OH County Jail Requires Creative Medical Budgeting
With county budgets trimmed to the bone, a major medical expense at the county jail could be an unexpected drain of county finances. That’s also true in Coshocton County, where Jail Administrator Lt. Jim McDonald has had to become a little more creative with his budget. Report in the Coshocton Tribune.
McDonald has been able to work with physicians to reduce the cost of medications provided to inmates over the past year by about $10,000. It helps that inmates with money in their commissary account make a $4 co-pay for their meds, and $7 co-pay for physician calls.
But the cost of care has risen pretty steadily during the past decade, from a low of $65,894.06 in 2003 to $121,819.81 this past year.
By state law, county jails and the handful of city jails are responsible for providing medical care for inmates. While some are able to pass the bill onto private insurance, and some end up releasing a sick inmate to avoid paying the bill, Ohio counties spent at least $38.3 million last year to treat prisoners, according to data collected by CentralOhio.com.
While totals have remained fairly steady the past few years, thanks to a change in state law, the cost per inmate can vary greatly, from $339 in Paulding County to $4,455 in Franklin County.
Some of the disparities are because of differences in recordkeeping; not every county reported the cost of mental health care, for example. Counties also structure their medical care differently. Larger jails have nurses on staff and buy medicine in bulk. Smaller jails will get inmate medications at the local pharmacy and arrange for visits with a local physician.
The Coshocton County Jail contracts with Premier Medical Services for doctor and nurse visits, Sheriff’s Lt. Bill Kobel said.
LOCAL INMATE CARE
“The doctor is scheduled in twice a week or more frequent if needed. The nurse comes in every two to three days to dispense the inmates meds,” Kobel said. “The most frequent medical issues we run into are anxiety, mental issues and drug/alcohol withdrawal.”Kobel said prescription drugs are filled locally as prescribed by the jail doctor or the inmates’ family doctors.
For other than routine medical check-ups, inmates can and have been transported to the emergency room because of life-threatening events such as chest pains, seizure activity, breathing difficulties and other ailments, Kobel said. Inmates who have dental needs or specialized doctor appointments are handled as necessary.
“The inmates have a right to basic health care/emergency medical treatment while incarcerated,” Kobel said. “We do not deny them these rights.”
NUMBERS, COSTS RISE
Counties house people sentenced to one year or less, or suspects awaiting trial who can’t make bond. And other than emergency rooms, many have no access to health care.Sen. Tim Grendell, R-Chesterland, is chairman of the Senate Judiciary Committee on Criminal Justice. He frequently hears from county sheriffs and commissioners that the cost of holding inmates is pricey. He called those costs an undue burden for taxpayers, but one that is difficult to fix.
Grendell said some criminals take advantage of their incarceration to get a root canal or other free dental services. Conversely, he said, some sheriffs would rather put a sick inmate back on the street than pay his medical bills.
Putting a monitoring bracelet on an ailing offender is far less expensive than jailing the inmate, something some counties are doing more often, Grendell said.
“If an inmate would be admitted to the hospital or required some type of major medical procedure we often will contact their sentencing judge and ask for a furlough which keeps the county from having to post a guard while the inmate is in the hospital or pay for the procedure,” Kobel said.
But costs remain a problem, even after 2005 legislation went into effect mandating that counties only pay the federal Medicaid reimbursement rate for medical services, Grendell said.
Some counties saw a great decrease. In 2004, Stark County paid $2.3 million for medical services and $1.9 million in 2009. Franklin County paid $9.1 million in 2004, and $8.7 million in 2009. Licking County paid $531,234 in 2004, and $367,760 in 2009.
At least 22 counties are paying more for medical care now than they did in 2004, including Coshocton County. Part of this might be because of rising populations. The county jail has 17 beds, but has housed an average of 50 to 60 inmates on a daily basis each year since 2002, Kobel said.
“The numbers I provided are the average daily head count for our jail,” he said. “That is the total number of people housed in our jail each day over a 12-month period. The state says we can only hold 17, but as you can see we are well over that number each day.”
But the cost increase locally could have been higher if it wasn’t for the legislation.
“Being billed at the Medicaid rate has saved the county a substantial amount of money,” Kobel said.
John Leutz, a senior policy analyst with the Ohio County Commissioners’ Association, said prior to the 2005 legislation some county governments had worked out deals with local hospitals and doctors to provide care at a lower cost.
Many counties charge inmates co-pays, often not as much to recoup costs but as a deterrent from seeking unnecessary care, Leutz said.
“To keep costs down the inmates pay $7 for doctor visits outside of the jail and pay $4 towards the prescriptions. This can only be done if they have money on their commissary books,” Kobel said. “On occasion we run into an inmate that fakes an illness in an attempt to get outside for a little while but we rely on the observations of the corrections officer to make sure everything is legitimate.”
STATE, COUNTY THOUGHTS
Robert Cornwell, executive director for the Buckeye State Sheriffs’ Association, said medical costs are a big problem for cash-strapped sheriff’s offices because medical incidents are entirely unpredictable. An instance of cancer or a heart attack is enough to put a county in the red.In addition to medical issues that come up, Cornwell said there has been an upswing in the number of people coming into the jails with mental illnesses. Psychotropic drugs are not cheap, he said.
Counties often try to avoid jailing mentally ill individuals and instead will help them get treatment elsewhere, Cornwell said.
Coshocton County Commissioners Curtis Lee, Gary Fischer and Dane Shryock said it is difficult for jail officials to forecast the rise and fall of medical costs and the money needed to pay for them.
“We allocate funds every year for that, but it’s kind of out of our hands and in the hands of the sheriff,” Lee said. “We’re on a limited budget, and you can only hope for things not to happen.”
Shryock agreed. “We give the sheriff an operating budget, that also includes medical costs, to operate the jail,” he said. “If the costs go over and beyond that, we may have to deal with it later.”
When asked by residents why a portion of their tax dollars go to pay for inmate medical costs, when some residents might not have health care coverage, the commissioners said that, too, is out of their hands.
State law requires all jails provide basic medical care “and that’s all you can tell them,” Lee said.
As far as solutions to the budget problems that state of affairs causes, the commissioners demure to the state.
“There’s not any easy way to resolve that one,” Shryock said.
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