1. Collaboration between public health and corrections
Finding Common Ground Between Public Health and Corrections Health: Lessons from New York
Collaboration between public health and corrections

2. How Public Health Differs
Many public health programs affect everyone, e.g. safe drinking water, food sanitation, immunizations
Some public health programs affect sub-groups of society, e.g. MCH, family planning, drug users, et al
In all cases the approach is keeping people healthy, usually applying to populations
So what’s that got to do with corrections?
Collaboration between public health and corrections

3. Who has Guaranteed Access to Health Care US v. AU?
In the US, only incarcerated people have access to health care that is guaranteed by the Constitution
Other groups such as children, disabled, elderly, et al, may have special access programs, but no guarantee
Since Australia tries to provide access to all, there is no incentive to focus on or even include corrections
Because incarcerated people are difficult to access (behind walls and wires and can’t come to our office) and because they are assumed to have done bad things so don’t “deserve” care, they are at the bottom of the care heap.
Collaboration between public health and corrections

4. People who need health care should have the care they need!
(and that includes preventive care!)
Collaboration between public health and corrections

5. Corrections Health and Public Health have not seemed natural Allies
“Liberal do-gooders” v. “conservative tough-on-crime” types
Community v. institutional care
Out of sight, out of mind
Para-military organization
Preventive care v. curative care
“It’s the Culture, Stupid”
Collaboration between public health and corrections

6. Public Health Implications
Interrelationship between what happens on the street and inmates, e.g. injection drug users, TB, HIV, hepatitis B and C, MRSA…
The better the health of our releasees, the better off society is
Releasees who harbor diseases can transmit them in the community!
It is easier to provide public health interventions in prison than on the street
Collaboration between public health and corrections

7. Health Problems are Concentrated in Inmates
They are risk takers—the same risk taking that leads to crime leads to diseases of public health significance
Prior lack of health care (economics and health not a priority)
Nearly all have abused alcohol and/or drugs
Low Income and low education are risk factors for ill health
Collaboration between public health and corrections

8. Communicable Diseases and Corrections
Corrections is not a disease “breeding place”
Best US studies say HIV conversion rate is %/yr
Hammett estimated that in any given year in the US
25% of HIV infected
40% of people with active TB disease
33% of hepatitis C infected—pass through corrections
29% of acute HBV had sometime spent time in corrections,
Jails and prisons see differing situations, e.g.,
1999 report 25% of jailed females in NYC had syphilis
Essentially none found in prisons; screened and treated in jail
Collaboration between public health and corrections

9. Correction Health’s Response
Environmentally safe living conditions
Screen and test
Diagnose
Treat and immunize
Educate
Especially peer education
Video and comic books
Treat substance abuse
Supervise
Collaboration between public health and corrections

10. Interaction Between Public Health and Corrections in NY I
Corrections Health is a Division of Department of Correctional Services (unlike South AU)
Department of Health is a sister agency
DOCS is expected to report reportable conditions
DOCS is treated as a local health agency
Collaboration between public health and corrections

11. Interaction Between Public Health and Corrections II
We treated each other as colleagues
We have a Memorandum of Agreement
DOCS health senior staff and DOH senior staff meet quarterly
DOCS provides funding for joint contracts with community based organizations in HIV
DOH reviews (and “blesses”) DOCS primary care treatment guidelines for HIV and HCV
Daily consulting regarding communicable diseases
Collaboration on continuity programs
Drills for health-related emergencies, e.g., norovirus …
Collaboration between public health and corrections

12. Collaboration with Department of Health
Continuous collaboration essential
Environmental Health
Epidemiology, Disease Investigation
HIV/AIDS
Immunization in facilities
Hepatitis B for all
Family Planning Initiative
Collaboration between public health and corrections

13. Unique Features of Correctional Health
Primary business is secure housing
Disruption, cost and security of medical trips
Health of incoming inmates
Health care is something to manipulate
Incarcerated people have time to do education including health education
Collaboration between public health and corrections

14. Collaboration With Security
Health is not primary mission of DOCS
Security can’t operate well without an effective health care system
Having health as a part of DOCS gives CMO authority in DOCS bureaucracy
Daily contact between health and security on ALL levels
For contracted services, robust monitoring of contracts is essential
Collaboration between public health and corrections

15. Magnitude of the System in New York State
NY has 55 prisons with approximately 57,000 prisoners (in 1995 was 70,000 in 70 prisons)
Nationally, in the U.S., over 2.1 million incarcerated people, 2/3 in federal and state prisons
The principles of organizing a system to assure public health and care don’t differ by size or number; they just need to be adapted
Collaboration between public health and corrections

