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Substance abuse increases jail costs

February 22, 2012
Jails operating like the one in "The Andy Griffith Show," if they ever existed in real life, would surely put Mayberry and the county at risk for legal action these days. Even Otis, harmless as he seemed, would be a lawsuit just waiting to happen.

It's easy to entertain a fictional view of what would be nice: someone like Otis getting lop-legged drunk then going to the jail and locking himself up in his "regular" cell, complete with handmade quilts, embroidered pillows and a complete breakfast prepared in Aunt Bea's kitchen.

But it doesn't work that way and probably never has. Times have changed and so have town drunks. And another issue, a major one, that Sheriff Taylor never had to deal with is drug abuse. A huge percentage of those now in jails and prisons have drug addiction and dependency issues, and corrections officers, sheriffs, prosecutors and the court systems spend massive amounts of time, energy and money dealing with the problem.

Like most jails these days, Crawford County has to deal with a set of state and federal rules and methods when it comes to housing inmates.

"It's not my job to determine if an inmate is guilty or not guilty," Sheriff Tim Wilkerson said. "That is the job of the court system. But it's my job to house them and keep them safe until that is determined."

And the job of housing them and keeping them safe often involves drugs.

Most jails now have a medical director, and Crawford County is no exception. Brenda Rogers, who formerly worked at Floyd Memorial Hospital and Health Services and was a home health specialist, received training to serve as medical director in the jail and works closely with the jail's contracted doctor to dispense prescription medicines as needed to prisoners with health issues and to monitor inmates and keep the doctor informed of any health problems in the facility.

"We have inmates come in here on a regular basis who have health problems," Rogers said. "One guy was on dialysis and had to have 15 different medicines. Another guy was on a breathing machine. And we get people all the time who are diabetic and need shots and medications. By law, we have to keep those people safe, regardless of the cost. If they are in our custody, we are responsible for their safety."

When the Indiana Department of Correction inmates who are housed by the county require medical care or prescriptions, the state picks up the cost. But when it's county inmates, the county has to foot the bill. Last year, the county paid out $44,197 in medical costs for county inmates.

"And that's not counting the cost of our doctor," Rogers said. "The cost of medical care can fall back on the inmate's insurance, if they have any. But for most who are here very long, they lose their jobs, which also ends their insurance. And after someone is in jail for three weeks, their Medicare runs out, and whatever medical care or medicines they need is paid for by the county."

And, if an inmate slips in the shower and has a head injury, they have to be checked out. Sometimes that involves a hospital visit involving MRIs and other tests.

"We had one hospital bill for about $10,000," Wilkerson said, "and, not long ago, we had to spend about $7,000 on another inmate. But we have to follow procedure. We have to know the extent of the injury and treat it. I had to take an inmate to the hospital on New Year's Eve. And anytime an inmate is in severe pain, we have to provide help."

"I can usually tell by watching an inmate if they are really hurting or just wanting meds," Rogers added. "That's part of my training. And many of them just want a pill. They don't care what kind. But we don't give narcotics, and we're even careful about giving Tylenol or Ibuprofen."

The county is also required to furnish eye care and dental attention when needed.

"We have a contract with a dentist," Rogers said, "but he only comes occasionally, so, if someone is in pain from a dental problem, we'll issue Tylenol or something similar to ease the pain until the dentist comes. And the dentist does no fillings or caps. He will only pull the tooth, so that keeps our costs lower."

And then there's mental issues.

"That requires a different set of doctors," Rogers said. "Our doctor can only do so much. We have had a woman who kept yelling that she was going to kill someone. She was in a cell with five others, so you have to take it seriously. Sometimes they just want to be sent to Southern Hills (Counseling Center) for help, and they want to get on medications. There are times when we're not sure if they're faking it or not, but we have to act on it."

All jail trustees — inmates who perform a large amount of duties in the facility such as helping in the kitchen and delivering food to other inmates — must be tested for tuberculosis.

"They have to have a PPD skin test for tuberculosis," Rogers said. "Otherwise, they can't be around food. And they are a lot of help in the jail. They put down new floors in the jail, and they do a lot of painting. And by helping in the kitchen, it's one less person on the county payroll."

The jail also supplies pregnancy tests to female inmates when they are requested.

"If an inmate is pregnant, we have to supply them with more nutrition," Rogers added. "If we fail to do that, and the baby doesn't develop right, they can claim it's our fault. Inmates who are diabetic have to have special trays from the kitchen, as well. We don't give them shots, but we watch as they do it themselves."

Every inmate who is booked into the jail is treated with Lice-Off, to be sure they don't carry lice into the facility. After the booking process, the inmates must apply the treatment to all areas of the body with hair then allow it to work for about 10 minutes before rinsing it off.

Another modern twist to operating a jail is the need to deal with the withdrawal symptoms of inmates who are hooked on prescription medications, methamphetamine and other hard drugs. Once those who are addicted are arrested and no longer have access to drugs, going through withdrawal can be a dangerous issue.

"We now have non-narcotic drugs that we can administer to help with the symptoms during the withdrawal process," Rogers said. "For instance, we see people now who have been using 'bath salts' combined with morphine for an additional kick, or a better high. For those people, we give them Clonidine, which is often used for high blood pressure. That drug calms them and makes withdrawal easier. It actually slows down their heart rate. They get it two times a day, and we have to monitor their blood pressure three times during every shift. We do it because it's better than having their kidneys, lungs or heart from shutting down here in the jail.

"When they come into the jail, if they are already going through withdrawal, we'll send them to the emergency room to have their organs checked. And the county has to eat that cost. They usually have to stay in the hospital a few hours to see if they can withstand withdrawal," she continued. "If they are already in withdrawal, medications we have may not work. When they are arrested and we know they have been using methadone or shooting up, we get them on the withdrawal drugs as soon as possible, before they begin the withdrawal process."

For alcohol withdrawal, a drug called Vistaril is used. And there's three drugs available for withdrawal from drug abuse. All of them are used only after contacting the doctor.

"Some of those, like Phenobarbital, calms their stomach and tricks their mind into thinking they are getting a fix with their old drugs," Rogers said. "But we don't give them any narcotics. In the last year, we've only used drugs for alcohol withdrawal a couple of times. Mostly, we have to deal with drug addiction. Some go through withdrawal for about three days, but we've seen some have problems for up to three weeks.

"We don't put them in with the rest of the inmate population. They are in a holding cell until they get better, monitored 24/7. Once they get it behind them, we take them to the doctor for a checkup and they can be cleared to be housed with the rest of the prisoners. A lot of them can't remember what they did while they were going through withdrawal."

All prisoners have a co-pay for medications and medical treatment, but, if they don't have access to money, the county has to pick up the tab in order to assure they are safe while behind bars. To keep costs down as much as possible, the sheriff's department orders medications from a large distributor that will send prescriptions by UPS or overnight carrier once the doctor approves them.

"We still buy some from local outlets when there's an emergency," Rogers said, "but it's a major expense the jail has that most people never think of. And it's the price we must pay to keep these people safe as long as they are in here. That's our job."

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