Innocent and indigent: Sen. Gardner’s office listens to jail healthcare concerns

ALAMOSA — Jails across the San Luis Valley are struggling to keep up with the medical needs of their inmates. To get a better sense of the issues Andy Merritt and Cathy Garcia, the state and regional directors for Sen. Cory Gardner, attended a roundtable with county commissioners and healthcare providers during the Alamosa County Commissioners meeting on Tuesday.

The discussion focused on the termination of Medicaid benefits once an individual is booked into a county jail. Since roughly 44 percent of the Valley population is on Medicaid, the medical expenses affect the budgets the counties, local hospitals and clinics that absorb the costs.

“We just really believe that that is an injustice,” said Alamosa County Administrator Gigi Dennis.

Being medically cleared by a hospital when arrested is covered by Medicaid. Yet the instant an inmate walks into the jail doors the coverage goes away. Even though the majority of Alamosa’s overcrowded jail population is pre-sentencing, they have no benefits. This includes coverage for preexisting conditions or mental health services. Additionally, veterans lose their benefits if they’re in jail for more than 60 days. With a quarter of Alamosa’s inmates awaiting trial for over a year that is entirely feasible.

“Private insurance benefits don’t get cancelled when you go to jail,” said San Luis Valley Behavioral Health Group CEO Fernando Martinez. “It’s a form of discrimination that has got to be resolved.”

In extreme cases the deputies will wait to arrest injured suspects after they have been treated at the hospital so it is still covered by Medicaid.

“That puts us in a vulnerable situation,” said San Luis Valley Health PR Director Donna Wehe.

Along with handling violence among inmates or self-harm, it is up to the sheriff’s department to manage substance abuse therapy. Alamosa County Sheriff Robert Jackson said their holding cells can have up to 10 detoxing inmates at a time.

“If you haven’t seen it, it’s like something out of a scary movie,” said Jackson.

San Luis Valley Behavioral Health has grants to offset some costs, but it is mainly emergency response personnel that aid the jail with their services. Tanya Anthony, the jail’s nurse, estimates that they spend $1,200 to $1,800 on medication for inmates such as buprenorphine so a newborn baby doesn’t suffer from withdrawal.

“I’m aghast that we treat our mental health in jail by putting them in jail,” Rio Grande Hospital CEO Arlene Harms said. “I just think that’s awful.”

Medicaid does cover the cost if an inmate stays at a hospital for 24 hours or longer. However, that doesn’t take care of quick visits to the pharmacy, dentist, emergency or clinic, which are the majority of visits.

For example, Jackson said an inmate that Alamosa County housed out in Custer County due to lack of beds suffered from an apparent heart attack. Custer County was ill equipped to handle the situation so they flew the inmate to Pueblo. The issue turned out to be an anxiety attack and because the inmate was discharged in less than 24 hours Alamosa County was left with a $23,000 flight bill.

State law requires that an inmate have access to medical treatment. With most Valley jails lacking an internal nurse or physician, deputies send a person to the hospital even if the issue is minor in order to not be held liable. It is also up to the jail to weigh the benefits and disadvantages of heading to an emergency room or a doctor’s office. SLV Health Clinic Administrator Antonio Gurule said a clinical visit could have a $20 copay and a $150 bill while a trip to the ER could be a $250 copay and a $1,000 bill.

“Their healthcare doesn’t stop because their address changed,” said Gurule. "They still may have some needs to be addressed and it’s unfair. The taxpayers are getting a double whammy...It has provided fragmented and inappropriate care to those individuals and increasing the cost for all of us. There has to be a better way.”

Deputies then have to escort the inmates to the hospital and monitor them, even if they get flown out to a larger facility in Pueblo or Colorado Springs. In smaller counties the expense is greater due to staffing issues. Conejos County estimates that sending an inmate to the ER occupies a quarter of their deputies.

Hospitals aren’t reimbursed through the state’s provider fee for indigent care when they treat the jail population.

“We’re at about $82,000 loss to our bottom line,” said Harms. “It goes purely to charity.”

Valley-Wide Health Systems Financial Manager Javier Martinez estimated they lost $800,000 to $900,000 in revenue among the 15 counties they service.

One solution is utilizing pretrial services like ankle monitors since Medicaid benefits are only terminated if the individual is in a government facility. Yet that doesn’t completely handle the sheriff’s department budgetary issues.

“It’s $8,000 a month for us to just do pretrial release programs,” Jackson said. “The jury is still out on whether or not it’s working.”

Alamosa County has also begun charging inmates to visit with Anthony to deter fake or superficial issues. However, it is still incumbent on her to determine when a case is worthy of a visit to the ER.

At the end of the meeting Merrit and Garcia thanked the participants for speaking about the subject.

“This has been really helpful in understanding the scope of the challenges you face,” said Merrit. “I’m not going to promise you that leads to anything because it is Congress, but it is really helpful to have this level of understanding. It became very clear to us that is an important topic and a significant topic impacting you.”