WakeMed will stop providing non-emergency care for the state's inmates on Oct. 1, citing the rising cost and hassle of treating those patients.
Wake County's largest hospital system notified the N.C. Department of Correction of its plan in a letter dated Aug. 20, forcing correction officials to scramble to find alternative arrangements.
"It creates some major challenges for us," said spokeswoman Pamela Walker. "They wanted some equity in the Triangle. We certainly understand that. But we have to do everything in our power to provide inmates with care."
The Department of Correction is in negotiations with the UNC Health Care System about providing care at more of its facilities, including Rex Healthcare in Raleigh, Walker said.
WakeMed officials have complained for years that it treats too many prisoners and that the fees paid by the state don't cover the medical center's costs. Last year, WakeMed did not renew a contract with the Department of Correction.
WakeMed also lobbied the legislature and this summer won a change in state law that requires the agency to distribute inmates more equally among hospitals, with no more than 5 percent of all sick prisoners statewide sent to a single facility.
"We will do our fair share, but we don't want to be the default hospital," said WakeMed CEO Bill Atkinson. "We didn't ask for that. So we went to the hospital association and the legislators and got engaged."
During the state's fiscal year that ended June 30, WakeMed treated 1,197 inmates, or about 17 percent of the nearly 6,900 inmates statewide that required hospital care during that period, the Department of Correction reports.
In its letter to Correction Secretary Alvin Keller Jr., WakeMed points out that rival Raleigh hospitals treated far fewer inmates during that period: Duke Health Raleigh treated 106, and Rex treated three.
UNC Hospitals in Chapel Hill handled the biggest share in the state, treating 1,595 inmates, or about 22 percent.
Caring for inmates requires additional security, and the Department of Correction provides officers. But handling inmates can disrupt care for other patients and tie up hospital staff and space, Atkinson said. Also, the inmate population is aging and requires increasingly complex care.
Part of the push to reduce inmates' care also was spurred by reductions in the fees the Department of Correction pays hospitals and other providers.
"There was probably a time when this was beneficial for DOC and the hospital," said state Rep. Darren Jackson, a Wake County Democrat who supported the recent change in the General Assembly. "Things have changed over the years. WakeMed is just bursting at the seams. They're trying to keep up with the need in our community. They don't have facilities where inmates can be kept secure and the public safe."
Reallocating patients
WakeMed, which runs Wake County's only level I trauma center, will continue to provide emergency care for inmates as of Oct. 1. That should be enough to meet the 5 percent threshold that state law now requires, Atkinson said.
WakeMed officials are scheduled to meet with correction officials on Monday to start developing a plan for reallocating patients scheduled for surgeries and other procedures.
The decision to limit inmate care is part of a broader strategy by WakeMed to cut costs and boost revenue over the next year. That effort is likely to include some lost jobs and the elimination of other services.
The inmate issue has nothing to do with a state audit released Tuesday that said North Carolina loses millions by not forcing hospitals and other providers to bill Medicaid when treating prisoners, WakeMed spokeswoman Debra Laughery said.
Prisons to do some care
Some inmates are expected to begin receiving treatment next year at new medical facilities under construction in Raleigh, including a $154 million facility at Central Prison and a $48 million facility at the N.C. Correctional Institution for Women.
But those projects aren't expected to open until late 2011, and even then, patients will need to be sent to local hospitals for major surgeries, emergency care and other procedures, Walker said. The new facilities will provide dialysis, chemotherapy and other treatments for chronic conditions.
UNC Hospitals has a contract with the Department of Correction and officials are in discussions about expanding that to other UNC-owned facilities, said UNC spokeswoman Karen McCall. "We're also talking about innovative ways to delivering care, including telemedicine," she said.
