In Legal Terms
- Volume 50, Number 5 - 2006
A commission's decision to privatize county inmate healthcare
Recently, a friend of mine sent me a page from The Valley Times-News, thinking I would enjoy one of the letters to the editor.
I did enjoy the letter, but my eyes were quickly drawn to the editorial on the same page from the paper’s publisher/editor, Cy Wood. The editorial focused on the most recent Chambers County Commission meeting, and I was quite pleased to read a very positive story about the county commission’ actions – with an impressive understanding of the plight of the county governing body.
The editorial dealt in large part with the county commission’s decision to contract with a private healthcare provider for inmate care at the county jail. This is an avenue more and more counties are considering in the ongoing effort to decrease these staggering costs.
As noted by Mr. Wood, this decision often meets with opposition in the community because it may include the purchase of medicines, equipment, or other medical services from personnel or suppliers outside the county.
However, Mr. Wood responds to this concern by stating that, “What should be troublesome to most county residents is not that a private company will be handling inmate healthcare, but that their tax dollars (totaling $170,000 in the current budget) are being used to pay for inmate healthcare.” He concludes eloquently that, “It puts a different perspective on the ‘lock ‘em up and throw away the key’ mentality on fighting crime.” He is definitely right about that.
The expenses of operating the county jail are almost always listed as one of the highest costs for the county – and unfortunately, these costs are frequently out of the county’s control.
Quoting again from Mr. Wood, “The most frustrating aspect of healthcare for inmates is that it’s an open-ended proposition. The commission can plug any number it chooses into the budget for inmate healthcare, but that number is an absolute shot in the dark.” As he notes in his editorial, one really sick inmate can consume the entire annual amount budgeted – and then some.
Of course, the same could be said for almost every aspect of operation of the jail. The county commission pays the bills, but often has very little control over what the expenses will be. There is no way to predict how many inmates will be held at any given time, and when state inmates will be transferred to the Department of Corrections. Likewise, the county is often in a constant battle with the sheriff over jail personnel costs, equipment and miscellaneous supplies.
The county is responsible for “necessary clothing and bedding” for those confined in the county jail, and “also necessary medicines and medical attention to those who are sick or injured, when they are unable to provide them for themselves.” Code of Alabama 1975, § 14-6-19. This section only requires the county to pay medical expenses only when the inmate cannot pay – but very few inmates have health insurance or other means for covering these expenses.
In addition, while § 14-6-22 directs the court to require a defendant convicted of a misdemeanor to pay his or her housing, maintenance and medical costs unless it will “impose manifest hardship” on the inmate or his or her immediate family, there are very few instances where the court has actually ordered these costs be paid.
In truth, there are few inmates who actually have the means to pay, particularly if they are to be confined in either the county jail or a state institution for any length of time.
Nonetheless, counties should pursue whether there are circumstances where the inmate has the ability to assume these costs, and the courts should be encouraged to order payments where appropriate.
The county clearly is responsible for the expenses of operating the county jail and providing necessary medical care for those confined, and that circumstance is not likely to change. However, counties should explore all avenues available to minimize the costs – and as with every other aspect of county government, one size does not fit all.
Chambers County has determined that contracting for the services may help to minimize and regulate the costs of providing medical care, and several counties have found this approach very beneficial.
Some counties have hired a licensed nurse to assist with distribution of medicines and minor medical needs, limiting the number of inmates who are required to be physically taken to a healthcare facility. Others have made arrangements with healthcare facilities for reduced costs. I am sure that there are other ideas or possibilities for curbing these costs in at least some small way.
While all of this is important, it is equally important to educate the public that the costs of maintaining the jail – and not just the medical costs – are truly staggering and are costing taxpayers exorbitant sums of money – in both county and state facilities.
As pointed out in Mr. Wood’s editorial, one major factor in this increase is the ‘lock ‘em up and throw away the key’ mentality. Unfortunately, however, it also appears that there is an ever-increasing growth in the rate of serious crimes.
There has been movement in recent years to look at alternatives to incarceration, such as work release, community corrections and increased probation. And, there have been recent minor changes in our sentencing laws.
However, state and local leaders need to continue working on ways to reduce the numbers in our state prisons and county jails, and to reduce the incidence of crime leading to incarceration.
In addition, state and local leaders need to work hard to educate the people in the state about the growing problem and its costs. Articles like the recent editorial in The Valley Times-News will go a long way toward increasing awareness of this serious problem and the need for many more reforms.
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