K.C. Jail Nurse Helps Avoid Needless Ambulance Runs

June 24--Shortly after Kansas City police booked a man into jail Wednesday for an outstanding warrant from Independence, he complained of chest pains.

He'd been in pain for a day and a half and had consumed a "half pint" that morning. A jail nurse took his vital signs, examined him and concluded he was simply drunk and didn't want to be in jail.

The man said as much when she told him he needed to lie down and drink lots of water.

"I'm OK," he said firmly. "Just get me home."

Before November, the man's complaints would have earned him an ambulance trip to a hospital and a get-out-of-jail-free card.

But now police have an in-house nurse, and she determined he was suffering from nothing other than "jail-itis." He was sent back to the tank until Independence police could pick him up.

Before the nurse program, police put five to seven inmates with similar complaints onto ambulances each day, racking up hundreds of thousands of dollars in medical costs and lost work time for police, firefighters and doctors. Police Headquarters claimed the top location in the city for ambulance calls by far, year after year.

The program has slashed ambulance calls by nearly 60%, saving the city more than $217,000 in estimated costs in the past seven months. Police summoned 615 ambulances from November 2011 to June 2012, but just 253 ambulances from November 2012 to June.

Police Chief Darryl Forte, who initiated the program with Mike Schumacher, an assistant to the city manager, said having an in-house nurse improves health care for inmates and reduces bogus ambulance calls.

"It's a no-brainer," said Forte, who had worked with Schumacher on the idea years ago. "It gets police back on the streets quicker; it's a benefit to the hospitals. The taxpayers were carrying that cost, too. Everybody wins."

Inmates had learned how to game the old system, Forte said, by claiming mysterious pains, trouble breathing or complications from diabetes. After an ambulance dropped them off at a hospital, many would walk out of the hospital doors and would be rearrested at a later date, starting the whole process again. Some inmates wouldn't even wait to get to the hospital; they would bail from the back doors of the ambulance.

"Everyone knew it was shenanigans," Schumacher said. "But the Police Department didn't have a choice. They're not doctors."

Officers do not accompany inmates facing minor charges to hospitals. But officers remain with inmates accused of serious crimes to ensure they don't escape. When symptoms were faked, that unnecessarily left the city with fewer officers responding to 9-1-1 calls.

Many ambulance calls would take six firefighters off the streets -- four on a pumper and two on the ambulance -- for an average of 43 minutes per call, Schumacher said.

The wasted efforts were costing the Fire Department the equivalent of a full-time position, he said.

"There's a cost to having an ambulance available and ready," he said. "And there's the cost to make a call. This program gives us more opportunities to run calls for our citizens."

Kansas City's police detention unit is a temporary jail holding inmates for a day or two at most. It books an average of 90 to 105 inmates each day. Inmates either post bond or are moved to the county jail after seeing a judge.

Medical claims often blossomed after arraignments each day, said Capt. Rex Tarwater, who oversees operations in the police jail. Inmates hoping a judge would free them on a signature bond would often claim illness or injury after realizing they had to stay behind bars, he said.

The old system forced detention unit supervisors with little medical training to make medical calls, so they erred on the side of caution.

The barrage of phony cases annoyed doctors at Truman Medical Center who called jail supervisors to complain, said Michael Harper, a detention unit supervisor.

"Then we'd have to explain the liability issue," he said.

The in-house nurse "is another layer of insulation for us," said Robert Price, another detention unit supervisor. "She screens the complaints for us."

Reducing the number of ambulance calls improves efficiency in the jail, too, Price said. Bringing in an ambulance crew disrupts the flow for jail staff and delays officers who are trying to book prisoners and get back on the streets.

Police still call an ambulance for obvious cases. A pregnant inmate went into labor a few weeks ago. Other inmates arrive with serious health problems that they've long ignored.

"There are probably a dozen cases per year where the person would have died if they didn't get arrested," Price said. "We've had guys come in here with a severe headache and nosebleed and they're on the edge of stroking out."

The nurse sets up shop in a holding cell for six hours each day. The rest of the day, nurses are on call from the Jackson County jail, according to the contract the city has with Correctional Healthcare Companies. The contract cost the city about $150,000 per year.

A detention facility officer stays with the nurse for her protection when she is seeing a patient. Angela Hall, one of the primary assigned nurses, said she hasn't had any problems, although she's had to jump out of the way a few times when inmates realize they aren't getting out and start fighting officers.

Hall deals with a lot of hypertension, wound care, anxiety and mental problems. She can administer insulin and medication to lower blood pressure. She calls family members to try to get inmates their needed prescriptions. But she can't prescribe medication. That's done when the inmate reaches the county jail.

When inmates find out there is an in-house nurse, some decide they no longer are sick, Tarwater said. Eighteen inmates this year have refused to see the nurse after claiming a medical problem.

Just as inmates learned they could get out of jail by claiming illness, they slowly are learning the jig is up.

"In the beginning, I was really busy," Hall said. "But I think they're adjusting."

To reach Christine Vendel, call 816-234-4438 or send email to cvendel@kcstar.com.

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