Can For-Profit Providers Help Rural Jails Cut Health Costs?

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Mary Jo Robinson, a registered nurse with Southern Health Partners, checks an inmate's blood pressure at the Lauderdale County Detention Facility. Blood press and blood sugar tests are among the most common procedures at the jail. Photo by Paula Merritt/The Meridian Star

With health care for inmates one of the main drivers of the high cost of incarceration around the U.S., some local jail authorities are looking at for-profit providers as one way of reducing the bill.

How well is it working?

Since 2008, Mississippi’s Lauderdale County has operated under an annual renewable contract with Southern Health Partners to provide services for defendants held at the Lauderdale County Detention Facility. The current year’s contract, ending in September, 2019, will cost the county just over $448,000—a two percent increase over the previous year, roughly in line with inflation.

But compared to decades past, this marks a decrease in healthcare expenses for the county.

“Before we got into this agreement, we were spending almost $600,000,” Lauderdale County Sheriff’s Department Chief Deputy Ward Calhoun said.

ward calhoun

Ward Calhoun. Photo courtesy The Meridian Star

“If an inmate ended up in a hospital for weeks on end, you’re talking about a substantial amount of money,” Calhoun said. “Once we incarcerate a person, we — meaning the government — have to care for them.”

At the Lauderdale County Detention Facility, a nurse is on site 16 hours of the day, with another nurse on call for the remaining eight hours. Southern is also responsible for dispensing medications as well as running an on-site pharmacy and doctor’s office, which is capable of taking X-Rays.

“Our goal, if at all possible, is to keep it in-house,” Calhoun said.

According to 2017 and 2018 service reports from Southern, most of its care for defendants includes blood pressure and blood sugar checks. In 2017, Southern conducted 4,459 blood pressure checks and 2,215 blood sugar checks for the 3,158 defendants who came through the facility’s doors.

As of the end of September, 2,057 defendants came through the facility in 2018, requiring 2,209 blood sugar checks and 3,476 blood pressure checks.

Other medical necessities for defendants may include caring for pregnant women (10 in 2017, three in 2018), treating defendants with HIV (39 in 2017, three in 2018) or placing defendants on suicide watch (64 in 2017, 62 in 2018).

Fifty defendants saw a mental health professional in the first nine months of 2018 while 77 total defendants saw a mental health professional in 2017.

“We do have a co-pay of $10,” Calhoun said, adding that cash is contraband within the facility.

Defendants use money from their canteen, which their family can contribute to throughout their imprisonment, to make that co-pay.

For a defendant without money, and no family support, their account is “dinged,” Calhoun said, and they owe the county money.

A judge has discretion to release a defendant on their own recognizance, meaning defendants swear to show up for court dates without paying bail, for medical reasons.

Detoxing a ‘Regular’ Part of Care

Melissa McCarter, the jail administrator, said that part of the intake for the facility includes a medical assessment and, at times, that includes detoxifying people from alcohol or drugs.

“We see it on a regular basis,” Calhoun said about the frequency of the detox process.

“But it requires them to be honest about what they took,” McCarter said. “And it depends on the severity — if we have to give them space until they’ve detoxed and they’re safe.”

In 2017, Southern reported 51 detox protocols, for an average of four a month. Detox protocols decreased slightly so far in 2018, with 28 total detox protocols, averaging three a month.

Defendants without insurance, who may have lapsed on their healthcare outside of the facility, complicate healthcare within the facility, McCarter said.

If the number of defendants in the facility exceeds 280 people, a fee of $1.98 will be added on top of the contract for each additional defendant, according to the contract.

The county exceeded this 280-person cap three times in 2017, in January, February and May, by 11 defendants, two defendants and one defendant, respectively. This cost the county roughly $28 in fees. The population of the facility hasn’t exceeded 280 in 2018, according to the service reports.

