Johnston County — Johnston Sheriff Steve Bizzell says many taxpayers bristle when they learn what it costs to provide health care to inmates in the county jail.

In fiscal 2007-08, that cost was $410,984, and in the first four months of 2008-09, the bill was $184,000, including $84,000 in October alone.

“A lot of people are critical of us for providing funding for medical care for inmates, whether it’s a preexisting condition or whether they get in jail and that tooth that’s been aching for six months, well, it is a good time to get it out,” Bizzell says.

For his part, the sheriff is ambivalent about inmate care. On the one hand, he balks at spending taxpayer dollars on people who have broken the law. On the other, he knows that inmates are people too.

“They are still someone’s son, daughter, mother, father, grandfather or grandmother,” Bizzell says. “There is always somebody that loves that person, and they are no different than you and I.”

Jamie Markham is an assistant professor in the School of Government at the University of North Carolina at Chapel Hill. He says it’s important to remember that most inmates in county jails are awaiting trial, not serving time.

“Over two-thirds of people in the jail have not been convicted of anything yet,” says Markham, who works closely with jail administrators and county sheriffs. “In terms of the moral issue of providing healthcare for people in jail, they are theoretically innocent until proven guilty. We are only providing care for them because they literally could not take themselves to the emergency room if they wanted to.”

In jails, as in households, the cost of health care can pile up quickly, Bizzell says. Shuffling through a stack of medical bills, the sheriff finds a couple of invoices from Johnston Medical Center. Together, they add up to $35,000 for two inmates with heart problems. Another inmate’s care cost $10,000, and a few days later, he died, Bizzell says.

Meanwhile, dental bills can top $400 a visit, and the sheriff has to budget for medicines, such as insulin, and for continuing care, like trips to a dialysis center.

In part, the high costs reflect the generally poor health of many inmates, Bizzell says. “It costs a lot of money to house inmates, but you’ve got to take into consideration we are sometimes bringing inmates off the streets,” he says. “Sometimes, they have been homeless. A lot of times they will come in with prior medical conditions.” Markham says jails are not welcoming the healthiest of people. “Part of the issue is the population they are

dealing with tends to be a pretty hard-living bunch of homeless people, drug users and people with mental health issues,” he says. “Although they may be in their 30s or 40s, they have the health problems or communicable diseases of 60-year-olds.”

In Johnston County, Southern Health Partners, a private company based in Tennessee, provides nurses and a doctor for the county jail.

Bizzell just wishes all Johnstonians had that kind of access to health care. “I think inmates that are incarcerated under county jails should be covered under Medicaid,” he says. “As the sheriff, I have a duty to give them basic medical care that is deemed necessary and appropriate. But then I think of all these folks out here who worked all their life, paid their dues, are good citizens and good church folks who can’t afford health insurance for themselves.”