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Editor's note: This is part of The Daily Times' occasional series on health care at the San Juan County Adult Detention Center. Find more stories on this topic at daily-times.com.

FARMINGTON — Two of the three inmates who have died this year at the San Juan County Adult Detention Center filed formal grievances with the jail in the months before their deaths complaining about being charged for medical services, a controversial practice that a national correctional health care organization has disavowed.

The medical service fees, also known as "co-pays," are collected by the jail from inmates for physician visits, dentist appointments and prescription medication refills, according to the detention center's procedures. An inmate is also charged if his or her medical chart is reviewed by an in-house clinician, the procedures state.

The fees, which range from $5 to $20 at the San Juan County jail, can impede access to medical care for inmates and can increase the risk that minor illnesses will erupt into costlier medical emergencies, according to the National Commission on Correctional Health Care. The commission was created by the American Medical Association in 1983 to set standards for care in the nation's correctional facilities.

According to the commission's policy, which was reaffirmed with revisions in 2012, the Centers for Disease Control and Prevention have identified inmate medical fees as a contributing factor for outbreaks of MRSA, or methicillin-resistant Staph aureus, an often fatal bacterial infection.

"Avoiding medical care for 'minor' situations can lead to serious consequences for the inmate or inmate population, since the minor situation can deteriorate to serious status or lead to the infection of others," the policy states.

Dr. Jacqueline Moore, of Greenwood Village, Colo., has 35 years of experience in the nursing field with an emphasis on development and supervision of health care programs in ambulatory and correctional institutions. She has not worked for the county detention center.

She said despite the commission's position, courts have ruled that co-pays are lawful, and the fees are common at detention facilities at the state and county level.

"They don't recommend it, but so many of the counties are doing it because of frivolous inmate complaints," Moore said. "Inmates would send a lot of sick calls, and you couldn't staff so many requests."

San Juan County inmates

The San Juan County Commission in July 2009 approved the detention center's policy, which allows for the charging of medical fees at the jail.

San Juan County jail administrator Tom Havel said the commission approved the following fee schedule last year: $20 for physician visits, $15 for medical chart inspection by an in-house clinician and a $5 fee, per month, for medications.

Inmates are not denied medical care because of their inability to pay, Havel said. The medical service fee is automatically debited from the inmate's commissary account, which is used by inmates to purchase items such as snacks, hygiene items and over-the-counter medication from the jail's in-house store.

A commissary account can develop a negative balance, according to county policy.

Havel said in an interview Friday that the intention of charging fees was not to discourage inmates from seeking medical care, but to encourage personal responsibility.

"I think the community wants everyone to be treated," he said. "Everyone wants everyone to be treated, but there is a cost for medical care, and we need to be prudent with taxpayer money. There has to be a shared responsibility."

However, the detention center's procedures specifically state that the co-pays are charged to reduce abuse of the jail's medical system and to reduce medical expenses.

When asked how effective the policy is at reducing frivolous medical requests, Havel said he could not say.

"I can't say what is frivolous or not," he said. "Inherently, nationwide, people bring these issues up, but I don't know what you would call frivolous. If someone puts in a (medical request form), it needs to be responded to."

Asked about whether he believes the fees could discourage inmates from seeking necessary medical treatment, Havel said he could not say what an inmate may or may not do.

Grievances

Jesus Marquez died March 3 while incarcerated at the San Juan County Adult Detention Center, as The Daily Times previously reported. His mother filed a lawsuit last week against the jail, the county and San Juan Regional Medical Center, among others, claiming her 34-year-old son's death was the result of negligent medical care.

The New Mexico Office of the Medical Investigator has not yet made Marquez's autopsy report publicly available, but attorneys representing the late inmate's mother, Olga Salazar, in the wrongful death lawsuit suspect Marquez died from complications related to diabetes.

According to the civil complaint, Marquez's mother contacted the jail several times after her son was incarcerated June 11, complaining that medical staff refused to properly treat his diabetes, which resulted in his placement in the detention center's medical ward.

Jesus Marquez filed seven grievances against the jail between July 4 and Dec. 13 concerning his medical treatment and at least one of those complaints was about co-pays, according to the inmate grievance log.

The Daily Times submitted a public records request to the county Wednesday for copies of those grievances. As of late Friday, the county had not released the documents.

Greg Tucker of the Tucker, Burns, Yoder & Hatfield law firm, filed the wrongful death lawsuit on behalf of Marquez's mother. His firm also filed a lawsuit on behalf of 18 current and former inmates who claim to have received negligent medical care while incarcerated at the San Juan County Adult Detention Center.

He said his firm is currently investigating the issue of co-pays at the county's detention center and what impact it may have on inmate medical care.

Another inmate, William "Billy" Carter, complained about medical fees on July 25. Carter, 57, died at the jail on Feb. 13, according to authorities.

Throughout the state

The company responsible for collecting medical fees on the jail's behalf did not charge or collect any fees in 2012, according to records provided by the county. In 2013, the company charged inmates $26,135.49 for medical services and collected $21,793.40, records state. In 2014, the jail charged $95,392.83 in medical service fees and collected $73,887.22, according to records.

The Daily Times obtained the detention center's inmate grievance log through a request under the New Mexico Inspection of Public Records Act.

According to the log, inmates filed 355 formal grievances in 2014 regarding the jail's medical services, that was out of a total of 1,113 grievances. Of those 355 complaints, approximately 135 were complaints about the medical fees.

Moore, the doctor from Colorado, said it's common for jails to have a significant number of complaints about medical care and the fees associated with it.

Policies at jails throughout the state vary.

Inmates at the Doña Ana Detention Center are charged a co-pay if they request a second medical opinion, but they are not charged a fee for prescription medication, said Kelly Jameson, a spokeswoman for the Doña Ana County Sheriff's Office.

Mabel Henderson, director of the McKinley County Adult Detention Center, said her facility does not charge inmates a co-pay for medical services.

Santa Fe County Adult Correctional Facility Warden Mark Caldwell said his facility charges a $5 co-pay per medical staff visit and a $7.50 fee for prescription medication.

Sandoval County Detention Center Director Al Casamento did not respond to requests for comment.

Steve Garrison covers crime and courts for The Daily Times. He can be reached at 505-564-4644 and stgarrison@daily-times.com. Follow him on Twitter @SteveGarrisonDT on Twitter.

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