New jail-health care collaboration keeps offenders out from behind bars



It was the lowest ebb of Dwight Rice’s life when he landed in jail after making “some bad decisions.”

While incarcerated at the Spartanburg County Detention Center, Rice experienced extreme pain and was taken to the hospital where he was diagnosed with acute appendicitis and a hernia. An emergency operation saved his life. A week later, he returned to the hospital for another operation to remove an intestinal blockage.

Rice, age 45, admits that he might never have made it to the hospital if he hadn’t been incarcerated. Every day he counts his blessings that he hadn’t ended up dead on the streets from a ruptured appendix.

But that was only the first blessing. The second one came after his operations when a case manager from AccessHealth Spartanburg met him in jail and offered to help him stay healthy when he returned home. AccessHealth is a privately funded nonprofit community-based group that connects uninsured and poor patients with doctors, medications and health care services at no charge.

“I was like, ‘Okay, what’s the catch?’ and they said, ‘There’s no catch. This is what we’re here for,’” Rice recalls.

For the past few years, Spartanburg Regional Health System (SRHS) and AccessHealth have worked with the local detention center to target inmates with medical and behavioral health problems. The goal is to reduce hospital emergency room visits and reduce recidivism. And early data suggest it’s working.

“Some co-workers tell me they’re not seeing as many calls from the detention center,” says Schenell Hawkins, a discharge planner with case management services at SRHS.

Also, staff noticed fewer hospital admissions among inmates, because those who are chronically ill are receiving health care in the community with AccessHealth’s help, Hawkins says.

“We’ve seen a 20 percent to 40 percent reduction in emergency room utilization,” says Carey Rothschild, director of AccessHealth Spartanburg.

Detention center patients are a small portion of the 3,000 low-income, uninsured and chronically ill people that AccessHealth helps. But they’re an important population, because keeping inmates healthy after they leave the local jail can keep them from being repeat offenders, says Neal Urch, who, until the end of 2016, was director of jail operations at the Spartanburg County Detention Center.

“It’s expensive to incarcerate someone. The state average is $50 per person per day in jail,” Urch says. “I do sympathize with the victims of crimes, but a lot of folks are cycling through jails for minor offenses like trespassing, shoplifting — misdemeanor crimes with a 30-day or maximum 90-day sentence.”

Urch made it a goal to reduce Spartanburg’s jail population, saving taxpayers money and giving minor offenders like Rice a second chance at life. He’s done this by encouraging collaborations with community groups that can help with medical and mental health care, education and job training and other issues that prevent them from being effective members of society.

One result is a reduction in the detention center’s daily census from 815 on average in FY12 to 769 inmates on average in FY16. Those 46 fewer inmates produced a savings of about $1.4 million over two years, Urch says.

How does health care impact jail recidivism? Urch offers this example: “We had a lady who in less than two years had been in jail 16 times on 34 different charges, including public disorderly conduct, shoplifting, trespassing and other minor offenses.”

To a layperson, the woman “was crazy.” Her last arrest was for spitting on a magistrate who was there for her bond. After that incident, she was diagnosed with a mental illness and given medication. Since she left the jail more than a year ago, she has not returned and has even gotten a job as a hotel housecleaner, Urch says.

Providing emergency medical care to inmates like that woman is very expensive. In applying for a grant, Urch and AccessHealth studied the financial cost of just 20 people who were frequent fliers in both the county jail and the emergency room. Their total cost to taxpayers was about $2 million.

Rice’s case also illustrates how AccessHealth’s case management services can help reduce both jail recidivism and emergency room visits.

After Rice’s surgeries, a case manager helped Rice fill out forms to obtain Medicaid and helped him find treatment for sleep apnea and blood clots in his lungs. When he was released from the detention center, “They went above and beyond their duties,” Rice says. “They connected me with people.”

They taught Rice how to organize his resume and even contacted his old high school in New York to get a copy of his diploma.

“They basically became my family,” Rice says. “They really held my hands going through a lot of things I didn’t understand.”

The extra support encouraged Rice to lose weight and get healthier. He started going to a gym, even referring 10 other people to the gym and earning a free year’s membership. He met with a nutritionist and began to pay attention to food labels and was motivated to be more health conscious.

Once his health improved, Rice focused on finding a job, and in 2016 — three years after his incarceration — he landed the best job he’s ever had. He’s a forklift operator and material handler for Lear, an automotive industry manufacturing plant. He has health insurance, a good salary and benefits. He also hasn’t had to visit the hospital since he had the blood clots removed.

And Rice is giving back to the community that helped him. He volunteers at several area agencies, including a homeless shelter, and regularly joins a team of people who visit the detention center to motivate inmates to seek help and get their lives together.

“I tell them that we have this program that won’t cost them anything but their time,” Rice says.

“When I go back and see guys in the position I used to be in, I know that I could be right back there, so returning as a guest to the detention center keeps it fresh in my face,” Rice says. “I have to keep moving forward no matter what.”

Dwight Rice got his life back on track after receiving help with his health.




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