A recent collaborative effort between the Nassau Health Care Corporation (NHCC) and the Nassau County Correctional Center (NCCC) in East Meadow has overhauled the jail's ailing health care system by expanding medical services staff, and restructuring the health care delivery system. A primary aim of the new system is to reduce the number of inmates who receive healthcare outside the facility, thereby decreasing overtime costs.

"We had a healthcare system here that was 'sick,'" said Dr. Anthony Angelo, NHCC's Senior Vice President for Medical Affairs. "It was not working to the satisfaction of the clients, who are the inmates, or the customer to whom we were providing it, the correctional center administration."

Becoming a public benefit corporation in September of 1999 freed the Nassau County Medical Center from Nassau County governance, allowing necessary changes in the system to be implemented, explained Dr. Angelo. In the past, medical staffing from the hospital was provided to the jail on a rotating basis, with different doctors coming in every day. Urgent cases were attended to first, with minimal follow-up provided for patients who had chronic conditions, such as diabetes, or sexually transmitted diseases.

"Under the old system, we had relatively sparse rotating coverage. Inmates were not by any means likely to see the same doctor two days in a row, and there wasn't enough coverage to see them all," said Dr. Angelo.

Currently working under a fee-for-service contract, a full-time staff of medical providers, headed by Dr. Martin Roginsky, preside over a newly restructured health care delivery system designed to bring medical care to the inmate instead of the inmate to medical care. Previously, there was one medical sick care facility in the jail. After restructuring, there are three clinic areas staffed by medical staff clinicians. This restructuring has dramatically decreased the total number of inmate requests for sick calls, as well as dramatically increased the number of inmates seen for disposition within 24 hours of a sick-call request, according to statistics provided by the NHCC.

"I was one of those doctors who worked on a rotating basis," said Dr. Roginsky. "I was really a visiting physician at the correctional facility, whereas my primary responsibilities were at the hospital. The full-time staff we have here now are truly dedicated to the care of the inmates in a way that was not possible before. The relationship between inmates and staff has certainly improved."

Of even greater interest to the communities surrounding the jail is the increased quality of screening for communicable diseases, such as tuberculosis and STDs, and the new rapid treatment plan for inmates who have contracted these diseases. During their period of incarceration, a larger percentage of inmates will receive an entire treatment program, so they will not be lost to follow-up outside in the community, where the majority fail to continue treatment.

"What you find in any community is that the carriers for STDs and diseases like tuberculosis often wind up in correctional centers," said Dr. Angelo. "If you catch them while they are at the correctional center and cure them, when they go back out into the community, they are no longer a carrier."

"It has been documented in medical literature that the spread of STDs is highest where inmates are released into the population. By dealing with that very aggressively at the jail, we hope to have a major impact on this problem in society at large," said Dr. Roginsky.

A follow-up system has also been developed, linking inmates, when they are discharged, to community health centers. "99.99 percent of prison and jail populations return to the community," said Elizabeth Boris, Health Care Coordinator and Medical Liaison for the NCCC. "They are going to live next door to you and me. Why not teach them how to access healthcare so they can do it for themselves?"

Another intended benefit of the new healthcare system is to improve the morale of both the inmates and the corrections officers. "It is no secret that we had problems with inmates and corrections officers, which had an impact on the morale of the institution in general," said Boris. "We have to restore the confidence of the corrections staff and the confidence of the community, as well."

Community leaders were introduced to the new healthcare system at last month's Jail Advisory Committee (JAC) meeting, where the plan was generally well received. Beverlee Szimanski, president of a civic association in Salisbury and a member of the JAC stated in a letter she sent to Nassau County Executive Thomas Gulotta, "I have been approached by residents over the years who have expressed their fears to me about the spread of diseases by inmates on discharge. They also had concerns about the corrections officers and other jail personnel contracting some of the communicable diseases and bringing those into the community. When inmates are released on their way to good health, there is far less risk to the community at large."

The entire correctional facility stands to reap the benefits of an improved healthcare system because an inmate who is being treated properly for an illness will exhibit far less disruptive behavior inside the facility. "If inmates are healthy, they are easier for corrections staff to manage," said Boris. "The better you treat any individual, the less angry he will be, and the less likely he will be to act out his angry feelings in a lawbreaking way," said Dr. Angelo.

NHCC was recently authorized to take over the psychiatric care of inmates, as well as the medical care. Dr. Angelo spoke of a key way plan that was 85 percent complete, with the psychiatric care system and the medical care system merging completely by the end of April. In the past, the Nassau County Department of Mental Health was responsible for inmate psychiatric care, and the Nassau County Medical Center was responsible for medical care. "The two entities really didn't communicate with each other very effectively. We hope to eliminate this problem," Dr. Angelo said.

The NCCC has paid a price for these improvements. The new healthcare system is costing the jail millions more dollars than the old system, according to Boris. But the hope is that the final outcome will be a decrease in the overall cost, which is already in evidence, according to figures from the NHCC.

However, a corrections officer who requested that his name not be used said that the county may be paying more than it has to. The officer, a medical unit employee at the corrections facility said, "Although health services have improved for the inmates 100 times over, as a corrections officer and a taxpayer of this county, I think that charging the inmates a nominal fee for health services is in order."

The officer said that many prisoner complaints were "frivolous," that a tremendous amount of drugs, such as Benadryl and ointments, were leaving the prison pharmacy on a daily basis, and that some of the inmates were taking advantage of the improved services by requesting care for minor conditions. "Perhaps the pendulum has swung too far in the other direction, where the quality and quantity of inmate care is too good," he said. "If an inmate can spend up to $35 on commissary each month, why can't he or she pay a dollar for each visit from a health care professional? It would take the burden off the taxpayers."