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House | April 1, 2015 | Committee Room | Justice and Public Safety

Full MP3 Audio File

Go ahead and start this morning, I got several members have several other meetings going on today so Sam Pettite has that programe today so he said he was used to family side of town this week and he was used to talk to not many people so here we go. Flight for our pages to introduce themselves this morning. Hi, My name is Hasheem [xx], and I'm in ninth grade. Okay. Who's your sponsor? Representative [xx] very good, glad to have you here. Hi I'm Caroline Oil and I'm in the ninth grade too. And who's your sponsor? Speaker Moore. Good to have you here I hope you enjoyed it and we're glad to have you back. I think you were here yesterday? Yes ma'am. Yes, glad to have you, I hope you enjoy your visit this week. Thank you for service. Okay and our sergeant in arms Derry Moore HV Pamel and Davis [xx] to come also on okay, what did they say? You can't pronounce like them. Alright okay, it's okay hold on we're coming to there. Meaning today thank you. Cost you and get this. Good morning. We're going to pick up yesterday we wrapped up the prison program side of things. Where we left off yesterday we'll begin talking about the community based residence of treatment parts of the substance abuse programs, and their two facilities. There's DART-Cherry down in Goldsboro which serves as male probationers and parolees they've got a bunch of $ 5 million and a capacity of 300 treatment slots almost 90% treatments slot and for probationers and for 11% are for parolees. They have an 82% completion rate and the utilization has declined a little bit over they last two years, it's down to about 76%. There are a couple of reasons for this one, people who are ab-scorners or have withdrawn form the program, and then once a covert a group starts in the program if somebody drops out they don't replace somebody from this. Representative Macneal. I'm sorry pardon me, you say I plan dollars. I hope not. Tell something about dollars. So they're kind of $5 billion budget.   Okay Yes I heard something you didn't say. Or maybe I said something I didn't mean to say. I don't know. We'll start again. so once the cohorts starts they don't repay somebody except have to wait for the next class to come in and then also their is a possible some of the referrals had declined some of the probation programs the text program that list will talk about tomorrow may have also affect the population and the fine female facility up in Swananoah it's got an enrollment of three on three forks last year they've got 60 treatments slots and they had an 82% completion rate. Changing gears to correction enterprises, here you see the brot and laundry, and the Caledonia firm where we took a couple of years going oversight. North Carolina have the second largest prison industry program in the nation. They're 15 industries at 34 plants last year they had $92 million in revenue, they have 391 employees, and almost 2, 500 inmates, and the largest customers of theirs are the department of public safety and the department of transportation. As you all know I like to try and sort of provide context for you of the size of some of these enterprises. Last year the ladies of the women prison produced 16, 000 licence plates, and 1000 plastic plates daily. They raise 36, 000 chickens which lay 1 million eggs a month. They process 303, 000 cane cases of food from 22 different products. And I must say going down the site visit to the Canary down at Caledonia was awesome, they washed 14, 000 tonnes of laundry,

and I tried to find the equivalent for you of an aircraft carrier or a  battle ship, and I kind of ran out of time last night doing Google searches for that, so just take my word for 14, 000 tonnes is a lot. they produced 189, 000 pairs of inmates pants, and produced 19.4 million copies over the quick copy plant. Unlike most of the rest JPS budget area, the largest percentage of the budget is the supply line item, obviously the goods and the raw materials they need to produce the goods. This is very difficult to read the pie chart, drives some people in our team crazy but its a elusive of all the different things the collection enterprise does their largest products they do are food products which is about one third, laundry is the third largest and their sewing products are the second largest. This is the list of offender jobs the biggest employers of inmates are the Canary and the farming enterprise down at Caledonia, the six laundries, and then the five selling plants prison enterprise has, about 2.7 million dollars in intergovernmental transfers, they transfer $500, 000 dollars to the general fund. They transfer money to the crime victims, compensation fund, and like yesterday when we were talking about inmate welfare. This figure is a little bit, you're kind of wondering how do we get to the 88, 933. A transfer 5% of the remaining revenue after, their operating and capital expenditures, and so this figure fluctuates, from year to year. And they transfer $2M to the custody and prison side of things for operations. They also pay all the inmates, labor costs the incentive wages, of all the programs we talked about yesterday. People who work in the work units, in labor contracts, things like that, and they also obviously pay their own employees, $2.1 million. Are you sure if that's all, completion of that part of presentation? We have any questions concerning this? It's well worth your time to go see these, facilities and the see them working and how the Canary works and how the things they provide for our prisons and save, the state money, are doing this. Okay.  