Addressing Healthcare in Jails

Throughout the United States, there over 3,200 local and county jails housing more than 700,000 inmates. Providing adequate medical care to the inmate population is challenging to say the least, which has led to many states contracting out their jail healthcare to private companies. Unfortunately, many of the leading jail healthcare vendors have been on the receiving end of hundreds of lawsuits, some with multimillion dollar judgements.

Increased exposure to liability and significant medical costs indicate a current healthcare crisis in jails yet public entities remain challenged with controlling costs without jeopardizing the quality of medical services. Taking a proactive approach to establishing strong management and oversight of jail healthcare is necessary to reduce complaints, claims and overall liability to your public entity.

Jail Inmates Have Complicated Healthcare Needs
Caring for the pre-existing conditions of jail inmates is a major contributor to the high cost of jail healthcare. Jail inmates tend to have high rates of chronic illness, substance abuse, and mental health conditions. According to data published by the journal American Family Physician, 26.3 percent of jail inmates are presented with hypertension, 63.3 percent with drug dependence or abuse and 44.3 percent with a history of mental health issues. It’s common for inmates to have multiple pre-existing conditions when they arrive at the jail. It is important to accurately identify, acknowledge and treat these issues. Some courts say that jails need to go so far as to treat the inmate’s conditions regardless of whether the inmate sought prior treatment or not. Once again, your legal council’s advice here is necessary.

Budget Decisions Can Impact Liability and Service Quality
A recent study conducted by The Pew Charitable Trusts provided several insights into the jail healthcare crisis. Decisions made for budgetary reasons can increase exposure to liability and have a tremendous impact on the quality of medical care. One example that can have various negative outcomes is the common practice of not budgeting to staff a jail with healthcare personnel around the clock.

Since jails book new inmates at all hours, some inmates are not screened by trained medical personnel when they arrive. It's easy for correctional staff, who usually do not have medical training, to miss that a new inmate needs medical treatment or has symptoms of a communicable disease. If the inmate or someone the inmate comes in contact with experiences a negative health outcome due to the delayed medical screening, a claim or even a lawsuit could result.

Not having medical care on-site has resulted in unnecessary expenses. When correctional staff cannot reach medical staff for advice about an inmate's condition, their next step is to have the inmate taken to the hospital for an expensive emergency room visit.

Improper Management of Private Providers Can Aggravate the Crisis
Many public entities have a contract with a private company that provides jail healthcare. It's important that public entities involve the entity's legal counsel in the creation of these contracts. Otherwise, the public entity may later find it disagrees with the private provider's interpretation of the company's responsibilities.

It's also critical to ensure RFPs are detailed enough for contractors to create adequate proposals. Although such diligence may seem obvious, the aforementioned Pew Charitable Trusts study found critical omissions in the RFPs related to jail healthcare. A sample of their findings follows:

Many RFPs did not include any utilization data.
70 of the 81 RFPs they reviewed did not request medication-assisted treatment, an evidence-based protocol for treating substance abuse.
Most RFPs didn't include performance requirements.
When contracts have performance requirements, failure to meet them can have serious consequences for the health of inmates as well as legal action against the public entity. Also, it's important to acknowledge contracts with performance requirements that carry financial incentives or penalties are meaningless if the public entity does not assign anyone to monitor the third-party provider's performance.

Public sentiment toward the healthcare system in jails may never change; however, public entities can certainly work to develop stronger partnerships with medical providers helping to support continued care for their inmate population.