Dallas County inmates' hospital trip bills more than doubled in two years
By Kevin Krause
The Dallas Morning News
DALLAS COUNTY, Texas — Dallas County's cost for transporting sick inmates to Parkland Memorial Hospital more than doubled in two years, as inadequate health facilities in the jail continue to drive inmate hospitalizations, county records show.
Parkland doctors in the jail have been authorizing more hospital trips since taking over jail-health duties from a contractor in March 2006. An infirmary is planned for the main jail that would cut down on such trips, but it is nearly two years from completion.
The city of Dallas bills the county every month for ambulance trips from the jails handled by Dallas Fire-Rescue.
In fiscal 2005, the city billed the county about $76,200 for the service. In fiscal 2006, the county's tab increased to about $207,500, partly because of higher transport rates the city charged that year. Last fiscal year, which ended Sept. 30, the cost jumped to slightly more than $500,000, according to county invoice records.
"Nobody is just joyriding. We're not trying to second-guess the doctors," said Commissioner John Wiley Price, who oversees jail operations.
Jail doctors are probably being extra cautious in ordering hospital trips, he said, which is something he supports given the current federal oversight of county jails.
"I want them to err on the side of caution. That's what I expect them to do," he said about the doctors.
Sharon Phillips, Parkland's vice president in charge of jail health, said emergency trips have been declining, including transports by deputies, but she couldn't provide exact figures. Neither could the Sheriff's Department.
Price said that he wants to "pare down" the costs but that the county is required to use the city's ambulances for trips from the jails. City ordinances don't allow the county to contract with a private ambulance service for emergency calls as it does in unincorporated areas, he said.
Darryl Thomas, the sheriff's chief financial officer, said he would prefer to have a special fixed-rate contract. But Price said the county has tried unsuccessfully to reach an agreement with the city.
"The city says their costs are going up, too. They're passing them on," he said.
The city of Dallas did not respond to a request for comment.
The county's costs may get even higher this fiscal year.
The city raised its ambulance rates in October by 33 percent. The county now pays $800 per trip to transport inmates who are city residents and $900 for nonresidents. But Mr. Price said he expects the higher costs to be partially offset by the savings that will result from a kidney dialysis unit in the jail that opened in December.
Care at the jail
The high number of ambulance runs from the jails was noted by federal jail monitors who said in their most recent report filed last month that it "reflects the lack of emergency care and infirmary care at the jail."
The county plans to spend about $50 million to build a 168-bed infirmary in the north tower jail at the Lew Sterrett Justice Center. But the project is still in the design stage, and completion is at least 20 months away, county officials say.
Price said it's more difficult to retrofit an existing building than to build from the ground up. Prisoners have to be moved, and contractors must be escorted in and out of the jail, he said.
The latest federal inspection, conducted every six months under an agreement with the government, found that there's no mechanism for doctors to address emergencies at the jail.
"All patients with emergencies are transported to Parkland even when they could be managed by a physician on an outpatient basis," the report said.
Hospital trips from the jail also require jail guards to accompany the inmates to Parkland and then stand watch outside hospital rooms. That creates a risk of escape and violence in the hospital. In recent years, Parkland has had a number of inmate escapes and two emergency-room shootings involving inmates, although neither resulted in injury.
The county used to pay a private security firm to guard inmates at Parkland. But commissioners ended the contract in 2007 when the firm failed to maintain its insurance.
The company previously came under fire for allowing escapes and for not being able to provide enough guards to meet demand, which required the Sheriff's Department to cover unfilled shifts with jail guards working overtime.
September 2002 -- In an attempt to save money, Dallas County commissioners vote to outsource jail health to the University of Texas Medical Branch in Galveston.
2003 --The county pays the city $26,731 for ambulance trips from the jails to Parkland.
2005 -- The county pays about $76,200 for inmate hospital trips.
October 2005 -- The city raises ambulance rates 87 percent to $600 per trip for city residents.
2006 -- The county pays about $207,000 for inmate hospital trips.
March 2006 -- Parkland takes over jail health duties from UTMB.
December 2006 -- The U.S. Department of Justice releases a report critical of the county's lack of medical facilities in the jail. Federal oversight begins.
2008 --The county pays about $500,000 for inmate hospital trips.
October 2008 -- The city raises its ambulance rates 33 percent to $800 per trip for city residents.
December 2008 -- A kidney dialysis unit opens in the jail, reducing the need for some hospitalizations.