When warden Greg Gebauer started with the Elk County Prison roughly 25 years ago, he saw three to five new inmates in a week.
He currently sees that many new arrivals in a single day.
As a result, the prison has been at or over the 88 person capacity since January with prison staff out-manned nearly two-to-one. Its female population at an all time high, with 20 inmates on the books and enough room for 12.
The problems posed by an over-abundance of incoming inmates include housing and prisoner misconduct concerns.
Less obvious are growing challenges in the area of inmate health care. The difficulties are compounded, as Gebauer pointed out, by ever-increasing rates of substance abuse and mental health problems among the inmate population.
Gebauer estimates 65 percent of current Elk County inmates suffer from mental health problems.
He believes another 75 percent suffer from substance abuse issues, while acknowledging the potential for overlap.
“Substance abuse is a big problem for our small county and I don’t know what the answer is,” Gebauer said. “We have a lot of inmates who are sick, have severe mental health problems, drug addiction, alcohol addiction, medical problems that they don’t tend to on the outside because they’re either drinking or doing drugs and when they come to jail not only do we have to treat their drug addiction, we have to medically treat any alcohol issues they might have and also have to treat any medical issues they might have.”
Gebauer associates the growing prison population and increased instances of health problems in inmates with a steady rise in prisoner medical costs.
These costs are shouldered almost exclusively by the county as Gebauer explained. “If they’re on Medicaid or welfare when they come in the door that stops, done.”
Privately held insurance coverage, which continues after a prison bid begins, is a rarity among convicts, he said.
With revenue largely limited to the local tax base and a majority of inmates lacking insurance coverage, wardens like Gebauer struggle to balance prison budgets against rising medical costs.
He has resorted to striking deals with providers, negotiating reduced rates with local hospitals and enlisting cost management firms as medical service bargain hunters.
Additional help came in the form of legislation significantly limiting what health care service providers can charge for services provided to inmates of Pennsylvania prisons.
Act 22 went into effect on July 1, 2011, effectively capping inpatient hospital care for county and state inmates at Medicaid rates and outpatient care at Medicare rates. Additionally, a Medical Assistance qualification can result in up to 50 percent of the inpatient care being paid by the federal government.
The legislation was endorsed by the county commissioners and prison wardens alike.
Under Act 22, Gebauer said he has seen, “a $2,000 CAT scan bill knocked down to $700.”
Comparatively, prior to Act 22, a 30 percent discount negotiated between the Elk County Prison and its local hospitals would have seen the $2,000 CAT scan bill reduced to $1,400.
“Act 22 is a huge costs savings to the county, it really is,” Gebauer said. “We’re still paying, but it’s significantly less.”
In 2010, prior to the implementation of Act 22, the prison spent $136,725 on inmate medical, including employment of prison medical staff, inmate prescriptions, counseling and dental. In 2011, the number rose to $189,398; it fell to $176,425 in 2012, and rose again to $181,324 in 2013.
In 2014, the prison has budgeted a total of $214,000 in medical expenses.
“So, I think this year is going to be the big test of how my budget is going to play out because I’m running maximum capacity plus since January and that’s where I’ll probably see the savings (from Act 22),” Gebauer said.
Not all area prisons are at critical mass or reaping the benefits of prison health care cost regulations.
Potter County is currently at less than half capacity, with 38 out of a possible 73 inmates incarcerated. Like its population, the prison budget reflects little to no fluctuation in medical costs in recent years since the passage of Act 22.
In 2014, the Potter County Jail in Coudersport has $65,000 budgeted for prisoner medical services, including medical costs, inmates prescriptions and dental — it is the same amount in each year since the passage of Act 22, according to Kathy Majot, Potter County’s chief clerk.
Angela Milford, assistant jail warden for Potter County, said there have been some, albeit minimal, savings through the Act.
“There have been savings when we’ve needed it. If we had an individual with a major emergency heart problem and had to rush them to the hospital then to a bigger one. From Cole Memorial Hospital to Hamot (in Erie) for example,” Milford said.
In McKean County, the prison budget reflects what may be significant savings since 2011.
According to the prison budget, the amount set aside for items, including prisoner medical services, ambulance trips and dentist visits, fell dramatically in the first year of Act 22’s implementation — from $107,209 in 2011 to $86,952 in 2012 and $88,237 in 2013.
