NACo’s Justice and Public Safety Steering Committee focused its annual retreat on two major issues: implementing a regional strategy for homeland security and finding solutions to skyrocketing correctional health care costs in the juvenile and adult corrections system.
Solutions to Health Care Costs in Correctional Systems
Dr. Thomas J. Conklin, a psychiatrist, and for the last 10 years, the director of Health Services for the Hamden County Correctional Center in Ludlow, Mass., opened the discussion by providing a historical perspective on health care in jail.
Medical care was virtually “non-existent in jails prior to 1970,” Conklin said. Survey data at the time showed health care in correctional facilities was at a very rudimentary level – with 14 jails reporting that their health care system consisted of a “first aid kit.”
While there have been significant achievements in the last 30 years, “public health, community health and correctional health care must come together,” Conklin stressed. “After all, what happens in jail has profound implications for the community.”
In too many circumstances, the jail serves as a “reservoir of infections and diseases,” Conklin said. Inmates frequently leave jail and spread contagious diseases (e.g. hepatitis C, AIDS, tuberculosis, etc.) within the community.
For many, the average stay in jail is very short. One-third of the inmates will be released within a week, one third will be released within a month and most of the rest within 90 days. Meanwhile, 17 percent of all AIDS, 20 percent of HIV and 35 percent of TB cases continue to cycle through the nation’s jails.
In addition to the danger inmates pose in terms of infecting the community after they are released from jail, Conklin lamented “the wasted opportunities” to treat them while they are in jail.
“Jail provides a huge public health opportunity,” he said. “… outside of jail, these folks almost always go to emergency rooms for care [the most expensive form of treatment],’’ and since many of the emergency room patients are indigent, county governments often wind up paying the bill. Thus, says Conklin, there is a need to widen the boundaries of the system and focus greater attention on prevention, aftercare and, in general, a communitywide approach to health care.
To accomplish this, Conklin called on county boards and county executives to determine where inmates reside in the community and to then designate a system of “community health access centers” to provide prevention and follow-up services upon their release.
In most communities, prevention and follow-up care for inmates does not exist. “Create the link back to the community to overcome barriers. Include assistance in health, housing, vocational, family … etc … Prepare them so they have a chance. This protects the county investment,” Conklin said.
Leonard Bersky, the retired chief operating officer for Cermak Health Services at the Cook County Jail emphasized the importance of training in providing competent care and in reducing lawsuits. In Cook County, one-third of the annual jail budget is spent on health care. Among other reforms, Bersky called for greater use of physician’s assistants and better utilization of National Health Services Corp assignees. He discussed Cook County’s pre-arrest program for diverting the mentally ill.
Frank Hutfless, a former county attorney in Jefferson County, Colo., maintained that keeping people out of jail in alternative programs was a realistic solution to escalating health care costs for non-violent offenders, and that Medicaid reform could also significantly lessen the costs, although he acknowledged it was probably unlikely to happen anytime soon.
Hutfless emphasized the importance of measuring performance. “Inability to measure performance and quality of care equates to lack of accountability and increased vulnerability to litigation,” he said. “Initial strategies should also focus on developing intergovernmental cooperation at all government levels.”
A Regional Focus on Homeland Security
At the same moment Tom Ridge was being sworn in as the secretary for the new Department of Homeland Security (DHS), the retreat began to examine the importance of implementing a regional strategy in combating terrorism. “A regional approach to preparedness, prevention and response will best allow the resources of multiple jurisdictions to be quickly employed in the event of a terrorist incident,” said Commissioner Tony Bennett of Ramsey County, Minn., chairman of NACo’s Justice and Public Safety Committee. “For smaller counties and denser areas of the nation – many of which have critical infrastructures in their communities such as nuclear reactors and dams – the benefits of regional collaboration will add to their capacity to respond to all hazards, not just terrorism,” he said.
To support the importance of regional strategies in combating terrorism, the retreat attendees examined systems that incorporate regional approaches in achieving interoperability. George Ake, the project manager of the CAPWIN project in Maryland discussed such a system. The Capitol Wireless Integrated Network (CAPWIN) was designed to bridge the gap in public safety and transportation communications. “The system shared regionally by police, fire, EMS, and other first responders will enhance existing software systems and connect them for shared communications,” said Ake.
Another very advanced regional information system is the CriMNet system in Minnesota. “CriMNet is Minnesota’s statewide information system that will connect criminal justice and juvenile systems throughout Minnesota,” said Tom Kooy, deputy director of the program. This innovative system is already active in the state and has assisted Minnesota in linking more than 1,100 criminal justice jurisdictions by using common practices and a standard computer language.
After a vigorous discussion concerning interoperability, retreat participants heard presentations from both Gil Jamieson, director, Program Coordination Division in the Office of National Preparedness, and Katheleen Steinle, project manager, Office of Domestic Preparedness.
Both Jamieson and Steinle stressed the importance of regional collaboration in effectively combating domestic terrorism at the local level. “There are never enough resources at the national level to prepare every local community for potential terror attacks … there is an absolute need for leveraging human and fiscal resources within a mutual aid agreement in regions,” said Jamieson.
Committee members also heard from a representative of the Department of Defense’s Civil Support Teams (CST). “These 22-member support groups are military first responders that assist local governments by responding within 2-8 hours of a terrorist incident,” said Lieutenant Colonel Fred Hoon of the 8th Civil Support Team in Colorado. Created in 1996 after the 1995 Tokyo Subway poison attack and the Oklahoma City bombing, these teams are located in each of the 10 FEMA regions. Although they are not located in every state in the nation, these teams enhance a local first responder’s response and capability to contain a terrorist incident in their communities.
On the final day of the retreat, in a session entitled “Connecting the Dots between Local, State and Federal Emergency/Homeland Security Agencies,” a panel of experts discussed the importance of the federal, state and local partnership in protecting the nation.
The meeting was held in Arapahoe County (Englewood) Colo., Jan. 23-25.
