New blueprint for jails aim of CDC project
New blueprint for jails aim of CDC project
Two counties look for cracks that need filling
A new federally funded project in Los Angeles and Baltimore is about to begin looking at how jails can improve TB screening and treatment. It’s a tall order, given the spectrum of challenges, says Paul Davidson, MD, medical director for the TB control program in Los Angeles County.
"Inmates move around so much between jails and prisons and within the prison system itself that there’s always the danger someone will fall through the cracks," he says. In addition, there’s the tension inherent in trying to serve the frequently conflicting demands of good security and good medical care.
Add to that the huge variation in how jails carry out their TB screening and other health-related procedures, says Davidson, and you’ve got the ingredients for missteps. Just such a slip occurred recently at the Los Angeles County jail, despite the fact that the jail is known for its aggressive TB screening program and enjoys good relations with local TB controllers.
In that instance, an inmate started out with a clear chest X-ray but hung around for three months — long enough to develop full-blown disease. As a result, he exposed a bus load of fellow passengers during his transfer to the state prison system, where his case was quickly spotted, managing to infect a few of them.
Working on a template
In that episode, everything was done by the books, Davidson points out. "It’s just that there wasn’t a process in place for screening him a second time," he says. "That’s the kind of thing we want to be able to document more precisely so we can see what needs to be done to prevent other such episodes from recurring."
The intended outcome of the two-site project is the production of "a template, a working blueprint," says Mark Labado, MD, medical epidemiologist with the Centers for Disease Control and Prevention’s Division of Tuberculosis Elimination. The idea isn’t to come up with more guidelines, but rather to see what it looks like when existing guidelines are plugged in and working well, he adds.
The project originally was conceived as simply a study of jails, not prisons, he adds. "Jails are especially difficult, since every county has its own system. In jails, TB screening policies, politics, and lines of authority all vary enormously." So do systems of health care, he adds. "Sometimes the sheriff hires the medical staff; sometimes there’s a private system in place, and sometimes the county provides the health care." With prisons, by comparison, "at least you’ve got a centralized system run at the state level."
That’s why the study calls for taking a closely focused look at jail-based intake and screening procedures, continuity of treatment, and how contact investigations are best conducted in a jail setting when needed.
Expanding the scope into prison system
Los Angeles TB controllers decided to expand the scope of their part of the study into the prison system as well, says David Berger, program manager for TB control in Los Angeles County. "Given that there’s such a high volume of traffic between the two systems, we decided we wanted to see how well the jail and the state prison systems are communicating," he says. "We know that sometimes there’s a conflict between care and custody. That’s something we want to better assess. We also want to know whether information being provided is timely, whether communication is reliable, and whether the information being provided is sufficient."
Since fully 35% of state prison inmates come from the LA county jail, it stands to reason that mistakes on the jail side will show up sooner or later in the prison system, Berger adds. "If we’re missing cases at the jail, they’re going to turn up eventually in the prison setting. So looking closely at the prison setting is a good way to evaluate the strengths and weaknesses of our jail detection system."
By deciding to fund the project, the CDC is acknowledging the growing importance of "special populations" in the fight to eliminate TB, adds Berger. "As we move forward, we need to look especially hard at high-risk populations such as are found in jails and prison," he says. "Certainly, we don’t have all the answers yet, but studies like this will help increase our understanding of what challenges and obstacles remain."
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.