ALAMOSA — In the recently approved Alamosa county budget for 2018 the sheriff's department was allocated funds to hire a medical assistant for the jail. However, on Wednesday commissioners approved the hiring of a registered nurse instead.

The commissioners approved the search for the jail's first RN last June, yet taking care of the inmates has proven to be too large a task for one person.

"As we started the budget process we knew we needed more help on the medical side," said Alamosa County Sheriff Robert Jackson. "We were able to show how much money we've been able to save everyone by having one registered nurse five days a week, but it became plainly obvious that that wasn't enough."

A second full-time RN will allow for seven days of coverage, though it won't be around the clock. It will also help manage the increase in inmates once construction on the 74-bed addition is completed.

"We've kind of opened Pandora's box because now we have people in custody that expect medical care, which they deserve," said Dr. Patrick Thompson, the jail's physician advisor and medical director.

Already Tanya Anthony, the jail's nurse, has seen patients with heroin and alcohol withdrawal, diabetes, high blood pressure and other chronic diseases along with addicted pregnant women. The jail is the only one in the San Luis Valley with internal medical staff and Jackson estimates that they've cut trips to clinics and the hospital in half since hiring the first RN.

"I manage anywhere from 18-35 patients on medication and I'm pretty much on call 24 hours a day," Anthony said. "On weekends I get multiple phone calls requesting assistance. The complexity of the patients is kind of overwhelming at this point."

Thompson said that a medical assistant wouldn't be able to handle the same magnitude of triage that Anthony can. "[Anthony] is practicing at the very edge of a nurse's license," said Thompson. "Once those new cells open up in the jail, you're going to go beyond her abilities to practice safely within her scope of her license. And when she's practicing under her license she's actually practicing under my license as well, so it puts a liability on both of us that's pretty high."

Though the salary for the new full-time RN wasn't mentioned, it will likely be similar to the first approved salary, which was $36,000. Jackson said he would do what he could to find the funds since that's $5,000 more than what was approved for the medical assistant.

"I'm willing to make cuts in my staff to where we can do this," said Jackson. "It's critical that we have nursing."

"We need to find another RN and get them on board," added Alamosa County Commissioner Darius Allen.