By Kaitlin Durbin
cleveland.com
CLEVELAND, Ohio — The MetroHealth System is hiring an overnight physician to address nighttime medical calls in the jail and avoid millions of dollars in transportation costs for inmates who would otherwise have to be sent to the hospital.
The nocturnist, as the overnight physician is called, will be providing care in the jail starting this month, MetroHealth CEO Dr. Christine Alexander-Rager told councilmembers at a recent committee meeting.
“We’re never going to be able to eliminate transports,” she cautioned, noting some services and medical care are not available in the jail. She equated the jail to “running a 1,000-bed hospital” because of the significant medical needs, adding that she practices there herself.
However, “we think this next step is really going to help us decrease the amount of transports that we need to do,” she told committee members.
The hire follows a number of other measures that the safety-net hospital, which receives $35 million in county funding, has been taking to reduce the number of inmates having to be sent offsite for medical care.
Those efforts include tracking the types of services inmates are receiving offsite to determine if they can be provided in-house, increasing tele-health options, and working to get inmates diagnosed and set up with a treatment plan sooner, so they can continue their care in the jail, according to Alexander-Rager. “We’ve been pretty successful with that,” she said.
But those efforts alone weren’t helpful on evenings and weekends, when the majority of the transports are occurring. Those inmates often have to be sent out as a precaution, because there aren’t medical staff in the jail to assess them.
A person presenting with chest pain could be having a heart attack, or they could be experiencing indigestion, Alexander-Rager explained to council. “It’s really hard to know the difference when you’re on the phone,” she said. “So, safety first, you end up asking for them to be transported in.”
The nocturnist will now be able to do most, if not all, of the assessments onsite, though, potentially preventing a trip to the hospital, she said.
That was welcome news to councilmembers, who have been urging MetroHealth to hire an overnight physician to help cut down on transportation costs and tighten the sheriff’s budget. In May, the sheriff’s office told council that offsite medical services are costing the county about $3 million, including $2 million in overtime for the sheriff’s deputies and correction officers who have to supervise them.
At that time, it was reported that inmate transports to MetroHealth had tripled over the last eight years.
“My read on the history is that we’ve gone from two extremes,” Miller told Alexander-Rager.
Prior to MetroHealth taking over medical care in the jail in 2019, the county was “not providing nearly enough medical care to the inmates, and it created a lot of health problems, and it was a very bad situation,” he said, referring to an 11-month span when nine inmates died. Several jail officials and officers were later convicted of crimes.
“But it now seems that we’ve gone to the other extreme where people are getting transported to the hospital if there’s even the slightest question whatsoever,” Miller said, “And it just runs up the cost tremendously.”
One nocturnist will help with that, Alexander-Rager assured, but she said the county really needs at least two to meet the need.
MetroHealth currently has the job posted, seeking a second doctor with “broad knowledge and experience in general and urgent care medicine” willing to work in the jail from 7 p.m. to 7 a.m. But it’s a hard job to fill because of the hours and location, she said.
To increase the pool of candidates, MetroHealth is training more of its residents in correctional medicine and working to register the jail under a special federal program that would allow the doctors who work there to access loan forgiveness. Alexander-Rager believes that will make it easier to fill the position.
“That will be a game-changer for us,” she said.
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