Thursday, January 13, 2005

For Those About To Be Cut From TennCare

Here's an idea on how to continue getting medical care: become a criminal. Here's a story from the local radio station WJLE here in Smithville on the current budget crunch concerning medical care for prisoners:

Inmate Medical Costs Putting Strain On Already Tight County Budget
By Dwayne Page

Inmate medical costs at the DeKalb County Jail are already over budget with six months still remaining in the fiscal year and that has caused a concern not only for Sheriff Lloyd Emmons but for County Executive Mike Foster and the county commission.

Foster and members of the commission met with Emmons and County Attorney Hilton Conger Tuesday night to discuss the problem and to try to come up with a remedy.

Foster says there are no easy solutions. "The commission budgeted $55,000 (for medical costs for the year) and we are currently at $87,000, so we're already over budget by about $32,000 and we're only half way through the year. Realistically, we probably under budgeted a little bit compared to what it was last year and the year before. We were trying to maintain a really tight budget and stay within it, but accidents and illness involving prisoners has changed all that. Part of the problem is inmates fighting in the jail. I don't know what we can do to correct that, maybe move some of the prisoners out of here and to the state prison, maybe shuffle people around so that they're not with people they don't get along with, but we're limited as to what we can do in that. Working tonight (Tuesday), the commissioners came up with probably twenty eight to thirty thousand dollars that could be cut in the sheriff's budget. We're going to look at everybody else's budget too to see if we can pick up a little money here and a little there to offset some of these ongoing costs. As for the future, we're looking at a plan offered by a company from East Tennessee that does some in-house health care management and we discussed maybe having a nurse practitioner who could come to the jail on a regular basis and screen these people. We're also going to bid some services to see if we can't reduce costs. We already have an agreement with the hospital to cut costs on some things."

Foster says there's not enough fat in the budget that can be cut to overcome the excessive medical costs, so more than likely, the county will have to dip into the reserves and fund balance, which has already taken a hit this year. "We've already had to take money from the fund balance this year because of some prior lawsuits and findings by the federal government, one of which was a fair labor and wage issue, where we had to pay $57,000 (for comp time), then the fund balance was hit for $27,000 because of a lawsuit, and then there was another lawsuit settlement for $12,500, which actually cost the county only $2,500 for the deductible".

Sheriff Emmons says he is doing what he can to address the problem. "We're seeing more cases of hepatitis, HIV, and other diseases, teeth problems, and at times we are having fights in the jail and all of these things require medical treatment. We have had to send prisoners to the emergency room at the hospital several times and the costs have really ballooned unbelievably. We're looking at every way in the world to cut down on these costs including releasing some prisoners on medical furloughs, the people that we feel are not a danger to the citizens of the county. For example, say a prisoner comes into the jail and he has hepatitis and the disease flares up and gets worse while he is in jail, then many times we'll contact the judge and he will grant a medical furlough for the prisoner and the inmate will then seek treatment and pay for it himself or through TennCare, private insurance, etc. Another huge increase is the number of prisoners we take to Moccasin Bend. Many times we get calls to pick up somebody who is totally out of control, usually because of drug abuse, who may be threatening to commit suicide or kill somebody else. In those cases, after we arrest a person like that, we have to take him to the hospital. The doctor will then recognize that the prisoner is mentally unstable and then we have to transport that prisoner to Moccasin Bend, where he will be stabilized with whatever type of drug is needed. Once he is released back to the sheriff's department, almost always he will have several prescriptions and when he comes back into the jail we are taxed with that cost. We must fill these prescriptions."

Emmons says the county has an opportunity to participate in a program to manage medical care costs similar to the inmate dental plan that has saved the county money. "Under our dental program, we pay $375 a month and then we take to Cookeville any inmate that needs a tooth pulled and a dentist there will pull the tooth. They will pull as many teeth as needed. Before, we were taking prisoners to the health department then from there, many times we would have to go to an oral surgeon, where the cost for one inmate to have a tooth pulled would exceed $350 to $400. So our dental program has definitely paid for itself because our prisoners get unlimited dental care for $375 a month. Of course, they don't fix their teeth, they don't give them dentures, they just do maintenance. If a tooth needs to be pulled, they'll pull the tooth."

End of WJLE story.

My father was cut from TennCare in the first purge. He's a 68 year old semi-retired person and he's not even near being middle class. He recently had to have skin cancer scraped off one ear and an eyelid. The good news is that the doctors got it. The bad news is that without TennCare he's in so much debt he probably won't live long enough to pay it back. It seems like he should be a beneficiary of TennCare, especially if there are younger and healthier people still on the rolls. Maybe Governor Bredesen's upcoming cuts will take care of that and only the truly needy will be eligible. I could debate that my father is "truly needy" especially since I'm his only child and I can't afford to give him any money, but I'm also opposed to a system - TennCare - that's bankrupting the state. So I wasn't out protesting last night with the TennCare proponents. If they were healthy enough to be out last night then why do they need health coverage anyways? My disconnect is with our state govenernment paying for prisoner's medical visits. If inmates are fighting, let then suffer through their injuries. If they have a toothache, let them suffer like my wife did for years while we had no dental benefits. Prisoners shouldn't have a dental plan. I understand needing to dole out the antibiotics to prevent an entire cell block from getting sick, but it's ridiculous when the victimizers of society are granted a benefit that doesn't go to the victims.

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