Dodge County has already surpassed its budget for medical costs for jail inmates, still months before the end of the fiscal year, according to Dodge County Board of Supervisors Finance Chair Rob George.
The ballooning costs this year were, what George calls, an “aberration,” with only a few inmates’ services accounting for an outsized portion of spending.
One inmate, for instance, who committed suicide in August, had medical bills that accounted for $114,000 of Dodge County’s $140,000 budget for correctional medical costs, George said.
“That’s the first big one we’ve had since (housing inmates at) Saunders County,” George said.
Dodge County Clerk Fred Mytty told the Tribune that inmate medical costs have risen to $286,148.80 through February.
The budget overflow won’t have any noticeable impact on inmate health services or on taxpayers’ wallets, officials assert. But it does highlight the difficulty of estimating the county’s correctional medical costs, which can vary significantly each year and have risen significantly since 2013.
“Over the years, the medical costs in the jail, it’s kind of like throwing a dart,” George said. “You have no idea.”
The August incident involved a 19-year-old man who attempted suicide in his cell at Saunders County Jail, which houses Dodge County inmates. He was found by guards alive but unresponsive and was taken by helicopter to Bryan Medical Center in Lincoln, where he received medical attention but ultimately died.
The inmate’s medical bills cost more than $81,000. The helicopter ambulance cost the county an additional $33,000.63, according to the County’s general ledger.
Dodge County Attorney Oliver Glass claims that the helicopter’s initial cost was even higher, but that he was able to negotiate a reduction, as he often tries to do with hospital expenses for inmates.
“We’ve also just had some inmates in jail with some very serious health problems,” Glass said.
Glass emphasized that the expensive year will have no bearing on the quality of medical services provided to Dodge County’s inmates.
“If somebody’s in jail with major medical issues, we’re not going to attempt to deny that person the help that he or she needs,” Glass said.
Additionally, the county has enough money in the reserves to counteract any budgetary issues, George said.
“In June, we’ll actually transfer some money out of one of our inheritance fund, our interest fund,” he said. “We’ll just move this money and, quite frankly, pray that we don’t have something like this that happens again next year.”
It’s difficult to predict the health needs of Dodge County’s inmates in any given year, the officials said. In this case, a handful of significant expenses were exacerbated by one dramatic incident, which threw the county off balance.
“It’s just a perfect storm right now,” George said.
The corrections department’s medical costs have varied significantly over the last 10 years, according to a Tribune survey of public records. The costs reached as high as $111,589.02 in the 2009-2010 fiscal year and as low as $29,732.28 in the 2013-2014 fiscal year. This year, medical costs will exceed the budget for the first time in the years surveyed.
The costs of correctional medical services do seem to be on the rise, however. Since the low point in the 2013-2014 fiscal year, the corrections department’s medical expenses have more than tripled, surging up to $101,456.75 last year.
The county budgeted $120,000 for correctional medical costs between 2013 and 2017. After last year’s surge into six-digit figures, the county raised the budget to $140,000 for the 2017-2018 fiscal year, George said.
“We increased our budget to $140,000, unbeknownst to us, we were going to have an $81,000 hospital bill,” George said. “It’s not anybody’s fault, it’s just the way it is.”
Glass suggested that an increase in drug-related arrests by the III CORPS Drug Task Force may be contributing to rising health issues.
“We get a fair amount of people in jail that have drug issues, and with drug issues come health issues,” Glass said. “When individuals, for lack of a better way to say it, are incarcerated, and they don’t have access to the street drugs, or whatever they were using to self medicate, these health issues come to the forefront.”
George agreed that it seemed that a large number of people were getting put in jail with drug-related illnesses.
“It’d be nice if we could get it through to some of those people that this is what it’s doing to you,” George said.
Medical needs for inmates are growing throughout the state of Nebraska and across the country, according to Dr. Gaylene Armstrong, the director of the University of Nebraska at Omaha’s School of Criminology and Criminal Justice. And that’s because there are often few options for individuals with mental health and, often, coexisting substance abuse issues who commit crimes other than jail.
“These folks have difficult histories and lives so they’re presenting with all kinds of other health conditions as well,” Armstrong said. “This population is an unhealthy, in-need population and that ends up falling on the public dollar while they’re in the jail, which is, some of the time anyway, not the best place for these individuals.”
She argued that medical services in jails, especially mental health services, are important because they benefit communities long-term.
“If they’re not receiving services at that point, eventually these individuals are going to be released back into the community where they’re still going to be unhealthy or left untreated,” she said.
Jails have also seen increases in their daily populations across the country, Armstrong added. Dodge County is no exception. Dodge County now deals with about 75 and 85 inmates daily compared to 55 to 60 years ago, George estimates. That can also drive up corrections costs.
In Dodge County, the overall budget for corrections has increased from $1,591,000 to $2,371,200 between 2014 and 2017, public records show. That’s largely because of increases in pricing for housing prisoners and the number of prisoners, according to George. The budget for boarding and transporting prisoners has indeed risen steadily over the last decade, from a little more than $300,000 in 2008 to $1,650,000 last year—the largest operating expense in the Corrections Department’s budget.
When it comes to medical expenses, Glass also tries to negotiate with judges over cases where someone who’s committed a crime might have particular health needs. Depending on the crime, Glass might argue that the individual is capable of being released on bond on his or her own recognizance, allowing them to be tried without taking up resources in jail. That might include somebody facing charges like driving under a suspended license, for instance, whose not an immediate flight risk or threat.
“People like this, you know they don’t necessarily need to be sitting in jail,” Glass said.
George, meanwhile, said that the County Board of Supervisors could increase the medical cost budget another $20,000 or so next year, but doesn’t anticipate raising it to anywhere near the costs incurred this year.
“This is not a typical year,” he said.