Swain County is outsourcing medical care for inmates at the county jail to an independent firm that specializes in the niche field of health care for prisoners, and move the county hopes could save several thousand dollars a year.
The county currently spends between $105,000 and $150,000 on health care for its inmates each year. The new contract with Southern Health Partners could mean a savings of $20,000 annually.
Rising health care costs were the catalyst for two budget decisions by Haywood County commissioners, one that will hopefully save taxpayer money and the other a stopgap measure to keep up with employee health insurance.
Commissioners were forced this week to pay an additional $150,000 into the health insurance fund for retired employees who are under 65 — twice what was budgeted.
Commissioners seemed surprised over the increase.
“Should we be concerned about this?” asked Commissioner Kirk Kirkpatrick. “We have a liability, and it is going up. It is more than twice the budgeted amount.”
The rise is due mostly to an increase in the number of retired workers under 65. When the county down-sized its work force during the recession, it offered early retirement options to workers under 65, and so the number of former employees in this category has now risen. The county only pays a portion of the health insurance for employees who retire before 65.
Stamey said the cost for retired employee health insurance would almost certainly continue to rise, however. The county also had to pay an additional $27,000 into the fund for employees over 65.
He hopes switching to almost exclusively generic drugs — unless a brand name is prescribed for medical reasons — could provide huge savings and is working on implementing that change.
Commissioners also voted unanimously to enter into a contract with Southern Health Partners to provide medical care for inmates at the county jail.
This fiscal year, the county will spend an estimated $230,000 on medical care for inmates, from dental work to prescription meds to doctor’s check-ups. By contracting out the lion’s share of inmate health care to a private firm, the county hopes to knock about $25,000 off its costs.
The contract with SHP is $134,888 a year but doesn’t cover everything. In addition to doctor and nurse visits, it only covers the first $30,000 in hospital visits, pharmaceuticals and specialist care. After that amount runs out, the county will be on the hook for whatever additional costs are incurred in those areas.
In addition to the contract with SHP, the county is budgeting another $70,000 for inmate medical care.
Commissioners still hope the contract can save a few dollars.
Haywood’s detention facility averages about 75 inmates a night, and the county is legally obligated to provide medical care for inmates under its watch.
While the coming year’s projected savings are modest, commissioners say the contract should help.
“We all hope this will reduce inmate healthcare costs and provide a solution to overall rising costs,” said Commission Chairman Mark Swanger.
— By Scott McLeod
Marty Stamey, like any county manager, takes pride in crafting a water-tight budget: one that squares up the minutia of how many reams of computer paper and tanks of gas county employees will use on one side of the ledger with property tax and sales tax flowing in on the other.
But no matter how persnickety Stamey is in his forecasts, there is one irksome line that’s simply a roll of the dice. So he just crosses his fingers, gives it his best guess and hopes like heck a jail inmate won’t need open heart surgery.
Whether it’s a simple cavity or a serious brain aneurism, any medical ailment that befalls inmates while awaiting trial lands on the county’s tab. Even medications inmates are on, whether its insulin for diabetes or blood pressure medicine, are filled courtesy of Haywood County taxpayers.
Haywood isn’t alone. All counties are saddled with what Stamey called perhaps the “most unpredictable” area of the budget.
The county will spend around $230,000 in medical costs for inmates in the current budget year. Most of that is for hospital bills and visits to specialists, for everything from X-rays to dental work. But, the sum also includes an in-house nurse, a retainer for an on-call doctor and prescription meds.
The costs and hassle of managing inmates’ medical needs has become so complicated, however, the county has decided to outsource the job to a private firm.
The firm, Southern Health Partners, manages medical care for inmates at 190 jails and prisons in 13 states. Half of North Carolina’s 100 counties contract with the firm.
Haywood County will pay the company $134,000 a year for basic medical care to inmates. The contract isn’t all-inclusive, however. It mostly includes nurse and physician services provided at the jail, such as health assessments and dispensing daily medications taken by inmates.
