Archive for Monday, February 23, 2004

County may charge inmates for health care

February 23, 2004


Inmates at the Douglas County Jail soon could be helping to pay for each visit to a doctor, checkup from a nurse or month's supply of medicine.

New co-payments for such health services -- which have been provided for free for years -- could be in place within a few months, once Douglas County commissioners receive a formal proposal from Sheriff Rick Trapp.

"That's part of paying their debt to society," said Commissioner Jere McElhaney, who first suggested such fees two years ago. "It's not a free ride out there."

Commissioners are searching for ways to mend financial wounds opened by recent cuts from state and federal governments, especially as health care costs continue to rise. Commissioners are encouraging departments and outside agencies to propose increasing fees, or imposing new ones, instead of asking for more tax revenue.

The jail's $400,000 budget for medical services has become an early focus, as commissioners prepare for budget discussions this spring.

Under the co-pay concept, inmates wanting to see a nurse, doctor or dentist would be charged a prearranged fee for service. The money would be taken out of the inmate's commissary account, the personal fund that can be used to buy snacks, toiletries or other items at the jail.

In Johnson County, where such co-payments started in 1995, the number of inmate requests for heath services dropped by more than 50 percent.

'A different world'

"It's a different world once you start spending your own money," McElhaney said. "You'll think twice about having a muscle ache or a sore throat or having to have some dental care. I think we should be charging the maximum (co-pay) that is allowable."

Medical expenses paid at the Douglas County Jail:¢ 2003: $374,332¢ 2002: $391,507¢ 2001: $409,587¢ 2000: $299,393¢ 1999: $240,586

Last year, the Douglas County Jail booked 5,336 inmates, who together made 3,389 visits to a nurse, doctor, dentist or mental-health professional, Sheriff Rick Trapp said.

None paid anything for the service, other than the time it took to fill out a form asking for help.

"We don't charge any fees at this time," Trapp said, "but we'll be seeking to."

Such fees are becoming increasingly commonplace in jails across the country.

But Edward Harrison, president of the National Commission on Correctional Health Care, cautioned that any county looking to cash in on inmates' health needs should do so carefully.

Devilish details

Imposing fees that are too high could prompt an inmate with a persistent cough to stay in his cell, rather than ask for a checkup, Harrison said.

If that cough turned out to be an early sign of tuberculosis, he said, the cost savings from the avoidance of a single sick call soon could be overwhelmed by an infection spread to other inmates, corrections officers and even the public.

"It could very much be a concern," said Harrison, whose Chicago-based organization, a spin-off from the American Medical Assn., provides accreditation services for medical services in more than 3,000 jails in the United States. "The devil's in the details of how it gets implemented."

Trapp and other county officials say they would be careful to avoid such problems.

Inmates unable to afford the co-payments would continue to receive free medical care, said Craig Weinaug, county administrator. Officials still are looking into ways to ensure that the best care is provided for the most economical cost.

Commissioners are confident they can work out a healthy plan.

"The politics of it are difficult, because we want to have a humane and decent jail," said Charles Jones, commission chairman. "On the other hand, it is troubling to find out that people in jail get better health care than many of the people who aren't in jail. There's a basic social equity issue there.

"I think we want to find the middle ground, where we're conservative and careful in terms of providing medical care, but that the medical care is sufficient."

Johnson County jailers already charge inmates $8 for each visit to a doctor or dentist, $5 for each checkup with a nurse and $5 for every 30-day supply of medicine dispensed.And while the charges raked in less than $3,000 a month last year, "small change," Capt. Vicki Simpson said, the real savings for taxpayers likely was much larger.Johnson County spends nearly $2.9 million a year on health services for inmates at its two jails, Simpson said, and the modest co-payments easily have cut the number of inmates' requests for health assistance by more than half."They're not going to waste their money to go down and see the doctor when they don't have to," said Simpson, an administrator for the jails, where co-payments took effect in 1995. "Before, we'd have so many inmates that would go down to see the doctor, just because they wanted to get out of the housing areas, just to walk down the hallway, to get out and do something. They'd go see the nurses, or go down and see the doctor for a sore throat, or because their arm hurt, or because their back hurt."We don't have those complaints anymore."The fees have proven so successful that Johnson County Sheriff Lynn "Currie" Myers wants to impose more. He's working with state Rep. Ray Merrick, R-Stilwell, to push legislation that would allow counties to charge inmates as much as $35 a day to defray the costs of their incarceration."Convicted inmates should not be allowed to live off Kansas taxpayers' money," Merrick said Thursday, as he introduced a bill that would require inmates to reimburse counties for the costs of their stays. "They have damaged their communities, and their communities should not have to pay to feed, clothe and shelter them in return."The bill is being considered by the House Local Government Committee.

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