Scott County sees decreased inmate medical demand after refusing to pay

~ Cape Girardeau County Sheriff hopes to see same results.

Stop paying the inmates' bills, and they'll stop requesting visits to the hospital.

That's what happened at the Scott County Jail when Sheriff Rick Walter implemented a policy after he took office on Jan. 1, 2005.

Cape Girardeau County Sheriff John Jordan said the same change will yield the same results in his county. He decided recently that the jail would no longer pay for doctor visits.

In years prior to Walter taking office, the sheriff's department footed the hospital bill for inmates. Missouri law requires sheriff's departments to provide medical care for an inmate, but it leaves counties' the choice of whether to pay the hospital bill.

"Once the inmates found out they had to pay, they quit complaining about being sick," Walter said. "Basically they wanted a free ride to see the doctor. Well, those free rides are over."

When Walter took office, the Scott County Sheriff's Department hired a part-time nurse who works at the jail and a doctor who comes in once a week. This resulted in fewer trips to the hospital and saves the county money.

"That's one thing I really wanted to implement in the jail, good health care," Walter said. "If the inmates want to visit the nurse or a doctor, then they have to pay a co-payment.

"Once they found out they had to pay, they decided they weren't really sick," he said.

In Cape Girardeau County, Jordan began charging inmates $10 per doctor visits in 1996. Now that the jail has a full-time health care staff available, inmates are charged co-payments of $10 for every visit to the physician inside the facility, $3 to see the on-staff nurse and $4 for any prescriptions.

"We saw a decrease when we implemented the co-pay policy, and now we expect there will be a decrease in trips to the hospital," Jordan said. "People who are sick will still want to go and people who just want to see the sun will decide they don't want to go."

Jordan said most decisions to send an inmate to the hospital are made by the staff nurses or doctors.

The Cape Girardeau County Jail expenditures were more than $65,000 under budget in 2005. This year the jail has a total budget of $706,600 -- last year's budget was $775,550. Even with $10 million in budget surplus coffers, county officials are still looking for ways to cut costs.

In smaller county jails that don't house as many inmates, paying for an inmate's hospital bill is not as costly as in bigger counties. Both Cape Girardeau and Scott County jails house more than 100 prisoners on an average day. Bollinger County has about 15 inmates in its jail, and that number will sometimes drop to less than 10, said Sheriff Terry Wiseman.

Bollinger County budgeted $6,000 for its prisoner medical aid this year. The Cape Girardeau County Sheriff's Department has $220,000 in its 2006 budget for prisoner's medical aid.

"It really doesn't hit us like it hits Cape County," Wiseman said. Bollinger County still foots the bill for inmates but rarely sees an inmate who requires a visit to the hospital.

At the Perry County Jail, one hospital bill -- for more than $500 -- was paid by the sheriff's department in 2005.

Perry County Sheriff Gary Schaff said he tries to get inmates to pay for hospital bills through commissary money, personal funds that are held when the subject is booked or brought in later by family members, or through their personal insurance.

"But a lot of times we get stuck paying them," Schaff said. "I considered making them pay for it when the statute came out but I'm afraid if we go to that system exclusively, then we won't get anyone to come look at our inmates."

But Walter hasn't run into problems with the inmates paying their own bills.

"What you have to figure in was that the sheriff's department was paying for all these things when an inmate had to go to the hospital," he said. "An ambulance is needed to take them to the hospital, a deputy has to go with them and take a car to get to the hospital. That takes the deputy away from what he is supposed to be doing, which is patrolling."

Southeast Missouri Hospital President and CEO James W. Wente would not comment on the issue.

Saint Francis Medical Center did not return phone calls on Monday.

jfreeze@semissourian.com

335-6611, extension 246