“I really think I need to be out of hiring nurses and supervising nurses and leave that to the medical professionals,” said Sheriff Chip Hall, Buchanan’s boss. 

That’s the opportunity he hopes the county’s contract with TransformHealth Correctional Services, approved by commissioners last month, will provide. The Statesboro, Georgia-based company sells itself as a one-stop shop for jail health care, offering everything from seven-day-a-week nursing to mental health services to portable equipment for doing procedures like X-rays in-house. 

That’s become an appealing pitch to many counties since the company began in 2003, said Shannon Middleton, chief financial officer. Inmates have a constitutional right to health care, but providing it can be expensive and unnerving, especially when detention officers not trained as medical professionals are asked to step in. 

“There’s multiple ways to provide it (medical care) but the security risk of transport and the time for the officers to take them over to the hospital and sit and wait is exorbitant, so a lot of places are going to this service,” Middleton said. “It takes a lot of the liability off the county.”

Anytime a prison inmate goes off-campus, an officer must accompany them. That includes long waits in the hospital waiting room, sitting at the patient’s bedside or travel to out-of-town hospitals. 

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“It is a tremendous burden,” Hall said. “We’ve had people sit at the hospital for as many as seven days.”

The agreement with TransformHeatlh won’t replace a hospital, but it will mean that more tests can be done inside the prison. X-rays and blood work, for example, won’t require a trip outside under the new contract, and the cost for service will be far less than it would be at a hospital. For instance, at a hospital it might cost between $50 and $140 to do a complete blood count, but TransformHealth can do the same thing for less than $5.

Avoiding lawsuit

Having that resource available is expected to save a lot of money, but for all involved, one of the most important benefits of allying with TransformHealth will be having a nurse onsite eight hours a day, seven days a week. Jackson County had hired a nursing position for the jail, but it was only 40 hours per week. That meant no on-site medical professional during the weekends, which in turn meant that officers wound up dispensing medication when no nurse was available. 

Reversing that reality, Buchanan said, might be reason enough to look for other options. 

“Lawsuits have been awarded due to a mix-up of medication by a detention officer,” he said, later adding, “It’s just a huge liability for them to handle medication, and with Transform our hands are out of it.”

Lately, it hasn’t been just the weekend when Jackson officers have had to fill in the nurse’s role. Michelle Dillard, who had been the jail nurse, saw her contract end Oct. 30 of last year, five days after a Halloween party Dillard allegedly hosted. Dillard faces one felony count of obstruction of justice for allegedly intimidating a teenage girl who officers were preparing to interview as a witness — the party allegedly involved underage drinking and led to the statutory rape of two 14-year-old girls. 

The position has remained empty since. Hall took his seat as sheriff one month later after winning the November election and turned his eye toward making changes bigger than just filling the vacant position. Meanwhile, officers have been the ones doling out meds and standing watch to make sure inmates swallow the pills they’re supposed to. 

County Commission Chairman Brian McMahan said working with TransformHealth will put the county’s level of care ahead of where it was before Dillard’s termination.

“This company is going to be able to provide more coverage from a nurse standpoint than we could have provided with in-house nurses on staff,” he said. “They can only work so many days a week.”

Transform, meanwhile, has similar contracts with a total of 22 counties, five of them — including Jackson — in Western North Carolina. That gives it the economy of scale to hire enough nurses to provide staffing throughout the week. 

Dillard’s firing hasn’t been the only blow to health care at the Jackson County Detention Center recently. A State Bureau of Investigation report looking into the March 13 suicide death of Steve Ross, then an inmate of the jail, is now on the desk of District Attorney Ashley Welch. Ross’s death followed the November 2014 suicide of Charles “Chuckie” Moose, also an inmate at the time. Investigations by the N.C. Department of Health and Human Resources found that in both cases detention officers had failed to make rounds as often as law requires them to — the same officers were on duty in both cases, and both remain employed by the sheriff’s office — and pointed out that officers did not follow proper detoxification protocol in the case of Ross, who was arrested on multiple drug-related charges nine days before his death. 

In the fallout from the two suicides — one occurred nine days before Hall took office, and the other happened four months into his administration — Hall said that he’d be working to improve the jail’s detoxification procedures, screening for suicidal tendencies and training of officers to follow these procedures. 

