Beaufort County Health Department is looking for ways to expand its services to a larger population.

Jim Madson, director of the health department, spoke to county commissioners earlier this month about his desire to offer more services to the general public, as well as to the inmate population at the Beaufort County Detention Center,

Madson has proposed creating the Healthy Living Clinic, which represents a shift for the health department into preventative care, and would mean residents would have more access to health assessments, counseling and educational resources.

Madson said the push to incorporate an onsite clinic was spurred by the department’s latest health assessment, in which the health of Beaufort County residents was measured against that of residents statewide. Of 100 counties, Beaufort County ranked 81st in health factors, which weigh poverty and economics issues, as well as risky behaviors such as smoking, non-activity, substance abuse and unhealthy eating.

“Those behaviors are very prevalent in our county,” Madson told commissioners at the January meeting.

According to the health assessment, 11 percent of county residents have diabetes; another 130 people die each year from heart disease-related issues; and 12,000 residents — of approximately 48,000 — are obese or overweight, a contributing factor to heart disease and diabetes, and also has impact on the prevalence of surgical procedures such as knee replacements.

Madson said the data speaks to the need to incorporate preventative services.

“I wear two hats: one of them is I’m the administrator of the health department; the other hat is to look at this kind of data, get feedback from the community, everybody, then try to improve the numbers in our population,” he said. “Something that I’ve been doing for years is advocating for preventative, because to me it is more important to educate to prevent the disease rather than wait to treat the disease.”

The Healthy Living Clinic would provide resources about diabetes prevention, weight management, tobacco cessation, as well as offer the standard vaccinations for measles, mumps, rubella, pertussis, tetanus and rabies. Manned by a health care provider — either a doctor or nurse practitioner — and three nurses, the clinic would operate using a sliding scale for fees, based on income.

Madson said he could do this with no cost to the county, as the health department would be able to bill insurance companies and expand its services to the detention center inmates — the funds currently budgeted by the county to pay an outside contractor for inmates’ health care could be allocated to the health department. According to Lt. Kathryn Bryan, the jail’s administrator, the sheriff’s office pays Southern Health Partners, a Tennessee-based company, approximately $270,000 a year for the health care of inmates. Outside medical care, such as emergency room visits, and safekeeping of inmates in other facilities is not included in that cost, she said.

Madson estimates the cost of the Healthy Living Clinic and providing health care for the jail is $150,000.

“(The detention center will) still need some of the funds to take care of special needs; we’re just going to be dealing with primary needs,” Madson said. “What we’re trying to do to is make sure we have a good working relationship with the detention center staff, bringing down the cost of services and addressing things like substance abuse.”

Madson said that under current contract, medical staff at the jail offers only treatment of the immediate health issues, with no follow up on preventative care or resources available to inmates who eventually will be released and resume their lives.

Bryan said the service offered by Southern Health Partners also has its own issues: the doctor is based in another county and there is limited availability for the doctor and nurses on site to participate in phone consultations.

“Our default is — if the nurse can’t take care of the medical issue — is that we take the inmate to the emergency room,” Bryan said.

This adds up in cost for deputies’ time, as well as for the expense of emergency room visits, she said.

Bryan said she has also seen good results in the partnership formed several months ago between the jail and the health department. Through a grant, the health department has been providing free STD screenings to inmates, and by talking with nurses during those screenings, they are learning about the broad range of services offered by the health department.

“It has decreased the stigma of the health department,” Bryan said.

Madson approached commissioners about the initiative to give county staff notice regarding the 2017-18 budget, as well as allow the county time to get out of its contract with Southern Health Partners, should commissioners vote yes to Madson’s proposal. With Madson’s business plan in hand, commissioners will vote on the expansion during February’s regular meeting.

But at least one commissioner is not on board.

“I’m opposed to doing this. I think it’s a bad idea. We’re going to be increasing the county staff.

How does this work with the rest of the medical care that’s going on here?” Commissioner Hood Richardson asked. “It’s making government bigger. I am not going to vote to make government bigger. Why should we as a taxpayer be providing that type of service?”

Richardson said there are already services offered by other providers in the community, and the health department assuming care for the inmate population would eliminate the firewall of the subcontractor that exists between the county and any inmate suing the county because of a health-related issue or injury.

“What we’re looking to do is not compete with health services in the county, but supplement the services already provided,” Madson said.

He said the fact the county already has liability insurance and likely would be named in any lawsuit based on a health-related issue occurring in the jail indicates the county’s liability would not change from existing conditions. Bryan agreed with the assessment.

For Madson, the move is about improving overall health of the residents of Beaufort County. For Bryan, it’s about providing inmates quality and continuity of care, along with being good stewards of taxpayers’ money.

“I mean, how do we not do this?” Bryan asked. “We’re saving money.”