By Jaime Shimkus

It says something about teamwork and professional pride that no fewer than six individuals walked onstage when McCain Correctional Hospital was honored as 2004 Facility of the Year during the awards ceremony at NCCHC’s National Conference last November.

The NCCHC committee charged with selecting a winner commended McCain’s “excellent professionalism in providing for the health needs of a diverse and challenging population.” That achievement is made possible by the hospital’s well-developed culture of cooperation, not only among the caregivers themselves but also extending to the administrative and security staffs.

Located about 20 miles west of Fayetteville, the minimum-security facility is operated by the North Carolina Department of Correction’s Division of Prisons, and admits male inmates in need of medical care from throughout the state. While the special needs of these inmates are indeed diverse, there are common threads, particularly chronic conditions, impaired mobility, geriatric infirmity and need for dialysis.

Overcoming Limitations
The fact that the facility is a former sanatorium works both in its favor and against it, says former medical director Abhay Agarwal, MD, who recently was promoted to deputy medical director at the DOC. On the plus side, the building’s hospital design promotes the health care mission in a less-penal atmosphere. The downside: The functionality of the 85-year-old building is hardly state-of-the-art.

Another challenge, common to many correctional facilities, is recruitment and retention of health care providers. Agarwal says a medical rotation program for nurses has helped to alleviated shortages, and a similar approach may be tried for physicians.

Despite the “tough environment,” Agarwal notes, the staff succeeds in providing comprehensive health care thanks to hard work, cooperation and dedication to quality improvement. In fact, while NCCHC prison standards call for quarterly meetings of a multidisciplinary QI committee, at McCain the group meets monthly to keep close tabs on quality of care.

Beyond that, frequent communication in general has been key to cultivating an organizational culture that values mutually supportive attitudes between custody and health staffs. (For more on this subject, see the Spotlight article in the Fall 2004 issue of CorrectCare.)

Providing such comprehensive care can be costly, so to make best use of limited resources, McCain, like other NC DOC facilities, is guided by a computerized utilization review program that is managed at the state level by Agarwal. Borrowing from the community managed care model, this business tool saves money while maintaining quality care, he says.

Quality of Life
Fostering a healthy quality of life is important at McCain, and to that end the facility offers inmates activities such as exercise classes, horseshoes and ceramics. Programs to promote mental and social well-being include “reminiscent therapy” group sessions, horticulture therapy and collaborative activities organized by prison and community senior citizen clubs.

To aid patients at the end of life, the prison became the first in the state to offer hospice care. Designed to be similar to a community hospice, the program uses dedicated infirmary beds to provide compassionate pain management and palliative care for those suffering with AIDS, cancer and other terminal illnesses. The hospice team includes trained custody staff, physicians and nurses, social workers, pharmacists, chaplaincy staff and volunteers.

Among the goals of the DOC’s health services department are “to view correctional facilities as public health stations that significantly impact the health status” of the community and “to improve the health status of the inmates and the citizens of North Carolina....”

That broad interpretation of “prison health care” is evident in McCain’s strong continuity-of-care efforts. The hospital employs social workers to manage release planning, nursing home placement and aftercare planning for medical and mental health services. This includes establishing enrollment in Medicaid or other insurance programs.

With such strong public health linkages, McCain’s correctional health staff are, in a sense, extending their compassionate care to the entire community.

— About the author: Jaime Shimkus is NCCHC’s publications editor. To contact her, e-mail jaimeshimkus@ncchc.org.