MERCER COUNTY — As the debate rages in the halls of Congress on whether to include a public option for health insurance, one group in Mercer County already enjoys a government-run plan.



Prisoners at the Mercer County Jail are provided essential health care coverage at bargain rates — for them.

Consider this, prisoners at the jail do not have a co-pay on:

• Any hospitalization costs.

• Any prescription.

• Any hospital tests such as blood, X-ray, CT scan or MRI.

• Any outpatient hospital care including surgery.

Major pre-existing illnesses aren’t a problem as inmates will be treated regardless of any ongoing or prior malady. Unlike most private insurance plans there is no monetary cap on the amount of health care coverage an inmate can receive. Those bothersome claim forms aren’t a problem as inmates never have to file one.

There are a few out-of-pocket expenses. A $3 fee is charged for prisoners seeing a prison nurse and $5 for a doctor — well below the co-pay average of private insurance plans.

Finding a health care practitioner at odd times usually isn’t an obstacle as a nurse is on staff at the jail 16 hours a day, seven days a week.

There are limits though. Prisoners have no choice in which practitioner they get to see and the only eye and dental coverage they get are for emergency situations such as a tooth with an abscess.

“We don’t do teeth cleanings or elective surgeries,’’ said Jeff Gill, the jail’s warden. “This isn’t a case where you come to jail and we take care of all your medical needs.’’

Still, while health care for inmates at the jail isn’t the Cadillac of plans it is better than — in many cases considerably better — than plans outside the jail. An estimated 45 million Americans have no health insurance.

All of the medical costs at the jail are borne by the Mercer County taxpayers as the prison gets no state or federal reimbursements for health care.

This isn’t a situation where the county has a soft spot for prisoners. Such treatment is standard among county jails throughout the state and most of the nation.

State law and federal court rulings have mandated inmates must be provided with fundamental health care services regardless of the cost to taxpayers. In essence, courts have ruled withholding essential medical treatment is tantamount to cruel and unusual punishment.

Keeping prisoners healthy is costing the county dearly.

Health costs at the jail have exploded to $718,638 in fiscal 2008 ending in June from $392,220 in 2004 — a heart pounding 83 percent hike.

In addition to government mandates and rising medical costs, the large increase in prisoners at the jail over the same five year period is seen as another major culprit. The average daily inmate population at the jail has skyrocketed 45 percent since 2004 from 183 to 266 in 2008. That’s due to the new, bigger jail opening in December 2005.

Pennsylvania state prisons aren’t immune to higher medical costs. In the latest state budget which saw countless projects slashed from economic development to witness relocation programs for those testifying against criminals, funds for inmate medical care got a three percent increase.

All of this doesn’t make it an easier for prison boards to explain ever higher medical costs and why inmates get health care on the cheap.

“It is very frustrating for us to watch inmates get covered for free when employees out there have co-pays on medical care,’’ said Mercer County Commissioner Brian Beader.

Like the other two county commissioners, Beader sits on the Mercer County Prison Board along with the county’s controller, sheriff, district attorney, jail warden, and president judge.

When it comes to health care at the jail Beader complains they have little wiggle room due to state and federal mandates.

“When it comes to fairness it isn’t fair,’’ Beader said. “It puts a very sour taste in your mouth to see someone commit a crime and then get health care provided to them. We are required by law to provide it. There is no law that state’s an employee or individual in the private sector must have health care coverage.’’

Complying with jail health care measures comes at a time when the county is scrimping everywhere it can to save money. The county now has 15 positions unfilled outside of the jail as part of an austerity measure. In August the county furloughed non-union courthouse employees for a week which amounted to a three percent wage cutback.

County commissioners and administrators such as Controller Tom Amundsen also agreed to take a three percent pay cut. As president of the Prison Board, Amundsen agreed it’s a hard pill to swallow to see employees take a hit in the wallet while jail health care costs soar.

“We’re mandated by the state to provide a level of care at the jail,’’ Amundsen said.

In 2008 alone jail health care surged 34.5 percent from the prior year. Of that figure 3 percent is attributable to a higher inmate population while the remainder is due to hiring a registered nurse to cover a shift on Saturdays and Sundays. Prior to that the prison had a licensed practical nurse covering one 12-hour shift on both days.

