Etowah County Detention Center budgets in-house healthcare


Featured photo: Etowah County Commissioners, pictured here promoting Summer of Child Abuse Prevention and Awareness on August 2, discussed Etowah County Detention Center inmate healthcare on their Tuesday, August 16 meeting. Pictured, from left: Chief Administrative Officer Shane Ellison, District 1 Commissioner Joey Statum, District 3 Commissioner Jamie Grant, District 2 Commissioner and Commission President Johnny Grant, District 4 Commissioner Tim Ramsey, District 5 Commissioner Jeffery Washington and District 6 Commissioner Craig Inzer, Jr. (Emma Kirkemier/Messenger)


By Emma Kirkemier, News Editor

Etowah County is currently renegotiating its contract with Doctors Care Physicians for healthcare in the Etowah County Detention Center.

The contracted cost has been reduced by around $240,000 following the end of the detention center’s housing agreement with U.S. Immigration and Customs Enforcement in May 2022, according to Etowah County Sheriff Jonathon Horton.

Removal of ICE inmates — and the federal funding attached to their housing — necessitated that the healthcare contract be reworked.

Federal dollars that had previously reimbursed the county for the provision of healthcare to its ICE detainees left with the detainees themselves. This caused an apparent spike in healthcare costs, despite the number of inmates and the net cost both decreasing.

That loss of federal funding, Horton said, triggered a clause in the detention center’s healthcare contract stipulating that the contract holder could re-arbitrate following major population loss.

“There was a clause in it that stated if there was any significant change in the population or if ICE were to no longer be housed within the detention center, then the contract could be re-arbitrated,” Horton explained. “So we’ve been negotiating that with Doctor’s Care actually, locally. It’s who provides contractual services for our medical (care) inside the jail.”

Horton said the jail’s medical costs are “more realized than before” since the negation of federal reimbursement.

Negotiation is ongoing at the time of reporting, but Horton noted the removal of ICE detainees still ultimately “reduced the medical care bill by a little over $300,000 a year,” between a $240,000 drop in net cost and factoring discounts offered by local providers into the contract’s reworking.

On paper, the detention center could previously host up to 300 ICE detainees, but Horton pointed out the population never reached that number. He said the jail housed still fewer detainees during the last three years of the program, “rarely over 75 or 100.”

Horton told Etowah County Commissioners at an August 16 meeting that ICE-sponsored inmates “occupied less than 20 percent of the facility but covered 50 percent of the cost.” This, he noted in a later interview, referred to federal reimbursements that were allocated to cover healthcare for not only those detainees, but the entire jail.

The “50 percent (healthcare) billed to ICE” Horton said, “made up 100 percent of the medical budget.” This meant that the healthcare funding thereafter needed to come from somewhere else.

Horton recalled that for years, the sheriff’s office had tracked the cost for all ICE detainee care and housing in its yearly budget, totaling about $240,000 per year, separate from other inmate care. The ending of the housing contract then voided that $240,000 cost, accounting for the equivalent drop in net healthcare costs.

“ICE had certain (medical protocols),” Horton said. “As a matter of fact, when we re-arbitrated the last ICE contract, they required maybe three or four extra nurses that we had to have, versus what we would have if we weren’t caring for ICE detainees.”

According to Horton, Doctors Care continues to provide 24-hour healthcare to detention center inmates, including mental health and dental care.

“It provides the reasonable service we need for the county and state inmates that we house and care for,” he said. “And I don’t just say that. We’ve got a great (medical program). I mean, that’s the best thing we’ve got in that jail. We’ve always had outstanding inspections; our medical (care) has always been used as an example.”

Horton claimed Doctors Care provides both a fair price and “great personal service” to its contract holders and patients.

“We’re really fortunate because most jails, they use a (healthcare) company that’s in business for that, so they might do 15 jails in four different states,” Horton said. “Ours is all local, and it means a lot because if I have an inmate that needs medicine at 2 a.m., Doctors Care has a local pharmacy they can call. And they’ll come open the doors and meet us and give us the medicine.”

Doctors Care offers dental and mental healthcare through its own contracts with Smith & Bailey Dental and CED Mental Health Center, both local providers.

“We have found by investing in mental health — and it’s a good portion of our medical (care) is mental health — that by giving them that one-on-one counseling and that ability to actually sit down and talk to a real person, then it helps them cope and deal with (mental illness and other mental health conditions),” Horton said.

CED Mental Health Center “specialize[s] in providing mental health services for many incarceration institutions,” Horton explained, but it retains a local staff assigned specifically to the Etowah County Detention Center.

“I think the sheriff is right,” said Etowah County Probate Judge Scott Hassell at the August 16 commission meeting. “Unfortunately, the mental health facilities in Alabama really don’t exist. The new de facto mental health facilities are the county jails across our state, which are ill-equipped to do that. We’re asking them to do an impossible task. That’s why your bills have gone up.”

While a lack of state and federal support puts pressure on the county government to provide its detainees with healthcare, particularly mental healthcare, Hassell said doing so is far from beyond the county’s scope. One of the ways county government is addressing mental healthcare is through a program sponsored by Hassell himself, called the Mobile Crisis Assistance Team.

“I don’t get excited when I hear that Washington or Montgomery is going to solve our problems,” he said. “I think we do a better job addressing them here locally, and we have already seen that.”

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