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The Lauderdale County Sheriff’s Department claims that using a private health contractor, reduces healthcare costs over the previous system of county-provided healthcare. Photo by Paula Merritt/The Meridian Star

The contract allows for up to $40,000 in out-of-facility services, such as ambulance costs or procedures done at a local hospital. Beyond that, the county pays. In the previous year, the county paid $20,600 more than that $40,000 cap.

“We’ve had a multitude of years where we’ve exceeded $90,000,” said Sheriff Billy Sollie.

According to the service reports, 49 defendants were admitted to the emergency room in 2017 and 26 so far in 2018. Outside medical visits (which includes any specialized visits) numbered 44 and 54 in 2017 and 2018, respectively.

Most recently, Southern added a $39,000 cap on pharmacy costs, as discussed by the county’s Board of Supervisors during budget negotiations, who ultimately approve each year’s contract.

With recent reforms recommended by the Mississippi Supreme Court, however, the number of defendants held pre-trial on bond amounts they can’t afford may be reduced, decreasing the number of defendants in the facility.

“If fewer people are being held pre-trial, then we’re going to have lower medical costs and meal costs,” Sollie said.

The number of defendants seeking care from Southern has decreased in 2018 compared to 2017.

Though reports for 2018 are incomplete, the average number of defendants per month decreased from 263 to 229. January of 2017 began with 291 defendants and the year ended with 253 defendants.

Legal Concerns

Calhoun sees another benefit to the contract with Southern Health Partners: legal protection.

Southern carries the responsibility for its court proceedings and Calhoun said defendants in the facility most frequently file complaints in federal court about their healthcare.

“That’s one of the leading issues we get sued over — not providing adequate healthcare,” Calhoun said.

One example is the wrongful death suit of Davie Lee Chapman, who died in the custody of Lauderdale County on Feb. 2, 2015 from bronchial asthma, according to an autopsy report.

In December of 2014, Chapman alleged that Southern, specifically Sheila Hamlin, a Southern nurse, and John Mutziger, a Southern doctor, had denied him medical care by not giving him adequate breathing treatments for his asthma, a rash and hernia.

“Been having trouble with my asthma for several weeks. Clog up so bad, I couldn’t sleep, half the time,” Chapman said in his complaint. “I have request(ed) outside help for my skin condition, hernia and my asthma… We inmate(s) been charge(d) like we got a job. $10 for (a) clinic visit and $2 for (over the counter) medication.”

In a Mississippi Bureau of Investigations death investigation report, attached to the court records, various logs and sign-in sheets detail the efforts of guards to administer breathing treatments and Chapman’s multiple visits to the on-site clinic. Chapman requested to be released on his own recognizance, or released without bond, in order to continue seeking outside treatment.

The case was settled in December of 2016 and dismissed by Judge Daniel P. Jordan III the following May, according to the court docket. Details of the settlement aren’t included and the county hasn’t yet responded to an information request about the settlement.

In a different case, Gary Hugh Curtis filed an Aug. 2012 complaint against the county for failing to deliver his medication, which he said was prescribed by a doctor outside of the facility.

“The medical records submitted reflect that Plaintiff was being treated conservatively by Defendant (Sheila) Hanlin with medication, but was sent to the emergency room as soon as the need for further treatment was identified.

Mere disagreement with the prescribed course of medical treatment does not give rise to a Section 1983 claim, nor does medical malpractice,” the report filed by U.S. Magistrate Judge Linda R. Anderson said.

Anderson, adding that the evidence didn’t suggest the defendants had been “deliberately indifferent,” dismissed the claim on Nov. 3, 2014.

For reasons such as those, Calhoun sees multiple benefits to working with Southern to provide healthcare, rather than supplying it completely on the county’s dime, even if the costs increase annually.

“It is the best way to do business,” Calhoun said about hiring companies such as Southern. “It’s not an option for government to not take care of them.”

See also: Cost of Incarceration a Statewide Concern

Whitney Downard is  a staff writer for The Meridian Star and a 2018 John Jay Rural Justice Reporting Fellow. This is a condensed and slightly edited version of a story published this month as part of Downard’s fellowship project. The full version is available here.

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