For members of the general public, prison can seem like a frightening place. Dr. Randolph Maul, Chief Medical Officer of the Colorado Department of Corrections (CDOC), reflects on his career of 27 years in medicine and how his current work not only centers on providing medical care for incarcerated persons but also focuses on helping change minds and hearts about those behind the walls.
“There’s a big difference between what we see in movies vs. reality,” Dr. Maul said. “There are somewhere between 14-15,000 people incarcerated in Colorado’s state prisons, which is down from before the COVID pandemic started. It’s my job to make sure we provide those within the walls every opportunity to succeed, from a medical standpoint, while incarcerated and upon release. Our goal is to help them be as healthy as possible so they can re-enter the community and be productive members of society.”
For some members of the prison population, Dr. Maul and his team will be their custodians for the rest of their lives. However, many will come back out to rejoin society, whether it is after a few months or a few years. And while some might be reluctant to sympathize with the prison population, their healthcare will once again become a community-shared burden after rejoining society. According to the American Academy of Family Physicians, incarcerated and detained individuals are disproportionately affected by chronic health conditions, mental illness, and substance abuse.
Failure to provide the necessary access to care is more likely to lead to more crime as well as reincarceration. In fact, research by the Brookings Institute shows that offering broader access to treatment for those in the prison population is not only a compassionate responsibility but is also a cost-effective way to reduce crime rates. The authors estimate that each additional treatment facility in a county reduces the social costs of crime in that county by $4.2 million per year. With annual costs of treatment in a facility being $1.1 million, the benefits far exceed the costs.
“We’re being asked right now to create a healthcare system that is restorative and would remove any barrier that would prevent someone from leading their healthiest life,” Dr. Maul said. “We’re doing our best to provide a healthcare system that is equivalent to the community standard of care.”
That’s why there’s an urgent need to ensure all those behind the prison walls have the best access to care possible. However, there are several challenges to doing so, ranging from COVID-19 restrictions to resource constraints to cultural perceptions of this population. Ultimately, Dr. Maul credits telehealth for helping the Department utilize resources more effectively while tackling health inequity facing those behind the walls.
Challenge: Chipping Away at Health Inequity
Part of Dr. Maul’s role is to maintain an environment where those who are inclined can attend to their health. “A lot goes into taking care of incarcerated persons,” he said. “This includes behavioral, psychiatric, physical, disability, and emotional care. Each one forms a pillar of their healthcare system.”
Each day, Dr. Maul must ask, “How can we offer this population the best care with the resources that we have?” As someone who sits on the Health Equity Commission, he understands how difficult it can be for some within the community to get access to the medical care they need, especially if they require specialized care.
Many prisons in Colorado are in rural areas. In these communities, accessing specialty care may require an hours long drive to a metro area. “It takes a lot of man hours and travel to get to a specialty provider and with tele-health, this contact can be accomplished with greater ease and safety.” Dr. Maul said.
With the COVID-19 pandemic and many doctors’ offices closing their doors, it became even more difficult to help incarcerated individuals access the care they need. That’s when Dr. Maul and his team had to be highly creative in ensuring resource stewardship.
“I call it the obstacle to providing care,” Dr. Maul said. “But we’re slowly chipping away at it.”
This blog is an excerpt from Iron Bow Healthcare Solution’s latest hero highlight, “How the Colorado Department of Corrections Is Using Telehealth to Chip Away at Obstacles to Providing Care.” To read the full hero highlight, head here.
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