(This story was updated to include additional information at 7:03 p.m.)
TUESDAY, April 26 — A growing backlog of several dozen inmate medical evaluations and an in-house skeletal staff unable to adequately tend to inmates’ needs are creating some “big risks” at the Ingham County Jail, according to its top healthcare administrator, who plans to quit the job in June.
“You will not have a provider. You will not have an administrator. You’re lacking three nurses. You’re lacking a medical assistant. We have a list of 67 patients who have not been seen yet. That’s a big risk,” the administrator, Kelli Zurek, explained to the Law & Courts Committee of the Ingham County Board of Commissioners two weeks ago. “They’re just not getting seen because we don’t have the staff to do it. Every day, there are complaints about them not being seen. It’s really very unsettling.”
The medical division of the jail, an arm of the county Health Department, is in place to evaluate all incoming inmates and acts as the de facto urgent care clinic for an average of 380 prisoners. Its employees treat inmates’ acute health issues and longer-term conditions, as well as dispense medication at least twice daily and coordinate whether more specialized treatment may be needed at an off-site health care facility.
And over the last few years and particularly the last several months, those responsibilities have been growing much more difficult to manage amid a staffing shortage at the jail, Zurek said.
As of last week, well more than half of the health care personnel at the jail quit — leaving Zurek’s usual 14-person staff down to just five employees with nine vacancies, and sending the Board of Commissioners into a scramble to fix the situation.
The 60- and 70-hour weeks Zurek has been forced work to fill the gap is part of the reason she’s leaving the job, she explained.
In total, the jail is down by one provider, a full-time dentist, one health services administrator, three nurses, two medical assistants and one medication associate to help distribute pills. And that means inmates’ medical needs simply aren’t being handled in a timely fashion — if at all.
“I don’t know what else to say except that this jail medical system cannot run like this. It cannot function. Something is going to happen. Something is really going to happen, and we don’t have the staff to fix any emergencies,” Zurek said. “Please consider these inmates. These inmates are people. They need healthcare, and they’re not getting the healthcare they need right now.”
Ingham County Sheriff Scott Wriggelsworth, as well as his father and former Sheriff Gene Wriggelsworth, have been sounding alarms about the slipshod staffing conditions of the jail’s medical system for decades. Scott Wriggelsworth again urged commissioners last week to find solutions to fix the problem quickly or risk jeopardizing the health of hundreds of inmates.
“The jail medical clinic that facilitates inmate healthcare needs help right now, today. In a short time and without immediate help, the clinic won’t even be consistently staffed Monday through Friday,” Wriggelsworth said. “We have to have a plan for what we know will happen in just a few short weeks. When I speak to other sheriffs, they’re shocked at our current setup.”
Ingham County is the only one of Michigan’s 83 counties that operates its correctional health care through its Health Department rather than the Sheriff’s Department or a third-party firm.
Health Officer Linda Vail said the current arrangement was formed in 2007 in response to an administrative hiccup that involved inmates erroneously retaining medical coverage after their release — a mistake that ultimately cost the county a “significant” amount of money, she said.
But that solution hasn’t been without challenges. Former Sheriff Gene Wrigglesworth raised issues with the setup in 2011, then pushing the county to solicit bids from outside firms to take over the job. Intimidated by the price tag for those medical services, however, the Commission has now twice decided to stick with the Health Department over finding an alternative system.
And ever since, “chronic understaffing and staff retention, as well as the extensive oversight to support day-to-day operations” has posed a growing challenge inside the jail, Vail explained.
“This has been an ongoing issue for more than a decade,” Vail said. “We have points in time where the staff builds up and goes back down. That’s not unusual in a jail medical situation, but what we’re doing right now just isn’t sustainable. We hire them. They stay here for a while. They resign. I wouldn’t call it a crisis, but it’s a longstanding issue that really needs to be fixed.”