And I also wanted to point out other state employers you are eligible to purchase products, from correctional price including, glasses pulpits Ryan Bells, Cary Brown is at the back and will have an application for you, if you want to fill it out and she'll get you, an order form. Also meant be frame, picture frames or anything, they've got a great frame in the department. Of the women's prison they have an excellent frame shot, will have a little bit of time afterwards for us to all offer testimonials about the different products we've all used through christian enterprises still waiting for my big massive can of mustard green, I'm not close enough to curing to get that OK change in gears to talk about inmate care today, here is the statutory requirement related to the provision of health care services. The most important slide if you will in this presentation is what the state has to do, it has to provide what's called the community standard of care. They're supposed to provide necessary level of healthcare to diminish pain and suffering but they do not offer elective surgery the standard of care is basically the same thing that would happen to your average community it's also called what the medical director calls the best practice. And then finally in 1992, there was a state supreme case that said the public has a duty to provide adequate medical care to inmates who are in custody. To give you a at a glance looking at the whole health services budget it's $236.8 million, they have over 1200 bed's not just the hospital's here in rally but also some infirmary bed's and chronic care bed's around the states, they have almost 1900 Employees they dispense 2.2 million tablets of ibuprofen, they perform 6-700 procedures at the Central Prison Facility, and I'm happy to report they didn't know tummy tuck's last year. Represent or demean Is there a lot of, think about it, is there a lot of surgery? That amount to this problem's.

And let me stay here, thy're not hearing the question which is good, when your listening here The question is, what level of oral surgery, do they have? Share if you don't mind in front of the apartment Tell us who you're Good morning I'm Catlely Kaitlin I'm the deputy director for health service and yes we do have an oral surgeon that takes care of any kind of infection, or any kind of surgery that the male or female offenders, would require and it's done in house all of that all of that? If they make good come back surgery because of their own drug use or drug abuse do we provide bleaching? No we I'm sorry we only provide.  let me do the question again or you say it again so I can repeat it If they're made at this oral surgery or destruction's as a result of their own activity which destruction activity? is this the place of teeth? Because if they're impersonal activities that we repair the teeth, give the teeth, fix the teeth. We will get them to the when they're functional, but we don't do bridges, or any of these type of appliances. Leo. Excuse me, I was just wondering of these costs are mitigated by may be people that are in prison and have private insurance or medicate in any care representative McNeil we'll talk about medicate in a little bit, that's a very, very small most insurance does not cover inmates once they go to prison because there now in the custody of the states and most insurance plans suspend payments for all people who are incarcerated. Looking at the healthcare budget, this is a somewhat familiar part, the difference here is personal services only account for about 63% whereas the rest of the present budget it's about 78%, purchase services is also a much larger chunk it's a little over a forth as compared to 12% for the rest of the present budget. Employees account for about 51% of the spending, the second biggest category are prescription drugs and we'll spend some time talking about that and the large cost associated with that especially over the past few years. In the hospital services, the pad wedge down there a cancel of 14% in that $34 million. What of a budget drives of inmate healthcare? it's one or two to what's going on in the community if they are population, it makes the state prison just some range fro the age of 15-89, and just for your information, when I looked up the 89 year old, I assumed he's been in prison for for a very very long time, he was admitted in January, he had some issues with a gun and drinking the majority of the population as you can see is 20-49 year old. The aging of the population