Sunday, May 17, 1998
Commissioners question funding prisoners' medical expenses
By Jodi Billerman
Staff Writer
The Seneca County Commissioners have some tough questions for Sheriff H. Weldin Neff, jail physician Donald W. Shanabrook, M.D., and jail administrator Capt. Dennis Brady. And if the commissioners get the same answers given the A-T Friday, changes might be coming soon.
Commissioners Janet Dell, Kenny Estep and Jeff Wagner have received a request from Neff's office for $20,000 in additional funding for prisoners' medical expenses. In the letter, Neff attributed the expenses to higher prescription medication costs and an increased number of referrals to specialists.
Before granting the request, the commissioners intend to ask Neff for more detailed information on the increases, including records for the past few years. The board also wants suggestions for how to keep those numbers down.
Asked in a phone interview why those costs are so high, Neff said, ''The major problem is the fact that Judge Spellerberg has court-ordered a prescription from a Toledo doctor,'' reportedly costing around $800.
As to the necessity of specialist referrals, Neff said, ''I guess we can't tell the doctor how to do his job. We're kind of stuck dealing with it.''
Neff's administrative assistant, Barb Gracemyer, said the commissioners had underfunded the program to begin with. She said, ''From our original budget request, we were given about two-fifths what we requested.''
Nor does she feel the medical expenses are any worse this year than last year. ''We based our budget requests on expenses from last year plus about 20 percent... We're pretty much on track with last year. We've just had a lot of prisoners with a lot of different medical problems,'' she said.
Whether the referrals are necessary, Gracemyer said, ''We do try to check that the referrals are legitimate.''
Shanabrook feels the costs are unfortunate, but necessary. He said, ''We've been very careful and conscientious in making sure that when prisoners come in here on prescription medication, they continue with that medication.''
His referrals are appropriate as well, he said. ''I don't know that the referrals have really changed all that much.''
It just happens, he said, that the county has two prisoners with serious cardiac problems, one with a pacemaker and one having just undergone cardiac surgery. ''So (the latter) has to be seen by a cardiologist.''
It's a matter of chance, he said, not mismanagement. ''There's a lot more expensive patients than we're used to. I think it's the luck of the draw.''
And he's doing his best to control those costs, he explained, ''But we've got to remember that these people all have attorneys and families that, no matter what you do for them, it's not enough.''
Shanabrook feels it's safer to overdo it than to risk legal troubles. ''You've got to be careful or you're going to be looking at more than $20,000. Big lawsuits are hard to defend and give you a bad name. The perception is always there that something is wrong, even if it's not.'' In his opinion, ''the problem is the system.''
Brady feels Shanabrook's caution might be the source of the added expense. He cited previous jail physician Kassicieh's more conservative treatment. Brady said, ''Let's just say one of them took more of a liability chance than the other. I believe we could treat these people in-house more often and reduce the number of prescription medication.''
He also pointed out that while Shanabrook has made at least 10 specialist referrals just so far this year, Kassicieh had perhaps one for the entire lastyear he served.
Brady has spoken to Neff about his concerns, and was told to talk to Shanabrook. He did, to no effect.
Brady said, ''(Shanabrook) is looking at the prisoners' long-term care, rather than the immediate needs,'' and that results in higher costs to treat long-term, pre-existing health problems.
But often, Brady said of the prisoners, ''They're only sick when they're in here,'' manipulating the system to get treatment for illnesses they ignored when financially responsible themselves.
At one time the county charged prisoners $5 to see a nurse and $10 to see the physician, to both discourage frivolous requests and offset the costs. But previous sheriff Larry Stephens stopped that, Brady said, because ''He didn't know if it was legal. You don't argue with the boss when you're a fiduciary appointment.''
Brady would like to restart that practice, he said, as soon as he has time and manpower to do it.
If, in the meantime, the commissioners refuse the request for funding, Neff said, ''When there's no money left, we just won't pay.''