In September 1996, a telemedicine suite was opened at the U.S. Penitentiary at Allenwood, Pennsylvania, with telecommunications linkages to the Department of Veterans Affairs Medical Center (VAMC) in Lexington, Kentucky. The telemedicine suite was designed to serve inmates at this prison and at the adjacent Federal Correctional Institution (FCI) at Allenwood. Four months later, in January 1997, a second suite was opened at the U.S. Penitentiary at Lewisburg, Pennsylvania. Telemedicine equipment was also installed during the closing days of 1996 in the Federal Bureau of Prisons’ (BOP’s) Federal Medical Center (FMC) in Lexington, Kentucky.

In this network, all four prisons served as remote sites, meaning that prisoners and health care providers there would initiate requests for services from the providers of telemedical specialist services at the hub site. VAMC was designated the major hub for this network, and planners secured agreements with VAMC’s administrators to provide physicians in several specialties thought suited to telemedicine and the needs of the remote sites. In addition to serving as a remote site, the FMC at Lexington was also designated a minor hub, as it was to provide telepsychiatry services to the other three remote prisons.¹

The principal objective of the demonstration was to test the feasibility of using a sophisticated array of telemedicine equipment for remote specialty consultations and develop data from which to project the impact of telemedicine on health care spending for a prison population. Ancillary objectives of the demonstration were to:

• Reduce security risks associated with taking prisoners to community-based providers outside the prison walls for treatment or diagnoses.

• Provide access to specialists of a kind and quality not available locally.

• Reduce delays in prisoners’ access to medical specialists.

The demonstration was jointly sponsored by the U.S. Departments of Defense (DoD) and Justice (DOJ) and managed by a steering group, the Joint Program Steering Group (JPSG). JPSG is staffed by both departments and managed by two lead agencies, the National Institute of Justice (NIJ) and the Defense Advanced Research Project Agency (DARPA). NIJ’s objective in supporting the project was to provide information useful for State and local corrections, in addition to assisting BOP, its sister agency. DoD’s research and development (R&D) community (DARPA among them) developed telemedicine and enabling communications technologies. DoD’s objectives in supporting the project were greater than testing the utility of technology derived from its R&D community. DoD requires the same kind of access to medical information from remote areas, both in war and in operations other than war (such as providing humanitarian relief, giving disaster assistance, or detaining large groups of foreign nationals), as is available domestically. DoD also maintains a system of prisons and jails for incarceration of military law violators and many hospitals serving active military personnel and their families.

The Department of Veterans Affairs (VA) operates a network of hospitals for veterans and their dependents. The VA is interested in developing telemedicine capabilities to serve veterans in rural locations and provide remote consultant services to other public health care entities.

No single demonstration could successfully serve all the interests of such a diverse group of public agencies. However, the evaluation below has been structured to provide information that should be useful to BOP, State and local corrections, DoD, and the VA.

The technology used in this demonstration is standard, commercially available equipment, and although skill is required to operate it, physician assistants can readily gain proficiency. A physician is not required at the remote location. Consequently, a single specialist can serve a number of remote locations, and each remote location has access to all the specialists in the network.

Telemedicine Network Sites USP-Lewisburg is a maximum-security prison that was built in 1932 in what remains a rural area. It housed adaily average of 1,349 male prisoners during FY 1997. USP-Allenwood is newer, having opened in 1993 near White Deer, Pennsylvania. The average daily population at this facility was 1,037 maximum-security male prisoners during FY 1997. FCI-Allenwood, which also opened in 1993, is located on the same BOP campus as USP-Allenwood. On any given day during FY 1997, it held an average of 1,100 low- and medium-security prisoners. Prisoners at the FCI are transported to the USP-Allenwood for telemedicine sessions. The Federal Medical Center at Lexington, Kentucky, had operated as a Federal correctional institution since 1974 but was converted to a Federal Medical Center in 1991. This facility accepts patients, many of whom require specialized health care, from institutions in the Federal prison system. Its particular mission is to provide care to medium- and minimum-security prisoners with chronic illnesses. During FY 1997, the center’s average daily population was 1,450. Most were men, but the FMC also houses a small number of female prisoners.

¹ A dietician at FMC-Lexington also used the system for group instruction.