Once lodged into the jail, an inmate’s medical care becomes the responsibility of the jail (Sheriff). On a daily basis we deal with everything from cuts and scrapes, broken bones, diabetes, cancer, heart disease, dementia, kidney failure (requiring dialysis 3 times per week) and any other medical issues you can think of.
The U.S. Supreme Court has determined that failure to provide “adequate medical care” may rise to a constitutional violation of the 8th Amendment prohibition on cruel and unusual punishment. Any court takes a violation of someone’s constitutional rights very seriously. When a Court determines that you violated someone’s constitutional rights they tend to give out large awards, potentially into the millions of dollars which would have to be paid by the county.
The difficulty is determining what is “adequate.” Many times there are no textbook definitions for this. In some cases adequate medical care may be as little as a Band-Aid and anti-biotic cream. In other cases it may involve serious interventions such as surgery, chemotherapy, or kidney dialysis. Every day the corrections and medical staff work together to determine the best way to deal with the individual medical issues in the jail while maintaining safety and security of the facility.
The Sheriff has chosen to contract out inmate medical and mental health services. Our current provider is Correct Care Solutions (CCS). We pay them $355,000.00 per year. For this amount they provide the jail with medical coverage for 16 hours a day and a nurse available by phone after hours. Their staffing consists of a combination of LPNs, RNs and medical technicians to pass out necessary (prescription) medication 3 times daily. There is a Medical Doctor who oversees the medical operations. The Doctor provides sick call twice per week, seeing those inmates that have been triaged by nursing staff. Minor procedures can be handled in the jail medical clinic, with more serious or complicated conditions sent out to local medical providers.
We do charge the inmates who want to see the nurse or doctor a “co-pay.” A visit with a nurse or nurse practitioner will cost them $4.00. A doctor visit or prescription/prescription refill costs $5.00. While this doesn’t cover much of the cost, it does help weed out those “med seeking.” Narcotic medications are avoided unless absolutely necessary. No inmate is denied medical care due to an inability to pay. If the prisoner has no money, their individual account is billed and their account is sent to the Oregon Department of Revenue to try and collect some of that money.
Many inmates are eligible for the Oregon Health Plan but unfortunately one of the caveats to this is that the Oregon Health Plan Is suspended once an individual is incarcerated. In a weird twist OHP may cover the inmate if they are hospitalized for more than 24 hours.
Inmates as a group tend to be sicker than the general public. Chronic diseases are more prevalent due to poor self-care, substance abuse and generally living in unhealthy conditions. Oregon law (O.R.S. 169.166) requires the sheriff to pay for inmate medical bills after 45 days if the provider has not been paid by the inmate or their insurance.
As you can see meeting the needs of inmate health care is an expensive and complex process. The corrections and medical staff work together every day to assure that adequate medical care is provided to each and every inmate that needs it regardless of the crimes they are charged with.