Marty Stamey, like any county manager, takes pride in crafting a water-tight budget: one that squares up the minutia of how many reams of computer paper and tanks of gas county employees will use on one side of the ledger with property tax and sales tax flowing in on the other.
But no matter how persnickety Stamey is in his forecasts, there is one irksome line that’s simply a roll of the dice. So he just crosses his fingers, gives it his best guess and hopes like heck a jail inmate won’t need open heart surgery.
Whether it’s a simple cavity or a serious brain aneurism, any medical ailment that befalls inmates while awaiting trial lands on the county’s tab. Even medications inmates are on, whether its insulin for diabetes or blood pressure medicine, are filled courtesy of Haywood County taxpayers.
Haywood isn’t alone. All counties are saddled with what Stamey called perhaps the “most unpredictable” area of the budget.
The county will spend around $230,000 in medical costs for inmates in the current budget year. Most of that is for hospital bills and visits to specialists, for everything from X-rays to dental work. But, the sum also includes an in-house nurse, a retainer for an on-call doctor and prescription meds.
The costs and hassle of managing inmates’ medical needs has become so complicated, however, the county has decided to outsource the job to a private firm.
The firm, Southern Health Partners, manages medical care for inmates at 190 jails and prisons in 13 states. Half of North Carolina’s 100 counties contract with the firm.
Haywood County will pay the company $134,000 a year for basic medical care to inmates. The contract isn’t all-inclusive, however. It mostly includes nurse and physician services provided at the jail, such as health assessments and dispensing daily medications taken by inmates.
The fee only covers the first $30,000 in hospital bills, visits to specialists and medications. Anything more than that, the county will still have to pay for.
The county has earmarked another $70,000 in its budget for that, so when it comes to the total cost of providing medical care for inmates, the county is budgeting $205,000 —compared to $234,000 now — a small net savings.
Regardless, it’s worth it simply not to deal with it, said Haywood Sheriff Bobby Suttles.
“Even if it is a wash or is a little bit more, it is still a good deal in the long run,” Suttles said.
The county still faces a potential legal liability if something goes wrong with the medical care provided to an inmate. The county currently faces a lawsuit from the family of a female inmate who died. She was rushed to the hospital after collapsing, but the family blames the jail for not paying closer attention to her condition and failing to take action sooner.
Contracting with a firm to handle medical care won’t absolve the county from being targeted by such suits, but the firm would at least be named in the suit along with the county as a co-defendant.
“The whole point of this is to get our risk down and our performance up,” said Julie Davis, the county finance officer.
The firm should deliver a higher standard of medical care and expertise. That will hopefully translate to fewer trips to the hospital as the staff brought in by the firm will be able to more confidently handle health care needs.
Stamey said the firm will do a better job determining when an inmate truly needs to go to the hospital.
“Sometimes they probably don’t need to go, but to be on the safe side, we probably send them on to the hospital,” Suttles said.
Jailers also will get training on how to handle medical needs when faced with them.
There could be other hidden savings as well. Any inmate going for medical care has to be accompanied 24-7 by a deputy. When a deputy is taken off his regular assignment to escort an inmate to the hospital, a back-up deputy is called in to cover the hole.
“That’s running me into money,” Suttles said. “I think in the long run it’s going to save.”
Being able to provide more health care at the jail instead of sending the inmates out for care is where the $30,000 in hoped-for savings would come in. Also, helping to save money on hospital bills for inmates is a new health care network for jails, formed under the N.C. Sheriffs’ Association.
Currently, the county has to pay the out-of-pocket rate when taking inmates to the hospital or to see specialists. Under the Inmate Medical Costs Management Plan through the state sheriffs’ association, the county would be eligible for a discounted rate, much like the discounted rate insurance companies are able to negotiate.
There’s roughly 75 inmates bunked up in Haywood’s jail any given night. Some are there serving short sentences, like a week-long stint for DUI convictions. But, most have only been charged with a crime and are still awaiting trial.
If convicted, they are sent off to state prison to serve their time and are no longer a health care liability for the county. If they aren’t violent or considered a flight risk, and they get out on bond while awaiting trial, they likewise aren’t the county’s problem.
It seems to Suttles like more inmates than ever are on medications now or have health problems. Buncombe, Transylvania, Henderson and McDowell counties all contract with the same firm.