you can see the growth over, and part of it has to do with structured sentencing and that sort of stacking effect that we keep talking about, so now as of the end into the last fiscal year, there is 1700 individuals who are above the age of 60, it's gone 136% growth as of the end of February, there're over 1800 individuals who are older than 60, and 307 inmates who were above the age of 70. The crime disease that you see in prison are similar to what you see in the community except they are amplified because of lots of lifestyle problems that inmates have had hypertension, diabetes, and chronic lung disease, cardiovascular disease. These are the major cost drivers associated with inmate healthcare. This is the past five years of inmate healthcare spending, you can see it's a pretty positive story and we'll dwell into that more in a little while it's gone from $253 million dollars in fiscal year 9 10 down to 2000 13 14, it was $241 million. If you look at the past two years, and that flat rise, there are a couple of reasons related to that in part the increasing cost of temporary nurses, and also the increase in Pharmacy services You all begin in 2011 recording that the parliament provide quarterly reports due on hospitals emissions. There're two types of hospital emission

there's the emergent emission, somebody has to go to emergency room and this a scheduled visit. 87% of the emissions are for emergencies, 13% are scheduled. In addition you have, you request that they provide the report, people who got a contract to hospitals, and probably has a contract with for more favorable rates and a non-contract to hospitals. Good news is, the contract to hospital have increased from 50% of emissions in the first quarter of 2011, to the first quarter of this year, up to 62% so, that's moving in the right direction. Here is a five year comparison of where inmate healthcare has been going. The contractual services have declined about 49% The Ministry of Service puts this contemporary agency as a very a way of saying temporally nurses, that wasn't a separate line item its a separate category in the 2009 and 10 report, but last year it was $12 million, the employees have gone up 25% and that has to do with staffing of the new hospital that we'll talk about in a little while. The good news is that hospital services and other provided services has declined substantially. Prescription drugs have gone up 28% and equipment has gone up substantially that has to do with again, opening of the new hospitals. The healthcare budget is divided into four components. General health, mental health, dental health that representative Stephens eluded too, and then pharmacy services. We'll look at just each of those quickly individually. The general health component is the largest part. It's got over 1300 employees, $158 million dollar budget. It's the second largest component of the budget after the custody's staff, personal services account for two thirds, and just to kind of give you nursing coverage facilities, there are 26 facilities that have nursing coverage 24/7,  and then,  we have got 26 other facilities have nursing coverage, 16 hours a day, either five or seven days a week. Middle health is 339 FTE, $28 million, personal services is 98% of it,  and then12% of the population coming into prison, receive some type of middle health service, and they sort of range between the outpatient which are called the M1,  all the way down to M4.  So the out-patient psychiatrists, the folks who are out-patient are seeing, a social worker or  psychologist receiving services. The M2's or people over 32, 200 that you see there,  they're receiving services as well as also seeing a psychiatrist in the hospital under a psychotropic or under receive medication, the residential male health is a large growing part of this. There are 228 individuals, and that is sort of counties that there adding up a large middle health component down there and then find the impatient those are the folks who are the deepest in the system and there having housed at central prison and women's prisons middle health facility. We spent a lot of time during the general insight talking about middle health services. In this governor's budget, he has two proposals, one is to add additional middle health staff, central prison, there are 72 beds out of the 216 at central prison that are not operational because of staffing. The governor's proposing to add an additional 66 staff to fully open that facility, open this additional units. In addition they want to establish a behavioral treatment unit as the sort of state and that will be 271 FTE as well as the department has some outside groups coming and consulting with them on the whole issue of inmate male health looking at the dental budget. Thank you very much Mr. Chairman. I'd like to have some ideas to, if we know how many men neural health related issues that we have located in the county jails, and what I'm trying to get to the given the difficulty of chance, a lot of our mental health individuals are showing up in jail and that becomes their treatment as opposed in being in a real and normal health type setting. He wonders how many mental health patients or those of known health issues are in the jails. Yes sir. Female chair, representative last year during the oversight meeting we were talking about this, the sheriffs association presented on what

