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CCAP PIMCC News
Volume 3 Issue 1
March 2016
www.pacounties.org
PIMCC NEWS
An e­newsletter of Prison Inmate Medical Cost Containment, a program of the County Commissioners Association of Pennsylvania
In This Issue
Heart Month
Stress
Narcan
Segregation and
Mental Health
Sexually Transmitted
Diseases
ACT 22 Coverage
Policy Update
ACT 22 COMPASS
Application
Upcoming Events
NEW ­ Drug
Information Center
Quick Links
CCAP Website
PIMCC Program
Act 22 Service
PIMCC Online Prison
Directory
Insurance Programs
Contacts
February was Heart Month
If you love someone or they love you, visit the Million Heart website to calculate your HEART
age. There are many tools and helpful ideas on the website to help you make healthy heart
decisions. So, take a walk with your sweetheart and keep your heart going.
How well do you know your heart? These facts may surprise you:
The heart weighs less than one pound. The average heart weight for women is eight
ounces and for men, 10 ounces.
Your heartbeats with enough strength to shoot blood a distance of 30 feet.
Your left lung is smaller than your right one to make room in your chest cavity for your
heart.
On average, a million barrels worth of blood is pumped through the heart in a lifetime.
Every year, your heart beats approximately 35 million times. That is an average of
100,000 beats per day and 70 beats per minute. Over the course of a lifetime, that adds
up to an average of 2.5 billion heartbeats.
Your heart is made up almost entirely of muscle. It is strong enough to lift approximately
3,000 pounds ­ roughly the weight of a compact car.
The blood vessels fed by your heart are more than 60,000 miles long. According to The
Cleveland Clinic, they could wrap around the world twice.
Clench your fists and put them side by side. This is roughly the size of your heart. A
child's heart is approximately the size of one clenched fist on an adult hand.
Women's hearts beat faster than male hearts.
The human heart begins to beat as early as four weeks after conception. Scientists believe
that by eight weeks, when the embryo is only an inch long, the heart is fully developed.
Facts retrieved from 2020 site.
Animation of a heart can be found by clicking here.
Stress Wouldn't a few minutes without stress be nice?
Working with the prison population can be challenging and stressful. So how about taking a few
minutes and trying one or more of the following: meditate, take a deep breathe, socialize with
friends, laugh, crank up the tunes and move!
Take some time to care for yourself. Visit WebMD for ten relaxation techniques that zap stress
fast.
Narcan Act 139 ­ Naloxone Administration and its use in Jails What is Act 139?
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Senate Bill 1164 was signed into law by Governor Tom Corbett in late September as Act 139 of
2014. This legislation allows first responders including law enforcement, fire fighters, EMS or
other organizations the ability to administer a medication known as naloxone. Naloxone is a life­
saving opioid reversal medication used with individuals experiencing an opioid overdoes. The
law also allows individuals such as friends or family members that may be in a position to assist
a person at risk of experiencing an opioid related overdose to obtain a prescription for naloxone.
Additionally, Act 139 provides immunity from prosecution for those responding to and reporting
overdoses.
What is Naloxone? Naloxone is a medication that can reverse an overdose that is caused by an opioid drug (i.e.
prescription pain medication or heroin). When administered during an overdose, naloxone blocks
the effects of opioids on the brain and restores breathing within two to eight minutes. Naloxone
has been used safely by medical professionals for more than 40 years and has only one
function: to reverse the effects of opioids on the brain and respiratory system in order to
prevent death. Information retrieved from the Pennsylvania Department of Health.
Naloxone in Jails?
The National Commission on Correctional Health Care (NCCHC) supports increased access to and
use of naloxone in correctional facilities. NCCHC recommends that correctional and medical staff
undergo training that includes education regarding opioid overdose and its signs; correct
technique for administration of naloxone, either by intramuscular injection or by nasal
inhalation; positioning of the inmate; and essential related procedures, including performance of
cardiopulmonary resuscitation and emergency transfer of the inmate to a facility equipped to
treat overdose. Information retrieved from the National Commission on Correctional Health
Care.
Dr. Burke, Medical Director for the PIMCC program, recommends the placement of Naloxone in
emergency boxes at county jails. Additionally, the Pennsylvania Department of Corrections has
stocked Naloxone in their emergency response equipment.
Next Steps...
