Inmate health-care issues make budgeting difficult

Lauderdale County Sheriff Ronnie Willis quickly acknowledges that budgeting for inmate health care is a hit-or-miss process.

"You don't ever know from year to year what to expect," the sheriff said.

Law enforcement and the courts never know what medical issues might surface in a criminal suspect or defendant once they're placed in jail.

Once an inmate is in jail, the county is responsible for providing health care, which includes medication, dental work and transportation to the hospital, if necessary, and all treatment while they're there.

"If you have one in there, and they have a baby, you have to pay for that," Willis said. "It's too bad you just can't make them pay."

It doesn't matter that the person who is incarcerated may have arrived with a pre-existing condition.

"By law, we're required to provide emergency medical care," said Lauderdale Jail Administrator Jackie Rikard. "If it's something chronic - blood pressure, heart problems - we have to pay for it."

These issues make it difficult for administrators to budget money for inmate medical care. It's an issue that must be dealt with every year, and county officials are fighting that battle right now.

"Basically, all we can do is establish a figure and hope for the best," Lauderdale County Administrator Jenoice Bevis said. That figure can vary wildly from year to year depending on the inmate population.

Bevis said Lauderdale County saw its inmate medical expenses soar in 2007 and decided enough was enough. "Now we're doing something a little bit different," she said.

Instead of having a nurse on duty and a doctor under contract with the county to treat inmates, Lauderdale County is paying Southern Health Partners $20,000 per month to render medical care to the county's inmate population.

Bevis said the company specializes in inmate health care. The company provides a doctor and two nurses. The monthly cost includes inmate medical treatment, medication, hospital visits and ambulance service. The monthly charge is the same unless the amount reaches a certain point.

She said the change was made after a period of unusually high inmate medical costs.

Franklin County Sheriff Larry Plott also has a contract with a health-care provider, but utilizes a new type of system, Telemedicine, which allows a physician to examine a prisoner in jail from his office.

"It's basically using fiber optics that are hooked up to a local doctor's office," Plott said.

It allows the doctor to see the patient, even into his mouth and ears.

A nurse is present to assist with the long-distance exam.

Plott said the system cuts down on inmate visits to the hospital and on inmates who may fake an illness.

It also helps maintain security since inmates are not being moved from the jail to the hospital.

Inmates faking injuries or illnesses in Franklin County may find themselves paying a small fee for their exam, the sheriff said.

Before utilizing the contract health care and TeleMedicine system, Plott said budgeting for inmate health care was a challenge.

"This program seems to be working," he said. "We better know what to expect."

Colbert County Sheriff Ronnie May said the county contracts with a doctor, two nurses and a psychiatrist, but still has to estimate the remainder of the budget to account for hospital visits, medication and ambulance trips.

"All we can do is a rough estimate or an educated guess," May said. "It's always difficult."

While county jails are required to pay for inmate health care, municipal jails are not, said Sheffield City Clerk Clayton Kelly.

Kelly said an Alabama Supreme Court decision states that municipalities are not responsible for inmate health care unless it involves something that is caused by the jail, such as injuries related to a fall or other accident.

"If they get sick while they're in jail, we take them to the doctor or the emergency room," Kelly said.

"We're not responsible for the bill - they are."

Russ Corey can be reached at 740-5738 or russ.corey@TimesDaily.com.