Untreated minor health concerns can grow into big, expensive ailments, maybe even fatal illnesses. That’s true for people who are in jail, too. Many of the state’s jails charge inmates copays for their medical care, but some say the fees deter inmates from seeking the help they need before health problems get out of control.
At the colorless entrance to the San Juan County Adult Detention Center, uniformed employees sat behind a wall of Formica and glass, answering phones and listening to a small radio. Next to me, a young mom held on her lap a crashed-out toddler with spikey black hair. Lots of people who work in incarceration will tell you: It isn’t only the inmate who does the time.
Family members are often health advocates for people inside. Dee Malagon Hernandez worried about her son getting the right prescriptions and seeing a doctor. "I’ve personally gone down there, numerous times, not just once," she said.
He’d been in the San Juan County jail for about a year. And inmates often lose their insurance or Medicaid while they wait for their day in court. "You know, if he did wrong, and he needs to do time, fine," she said. "But if these inmates or my son is sick and they need medical help, they should get the medical attention."
I asked Hernandez what she thinks it's like for inmates who don't have family advocating for them. "It’s bad," she said.
The fact that three inmates died in the jail earlier this year weighed on her mind, too. "I would not have my son coming out through the back door as other people, feet first, dead," she said.
And then there are the copays. Inmate Jason Trujillo and I spoke at the San Juan County jail this summer. "They take it off of your books," he explained. He’s talking about an account that people get when they enter jail that’s often used to buy things from the commissary, like toiletries or food.
"If you’ve got any money coming in or if you have any money on your books already, then it’s taken from there," Trujillo said. So if you request medical care but can’t pay for it, your jail account goes into the red. The next time your family sends you money, their cash pays off your health care debt first.
And it’s hard for inmates to ask for money, Trujillo said, and they often feel ashamed because they can’t provide for their families.
"There’s quite a few people back there who just decide not to put in a request for that reason and just tough it out or deal with it the best they know how."
KUNM contacted all 29 jails in New Mexico and learned that copays are somewhere between $3 and $10 for a visit with a doctor, and around $5 for prescriptions. According to just about every jail administrator we spoke with, the fees are meant lighten the burden on the taxpayer and discourage inmates from abusing the system.
There’s no entity tracking medical care in New Mexico jails. There are no state laws in place, no one counting illness, injuries or deaths. And unlike prisons—which are overseen by a single department—the jails are run independently. County commissioners set fee policies and medical care contracts.
Grace Philips with the New Mexico Association of Counties confirmed there aren't mandatory standards. There is accreditation, she said, but it's voluntary, meaning jails can choose whether to seek it. Meanwhile, she added, a jail population is often dealing with higher rates of mental illness and infectious diseases. And even before factoring in those issues, jail’s expensive.
"We know that on average counties are spending one out of every three general fund dollars on detention," she said. "And the cost is going up dramatically."
Since I did those interviews at the San Juan County jail this summer, commissioners voted in mid-September to change the policy and stop charging copays. The warden, who wouldn’t speak to KUNM on the record, told the commission that the fees are more trouble than they’re worth. The facility is facing lawsuits alleging shoddy medical care—and that some people died as a result.
Still, inmates in 13 other jails in New Mexico are charged copays for health care.
Click on the facilities in the map below for more information about their copay policies. Public Health New Mexico is funded by the W.K. Kellogg Foundation.
Data from healthcare-in-nm-jails.silk.co