The Miami Herald, Inc.; Tuesday, February 18, 1997
Herald Staff

The decision by Metro-Dade Corrections officials to charge jail inmates who can afford it a $5 fee for every sick call must be implemented with great care, a built-in time clock, and realistic goals. Otherwise, it won't work.

As it is, the health care provided to inmates has no place to go but up from a troubling period of neglect after more than 30 workers were laid off last year.

The plan to charge a co-payment of sorts for medical care that till now has been free appears to have been designed with judiciousness. Indigent inmates will not be charged for visits to jail doctors and dentists or for over-the-counter medications. Those who can pay out of their canteen accounts -- what they earn in jail work or receive from families -- will pay. Serious diseases such as tuberculosis and HIV infection will be treated regardless of the inmate's ability to pay.

So far, so good.

The plan should have a six-month trial. At that point its effectiveness should be evaluated to determine whether inmates are getting needed care or going untreated because they are unwilling or unable to pay. Health risks are immense in Dade's jails. The county's overall high rates of TB, HIV, and other communicable diseases are exacerbated in crowded cells.

There should also be a close evaluation in six months of the plan's two overt goals: saving costs and reducing inmate goldbricking. Frivolous sick calls are nothing new in the corrections system, and Metro-Dade isn't the first to attempt to stymie needless and expensive clinic visits by making inmates pay. Broward County has charged inmates for two years, but is lenient about extracting payments.

Dade's will be the largest corrections system in the nation to try medical co-payments. According to Metro Corrections officials, Dade's approximately 7,000 inmates made 562,183 sick calls during the 1995-96 fiscal year. Surely, many of these were unnecessary. Yet other jail systems' efforts to stop frivolous sick calls with fees haven't shown dramatic drops in needless clinic visits.

Metro may want to reconsider this goal and its emphasis on keeping inmates out of jail clinics. Concentrating on reducing frivolous sick calls at the expense of ensuring basic health care for all inmates could trigger a nightmare of neglect in Metro's many jail cells. Better to concentrate on making inmates who can afford it pay for the services that they need, thus cutting -- even by a small proportion -- the enormous and ever growing costs of incarceration. If frivolous calls coincidentally drop, all the better. What must not decline further is inmates' general health care, already a bare-bones service.

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