A pro-active approach to women’s breast health in Michigan state prisons

By: Pam Duncan, RN, Oncology Manager, Corizon Michigan Regional Office

October is Breast Cancer Awareness month and reminders to the public are everywhere; pink ribbons to remember to get your mammogram or encourage your friend, mother, sister, or loved one to participate in getting screened for breast cancer.

But what about our female offenders? Female offenders account for roughly 7 percent of the incarcerated population in state and federal prisons. What are we doing to assure our female prisoners are screened for breast cancer? The Michigan Corizon Team has implemented a unique mammography program for female offenders that is achieving a 95 percent compliance rate for annual exams.

All women incarcerated by the Michigan Department of Corrections are housed at the Women’s Huron Valley Correctional Facility in Ypsilanti, Michigan.

Until 2014, a mobile mammography company was contracted from the State of New York to travel to the facility about every three to four months to perform mammograms inside the Health Care Clinic. In the weeks leading up to these visits, the offsite scheduler would be very busy entering all of the callouts into the EMR and prisoner callout system to ensure our patients made their appointments. All of the equipment would have to be checked through security into the facility and the contracted technician and one assistant would do 100 to 120 call outs over a weekend, leaving no time to properly educate the women about the procedure and why it was important, leading to refusals.

Many of these women did not have proper access to health care before they were incarcerated. They had never had a mammogram and were not sure what to expect. Some patients would refuse because they did not understand what the exam entailed, weren’t familiar with the staff performing the mammograms, and/or didn’t want to undergo the long wait for their turn. The incarcerated women were not happy with the process, which would result in grievances, extra time for custody staff tracking down no-shows, writing tickets, etc.

Films from the weekend would be taken all the way back to New York to be read by a radiologist. Hard copies of the final reports would then be sent back to Michigan to the medical providers at the facility to be reviewed. For those patients requiring a three-month follow up, the films would be transported back from New York. If treatment was ordered, often another mammogram would be needed.

The process worked – our female patients were receiving their mammograms – but it was tedious, costly and time consuming.

In 2014, Mason Gill, Corizon Health’s Michigan VP of Operations, thought there had to be a more effective, efficient, safer way. If Corizon could install mammography equipment at the facility and hire a dedicated technician, it would improve the overall healthcare delivery for the female offenders in Michigan. Mason located some used mammography equipment and worked together with Dr. Robert Lacy, Regional Medical Director for Women’s Huron Valley, to get the equipment installed. Dr. Lacy hired Mammography Tech Theresa Saumier to assist in the licensing process and serve as the full time Mammography Tech.

Theresa Saumier, Mammography Technician and the Mammography Unit at Women’s Huron Valley Correctional Facility

There were many challenges in getting this program up and running at the female facility. The dark room had to be completely revamped, new equipment was needed for transmitting the images, the flooring had to be replaced, and everything had to pass the many inspections required to obtain the license. Dr. Lacy also developed a Policy and Procedure Manual for the Mammography Clinic.

By mid-2015, Women’s Huron Valley Correctional Facility had a licensed operational Mammography Unit with a full time Mammography Tech. This unique correctional health care program for female offenders is one of very few in the country.

The experience for female patients is now very similar to that in the community healthcare setting. All female prisoners over the age of 40 are offered a mammogram annually, usually in their birthday month. Theresa schedules each mammogram for 30 minutes, and is able to reschedule an exam if there is a scheduling conflict. She can take the time needed to explain the process to the patients, make them feel more comfortable, and answer any questions they have.

“When you take the time to explain the importance of the exam when a patient wants to refuse,” Theresa said, “a lot of times the patient will change their mind, and go ahead with the exam.”

Theresa reported that the prisoners say they now “don’t feel like cattle herded through Health Care to receive an exam” and “feel more comfortable” because they are familiar with the staff because they see them every day, working in health care.

Digital images being processed

Mammograms also are now digitized. Theresa is able to complete the mammogram and digitally send it to the MDOC radiologist for reading. The Radiology Report is entered into Nextgen, the Michigan DOC EMR.

In 2014, the last full calendar year the contracted mobile mammography company was used at the facility, there were 442 mammograms completed.  In 2016, 947 mammograms were completed. The compliance rate is now 95 percent and five breast cancer cases have been identified.

Dr. Azimi, the facility OB GYN, is very pleased with the program. “The overall compliance has vastly improved and we receive the results within days instead of weeks,” he stated.

The Michigan mammography program is a great example of Corizon Health teamwork to deliver safe, effective and efficient health care services to our Michigan female inmate population and exceed the expectations of our patients and client.

In honor of Breast Cancer Awareness Month, encourage your health care team to educate your female offenders about breast cancer and the importance of having their annual mammogram.  Access to these services in the community may have not been available to the patient you are taking care of today. Take the time to answer their questions and explain the exam, you may just save a life!