Reinventing a Broken System. The Transformation of California Prison Health Care E39

Transcription

1

2 Welcome

3 Reinventing a Broken System The Transformation of California Prison Health Care E39

4 Speakers Larry Bongort, Senior Healthcare Architect, Stantec Tonya Church, Supervising RN III, California Correctional Health Care Services (CCHCS) Robert St. Germain, Captain Adult Institutions, California Department of Corrections and Rehabilitation (CDCR)

5 Learning Objectives Understand the history, current status and future course of health care facilities in California prisons Learn the planning and design considerations particular to secure health care environments Identify the outpatient care delivery model for inmatepatients and how it is supported by technology Understand the accelerated processes being used to deliver projects rapidly.

6 Agenda 1 Overview 2 Reinventing the System 3 Health Care in a Security Setting 4 The Projects and the Process 5 The Future 6 Questions

7 1 Overview Institutions and buildings Inmate population Health care system 7

8 34 adult institutions

9 9 Most institutions are remote from population centers

10 Older institutions have centralized health care facilities 10 San Quentin State Prison

11 Newer institutions have decentralized primary care and centralized specialty care 11 Substance Abuse Treatment Facility

12 Existing facilities typically do not accommodate: Current health care delivery practice - Teams, electronic medical records, telemedicine, imaging, laboratory services Current standards for facilities - Infection control, HIPAA, accessibility Current pharmaceutical practice 12

13 Prison population exploded between 1980 and 2010, resulting in severe overcrowding 93% male, 7% female 13

14 Prison population is greying Complex care Disabilities Geriatric care 14

15 Broken beyond repair: Preventable death rate rising Little or no continuity of care Multiple lawsuits were filed 15

16 2 Reinventing the System California Prison Receivership Colossal change needed California Correctional Healthcare Services Construction 16

17 California Prison Receivership Established in 2006 starting CPR System-wide comprehensive evaluation Creating a new identity 17

18 Colossal change: where we were Low wages Maxed-out infrastructure Medication mismanagement Skyrocketing contract medical costs Inability to recruit 50% vacancy rates Low morale Supply chain deficiencies Failing equipment Lack of clinical space Technology challenges No standardization 18

19 Colossal change: what has been accomplished 19 Higher wages Recruitment & retention bonuses Inmate Medical Services Policies & Procedures Streamlined hiring Medical Classification System Technology Health Net Monitoring tools Primary care team delivery model Health care initiatives Continuum of care

20 California Correctional Health Care Services Reception Center Basic Institution Intermediate Institution Center Facility Medical Classification System Pharmacy Continuity of care across the state Electronic Health Record Appointment Scheduling System Telemedicine 20

21 Construction Central Health Services Building at San Quentin California Health Care Facility Health Care Facility Improvement Program (HCFIP) 21

22 Assessment of facilities Lack of space 22

23 Assessment of facilities Lack of patient privacy 23

24 Assessment of facilities Lack of infection control 24

25 Assessment of facilities Lack of cleanable surfaces 25

26 Assessment of facilities Lack of IT infrastructure 26

27 Assessment of facilities Lack of medication distribution space 27

28 Assessment of facilities Lack of accessibility 28

29 Construction: getting the form to follow function What is the flow of the clinic or area? Does everyone on the team have a place to sit? Where is all the equipment placed, parked or stored? Accessibility requirements met? Deliberate decisions 29

30 3 Health Care in a Security Setting Inmate populations Escorting inmates to care Features of secure health care environments 30

31 Complex prison population Varying security levels Need for segregation 31

32 Escorting inmates to care Dependent on security level 32

33 Escorting inmates to care 1.1 miles 33

34 Features of a secure health care environment Visualization: direct supervision model Denial of barricading opportunities 34

35 Features of a secure health care environment Corridor widths Treatment room sizes 35

36 Features of a secure health care environment Furniture & equipment Secured supplies & equipment 36 San Quentin Central Health Services Building. Architect: HOK; Contractor: Hensel Phelps

37 Features of a secure health care environment Anti-suicide features 37 San Quentin Central Health Services Building. Architect: HOK; Contractor: Hensel Phelps

38 Features of a secure health care environment Anti-ligature features 38

39 4 The Projects and the Process Completed projects Project delivery Projects in process 39

40 San Quentin New 5-story, central health services building opened in Architect: HOK; Contractor: Hensel Phelps

41 San Quentin 116,000 gross SF, LEED Gold $136 million construction cost 41 Architect: HOK; Contractor: Hensel Phelps

42 California Health Care Facility New medical facility opened in 2013 Architect: HDR; Contractor: Clark-McCarthy A Joint Venture 42

43 California Health Care Facility 1,722 beds, 1,200,000 gross SF LEED Silver $514 million construction cost 43 Architect: HDR; Contractor: Clark-McCarthy A Joint Venture

44 HCFIP project delivery Batched projects Assessment, gap analysis, scoping & concept plans Creation of space, room and equipment standards Coordination with concurrent dental and medication distribution projects 44

45 45 Reception center clinics

46 46 Primary care clinic renovation and addition

47 47 Primary care clinic renovation and addition

48 48 New primary care clinic

49 49 ASU primary care clinic

50 50 Central health services

51 51 Central health services

52 52 Pharmacy and laboratory

53 53 Administration

54 54 Medication distribution

55 55 Medication distribution

56 5 The Future Total project stats Timeline for completion Construction challenges Opportunities for standardization 56

57 6 Questions? 57

58 Thank You

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