Impact of Crime and Violence on Illness and

Impact of Crime and Violence on Illness and Health M 6920 Spring 2001 February 20, 2001 1

Definition of crime varies by time and by culture M 6920 Spring 2001 February 20, 2001 2

Examples: z. Witchcraft z. Polygamy z. Seduction of a chaste woman z. Prohibition of alcoholic beverages z. Illicit drugs z. Child abuse z. Corporal punishment M 6920 Spring 2001 February 20, 2001 3

IS VIOLENCE MORE TOLERATED OR LESS TOLERATED TODAY THAN IN THE PAST? M 6920 Spring 2001 February 20, 2001 4

z. Media, e. g. . movies z. Against children, i. e. child abuse z. Gun violence z. Capital punishment M 6920 Spring 2001 February 20, 2001 5

Violence includes injury of all types, intentional and unintentional. z. Injuries are not Accidents M 6920 Spring 2001 February 20, 2001 6

Reasons Crime has been higher than 40 years ago z"Crime is a barometer of social disorganization" z. Greater visibility "live and direct" TV copy M 6920 Spring 2001 February 20, 2001 7

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New York City Situation z. The Mayor and police commissioner z. Applied epidemiology z“Broken window theory” z"Beer and piss patrol” M 6920 Spring 2001 February 20, 2001 10

Reasons II z. Demographic changes z. Change in drug of choice z"Mature" drug market z. Statistics exclude drug crimes M 6920 Spring 2001 February 20, 2001 11

Who is at greatest risk of being personally impacted by crime and violence z. Perpetrator (NYS Prisons) z. Women Offenders z. Victim M 6920 Spring 2001 February 20, 2001 12

Historical penalties for with crime and violence z. Trend in philosophy z. Trend to longer terms M 6920 Spring 2001 February 20, 2001 13

Problems with work programs z. Competition with business z. Maintain facilities or marketable skill? M 6920 Spring 2001 February 20, 2001 14

Shock Incarceration z. Disciplined life z. Build self-respect M 6920 Spring 2001 February 20, 2001 15

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Why we deal with crime and violence in these ways? z. Don't want crime to threaten us z. We are angry and want retribution z. Don't want to pay cost of punishing M 6920 Spring 2001 February 20, 2001 19

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Prevention zof Crime zof Violence M 6920 Spring 2001 February 20, 2001 21

True Prevention requires z. Avoid risk-taking z. Help people know their value M 6920 Spring 2001 February 20, 2001 22

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• Nationally, New York State has the largest number of inmates in separate drug treatment units in correctional facilities • The 9, 027 New York State inmates housed in such units in 1999 represent 22% of all inmates in dedicated treatment units in prisons nationally Inmates in Separate Drug Treatment Units in Prisons (1999) 10 8 6 4 2 M 6920 Spring 2001 0 February 20, 2001 New York Texas Federal California Illinois Missouri Arizona 24

Health problems of perpetrators zinjuries z. Infectious diseases z. Dental problems z. Psychiatric problems z. Substance abuse problems M 6920 Spring 2001 February 20, 2001 25

Health problems of victims z. Injuries z. Infectious diseases z. Psychological injuries z. Health hazard of work in facilities M 6920 Spring 2001 February 20, 2001 26

Who has guaranteed access to health care in US? z. Active Duty Military z. Native Americans z. Service-connected Veterans z. End Stage Renal Disease z. Prisoners--the only class with constitutional guarantee M 6920 Spring 2001 February 20, 2001 27

WHY ARE PRISONERS INCLUDED IN THE LIST? z. Custodial responsibility z. The 8 th Amendment z. Denying necessary health care to those in custody is cruel and unusual punishment z. Community standard of care M 6920 Spring 2001 February 20, 2001 28

