Two years after the Skagit County Board of Commissioners privatized the Community Justice Center’s medical services, the board must soon decide how to continue providing health care for inmates.
Now well into its three-year contract with jail medical services provider Naphcare, the county commissioners are using a report from David Chambers, principal consultant with Sullivan Road Insurance, to help make the decision.
Providing adequate medical care in a jail has proven to be a challenge for counties throughout the country, Chambers said in a presentation Wednesday.
“Law enforcement, even senior law enforcement, doesn’t know about health care,” he said.
Clustering hundreds of people, many of whom have compromised health from a history of homelessness or substance abuse, makes health care a daunting and expensive task, especially in the midst of the novel coronavirus pandemic, he said.
“Addiction-related crimes is what almost everyone in jail is in for,” he said.
Further, about half of inmates have some degree of mental illness, and about a quarter have a severe mental health condition, he said.
“They get patched up, then they’re released back to the community,” he said.
Because much of the medical equipment used in the jail is owned by Naphcare, Chambers said should the county decide to again provide health care on its own there would be significant upfront costs.
County Commissioner Ken Dahlstedt said he supports seeking an extension with Naphcare, saying there are too many uncertainties with the COVID-19 pandemic to take risks on this essential service.
Tax revenue, crime rates and community health are all in flux, and it’s unclear how long this uncertainty will last, he said.
That being said, Chambers said Naphcare has provided a significantly higher level of care than was offered previously.
Prior to 2018, the county managed the system on its own, and it was nowhere near meeting its legal requirements to provide adequate care, he said.
His research found deputies had been tasked with making medical decisions when medical staff weren’t present. Staff were not consistently keeping sufficient medical records, he said.
“Drugs went missing, and nobody knew where they went,” he said.
He said this doesn’t mean that medical supplies were stolen or used improperly, but without a paper trail he said there is no way to be certain.
In his report, Chamber also suggested a handful of cost reduction strategies.
He said about 30 percent of inmates in the Community Justice Center are there because they failed to appear in court. As such, making it easier for people to make their court dates will reduce the jail population — and thus the cost of providing medical services.
Chambers suggested texting reminders, and offering free rides to court.
“Spending 15 bucks to send that person an Uber ... is massively cheaper than sending a deputy to pick them up (and book them in jail),” he said.
Creating a small copay for inmates would discourage unnecessary care, he said.
“It could be (as low as) $5,” he said.
Chambers also proposed an expansion of existing medically assisted treatment for drug addiction, which is proven to reduce chances of relapse and would reduce the jail population.