The fee only covers the first $30,000 in hospital bills, visits to specialists and medications. Anything more than that, the county will still have to pay for.
The county has earmarked another $70,000 in its budget for that, so when it comes to the total cost of providing medical care for inmates, the county is budgeting $205,000 —compared to $234,000 now — a small net savings.
Regardless, it’s worth it simply not to deal with it, said Haywood Sheriff Bobby Suttles.
“Even if it is a wash or is a little bit more, it is still a good deal in the long run,” Suttles said.
The county still faces a potential legal liability if something goes wrong with the medical care provided to an inmate. The county currently faces a lawsuit from the family of a female inmate who died. She was rushed to the hospital after collapsing, but the family blames the jail for not paying closer attention to her condition and failing to take action sooner.
Contracting with a firm to handle medical care won’t absolve the county from being targeted by such suits, but the firm would at least be named in the suit along with the county as a co-defendant.
“The whole point of this is to get our risk down and our performance up,” said Julie Davis, the county finance officer.
The firm should deliver a higher standard of medical care and expertise. That will hopefully translate to fewer trips to the hospital as the staff brought in by the firm will be able to more confidently handle health care needs.
Stamey said the firm will do a better job determining when an inmate truly needs to go to the hospital.
“Sometimes they probably don’t need to go, but to be on the safe side, we probably send them on to the hospital,” Suttles said.
Jailers also will get training on how to handle medical needs when faced with them.
There could be other hidden savings as well. Any inmate going for medical care has to be accompanied 24-7 by a deputy. When a deputy is taken off his regular assignment to escort an inmate to the hospital, a back-up deputy is called in to cover the hole.
“That’s running me into money,” Suttles said. “I think in the long run it’s going to save.”
Being able to provide more health care at the jail instead of sending the inmates out for care is where the $30,000 in hoped-for savings would come in. Also, helping to save money on hospital bills for inmates is a new health care network for jails, formed under the N.C. Sheriffs’ Association.
Currently, the county has to pay the out-of-pocket rate when taking inmates to the hospital or to see specialists. Under the Inmate Medical Costs Management Plan through the state sheriffs’ association, the county would be eligible for a discounted rate, much like the discounted rate insurance companies are able to negotiate.
There’s roughly 75 inmates bunked up in Haywood’s jail any given night. Some are there serving short sentences, like a week-long stint for DUI convictions. But, most have only been charged with a crime and are still awaiting trial.
If convicted, they are sent off to state prison to serve their time and are no longer a health care liability for the county. If they aren’t violent or considered a flight risk, and they get out on bond while awaiting trial, they likewise aren’t the county’s problem.
It seems to Suttles like more inmates than ever are on medications now or have health problems. Buncombe, Transylvania, Henderson and McDowell counties all contract with the same firm.
The state will not investigate the death of Jessica Martin, who died last week after collapsing in a holding cell at the Haywood County Justice Center.
“The State Bureau of Investigation is not planning to open an investigation at this time, given the results of the autopsy,” said Noelle Talley, a spokesperson for the N.C. Department of Justice, in a voicemail message.
The autopsy report hasn’t been completed or publicly released, but Talley said the justice department received preliminary information that helped them make their decision.
Martin died on Aug. 10 at MedWest Haywood after emergency services were called to the courthouse around noon that day, but no cause of death has yet been released.
Haywood County Sheriff Bobby Suttles said that Martin had been seen, at least once, by the nurse kept on staff at the jail before she was sent to the courthouse to await her appearance. The nurse determined that Martin didn’t need to go to the hospital.
Martin fell ill before making it to the courtroom, and life-support measures were started when the ambulance arrived.
Martin was a 20-year-old Haywood County native and Pisgah High School graduate who was in the county’s jail because she didn’t show up for a court date in late July.
The charge was a holdover from her sole conviction, a 2008 drug paraphernalia charge, to which she pleaded guilty.
She was given a year of unsupervised probation and ordered to pay a fine of $331. But she never paid, and then missed both resulting court dates, in February and July.
She had been in the jail for five days before her death, and Suttles asked the SBI for an investigation.
