Kosciusko County Council members, from left, Dave Wolkins, Tony Ciriello, Kathleen Groninger, Mike Long and Sue Ann Mitchell listen Thursday as Sheriff Jim Smith, sitting next to jail matron Michelle Hyden, explains the need to increase the jail medical care budget for 2025. Photo by David Slone, Times-Union.

By David Slone
Times-Union

KOSCIUSKO COUNTY — Sheriff Jim Smith told the Kosciusko County Council Thursday, June 6, that he’s taking a look at increasing medical coverage in the jail to 24 hours a day, seven days a week.

The increased medical coverage could add about $150,000 to the budget annually.

“As we’re going through our budget in our office, we’ve come across the medical portion inside the jail budget. The staff and I, we’re in agreement that it’s time to really take a good look at maybe upping our medical presence in the jail to 24/7 coverage. We are currently not,” Smith said.

Currently, the jail contracts with Quality Correctional Care or medical care for inmates. At 9 p.m. each night, QCC leaves and then returns the next morning at 6 a.m.

“What happens between those hours can vary on any given night, but oftentimes a lot of your more intoxicated or your more impaired folks that would otherwise maybe need some medical attention or maybe some good advice, is now fallen on the shoulders of the jail staff. They’re going to call the physician on call, but as you can imagine, when the physician is not on-site, they’re going to weigh in on the side of caution and oftentimes they’re going to send them out to the hospital, which incurs a lot of additional expense,” Smith explained.

He said they have to pay overtime to have an officer go with the inmate to the hospital, which also leaves the jail staff short and a “whole host” of other issues that come with that.

“We’ve come to a time where I think we really need to look at that. It’s not going to be an inexpensive addition to it,” Smith said, adding that they’ve negotiated with QCC through a couple meetings to where they think they can get the increased medical coverage done for a little over $150,000 annually.

Jail Commander Kevin Gelbaugh goes to different seminars on jails.

Smith said, “These lawsuits with these attorneys that are being involved with anything medical, that’s the first thing that they’re going to look at in these jail and what the medical coverage is, and then the minimum lawsuits generally associated with those are about $100,000.”

When QCC is on duty and in the jail building, he said they have that little bit of help and some peace of mind knowing QCC is making those medical decisions.

“But I don’t hire jail staff to make medical decisions. I hire them to take care of inmates in other ways and feed them and that sort of thing. So, I know it’s an added cost but I feel that we’ve entered a time where we really need to take a look at it and you’ll probably see that when we present our budgets to you,” Smith said.

Council President Mike Long asked Smith if he had any historical information on how 24/7 medical coverage would have impacted the jail prior to now. While Smith didn’t have it with him at Thursday’s meeting, he said he would have information prepared for the council when his office presents their 2025 budget.

While there’s no guarantee that trips to the hospital can be avoided even with QCC on hand 24/7, Smith said he’d rather have someone on site who can monitor an inmate at the jail and not have to be too quick to push them out to the hospital.

Long asked if the requirement for increased medical coverage would be a registered nurse, paramedic or what. Smith said they could have a registered nurse, but they then would have to pay even more money. QCC has recommended somebody at the level of a paramedic or a trained medical personnel. By going with QCC’s recommendation, Smith said it will be less money and they still will have a certified nurse as a supervisor during the day.

Long asked if increasing the level of medical care for the inmates could possibly eliminate the county’s liability should something happen.

“I wouldn’t say eliminate, but it would certainly soften the blow on some of it,” Smith said.

Council Vice President Kathleen Groninger asked if there was a nurse at the jail during the day currently. Smith said they have a couple nurses who cover the jail until 9 p.m. The nurses distribute the medications before they leave – and there’s a lot of inmates that have medications, Smith said — and return at 6 a.m., starting by giving the inmates their morning medications.

“A lot of times when you bring people into the jail, and they’re intoxicated and things like that, they’re happening in the middle-of-the-night hours when most of us are in bed, but there’s people out there that are not, and those are the ones that oftentimes you’re asking a 20-year-old jailer to make a decision on,” Smith said. If medical staff were on hand 24/7, he said that would provide more peace of mind during the overnight hours.

Councilman Tony Ciriello, a former officer and county coroner, stated historically that deaths that occur in jails usually occur between 10 p.m. and 3 a.m., whether it’s a medical condition, suicide or whatever. That’s during the window when the Kosciusko County Jail currently doesn’t have medical coverage. There are more and more medical issue-related deaths in jails than suicides, he said.

After the county council meeting, Smith confirmed that when a person is in the sheriff’s department custody, medical care for them is going to fall back on the county, even when it’s a pre-existing condition. “That’s why it’s imperative to have as much presence as we can with QCC, and the medical company we partner with, they’re in like 70% of the jails in Indiana, so they’re well in-tuned with what’s going on,” he said.

For many years, the jail nursing staff were county employees. Smith said several sheriffs ago, it was decided to instead partner with the medical companies, in large part due to liability. The medical companies also are able to pay more competitive wages for the nurses.

He reiterated that the lawsuit trend is targeting the medical care in jails, there’s a lot of people with medical needs and he wants to make sure they’re meeting those needs.

The jail currently has almost $500,000 budgeted annually for inmate medical care. The contract with QCC is around $400,000, so the budget is not totally for QCC, but Smith said about 85% of it is.

Asked how many times an inmate has been transported to the hospital, Smith said it’s been too many times to count. Even with nurses at the jail, he acknowledged that doesn’t mean an inmate would never have to be taken to the hospital.

“But what’s happening right now in the evening time, when there’s no nursing at all, our jail staff is having to call somebody that is not on site,” Smith said, and they’re going to err on the side of caution.