CHATEAUGA Y ALTONA BARE HILL FRANKLI LYON MT. FRANKLINN CLINTON UPSTATE NEW YORK STATE DEPARTMENT OF CORRECTIONAL SERVICES FACILITIES OGDENSBURG RIVERVIEW CLINTON GABRIELS ST LAWRENCE GOUVERNEUR ADIRONDACK ATTICA AUBURN BEDFORD HILLS (FEMALES) CLINTON (ANNEX) GREEN HAVEN (ANNEX) SHAWANGUNK SING (ANNEX) SOUTHPORT COXSACKIE DOWNSTATE EASTERN (ANNEX) ELMIRA GREAT MEADOW CLINTON HUB WATERTOWN HUB MAXIMUM SECURITY SULLIVAN (ANNEX) UPSTATE WENDE JEFFERSON ESSEX CAPE VINCENT ADIRONDACK MID-ORANGE ALBION (FEMALES) MID-STATE (ANNEX) ALTONA MOHAWK ARTHUR KILL ASACTC MT. Mc. GREGOR (CAMP) BARE HILL OGDENSBURG BAYVIEW (FEMALES) ONEIDA ORLEANS WASHINGTON BUTLER ASACTC WARREN CAPE VINCENT OTISVILLE CAYUGA RIVERVIEW CHATEAUGAY ASACTC TACONIC (FEMALES) ASACT GREAT COLLINS ULSTER MEADOW WASHINGTON FISHKILL WALLKILL FRANKLIN WASHINGTON (ANNEX) GREAT MEADOW HUB GOUVERNEUR WATERTOWN SARATOGA GOWANDA WOODBOURNE LEWIS HAMILTON OSWEGO ALBION ORLEANS NIAGARA ORLEANS GENESEE BUFFALO WENDE HUB ONEIDA WAYNE MONROE MOHAWK ROCHESTE R ONEIDA HUB CAYUGA LIVINGSTON CATTARAUGUS ALLEGANY SCHOHARIE OTSEGO ELMIRA HUB TOMPKINS GREENE MONTEREY CHAUTAUQUA PHARSALIA CHENANGO STEUBEN COXSACKIE HUDSON GREENE DELAWARE CHEMUNG BROOME SOUTHPORT MINIMUM SECURITY: CAMPS ULSTER DUTCHESS GABRIELS GEORGETOWN ULSTER EASTERN WOODBOURNE SULLIVAN MEDIUM CORRECTIONAL FACILITIES DOWNSTATE FISHKILL WALLKILL DRUG TREATMENT CAMPUS WILLARD (INC. FEMALES) BEACON ORANGE OTISVILLE PUTNAM GREEN HAVEN HUB MID-ORANGE WESTCHESTER (MINIMUM CAMPS) CORRECTIONAL FACILITIES TACONI C BEDFORD HILLS ROCKLAND RECEPTION CENTERS PHARSALIA GREEN HAVEN SHAWANGUNK SULLIVAN HUB MINIMUM CORRECTIONAL FACILITIES LYON MOUNTAIN MONTEREY SHOCK MORIAH SHOCK QUEENSBORO ROCHESTER SUMMIT SHOCK LAKEVIEW SHOCK (INCL FEMALES) LINCOLN TIOGA SULLIVAN MAXIMUM CORRECTIONAL FACILITIES BEACON (FEMALES) BUFFALO BUTLER EDGECOMBE FULTON COLUMBIA ELMIRA LEGEND GROVELAND (ANNEX) WYOMING (ANNEX) MINIMUM SECURITY RENSSELAER ALBANY SUMMIT CORTLAND SCHUYLER GREENE HALE CREEK ASACTC HUDSON LIVINGSTON MARCY SCHENECTADY GEORGETOWN WILLARD GROVELAND GOWAND A LAKEVIE W MONTGOMERY SENECA YATES COLLINS MT. Mc. GREGOR MARCY MADISON ONTARIO LIVINGSTON WYOMING HALE CREEK AUBURN WENDE ATTICA WYOMING FULTON HERKIMER MID-STATE BUTLER ONONDAGA ERIE MEDIUM SECURITY MORIAH WATERTOWN DRUG TREATMENT CAMPUS SING WORK RELEASE M 6920 Spring 2001 SHOCK INCARCERATION February 20, 2001 ASACTC BRONX EDGECOMB E FULTO N NASSAU LINCOLN NEW YORK CITY HUB QUEENSBOR O BAYVIE W QUEENS KINGS RICHMOND ARTHUR KILL SUFFOLK 29 Varelli 7/99

DESCRIPTION OF THE DOCS HEALTH CARE SYSTEM IN THE EARLY 1990'S. z 70 prisons housing 70, 000 z 4 reception sites z. Frequent moves M 6920 Spring 2001 February 20, 2001 30

Health care sites z. Health presence in all facilities z. Clinics z. Infirmaries provide 24 hour supervised care z. Acute hospitalization z. Antiquated health facilities M 6920 Spring 2001 February 20, 2001 31

Health care Operations z. Primary care by salaried employees z. Referral to private specialists arranged by each facility z. Use of outside hospitals arranged by each facility z. Each medical trip COSTS and has security concerns M 6920 Spring 2001 February 20, 2001 32

Major disease issues: z. Approximately 16% of males HIV infected, 20% of females [Now 10%m and 18% f ] z 23% had PPD+ z 57% had drug history [now 55%] z 26% had history of alcohol abuse [now 40% test as alcoholic or possibly alcoholic] z. Incredible dental neglect z. Aging population M 6920 Spring 2001 z 6 % women pregnant at reception February 20, 2001 33

Services provided per year: z 1 million primary care visits z 37, 600 inpatient hospital days z 30, 000 outpatient specialist encounters M 6920 Spring 2001 February 20, 2001 34

"Medical Call Out-Driven" z. If an inmate wants to be seen, he/she drops a note asking to be seen by the nurse who will evaluate whether or not the condition requires a physician visit M 6920 Spring 2001 February 20, 2001 35