Jail officials insist adding the nurse was necessary to avoid liability and to prevent situations where prisoners have to be carted off by ambulance to a hospital.

“That is something very, very expensive to do,’’ Amundsen said.

Another state mandate that adds to costs are that every prisoner must be examined by a health care practitioner within 14 days of their arrival. With the jail getting 180 new prisoners every month that adds up to a lot of examinations.

Even with all these precautions and benefits Beader said prisoners file lawsuits.

“On a regular basis we get sued for having a proper lack of health care coverage,’’ Beader said. “We believe we provide adequate coverage and are within the law on health care coverage at the jail.’’

Medication alone is a huge expense as prison records show 55 percent of all inmates receive at least one kind of prescription.

In looking at June as an example, prison records reveal inmates consumed $16,000 worth of medication. Of that dollar figure $9,000 was spent on drugs for emotional or psychological reasons — known in the medical community as psychotropic drugs. These are often pricey drugs as 10 prisoners alone racked up a $7,000 bill for the month.

Since many of the inmates enter prison as alcoholics, drug abusers and with mental disabilities, psychotropic drugs are indispensable in keeping prisoners and jail employees safe, Gill said.

“The people who come to jail are an average 33 years old and are not a very healthy group of people in general,’’ Gill said. “Some have additional problems for a variety of reasons.’’

To tame costs the jail buys its pharmaceutical supplies through the state which buys in bulk for better deals. Prisons are allowed to return unused prescriptions for reimbursement.

But a new state regulation going into effect last year added more costs on jails.

“We’re now required to send an inmate with three to five days of their medical supplies if they are released, paroled or transferred,’’ Gill said.

Attempts are made to recoup health costs from inmates who have private or other insurance coverage but that doesn’t happen very often.

“It’s the exception to the rule to find someone like that,’’ Gill said.

Getting prisoners to pay for medical treatment out of their own pockets is legally almost impossible, he added.

“Federal courts have ruled we can’t ask them for money to recoup our expenses,’’ Gill said.

While the jail has nominal charges for prisoners to see a nurse or doctor and for over-the-counter drugs like Tylenol, Gill said courts have ruled that is only allowed to prevent abuse or frivolous treatment.

A typical stay at the county jail is only 17 days, but sentences of up to five years are allowed which can pile up more medical costs.

There are cost saving measures at work. A doctor under contract visits twice a week to give higher level of treatment at the jail instead of the more expensive alternative of transporting prisoners to doctors offices or hospitals.

In severe medical cases Gill is able to transfer prisoners to the state penal system to cut costs. One prisoner undergoing dialysis three times a week, which cost the county thousands of dollars monthly in medical and transportation expenses, was transferred to the State Correctional Institution at Laurel Highlands which has dialysis equipment on hand.

Mercer County taxpayers however must still foot the bill for treatment.

“The monthly bill the state is charging us was equal to one dialysis treatment locally,’’ Gill said. “All the state is charging us for is supplies. They already have the equipment and don’t charge us for labor costs.’’

Those on work release are responsible for their own medical costs.

But if they lack health insurance and are unable to pay, which often is the case, the county is obligated to treat them.

Another way to keep costs in check is the county uses Cost Management Plus Inc., a quasi-state agency which looks for ways to trim costs by overseeing billing and medical contracts for county jails throughout the state.

One area which no county prison has control over is an inmate developing a catastrophic illness requiring expensive, life-saving. At any given time the Mercer County jail has three to six pregnant inmates.

Although none of them have ever given birth while under county care, if one of them did and it was a premature birth it could easily create a $1 million medical bill. Since the county jail is a self-insured operation, taxpayers would have to shoulder the cost.

“Fortunately we’ve never had something like that happen,’’ Gill said.

“Counties are pretty creative in dealing with massive medical bills. If we did have a high-risk situation I would petition the state to take them.’’

Beader, Amundsen and Gill agree that while it sounds great to have medical treatment provided on the taxpayer’s tab, the complete loss of freedom and privacy a jail offers isn’t an enticing surrounding which would cause people to flock to the site.

“I’ve never had anyone knock on our door asking to come here to take care of their health care,’’ Gill said.

“If you were to ask people already in here if they wanted to stay for the medical treatment or go home, I would be surprised if any of them said they wanted to stay.’’