With Henrico’s inmate population rising, the county’s annual medical care budget shortfall widens
Henrico County officials habitually underestimate annual health care costs for inmates in the county’s two jails, but a $4 million shortfall in the sheriff’s budget — the largest in seven years — shows an expanding jail population in the county is requiring more public resources.
The county regularly appropriates additional funding at the end of the fiscal year to cover inmate health care costs, but with the county’s jail populations now exceeding their capacity, the cost of taking inmates to the emergency room or to see specialists generated larger budget shortfalls in each of the past three years.
Overcrowding at the jails recently prompted County Manager John Vithoulkas to task officials with studying alternatives to incarceration and strengthening the county’s addiction recovery programs.
“We’re seeing increases in the cost of medical, food and staff overtime. All of those are related,” Vithoulkas said. “If we can deal with [the inmate] population differently, then the numbers at the jail will all go down.”
With the 2018-19 fiscal year coming to an end on June 30, the Henrico Board of Supervisors last week agreed to shift $4 million to plug the hole in the local jail system’s budget.
The transfer is the largest in a seven-year period during which the county sheriff’s office has needed extra money at the end of each fiscal year to care for people incarcerated at the jails. The annual budget for medical services in the jails has remained around $6 million over the past seven years. According to the Sheriff’s Office, there were budget shortfalls of $2.4 million and $3.4 million in the 2017 and 2018 fiscal years, respectively, while the average daily inmate population climbed from 1,150 to nearly 1,450 from 2016 to 2018.
Jail West and Jail East have a combined capacity of about 1,350 people, which means some cells are holding more than two people, while some inmates are sleeping on bunks in common areas.
“We have a horrendous drug problem in this area. And people aren’t arrested for buying or selling drugs. Most of them are arrested for property crime or big offenses,” said Henrico Sheriff Mike Wade. “Those people are going to come to jail.”
Meanwhile, the inmate population at Richmond’s jail has steadily decreased from nearly 1,000 in 2017 to 689 this year. The spending on medical services for inmates in the past two years was about even with the budget, but the city is anticipating a $1.2 million shortfall by the end of this fiscal year on June 30.
Wade and Chris Pecci, a finance manager for the Sheriff’s Office, said the county prefers taking money from its reserves at the end of the year rather than allocating too much money to a department, because it cannot take back what is left over.
Vithoulkas said budgeting for the medical costs in the jails is difficult because officials cannot predict how many inmates are going to become sick or develop a condition that requires a trip to the emergency room or a specialist.
Wade said some of the health care complications are related to drug addictions and mental health conditions, but the health care services inmates require vary, ranging from pharmaceuticals for behavioral and mental health conditions to treatments for heart, kidney and liver problems, pregnancies, skin infections, sexually transmitted diseases and chronic conditions such as diabetes.
The biggest expenses are incurred from major medical problems that require outside care. According to the Sheriff’s Office, the cost for in-house medical care, prescription drugs and mental health care services has remained relatively level in the past five years, but the cost of outside medical services increased from $1.8 million in the 2016 fiscal year to nearly $4.7 million in the 2018 fiscal year.
But as the inmate population has steadily increased in the past three years, the budget shortfalls are requiring larger withdrawals from the county’s savings.
“It’s at an all-time high,” Vithoulkas said. “This is driving those costs.”
Wade said he believes those rising costs reflect broader challenges in the health care industry, but that caring for inmates is more expensive than for other people because the county has to pay the full cost of their medical bills in many cases.
Though some may question why taxpayers should pay to care for criminals, the government has a constitutional obligation to do so, said Shannon Ellis, a Legal Aid Justice Center lawyer who is representing inmates at the Fluvanna Correctional Facility for Women who say the jail has not provided adequate care. “Unlike people in the community who can go to the emergency room or call a doctor, inmates have no access or options other than what the jail provides them,” she said.
In 1976, the U.S. Supreme Court affirmed that the Eighth Amendment’s prohibition on cruel and usual punishment means jails cannot ignore the medical needs of inmates.
“Henrico probably errs on the side of caution more than most, ensuring that any individual in our jail receives proper medical care at any time they need,” Vithoulkas said. “Our medical costs are probably going to be higher because of that premise.”
Both Wade and Commonwealth’s Attorney Shannon Taylor said people who show symptoms or say they are struggling with addiction are often returning to jail or being refused bail because it is believed they will be safer and can undergo a supervised detox.
“That’s a real issue right now,” Taylor said. “The courts are not feeling comfortable with options that exist, and we are trying to educate the bench on what it means to have an [addiction] treatment program with the right resources.”
Wade said some families are choosing to not pay bail for their loved ones who are arrested for the same reason.
Though Henrico officials say they are not entirely sure why the jail population in Henrico has grown significantly in the past three years, Vithoulkas and others believe that focusing on addiction recovery treatment, rather than incarceration, can help deter crime and prevent people from coming back to jail.
The task force Vithoulkas created includes two county supervisors, public safety officials, a circuit judge and representatives from the Commonwealth’s Attorney’s Office, the Health Department, the Sheriff’s Office and several community agencies and associations involved in addiction recovery.
Henrico Board of Supervisors Chairman Tyrone Nelson, the chairman of the task force, said the cost of medical care did not come up at the group’s first meeting last month, but that it should be considered as the group looks to draft recommendations before the end of the year.
“We need to look at why the costs are so high and what the deal is with overcrowding in the jails,” he said. “I think that’s why we need to take a total look at the whole system.”