Unique collaboration leads to swift treatment for insulin-dependent prisoners

Until last year, a diabetic prisoner attending court who needed insulin was taken to a nearby emergency department (ED). This required the presence of two court officers, plus EMS personnel and required blood work in the hospital lab and attendance by ED physicians. The whole process could take 2-6 hours, causing court delays, overtime for court officers, and non-urgent use of emergency department resources. There was also an increased risk of escape or assault when a prisoner is taken to a less controlled environment.

Thinking there must be a better way led Toronto Police Services to approach the Toronto Central Community Care Access Centre (TC CCAC) looking for an alternative. Working collaboratively, and with the inclusion of  Spectrum Health to offer nursing support, a pilot project, the “Insulin Dependent Diabetics in the Court System Program,” was developed to test a new, simplified process. The pilot involved the College Park Courts and prisoners from the Toronto West Detention Centre.

In the new process, when an inmate demonstrates behaviours that indicate he or she requires insulin, a call is placed to TC CCAC. A Spectrum Health Registered Nurse (RN) is sent to the court. There, the prisoner waits, seated in a private room, with a court officer present. The nurse assesses the client, refers to the existing physician’s orders and, if necessary, administers the insulin. The whole process takes 15-60 minutes, avoiding or reducing court delays.

The cost savings per client are significant: now $60 for a nurse’s visit  compared to approximately $830 for the trip to the emergency department, hospital costs and the time of the attending court officers.

The initial objectives of the pilot project have been successfully met: to find a more efficient way to manage the health needs of prisoners with diabetes; reduce delays in judicial proceedings; maintain a secured environment for the prisoners and Court Officers and find a way to reduce costs for all parties involved.

Participants have discovered it is critical that everyone involved have excellent communication skills, compassion and motivation.  The staff and client satisfaction level is high. As one nurse, Simcha says, “It’s an outstanding opportunity to participate in care provision for the community in a new way, working together with other sectors.”

The innovative program has been recognized through a Toronto Police Service, Service Award and a Business Excellence Award from The Toronto Region Board of Trade. The partners have expanded the program to include Old City Hall and Superior courts. Prisoners will now come from the new Toronto South Detention Centre. And down the road, this model could be a practical solution for other medical conditions, including wound care or IV therapy.

About Toronto Central CCAC:
Toronto Central CCAC connects people across Toronto with quality in-home and community-based health care. They provide information, direct access to qualified care providers and community-based services to help people come home from hospital or live independently at home. In any given month they serve a population of nearly 1.5 million residents of the Toronto area with their care needs in the community. In any given month Toronto Central CCAC supports:
•    More than 19,000 people of all ages, cultures and backgrounds
•    1,700 kids getting support at their schools
•    400 adults receiving rehabilitation services
•    23,000 information and referral inquiries
•    The transition to a long-term care home for 240 clients
•    600 individuals to die at home with dignity
•    Saving 1000s of hospital days by transitioning 7,000 clients home for care