MITCHELL, S.D. (AP) — Drug use may lead to extensive jail time, but the user isn't the only one paying for the crime.
Through the first eight months of this year, jailed methamphetamine users have cost Davison County taxpayers about $40,000, accumulated by medical and dental bills stemming from, in some cases, a lifetime of drug use, The Daily Republic (http://bit.ly/2cM26At ) reported.
"All the different complications they may have due to using meth for as long as some of them have, it's anywhere from recovery or detoxing to medical or dental issues — because meth rots your teeth — to a variety of other (issues)," said Davison County Jail Administrator Don Radel. "Picking on meth is probably not the right way, but it's probably the highest one we see right now."
Radel estimated 50 percent of inmate medical expenses in the Davison County Jail this year is connected to meth use.
According to the Davison County Auditor's Office, the jail has spent $79,338 paying for hospital visits, ambulance transports, prescription medications and other medical expenses from January through August, putting the jail on pace to surpass 2015's total of $115,005 and already approaching the 2014 total of $99,961.
But methamphetamine is not the only substance causing problems. Alcoholics often must be treated or detoxed, Radel said, and there was even one inmate about three years ago who used needles to inject fentanyl and contracted a flesh-eating disease on her arm, which permeated to her tendons and cartilage.
"Medical conditions due to substance abuse is high every year," Radel said.
Davison County Sheriff Steve Brink attributed the rising costs to a higher number of inmates.
"We're running quite a bit higher this year than normal, or than in the past, so that obviously is going to boost the cost up," Brink said.
Radel, on the other hand, said more inmates are requiring treatment and medications. For instance, he said there have been more pregnant women in custody this year.
"One trend we're seeing now is we're getting a lot of people going into treatment, and the county is paying for physicals," Radel said.
The types of medical procedures, meanwhile, varies year by year. About five years ago, the county even paid for heart surgery when an inmate was diagnosed with a hereditary problem.
The line item with the largest increase over the past year is clinic costs. In 2015, the jail paid $3,700 in clinic bills. So far in 2016, the county has already paid $6,500. Radel said the jail contracts with Mitchell Clinic, which sends someone three times a week for checkups.
But the real problem, Radel said, is the shifting of the burden onto counties. When someone becomes an inmate, all assistance programs, including welfare, Veterans Affairs and Indian Health Service benefits, are cut off.
"If we have an inmate in our jail who needs medical care, we can't access the veterans systems, the VA hospitals. If we have any Native Americans that may be treated at Indian Health Services ... once they become a county inmate, those services stop," Radel said. "Unfortunately, the system is kind of rigged, I guess you could call it that, to make it the county responsibility."
Some of these people receive benefits throughout the year, but as long as they are incarcerated, the programs stop, but the county is still responsible for their healthcare.
"To me, it would make more sense if those program just continued because somebody's paying for them, and it's the taxpayer, number one, whether it's the county taxpayer only or the bigger pool of the national taxpayer," Radel said.
Counties are also seeing increased costs coming from the state, as presumptive probation — implemented in 2013 — requires most first-offense, non-violent offenders, like drug users, to be placed on probation instead of going to prison. They are often given a short time in a local jail, but if they violate probation, they are the county's responsibility until they can be sentenced again.
And those inmates, many of them meth users, may have extensive medical bills stemming from their addictions.
Davison County also pays the medical bills of federal and state inmates who are temporarily residing in the jail after violating parole, for example. Although they may only be in town for a short time, these inmates have already racked up $3,200 in medical bills, paid for by Davison County. They accumulated a total of $800 in 2015 and $2,850 in 2014.
The difference with these inmate costs comes at the end of the year, as the county is reimbursed for those expenses, Radel said.
Local inmates are expected to pay back their bills, too, but Radel said it rarely happens. Whenever an inmate who received medical care is released, the bills are sent to the county auditor, who places the bills in the lien system. If the county receives no response, the bills are turned over to a collection agency, but according to the auditor's office, reimbursement is rare.
Radel believes some inmates see jail time as an opportunity to receive overdue treatment. Over the course of two years, Radel said one man was checked into the jail five times for various offenses, and each time, he requested assistance with a dental problem. Because it wasn't an emergency, the request was denied.
"He wasn't doing the crime just so he could come in and get his medical care, but once he was here, he was going to take advantage of everything he felt he deserved," Radel said.
More often, Radel said inmates use medical excuses as a reason to get out of jail. One woman who purported to have a serious kidney problem has used her diagnosis as an excuse numerous times to be released.
"From my side of things dealing with inmates, it's an excuse for them to get out of jail — not a valid reason to get out of jail," Radel said.
Radel said a judge eventually caught onto the ruse and decided if the woman wasn't taking care of herself outside the jail, there was no immediate need for release.
Legislators changed state law in recent years so insurance providers are charged before the county, but many inmates are uninsured.
