinic inside the state prison here, officials at the Kansas Department of Corrections are so pleased with the results that they are starting to plan for another, perhaps inside the prison at Winfield.
The clinic at Lansing Correctional Facility is part of the state's strategy for controlling inmate health care costs, officials said.
As services are provided within prison walls, many costly hospital fees can be avoided and fewer staff hours are required for security, said Viola Riggin, director of health care services for the prison system.
The clinic also provides improved access to routine, preventive care, which minimizes the number of major procedures performed on inmates, she said.
As wards of the state protected by constitutional safeguards against “cruel and unusual” punishment, inmates are guaranteed health care services.
"They definitely don't get Cadillac care. They get constitutionally necessary care," said Riggin, whose office is charged with ensuring the care meets national standards. "It's a very thin line that we have to walk to make sure we're providing adequate service without being overindulgent.”
Kansas paid managed-care contractor Correct Care Solutions $46.1 million for inmate health services in 2010. There were 9,004 prisoners in the system.
In 2000, the state paid then-contractor Prison Health Services $21.4 million to care for 8,513 inmates.
Riggin said the managed care contract and the new clinic at Lansing have helped contain the state’s costs. This year, the contract is expected to cost $45.5 million though the inmate population has grown to 9,186.
The clinics at Lansing at other state facilities mean that most health services, particularly those for treating chronic illnesses, can be provided within prison walls. That spares the expense of more frequent hospital trips, each of which requires at least two guards to accompany the prisoner.
For example, inmates with kidney failure are housed at Lansing or at the women's prison in Topeka — both of which provide on-site dialysis. The three- to six-hour treatment removes excess water and waste from the blood and is typically administered three times a week.
"A lot of states don't have inpatient dialysis (for inmates). We do — and that's one of our huge cost savings," Riggin said.
Upgrading from a ‘ward’
The new two-story, 48-bed clinic at Lansing cost $5.5 million, paid for by bonds, on which the state makes payments each year from the State General Fund. Because the facility was built largely using inmate labor, it cost less than half of what a comparable free-world clinic would cost, according to recent facility construction costs provided by the Kansas Hospital Association. Its costs are not factored into the contract with Correct Care Solutions or counted in the state’s calculation of inmate health costs.
The new facility also has improved security, officials said.
Lansing Deputy Warden Kyle Deere said the previous 19-bed clinic was in a 30-year-old Morton-style building.
"It wasn't a good security setting for a prison. There were blind spots ... it was loud at times," Deere said. "It was just not conducive to good health care services at all. I’m not saying the health care wasn't good. It just didn't correlate with healing. When you go to a hospital, it's supposed to be comfortable, it's supposed to be fresh, and this was an old, old building."
Nurse Anne Marie Dalton echoed that sentiment.
"This is so high-tech compared to that," she said. "It's just a lot cleaner, private, a lot safer. It's a lot more sophisticated. You really feel like you're doing more quality nursing care. The other one was just, I mean, a ward. You just couldn't keep it clean, you couldn't keep (out) germs, infection, staph."
More conducive to health care
The new facility features negative air circulation to minimize airborne pathogens.
The glassed-in nursing station that Dalton works from is on the clinic’s second floor. It provides direct lines of sight to all of the units surrounding it, as does the guard's station just outside the glass.
At the station, Dalton and two other staff members can prepare medications, review electronic health records and perform other tasks while monitoring the 48 short- and long-term beds, including two adjacent intensive care beds, long-term care multibed rooms and cells for inmates who are on suicide watch or have other high-risk needs.
The first floor of the clinic features another nursing station and guard post with views into the waiting room — a large concrete space resembling a garage with a bench built into the wall all around. Though there are no magazines to read or forms to fill out, inmates move about and are admitted for care mostly without restraints or accompaniment by guards.
The first floor also includes a string of examination and treatment rooms, the dialysis center, offices, an emergency room constructed for treating up to two hostile inmates at the same time and a room outfitted for telemedicine that's digitally connected to the state's other seven correctional facilities.
Inmates also may be treated outside the clinic — particularly those who need regular care, such as diabetics confined to "the hole." Several times a day, nurses visit that lockdown area, which is reserved for the most volatile inmates, to test blood-sugar levels and administer insulin shots.
“It would take too much manpower and too much time if we had (guards) escort everyone to the clinic to get their insulin,” she said.
Though the clinic has beds for 48 inmates, to control costs only half of the beds are used, said Riggin, the corrections health director. She said it takes more than eight full-time nurses to operate the clinic at half-capacity for 24 hours. It would take nearly twice that to open the rest of the clinic.
"So we don't open half of it because of the budget crunch. We'll keep the 24 beds offline for at least this fiscal year," Riggin said. "If we opened it, we would fill it. And some of our patients would do better in the infirmary than in general population. But it's a matter of practicality.”
She said the agency was requesting funds in the coming fiscal year to open the other 24 beds.
Centralizing special services
Seven of the state's eight correctional facilities specialize in one or more health care services. Inmates with special health needs are transferred to the appropriate facility when possible. The seven prisons together have 103 beds for inmate health care.
Lansing specializes in cardiac and orthopedic services. It's also where all male inmates with kidney failure are housed. It is equipped to handle 26 dialysis patients. This year, an average of five patients per week have been on dialysis.
Winfield Correctional Facility is the one prison without a well-defined specialty, but plans are being developed to potentially change that.
Administration officials are working to identify an existing building or perhaps build a new one that would specialize in treating geriatric inmates with more intensive needs. Riggin said about 175 inmates currently need such services.
"Right now, they're dispersed around the state and we're trying to get them all at Winfield," Riggin said.
Winfield's small, minimum-security facility would be well-suited for elderly, wheelchair-bound or otherwise largely immobile inmates, she said.
But, she said, "We're looking at any area (in the state) that can meet our needs. It's a top priority. We're asking for anyone in the community who's interested to put forward ideas and solutions.
“Hopefully in the next year or two we can fund that, because we could very much use it. It means the difference on whether someone stays in a cellhouse who's on oxygen and in a wheelchair versus living (in a clinic) where we can keep a closer eye on him."