“That’s just standard procedure for us,” said Suttles. “Not every time, but almost every time, we request the SBI.”
Martin is survived by a two-year-old son, Dillon, as well as her mother and several grandparents, all of whom live in Haywood County.
Her father, who operated heavy machinery for a local construction company, died last year.
Counties with jail beds to spare will soon be able to make a little cash housing state prison inmates.
Under a new program introduced by the N.C. General Assembly earlier this year, minor criminals with short sentences won’t be housed in state prisons anymore. The new measure will mean more heads in local jails and, for some counties, a little more money in local funds, too.
Currently, county jails hold inmates charged with a crime and awaiting trial. Once sentenced, they are shipped off to state prison, unless their sentence is less than 90 days, in which case they serve the short time in the jail.
But starting next year, county jails could end up housing inmates with sentences up to 180 days who would have otherwise ended up in the state system. It will only apply to prisoners convicted of misdemeanors; felons will still go into the state system.
Essentially, it’s a logistical move, said Eddie Caldwell, vice president and general counsel for the North Carolina Sheriff’s Association. They’re the group that’s going to manage the project.
“The legislature believes that there is available capacity in the county jails, but we’ve never had a mechanism to match up the heads with the beds that are available,” said Caldwell.
The program is completely voluntary. Local sheriffs don’t have to take on the prisoners if they don’t want to.
But for those who do have extra room, they’ll get paid to house these prisoners that would have otherwise ended up in the state’s prisons. How much counties would get is not yet known, according to Keith Acree, public affairs director for the department of corrections.
“The payment structure has yet to be determined, whether it’s a flat rate or something else,” said Acree. But, he said, what is certain is that on January 1, the department of corrections will get out of the business of housing misdemeanor criminals.
It’s welcome news for some counties that have new or unfilled jails where empty beds are eating up money.
“If you’ve got a county that has beds sitting vacant, there’s a certain amount of cost built into that bed anyway, so the cost putting an inmate in there is incremental,” said Caldwell. “We think that those sheriffs who have vacant beds would be glad.”
Especially if it means they can make a little money to cover their jail overhead.
Originally, state lawmakers wanted to save money by dumping the misdemeanor criminals on counties without compensating them, an idea bandied about for several years, said Caldwell. Several other states already do it.
But clearly the state’s sheriffs didn’t like the idea unless it came with money to cover the inmates room and board.
In the current scenario, the state is still projected to save a bit of money. They’re closing four small, minimum-security prisons, including the Haywood Correctional Facility, which will cut some costs.
And the state will increase court costs starting this month to cover the cost of housing prisoners.
Statewide, the changes should affect between 5,000 and 6,000 inmates, said Caldwell. It’s hard to really pin down an exact annual number of those that could land in county jails — those with sentences between 90 and 180 days with misdemeanor crimes.
On one day in March when he took a tally, there were 1,700 inmates who fit the bill, and he figures that’s about average.
In Haywood County, there were 14 inmates convicted in 2010 who match the criteria. Jackson County had four, Macon County had eight and Swain County only two for that year.
So, on the surface, it doesn’t seem such a big deal for smaller, rural counties.
But in Wake County, the state’s most populous, there were 296 convictions in 2010 that would have to be housed locally somewhere under the new rules. And portioning those out could be a boon to empty jails.
Eventually, Caldwell sees this program giving counties an incentive to build bigger jails than they may need, theoretically paid for by prisoners other places didn’t want.
Currently, the N.C. Sheriff’s Association is figuring out how many beds there are in facilities around the state, then contracts will be signed before the program goes into effect at the beginning of next year.
The health care bills rolling into the Haywood County jail for inmate care might now be slashed by up to 25 percent after the sheriff’s office contracted with a company who will ferret out discounts on the county’s behalf.
Currently, the county pays full sticker price for all health care given to inmates, and since they’re legally obliged to foot the bill for any inmate treatment, it can get pricey.
