Baltimore County facing higher costs for inmate care due to addiction, mental health services

The Baltimore County Council is scheduled to vote Tuesday on a contract for medical services at the county jail in Towson.
The Baltimore County Council is scheduled to vote Tuesday on a contract for medical services at the county jail in Towson. (Baltimore Sun)

The cost of providing medical care for inmates at the Baltimore County jail in Towson is rising more than 50 percent — several million dollars a year — due primarily to an increase in inmates and detainees with opioid addiction, mental illness or chronic diseases.

The County Council is set to vote Tuesday on a contract for a private company, PrimeCare Medical, to manage medical, dental and behavioral health treatment for the jail's roughly 1,200 inmates.


That contract calls for an expenditure of about $10.5 million annually — up from $6.8 million a year the county has spent over the past decade. The contract was competitively procured and county officials selected PrimeCare's bid.

At a briefing last week for council members, county health and corrections officials said that inmates' medical problems have become increasingly complex and expensive to treat.


For instance, when the county signed its previous health care contract in 2007, about 25 percent of the jail's inmates needed mental health treatment and services. That's now up to 50 percent, said Deborah Richardson, the county's correctional administrator.

"Nationally, across the board, that has occurred," Richardson said.

Dr. Gregory Wm. Branch, the county health officer, said the Towson jail also is seeing more inmates with heroin and opioid addiction, coronary artery disease, diabetes and HIV.

Inmates who arrive suffering from heroin or opioid addiction often may need detoxification treatment to stabilize them, especially if they have other diseases or mental health problems that put them at risk for complications or suicide, Branch said.

The Baltimore County jail uses medication such as methadone, buprenorphine or vivitrol to manage the health of opioid users, Branch said. Jail officials also work to connect inmates with health care on the outside, so they can continue treatment when they are released, he said.

The Baltimore County Council effectively killed a bill that would have required the county jail to screen inmates for immigration violations, but the measure's chief sponsor vowed to try again.

Baltimore County is not the only municipality experiencing rising health care costs for inmates, according to Terry Kokolis, the corrections administrator in Anne Arundel County, who also serves as president of the Maryland Correctional Administrators Association.

Often jails serve as a de facto community detox facility, as people who are high commit crimes, are arrested and sent to jail — where the staff must assess and handle their condition, he said.

And mental health care is expensive too, Kokolis said. Where a jail previously may have had one part-time psychiatrist, many jails now find they need one or more full-time psychiatrists.

Kokolis said Anne Arundel also has seen costs increase, for such things as sending inmates more frequently to expensive off-site treatment such as dialysis or hospital procedures.

Anne Arundel recently signed a contract with a vendor, Correct Care Solutions, for about $6 million per year to treat the roughly 800 detainees and inmates in the county's two detention centers, Kokolis said.

State corrections officials are seeking bids for a new five-year contract to provide medical care to thousands of detainees in the 24 state prisons and detention centers — including its facility in Baltimore city. The previous $598 million contract began in 2012 and provided care for about 26,000 inmates statewide. The population has declined to about 21,000 today as arrest rates drop statewide, which should offset any increase in medical costs, officials said.

In other local jurisdictions, Howard County has seen expenses to care for inmates increase about 5 percent annually in recent years at the county jail. The costs climbed about $130,000 over the past two years to $1.7 million, said Jack Kavanagh, director of the Department of Corrections.


In Harford County, the cost for care at the county detention center has increased 2.5 percent from last year to $3.2 million, said Kyle Andersen, spokesman for the sheriff's office. Information was not available Friday from Carroll County officials.

State officials agreed to overhaul health care services and make improvements to the city jail system under the terms of a settlement in a decades-long dispute with advocates for prisoners.

Despite the cost, Kokolis said jails have an obligation to keep inmates as safe and healthy as possible.

"Part of the mission is to ensure the safety and well-being of those committed to our custody and care," Kokolis said. "You have to identify and provide treatment for that segment of the population."

The Supreme Court has ruled that prisoners have a constitutional right to adequate medical attention.

At last week's briefing, some Baltimore County Council members expressed a bit of shock at the price of the new medical care contract for inmates.

The council approves all county contracts valued at more than $25,000, and a vote on this contract is set for Tuesday night.

Baltimore County's initial contract with Harrisburg, Pa.-based PrimeCare Medical would be for three years. Under terms of the deal, the county initially would pay PrimeCare $874,363 per month — nearly $10.5 million per year — to provide medical treatment for up to 1,400 inmates. If more inmates enter the system, PrimeCare would be paid $4.24 per inmate per day.

The contract has built-in price increases to adjust for inflation. There are also multiple renewal options for a potential contract term of up to nine-and-a-half years worth more than $115 million over its life.

Council Chairman Tom Quirk expressed concern that the price tag could affect county finances, and asked administrative officer Fred Homan whether it could be accommodated in a budget that was just approved this past spring.

Homan said officials would work to find room in the budget.

"We need to do this," Homan said. "We're only two months into the fiscal year, so we fully intend to work this out by the end of the fiscal year."

Baltimore Sun reporter Tim Prudente contributed to this article.

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