Improving mental health service 

For commissioners, an important component of TransformHealth’s offerings is the access it will provide to mental health services. Part of the contract is a twice-monthly visit from a mental health provider, with on-call services and telecounseling available on a cost-per-use basis. 

“When they’re booked in and we’re laying hands on them, within that 24-hour period part of the questionnaire we ask them is,  ‘Have you ever tried to commit suicide? Has anyone in your family committed suicide?” said Laura Busbin, clinical accounts manager, going on to give a long list of similar questions that will be part of the screening. 

The answers help determine how urgent the case is, and the company has the mental health resources to respond appropriately, Busbin said. The “worst-case scenario” for how long it might take one of the mental health providers working with the company to arrive in Sylva, Busbin said, would be about a one-hour drive from Asheville. 

Commissioner Vicki Greene made it clear that improved mental health services would be an important feature of the company’s service. 

“Given some things that have happened in our jail where perhaps clients could have used mental health services sooner than they got them, I just want to make sure that those services are available just as quickly as they can get them there to the jail,” she said.

A track record in WNC

While the Georgia-based company is fairly young, it’s not new to Western North Carolina. It began its contract with Transylvania County seven years ago, and then started working with Buncombe, Haywood and — as of July  — Henderson. 

It was the reviews coming back from these counties that got Hall interested in talking more with Transform, particularly his conversation with Haywood County Sheriff Greg Christopher. 

“Medical care of an inmate is just as important as for anybody else out there that needs medical care,” Christopher said. “TransformHealth, they have that same philosophy, and I like that philosophy.”

Christopher said he first signed Haywood on with Transform when the health care contract they had been holding came to an end. Calling around to some neighboring counties turned up positive reviews for Transform, and Haywood has been under contract with the company for the past two years. 

It’s worked out well, Christopher said. The seven-day-a-week nurse is invaluable, taking detention officers out of the position of having to dispense medication. More generally, having a company whose expertise is in health care managing patients’ medical needs is comforting when it comes to liability concerns. 

“I’m very pleased with what we are getting in return as far as service goes,” Christopher said. “It’s not only just our nurse here that I like. It is also their company and the corporate headquarters down in Statesboro, Georgia. If we have a situation that we need to pick up the phone and give them a call, they are very, very responsive.”

An up-front investment

Hall, County Manager Chuck Wooten and Jackson’s county commissioners expressed confidence that contracting with Transform would save the county money in the long run. But that doesn’t mean they’ll see the savings right out the gate. The county will have to make several one-time equipment purchases to comply with what Transform requires — the exact figure remains to be seen, pending an inventory of existing equipment, but would likely be between $10,000 and $15,000 — and as it stands now the $201,400 contract is $42,000 more expensive than the amount budgeted for jail health care in 2015-16. The county will have to pay the difference out of its contingency fund and look at increasing the sheriff’s department’s budget going forward. 

But, county leaders decided, the expanded services and the potential to save money in other areas justify the additional expense. They unanimously approved the contract. 

“Initially it looks like it might be a little more, but the fact of in the long run what they might be able to save us will actually pay for the plan,” McMahan said. 

Currently, there’s a good deal of year-to-year fluctuation in the county’s jail health care costs. In the 2011-12 fiscal year, for example, they spent $187,000 on health care, but in 2014-15, that number jumped to $418,700. 

“This past year we had a significant expenditure because of a terminal case where we had a person that could not be housed with us,” explained Wooten. 

Contracting with Transform would not mean that, should a similar situation arise in the future, the county would get out of footing the bill for expensive medical care. But it would mean that a good many incidents that now trigger a pricey trip to the hospital could be handled in-house for a lower rate, and that the county would have Transform’s team on its side to make sure there wasn’t another liable party before it paid the bill. 

For instance, Busbin said, one of the counties Transform works with had an inmate who racked up $22,000 in medical bills. But the county didn’t pay any of it, because through some sleuthing the Transform team found that he was on Medicaid — the county didn’t have to pay the bill. 

“They called us to say thank you for that new patrol car they were going to get to buy instead,” said Middleton said. 

“We want to provide the best services possible in there (the jail), and this is just another step in moving that direction,” Hall said.