THE ELECTRONIC HALLWAYTM NETWORK A PRODUCT OF THE PUBLIC SERVICE CURRICULUM EXCHANGECOSTS AND CONSTRAINTS IN THE ARIZONA INMATEMEDICAL TRANSPORT SYSTEMSam Lewis, Director of the Arizona Department of Corrections (ADC) has just returned from another legislative budget meeting. As usual, it was a painful experience. The same old dichotomy came up: resistance to spending money on prisons, but insistence on incarceration as the main vehicle to protect the public from criminals.Lewis sat down to think about the budget meeting, searching for a strategy to cut costs and still preserve public safety. The department budget was already pushed to the limit from the last round of cuts. He remembered the discussion with his management team about the costs and problems involved in transporting inmates for outside medical care, although no one had come up with a comprehensive solution. Perhaps this was an area where improvement in performance would lead to significant cost-savings.Lewis decided to meet with a group of staff and subcontractors--managers, security personnel, finance experts, and health care providers--to learn more about the inmate medical transport system and to see if he could identify possible improvements which would lead to cost savings. He knew it would be a challenge. It was not as if they could just stop providing the services. And inmates had lots of health care needs, not to mentionsupport from inmate rights groups which had successfully advocated inmate medical rightsthrough the court system.This Public Service Curriculum Exchange case study was made possible through the generous contributions of the Pew Charitable Trusts as part of their support for this national curriculum development project. The case was prepared by Dr. Eileen Kelly Aranda, Chair, Prison Venture Team and Dr. John Vivian, Manager, ADC Venture Team Analyst Unit for use by the Cascade Center for Public Service.The Public Service Curriculum Exchange, a multi-university consortium, is administered by the Cascade Center for Public Service, a branch of the University of WashingtonÕs Institute for Public Policy and Management.This case study is intended as a basis for class discussion and is not intended to suggest correct or incorrect handling of the situation depicted. While based on field research, names and certain facts may have been disguised in the interest of confidentiality. Drs. Aranda and Vivian wish to thank Samuel A. Lewis, Director of the Arizona Deparyment of Corrections and the Prison Venture team for their cooperation in the development of this case.This Public Service Curriculum Exchange Electronic Hallway material may not be altered, electronically stored, transmitted, or distribution or other use of this material. This network material may not be altered or copied without written permission from theCascade Center for Public Service. For more information, contact the Cascade Center at [email protected] or (206)685-0523.Copyright 1996 Cascade Center for Public ServicePublic Service Curriculum ExchangeRevised 8/94F96Costs and Constraints in the Arizona Inmate Medical Transport SystemPressures on the Medical Transport SystemThe two largest Arizona prison complexes are in the town of Florence. In 1991, these twocomplexes housed approximately 4,390 inmates in the three security levels -- minimum, medium, and maximum. About 1%, or fifteen of the 1,404 correctional service officer (CSO) positions allocated to Florence, were assigned to medical transportation duty. The transportation process and interaction with outside medical centers is similar at both prison sites. The inmate population at Florence is the most complex in terms of custody level and, therefore, accounts for most of the problems in inmate medical transport in the state.Travel outside the Arizona correctional system for medical care creates a host of security and staffing problems. Because of these constraints, the Arizona Department of Corrections (ADC) would rather deliver medical services within the secured perimeters of the prisons. However, when specialized procedures cannot be handled internally or in the immediate vicinity by local providers, care must be delivered outside the prison complex, often at the Maricopa County Medical Center (MMC) in distant Phoenix.The transportation of inmates for medical services has been a serious problem for ADC fora number of years. But the combination of overcrowding, severe budget constraints, and management directives to improve security measures, has provided new impetus for tackling the problems. In 1991 the ADC transported 4,950 inmates on 5,446 separate trips for medical treatment at a cost of just under two million dollars (See Attachment 1). Of the 4,950 inmates who were transported for medical care, 3,195 inmates were transported once, and 1,755 inmates were transported more than once (See Attachment 2). During medical runs, the staff to inmate ratio was nearly two to one, with an average of 1.9 inmates transported per trip,accompanied by an average of 3.8 transportation officers (See Attachment 3).Correctional service officers, (CSOs) who normally work only at the prison, must often bereassigned to transportation duty due to this heavy volume of medical runs, taking them away from prison-based security tasks. The need to ensure adequate security coverage onthe medical runs leads to constant overtime commitments by correctional service officers, stressing both employees and the prison budget.The provision of medical care is not discretionary for ADC. In response to various court rulings, the department issued an internal policy stating that inmates "shall be provided reasonable access to physical, mental, and dental health care." Services must be provided at what is known as the community standard of care, so reducing appropriate access to medical care is not an option for resolving the medical transportation problem. 2Costs and Constraints in the Arizona Inmate Medical Transport SystemInmates have disproportionately heavy health care requirements compared to the general population. They often enter the system with serious or chronic conditions, worsened by the lack of routine medical care. Once incarcerated, inmates have both the time to focus on their health status and the access to treatment. They are generally cognizant of their rights and quick to file lawsuits if they feel their rights to health services are being denied.