Department of Correction
George M. Little, Commissioner
Clinical Services
In 2006, the Correction Commissioner formed the division of Clinical Services which includes the Office of Health Services and Mental Health Services. The Clinical Services division operates under the leadership of the TDOC state medical director.
Support Functions of Clinical Services:
- Develop Policy & Procedures
- Conduct Medical Contract Monitoring
- Conduct Mental Health Contract Monitoring
- Investigate Inmate Correspondence/Grievances
- Clinical Recruitment/Retention
- Oversee Quality Improvement/Risk Management:
- Mortality Review
- Provider Credentialing
- Peer Review
- Pharmaceutical Management
It is the goal of the Clinical Services division to provide the required constitutional level of health and mental health care in the most efficient, cost effective manner possible to the Tennessee Department of Correction's 19,000 inmates. In FY 2008, the department remained vigilant in delivering care as economically as possible while maintaining its attentiveness to the public health responsibilities inherent in a correctional population. Clinical Services will continue its commitment to managing an increasing number of physically and mentally ill offenders efficiently with medical and ethical integrity. The following section provides pertinent facts regarding key statistics and major accomplishments during FY '07 - '08.
Key Statistics FY '07 - '08
- 1.5 million medical encounters and 40,000 dental encounters
- Medical costs totaled $8.98/inmate/diem; including 1,177 hospital admissions and 1,455 ER visits
- 151 telemedicine consultations completed, reducing the need for off-site transportations and security personnel
- 51 mobil MRI procedures; 80 mobile CT procedures; and 224 mobile mannogram procedures completed
- 4 of 11 requests for medical furlough were approved
- 408 inquiries were investigated and processed by the Inmate Correspondence Committee
Not unlike the community at large, escalating medical costs is one of the principle drivers in department's budget increases. Under the 1976 U.S. Supreme Court ruling Estelle v. Gamble, states are complelled to provide constitutionally adequate level of medical care, or care that generally meets the "community standard." High incidences of communicable diseases and the graying of the prison population create a multitude of challenges and are causing medical costs to swell. The rapid growth of the incidence of chronic diseases such as cancer, end stage liver disease, and heart disease contribute to the complexity operating the department's health care system. In FY 2008, there were 1,177 hospital admissions with an average length of stay of 3.88 days (see Table 1).
TABLE 1
Over the past ten years, the mental health case load has continued to grow statewide (see Table 2). As the end of FY 2008, there were approximately 5,442 mentally ill inmates diagnosed within the TDOC system, an increase of almost 3% from the previous FY. In the last few years, TDOC has utilized its resources to meet this increasing demand by implementing case management and utilization review. Of the 5,442 inmates with mental health diagnoses within TDOC, 1,999 had a serious mental illness (e.g., schizophrenia, bipolar, major depression, and psychosis) and 741 were diagnosed with co-occurring disorders. In FY 2008, a total of 4,168 offenders with mental illness received psychiatric medication management.
TABLE 2
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