Inmates currently go without overnight, weekend nursing

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The Howard County Council heard a raft of additional appropriation requests from various county offices, but it was one ask in particular that caused a bit of heartburn. Howard County Sheriff Jerry Asher submitted a plea for $261,419 to fund the hiring of additional nursing staff, covering overnight and weekend shifts as well as providing a mental health treatment component.

The request was met with pushback, resulting in the measure being tabled until the council’s February meeting.

Jail Commander Captain Matt Deckard addressed the council on behalf of the sheriff, and he explained the current situation at the jail in defense of the additional appropriation.

“Currently, I don’t have 24-hour nursing in the size of jail that we are,” said Deckard. “We really need 24-hour nursing. I have nursing staff there from 6 a.m. until 10 p.m. From 10 p.m. until 6 a.m., I don’t have a nurse.

“If there’s an emergency that happens, or an inmate that comes into the jail that has an issue, we generally have to contact an on-call nurse to evaluate the individual. What happens 99 percent of the time is the nurse says send them to the hospital. I’m not saying the individual didn’t need to go to the hospital. What I’m saying is sometimes they didn’t need to go to the hospital had there just been a nurse able to take care of them.”

The jail currently houses approximately 280 inmates at any given time. Deckard contended that 40-60 percent of the medical emergencies in the jail take place after hours. Having nursing staff available after normal hours and on weekends could provide some cost savings, he believes.

“Sending them out automatically to the hospital, that’s an automatic (emergency room) charge,” said Deckard. “When a nurse is there, able to evaluate and to address an issue, (money) could have been saved. There are individuals who need to go to the hospital when they get arrested. Generally, we try to stop that at the door. If they need to be at the hospital to get evaluated, the officer would take them. But sometimes those issues don’t arise until after they come in and they’ve been there for a couple hours.”

Deckard added that a portion of the appropriation would be used to provide additional manpower for mental health treatment. The jail currently employs one mental health profession 40 hours a week during normal business hours. The second professional would help lighten that load.

“Sometimes she gets inundated with those types of calls, as there’s a lot going on,” said Deckard.

The jail commander disclosed that two or three additional nursing staff would be hired with the funds to cover the hours when nurses and mental health services aren’t available in-house. The council balked at the idea.

“I’m not against it,” said council member Martha Lake. “I’m just afraid if we commit ourselves now, we don’t know what the (state) legislators are doing until the end of February and beginning of March.”

Lake cited the funding changes enacted last year by the Indiana Legislature that sent local units over government across the state into panic mode, scrambling to find ways to make up for revenue projected to be lost by reductions in property tax revenue.

Deckard held firm in defending the need for the medial services.

“We absolutely need it for the size of our jail,” said Deckard. “I can’t speak for all other 91 counties that have jails, but for the size of our jail, we need 24-hour nursing. The demographics of Howard County, the people that come in the door, they are often sick, sometimes drug ridden. These are just facts.

“So, when you have a nurse there all the time, they’re there to evaluate that person when they come in the door to see if they need to be here in the jail and if there’s issues that arise after hours.”

Deckard further explained that the nurses find themselves with a backlog of medical needs and paperwork most mornings to catch up with what takes place overnight and on weekends. As a result, needed treatment and evaluation is delayed during the week.

“Oftentimes, the nurse who comes in at 6 a.m. has issues from the night before that she has to address along with her other day-to-day operations,” said Deckard. “There are 280-something people currently in the jail who have lots of needs, and so there is a backlog. Monday morning is the worst backlog, but every morning there’s something.”

Howard County Commissioner Jack Dodd addressed the council in support of the expenditure, expressing the unfortunate situation in which the jail serves as the community’s largest mental health treatment facility. For years, citizens experiencing a mental health crisis often have found themselves in the jail for lack of a better option.

“We keep a close look at the jail course, and with the amount of injuries, suicide attempts that we see out there, while it’s not our best option, (the jail) is our biggest mental health facility that we have right now,” said Dodd. “I realize that our mental health professional we have and our nursing staff are overwhelmed.

“Getting this additional coverage, I think, is what we need right now, until we get the new jail built to try and address some of these issues. I know the staff out there is doing what they can, but I think we need to do more. I know the commissioners, we would support their request.”

Hearing that, council member Frank Faulkner made a motion to grant the request for funding, but council member John Roberts intervened.

“I’d like to have more discussion to understand it better, before we appropriate such a large amount and put ourselves in this position where we are spending more than what we can board to spend,” said Roberts. “Perhaps we can table that request until February’s meeting, until we get a better grip on this.”

Roberts contended that no in-depth discussion of the jail’s nursing needs had been held to this point, a claim Deckard refuted, stating that the nursing need had been raised to county leaders prior to the request being made.

Further lobbying for the appropriation, Dodd offered to pledge $30,000 from the county’s unrestricted opioid settlement funds to mitigate the cost of hiring additional nursing staff. But council member Bryan Alexander expressed his own uncertainty about the request, wondering how the $261,000 would be allocated and whether the funds would hire two or three nurses. Council president Darrell Maple tried to clarify the request.

“You’re talking about essentially two nurses plus additional mental health coverage,” said Maple. “That’s salary, benefits, insurance, and liability. To me, the numbers somewhat make sense, considering the amount that you know a nurse would be paid for midnights.”

Roberts did not relent, pleading poverty on behalf of the county.

“There’s only so much pie to pay for all these needs,” said Roberts. In my humble opinion, we have to say there’s just not enough money to do the job. I’d just like more information. I’d like to learn more about this before we commit to this financial obligation.”

The council opted to grant Roberts’ request and voted to table the appropriation request until February.