Though the cost for inmate medical services has increased over the last three years, per-inmate expenditures (estimated at $3,034 in FY19) are still lower than they were in FY15 - the year before Coffee County contracted medical care at the jail with a private company, Quality Correctional Health Care (QCHC).
The company has been responsible for inmate care since May 2015, according to Andy Farrar, purchasing agent for Coffee County. Last Tuesday, the Coffee County Commission approved a renewal of QCHC’s contract for FY19, negotiated by the Coffee County Purchasing Commission and Farrar.
According to Farrar, the commission approved an amount of $1,213,760 to cover both on-site and off-site jail medical services in the coming year.
Of the total amount, $713,760 was allocated for on-site care, up from last year’s $645,000.
The remaining amount was assigned for services outside the facility. Off-site care includes emergency room visits, hospitalization and any specialized care needed, such as for cancer and HIV, according to Farrar.
The on-site increase, Farrar said, is due to transitioning a mental health professional from a part-time to a full-time position. Additionally, electronic medical records software will be implemented at the jail this year, and, according to Farrar, “QCHC did have a price increase of 1.8 percent.”
Commissioners Missy Deford, Steven Jones and Diane Argraves have expressed concerns that Coffee County Sheriff Steve Graves has no control over the jail medical contract or medical staff.
Graves has also taken issue with the fact that he has no oversight over medical services.
“I don’t take complaints any more, I send them to Andy (Farrar),” Graves said. “I have nothing to do with medical.”
Farrar disagreed that the sheriff has no oversight over the medical agreement.
“The sheriff has any control over medical he wants,” Farrar said. “If the sheriff doesn’t feel the inmates are getting the medical care they need, he has the say-so. Yes, he does have the say-so.”
Contracting with a private company makes the medical care more efficient and reduces the risk for liability issues for the county, said Farrar.
“QCHC does everything,” Farrar said.
Before 2015, the sheriff was making decisions related to medical care, said Farrar.
“We have taken that liability off the sheriff, which is better for this county and helps us with lawsuits,” Farrar said. “QCHC is responsible for these lawsuits. We are still named but they represent us. That’s a huge factor for this contract. QCHC is a professional medical company that has professional medical lawyers.”
QCHC’s services include 24/7 staff, including a jail physician, a mental health professional, health services administrator and nurses.
They take care of all day-to-day needs of the inmates, medication, sick calls, records, scheduling of appointments, state mandated 15-day evaluations, etc.
The company took over May 2015.
Graves said he had requested the contract be bid out this year, and was told by members of the Coffee County Budget and Finance Committee that it had been. However, Farrar said, it was not.
Farrar cited a state law (T.C.A. 12-3-1209) governing professional service contracts, noting the law provides that contracts by governments for services by “a professional person or group shall not be based upon competitive solicitations, but shall be awarded on the basis of recognized competence and integrity.”
Increase of jail population
An increase of jail population has resulted in higher medical costs, both on- and off-site.
In 2015, the jail population was under 300, but over the last year it has often topped 400.
“For the last seven years, we have always budgeted $200,000 to $300,000 for outside medical care,” Farrar said. “Due to increase in inmate population, we have increased that amount to $500,000 in FY19.”
Regardless of the escalation in expenditures over the last three years, the cost per inmate is lower and the quality of the care is better than it was prior to QCHC taking over.
Before signing an agreement with QCHC, “the county contracted with a local family practitioner to come one day per week and assist the jail nurses,” said Farrar, noting the county employed two to three nurses that reported to the sheriff.
“This put total liability on the sheriff and the county,” Farrar said.
Prior to May 2015, the jail did not have 24/7 medical care, said Farrar.
By June of 2015, jail medical costs had reached $1,270,907. With an inmate population of around 300, that equated to $4,236 per inmate per year, according to Farrar.
The first year QCHC provided care (FY16), the cost went down to $697,711. With inmate count of 357, the per-inmate, per-year cost dropped to $1,954.
For FY17, with an inmate count of 376, the cost was $886,305 – or $2,357 per inmate, per year. For FY18, with an inmate count of around 400, the cost for medical care was around $1,317,302. That equated to around $3,293 per inmate, per year – a rising number, but one still below FY15 levels.
For FY19, according to Farrar, annual per-inmate expenses are expected to drop slightly.
“So in 2018-2019, with the budget estimated at $1,213,760 and the jail population around 400, we’re looking at $3,034 per year per inmate,” he said.
Elena Cawley can be reached via email at firstname.lastname@example.org.