Etowah County jail medical costs run $50,000 over budget, headed to $1 million

Etowah County is spending about $800,000 a year to send jail inmates to outside doctors and hospitals, roughly $50,000 more than it budgeted. A budget amendment on Tuesday’s commission agenda raises that line to $1 million. County officials say the cost is rising because the jail is holding more inmates, and sicker ones.

GADSDEN, AL – The Etowah County Commission took up a General Fund budget amendment Tuesday that adds $349,139 for inmate health care, most of it to cover medical treatment that happens outside the jail walls.

The amendment adds $250,000 for outside medical services, $74,354 for inmate medical and dental care, and $24,785 for the medical care of federal inmates housed in the county jail. It draws $347,520 from the General Fund balance.

Chief Administrative Officer Shane Ellison said the increase is not the result of one or two expensive cases.

“There are always a few high-cost medical cases, but this is more a function of increased numbers of inmates and sicker inmates,” Ellison said in a written response to GadsdenThrive.

How far over budget is the jail’s medical line?

The outside medical expense is running about $50,000 over budget, Ellison said, with actual costs of roughly $800,000 for the year.

The amendment raises the budgeted amount to $1 million. That is not a projection of new spending so much as the county catching its budget up to what it has already been paying.

Outside medical services covers care the jail’s own medical staff cannot provide on site. That means trips to a hospital, visits to specialists, and treatment that requires equipment a county jail does not have.

Why does the jail send inmates to outside doctors?

Because the medical staff is required to.

Ellison said the jail’s medical staff works under standard operating procedures that spell out when an inmate must be taken to a hospital, to a specialist, or elsewhere for care. Those are not case-by-case judgment calls made to control spending.

He was blunt about why the county does not simply spend less.

“No one is happy with the cost of inmate medical, but the liability associated with an insufficient level of healthcare is simply too great to ignore,” Ellison said.

Counties that fail to provide adequate medical care to people in their custody face lawsuits, and the cost of losing one can dwarf the cost of the care that would have prevented it.

What is the $24,785 for federal inmates?

Etowah County houses federal detainees in its jail and bills the federal government for the cost. The $24,785 on the expense side of the amendment covers medical care for those inmates.

An identical figure appears on the revenue side of the county’s books as a wage reimbursement for federal prisoners. Ellison confirmed the two entries offset each other, so that piece of the amendment does not come out of local money.

Did this have to go before the commission at all?

No, and that is worth understanding.

Ellison said that under a policy the commission adopted previously, he and Chief Financial Officer Kevin Dollar have the authority to make budget amendments like this one on their own, without placing them on a public agenda.

They brought this one forward anyway.

“Because it is such a large number, we wanted them to bless it, even if it’s under consent,” Ellison said.

Consent agenda items pass together in a single motion, without separate discussion, unless a commissioner asks to pull one for debate. So the item appeared in public, but it was not scheduled for a conversation.

Will these costs continue next year?

Ellison expects so.

He said the cost of inmate medical care has increased significantly over the past five years and projected that it will remain a significant expense going forward. The county begins work on its fiscal 2027 budget in the fall.

That makes the $1 million figure less a one-time correction than a new floor.

What else was on the agenda?

The same meeting included a resolution certifying local match money for a state grant to study a 190-acre addition to the NEAR Megasite, along with nine Sheriff’s Office personnel actions and several one-year contract renewals.

GadsdenThrive is seeking details from the Etowah County Sheriff’s Office on the jail’s average daily population over the past five years, which would show how much of the cost growth comes from the number of people held and how much comes from the price of care.

Frequently asked questions

How much does Etowah County spend on inmate medical care? About $800,000 a year for outside medical services alone. The amended budget raises that line to $1 million.

Why is the cost going up? The county says the jail is holding more inmates, and inmates who are in worse health.

Does the county pay for federal inmates’ care? It pays up front and is reimbursed. The $24,785 expense is offset by matching revenue.

Where does the extra money come from? The amendment draws $347,520 from the county’s General Fund balance.

Read more Gadsden and Etowah County news from GadsdenThrive.