RavCo to hire five nurses to help with inmate medical services

By EVE BYRON for the Ravalli Republic | Sep 28, 2017

The conundrum over inmate medical care at the Ravalli County Detention Center appears to be solved.

The county plans to hire two full-time registered nurses and one part-time, as well as two part-time nurse practitioners. With an Oct. 1 cutoff for the current medical service provider, county officials plan to do the hiring quickly; by 1 p.m. Wednesday, the sheriff’s office issued a job posting for a full-time registered nurse beginning at $35 per hour. The closing date for the job posting is Monday, Oct. 2.

Lt. Travis McElderry said that after looking over the limited options, he worked with the current nursing staff to come up with the proposal, which was approved by Ravalli County Commissioners Wednesday. Those nurses currently are employed by Sapphire Community Health, which had a three-month contract with the county to provide services after Benefis Spectrum Medical unexpectedly cancelled its contract earlier this year, citing costs.

“Our biggest concern is medications,” McElderry told the commission, adding that at any given time, 25 to 30 of the inmates have some sort of prescription that needs to be given to them regularly. Without the supervision of medical providers, the detention center can’t order medications for them, and even having detention center officers distribute the drugs creates a high risk of liability for the county.

“You would have to give the bubble packs to the inmate, who administer it to themselves. You have to make sure the inmates take it, and make sure it’s the right medication,” McElderry said. “If you have one detention officer on the floor, and two other administering meds, that can lead to high liability to the county.”

The county also considered having deputies take inmates to community health care centers, but noted not only is that dangerous, but they don't have the staff to cover the effort. In addition, Ravalli County officials have voiced concerns that inmates would abuse the privilege because they might see it as a junket that gets them out of jail, at least temporarily.

Instead, the commission agreed to the hires, which it estimated will cost the county between $302,500 and $340,000 annually, including salaries that range from $31,700 for the part-time nurse practitioners to $83,200 for a full-time registered nurse who also would have supervisory authority. Benefits also would be offered, and are included in the annual estimates.

That’s less than the $507,000 annual contract the commission earlier had considered with Sapphire Community Health.

McElderry noted that the demand for nurses is high in the area, and they’re sometimes hesitant to work with the prison population. As of Wednesday afternoon, 55 people were incarcerated at the detention center.

Sapphire Community Health is providing him with applications they received when they were considering providing the inmate medical services, and McElderry said that two of the Sapphire-employed nurses who currently are working at the jail have offered to stay on as county employees.

He’s also reached out to other nurses with correctional institution experience, including some at the state prison at Deer Lodge.

“I think we can get the ball rolling immediately and continue services,” McElderry said, adding that two nurse practitioners also agreed to help out to ensure all medication and medical needs are current.

The county also needs to obtain malpractice insurance, which he believes will cost $15,000 to $20,000 per year. And once a nurse quits, the county will need to provide “tail insurance” for between three and six years, which covers any claims made against the nurse by inmates. McElderry theorized that the tail insurance could cost two or three times the malpractice insurance; he’s looking into that, too.

Additional costs could be incurred that involve medical record keeping in compliance with federal patients’ medical privacy laws, but commissioners said this is the best route to take now.

“Excellent work on this,” Commissioner Ray Hawk told McElderry. “You did a good job.”