How to cut health care costs at jail

Last in a series
‘The inmates in Harrison County are human beings, and they deserve health care, but they don’t deserve health care at a higher standard than John Q. Public.’
That’s the assessment of Capt. Bruce LaHue of the Harrison County Corrections Dept.
Speaking yesterday from his hospital bed in Louisville, LaHue said he will probably be back on the job at the jail tomorrow. Job One will be getting a handle on the medical cost of inmates. Then he’ll start trying to improve internal communications in the corrections department with a radio system, initiate a plan to keep inmates separated by age and type of crimes, and improve public opinion of corrections personnel, who are responsible for policing the jail.
‘I will maintain my position as jail commander until all those issues are resolved,’ said LaHue, a former Emergency Medical Technician who worked more than a year as a road officer before a heart problem kept him from passing the rigorous physical tests required of a rookie by the state. He’s now all patched up and ready to return to work as soon as his strength returns.
LaHue does not believe an outside consultant needs to be hired as proposed to come up with a plan to cut medical costs. At least not yet.
First, LaHue asked Harrison County Hospital to give the county the 35 percent discount it gives to Medicare patients.
The hospital cooperated and the 35-percent discount across the board took effect last month.
According to Harrison County Auditor Pat Wolfe’s office, nearly $113,000 has been paid so far this year for inmate medical costs plus $49,000 carried over from 2004. Altogether, medical expenses for 2004 totaled $292,000.
That’s not just hospital costs. There are bills for doctor visits, prescriptions and non-prescription drugs and eye care. By law, all the inmates must be given the opportunity to be examined by the jail physician or his or her designee within 14 days of being locked up.
After that, a physician must be available at least once a week to evaluate and respond to inmate medical complaints. Also, emergency medical and dental care must be available around the clock.
LaHue said money could be saved by reaching a contract with a doctor to provide service for a flat fee for up to 10 patients at a time.
‘We could potentially save money by saying, if you come to the jail, we will pay you a minimum amount of $350 for up to 10 patients (a $10 savings per patient),’ LaHue said. ‘If it’s less than 10, it will be worth his ‘ or her ‘ while to come out.’
Another way to cut costs would be to use generic drugs when possible.
Most of the prescriptions are now filled at Davis Drugs in Corydon ‘ at a cheaper price ‘ instead of an out-of-state company that specialized in one-stop shopping for jails nationwide, LaHue said.
Sheriff Michael Deatrick stopped using the specialized company when he took office two years ago. ‘The prices were a lot higher, but they took care of everything,’ LaHue said. ‘That was their selling card.’
Besides using local pharmacies, the jail now buys over-the-counter products cheaper at Wal-Mart, when possible, he said.
Davis Drugs is equipped to use ‘blister packs’ for prescription drugs, which saves because any pills left over when an inmate is released can be returned to the drug store for credit, LaHue said. ‘And you can’t beat the service.’
Of the 130 or so inmates in Harrison County Jail on most days, LaHue said some 75 percent are on medication. As of March 31 this year, more than $32,800 had been spent for drugs and over-the-counter items such as Ibuprofen, Ace knee braces, tape, gel insoles, antacids and bandages.
Prescription drugs include ‘anything from anti-depressants to antibiotics,’ LaHue said.
Anti-depressants?
‘Jail is damn depressing,’ said LaHue. ‘But I don’t think it requires medication.’
LaHue said anyone who is on an anti-depressant when they are locked up should continue taking the medicine. ‘We are obligated to maintain that,’ he said. ‘Otherwise, it could be harmful.
‘The same with anti-psychotic medicines. But most doctors agree that if they’re not on anti-depressants when they come in, there’s no need for them to be on anti-depressants once they are in jail.
‘Over the years, it’s been easier to put them on anti-depressants than deal with them,’ LaHue said.
He estimated that 90 percent or more of the inmates used tobacco in some fashion, either by smoking, chewing, dipping or in a combination of two or more of those. Once they’re in jail, the inmates have no tobacco and some become quite irritable from that as well as losing other freedoms. ‘That’s another reason for the anti-depressants,’ LaHue said. ‘It makes them less jittery, irritable.’
A nicotine patch might be less expensive than the drugs, he said, but that’s not the only factor.
While the jail is constructed of non-combustible material, items inside the cells aren’t ‘ clothing, bedding, books and other reading material.
‘If they get (angry) and decide to riot, the first thing they do is set stuff on fire,’ LaHue said.
And there’s the issue of second-hand smoke, he said. ‘We would have to have segregated, smoking and non-smoking cells,’ he said. ‘We’ve been kicking around the idea of controlled smoking, outside,’ but that could make matters worse by increasing the desire for more. ‘It just wouldn’t work that well.’
It is more important to segregate inmates by age and types of crimes, he said.
Dr. Michael Bonacum, head physician at the jail, did not return a phone call to comment on these issues.
Jail personnel must follow the doctor’s orders and cannot substitute one drug for another, LaHue said.
Some of the drugs prescribed for inmates are newer anti-psychotic drugs for which there is no generic, said pharmacist Denise Orwick of Davis Drugs. The newer drugs are superior because they do not have the side effects of the older medications.
‘The side effects from the older ones can outweigh the reasons for giving them,’ Orwick said.
‘I really don’t know what the answer is,’ she said.