Dallas jail will take fees for inmate health services out of commissary accounts

Dallas County will soon begin charging inmates fees for healthcare services reports the Dallas Morning News ("Dallas County begin charging jail inmates for medical care," Feb. 22, behind paywall). The story opens:

Dallas County Sheriff Lupe Valdez said Tuesday that she will soon begin charging certain jail inmates for their basic medical expenses, a practice common in some other states and a few Texas counties.

Valdez said Tuesday that within six months she will implement the plan to charge inmates a medical co-payment by tapping money in their commissary accounts, which they use to buy such items as toiletries and snacks. Inmates and their families put money in the accounts.

Those without commissary money will not be charged for medical services, officials said, and emergency and chronic care will still be covered by taxpayers.

“The families are putting money there and inmates can use it for gummy bears or to take care of their health,” said County Commissioner John Wiley Price.

Dallas County spent $32.3 million last year on jail medical services, which are provided by Parkland Memorial Hospital, said budget director Ryan Brown. Roughly 65 to 70 percent of the total inmate population receives some medical care, he said.

The Sheriff’s Department is working with Parkland to establish fees to charge for certain medical services, Price said.

The county has explored the co-payment idea, which is used in Travis, Harris and Collin counties, since 2004. But it has only become possible with a new three-year, $18 million commissary contract that the county commissioners awarded Tuesday to Keefe Commissary Network, Price said.

One statement in the story by Kevin Krause merits correction, where he mistakenly reported that a bill to have state prisoners pay for healthcare died in the Legislature:

A bill that would have increased inmate medical fees in state prisons passed the House in June but died after failing to receive support in the Senate . The bill, authored by state Rep. Jerry Madden, R-Plano, would have charged prisoners $100 per year for medical care unless they were poor.

Currently, state prisoners pay $3 per doctor’s visit.

In fact, though that bill died, the measure passed attached to another bill and has been implemented. See TDCJ's explanation of the new fee (pdf). That said, TDCJ's fee is a little different from how it's done in jails. Reports Krause:

The idea is not to generate revenue for the county but to cut recurring costs of transporting inmates to receive care, Price said.

“We won’t get what is called frivolous calls. So it saves us on staff,” he said. “We’ve got to try to contain costs where we can. Most of the time it’s about staff.”

Collin County charges $10 for a sick call visit, $3 for each medication prescription, and $15 for a doctor visit as well as a dental visit, officials there said. Mental health services are free as are chronic care services for such things as blood pressure conditions and diabetes.

Bexar, Fayette and Stephens counties also charge jail inmates for medical services, said Adan Munoz, executive director of the Texas Commission on Jail Standards.

Grits must admit, reducing malingering and unnecessary clinic visits was by most accounts a big effect of TDCJ's new fee, which is $100 per year, due on the first clinic visit from your commissary account or as your friends and relatives add money in the future (that's a ham-handed summary, see here for details). Though Grits generally disapproves of casting off incarceration costs on prisoner families, at the same time I must admit at being pleasantly surprised that the economic incentive reportedly worked to reduce malingering in an already overburdened system. (Prison Doc, Nurseypooh and other prison health workers/commenters, please correct me if I'm wrong about that in the comments.)

Down the line at TDCJ, it remains to be seen if those who do pay go back more frequently because they've "already paid" the fee (which is still far below the cost of actually providing healthcare). But in the short term, from what I've heard anecdotally, its success in reducing frivolous clinic visits was fairly dramatic when the fee was first initiated. The fee structure described for health services in jails creates somewhat different incentives than the higher TDCJ fee, but then jail inmates are also incarcerated there a lot shorter periods, at least in most cases.

Stepping back to look at the broader picture, there are a lot of important but seldom discussed policy issues surrounding commissaries, which let prisoners purchase goods with money put in an account for their use by family members or friends. So when government mulcts money from the commissary, they're not taking it from offenders (or in the case of pretrial defendants in jail, alleged offenders), but from their families and friends. Lately the state and some counties have been taking money out for healthcare costs. But they've also been in the news related to corruption scandals where private vendors allegedly bribed Sheriffs and or others, took them on lavish trips, etc., in order to get the lucrative contracts.

The Department of Justice says prison gangs use commissary accounts to "support gang members in prison by funneling [drug] money into prison commissary accounts of gang leaders."

Then there are the health issues, since everyone is worried about inmate healthcare costs. The examples of commissary foods given in the article are "gummy bears" and "Twinkies." You've literally got a captive market, why not offer healthier alternatives? (That goes for regular prison and jail meals, too.)

Then there's the big issue that separates TDCJ's fee on families to doing the same thing at the jail: Prisoners in TDCJ have all been convicted, while at the jail most are pretrial defendants who may or may not end up being convicted. Should the inmate or their family get the money back if charges are dismissed? How do you navigate that, or do you just ignore it?

In any event, I doubt we've seen the last of this trend. What do folks think about it?