A few weeks ago, a county commissioner complained about the cost of inmate medical care at the Bradley County jail. Last week, another commissioner accused the sheriff’s office of under-budgeting inmate medical costs for the current year.

I agree that the cost of inmate medical care seems high. But that is not a problem the sheriff’s office causes or creates. The fact is the cost of medical care in the United States is too high, regardless of state or region. That is why I support initiatives to make health care more affordable and accessible for everyone.

In the state of Tennessee, the law requires inmates incarcerated in county jails to receive a basic level of medical care while they are incarcerated. To deny this would violate the law and constitute inhumane treatment. The law also states the body responsible for funding this care is not the sheriff’s office, but the county commission.

Currently, the county contracts with Detention Heath Care Associates (DHCA) to provide a basic level of medical care to our inmates on-site at the Justice Center. The contract was signed by the county mayor and approved by the county commission.

The vast majority of medical issues can be handled on-site by DHCA. But, under the contract, when there are medical issues that cannot be handled on-site ~ such as necessary emergency room visits, hospitalization and specialty treatments that are determined to be necessary by qualified medical personnel ~ additional charges will apply over and beyond the monthly contract fee.

When it comes to inmate medical issues, it is difficult to anticipate contingencies that might require an inmate to receive treatment off-site; and keep in mind our inmate population is generally not comprised of the healthiest people. Many inmates have addictions and illnesses requiring hospitalizations, including mental heath issues. Some examples, now and in the past, include hepatitis, AIDS, heart conditions, heart attacks, liver disease, kidney disease, cancer, brain tumors, diabetes, self-inflicted injuries and the like. These outside medical costs can vary widely from year to year, depending on the size and health of the overall inmate population.

Trying to budget for varying medical conditions is guesswork. That is why, since I have been sheriff, those outside medical bills have been paid from the county’s fund balance and not from the regular jail medical line. In order to avoid any future confusion, and since some commissioners didn’t seem to understand the set-up, the BCSO has requested extra monies to the inmate medical care line to next year’s budget to allow for outside medical contingencies. But the amount is only an educated guess and it is possible more money will be needed. It is also possible less will be needed.Having said that, the current situation regarding our medical budget should not have been a surprise to any commissioner, as I have in my possession a letter dated July 8, 2008, confirming that Bradley County officials outside the sheriff’s office knew these outside medical charges were not included in the monthly contracted amounts, budgeted by us in 2008.

While it may seem an easy fix to take money from the BCSO salary line to cover inmate medical costs, as suggested by some commissioners, I cannot do that. That money is needed to pay deputies for comp time and holiday time they have already accumulated. BCSO deputies are underpaid as it is ~ it would be unfair to deny them earned income in order to cover medical expenses for inmates. Especially since the commission knew, or should have known, that additional money could be needed for inmates requiring off-site medical care, and that money has traditionally been paid out of the fund balance.

Keep in mind, the BCSO already off-sets operational costs each year by bringing in approximately $4.2 million to the county, which is nearly a third of our budget. If the commission would like to further off-set incarceration expenses without denying fair and just compensation to our deputies, they could, as I have previously suggested, pass a resolution charging a Jailer’s Fee to each local inmate per day to cover all or a portion of local inmate incarceration costs. Many jails in Tennessee and across the country do this, and it makes sense. Why should law-abiding taxpayers be responsible for incarcerated inmates who opted to engage in criminal activity? The ones who break the law should have the responsibility for the costs of their incarceration.

I understand that not all those incarcerated have the capacity or means to pay a Jailer’s Fee, but collecting some costs is better than nothing. The commission should pass a Jailer’s Fee in accordance with TCA Section 8-26-105, and  let those who are incarcerated at least off-set a portion of the costs of their own housing and care, rather than placing that additional burden solely on the taxpayer. Instituting a Jailer’s Fee of $10, $20 or $40 per day charged to the inmate is just good public policy and may help serve as a deterrent to crime as well.