ST. JOSEPH COUNTY — When 47-year-old Brian left the St. Joseph County jail, it was the cold concrete and steel, he vowed to never see again. After not paying child support, he spent 65 days behind bars.
During his time in jail, he used jail healthcare for his pancreas problems. He wasn’t happy with his healthcare experience and that’s why Brian chose to be identified only by his first name.
“I think I was more angry than anything,” said Brian.
Brian was one of hundreds of inmates who have used the county jail’s healthcare system. But in 2016, the medical bills exceeded what county officials expected.
Sheriff Mike Grzegorek asked the county council for $197,820 to pay for additional medical expenses. That’s on top of the $1.7-million contract it has with Beacon Health and $236,130 used for psych medicines and other medical services.
“It’s a statutory responsibility of the sheriff and the county to take care of those medical needs while someone is incarcerated,” said Sheriff Grzegorek. “It just so happens that this year, we had a lot of really sick inmates that cost a lot of money.”
This was the first time Grzegorek had to ask for additional money to cover medical expenses during his six years in office. The money comes from a fund that inmates’ pay into for their co-pays and other uses.
If not all the additional $197,820 is needed for medical bills, it will go back into the original fund.
“You can’t control who is going to have what disease when they’re incarcerated and how long they’re going to be here,” said Grzegorek.
On average, inmates cost taxpayers about $3,025 per inmate in 2016. That average is lower than the average cost of an inmate in an Indiana state prison at $3,858 in 2011, according to a State Prison Healthcare Spending Report.
But not all inmates cost that average amount. For example, Grzegorek said an inmate in the St. Joseph County jail is costing taxpayers $12,000 per month in medical services while he awaits trial. Other inmates may cost nothing at all.
“We really don’t have a lot of choice in the situation because by statute, it says that we must provide them medical care and must take care of those needs,” said Grzegorek.
An aging inmate population
One reason scholars contribute towards rising costs is the aging prison and jail populations. From 1999 to 2012, the number of prisoners aged 55 and older in the US, grew by nearly 204%, according to the spending report.
According to that report from Pew Trusts, “older inmates are more susceptible to chronic medical and mental conditions, including dementia, impaired mobility, and loss of hearing and vision.”
The day in December that WSBT 22 asked, 18.5% of prisoners in the St. Joseph County jail were 55 and older.
The Sheriff said prisoners have dealt with a gamut of costly diseases from kidney dialysis to hepatitis C or cancer treatment. But he also said many people may cost the county far less.
“People who come into jail sometimes don’t live the best lifestyles and may not even be diagnosed with an illness until they get here because they don’t see doctors on the outside,” said Sheriff Grzegorek.
Tina Maschi is a professor at Fordham University and focuses her research on aging prison populations within the criminal justice system. She said people who are in prison age faster than their counterparts in the community.
For example, she said someone who is 50 in prison has the “health status” of someone who is living outside of jail at 65. She said prison conditions like the confining space, little sunlight, poor diets and smoking create an unhealthy environment that not only is stressful, but that stress can impact overall health.
“They’re definitely going to cost the taxpayer more,” said Maschi. “And I have to say, there’s a moral cost tooif we see someone who is sick and dying, most of us have compassion for that individualwhen they have incarceration history, especially if they have a series of offenses, like they killed someone – all the sudden the compassion goes out the window.”
‘Just and efficient’
Every inmate who is detained is entitled to healthcare while staying in the jail and awaiting trial, according to state statute. But there are some things the prosecutor and sheriff can do to speed along the process in certain cases.
St. Joseph County Prosecutor Ken Cotter said he’s been contacted on a “number of occasions” by the sheriff to review the particulars of a case.
In one instance, Cotter said a person was arrested for resisting law enforcement but had a broken bone.
“The sheriff asked me whether or not we could review that case while the person is out of custody, instead of having them in custody,” said Cotter. “I authorized the release of that person and we reviewed the case, charged it, but we sent it out by summons instead of the person being arrested.”
Cotter and the sheriff said they would never release an inmate solely based on their medical condition; but that they are conscious of the cost burden.
“We’re trying to be just and efficient, both,” said Cotter. “The efficiency is not only let’s get it done in a timely fashion, but also: what are the costs to the community, and whether it would be more appropriate for this case to be handled while the person is out.”
Cotter adding that “the safety of the community is worth much more” than the cost of an inmate’s medical procedures.
Cotter is able to review those cases both, before a person is charged, or after a person is charged, but is awaiting trial. He said it’s a process that involves a series of conversations and questions.
“Weighing the cost and benefit,” he said. “If it’s more beneficial if the person is out of custody and not in custody.”
Until an inmate has their chance at a fair trial, the county is required to pay the inmate’s medical bills. Sheriff Grzegorek said inmates’ are responsible for paying co-pays and other expenses that taxpayers aren’t responsible for paying.
Should a person be found guilty and sentenced to the Department of Corrections, the state would likely pay for the healthcare expenses. But if that person is sentenced to the county jail, then the county, most often, is responsible.
If a person is found not-guilty, they are not required to pay back any medical expenses that the taxpayer paid, according to Grzegorek.
“It’s constantly an evolving process,” he said. “We watch on a monthly basis to see where we’re at.”
Grzegorek said it’s hard to predict how health costs will be in future budgets because it’s so unpredictable. He said in years past, the county has saved money, yet this year the cost was more than anticipated.
In Elkhart County, the jail has an agreement with Correct Care Solutions for $2.9-million for all healthcare needs in 2016. An Elkhart County Police spokesman said it’s too unpredictable to guess whether they will have to adjust the budget next year because of current health needs.
At the time of the report, a spokesman had not responded whether the Elkhart County Sheriff’s Department had ever asked for more money to pay medical bils.
As for Brian, he’s moved on with his new life, and a perspective that he gained while serving time.
“We’re all human, we’re all Americans,” he said. “We all make mistakes. Some people make worse mistakes than others.”