County Jail Medical Care Costs Increased by $238,632 Per Year

The Tom Green County Commissioners' Court decided to increase the amount of health care professional hours at the jail Tuesday, increasing the cost to taxpayer for providing medical care to inmates by $238,632 annually.

Correctional officers corral a handful of men in green jumpsuits from the kitchen, each working in an assembly line, filling slotted trays with food and loading them onto pushcarts. Breakfast has to go out by 6 a.m., and before then, the various medications the roughly 400 inmates receive twice daily are sacked and distributed by correctional officers. There’s no one else to do it on Saturday or Sunday.

As the normal operations of the jail continue—a drunk driver is booked in, a suicidal subject in a holding tank is checked on every 15 minutes, a shake-down of several pods comes to an end—officers divide their attention and dole out the meds, working quickly so that their chores are finished by the time their relief comes in at 6 a.m.

“Jailers all across Texas pass out medications,” Sheriff David Jones said. “By statute they can. But it’s not the best practice.”

Jones explained that the county and its correctional officers are responsible for anyone who is arrested, and must keep them safe, including guarding their health.

“I think medical is one of our biggest liabilities in the jail as far as making sure that they get the kind of treatment that we’re required to give them,” Jones said.

For decades, correctional officers in Tom Green County went through the motions of sacking and distributing medications twice a day to inmates in medical need. As the population began to shift and the county facility was confronted with increasing health and addiction issues, they began looking for an outside provider to assist with medical concerns.

Shannon Medical Center was awarded the contract in January 2014 after the previous doctor retired. Today, Shannon is the exclusive vendor in control of the jail’s health needs. The staff has since traveled to other counties to see how other professional medical personnel operate in a jail setting and have adapted to the environment with impeccable success, Jones said. The only problem now is the demand of a growing jail community.

“When we entered into contract with them, we asked them to replace the amount of people we had working in the jail at the time when they took over,” Sheriff Jones said. He estimated that number to include 11 people total, one of whom is an RN. “That’s really proved to be inadequate for the level of services that we need to provide.”

In response to the struggle the current medical staff is facing in keeping up with the needs of population, Sheriff Jones and representatives from Shannon Medical Center made an appeal to commissioners’ court on Tuesday, presenting a proposed addendum to the current contract that would add more staff and lengthen the shifts.

Jones conceded that the proposal before the court Tuesday was an expensive one, but noted that housing inmates is never cheap and that the county is responsible for the health of everyone detained in its detention facility.

“You have to understand that the people coming into the jail, their health is way below what the normal health is of most people,” Sheriff Jones said. “I mean, the health needs in the jail are just tremendous. We have people detoxing off of heroin, off of meth, off of alcohol. We have a lot of the health issues—you’d be surprised at how many people are diabetic. These CMAs have to check their blood sugars and, I mean, it’s a big job just providing the minimum amount of care we have to provide.”

Anna Pittman, Director of Nursing at Shannon, stood before the court and relayed that she had assessed the needs of the county jail and concluded that they require four additional staff members, including three certified medical assistants (CMA) and one registered nurse.

“The reason for the CMAs is that currently we have non-clinical staff passing medications to inmates and clinically I feel that we could provide safer care—I mean, knowing why you’re taking it, side effects, adverse reactions, what interactions can be had with other medications—so I think we can improve the safety of that practice with adding three CMAs,” Pittman said.

The proposal would extend the care provided by medical professionals by adding a CMA to the 6 a.m. to 2 p.m. shift, one to the 2 p.m. to 10 p.m. shift and another to the weekend shift, which is currently an eight-hour shift running from 10 a.m. to 6 p.m. but would be extended to run from 8 a.m. to 8 p.m.

Weekends are currently the most problematic for correctional officers, who are passing out medications in the early morning and late evening hours themselves because there is no medical staff on duty at those times. Moving the times the meds are passed isn’t an option due to the various types of some of the medication, including time-lapsed doses and those that have to be administered on a regular interval.

The addition of the three CMAs with extended shifts would eliminate the need for jailers to pass medications at all, and would free up LVNs to collect information for the registered nurse tasked with triage and treatment, Pittman explained.

“There’s a lot that goes into triaging in the county jail,” Pittman said, citing drug and alcohol detox protocols as example. “Licensed nurses, LVNs, under the Texas Board of Nursing, cannot treat a patient. They can’t define the acuity, who goes first, who goes second. An LVN collects data and reports it to the provider.”

Currently, one RN works at the jail Monday through Friday from 8 a.m. to 5 p.m., but the sheriff and medical staff would like to have a second RN scheduled for a 2 p.m. to 10 p.m. shift to assist with after-hours issues when the jail is at its busiest, booking-wise.

The proposal comes with a monthly $56,425 price tag, which includes only the new staff, not an increase in fees for added hours. At the present, the county pays $36,539.64 a month for medical services in the jail.

“I will have to say that we contracted with our nurse practitioner for four hours a week and she’s been providing about eight hours,” Jones said. “She’s not increasing her fees or anything. What she’s providing, she’s doing an excellent job and providing excellent care and saving us a lot of money by not sending a lot of people to the ER and other facilities when she can provide the car in-house.”

As discussion tapered, Commissioner Bill Ford, who has witnessed the change in the inmates over the years and described their health issues as getting progressively worse, called the proposal not only “timely, but imperative”.  He made motion to accept the proposal, which carried unanimously.

The additional staff is anticipated to be able to start on July 1.