Sherriff Bobby Suttles told county commissioners that $20,000 a year was on the low end of what they might expect to pay. In a year when an inmate needs major medical care, such as open-heart surgery, costs can skyrocket to more than $100,000.
What the company, Correctional Risk Services out of Brentwood, Tenn., would do is comb through the bills looking for mistakes, such as being billed for a higher priced procedure or more treatment than an inmate actually received.
A company spokesman said that they save counties an average of 20 to 25 percent. They work solely on commission, keeping 30 percent of any savings that are found.
In addition to checking the bills for accuracy, the company will also be able to save the county from shelling out for full-price procedures by bringing them into a PPO — preferred provider organization — which would give the county the same kind of discounts private citizens can get by being under a medical insurance plan.
If the county sees savings from the contract, the majority would be from such markdowns.
Suttles characterized this as a win-win situation for the county. If no reductions are found, they lose nothing, and whatever savings they do glean will be a big help to the sheriff’s healthcare budget, which is, he said, notoriously hard to manage.
“Right now, we’re holding $8,000 worth of bills,” said Suttles. “It’s just hard to budget for the unknown.”
Bryson City merchants can expect some relief from the downtown parking crunch once the old Swain County Jail is torn down in the next two weeks.
The crumbling jail was abandoned a couple of years ago for a new multimillion-dollar facility since it no longer met state codes. County commissioners have opted for the low-cost option of converting the old jail site into a public parking lot once the building is demolished.
“There is a need for downtown parking, especially in the summertime,” said Commissioner David Monteith. “A lot of merchants don’t have a place to park.”
“You’ve got to run yourself to death to find a parking space,” said Commissioner Glenn Jones. “It’s no different from any other town. Parking is always at a premium.”
Tourists riding the Great Smoky Mountains Railroad exacerbate the problem. Some train riders hunt for free on-street parking rather than paying to park in the train’s lot, tying up valuable downtown spots for hours.
There could be up to 20 additional parking spaces to accommodate downtown patrons now, and also future visitors to a museum planned nearby.
“We’re going to need a lot more parking for that project,” said Kevin King, Swain county manager. “The county doesn’t need another building.”
Commissioners are also planning ahead for a greenway with picnic tables at the edge of the parking lot along the river.
The historic courthouse, which is adjacent to the old jail, will one day house a heritage museum, along with a visitor’s center and store run by the Great Smoky Mountains Association, a nonprofit that supports the Great Smoky Mountains National Park by operating bookstores in the park’s visitor centers.
The visitor’s center will take up about a quarter of the first floor of the old courthouse, according to Monteith. The cultural museum will showcase the history of Swain County and its people, while the visitor’s center will increase the nonprofit’s presence in North Carolina.
But with the courthouse dating back to 1908, major repairs are needed to render the building safe for use. Monteith says the upstairs floor must be taken out and rebuilt, according to a study done early on in the project.
“That is why we had to literally stop before we got started,” said Monteith.
“It’s a laundry list of repairs and improvements,” said Commissioner Steve Moon. “But the historic value of that building is something that we cannot ignore. We need to preserve that all we can and do the best we can with it.”
King estimates it will cost about $800,000 to renovate the courthouse, significantly lower than the $4 million originally estimated. For now, the county has $150,000 in its hands, much of which came through grants from the GSMA, King said.
Several other grant applications are still awaiting responses.
In rare good news for Swain County’s jail, a new agreement will soon usher federal prisoners into the often half-empty facility.
Sheriff Curtis Cochran has worked for months to secure an official deal with the U.S. Marshals Service, which will pave the way for the return of federal prisoners and score the county $55 per prisoner per day.
“We’re thrilled to have this agreement with the Marshal Service and look forward to working with them,” said Curtis.
For now, it’s hard to say how many federal prisoners will be filing into Swain’s jail. The new deal falls short of a contract, so the marshals aren’t obligated to send any prisoners, and the jail is not required to set aside a certain number of beds for them. Such contracts only go to jails with federal money invested.
Swain’s new $10 million jail, which opened in December 2008, is more than four times larger than what the county needs to house its own inmates. County leaders hoped to house overflow inmates from other counties, but those counties were simultaneously building new jails of their own.