Staffing shortages in the healthcare industry aren’t a new phenomenon in Lansing, especially after the pandemic’s arrival, Vail said. But even after ratcheting up paychecks for in-house medical personnel last year, the jail has still struggled to retain a stable roster of trained talent.
“An outside entity would have pools of people they can draw from to fill vacancies. At the Health Department, we don’t have pools of nurses we can shuffle to the jail,” Vail said. “We’ve had thin spots like this in the past, and it’s always the same takeaway: This model is not sustainable.”
A report presented to the Commission last week took Vail’s assessment a step farther.
Officials at Jensen Partners — which was paid a total of $53,100 to review medical staffing at the jail and make recommendations on future models of care — labeled the situation as both an “emergency” and a “crisis” that requires some immediate intervention before it gets even worse.
“I think we’re really sorry that you’re in this situation, which is a crisis,” said Dr. Ken Bellian, a top executive at Jensen Partners. “I mean, right now you have 38% of your budgeted positions actually on site to take care of patients. It’s just not adequate for people who need health care.”
Bellian said an average of 10 inmates arrive at the jail in Mason daily and stay for about a month — with some who check out the same day and others who stay there several months.
State accreditation standards require every inmate to be medically evaluated within 14 days, Bellian said. But because the skeleton crew can’t see enough patients, a backlog has been growing for weeks — including a list of at least 80 inmates who have specifically requested but have not yet been able to receive medical assistance for several issues, Zurek said last week.
“That’s the problem right now: You don’t have enough throughput with the staff you have today,” Bellian added. “It’s a large population and there aren’t enough employees to tackle the backup.”
Bellian also pitched a “preferred” model of care to the board last week that would involve filling all nine vacancies and then hiring another eight employees in order to provide 24-hour service.
Even with a full staff, the standards of medical treatment at the jail are “antiquated,” he said. That new model would also allow the jail to incorporate more telehealth options rather than calling ambulances to take inmates to hospitals and clinics for specialized care, he explained.
Sheriff Scott Wrigglesworth said the staffing situation forced his deputies off the road to handle more than 200 inmate transports last year, taking a total of more than 3,300 hours in staff time.
“It’s not fair to my guys. It’s not fair to the people who work in the clinic. It’s not fair to the inmates who find themselves inside the facility — especially because they don’t have a choice,” he said. “Inmates are getting seen, it’s just not operating like it should. That causes problems.”
Commissioners Mark Grebner and Randy Schafer, who have spent nearly a cumulative century serving on the Board of Commissioners, also expressed concerns about the extent to which the county would be liable if the problem remained unchecked and an inmate were to die.
“The nature of this crisis is that we’re putting inmates’ health and lives at risk,” Grebner said. “There are lots of standards of medical care, but the standard that really matters is called ‘depraved indifference to human life.’ That’s what triggers seven- and eight-figure judgments.”
Commissioner Mark Polsdofer described the current staffing situation as “bordering inhumane.”
Added Commissioner Randy Maiville: “We don’t need another opportunity for Geoffrey Fieger to file a lawsuit against Ingham County, and I’m starting to sense that we’re getting close to that.”
A resolution that was unanimously approved tonight by the Board of Commissioners gave County Controller Gregg Todd a greenlight to contract with an outside agency to get the jail staffed — and quickly. Todd said he hasn’t finalized the plans for that stop-gap solution, but he has only mentioned one potential arrangement by name: And it’s with Sparrow Health System.
Todd said that a potential “public-private partnership” between Sparrow Health Systems (and its staffing agency Vituity) could help temporarily re-staff the jail while the county solicits bids for longer term models. Those could also include a permanent partnership with Sparrow or Vituity.
Todd also floated the idea of hiring an outside firm that specializes entirely in jail healthcare, but several commissioners said they’d prefer pursuing an arrangement with a trusted, local partner.
Officials at Sparrow Health System didn’t respond to multiple messages over the last week.
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