by Joy Matienzo
For many diabetic Canadians, taking their insulin is a daily task they’re able to do themselves in minutes, but for prisoners in detention and attending court hearings in Toronto, the procedure is a lot more complicated.
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 and EMS personnel and required blood work in the hospital lab and attendance by ED physicians. The whole process could take two to six hours, causing court delays, overtime for court officers and non-urgent use of ED resources. There was also an increased risk of escape or assault in taking 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, the TC CCAC is called. 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.
Down the road, the model could be a practical solution for other medical conditions, including wound care or IV therapy.
Joy Matienzo is Manager, Client Services, Toronto Central CCAC.
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