Cuyahoga Sheriff estimates $40 million overruns for jail operations, medical services (2024)

CLEVELAND, Ohio – The Cuyahoga County Sheriff’s Office needs nearly $27 million to provide medical services for inmates in the jail through January 2025 and is projected to need another $13 million by the end of the year to cover other operational costs, particularly in overtime, members of council’s Public Safety and Justice Affairs Committee learned on Tuesday.

The “sticker shock” irked committee Chair Michael Gallagher and other members, who called for more accountability over MetroHealth Hospital’s rising costs, an itemized list of the services it is providing and how often inmates must be transported out of the jail for care. MetroHealth has provided all medical care in the jail since 2019.

Under the county’s current contract with MetroHealth, which expired on May 8, the hospital makes all decisions about the type of care inmates need and where it is received. But the county has no way to track that care, which costs nearly $20 million a year in onsite care and another $2 million in offsite care, when inmates are transported to an area hospital.

“We’re spending a huge amount of money, and I think the oversight is fairly minimal,” Councilman Dale Miller criticized. “I think we have to ask ourselves what kind of systems can we put in place so that we can get a better sense of what we’re spending and how we’re spending it, and if there’s ways that cost-savings can be achieved without sacrificing quality of service and inmate safety.”

He and other councilmembers called for an audit of how services are working and a dedicated person to monitor the medical contract, which is already required as part of the recent settlement over “deplorable” conditions in the jail.

Brendan Doyle, special counsel to Executive Chris Ronayne, said the county will be posting the monitoring job in a couple weeks, and that the county plans to incorporate “lessons learned” into crafting a new contract for medical services in the jail beyond January 2024. The county is starting to draft a request for proposals for that contract now.

MetroHealth contract

When the contract was first signed in May of 2019, it envisioned about $14 million in annual medical expenses, but costs have been several millions of dollars more, eating up funding.

As a result, the county has about $4.7 million in unpaid invoices from January through March that are due to MetroHealth soon. That contributes to the estimated $20.6 million the county is expected to need to pay bills through January of 2025, Chris Costin and Donna Kaleal from the sheriff’s accounting department told councilmembers on Tuesday.

Council will also soon be asked to consider a separate $1 million contract extension to pay for offsite medical services, which are not included in MetroHealth’s main contract, Costin said. Those services also rack up about $2 million in overtime costs, because they require two deputies to provide transportation and security, and they have tripled in the last eight years, Kaleal said.

“We were told, ‘pay it, just pay it,’” Kaleal said in response to questions from council about the spiking costs and accumulating unpaid bills. “As to why the costs are going up, I believe that’s a MetroHealth question.”

Aisha Parnell, MetroHealth’s director of nursing for correctional medicine, listed numerous compounding factors that have increased costs over the years, including higher salary costs for nursing staff, a higher daily population in the jail in need of medical attention, and increased use of costly medicines for illnesses like cancer and HIV.

Inmates became sicker during the coronavirus pandemic, she said, when they put off appointments. More of those ailments require attention that medical staff in the jail doesn’t have the equipment or resources to provide, especially related to eye and head injuries, leading to more transports.

But as part of the new contract extension, MetroHealth will be increasing nurse and paramedic staffing and adding an overnight physician, which could reduce transports, she said. It has also partnered with CVS pharmacy on a new program that has saved about $35,000 in prescription costs, she said.

“In as much as we are providing comprehensive healthcare, we want to make sure we’re fiscally responsible, as well,” Parnell said.

Councilwoman Yvonne Conwell, who chairs council’s Health and Human Services Committee, wasn’t convinced.

“I don’t see fiscal responsibility,” Conwell said.

Council members hoped a new jail with an extended medical wing would reduce medical costs in the future but seemed poised to approve funding to cover rising costs in the meantime. The committee voted to send the contract to the full body for approval on second reading, with Conwell voting against it.

Additional overspending

Following a separate presentation by Sheriff Harold Pretel, council was also highly critical of projections that the office will overspend its budget by about $13 million this year. Most of that will go toward paying overtime to corrections officers in the jail, amid a staffing shortage and salary increases negotiated by the various bargaining units.

Pretel said he is working to address the deficit.

The office has hired 60 new officers so far this year, though it also lost 37. He’s overhauling the department’s disciplinary procedures to more quickly hold officers accountable when they show up late or miss work, forcing overtime on the staff who do come to work, and terminate officers who do wrong.

“That’s part of changing culture,” Pretel said.

He noted other changes the department has been making to improve conditions and operations, including:

• Boosting a canine screening unit to prevent drugs from entering the jail
• Purchasing AED for patrol cars and the jail “because they save lives”
• Updating and painting housing pods in the jail
• Creating a transition team to begin preparations for a new jail

But council wasn’t impressed. Gallagher criticized the sheriff’s decision to pay eight officers to patrol downtown Cleveland, a service which the department is not required to provide and which the city does not help pay for. He called the city “a horrible partner” and indicated the sheriff needed to consider cuts.

“I’m looking at the numbers, and you have a huge problem...where do we find $13 million?” Gallagher said. “We’re not in a position to be giving things away that we can’t afford.”

Pretel pushed back, arguing that the patrol is unrelated to rising costs of the jail and described the impact it’s having as “significant to our region.” He did not provide details, but cleveland.com previously reported the patrols have taken more than 100 guns off the street. The program is projected to cost up to $1.2 million a year.

“For us to get stuck on eight deputies out of a staff of nearly 1,400, because of their function...seems a little shortsighted,” Pretel said.

He said the county has been in talks with Mayor Justin Bibb about contributing funding toward the patrol, but they have not yet reached a solution.

Councilwoman Sunny Simon was direct: “Sheriff, just get the money,” she said.