16. Collaboration between public health and corrections
UPSTATE A
CHATEAUGAY
NEW YORK STATE DEPARTMENT OF CORRECTIONAL SERVICES FACILITIES
ALTONA
BARE HILL
MAXIMUM SECURITY
OGDENSBURG
FRANKLIN
FRANKLIN
LYON MT.
RIVERVIEW
CLINTON R
ATTICA GREEN HAVEN (ANNEX)
AUBURN SHAWANGUNK
BEDFORD HILLS (FEMALES) SING SING (ANNEX)
CLINTON (ANNEX) SOUTHPORT
COXSACKIE SULLIVAN (ANNEX)
DOWNSTATE UPSTATE
EASTERN (ANNEX) WENDE
ELMIRA
GREAT MEADOW
CLINTON HUB
WATERTOWN HUB
CLINTON
ST LAWRENCE
GABRIELS
GOUVERNEUR
ADIRONDACK
JEFFERSON
CAPE VINCENT
ESSEX
MEDIUM SECURITY
WATERTOWN
MORIAH S
ADIRONDACK MID-ORANGE
ALBION (FEMALES) MID-STATE (ANNEX)
ALTONA MOHAWK
ARTHUR KILL ASACTC MT. McGREGOR (CAMP)
BARE HILL OGDENSBURG
BAYVIEW (FEMALES) ONEIDA
BUTLER ASACTC ORLEANS
CAPE VINCENT OTISVILLE
CAYUGA RIVERVIEW
CHATEAUGAY ASACTC TACONIC (FEMALES) ASACTC
COLLINS ULSTER
FISHKILL WALLKILL
FRANKLIN WASHINGTON (ANNEX)
GOUVERNEUR WATERTOWN
GOWANDA WOODBOURNE
GREENE GROVELAND (ANNEX)
HALE CREEK ASACTC WYOMING (ANNEX)
HUDSON
LIVINGSTON
MARCY
LEWIS
HAMILTON
WARREN
WASHINGTON
OSWEGO
GREAT MEADOW
ALBION
ONEIDA
WASHINGTON
NIAGARA
ORLEANS
ONEIDA
ORLEANS
WAYNE
GREAT MEADOW HUB
MONROE A
MOHAWK
HERKIMER
FULTON
SARATOGA
ROCHESTER W
BUTLER
MID-STATE
GENESEE A
HALE CREEK
MT. McGREGOR
BUFFALO W
ONONDAGA
MARCY
AUBURN R
WENDE
MADISON
WENDE HUB
ATTICA
MONTGOMERY
ONTARIO
SENECA
ONEIDA HUB
SCHENECTADY
WYOMING
CAYUGA
ERIE
LIVINGSTON
CAYUGA
GEORGETOWN
ALBANY
RENSSELAER
MINIMUM SECURITY
WYOMING
LIVINGSTON
YATES
WILLARD S
SUMMIT
COLLINS
GROVELAND
CORTLAND
PHARSALIA
SCHOHARIE
BEACON (FEMALES) LYON MOUNTAIN
BUFFALO MONTEREY SHOCK
BUTLER MORIAH SHOCK
EDGECOMBE QUEENSBORO
FULTON ROCHESTER
SUMMIT SHOCK LAKEVIEW SHOCK (INCL FEMALES)
LINCOLN
OTSEGO
LAKEVIEW
GOWANDA
ELMIRA HUB S
SCHUYLER
TOMPKINS
GREENE S
MONTEREY
CHENANGO
CHAUTAUQUA
CATTARAUGUS
ALLEGANY
COXSACKIE
STEUBEN
DELAWARE
GREENE
HUDSON
CHEMUNG
COLUMBIA
ELMIRA
TIOGA R
BROOME
MINIMUM SECURITY: CAMPS
LEGEND
SOUTHPORT
ULSTER
DUTCHESS
SULLIVAN
GABRIELS PHARSALIA
GEORGETOWN R
ULSTER
GREEN HAVEN
MAXIMUM CORRECTIONAL FACILITIES
WOODBOURNE
EASTERN
DRUG TREATMENT CAMPUS
SULLIVAN
SHAWANGUNK R
DOWNSTATE
MEDIUM CORRECTIONAL FACILITIES
SULLIVAN HUB
WALLKILL
FISHKILL
WILLARD (INC. FEMALES)
ORANGE
BEACON
MINIMUM CORRECTIONAL FACILITIES
OTISVILLE
PUTNAM
GREEN HAVEN HUB
MID-ORANGE
(MINIMUM CAMPS) CORRECTIONAL FACILITIES
WESTCHESTER
ROCKLAND
TACONIC R
RECEPTION CENTERS
DRUG TREATMENT CAMPUS R
BEDFORD HILLS
SING SING W
WORK RELEASE
EDGECOMBE
BRONX W W
FULTON
NASSAU
SUFFOLK S
SHOCK INCARCERATION
LINCOLN
Collaboration between public health and corrections
BAYVIEW W
QUEENSBORO A
ASACTC
NEW YORK CITY HUB W
QUEENS
RICHMOND
KINGS
ARTHUR KILL A
Varelli 7/99

