Demands for medical and dental care are straining jails as never before, and sheriffs are looking for answers.
Hennepin County was paying so much for jail inmate dialysis that it bought its own machines to do the job.
As lawmakers in Minnesota and Washington, D.C., debate health care and human service programs, county taxpayers wind up footing the bill for people in county custody -- regardless of whether they're convicted of a crime. Authorities note a rise in the number of inmates who have mental health problems, expensive medications and treatments, and a general increase in health care costs. For instance, medicine costs at the Hennepin County jail were $156,000 in 2005 and jumped to $300,000 in 2009.
"Add all those things together, and you have a collective mess," said Jim Franklin, executive director of the Minnesota Sheriffs Association.
Federal and state medical assistance programs and many private insurance plans cease once someone enters jail, putting the cost on counties. It's an ongoing issue magnified as government budgets get tighter and funding is slashed or obliterated.
"Trying to budget for these costs is a little like roulette because you don't know who's going to be booked for what or who's going to be how ill," said Ramsey County Commissioner Victoria Reinhardt. "We just don't know."
What county officials do know is that they're required by law to pay for inmate medical care, even though they likely won't be reimbursed. They're required to provide essential and reasonable medical and dental care, not things like elective procedures. And when an inmate goes to a hospital, an officer has to be along to guard him or her 24 hours a day, forcing juggling of schedules that often leads to overtime costs.
The mandate thrust upon counties also forces them to strike a delicate balance between providing adequate care and making sure they don't open themselves up to legal action for neglect.
"It's definitely one of the biggest issues we face," said Dave Pacholl, detention captain at the Anoka County jail. "We have no control over our clientele. We take whoever police officers bring us."
The reality is, many people who end up in custody don't live the healthiest lifestyles or have access to private medical insurance. County officials don't argue the need to provide medical care; they question whether the right pot of money is being used to pay for it. Their common question: If a person was getting federal or state medical assistance before, why shouldn't money from those programs cover costs while incarcerated?
Well, because federal rule 435.1008 says so.
It's an answer that just doesn't sit well. "If they do have medical insurance and they are somehow covered, it needs to stay in force while they are in our custody," said Washington County Sheriff Bill Hutton. "It should not stop when they walk through our doors."
Looking for savings
Things are different in Dakota County. The Sheriff's Office has seen its inmate medical costs drop nearly $200,000 over three years.
"We've been very aggressive," said Sheriff Dave Bellows. Along with a declining inmate population, Bellows credits the drop to a change to state law in 2005 that lets counties pay medical providers a discounted rate. More recently, the county switched to a mail-order pharmacy, and that move is expected to save from $70,000 to $100,000 this year, Bellows said.
The Hennepin County Community Corrections and Rehabilitation Department spent $5.2 million on inmate health care in 2009. This year, the department signed a $4.3 million contract with a private company that provides medical services to correctional institutions in an effort to save money and provide better care.
The Hennepin County jail's medical care costs were $4.8 million in 2009, about 14 percent of the overall budget. Sheriff Rich Stanek said the jail has saved thousands of dollars in labor and transportation costs by offering X-rays and kidney dialysis in the jail rather than sending inmates to the hospital with deputy escorts.
The Association of Minnesota Counties and the National Association of Counties have lobbied on behalf of their members to get some relief, but so far there hasn't been a sweeping solution.
"It's a consistent problem," said Ryan Erdmann of the state association. "I don't know how much there is we can do about it."
Authorities will continue to watch costs and look for ways to save money, while elected officials will continue to work bureaucratic channels. Ramsey County commissioners, for example, will meet Feb. 15 to discuss correctional health costs and ways to lower them or work out better reimbursements.
"We've got to get people to think about this," Reinhardt said.
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