Medical care in jail is the new budget buster

The unpredictability of rising medical expenses at Anoka County's jail is putting more pressure on the budget in tight times.

The county is seeing more inmates with critical medical conditions and chronic diseases than ever, Capt. Dave Pacholl, Anoka County jail administrator, said last week.

"Treatment for HIV is very expensive. Intensive care costs are very high. One or two big medical [cases] can blow the budget out of the water," Pacholl said.

So when officials ask the County Board to approve a budget of $1.105 million to care for inmates in 2009, there's no way to know if a 13 percent increase will be enough, said Rina McManus, director of the county's Community Health and Environmental Services Department.

"We set the budget on what we expect," she said. "But if you have somebody come in with some severe cardiac condition, or a condition involving kidney malfunction that's in need of dialysis, or someone who comes in with severe injuries, they've got to be treated in a safe, medically appropriate manner. And that costs money."

In metro counties and elsewhere in Minnesota, medical costs are surging in jails, 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."

"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."

Other counties in the metro area are reporting challenges similar to Anoka County's.

In Washington County, for the first time, medical care costs more than food at the jail. In Hennepin County, the number of inmates who need medical attention is steadily growing, driven partly by cuts at state and community facilities that once treated mental health problems. In Dakota County, medical costs for inmates last year were up nearly 30 percent over the $1 million budgeted in 2006.

The cost of keeping an inmate in the Anoka County jail can be as high as $112 per day, Pacholl said. The state's daily reimbursement for an inmate's meals, health care, security and other expenses was $30 in 2007, but cut back by the Legislature this year to $10, said Jerry Soma, Anoka County Human Services Division manager.

The jail's medical budget for 2008 is $975,000. But the medical costs of just two inmates totaled about $200,000, Pacholl said. That's more than one-fifth of the total budget for a jail that houses an average of 200 to 230 inmates per day.

Data privacy prohibits county officials from discussing specific cases. But one recent example of unexpected jail medical expenses could be Arthur Torgesen, the Columbia Heights man charged with second-degree murder after he allegedly stabbed his wife to death and then set their home on fire in July. Torgesen spent four days in Hennepin County Medical Center with severe burns to his chest, arms and back before his transfer to the Anoka County jail.

Taxpayers may grumble, but recently arrested inmates must be presumed innocent. The threat of infection and necessary treatment cannot be ignored, Pacholl said.

Other county costs include moving inmates to St. Cloud. The Anoka County jail, which handles "high-security" inmates, has capacity for 248 inmates, although the jail occasionally exceeds that, Pacholl said. But another 25 Anoka County prisoners are housed in the Sherburne County jail, at a cost of $55 a day per bed, Soma said.

Some of those expenses are balanced by the 18 state prisoners held at the Anoka County jail, at a cost of about $80 per day.

And then there are meals at the Anoka County jail, which cost the county $1.20 apiece.

"There are more disturbances over bad meals."