Inmate medical costs down with nurse visitsSeptember 8, 2017
By CANDY NEAL
Medical care for inmates can be costly. But the county has found a way to reduce those costs by having medical staff come to the Dubois County Security Center.
A registered nurse from the Dubois County Health Department visits the center about three times a week to check on inmates, review their medicines and check their medical problems. Staci Bolden is that nurse; the regular nurse, Emily Mehringer is on medical leave for another five weeks.
If Bolden didn’t visit inmates on a regular schedule, that care would have to be done either by trained jail staff under the guidance of a doctor, or at a hospital emergency room, with an officer taking the inmate to the hospital.
“It has saved us money and so much time,” Sheriff Donny Lampert said. “And it’s helped with inmates in keeping them consistently healthy.”
The center also has a doctor and counselor who come for medical visits. They are part of Advanced Correction Healthcare, a correctional healthcare company that operates in 17 states. Those medical professionals visit weekly. The jail nurse is there more often than that.
On a given visit, Bolden sees inmates who have filled out a slip indicating that they have a medical problem. Along with checking the problem, which could be an infections= or a physical condition, she also checks the inmate’s vitals, like weight and blood pressure. She calls and consults with the jail doctor and follows the medical protocol set by the doctor for treatment.
“Last week an inmate said that his blood sugar was high,” she said, referring to a condition that comes with diabetes, which the inmate has. “I checked myself to make sure it was right, and it did read high.” She checked previous readings, which were high as well.
“I asked about what he was getting in commissary, what he was eating and drinking. And I found out that he was drinking a lot of Mountain Dew,” Bolden said. “So I called the doctor to get a one-time insulin change. And I sat down with (the inmate) and discussed his diet.”
Talking to the inmates about how they should be taking care of themselves is a big part of the jail nurse’s job. “There is a lot of education I have to do with inmates,” Bolden said. “Sometimes they kind of neglect themselves.”
The inmates appreciate being seen by Bolden when needed, Lampert said. “Inmates who are ill don’t know what’s wrong,” he said. “The nurse reassures them that they are OK.”
It also helps the jail staff, who would be the ones who would have to deal with the medical issues if medical staff didn’t come in. “It’s reassuring for the officers to have a medical person there to take care of the inmate’s medical needs,” Lampert said, “instead of them trying to determine if an inmate needs to go to ER.”
The center doesn’t know what kinds of medical conditions they will have to tend to; by law, the center has to take care of an inmate’s medical issues for as long as the person is in jail. And in years’ past, there were no medical staff coming to the center. Medical issues required a trip to the ER, which meant an officer had to transport the inmate to the hospital and stay with the person for safety reasons. Also, there is no way to know how many ailments will have to be treated, so the cost of medical care fluctuates year by year.
In 2011, the security center spent $160,000 on medical costs. In 2012, the amount was $148,000; that year, a mental health counselor started visiting the center weekly. Medical costs were $104,000 in 2013 and $66,000 in 2014.
The jail nurse started coming to the center on weekdays in 2015. The center’s medical costs were $105,000; but there were some inmates that had some high-risk conditions — diabetes, pregnancy, liver disease. In 2016, medical costs dropped to $77,000.
“Having a medical person there has saved us money,” Lampert said.
But more than that, the inmates are more content because they know they will be seeing someone who is a medical professional. “They know when the nurse or doctor or counselor is coming,” Lampert said. “They know that they are going to be seen. They know that someone cares.”
The service was put in place to help with the sheriff’s department’s costs.
“We thought we could split that position,” said Donna Oeding, the county health department’s administrative director. “And I would be able to manage that staff position better than the sheriff’s department could. That’s good working relationships among county offices. It’s worked really well.”
Bolden said that she reiterates things the doctor may have already told the inmates, such as they can’t have certain medications they are requesting.
“I have to investigate, and check their file to see what the doctor has told them from before,” she said. “Sometimes they are hoping that I will give them a different answer from me. They think they get it past the nurse. But I have to have certain orders from the doctor, so that doesn’t work.”
The nurse is also able to draw blood and send those samples to the lab, which is cheaper than having that done at the hospital. They can also take care of other nursing duties, like removing stitches. If that wasn’t done by the jail nurse, it would have to be done at the hospital, which would likely be more expensive.
How long Bolden is at the jail depends on how many sick slips she receives from inmates who want to see her. One week, she spent an hour going through paperwork because there were no sick slips. Just last Friday, she was there seeing inmates for almost three hours.
In the past, the jail nurse visited every weekday morning. Now, the nurse comes in only three days a week.
That’s because the health department has had to make some changes to its budget to make sure the department’s revenue is more than its expenses. Along with changing some fees for services, the department had to cut a nursing position.
“We’ve had to reshuffle responsibilities among the nurses,” Oeding said.
“I know they would love to have someone there five days a week,” she said, “but my responsibilities to the services I provide here and to other parts of the county don’t allow me to go five days a week. Can we manage the responsibilities of the jail in the three days that we have? Not as fully as we like, but yes we still can.”
Each of the health department’s nurses now have more duties. Along with Bolden’s duties at the jail, she also acts as a home health provider, visiting patients who need help in their home. Now that school has started, she will also do school immunization clinics.
Sometimes it can be tough for her to get to the jail even three times each week.
“I have my other duties as well,” she said. “So I have to work the jail in.”
Lampert is pushing to have a nurse visit every weekday again, like in the past, although the funding will be a challenge.
“We’ve got to get back to where we were, for the sake of the people in here, for the sake of the county,” Lampert said. “For them to be able to see a nurse every day is helpful.”
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