Training: Naloxone training must be through a Pennsylvania Department of Health (DOH)
approved program. There is online training through the Department of Health website, which
after passing the test will certify the individual. Note hands on training will need to be
performed at the jail. The Department of Corrections Academy has a training program pending
and will offer refreshers when staff completes CPR/BFA training. Refer to the guidance document
for specifics on the training available.
Policy and Process: For use of Naloxone in the jail including pre­release, it needs to be
created with the medical department and applicable prison staff. Refer to the guidance document
link above for recommendations and the attached Sample Naloxone Policy for key elements to
be included.
Written Standing Order: Created and renewed annually by your sick line provider.
Cost: Naloxone's cost is based upon the method of administration. The approximate cost for one
dose of using the nasal atomizer is $35. The approximate cost of Evzio (auto injector) one dose
is $560. Drug prices were obtained through Diamond Pharmacy.
Miscellaneous: Consider stocking at least three to four doses of Naloxone and the atomizers
in your emergency box. Consider the distance from your jail to the nearest hospital and or EMS
response times. Diamond Pharmacy is in the process of developing Naloxone training for
correctional officers and related prison staff, they anticipate approval in early 2016.
Click here to view a short video on Naloxone and how to administer.
Segregation and Mental Health According to Metzner (2015) mental health clinicians report development of new symptoms, such
as anxiety, irritability and dysphoria when housed in segregation units for long periods of time.
Providing mental health care to segregated inmates has barriers of space and security. The
effects of extreme isolation on inmates with serious mental health can result in harm and
possible litigation. Regular rounding by trained staff, mental health preferred, is included in the
NCCHC Standards for Mental Health Services in Correctional Facilities.
For more information and recommendations visit the National Commission on Correction Health
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Care.
Sexually Transmitted Diseases (STDs)
By: Diamond Pharmacy Centers for Disease Control and Prevention (CDC) Reports STDs on the Rise
In November, the CDC published STD surveillance data for 2013­2014. Reported cases
demonstrated an increasing rate in chlamydia, gonorrhea and syphilis infections compared to
past years. This rise is concerning because, prior to 2013, the reported rates for these sexually
transmitted diseases (STDs) had been decreasing. Additionally, this is alarming because of the
vulnerable patient populations (young persons, minorities and gay/bisexual men) that are
affected and increasing documented drug resistance.
The 1,441,789 reported cases of chlamydia represent the highest number of annual cases of any
condition ever reported to the CDC. That number translates into 456 infections per 100,000
people. Most reported chlamydia and gonorrhea infections affect 15­24 year olds, 57% and 53%
respectively. These infections are often asymptomatic in women, so they can go untreated.
Untreated cases can result in lasting consequences, like pelvic inflammatory disease, infertility
and pelvic pain issues. In 20­24 year old women, the chlamydia case rate increased 1.6%
(3,651 cases per 100,000) from 2013­2014. Additionally, untreated sexually active persons can
unknowingly infect their partner or partners. Men aged 20­24 years had a 4.4% (1,368 per
100,000) increased rate of chlamydia reported during 2013­2014. In comparison, gonorrhea
infections decreased for all persons aged 15­19 years but increased 2.8% for all persons aged
20­24 years.
Any increase in gonorrhea is concerning because of increasing resistance of Neisseria
gonorrhoeae to antibiotics regimens. In 2007, the emergence of fluoroquinolone­resistant N.
gonorrhoeae resulted in the CDC no longer recommending fluoroquinolones for the treatment of
gonorrhea. Around that same time, minimum inhibitory concentrations (MICs) for cefixime to N.
gonorrhoeae increased, suggesting the development of resistance to cefixime. The CDC no
longer recommends cefixime as first­line treatment in the United States. Dual treatment with
ceftriaxone and azithromycin is the recommended regimen (see Treatment Regimens for
Gonorrhea Infection).
Syphilis infection rates have increased since 2001. In 2014, 6.3 cases per 100,000 people were
reported. Men accounted for 91% of all reported syphilis cases, with men having sex with men
(MSM) accounting for 83% of the reported cases involving men. Of the 83% of syphilis­infected
MSM group, 51% were also HIV­positive. Alarmingly, there was a 22.7% increase in syphilis
infection among women. This is concerning because an infected mother can transmit syphilis to
her unborn infant. Incidentally, reported cases of congenital syphilis (mother to newborn)
infections increased 27.5% (11.6 per 100,000 live births) with 458 total cases reported in 2014.
