TAMPA — The inmate in the red jumpsuit and handcuffs leaned back in a recliner, ready for his twice-weekly round of dialysis.
A technician had arrived at the Hillsborough County jail just for this man, a felon in town on appeal. In a nearby room, a dentist examined another inmate's tooth. It might need to be pulled.
If it does, the procedure can be done at the Falkenburg Road Jail, which houses a bustling medical center that sees dozens of patients each day and offers specialized care, including eye exams and ultrasounds.
Each year, county jails in the Tampa Bay area spend millions on inmate health care. Since 2005, Hillsborough's annual totals have hovered around $21 million. That's 6 percent of the agency's budget, funded by public money.
Treating them is not optional, said Col. Kenneth Davis, who is in charge of Hillsborough's jails. The sheriff's offices are required by law to provide inmates with care when it is "medically necessary," which is anything a physician determines is needed to alleviate, prevent, diagnose or correct a painful, chronic or life-threatening condition.
Once an inmate enters the jail, he does not have the option to leave for a medical procedure, even if he has the means to pay for it himself. So regardless of whether an inmate neglected his health outside of jail, once he is inside, "he belongs to us," Davis said, "And as long as it's medically necessary, they get it no matter how expensive it is."
Medical care is provided by a private company that contracts with the Sheriff's Office: Armor Correctional Health Services, a physician-owned, politically connected company based in South Florida. It's the biggest jail medical care provider in the state.
Armor has contracted with Hillsborough since 2005 and has been involved in a number of lawsuits, including one that was settled this year for $1 million, with Armor paying $800,000 and Hillsborough the rest. In that case, a Tampa man spent 34 hours in jail without being diagnosed with a stroke. He later died.
Armor charges the Sheriff's Office a flat rate per inmate per day, based on the total number of inmates. Now, with about 2,900 inmates on average, Hillsborough pays Armor $20.36 for each inmate each day.
Once an inmate reaches $40,000 for a particular medical incident, Hillsborough has to cover the additional costs. That can easily be reached with longer jail stays and expensive bills.
The jail bills inmates who have insurance, but that is infrequent. The Sheriff's Office is not allowed to bill Medicaid.
Pinellas County has recently spent between $14.8 million and $16 million a year on inmate care. Hernando County has spent about $1.4 million annually and Pasco County between $4 million and $4.5 million. Hillsborough's jail sees fight injuries and gunshot wounds, but the majority of issues are not caused by crime. It's diabetes. High blood pressure. Heart disease. On average, Hillsborough has about 70 inmates detoxing from drugs or alcohol.
Lately, about one inmate a month is diagnosed with cancer.
Earlier this year, a Falkenburg inmate received daily radiation for colon cancer. He had to be taken to the hospital, accompanied by two deputies each time.
The jail also regularly houses pregnant women. Nurse practitioner Linda Gilbert says she has seen up to 45 at one time.
But with the average stay in the county's jail at about 20 days, most don't give birth while in jail. Nonetheless, they get ultrasounds and education. Doulas — nonmedical workers trained to assist pregnant women — come in to talk about birthing processes, diet, exercises and fetal development, Gilbert said.
On a recent Thursday, doctors at Hillsborough's main jail had seen 67 inmates by 11 a.m.
They sit on exam tables, shielded by pastel-colored curtains for privacy. The room is bright, with sunshine streaming in from skylights. Doctors wear white coats. Nurses wear scrubs.
The patients are in bright jumpsuits. Most are not handcuffed. The majority are polite and compliant, welcoming the care, said Dr. Beth Weaver, who works for the Sheriff's Office.
The doctors usually do not know why their patients are in jail, and say their job is to provide good medical care.
But some unique aspects of the job can't be avoided. High-security inmates remain shackled during exams with a deputy or two standing nearby.
Some inmates are belligerent when they are booked into jail and are immediately examined by a nurse. Some are mad. Some spit. Others lie about ongoing medical issues, Weaver said.
"They don't want to describe their whole life's story at the door," she said. "They're in crisis. They think they're going to get out."
But if they don't get out quickly, inmates can suffer without daily medications, such as those used to control blood pressure. It is challenging for the jail to quickly get medical records and verify medication with outside providers, Weaver said.
The demographics of the jail also pose challenges.
Many inmates do not regularly see doctors, said Dr. Juan Nuñez, who works for Armor. Some are dependent on drugs or alcohol. Many have mental illnesses.
He has seen inmates dramatically improve while in jail. They gain healthy weight and become more lucid.
But most inmates don't stay long. Jail doctors see inmates return months later in terrible health. Some have to start the detox process all over again.
There are intense cases. Dr. Diane Rogers, who works for Armor, remembers Matthew Wong, who was booked into Hillsborough's jail with severe burns in 2012. He had tried to set his estranged wife on fire, but burned himself instead.
When Wong arrived, he used a trachea tube. He was oxygen-dependent. His burn wounds needed to be regularly rewrapped. He could not walk.
By the time he was convicted and transferred to prison a year later, he could walk and talk.
Jeanne Phillips, who manages the Pinellas County Sheriff's Office inmate health care, said she has seen inmates re-offend because they are not getting the mental health care they need outside the jail.
If they were, "they wouldn't be rotating through the door, in and out," she said.
Jessica Vander Velde can be reached at firstname.lastname@example.org or (813) 226-3433.