the locals were doing and I can make that report available to you, inmates that local inmates that have the most serious mental problems however are sent to the state as part of a safe keeper and the safe keepers obviously can also be medical health patients as well as mental health patients also. So, people who have the most severe problems in county facilities are sent to the state typically, but I'll make that report available to you, to the subcommittee, thank you ma'am, thank you sir. I don't see anyone from the sheriffs association here to speak to that. The dental budget 107 FTE $11 million most of it's in personal services, they're 35 dentists, 17 dental hygienists and 54 dental assistants pharmacy services. I have a question, where and how many facilities are the dentists? Thank you representative farley[sp?], I have to ask further to the departmental matter if you don't mind. Introduce yourself. Good morning; Terry Catlett, Deputy Director. We currently have dental services in 40 of our facilities. If an individual requires dental care and he or she may be in another camp we will transfer them to the closest facility to that care provided. Are these clothes custody or are they. Not necessarily, not necessarily.  Okay so just safety issue may be you don't want to take them, and we don't have a mobile unit that come out or anything like that.  No. Okay Thank you [xx]. 40, 4 0, 40. All these positions [xx] That's correct. We do, we have dental clinics that may only be open one or two days a week a lot of our dentists travel and so they may, you one said it, frankly one day a week and odom the next day they'll travel to maybe five different facilities each day a we can still though provide services one side of that facility. So they're not necessarily at the small camp that doesn't require a dentist full time. Follow up. Yes 3549 is we work for eight hours a week some of them yes. Full time, we do have a few dentist that work for us on contract that may be the only one who worked 20 hours a week but as far as 35 FTEs, that's correct. Thank you. Overseas services from FTE of 83 and a budget of $38 million. I like most JPS budget, the largest portion of this budget is supplies. Nuclear is one of the 49 states that are part of the this is the State Contracting Alliance for Pharmacy. This is a buying consortium that allows States to get cheaper drug prices, we buy 95% of our drugs through this out of the pharmacy they fill not 5200 prescription daily, 66% of them are filled by three robots the robots can fill 100 orders per hour. The largest expenditures we have are, when the largest category are HIV & AIDS and hepatitis drugs, those account for about 49% of the total purchases I went to visit one of these and they had a big thing with, I don't know how many prescriptions well I think everybody can we now have many in these prisons have to take something, does everybody have to take a pill a day or do we have a number Sorry, but I win I couldn't believe it, it was a cat thing and it was hanging on every a little area that. Good morning, I'm Kary Katlet, Deputy Director, it appears he said then somebody's taken something that's for sure. We have approximately very few inmates that we consider essentially healthy males which mean's that do not take anything, but any given day that pharmacy could fill 5000 prescription per day, and get out the very next day to the camp with the facility. Then not only do we have our mental health medications which

really occupy a lot of direct observation therapy but we have our maintenance meds for all of our patients. As we thought earlier we have a lot of our patients who have that potential diabetes and all of them require daily maintenance. And I'm sure they includes probably those who run substance abuse and have to house certain things, is that correct too? Correct. Can we is there a way to break down per prison per unit, different counts what they do and if everybody there is having to take something? we can certainly try to get you that data, yes ma'am. OK, thank you. Alright, Representative McNeill. While we were talking about the pharmacy services in the market seem  like [xx] a couple of slides back you said that pharmacy or drugs had increased to 26% something like that and the [xx] pharmacy can replace the drugs or they were buying more of a particular drug, do we know why it cost to [xx]? Do we know why the coaster upon pharmacy? Yes ma'am, we do we know exactly why, he did recall.   