Medical care in jail is the new budget buster

For the first time, medical care costs more than food at the Washington County jail, where inmates often arrive with complex health problems that strain county finances.

Sheriff Bill Hutton and the jail commander, Chuck Yetter, say they're forced into constant reviews of the jail budget because of unpredictable surges of illnesses ranging from chronic diseases to depression, alcoholism and drug abuse.

"We have these conversations everyday because they're budget busters," Hutton said.

In metro counties and elsewhere in Minnesota, medical costs in jails are surging, driven by what the director of the Minnesota Sheriffs Association calls a "perfect storm" of circumstances. "It's well known that our mental institutions have basically closed so by default our jails have become our mental institutions," said director Jim Franklin. "It boils down to who's going to pay? Out of what budget? In the end, it all comes out of the taxpayer's pocket."

Inmates bring more medical needs than ever. In many cases, they require expensive medications. Some haven't seen doctors in years, others skip from one emergency room to another seeking treatment for their ailments, and often it's discovered that inmates booked into jail carry contagious diseases.

To avoid legal, moral and ethical dilemmas, sheriffs must treat jail inmates despite occasional public concern that money's being wasted.

"A sheriff may be an elected official but nobody's appointed him to be God," Franklin said. "For public safety and all other kinds of reasons you have to address those issues."

A physician's assistant comes to the jail three days a week. Nine nurses work part-time from 6:30 a.m. to 10 p.m. The jail also contracts with a doctor, a dentist, and pharmacy and laboratory services. About 160 inmates occupy the Washington County jail on weekdays, about 200 on weekends. The average length of stay is about a month.

Washington County plans a 10 percent increase in next year's jail medical budget for a total of nearly $800,000. And that's after a steep decline in the number of methamphetamine arrests in recent years.

By comparison, the jail's food budget for 2009 will be $545,000, same as this year.

Medical care is a state-mandated cost that creates challenges for county budgets, said Sue Hedlund, deputy director of Washington County's Public Health and Environment Division. "Rising costs in the jails put pressure on our tax base and the taxes we do collect and where we spend them."

Other metro counties are reporting similar challenges.

In Hennepin County, the number of inmates who received mental health assessments jumped from 1,990 in 2005 to 3,200 in 2007. "It's a sign that the mental health system is breaking down," said Mandy Dageford, the jail's nurse manager. "We have people who have been arrested on minor charges, and in the past they went to beds elsewhere after they were released. Now there's nowhere else to take them."

In Washington County, expenses can jump unexpectedly because many inmates have long histories of illnesses and often come to the jail untreated. Last year, three inmates cost the county $90,000 in medical expenses. Sometimes, the county has to pay for sheriff's deputies to guard inmates in hospitals, as was the case two years ago when police wounded Steven Van Keuren after he shot and killed two people in a house in West Lakeland Township.

Van Keuren had insurance that he purchased after being fired from his job. But, in many cases, inmates have no insurance.

"We become the default medical provider trying to fix things best we can while they're in custody," Franklin said.