Prisoners' transport between the correctional facility and the medical specialist requires a careful but expensive preparation. The Texas Department of Criminal Justice (TDCJ) therefore has investigated the possibility of setting up a remote medical consulting service to provide convicts with the community standard of health care while reducing both the risks and the costs. As a result, in 1994, Dr. William Gonzalez and his team, at the Texas Tech University Health Sciences Centre (TTUHSC), created a teleconsultation clinic whereas HealthNet, the university telecommunications department, in collaboration with NEC, manufactured the TeleDoc 5000 system, a portable videoconferencing tool for medical examination, consultation and education. Gradually, this procedure has turned into a success, as stated by ReLinda Longan during the " Medicine Meets Virtual Reality" Conference in San Diego, earlier this year.
Initially, the Bill Clements Unit in Amarillo served as the pilot test site for the telemedicine clinic, involving weekly sessions between the local primary care takers and specialists at Texas Tech University in Lubbock, at a distance of some 270 kilometres. Since then, eleven more sites have been connected, including more than 2.200 patients. The TeleDoc 5000 system allows the physician to study recent EKG's, lab work or X-rays and to talk directly to the patient. Standard procedures have been worked out to ensure the specialist has all the necessary data to make his diagnosis and to organise a treatment plan. Days before the actual consultation, the prisoners are examined in the teleconsultation room, offering them a chance to get used to the equipment in order to decrease their distrust. The on-site physician is responsible for the follow-up after the specialist has sent a hard copy of the diagnosis and treatment plan to the local unit for attachment to the patient's chart.
As a further development of the telehealth network, also a telepsychiatry clinic has been introduced between Lubbock and the Fort Stockton unit to assess the potential of teleconsultation for mental illness. By means of interactive video, psychiatrists tried to develop a diagnosis and treatment plan in order to bring the patients to a medically safe level and maintain them there. They quite successfully met the originally set purpose of avoiding as much as possible unexpected transfers to a psychiatric facility within a month of the teleconsultation. The majority of patients were able to remain safely on the unit without any threat to fellow prisoners nor staff. Evidently, strict protocols have to be respected with regard to a distraction free environment, a maximised time utility and clinical outcome, and a high level of prison practitioner's responsibility for the patient.
Questionnaires filled in by patients, primary care providers and specialists show an overall positive evaluation of the telemedicine consultation's quality and efficiency. Once their confidence is won, prisoners are rather satisfied they no longer have to endure the ordeal of being strip-searched, shackled and severely guarded during hours of transportation to the medical facility or the specialist downtown. The latter in turn, is relieved not to have to face the danger of receiving the prisoner in his office, in the presence of other patients, while the prison doctor eagerly benefits from the advise and opinions of his expert colleagues. Telemedicine in fact limits the prisoner's transport to medical emergencies or indispensable surgical interventions. Thus, the Texas experience has removed the heavy financial and security burdens from the prison administrators and left their inmates with greater ease.