17. Demographics Differ from the Community
Ave. age 36.5 years, women slightly older
5 % are age 55 or older
94.5% male
51.1% African-American, 26.3% Hispanic
47% have less than high school education
20% married
59% have children
Collaboration between public health and corrections

18. Blinded Seroprevalence Surveys
Done by DOH in collaboration with Corrections on blinded-collection blood samples from admission exams
Every other year
Provides a window on the community
HIV and Hep B and C
Collaboration between public health and corrections

19. Collaboration between public health and corrections
Major disease issues:
Approximately 4 % of males HIV infected, 10.6 % of females [Was 18% m and 20% f ]
Collaboration between public health and corrections

20. HIV Seroprevalence Trend
HIV seroprevalence rates for male inmates dropped 83% between 1988 and 2005
HIV seroprevalence rates for female inmates dropped 43% over the same period
HIV seroprevalence declined over time for both male and female inmate
Collaboration between public health and corrections

21. HIV-Related Death Rate in DOCS (Rate per 10,000)
Collaboration between public health and corrections

22. Collaboration between public health and corrections
Major disease issues:
Approximately 11.2 % of males infected with hepatitis C, 15.5 % of females [Was 13.4 % m and 24.1 % f ]
Collaboration between public health and corrections

23. Collaboration between public health and corrections
Hepatitis C Seroprevalence Among Incoming Inmates Entering NYS DOCS
Collaboration between public health and corrections

24. Collaboration between public health and corrections
Major disease issues:
19% have TB infection at reception
90 – 95% decrease in disease if prophylaxis for those with infection
Annual PPD test with “mandatory” prophylaxis if infected
Disease has decreased from 225/100,000 to 6 or less (no new disease cases for several years)
Collaboration between public health and corrections

25. TB Case Rate per 100,000 DOCS Inmates
Collaboration between public health and corrections

26. Collaboration between public health and corrections
Major disease issues:
90% give history of drug abuse or test positive for alcohol abuse
Use incarceration time for something useful like drug and alcohol education and prevention programmes rather than just for punishment
Collaboration between public health and corrections

27. Major Health Issue: Pregnancy
All women are tested for pregnancy and STD’s at reception
6% pregnant
Prenatal care starts immediately
High risk deliver at medical centre; normal risk at community hospital
Room-in with baby/infant for up to 18 months to allow bonding; structures to maintain relationships
Training in parenting
Collaboration between public health and corrections

28. Collaboration between public health and corrections
Women’s Health
Peer education
Family planning services before discharge
Collaboration between public health and corrections

29. Collaboration between public health and corrections
Major Health Issues:
Incredible dental neglect (m. 13 teeth mdf, f. 15)
Dental care for all
Office of Mental Health estimates 14 % are mentally ill
They estimate 1/3 of these are seriously and persistently mentally ill
Spectrum of care from outpatient to forensic hospital
MRSA (NIH funded study with
Columbia University)
Collaboration between public health and corrections

30. Collaboration between public health and corrections
Major disease issues:
Aging population
Longer term sentences mean older inmates with increasing health issues and needs for accommodations
NY built 5 LTC facilities in maximum security including a unit for the cognitively disabled
Collaboration between public health and corrections

31. Increase in % of Aging Population
Collaboration between public health and corrections

32. Collaboration between public health and corrections

33. Collaboration between public health and corrections

34. Description of NYS System: Greater Focus on Prevention
Health education
Peer education
Video and comic books
Immunizations (including HBV)
Treat latent TB Infection
Screening informed by US Preventive Medicine Task Force Guidelines
Collaboration between public health and corrections

35. Transition from Prison to Community
Most inmate/patients return to the community
(Average LOS in NYS DOCS about 4 years)
CBO assistance in arranging continuity of care for HIV infected patients
OMH working with continuity for mentally ill
Hepatitis C Continuity Program
Other chronic diseases?
Collaboration with NYAM
Family Planning for women in last 90 days of prison term, begun March 2009
Collaboration between public health and corrections

36. Collaboration between public health and corrections
Continuity Issues
Linking with Medical Home
Health care SYSTEM literacy
Don’t we all need that?
Effect of health care continuity on recidivism?
Collaboration between public health and corrections

37. Description of NYS System: Use Telemedicine
Decrease medical trips
More ready access to care
More humane for sick
Serendipitous education for primary care staff
Use equipment of staff education
Tele-triage potential ER trips
25% avoided
Collaboration between public health and corrections

38. Collaboration between public health and corrections

39. Collaboration between public health and corrections
Research Projects
Comparison of babies born to incarcerated mothers—NIH funded study
Prevalence and incidence of MRSA—NIH funded study with Columbia University
Diagnosis of diabetes mellitus
Age-specific death rates in HIV/AIDS
Development of Peer Education curriculum for women
Collaboration between public health and corrections

40. NYS DOCS Health Care System
Lessons in Collaboration
Collaboration between public health and corrections