The county recently learned its last and best customer, the Eastern Band of Cherokee Indians, is moving forward with plans for a jail of its own as well.
This flurry of jail building in the region has posed yet another problem for Swain — other new jails are stealing away a share of the federal prisoners up for grabs.
“Lucky for us, we had a lot of jails that were newly constructed,” said Lee Banks, supervisor of the U.S. Marshals office in Asheville. “When they came on line, we were quick to provide them with prisoners that we’ve had, Cherokee County in particular.”
Fortunately for Swain, though, a federal courthouse is located in Bryson City near the jail.
“It’s what, a mile away from where we’re at,” said Cochran. “If they’re going to utilize this courthouse, it would be more feasible for them to house their inmates here.”
Swain routinely housed federal prisoners until four years ago, when the Marshals Service pulled out due to safety concerns. The old jail was plagued by temperamental locks and lacked a fire sprinkler system. Back then, the daily rate for federal prisoners was only $30 per person.
Although the new jail opened 14 months ago, it has taken time to reconnect with the federal marshal service.
Banks said he hasn’t sent federal prisoners Swain’s way since the new jail opened more than a year ago simply because there have been less prisoners.
Swain’s jail is currently housing a lone federal prisoner, who’s been there since October.
“Now we’ve got plenty of jails on line, I have fewer prisoners,” said Banks. “I’m not complaining — it’s just that our prisoner population has been low recently.”
At this point, it’s difficult for Banks to pinpoint how many federal prisoners will soon be occupying Swain’s jail.
“We’re using multiple jails in multiple areas of the state,” said Banks. “So it’s hard for me to predict how many prisoners we’ll have in the future.”
Cochran estimates that he would have 21 beds available for federal prisoners, 16 male and five female, but that number is flexible, he said.
As of last week, Swain County had 40 inmates in its 109-bed jail, including 18 from Cherokee and one federal prisoner.
The Eastern Band of Cherokee Indians recently got a big push forward in building its own jail after receiving an $18 million grant from the Department of Justice.
The grant may be excellent news for the tribe, but for Swain County, it’s a source of anxiety. Swain’s new oversized jail relies heavily on prisoners from Cherokee to fill its 109 beds and to subsidize the $10 million facility.
Recently, Swain Sheriff Curtis Cochran reported that out of 61 prisoners in the jail, 32 were from Cherokee and just 29 were from Swain.
Swain is already struggling to prop up the jail, which carries a $450,000 annual loan payment, because surrounding counties that once housed overflow inmates in Swain’s jail have recently built new jails of their own.
Consequently, Swain has seen the number of out-of-county inmates decline by half from 2005 to 2008, and along with it, a significant decline in jail fees, which average $50 per prisoner per night.
Cherokee has been a lifeline for Swain’s jail, with more than 90 percent of the overflow inmates Swain houses coming from the tribe.
Cherokee Police Chief Ben Reed said the tribe does send some inmates to jails in Haywood, Cherokee, Clay and Rutherford counties, but Swain gets the greatest share by far. Since Swain opened its new jail a year ago, the tribe has sent almost 90 percent of its prisoners there, Reed said.
Though the arrangement has worked out well for Swain, EBCI has been studying the possibility of building its own jail for several years. In fact, Swain leaders knew before embarking on its oversized jail that the tribe hoped to build its own eventually.
“With Cherokee’s growth and development, I think it’s time that we have our own jail,” said Reed. “We spend a lot of money and resources to transport our inmates into different county jails.”
EBCI hopes to eventually build a justice center that would bring its courthouse, police department and attorney general’s office under one roof, along with a jail and parking garage.
Cherokee’s grant, part of $236 million in stimulus and public safety funds allocated to tribes across the United States, can only be used toward building the jail.
But it may be a while before that prison is built, as the tribe is just now forming a committee to guide the construction process. Mickey Duvall, economic development director for the tribe, said they hope to elect a chairman in the coming weeks.
