Telemedical Opportunities Behind Bars

In a landmark decision, Estelle v. Gamble, 429 U.S. 97 (1976), the United States Supreme Court affirmed that prisoners have a constitutional right to adequate medical attention. The Court held that correctional facilities exhibiting a “deliberate indifference” to an inmate’s medical needs are in violation of the Eighth Amendment. This decision required state-funded prisons to provide adequate levels of health care for inmates, and as a result, to incur the costs associated with providing care. In recent years, the cost of providing that care has substantially increased, creating a significant financial burden on state penal systems. These increased costs are predominantly linked to three factors: 1) the distance between prisons and health care providers; 2) the prevalence of mental illnesses among inmates, and; 3) an aging inmate population. Telemedicine, as a method of delivering health care, is perfectly-situated not only to curb these factors and improve access and the quality of health care for inmates, but also to. Dramatically reduce costs for state prisons.

Telemedicine drastically cuts the amount a state prison must spend on prisoner transportation, including the surveillance and security costs associated with travel. Telemedicine’s remote characteristic allows prisoners to stay within the confines of the prison, and allows doctors to treat patients from their homes or offices. For example, one Texas psychiatrist is able to see sixteen patients (at multiple different prison locations) a day without leaving his suburban home. Moreover, doctors often prefer not to be face-to-face with hostile inmates​. Telemedicine provides safety for doctors while still allowing them to provide care. Thus, telemedicine makes health care less costly because state prisons save travel costs and doctors are no longer incentivized to charge higher fees for costs associated with travelling to the prison and reluctance to treat hostile inmates.

Telemedicine also has the potential to improve the quality of care for prisoners with mental illnesses because it allows doctors to interact with and treat prisoners more consistently. Telemedicine permits real time monitoring and communication so doctors can stay up to date on patients. One New York doctor practicing telemedicine found that many of the inmates grew to prefer interacting through telemedicine. While the inmates initially disapproved of the process, they soon realized that most, if not all, of their medical needs can be satisfied by telemedicine. Telemedicine provides a communication and treatment system that fosters an approach aimed at providing value-based care for a cost-effective price.

Lastly, while telemedicine cannot lower the age of the people in prison who need health care, it can provide a flexible alternative to providing the older population with in-person care. Inmates are older, sicker, and staying in prison longer than ever before. Prisons need to manage the special needs of elderly inmates with creative and thoughtful policy decisions, such as telemedicine. One study found that there is a broad-based support for telemedicine technology from inmates, staff, and healthcare professionals. Like inmates with mental illnesses, an older inmate population’s access to care can be significantly increased through telemedicine. Not only is it feasible for an inmate to seek doctor’s advice more often, but that same inmate may have more expansive access to specialists as well. Furthermore, telemedicine can help the elderly who are physically incapable of receiving medical attention outside the prison.

In 2011, the Bureau of Justice Statistics found that nearly 20% of the $38.6 billion spent maintaining correctional facilities was spent on inmate health care. However, several states have been able to cut the costs associated with providing health care to inmates through telemedicine. One such state, Texas, has traditionally been a leader in implementing telemedicine practices in its prisons. Texas holds over 153,000 inmates (the largest population of inmates in any state), and has been able to substantially reduce health care costs through telemedicine. The state conducts over 127,000 telemedicine visits a year with inmates in eighty-three correctional facilities. While, in 2011, the national average​ of spending per prisoner on medical care was $6,047—the average spending per prisoner on medical care in Texas was $3,805. Telemedicine has played a vital role in cutting health care costs in Texas prisons, and other states should take notice and be willing to implement telemedicine practices in their own prisons.

Colin Rathe is a current student at DePaul University College of Law. Colin previously attended Illinois Wesleyan University where he received his Bachelor of Arts degree. He has a wide interest in a variety of litigation-related courses, and has a special interest in health law. Colin will graduate in May of 2018.