The Public Eye

The Public Eye: Health costs for counties rise with influx of inmates

The Public Eye
The Public Eye

Since the state gave counties responsibility for incarcerating lower-level offenders three years ago, health care costs at county jails have gone up dramatically – and legal actions threaten to push them even higher.

The state’s 10 biggest counties spent $560 million on medical and psychological care for inmates last fiscal year, a 16 percent jump over the fiscal year that ended in 2011, according to a Sacramento Bee analysis of data provided by the counties.

Figures collected by the state over roughly the same period show a similar pattern for all counties: Spending on medicine is up 21 percent and out-of-jail medical visits have increased 32 percent.

According to county officials, the increases are primarily the result of lower-level offenders being sentenced to county jails instead of state prison, the state’s response to a federal court order calling for a reduction in prison overcrowding. The order was aimed at improving substandard medical and mental health care. County officials worry about ever-increasing costs, in part because three counties are now being sued over jail health care by the same attorneys who successfully challenged the state prison system.

County jail populations have been on the rise since lower-level offenders started going to jails instead of prison in October 2011. That’s not the only reason for higher costs, however. The new inmates are staying in jail longer – sentences are often several years, compared with the previous one-year limit on jail sentences – and they’re in worse physical condition than most other inmates because of long-term drug abuse and other unhealthy behavior, county officials said.

“Jails are turning into convalescent homes,” said Dr. Robert Padilla, Sacramento County jail’s chief medical officer. “We’re being asked to do things we have never done before. It’s going to cost more money. It’s something we haven’t come to grips with.”

Not all of the cost increase is due to the state action, as there has been a rise in all medical costs, said H.D. Palmer, a state Department of Finance spokesman. The state has helped counties with the costs, including allowing them to buy medicine through the state at lower bulk rates, he said. The state is also developing a plan to allow the counties to use the federal Affordable Care Act and enroll inmates to reduce correctional health costs, Palmer said. Under the act, inmates receiving hospital care for more than 24 hours are eligible for coverage, as are inmates before and after their incarceration, he said.

The state provided about $1 billion to the counties last year to incarcerate the new inmates and supervise parolees previously watched by the state. The counties decide how to spend the money. County and law-enforcement leaders have said the appropriation doesn’t cover all the needs, which include incarceration, rehabilitation and health care.

For instance, Sacramento County figures show the Sheriff’s Department received $3.9 million for medical, dental and mental health care for the inmates, but spent $7.9 million. In San Diego County, the Sheriff’s Department received $2 million and spent $7 million.

Because inmates are staying in jails longer, the counties have been forced to spend more on chronic conditions such as diabetes, hepatitis and heart disease, officials said.

In a lawsuit filed in federal court three years ago, Paul Andrew Shields accused Sacramento County of failing to treat his Hepatitis C while he was in the jail. The case is pending. The county denies the allegation, even though medical records submitted by Shields say “(Sacramento County) Correctional Health does not treat Hepatitis C.”

While declining to comment on Shields’ case, Padilla said not everyone with hepatitis C, a liver disease typically caused by intravenous drug use, needs or is a good candidate for treatment. About 2,000 inmates in Sacramento County have the disease, according to Padilla. Padilla said he worries that counties will be forced to provide such treatment. He said that a May article in the New England Journal of Medicine advocated screening and treatment of the nation’s inmates – at a cost of $84,000 per person.

The attorneys who sued the state over care in the prisons are now pushing for an expansion of health care in county jails. The Prison Law Office has filed federal lawsuits challenging the level of medical and psychological care in Fresno and Riverside counties, and is considering a similar action in San Bernardino County, said Executive Director Donald Specter. Another Bay Area law firm has filed suit against Monterey County.

All three lawsuits were filed after the counties became responsible for the lower-level offenders, a process often called realignment. “Realignment aggravated preexisting conditions,” Specter said. “In some ways, the state prison health system is better than the county system.”

County inmates wait too long to get care and it’s often substandard when they do, Specter said.

In the lawsuits, Specter lays much of the blame on the counties not having enough medical personnel, a problem made worse because of budget cuts during the recession. Such cuts occurred across the state, including in Sacramento County, where the correctional health division is authorized for about 100 positions – or a third what it had seven years ago.

Despite annual increases in his budget in recent years, Sacramento County division chief Aron Brewer said he is only able to a provide a minimum level of service.

Some of the biggest spending increases in the state have occurred in Fresno and Riverside, counties sued by Specter. “We don’t think it’s anywhere near enough money,” Specter said.

Officials in Riverside and Fresno declined to comment on the lawsuits except to say they are increasing funding to meet greater needs. In court records, they deny Specter’s allegations. “This is going to continue to be a difficult issue for the counties,” said Fresno County Public Health Director David Pomaville.

Specter said he thinks the problems in Riverside and Fresno exist in county jails across the state, based on complaints the Prison Law Office has received. While the limited resources of his office make the prosecution of multiple counties difficult, Specter said he wants to address the problems in other counties. To that end, he recently reached out to Matt Cate, executive director of the California State Association of Counties, to consider holding informal discussions with county officials.

Cate, who was secretary of the California Department of Corrections and Rehabilitation when the prison reduction order was upheld, said he too would like to keep the disputes out of the courts, unlike the state, which spent decades fighting inmate advocates.

“We’re concerned that the counties not find themselves embroiled in the kind of litigation that the state was in,” he said. “Counties don’t necessarily have to do it the way state did.”

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