Learning from mistakes
After seeing counties like Swain struggle to fill an oversized prison, Reed acknowledged that the tribe must do its best to avoid overbuilding its own jail.
“We’re going to take a good hard look at where we are now and what our needs are going to be,” said Reed.
Swain County Manager Kevin King said the county’s jail was built big to accommodate population growth over the next 15 years, which he said would likely be accompanied by an increased crime rate. King planned to rely on prisoners from other counties in the short-term but thought the county would eventually fill up the jail with its own prisoners.
But Cochran said he doesn’t see that explosion in Swain’s population occurring fast enough to line the jail’s beds with Swain prisoners any time soon. Besides, much of the population growth in the mountains seems to involve retiring baby boomers or second-home owners, who are less likely to be committing crimes.
Meanwhile, Cochran is working with the U.S. Marshal Service to win back federal prisoners to the Swain jail. The marshals originally pulled out their prisoners due to the crumbling status of Swain’s old jail and its lack of fire sprinklers.
Cochran said all his paperwork is in with the marshals but admits it could take a while before they make a decision.
“It’s a slow process when you deal with the federal government,” said Cochran.
While County Commissioner David Monteith has brought up the idea of putting unused jail space to another use, Cochran just doesn’t find that feasible.
“A jail is a jail, that’s what it is,” said Cochran.
King pointed out the silver lining amongst dark clouds, stating that food costs would drop after Cherokee prisoners pull out. Swain County saw the cost of food at the jail climb 49 percent last year. But that doesn’t settle how the county will make up for the loss of revenue from the tribe when it builds a jail of its own.
King said Swain will have a few years to figure that out.
“As far as short-term, nothing’s going to change,” said King. “Long-term, hopefully the economy will gain what it lost.”
When it comes to Swain’s jail troubles, it’s easy to play the blame game, Cochran said, but no one could deny that Swain County needed a new jail.
“The one we had was completely dilapidated,” said Cochran, who was not in office at the time the decision was made. “Did we need a $10 million jail? I don’t know.”
Misuse of county credit cards by a Swain jailer has prompted tighter controls on charge card use across all departments.
Earlier this year, a jailer purchased a $500 or $600 big-screen TV with the county’s credit card at Sam’s Club, said County Manager Kevin King.
The officer came back from a shopping trip for prison supplies with the TV, saying that she would reimburse the county for the purchase. Even though the detention officer followed through on that promise, she was fired.
Finance Director Vida Cody said a supervisor should have informed all employees about the county’s policy on making purchases, but Swain County Sheriff Curtis Cochran said it shouldn’t take training to realize that buying a TV with county money is wrong.
“Common sense would tell you that’s not allowed,” said Cochran.
The out-of-line purchase was flagged in the county’s annual audit but was not serious enough to launch a full-on fraud audit. Auditor Eric Bowman simply called for better internal controls so the misuse would not escalate into a bigger problem.
That misuse of the credit card was “one of many,” according to finance director Vida Cody. Employees in the Sheriff’s Department have also exceeded their meal allowance of $34 a day for three meals and made work-related purchases of more than $100 without getting prior approval by the finance department.
The finance officer is supposed to approve every purchase over $100 to ensure there’s enough money in the budget for it. An exception, however, could be made for emergency purchases, like repairs on a squad car that has broken down.
Now, all county employees can only buy supplies online on the Sam’s Club Web site, rather than at the physical store. Before hitting submit on that online order, though, Cody must check a printout of the purchase to ensure there’s enough money budgeted for the buy. After Cody approves the order and the employee makes the purchase, Cody must compare the printout of the receipt against the original printout.
To help decrease spending in the face of a budget crisis, Cochran said his department is also cutting down on travel expenses, only making trips when they are “absolutely” necessary.
Cody said no matter what, it is difficult to have complete control over the county’s credit cards, as employees may not always pay attention to how much they’re spending.
“It’s easy to want to use those cards when you have it on hand and go over your limits,” said Cody. “You could operate on trust, but people are human too ... The economy is bad. People might do things they might normally not do.”