Unique features of correctional health care z. Primary business is secure housing z. Disruption, costs and security concerns of trips z. Health of incoming prisoners z. Health care as something to manipulate M 6920 Spring 2001 February 20, 2001 36

Analysis of the system z. Guaranteed Access z. Salaried primary care z. Private fee-for-service specialists z. Private hospitalization z. Minimal utilization review due to local control of care arrangements M 6920 Spring 2001 February 20, 2001 37

z. Movement within the system leads to lost records and delay of care z. COSTS of medical trips z. Need for chronic care and hospice M 6920 Spring 2001 February 20, 2001 38

Qualities of the system that facilitate "MANAGED CARE" z. Global budgeting z. Universal coverage z. Mandatory enrollment z. Limited disenrollment z. Limited patient choice z. Ability M 6920 Spring 2001 to regulate usage February 20, 2001 39

Decisions on Directions I: Retain primary care by employees z. It is a control issue z. And a union issue in a State with strong labor unions M 6920 Spring 2001 February 20, 2001 40

Implications: z. Many hold-overs z. Many work outside jobs and don't identify as part of the system z. Many International Medical Graduates z. Language/cultural barriers M 6920 Spring 2001 February 20, 2001 41

Response z. Orientation for old as well as new employees z. Clinical care guidelines z. Future classes in medical Spanish M 6920 Spring 2001 February 20, 2001 42

Decisions on Directions II: Regional contracts for specialty care and acute hospitalization z. The contracts are CAPITATED and RISK SHARING M 6920 Spring 2001 February 20, 2001 43

Reasons for CSC z. Guaranteed access to needed care z. Cost control z. Budgeting certainty z. Ability to pay market rates z. Utilization review M 6920 Spring 2001 February 20, 2001 44

Note we do not use the term managed care z. It means something different to each person z. It is considered the major "evil" force in health care today z. Invented a more precise term for our system, "coordinated specialty care. " M 6920 Spring 2001 February 20, 2001 45

Decisions on Directions III: Regionalize and Bring Care Inside z. Specialty clinics in-house z. Costs and security concerns M 6920 Spring 2001 February 20, 2001 46

Decisions on Directions IV: Construction z. Rebuild Health Units z. Building Regional Medical Units z. Secure wards in hospitals [40% fewer hospital days used 1999 v. 1997] z. Statewide contract for laboratory services z. Central pharmacy with hub subpharmacies [129, 000 Prescriptions by Central Pharmacy in ‘ 99] M 6920 Spring 2001 February 20, 2001 47

Decisions on Directions V: Computerize scheduling of consultations z. Facilitate regional scheduling z. Enable trip planning among nearby facilities M 6920 Spring 2001 February 20, 2001 48

Decisions on Directions VI: Adapting to schedule primary care z. Aimed at changing from Medical Call Out to Primary Care model. M 6920 Spring 2001 February 20, 2001 49

Decisions on Directions VII: Use tele-medicine z. Cut medical trips (save cost and security concerns) z. More ready access to care z. More humane for sick z. Serendipitous education by primary care providers M 6920 Spring 2001 February 20, 2001 50

Decisions on Directions VIII: Digitize medical records z. Ready accessibility z. Not lost during transfers z. Compatible with feeder institutions z. Legible records! z. Information to manage system M 6920 Spring 2001 February 20, 2001 the 51

Decisions on Directions IX: Explore alternatives for the unique work release population, particularly in the City M 6920 Spring 2001 February 20, 2001 52

Privatize or not? z. A classical make/buy decision EXCEPT in our system the equation includes visibility and control, unions and political pressure. M 6920 Spring 2001 February 20, 2001 53

Decisions on Directions X: Use of Quality Management techniques z. Revisions of data collection and selected indicators z. Clinical treatment guidelines z. Patient Satisfaction Surveys z. Health Education Interest Survey M 6920 Spring 2001 February 20, 2001 54

Decisions on Directions XI: Increase use of Mid-level Practitioners z. Situation demands relative independent practice M 6920 Spring 2001 February 20, 2001 55

Decisions on Directions XII: Increase staff education z. Use tele-health equipment z. Satellite broadcast programs M 6920 Spring 2001 February 20, 2001 56

Steps to Conversion I z. Supportive Commissioner z. Regional contracts z. Indoctrination of staff z. Monitor staff output M 6920 Spring 2001 February 20, 2001 57

Health staff work for Superintendents z. Health professionals involved in hiring z. Health professionals involved in evaluating M 6920 Spring 2001 February 20, 2001 58

Steps to Conversion II z. QM initiative z. Digitizing records z. Tightening Formulary z. Health System research projects M 6920 Spring 2001 February 20, 2001 59

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Impact of Crime and Violence on Illness and Health M 6920 Spring 2001 February 20, 2001 63