Zeke MacCormack: Express-News Staff Writer

HONDO Less than an hour after being booked into the Medina County Jail on July 20 on a charge of assault, Toby Guerra of D'Hanis was rushed to the hospital with chest pains.

Fortunately for taxpayers, the original $40,778 invoice for Guerra's treatment dropped to about $6,000 thanks to indigent care rates that medical providers charge the county for inmates.

Despite the discounts, officials here are upset by the climbing cost of treating inmates which totaled $130,000 last fiscal year, including prescriptions.

A decade ago the county spent $18,500 for a year's worth of medical care for inmates in the old 36-bed jail. In 2000, after the opening of a new 96-bed jail, the tab had grown to $103,813.

Presented Monday with a dental bill for $1,570 which included $600 for "deep sedation" to extract the inmate's teeth County Commissioner Beverly Keller said, "They don't need deep sedation. Pull them out when they're awake."

Commissioner Chris Mitchell said, "It pays to be arrested."

Commenting later, Mitchell said it's not right that the county provides better health benefits to suspected wrongdoers than it can afford to give its own employees.

The pointed remarks reflect a high level of frustration among county leaders across Texas at being saddled with such non-discretionary expenses they call "unfunded mandates."

"It affects both urban counties that have big jails and rural ones that have small budgets," said Elna Christopher of the Texas Association of Counties.

Treating detainees in Bexar County cost the University Health System $9 million in fiscal year 2004-05, spokeswoman Leni Kirkman said Thursday.

The system has clinics at the 4,000-inmate county jail and at two juvenile detention centers in Bexar County, and it maintains a secure ward for inmates at its hospital.

"We do about 90,000 patient visits a year by detainees," she said.

Some suspect there are people who commit minor crimes to get free medical care behind bars.

"We can't prove it, but we have a lot of pregnant females that come through here when they're about to have their baby," said Bexar County Jail Administrator Amadeo Ortiz.

A doctor visit costs inmates $15 in Bexar County, and $3 for prescriptions, but no figures were available to describe how much the health system actually collected. Those without money are treated for free.

In cases involving costly ailments, court officials and defense attorneys have been known to seek faster adjudication so that a patient can more quickly either be freed or sent to prison, where state funds will be used for their care.

"Some cases go on for months and months but, if there's an inmate with a big problem, everybody will cooperate so that we don't get stuck with a giant medical expense," said Jim Bernarduci, administrator of Kendall County's 55-bed jail. Inmate care there totaled $34,462 last year, with $486 reimbursed by prisoners.

Inmates in state prisons received more than $400 million in treatment last year, said Mike Viesca of the Texas Department of Criminal Justice.

Since 2002, the average daily cost of care per prison inmate has fluctuated between $7.92 and $7.42 last year, he said, while the inmate population rose steadily in recent years, to 151,056 now.

State inmates are charged a $3 co-pay to be treated at prison clinics or the system's hospital in Galveston.

Christopher, of the county association, said one reason counties bear the cost of treating jail inmates is that the prisoners don't qualify for Medicaid.

Her group has pushed for a constitutional amendment to stop such unfunded mandates, but "hasn't gotten far," she said.

Despite paying the indigent rates for inmate treatment, Medina County's outlay isn't credited toward another unpopular state mandate the allocation by counties of 8 percent of their general fund tax levy for indigent health care services.

Medina County spent $785,650 on indigent health care last year, far above the $544,402 it was required to set aside. The state will pick up most of the difference.

Gloria Guerra said her husband, a 38-year-old construction worker who lacks health insurance, wasn't ill before his arrest by Castroville police.

"I'm grateful that he was taken care of" in jail, she said, "He still has to have more treatment."

She's unsure if the county will seek reimbursement, but if it does, it "is going to have to be in small payments."

Medina County Judge Jim Barden called past repayments by inmate patients "very nominal," and said he hopes to change that.

He wants judges and prosecutors to make a better effort to include medical costs when deciding on any fines and fees that those convicted at trial are ordered by the court to pay.

The county also hopes to trim costs by eliminating any unnecessary treatments.

"We're trying to decide what kind of discretion needs to be exercised in determining the extent of medical care" provided, Barden said.

Medina County Sheriff Gilbert Rodriguez said his staff has little leeway on the matter.

"We at the Sheriff's Office, unfortunately, aren't doctors," he said. "By law, we have to provide them with medical care."