While inmate comfort isn’t any jail’s mission, those who find themselves behind bars in Hillsborough County, Florida, can rest easier knowing that their health care needs are well looked after. A pod-based “primary nurse” model and comprehensive medical discharge planning are just a few of the forward-thinking approaches the jail has taken to ensure that it meets the health needs of its inmates.

Building on the direct supervision style of security, the health services department has stationed an LPN in each of the facilities’ housing pods. “The concept is that she is a primary nurse for those inmates,” says medical director Beth Weaver, DO, MPH, who has worked at the jail since November 2005. “She gets to know the inmates and their needs, and is there to help if they have an urgent problem or want to request sick call.” A nurse is on-site 16 hours per day (in two eight-hour shifts), overseeing care for 72 inmates from a private office. She has a medication cart and wound care supplies, and monitors conditions such as hypertension and diabetes.

This approach is in keeping with the jail administrators’  philosophy of bringing care to the inmate whenever possible. Services given in the pods include physical assessments, which are done using equipment stored in a cart that’s wheeled from site to site; HIV and syphilis testing conducted by county health department employees; psychiatric visits in a private room; physical therapy; and discharge planning assessments (more about that below).

Doing this takes quite a bit of planning, Weaver notes, but says it’s appropriate for security reasons. Plus, everybody seems to like it. “For the inmates, it’s like a house call. The clinicians like it because they don’t have to wait around in a medical clinic if the inmates are delayed in transport.” There was some concern that the LPNs might feel isolated, but they often have to visit other areas of the jail and interact with colleagues so it hasn’t been a problem, says Weaver. “After they get used to it, they usually like it because they feel like they are part of something bigger.”

Award-Winning Program
While national recidivism studies generally look at releasees from prisons, not jails, it doesn’t take a statistician to know that the same old faces keep showing up in jail. The reasons are complex and hard to overcome, but the Hillsborough County jail has had measurable success in reducing recidivism through medical discharge planning.

Discharge planning is increasingly understood to be an important element of correctional health services and was added as a distinct standard in the 2003 editions of the NCCHC Standards for Health Services. The Hillsborough County program not only meets the standard but also goes several steps further.

In early 2006, the jail decided to revitalize its medical discharge planning efforts by making that task the sole role of a single, full-time staff member. When Nazim Hamid, PhD, wandered into a job fair, the human resources representative knew she found the perfect candidate. Despite his lack of experience in corrections, or even in discharge planning, he possessed the right combination of skills and traits that would be needed to build and run the program.

Just 15 months later, the jail’s medical discharge program had made such great strides in its approach to planning for inmates’ medical and mental health needs upon release that it was named 2007 Program of the Year by NCCHC.

With a diverse background that includes a Caribbean upbringing, a doctoral degree in agronomy and a long stint in horticultural administration in New York City, Hamid segued into health care by doing plant therapy in nursing homes and rehabilitation facilities. He worked with mental health and substance abuse patients in New York hospitals and earned a degree in health services management. Along the way he served as a captain in the U.S. Army Reserve.

At the Hillsborough County jail, Hamid’s enthusiasm for learning, military discipline, management experience and passion for nurturing proved invaluable. He educated himself about the world of corrections and analyzed operations and populations in his own facility. He researched discharge planning models but, finding little he could apply directly, he customized a model for his facility and patients. He forged relationships with contacts throughout the county, and he set up a way to track and measure outcomes.

After an intense month of preparation, he was ready to meet with inmates. That part was easy: “I enjoy helping people, and here I know I am doing a service to people who truly need it,” says Hamid.

Medical Planning and More
The primary charge for the program was to help patients with chronic medical and mental health conditions continue their care in the community. (Inmates with certain mental health needs go through a different process.)

Step one is to identify those inmates. Most referrals come from health or program staff, but word-of-mouth among inmates also prompts some to seek help. Hamid interviews them to discover the probable gaps in care after release. Often that means determining if they qualify for assistance from county or federal health programs and filling out applications before they are discharged. Other times he directs them to community clinics.

Based on this discussion and case review, he creates a plan for each inmate and makes connections with outside agencies as necessary. He also is very generous with coaching and encouragement. Each inmate leaves with transition paperwork, plus a three-day supply of medications (seven days for psychiatric meds) and a 30-day prescription, along with a list of pharmacies. Because a state program provides drugs for HIV and syphilis, Weaver manages securing those drugs for patients who need them.

These tasks are the essentials of medical discharge planning, but for Hamid that’s only the beginning. “Almost 80% of our inmates are homeless and have nowhere to go; they don’t know what help is available,” he says.

So he also provides guidance with the myriad details that help to ensure a successful transition into the community, such as housing, employment, education, transportation and community, which he defines as including family members and religious groups.

Hamid gets help from co-workers, the county and local health agencies, and others, but much of his work is a one-man effort. His caseload is heavy but he takes it in stride. “If somebody needs help, I cannot turn them away.”

His efforts are paying off, says Weaver. “We now have data that show a significant portion of people who participate in that planning are not coming back to jail.” Hamid calculated the following recidivism statistics after the first eight months (May-December, 2006) of the program’s operation.

• Average rate for all inmates (one-year period): 27%
• Inmates who received discharge planning: 23.1% (95 of 410)
• Inmates known to have visited the local health center for follow-up: 16.3% (16 of 98)

More current data are even more impressive: a cumulative annual recidivism rate of 15.3% among inmates who received discharge planning.

Harder to quantify but enormously important, at least to Hamid, are the success stories he learns about. “Sometimes I sound like an evangelist, but I am convinced that we are saving lives.”

— About the author: Jaime Shimkus is NCCHC’s editor. To contact her, e-mail jaimeshimkus@ncchc.org.