Gaelon Spradley, a member of the Lewis County Public Health and Social Services Advisory Board and the CEO of Valley View Health Center, testified during a public hearing in front of the House Civil Rights and Judiciary Committee on Wednesday, Feb. 12, in support of a bill that would enable community medical providers to provide medical care in jails and prisons.
Lewis County Commissioner Lindsey Pollock and Meja Handlen, director of Lewis County Public Health and Social Services, also offered support for House Bill 1743 on the county’s behalf, but did not get to speak before the committee ran out of time.
The goal of the new bill was to simultaneously lower medical service costs for county governments while improving the quality of care given to people when transitioning out of jail.
It hopes to achieve this by enabling smaller medical providers to provide medical services in county jails, and offering a local alternative to the larger out-of-state medical providers who are currently the only ones practicing in this setting.
After its public hearing in the House Civil Rights and Judiciary Committee, the bill was passed by the committee and referred to the House Appropriations Committee.
The bill has, as of Wednesday, March 12, missed the deadline to be passed by the House of Representatives and advance to the Senate. That means it's unlikely it will be passed into law this session. It’s a possible letdown for a bill some say would have impacted Lewis County for the better.
“Our county struggles with mandates across the board, and this bill provided a mechanism for reducing the ever-increasing costs of jail health care by having a choice of local federally qualified health centers versus nationally based providers,” Handlen said. “With limited competition, jail health care services will remain high and continue to increase, burdening public health and safety. Mandated services should be efficient and affordable.”
Obstacles
County governments are responsible for providing medical care for anyone in their jails and prisons — a group of people who may need a wide range of treatments for things like substance abuse disorder, mental health conditions and other chronic illnesses.
As rural governments like Lewis County are having funding shortfalls, many are having to pay more each year for the medical services they are required to provide in jails — assuming they can find a provider.
“We can't choose to not provide care to these individuals,” Handlen said. “So we are forced to pay that high price and then there is no opportunity or choice to go with a small provider at less cost.”
Last year, local medical provider Valley View Health Center, which has locations in Pacific, Lewis and Thurston counties, stepped in as a provider in Pacific County jails when the county lost its previous provider.
“We had capacity in the clinic, we had willing providers to offer services in the jail, and we did,” Spradley said during the hearing. “We simply walked in the jail and started offering primary care services. Then we realized that we couldn't find malpractice coverage.”
The risk of practicing without insurance is just too high, and Valley View was unable to continue providing primary care in the Pacific County Jail. Not much later, Lewis County published a request for proposal for the same services.
“We had to withdraw our services,” Spradley said. “And then we couldn’t respond to a request for proposal for Lewis County who was, like many counties, facing a budget crisis.”
He is sure Valley View could provide the same services as Lewis County’s current provider at lower cost to the county.
A study attached to the bill and conducted by the State Office of the Insurance Commissioner confirmed what the community providers had already found.
“The market conditions for a community-based health provider is that there is no private insurance market for them,” Senior Policy Advisor for Property and Casualty at the State Office of the Insurance Commissioner David Forte said. “It’s not just for community health providers but for any health providers working in a carceral setting.”
Forte added later that, during the period of the study, one of the two providers actually giving care in these settings went bankrupt and the other insured itself.
While the issue prompting the bill's creation is about cost, many testified that the legislation would also improve care for people.
“One of the most important factors in successful treatment and good clinical outcomes is continuity of care,” family physician and CEO of Olympic Healthcare Network Michael Maxwell said. “Ideally, our providers would be able to initiate treatment for these conditions during incarceration and then resume the care immediately upon release to continue that treatment.”
The solution
HB 1743 tries to solve the problem by essentially allowing the state to act as an insurer for community health providers. Similar to how anyone wronged by a federal employee can sue the federal government, this would allow people harmed by one of these providers to get compensation from the state.
It's called the sundry claims process, and there are already many situations where someone can petition the government for reimbursement. For example, when livestock is harmed by wildlife, a farmer can ask the government to pay for the damage.
The hope for supporters is that HB 1743 will lower costs to communities while getting people exiting jail treatment in their community that they are more likely to continue.
“We are already struggling. We need more jail deputies and more services there. But you can't if you are paying a maximum for the minimum,” Handlen said. “By having an entity that is community-based, they are aware of the follow-up care. They know which pharmacies are available or what mental health providers are available for providing that continuity of care.”
