DARTMOUTH — At least once a week, on average, each of the 1,400 inmates and pretrial detainees incarcerated by the Bristol County Sheriff’s Department requests to see a doctor, nurse, dentist or a medical specialist. their medical issues run the gamut from open wounds to flu symptoms, root canals and chronic heart disease.
Prescription medications are dispensed every day. Pregnant female inmates receive prenatal care from visiting midwives. seriously ill inmates are frequently driven to the hospital. last year, two older inmates died from advanced cancer.
“We’re required by law to provide the inmates medical care,” said Bristol County Sheriff Thomas M. Hodgson. “It is an absolute fixed cost we have to meet.”
The medical expenses include prescription medications, hospitalizations, off-site emergency room visits and follow-up appointments and treatment, including pre-natal care.
Correctional facilities are obligated under the Constitution’s 8th Amendment — which protects against cruel and unusual punishment — to provide medical care to inmates that is comparable to community standards.
This year, the sheriff’s department will spend $7.072 million for the inmates’ medical and dental care. That figure represents 19 percent of the sheriff’s $37.059 million budget, and it is almost double the amount that was spent for medical care five years ago.
“It’s an absolute burden to the taxpayers,” Hodgson said. “They’re the ones who have to pay, and they keep picking up the tab.”
The Plymouth County Sheriff’s Department will spend $4.7 million for health-related expenses this fiscal year, an increase of more than $1 million from a year ago.
“One of the major expenses of running a correctional facility has always been health care,” said James Pingeon, an attorney with Massachusetts Correctional Legal Services, which advocates for inmates’ legal rights.
Hodgson said the increased costs of providing medical and dental care medical expenses impact all areas of the operation, especially overtime costs, and prevent him from filling 75 vacancies for correctional officers.
“We don’t have a choice,” Hodgson said. “If someone needs medical care, we need to give it to them.”
But, “It’s a big impact on our budget. if our (medical) costs were $2 million less, we could hire more correctional officers.”
Correctional medical care expenses have been increasing at about the same rate as health care costs in general as new pharmaceutical drugs and therapies emerge.
But more people are being incarcerated and many of them enter correctional facilities with long-standing medical, dental and mental health problems.
“The more people we incarcerate, the more likely there will be people who need health care,” said Edward Harrison, president of the National Commission on Correctional Health Care, an Illinois-based organization that accredits prison health facilities.
Over the last 10 years, the inmate population at the Bristol County Sheriff Department’s facilities has increased by more than 33 percent, from 1,038 in 2001 to about 1,400 today, officials said.
And more inmates bring the need for more medical care.
The most commonly reported medical problems are arthritis and hypertension. About 50 percent of state inmates said they also had dental problems, officials said.
Other common health problems include HIV, hepatitis, cancer, heart disease and kidney problems that require inmates to receive dialysis several times a week.
A female patient at the Dartmouth House of Corrections was recently diagnosed with breast cancer and received treatment at a Boston-area hospital.
Mike Livingstone, director of medical services for the Bristol County Sheriff’s Department said he gets at least 6,000 requests each month from inmates who wish to see a doctor or a nurse.
“We send anybody to the hospital for the same reasons you would,” Livingstone said. “We have a number of people who have cancer and we send them out to the hospital for radiation. others have chemotherapy treatments. we send them to Mass General or wherever they need to go. we contact specialists when necessary.”
Livingstone said 10 of 200 female inmates housed by the Bristol County Sheriff’s Department are pregnant. of those, three are on methadone.
“People come in here after many years of not having proper medical treatment,” Livingstone said. “When they get here, they are medical basket cases,” he said.
The situation is similar at the Plymouth County House of Correction.
“Approximately 60 percent of our 1,500-inmate population is either alcohol or substance abuse involved, and 70 percent require mental health counseling or treatment,” said John Birtwell, spokesman for the Plymouth County Sheriff’s Department.
“As you might suspect, our population is not necessarily one that comes in with gold-plated medical plans. there is not a day that goes by that we don’t have double-digit requests from inmates asking to see a doctor or nurse practitioner.”
Veronica Madden, deputy commissioner of classification, programs and re-entry for the Massachusetts Department of Correction, said 66 percent of female inmates and 24 percent of male inmates at DOC facilities statewide receive care for mental illnesses.
“The Department of Correction is the largest provider of residential mental health treatment in the Commonwealth,” she said.
Further aggravating the medical picture in many jails and prisons is the fact that the inmate population is also growing older. more inmates at the Bristol County Sheriff’s Department today are in their 40s and 50s, even 60s, officials said.
