Pitkin County commissioners agreed to spend up to $20,000 last week on health care services for an inmate who needs to travel to Denver for a potentially life-saving surgery.
Don Bird, administrator of the 26-bed county jail, went before the Board of Pitkin County Commissioners (BOCC) last week requesting that it adopt an emergency resolution that would pay $586 a day, up to $20,000, to Denver County for the inmate’s treatment at the Denver Downtown Detention Center (DDDC). Commissioners approved the resolution unanimously and wished the person luck. It is the first time the county jail has had to transport a sick inmate out of the area for surgery, according to Bird.
Who the inmate is and the specifics of his or her condition were not articulated for privacy reasons, but a local specialist said that the person needs to have an operation, which can only be performed in Denver, Bird said. The inmate has been in the county jail for 18 months and is currently awaiting sentencing for an unspecifed crime.
“Our problem is we need to take the person down to Denver and have the treatment,” Bird said. “And then we want the inmate to convalesce — not in a hospital but in a secure facility.”
That requires the patient to be cared for and watched at the DDDC before and after the surgery. The jail’s facilities, which opened in 2009, have a state-of-the-art infirmary offering 24-hour health care, which the relatively small Pitkin County jail isn’t capable of providing, Bird said. Medicaid is covering the cost of the actual surgery, he said.
Bird anticipates that the patient will be at the DDDC for 10 to 14 days, which means the county’s bill would come out to about $12,000 once the cost of transportation and medical supplies are taken into account. The arrangement with the DDDC is good for two years, meaning the county and the Denver jail would operate under the same financial terms in that time frame in case the patient or other inmates need to go to the facility in the future, Bird said.
The situation is one example of the larger issue of how the county is dealing with the rising cost of treating sick inmates. Pitkin County’s small jail has provided health services for sick people who were jailed for as long as Bird has been working at the jail, but the cost of doing that is becoming increasingly difficult to manage, he said.
The jail’s policy is that the county will treat and pay for any condition that an inmate develops while they’re in the jail, but the local government does not assume responsibility for preexisting conditions. That is similar to almost every jail in the state, Bird said.
“We get inmates that come in with ... a whole lifetime worth of medical conditions,” Bird said. “We cannot possibly assume financial responsibility for all of those events.”
If an inmate gets a toothache while incarcerated, administrators will take him to a dentist, but not if the health issue is a chronic condition, for example.
Most of the county’s inmates have a range of health problems, Bird said.
“Some people we get in here, they have never been to the doctor and they have never been to the dentist,” Bird said. “As you can imagine if their life is in crisis their medical condition is the last thing they pay attention to.”
So far this year, the county jail has spent $68,343 of its $69,000 budget for treating sick inmates, according to Bird.
The budget includes a variety of services including psychiatric visits, the cost of medical supplies and an on-call nurse. The largest portion of that budget goes to paying for outpatient services at the Aspen Valley Hospital, Bird said, adding that the county pays the Medicaid rate, which is a fraction of the total hospital bill. Commissioners haven’t decided what fund will pay for the DDDC’s services, but it could come out of the jail’s total budget, which was $1.7 million this year, Bird said.
It’s almost impossible to determine what future annual costs will be for providing health services to those who are incarcerated, because the facility’s administrators can’t predict who will be jailed and what their health history is, Bird said. The administration typically budgets based on the previous year’s cost, but it keeps going up, he said.
Bird, the jail’s nurse and a local doctor typically make the call on whether an inmate needs to be treated. That can be tricky, because some people who are jailed try to get the county to pay for health issues they’ve put off, he said.
“We have to decide whether it’s a legitimate need,” Bird said. “Sometimes we ask ‘Why didn’t you get it fixed when you were out?’ and they say, ‘Oh, it wasn’t a big deal at the time.’ We have to sort of go through those kind of conflicts all the time.”
The county commissioners will have a public reading and hearing on the resolution at a board meeting on Dec. 19.