Introduce yourself, every time you speak you need to tell they're sorry. I'm Terri Catlett, Deputy Director, I apologize. We do know if you recall within the last year and a half we've brought up our operating room and our endoscopy suites, so a large portion of the increase is the aesthetics that we require to support those clinics, the operating room, the Endoscopy Unit, and the clinics that were holding them in essential prisons, so the direct result of the operational function of Central Prison Health care Complex. OK, I have another question and I was going to hold to the end but now my probably a good time. Earlier in the serving slide 24 is the hospital ignitions if that our hospital admissions are that in-house admission you consider that a hospital admission or? Terry Cutler deputy director so those figures there are patients who went to a local community hospital for an emergency situation, and they may or may not have been admitted it may have been evaluated and sent back to the facility follow up. Follow up and all those if there's need to all of those have to categorically the whole time was somebody allowed to stay without a [xx] [xx] Deputy Directory yes that's correct we have an officer with them hospital two offices is that correct? [xx] anyone else? Hey, right now we are okay? It's a take. So the major healthcare adventure categories, the largest one is obviously employees, it's 51% of the budget this category of provider are still 246 FTE, and this category of psychologist there over thousand nursing position and this includes nursing assistance, there are two and 37 help assistant And then there are 137 folks in medical records. There is a project that had purposed for a number of years on electronic electron, an inmate electronic record system called the acronym is called HERO it healthcare of electronic record of offenders and this is actually 30% live now by the year they should have a completely electronic so that instead of having the health staff from Rally go out and sort of audit the reports, everything can be electronically and it follows the inmate more carefully than having to have this big massive folder that has to go with every single time they move. And 99% or 900 employees are in the pharmacy. We still talking about outside hospitals, last years there were 118 outside hospitals, there were 20 thousand clinics for almost 12000 inmates. 10 hospital account for 65% of the claims, and 11 hospitals were paid more than a million dollars or 75% of the total. 62 of our community hospital serve 20 patients or fewer. One of the issues as I from jumping ahead a few slides to sort of wet to your appetite about the new hospitals one problems we had in the past, when inmates being sent out to community

hospitals is you all got lots of calls from your constituents because there was an inmate in the waiting room and there were two armed guards there with him, that caused a lot of concern with the hospital staff as well as people in community worrying about that the hospital at central prison women have taken care of a lot of that they still want inmate going out to the community but that problem has been alleviated a lot by this too this two hospital facilities and so this is inmate[sp?] going out the hospital is more of places like see hospital [xx] valley which has a unit dedicated for the department do complicit like that so the inmate they are concentrated in a field that is [xx] and not really as spread out as much as they used to be and the providers account for 10% and the prescription drugs for 15%. Because it's Spring and there's hope in the air and times are changing we can now talk about cost containment and the rest of the slide will just be awesome, as you can see the traumatic story. At one point there was the special session called the general assembly to appropriate additional funds to provide the cost of inmate healthcare. The General's told me he tried to tackle this problem and here are some three of the most recent steps. In 2009 they tried to attain health care services, through the State health plan. That was repealed in technical correction. Inmates are not [xx] to be part of the state health plan. In 2010 they were going to charge 70% of providers, the usual customary charges, and they were going to [xx] not withstand the providers from, the open records request log, so therefore the propitiatory information will be kept, private. The providers refused to participate in this, they said we're not going to be releasing our information to you, and then finally the last step was in 2011, that the public cannot pay, any more than 70% of bill charges, or twice the medical rateunless it's advantageous, to the department, for which they stay. And secondly they need to consult with, DMA to develop protocols, for medicated eligible inmates. For years, other states have been working with the federal medicare system to allow inmates to have certain conditions that offer facility for 24 hours or longer in in-patient situation in the medicated eligible, Medicaid would pay for the federal share of that and the state would take up the difference. North Carolina can never get a favorable ruling from the medicate office in a couple of years ago, they went out again and the medicate office allowed this and they've worked for DMA and they developed protocols now to allow the certain subset inmates to medicaid else to have medicare pay for