“We have an aging population, as do most prisons,” Hodgson said. “You have people coming in today with diabetes, heart ailments. … You’re going to end up with more medical expenses as they age.”
Harrison said: “The aging inmates population is relatively new compared to other factors. On average, we incarcerate inmates for a longer time. as a result, people who are older tend to have older medical needs that are expensive.”
The infirmary at the Dartmouth House of Correction is made up of two separate, 12-bed wards for male and female inmates. Nearby is a quarantine room for inmates with contagious diseases. Next door is a former cell equipped with a hospital bed for critically-ill inmates.
The area is under constant video surveillance by a security guard.
Just around the corner is a small space where technicians draw blood samples that will be examined by outside laboratories.
Prescription medications for a variety of symptoms are dispensed three times a day to inmates.
“We have a full-blown medical operation,” Hodgson said. the inmates “are probably getting treatment in a much more timely manner than anyone could on the outside.”
“The people here receive excellent medical care,” Livingstone added.
Attorney Pingeon of Massachusetts Correctional Legal Services said that medical care in county jails has generally been “spotty.” Contagious diseases and infections such as MRSA, a bacterial infection, are often problems.
“It’s sometimes difficult to get those infections under control,” said Pingeon, who has previously raised concerns about the quality of mental health services in Bristol County correctional facilities.
In October 2009, two female inmates at the Dartmouth House of Correction attempted suicide within an hour of one another. One inmate died while the other survived after being hospitalized.
At the time, Pingeon said those incidents followed several complaints about the quality of medical care at the jail, especially after the sheriff’s current medical vendor, Correctional Psychiatric Services, took over the operation.
The previous vendor, Correctional Medical Services, left because the sheriff’s department had not paid an outstanding bill for $3.6 million. Hodgson said that occurred during a severe budget crunch and added that CMS has since been paid.
Hodgson said his current medical vendor has “done an excellent job.”
Medical services have taken an increasingly larger share of the Bristol County Sheriff Department’s budget.
In 2006, the sheriff’s department spent $3.8 million in medical and dental expenses. That increased to $4.7 million in 2007, and has only been growing.
Next year, Hodgson estimates he will have to spend $7.361 million in medical expenses. He attributes some of the increase on the higher costs of pharmaceutical medications.
Those increases come as the state has lowered his department’s budget appropriation, Hodgson said. this year, the state appropriated $26.6 million for Hodgson’s department, down from $38.5 million in fiscal 2010.
Despite criticisms by opponents during his recent campaign that Hodgson wasted money on failed lawsuits and patronage hires, the sheriff is adamant that he runs an efficient operation that is chronically underfunded by the state.
Hodgson said higher medical expenses and diminished budgets comes at the “cost of jobs for the residents of Bristol County and poses a threat to the welfare and the safety of the remaining employees.”
Hodgson said he tried to offset some of the costs by collecting co-payments from inmates: $5 for medical and dental appointments, and $3 for prescription medications. the sheriff said imposing co-pays, from 2002-04, cut the number of inmate medical visits almost in half.
“They weren’t willing to pay out of their canteen to stroll down to the medical unit whenever they wanted to go for a stroll outside their cell,” Hodgson said.
However, those co-payments, along with a $5 daily fee the sheriff imposes, led to a class-action lawsuit and a 2010 Supreme Judicial Court decision that he did not have the authority to collect fees.
Other detention facilities have experimented with inmate co-payments for medical and dental care, but most found that approach was not cost-effective because of increased administrative expenses, said Harrison.
“There is also the problem that if you make it difficult to access health care, you might be violating the inmates’ constitutional rights,” Harrison said.
One tangible effect of the budget crunch is the fact that overtime costs are up at the Bristol County House of Correction. With fewer correctional officers to go around, they end up pulling in more hours to cover shifts and accompany hospitalized inmates.
Hodgson said that overtime expenses stemming from vacant positions will exceed $1.4 million in fiscal 2011, which is what he requested last year in supplemental funding from the state Department of Administration and Finance.
When an inmate is taken to a hospital, two correctional officers have to accompany the inmate for the duration of the hospitalization.
In 2010, 80 inmates at the Dartmouth House of Correction spent 350 days in the hospital, said Livingstone.
In Plymouth, the effect of higher medical costs is seen in the reduction of other service such as rehabilitation, re-enty, substance abuse treatment and mental health support programs.
“Those are areas where you could really make an impact on lowering recidivism,” Birtwell said.
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