Racial disparities in reported STDs can be significant. African Americans, Hispanics and
American Indians/Alaska Natives are disproportionally affected with higher reported STD rates
than those of white Americans. For example, chlamydial infections are 5.7­times higher for
black women and 7.3­times higher for black men compared to their white counterparts. Hispanic
chlamydia infections were 2.1­times higher than that of Caucasians. Societal conditions,
socioeconomic factors and cultural mores are probably factors contributing to differences
reported in STD rates. Identification and awareness of these differences creates an opportunity
for healthcare clinicians to direct screening and education to higher risk, ethnic groups.
Screening Recommendations:
The CDC recommends annual screening in all sexually active women <25 years, and older
women at risk for a chlamydia and gonorrhea infection. Routine screening in sexually active
men should be considered in clinically indicated situations (high prevalence, STD clinic,
correctional facilities, MSM). The focus is to detect, treat, prevent complications and test and
treat affected partners.
Presentation of Syphilis:
Primary syphilis presents as an ulcer or chancre at the infection site, while secondary syphilis
symptoms include, but are not limited to, skin rash, mucocutaneous lesions and
lymphadenopathy. Latent syphilis is typically asymptomatic and is detected by serological
testing. Neurological infection can occur at any stage of infection, with late manifestations
occurring 10­30 years after infection.
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References:
1. CDC Fact Sheet
2. CDC 2014 STD Surveillance Report
3. Gonorrhea Becoming More Resistant to One Antibiotic: CDC
4. CDC 2015 Sexually Transmitted Diseases Treatment Guidelines
ACT 22 Update in Coverage Policy To assure that physicians' inpatient related claims are addressed appropriately, the Department
of Human Services (DHS) policy department has clarified that if the individual was incarcerated
at the time of admission then the individual's eligibility period for medical assistance (MA)
should be set for the entire duration of the individual's hospitalization. This will be true even if
the individual's incarceration ended during their hospitalization. This is primarily driven by the
fact that the hospital charges are not separated by the hospital. This policy update requires the county correction facility to submit their COMPASS
application and CPIEF (County Prison Inpatient Eligibility Form) for the inmate for the
entire hospital stay. The above statement is different from what has been done in the past. According to the DHS
policy department, the individual's entire stay, including physician bills with dates of service
after release from custody should fall under ACT 22.
Although release from custody during an inpatient stay is not a frequent occurrence, it is
recommended in these cases that the county correctional facility coordinate with the hospital to
obtain the entire hospitalization dates. These dates should be documented on the COMPASS
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ACT 22 COMPASS Application Information At the end of completing a COMPASS application, under the Additional Information Tab, the
user will find the following question, "Do you have any additional comments?" Click yes and
use the space provided to place helpful information to the Department of Human Services
(DHS). Helpful information would be hospitalization dates and incarceration dates. See the
example below:
Individual was hospitalized from 08­16­2015 to 08­18­2015 at Memorial Hospital and
has been incarcerated since 07­31­2015 to 09­19­2015 at county prison.
Included is a screenshot from the COMPASS application as a reference for the county
correctional facility's COMPASS application user. Upcoming Events
2016 CCAP Spring Conference
March 13­15, 2016
Harrisburg Hilton, Harrisburg
Pennsylvania Prison Warden Association (PPWA) Spring Conference
April 21 ­ 24, 2016
Cranberry Township, Pittsburgh Marriott North, Pittsburgh
2016 CCAP Solicitors' Conference
May 6, 2016
CCAP Office, Harrisburg
Prison Risk Management Workshop
May 26, 2016, 9:00 a.m. ­ 3:30 p.m.
The Hotel Hershey, Hershey
PIMCC Board Meeting
June 17, 2016, 10:30 a.m. CCAP Office, Harrisburg
Prison Medical Management Conference
Formerly known as the PIMCC Nurses Seminar
September 28, 2016
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CCAP Office, Harrisburg
Your Med Corner
Announcing an excellent, free, clinical resource from Diamond Pharmacy for its PIMCC
customers.
The Drug Information Center­ Staffed by very knowledgeable pharmacists with doctorate
degrees is available at 1­800­882­6337 ext 2826 or call 1­800­882­6337 and ask for the
Drug Information Center.
Please share this information with your Sick Line Medical Provider, Nursing Staff and
Correctional Officers. Tap into the resources available to you as PIMCC members!
About Us Terms of Service Privacy Policy
...
Contact Us: John Sallade, Managing Director, CCAP Insurance Programs
County Commissioners Association of PA | 2789 Old Post Road | Harrisburg | PA | 17110
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