these services. So they have three main components, there is the 7% of bill charges there is medicaid and then there is the hospitals we'll talk about in a moment. So in  2009/2010 the yellow the bill charges the department receives for hospital and outside providers, they were billed $119 million, they paid $90 million hours or 76% of bill charges. You can see [xx] when the provision kicked in that figure dropped dramatically and so last year they were billed 93 million dollars and they paid 46.9% or 51% bill charges, if the department was saying paying the same percent today as they were 2009/10 of bill charges, they would have spent an additional $24 million on our five providers. I wanted to show that's why twice but I'm not allowed so just imagine you're seeing it twice. hustler pipe provider this figure has also come down dramatically in part because of the previous slide. So you can see that it's down to about $58 million this past fiscal year. So this is sort of a teaser for talking about the hospital I know what you're thinking, this is my annual April fools joke and it's not. The department has a contract with the provider to bring a mobile MRI unit to central prison on Fridays and inmates that need to have for [xx] reasons MRI they've provided one it cost $200 to get to the MRI and $80 to have UNC read the MRI

outside providers that figures vary widely cost up to $5000 depending upon what part of the body needs to be examined. That's 18 times more than the department phase for MRIs. We talked earlier about Medicaid eligibility, 12% and in 1011 and the reason this figure is so low is because the program just started that year, they were working with DMA working on the protocol and so there was only had part of the year. So what you see pretty consistently is around 45-50% of inmates are deemed medicaid eligible, and so when they go to an outside hospital for 24 hour period or longer and they're medicaid eligible the state pays the department pays the state medicaid share which is about 30-35% and then medicaid picks up the difference. The cost of loans of this is about $1.2 million for per month. And finally the two new hospitals. The central prison hospital has 120 medical beds, and 216 mental health beds and we talked about the governor's proposal to add to fully operate those extra beds at the mental health facility. In addition and they contracted UNC to provide 17 specialty clinics that the department does not have the in-house expertise because it will not be cost effective to hire those folks from July 14th to end of the last February. there have been 6700 procedures done, at the women's facility, there are 80 medical beds and 70 mini beds that in a contract of 16 specialty clinics to provide services over there. These are some examples of what a 6700 clinics or, excuse me, patient [xx] and procedures that have been done at the prison, they range evrything from cardiology to urology, anything can be done in central prison that does not require opening up a body cavity, because they do not have an intensive care unit, over there because that would no be cost effective. Not sure that is and you probably heard this somewhere how many physician are in central, one of you may have said that. I don't know how many physicians are in Central prison hospital, if Terry doesn't know we can follow it up. Good morning Terry Cutler deputy director, you want the number of physicians full time positions at central prisons, so we have psychiatrists and medical doctors so we probably have about 13 or 14 combined between psychiatrists and medical physicians. We also have as John mentioned 15 or 17 different specialties physicians that come on site from UNC to provide specialty care. And any given day, like yesterday for example the gastroenterologist was at central prison and we did end up giving some colonoscopy the whole day. We did probably twelve procedures and today in the ER we have the orthopedist working in the ER, every day of the week we have special [xx] in the OR doing different types of procedures. On Thursday we have general surgery, we have two ORs, we have one surgeon in one room one surgeon in the other room, they support each other and do multiple types of procedures throughout the day. So five days a week we are doing surgery at central prison Are they on contract? Yes the physicians that provide care in the OR are the UNC contract physicians. So for example, there are general surgeons as Dr. Anthony Meyer, he is the Chief of Surgery at UNC, he comes on site and does general surgeries on Thursdays for us. Can we get a copy of that? [xx]. Certainly. Okay residents statements is committing our staff and our committee to doing all

