Pubdate: Sat, 13 Jul 2002
Source: Clanton Advertiser, The (AL)
Copyright: 2002 Clanton Advertiser
Contact:  http://www.clantonadvertiser.com/
Details: http://www.mapinc.org/media/1742
Author: Ed Howell

MEDICAL BILLS AT JAIL HAVE DOUBLED

Chilton County Sheriff Billy Wayne Fulmer said Friday his "personal 
opinion" is that only 30 percent of his prisoners tell the truth when 
saying they need medical treatment - treatment that has cost more than 
double his medical budget at the county jail, with 11 weeks still left in 
the fiscal year.

"Some of them are prescription junkies anyway," Fulmer said. "A lot of them 
in here are here for using drugs. They know what symptoms to describe to 
the doctor." He said it is in essence a con game. "They're running a game 
on the doctors and a game on the system," Fulmer said.

Because many are able to fool the doctors, "we're buying their dope. Not 
only am I buying their dope for them, but I'm getting it for them on time."

And spending a bundle for it - which gives Fulmer a headache, as he is 
painted into a corner by regulations, tight budgets from county 
commissioners, high medical bills, untruthful prisoners, and almost no 
medical community to turn to.

For the fiscal year ending Sept. 30, the county has spent $110,000 for 
medical services at the jail. However, the Chilton County Commission is 
only giving him $50,000 a year. Fulmer requested $100,000 last year for 
medical services for prisoners and will ask the same this fall.

He even approached another local physician last week as a means of possibly 
lowering costs. However, that unnamed doctor turned Fulmer down out of 
concerns for his personal safety, and Fulmer will now approach the current 
physician to ask if there is a means of using generic drugs. Fulmer, who is 
running for a second term in office this year, is eager for anyone to grasp 
his point that he his office is locked in a tough situation, with 
restrictions on what he can charge for the care of state prisoners, 
regulations requiring him to hire a doctor, low ceilings in his budget, the 
complete absence of local physicians wanting to help, and prisoners wanting 
to beat the system.

On the other hand, county attorney John Hollis Jackson said regulations 
require medical services to be provided. Fulmer said he realizes if he 
incorrectly guesses a real illness is fake, he knows he could join the 
prisoners as a bunkmate.

"When one is saying, I'm having chest pains, we're not qualified to say 
you're lying," Fulmer said. When prisoners report an illness, they are 
referred to the doctor.

Earlier this year, local physicians began to beg off because of concerns 
about malpractice insurance. Fulmer said he understands this, as many of 
the physicians are established in a practice anyway and don't want to take 
any risks.

At one point this year, Fulmer had to send prisoners to the emergency room 
at Chilton Medical Center. As emergency rooms are more expensive, this 
began to eat even more away at an already freyed budget, Fulmer said.

Eventually Dr. Gilberto Sanchez, a Montgomery physician, was picked in 
April to serve as a physician at the jail after Fulmer had trouble finding 
anyone to take the job. The county agreed to pay Sanchez $3,000 a month no 
matter the number of visits, with the contract to be renewed annually.

Kay Parker, the jail's medical officer, said in May Sanchez was visiting 
every Monday at the jail, although Sanchez had a nurse on call 24 hours a 
day. Parker said Sanchez sees anywhere from 20 to 23 inmates every week.

However, the cost of medical service has continued as a problem, especially 
with the drugs. "The prescriptions are eating us alive," Fulmer said.

But so are the other costs. One doctor this year decided a patient needed a 
test that would require sending him to another specialist. The final cost 
of the test was in the range of between $3,500 and $4,500, Fulmer said.

"I'm not trying to second guess the doctor," Fulmer said. "He's the one who 
went to medical school." However, he said he plans to meet with Sanchez to 
see if more generic drugs can at least be used.

Commissioner Charles Ellison agreed with Fulmer assessment about the 
prescription drugs at last week's commission meeting, where he brought up 
the expenses. He said some of the drugs being prescribed are high priced.

"I think the doctor should use generic durgs," Ellison said.

Ellison brought up the subject about the budget overrun at the meeting, 
adding, "I'm not blaming the sheriff." However, he noted June had $43,000 
in expenditures, which almost almost amounted to the whole budget.

A total of $8,617 was approved by the commission in January, followed by 
$13,000 in February; $14,000 in March; $18,000 in April; and $14,000 in 
May, Ellison said. However, Commissioner Allen Wyatt said some of those 
figures might reflect bills coming in two or three months late for 
approval. Ellison said it still reflected an annual overrun on the budget.

Fulmer noted Friday the budget for medical services was set at $50,000 to 
cover everything from dental needs to prescriptions to x-rays to treatment 
for heart attacks. "That's everything. It's not enough," Fulmer said.

"I'm asking for $100,000. We're already at $110,000," Fulmer said.

Wyatt noted at the meeting when state prisoners are housed in the county 
jail, the state does not pay for for medical services until the bill 
reaches a certain level. Chairman Aubry Wallace, a former deputy, said that 
amount is $2,000, adding it would help if the state would pay for their 
prisoners.

"They should have to pay for it from the first day," Wallace said. Yet with 
many state prisoners awaiting sentencing, "it's a Catch-22," he said.

"It's the system," Wyatt replied. "It's set up to break the county."

Out of a recent count at the jail of 197 prisoners, 40 were state prisoners 
while another 40 were state prisoners not sentenced, Wyatt said. "About 
half of them are state prisoners" whose medical bills the state won't pay, 
Wyatt said. "The state is trying to put the counties out of business."

Fulmer said last Friday the system is built up so that he gets his 
financial problems from the state and the cities. One a city police officer 
makes an arrest, the suspect is taken to the county jail where immediately 
"he's my problem," even though the suspect has not been convicted.

Wnen the state arrests someone and puts the suspect in the county jail, and 
the county, not the state, is responsible for the medical and other costs 
of that prisoner until the prisoner is convicted and sentenced, Fulmer 
said. He said he cannot remember a state prisoner reaching the $2,000 
threshold to trigger payments by the state.

Fulmer said he is averaging about 190 prisoners a day.

Commissioner Bobby Agee reminded comissioners last week there was a move a 
few years ago to have prisoners who could afford to reimburse the county to 
pay up, but Wyatt said less than 1 percent of the prisoners can actually 
pay their bills.

"He's got a mess and it didn't just happen last year," said Wyatt.
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