Unlike people on the "outside," inmates in city and county jails are entitled by law to free daily health care services on demand -- at taxpayer expense.

Local jails, many of which were designed for short-term sentences, must house a rapidly increasing inmate population for longer periods of time, leaving corrections officials to address several problems at once.

Medical trips between a correctional facility and a hospital affect staffing levels, transportation and overtime costs. Some municipalities are considering more cost-efficient ways of delivering health care to inmates.

Typically, when one or more inmates is transported to a local hospital, they are escorted by several officers and vehicles. Crowded emergency rooms do not always have special holding areas where inmates and corrections officers can wait until a doctor is available. These factors have prompted corrections officials to examine more cost-effective ways of delivering medical services to inmates.

New York City's Rikers Island, the equivalent of a county jail for the city's five boroughs, houses 20,000 inmates in several facilities on an island adjacent to La Guardia Airport. Inmates needing trauma or acute care are moved off the island to a city hospital, a costly and time-consuming operation.

In 1993, the city of New York commissioned a study to determine if a centralized on-island medical/mental health facility would be more efficient and cost-effective than decentralized services. Recommendations called for an on-island mix of decentralized services and centralized functions, such as an urgent care center, with 24-hour staffing by medical personnel trained in trauma care.

In the suburb of East Meadow, N.Y., the 3,128-bed Nassau County Correctional Facility (NCCF) is adjacent to the Nassau County Medical Center, which provides medical staffing, inpatient services, emergency treatment and specialty care to inmates. Although the jail's new building, opened in 1992, was designed with a 40-bed medical unit, only primary care is now offered since there is no budget for a night shift to staff the infirmary.

"The hospital hills us for treatment of every inmate," says Ron Rogers, deputy commander of the facility's medical unit. Unlike some states, in New York it is illegal to charge inmates for medical care, though Rogers says a law was just passed enabling the county to bill third-party insurance, when an inmate is covered.

At NCCF, the average cost to house an inmate, without 24-hour officer coverage or medical care, is $150 a day, or close to $55,000 per year. This is exceeded only by Rikers Island, where the annual cost-per-inmate is an astronomical $58,536, averaging $160 per day. These costs escalate quickly when extensive psychological treatment, hundreds of routine clinical and specialty care visits and 24-hour protective custody are needed over a few months, as was the case recently with convicted subway murderer Colin Ferguson. According to a New York Times article, Ferguson's 15-month stay on Rikers Island cost taxpayers more than $1 million.

"Costs add up during transportation of an inmate to the hospital, even though it is literally next door," Rogers says. "Ideally, medical staff should be employees of the sheriff's department, not the hospital, to get the best management team."

Salt Lake County, Utah, currently is planning a 1,200-cell, 2,100-bed maximum security justice Center with an 84-bed medical unit, on a suburban site 20 minutes away from downtown Salt Lake City's existing jail. Currently, inmates at the downtown jail needing medical care are taken to a nearby hospital.

"The state and the city are working together to centralize functions and facilities, including the new $70-million courts complex in Salt Lake City's downtown government district," says Salt Lake City Deputy Mayor Brian Hatch. "The county, however, is pursuing a different, suburban strategy."

Another way to cut costs is to computerize inmate health records. While the average length of stay is 14 days at NCCF, there is a high rate of recidivism. In 1992, 12,000 admissions included only 4,000 new inmates. Routine intake medical screening includes a chest X-ray and tests for tuberculosis and other diseases.

Test results are computerized, allowing medical records to be readily retrieved when an inmate is arrested again or moved into the state prison system. The Rikers Island medical facility lacks computerized records; inmates are given a complete battery of costly medical tests each time they reenter the system.

New York state reimburses counties only $34 per diem for "state readies," those inmates waiting to be transferred to state prisons. Some counties are considering pooling resources for regional correctional medical centers, staffed with officers and medical personnel, for more cost-efficient operations.