the helping and all the people in the agencies who are helping us contain the cost for inmates medical. Okay, Allan. I just had a curiosity question on the charge bill, tele-med  is that mental health or what's service to that? Terry Cutlet deputy director, that particular, I think there is 15 there, that's actually dermatology, where the dermatologist would much rather see the lesion through the camera and doesn't come on site and does telemed through dermatology. However, with tele-psychiatry we do that in other sites and we had over 10, 000 [xx] last year. Thank you for that, Is there any consideration being given to may be expanding what you can do through tele-van. Terry Cutlet Deputy director, absolutely we have recently signed a new agreement with East Carolina university to be able to extend our tele medicine capability. What ares? Besides dermatologist obviously they can [xx] very well, what other services would you provide to tele-van. Terry cutlet Deputy director, there's at least 18 different sub specialties that East Caroline is ready to offer some of the very similar clinics that you see there, cardiology, phrenology, herpetology, infectious disease, there is about 18 different wards, that we have capability of, now the key is getting airtime, because specialists are limited with their obligations all through out the east but we do have an agreement and we're working quickly to be able to enhance the services. Follow up. Follow up.  Do you have any idea of what your call statement would be by expanding that? Terry Cutlet Deputy director well we projected that we could have several million dollars a year just with additional medicinal in the counters as long as we have these positions available on the other side of the camera, then we are willing to put patients there rather than have them go out to the community. Not a question just a comment, and I'll be tickled to death to may be that teleman slide hold that larger next year sounds like you are heading in the right direction Mr. [xx] wants to follow up on that, Thank you Mr. Chair. I realize when I was chairing[sp?] this inter prison hospital clinic in the facility. I failed to mention that one of the things the department does, if your out at Alexander Correctional and need to see one of the specialists, they transport you to central prison to do this, so while there's transportation cost there's not a cost to seeing somebody out to a community provider, and there's also not two armed guards that have to go with them. So the cost containment is trying to keep and move inmates within the system so when you go to the waiting room the receiving at Central Prison on one of these days, it's like Grand Central Station with inmates and vans and cars and buses coming in and out because they're reaping people from all around the state to try and take advantage of these two facilities, and I wanted to make sure that I have mentioned that is that true? Where you taught her You guys you noticed about the number of bid's you have for Mental health, and for are those flexible? Do you have more mental health sedated medical beds or you had more medical sedated mental health beds that they were available? Terry Cutler, Deputy Director, I'm actually know, the way the building is constructed, the medical beds are two hospital beds in our mental health units. They are single shelves, the mattress is actually built into the wall so we're not able to actually transfer patients from one part to the other so if you are a medical patient if you are admitted to med surge part of the facility if you are mental health patient you go to the mental health patient. Now that doesn't preclude the fact that the mental health patient need medical attention then he can't move over to one of the hospital beds, but as far as day to day housing we do keep them separate. Terry Cutler, Deputy director, initially

the patients brought to Central Prison, the in-patient unit for evaluation to determine if they are in a kind  of a crisis situation. If it upon emission and upon evaluation they don't need the criteria for in-patient status, then we can transfer them to a more facility or residential facility or one of our other facilities they can be managed as an out-patient, as they do come to central prison first to be evaluated and screened and tested to see if they need in-patient status. Any more questions? So what are the things that Terry made me think of, one of the things they figured out at Central prison hospital is they, because they're not dealing with typical hospital patients, they have developed lots of procedures and equipment that's sort of specialized that you wouldn't see in your regional hospitals and one of the things they've done is to limit the pole where the oxygen and the IVs and things go in. Lots of inmates are self-injurious and so what they've developed is the [xx] pole that you can plug in the equipment and then plastic shield comes around so the inmate can not damage the equipment or pull that out, so there are lots of things that are not part of a typical hospital but they have developed because of their unique population it's a fabulous [xx] by the way to go over to Central Prison Woman's Prison Hospital, that's fabulous. My team mates won't go anymore with me, but I'd love to go with [xx]. Is that all? OK that's all for today unless someone from the, does member of committee have any comments, any questions, anybody from the audience, give you an opportunity to speak, meeting adjourned.