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Macon amends contract for jail medical services

Macon amends contract for jail medical services

Macon County commissioners approved two amended contracts that will hopefully keep costs down at the detention center. 

The first contract was for medical services for inmates at the jail. Macon County currently contracts with Dr. Jason Creel and his staff for services for about $60,000 a year. The amendment to the contract would add the services of a registered nurse to the contract for an additional $3,000 a month, bringing the contract up to about $96,000 a year. 

“We’re continually trying to improve upon the medical services at the jail and trying to reduce the medical responsibilities on (the sheriff’s) staff — this amendment to the contract will take giant steps in accomplishing each of those things,” said County Manager Derek Roland. 

Roland said the county had previously looked at a number of outside companies that could come in to provide medical services in the jail, but none of the proposals from large-scale providers were under $260,000 a year.

“And even at that level, we’d never have the luxury of having a medical doctor on call and available 24/7 365 days a year. We’re blessed to have that here,” Roland told commissioners. 

Sheriff Robbie Holland said that many other county detention centers do use those large-scale providers, but the problem is the provider usually isn’t a physician and the sheriff’s staff never really knows who will be coming when they call upon them for assistance. 

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“This saves us money — still paying under $100,000 annually — and we have a good relationship with the doctor and the nurse,” he said. 

Commissioner Ronnie Beale also pointed out that having a doctor and/or nurse available at the jail reduces liability issues for the county when it comes to detention center staff having to administer medications. The additional cost of the contract will be paid for out of the sheriff’s 2019-20 budget. 

The cost of covering medical expenses for inmates continues to rise as the local jail population and average stays continue to climb. The sheriff has been budgeting more than $400,000 a year for medical expenses, but it’s a moving target depending on the jail population. 

Another sheriff’s department cost that has been on the rise is transport services associated with people who are involuntarily committed. Involuntary commitment is a legal process in which a judge will mandate emergency medical care for someone dealing with behavioral health issues. When that ruling is made, a law enforcement officer is required to get that person to a facility to be evaluated and if necessary, committed to a treatment facility. People often have to wait in the emergency room for an evaluation and then have to wait there for hours or days until a behavioral health bed opens up somewhere in the state. 

With the limited mental health and addiction resources in Western North Carolina, behavioral health beds are few and far between. Law enforcement might have to drive hours to transport people to where they need to go. And then they have to return days later to pick the person back up and bring them back to Macon County. Every transport can take two deputies off the roads of Macon County for several hours at a time and costs the county a lot of money.

Back in September, Roland said counties were required to submit their involuntary commitment transport process to the state. Since that time, Macon has been evaluating its process and decided hiring a third-party transport company would be the best option for keeping deputies on patrol locally and making the costs more predictable. 

The commissioners voted to contract with Mountain Area Transportation Services to transport involuntary commitments. Roland said he spent six months negotiating a contract that wouldn’t cost the county any more money than it’s currently paying for transportation costs. In 2014 alone, Macon County Sheriff’s Office spent 8,299 hours and $253,625 on 247 involuntary committals.

Roland said the contract can also be terminated with 30 days notice, but Mountain Area Transportation Services has already been vetted and utilized by the county’s Department of Social Services and is already approved to accept Medicaid reimbursement. 

County Attorney Chester Jones said the towns of Franklin and Bryson City would need to sign off on the amended contract for transport services before the new agreement could be put into place. 

The Smoky Mountain News requested a copy of the contract but did not receive it before press time. The contract was not included in the backup documents provided to the media before the Dec. 10 meeting. 

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