"Unfortunately, we're talking about inmates, and there's a low percentage of insurance carriers in the inmate world," Radel said. "It hasn't created that big of a difference as far as our repayment ratio in Davison County anyway."
The pharmacy tab is also on the rise, despite a switch at the end of last year from Walgreens to Lewis Drug, which sells many of the same prescriptions at a 30 to 40 percent discount. In 2015, the county paid more than $48,600. This year, it's already paid more than $44,300.
Radel said the jail's average prescription cost is $400, but it had to pay $3,000 for one inmate's medication this year, and mental-health drugs have been a large, continuing expense.
According to Davison County Commissioner Randy Reider, the Mitchell Clinic and Lewis Drug provide generic medications whenever possible to cut costs. Still, prescription costs are unpredictable for an organization like the jail, where the population changes so often.
The largest cuts are seen in hospital costs, which have fallen from about $45,500 in 2015 to $18,000 in the first eight months of 2016, and ambulance payments, which dropped from $12,200 to $4,800.
Still, Reider and the other commissioners are seeking a lower ambulance rate. The county contracts with the city of Mitchell to use the Department of Public Safety's ambulance service, which costs approximately $500 per trip for basic life-support transport and $1,000 for advanced life-support, Reider said.
Avera Queen of Peace and Mitchell Clinic offer the county a discounted Medicare rate, and the commission believes the ambulance service should be discounted as well.
If approved by the Mitchell City Council, the rates would fall to about $325 and $375, which could save the county about $4,000, Reider said.
"It wasn't a big amount, but when you're talking about tax-exempt entities — the county, city, the hospital, things like that — when you're a tax-exempt entity, you probably could give us a better rate," Reider said.
The council denied the request in May, arguing the cost would simply be shifted from county taxpayers to city taxpayers. City officials also said the current rate for jail transports does not cover the cost to operate the ambulance service.
But Reider said he expects the commission to readdress the request in the future, as he sees cutting costs as an important task.
"It's always important," Reider said. "If you put things into conversation and start to talk, sometimes you find new ideas from strange places. We don't care where they come from. We just want to do the best we can."
The jail receives inmates from the sheriff's office, local police departments and the Highway Patrol, so it cannot avoid taking in a prisoner who may have upcoming medical bills.
But according to Brink, the sheriff's office occasionally decides it makes sense to allow some people to finish a hospital visit before making an arrest.
If a suspect is injured before being placed in custody, in a car crash following a pursuit, for instance, Brink said his office may wait until he or she is cleared by a doctor.
For brief visits, a deputy may remain at the facility until the suspect is released. But for longer visits, law enforcement relies on a hospital notification before the individual leaves the property. If no one calls and the person is released, Brink and his deputies must get an arrest warrant and begin searching.
"We'll catch up with him, issue a warrant and get him that way," Brink said.
If the person is already an inmate at the jail, however, an officer must remain with the individual until he or she is cleared to leave.
"We sit hours and hours with inmates over there, for even new arrests or if they have some procedures and they're a flight risk, which most of them are," Brink said.
Another possibility, if the criminal charges are not too serious, is releasing the individual on a personal recognizance bond, in which an inmate is allowed to leave at no cost with a judge's approval, which means the would-be inmate is responsible for any medical costs. Radel supports such releases if the inmate meets certain requirements, as does Reider.
"I have tremendous confidence in our sheriff's department. I'm OK with those guys making decisions," Reider said. "When it gets to that and jailing and bonding, you have the court system. You have the law enforcement system. We tend to stand behind those guys and support them."
But Brink said the person's medical needs trump the financial concern, and the county will foot the bill if such care is needed.
"Paying for it is not the first thing we think about," Brink said. "Obviously, the person's health is the first thing, and we decide after that how we're going to deal with them."
Radel said the jail has good rapport with local doctors, who will make decisions about whether an inmate truly needs medical attention or not before they are checked in to a hospital.
But despite the costs, Radel said the jail will continue to provide the same level of medical care to all its inmates.
"Are we, as the sheriff's office, determining if they need to go to the hospital or clinic? No. That's all a medical issue the doctors handle," Radel said. "Medical care is one of those things that's required by the courts and laws. Unfortunately, the county's ultimately the one that pays for it."
Radel said officials have talked about hiring a medical professional, likely a physician assistant or an advanced-training nurse, who could work for the jail nearly full-time for screenings and some treatment in-house. A doctor could overrule any decisions the person made, but Radel said it could reduce many individual expenses.
However, Radel said the county likely could not afford to hire someone in that capacity.
Brink said jail staff does what they can to avoid injuries caused by fights or the spread of infections from one inmate to another, and while changes, like swapping pharmacies, have been made, there is no clear solution to rising medical costs.
"There's all kinds of stuff that goes on back there we've got to deal with to make sure other people don't get sick," Brink said. "It's a very complicated issue. There's so much, it's hard to put your finger on."
___
Information from: The Daily Republic, http://www.mitchellrepublic.com
An AP Member Exchange shared by The Daily Republic.
