CorrectCare

Facility Profile:
Small Jail Makes Big Strides in Care

by Jaime Shimkus

It was a cause for celebration at the San Miguel County Detention Center when it achieved NCCHC accreditation last July. The warden, Patrick Snedeker, even arranged a special meeting with the county commissioners during which the accreditation certificate was presented by NCCHC cofounder B. Jaye Anno, PhD, CCHP-A.

Snedeker, who has been warden for eight years, had long set his sights on this goal for the jail, which is in Las Vegas, NM. “The people we serve are residents of our community and we are entrusted with a great deal of responsibility for them,” he says. “Health services is a critical component, so we want to reflect the best practices and national standards.”

The fact that the jail is a small facility, with an average daily population of about 113, was no deterrent. In fact, its small size and limited internal resources have been the catalyst for several innovative achievements aimed at improving care in a cost-effective manner.

The accreditation process was set in motion about two years ago when a nonprofit agency, Health Care Partners Foundation, was contracted to assume full responsibility for provision of health services. (Mental health services are provided by the Behavioral Health Institute, a state-owned psychiatric hospital.)

HCP had handled certain health management services for several years prior, but, says HCP president and CEO Rita Torres, “When we gained complete control of the medical units, we were able to establish policies and procedures based on NCCHC’s standards. We could then ensure that everything was being done appropriately.”

At that time, Deborah Johnson, PA-NP, came on board as the facility’s medical care provider. She had been through the NCCHC accreditation process twice before while working at the New Mexico State Penitentiary and helped in bringing the jail into compliance with the standards. The whole team embraced the idea of becoming accredited, says Johnson. “We work really hard to deliver quality care.”

Quality Through Collaboration
Another way the jail is striving to improve quality is through creative partnerships. Case in point: Project ECHO, a telemedicine program offered through the University of New Mexico School of Medicine. The program was created to provide specialty care for chronic and complex diseases for community health clinics in rural and underserved areas, but Snedeker saw its value for incarcerated patients. Program officials agreed and now the jail has technology that enables access to telepsychiatry and about a dozen medical specialties, including hepatitis C. “It is difficult to provide specialty care in a small facility,” says Torres. “Project ECHO makes a tremendous difference in managing those high-risk cases, and it doesn’t cost us anything.”

Better yet, case review by specialists has decreased costs by having expert opinion on what is medically appropriate. As an example, Johnson says that substituting pricey antipsychotics for older medications when appropriate has led to dramatic reductions in pharmaceutical expenditures.

Also related to Project ECHO is an inmate peer assistance program being developed for jails with San Miguel serving as the pilot. It involves two types of activities. In one, inmates are trained to educate their peers on how to reduce hepatitic C and HIV risks related to injection drug use. In the other, inmates provide continuous suicide watch in the interim between checks by a corrections officer.

The partnerships don’t stop at the state line. Due to a shortage of medical providers in New Mexico, Torres and Johnson have worked with Colorado State University, Pueblo, to develop a two-year residency and fellowship for its graduate nurse practitioner students. In the program, which began this year, students spend the first year in rotation through correctional facilities, including San Miguel, and the second year in a fellowship at a single site. The students will receive specialty training (including the NCCHC standards) through a community college near the jail.

The Bottom Line
The jail met yet another goal this year when it completed its transition to electronic medical records. “This will assist with continuity of care,” says Torres, “and will make it so much easier for maintaining accreditation.”

As a whole, these efforts to improve quality of care also pay off financially. According to a June 2011 report on medical services, the medical budget has not increased in any of the past seven years and is actually below the 2004 level. In fact, cost savings have enabled the addition of services and staff, with an increase in patient medical visits for better continuity of care.

— About the author: Jaime Shimkus is the editor of CorrectCare. Contact her at editor@ncchc.org.

[This article first appeared in the Fall 2011 issue of CorrectCare.]