CMC transportation receives upgrades for efficiency, safety
By John Koloen
FEB. 7, 2007--When Bryan Schneider was given the assignment of improving medical transportation for Correctional Managed Care, he turned to Dwight Eisenhower for inspiration. He focused on a single quote: “Planning is everything; the plan is nothing.”
What worked for the architect of D-Day also worked for Schneider, CMC director of clinical support services. While Eisenhower had to figure out how to invade Europe, Schneider had to figure out the best way to move sick offenders from Texas Department of Criminal Justice prisons to Hospital Galveston, TDCJ’s prison hospital at UTMB, or to the one of the 10 newly established Regional Urgent Care Centers located in select prison unit medical departments. To do this he had to answer this question: “What does a warden do with an offender with a non-emergent medical condition requiring treatment at an outside facility?” As in the “free world” population, Schneider said, “we do not use an ambulance for non-emergencies.”
In years past, TDCJ would typically load the offender on an ambulance and drive to Galveston, or to a local health care facility for treatment. Alternatively, the offender might be taken to a nearby emergency room for treatment, posing risks not only during transport but during treatment.
UTMB and TDCJ incurred huge costs through the routine use of advanced life support capable ambulances for basic transportation. In addition, virtually all patients not treated at local health care facilities were routinely transported to Galveston. This led to another innovation—a hub system similar to the hub and spoke system used by U.S. airlines, where outlying facilities feed in to centers of excellence.
CMC set up 10 Regional Prison Urgent Care Centers to serve 31 high volume prison units. The prisons are located within 30 miles of a hub location. The hubs operate on a 24/7 basis and are staffed by a registered nurse and a medical provider. Instead of driving an offender all the way to Galveston from, say, Huntsville, the offender is now taken to the closest hub facility for medical evaluation. If the offender can be treated at the hub, the patient is then returned to his or her prison unit following treatment. Those who need additional care remain at the hub until a scheduled pickup is made using one of the new patient transport vehicles. The new vehicles look like ambulances but are equipped for high-security transportation rather than life support. Patients with serious medical issues continue to be transported by fully equipped ambulances.
“An example would be a potential overdose—now we have the capability to fully evaluate and assess the patient at the Regional Prison Urgent Care Center,” Schneider said. “If there is an indication for treatment such as gastric lavage or necessity of labs, we can provide those services at the Urgent Care Center.”
Schneider’s first assignment when he started working for CMC in November 2005 was to overhaul inmate transportation procedures that relied on expensive ambulance trips that often turned out to be unnecessary. In the past, offenders were transported to Hospital Galveston or a community hospital. One of the most frequent complaints was chest pain. “We now have the tools and capabilities to evaluate, monitor and treat patients at the Regional Prison Urgent Care Centers,” he said.
Presenting his plan to TDCJ administration and wardens implied a lot of cooperation between the Texas Department of Criminal Justice and UTMB, Schneider said. “I told them, ‘I can write a great plan, but it will take your commitment to make it successful.’” Many wardens endorsed the plan from the start because it reduced the number of inmates transported to Galveston or treated in free-world emergency rooms.
Focusing on health care delivery for the prison population, Schneider started by examining data on offender movement from prison to health care facility. Most of this movement was by prison ambulances and private ambulance services that contracted with TDCJ.
Two directives drove development of his plan. “One, we take care of offenders to the highest level we can. We have a responsibility to do this,” Schneider said. “Two, we have a responsibility to use the right mode of transportation relative to patient needs. Most (patients) don’t need ambulances.”
“I found a high percentage of offenders who were unable to ride a TDCJ van or bus. They needed medical transportation, but not an ambulance,” Schneider said. “They didn’t need medical intervention, just an attendant nearby.” This was particularly true of older and chronically ill offenders. “We were making a lot of ambulance runs with this type of patient.”
Not all prison units are part of the new hub system. Smaller facilities farther than 30 miles from a hub continue to use ambulances for transportation, but because of the smaller size of their prisoner populations, the number of runs is minuscule compared to larger facilities.
Most wardens like the hub system because it minimizes risk and doesn’t result in security officers being off the unit while transporting prisoners to Galveston, Schneider said. Officers still escort offenders when transported to a hub, but they return to their unit in relatively short time, either with the offender or without. Other officers handle scheduled transport from the hubs to Galveston using the new vehicles.
Along with new vehicles and implementation of a hub system, a new, high-tech command center remotely monitors patient transfers. The command center features a panel of three computer monitors that display a variety of data, ranging from sophisticated mapping and GPS tracking, camera, sensor, bar code data and for offender tracking, integration of internal and external databases, as well as tracking of the availability of health care resources. All of this is done in real time from Huntsville.
The new medical transportation system has greatly increased efficiency:
- Vehicles needed reduced from 16 to eight.
- New vehicles have higher capacity: seven of the vehicles accommodate up to four litters (similar to a stretcher) or seven ambulatory patients; the eighth vehicle accommodates up to eight litters or 10 ambulatory patients. Ambulances accommodate no more than two litters.
- New vehicles are more cost-effective. When a chassis needs to be replaced after 300,000–400,000 miles, the passenger compartment is designed to be removed from the old chassis and fitted to a new one.
With its new transportation system fully operational, Schneider notes that other states are taking notice of Texas’ innovations. “We are the pioneers,” he says, proudly. More importantly, “we’re providing a high level of care in a very efficient way to the patient population we serve.”