The Pinellas County Jail will no longer charge an $8 co-payment to inmates seeking medical care, forfeiting an estimated $50,000 in annual revenue from a policy that jail officials said created more problems than profit.
The jail used co-pays to help offset millions of dollars in medical bills and discourage requests for unnecessary treatments or bogus ailments. Most medical insurance does the same thing.
In 1995, when the co-pays began, jail officials told the Times that the charges had cut demand for care in half, an early sign that they were clearing waiting rooms of all but those with real medical need.
But in the years since, said Pinellas County Sheriff Jim Coats, the co-pays have bred hostility among inmates and bogged down staff with paperwork, making the tens of thousands in lost cash "not even worth it."
"The administrative reviewing and tracking of all that cost us more than we make," said Sheriff's Office Chief Deputy Bob Gualtieri. "The bang wasn't worth the buck."
Where Pinellas jail officials see a barrier to streamlining, other correctional institutions have found an opportunity for profit. From county jails near Tampa Bay to federal penitentiaries across the country, every facility charges a co-pay, returning tens of thousands of dollars annually to general funds.
Jails in Hillsborough, Hernando, Pasco and Polk charge between $5 to $15 for medical visits, higher than the Federal Bureau of Prisons' rate of $2. In 2005, when the co-pay system was instituted at all federal facilities, the bureau wrote it would encourage inmates "to be more responsible for their own health care."
A spokeswoman for the Florida Department of Corrections says the state feels the same way. Florida prisons earned $640,000 last year off a $4 co-pay, and in July state legislators increased the rate by a dollar.
"The money obviously is a big part ... but the other side of it is there are some inmates who would go to the doctor every day," said department spokeswoman Gretl Plessinger. "And if they have a medical need, they need to go, we want them to go. But this minimizes inmates who might be trying to game the system."
None of the county, jail or federal officials interviewed said they knew of plans to change their co-pay system, adding that the benefits of the charges made the collection process worth the trouble.
Not so in Pinellas, Gualtieri said. Jail employees, including more than 100 floor nurses and doctors working in the jail's $35 million health care building, said they felt weighed down by the often futile search for co-pays.
The inmates didn't like it either, filing more than 1,100 grievances complaining of medical care access, quality and cost last year. Inmate Eugene Betts, convicted of attempted murder, filed three lawsuits against the jail and two employees, claiming they charged him for treatment he didn't request after he was beaten by other inmates. In each case, he asks for his $8 co-pay, $2 in interest and hundreds of dollars in court fees.
For a jail population that saw more than 350,000 medical visits last year, the invoices and complaints added up. With the co-pay policy gone, officials said, medical staff will be freed to deal with more hands-on care.
"The nurses should be seeing inmates and treating them," said Lt. Sean McGillen, "not filling out paperwork for co-pays."
Still, the decision to abolish the co-pays comes at a tough financial time for the Sheriff's Office, which runs one of the state's most populated jails. In the past 18 months, the office's budget has been reduced by a quarter, meaning a loss of more than $67 million and 363 positions.
Coats said the Pinellas jail will continue to accrue revenue from other sources, like a recently increased $20 booking fee, to help pay for what amounted to $19 million in medical operation costs last year.
The money inmates once spent on co-pays, taken out of commissary funds filled by donations from friends and family, will stay in the accounts allowing them to buy such items as cookies and deodorant.
Inmates at booking will no longer be informed of the co-pay, which was levied on inmates who requested treatment unrelated to mental health, pregnancy, infectious diseases or emergency care. During the co-pay period, inmates without money in their accounts were not denied medical attention, officials said.
Dr. Allen Beck, a Kansas City criminal justice planner who studied the Pinellas jail, said co-pays have grown popular because of the expensive costs of health care. Considering that the ratio of health problems like drug and alcohol abuse is higher among inmates, prison medical costs "chew up a budget in a hurry."
He added that there are valid arguments against collecting co-pays, including the amount of additional effort they demand.
"It just doesn't make good business sense," Coats said. "You can only squeeze so much juice from an onion. Sometimes it gets to the point where it's counterproductive."
Times researcher Caryn Baird contributed to this report. Drew Harwell can be reached at firstname.lastname@example.org or (727) 445-4170.
Co-payments for inmate medical requests
Pinellas: Free (was $8 per visit)
Hillsborough: $12 per doctor visit; $5 per pharmacy visit; $10 per X-ray; $20 per dental visit
Hernando: $5 per nurse visit; $7 per doctor visit; $3 per pharmacy visit; $10 per X-ray; $4 per laboratory blood work
Pasco: $5 per nurse visit; $7 per doctor visit; $5 per pharmacy visit; $10 per dentist visit; $4 per laboratory blood work
Polk County: $10 per nurse visit; $15 per doctor visit; $10 per pharmacy visit
State prison: $5 per visit
Federal prison: $2 per visit