Page 21 - Delaware Medical Journal - May 2016
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PUBLIC HEALTH
provider’s compliance to the medical standards promulgated by the National Commission on Correctional Health Care (NCCHC) and the American Correctional Association (ACA) who are the national accreditation bodies for correctional institutions.
FACILITIES MEDICAL SCOPE OF CARE
The medical units of each of the four Level 5 security facilities include a main clinic capable of a full range of primary care skilled nursing supervision, laboratory, and basic imaging negative pressure Airborne Infection Isolation room to house those suspected of being admitted with active tuberculosis specialist. The guiding Bureau policy for Infectious Disease is 11-B-01, Infection Control.
CONTINUITY OF CARE
In addition to the intake screening process, and the availability
of the Airborne Infection Isolation Rooms for potential offenders with active TB, within a few days of admission the offender receives an initial medical, dental, and if indicated, during
intake screening, a behavioral health evaluation by a licensed professional who has undergone a credentials review of their education, training, and experience and been granted privileges
to diagnose and treat the offenders housed in the Department facilities. Depending upon the information obtained during the initial preventive medicine visit, an offender may be enrolled in one of the Chronic Care Clinics. These clinics afford an offender the medical care of their chronic condition, have their medications monitored and renewed as necessary, and have consultations
with outside specialists arranged as needed. The medical services contract provider subcontracts with an Infectious Disease specialist who visits the facilities or consults with offenders through a telemedicine arrangement. Sick Call requests are collected and triaged daily to address new symptoms the offender may develop during their time of incarceration.
PHARMACEUTICAL SUPPORT
In keeping with the philosophy of approximating the medical care a person could access if they were not incarcerated, the Bureau has contracted to obtain medications needed to treat the offender’s medical issues. The Bureau has designated the State of
Delaware Medicaid Preferred Drug List (PDL) as the formulary for the Department. As such, every medication can be available to an offender within the Scope of Care for the facility.
TUBERCULOSIS
Because of the close proximity of offenders, the early diagnosis and treatment of tuberculosis (TB) is a high priority.1 In order to comply with Delaware Code §502 Section 502: Report of Contagious Diseases and § 505 Section 505: Communicable Diseases; Regulations; Quarantine
concerning tuberculosis, every offender who enters a Department facility receives a skin test for Latent Tuberculosis Infection (LTBI) unless
there is a readily available previous report of
a positive test, i.e. one that was performed
during a previous incarceration. At the same
time a screening of current symptoms of fever,
cough, or weight loss occurs. Depending upon
the results, an offender who may have active Infection Isolation room until a chest x-ray or pulmonary consultation can be performed.
ACTIVE TUBERCULOSIS
The last cases of active TB in the Delaware Department of Correction occurred in 2014 when an HIV-positive offender whose disease was not well controlled on anti-viral medication was admitted and was housed with an offender who was prescribed a high dose anti-tumor necrosis factor medication. It could not be determined which was the index case of active TB but both offenders required hospital admission before the diagnosis and treatment could be initiated.
The Delaware Division of Public Health Tuberculosis Elimination Program Surveillance Data2
of Delaware as a low incidence of (active) Tuberculosis with less than 3.2 cases of tuberculosis per 100,000 population. Since 2012 the Department of Correction had two cases of website2 states that 4 to 6 percent of tuberculosis cases occur in quarters, interruption of therapy as offenders move in and out incidence of HIV infections with co-infection with tuberculosis progressing from latent to active disease.
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