Nevada prison officials say they sometimes have to take inmates through the back door or bring them before or after normal business hours for non-emergency medical care because off-site doctors are reluctant to treat them, if they treat them at all.

The hesitance to offer medical care to incarcerated people is one of the reasons cited by a new audit as to why prisons are sometimes resorting to more expensive out-of-network medical providers. Officials say there’s not much they can do to compel in-network providers to see an inmate.

“There is no statutory requirement that they would be forced to provide services to everyone that subscribes to their network,” said John Borrowman, the deputy director of support services at the Nevada Department of Corrections. “We have no leverage statutory or otherwise to force a provider to see an inmate.”

The audit, presented Thursday at the Executive Branch Audit Committee that includes all Nevada constitutional officers, noted that the prisons resorted to out-of-network providers in 16 cases, or about 8 percent of the sample. One example was that the prisons are favoring a single out-of-network urologist in Southern Nevada because that doctor is willing to serve inmates on-site at the remote Ely prison and in conservation camps, so officials also use that physician for off-site appointments.

Borrowman noted that the networks the state buys into for medical care are also used by the general public and other state health groups, such as the Public Employee Benefits Program, and aren’t exclusively designed for inmate populations. He said in a future request for proposals, there may be an effort to gauge how many providers in a network will take inmate patients.

Lt. Gov. Mark Hutchison said he hoped the state could use its leverage as a large payer of health services to negotiate

“We ought to have as a very basic requirement that these folks are willing to provide services for the inmates who need them so we don’t have to keep going outside the network,” he said.

The out-of-network services discussion is part of a larger conversation about how to manage the rising cost of health care in Nevada prisons. In 2017, the department spent $11.7 million on off-site medical expenses alone.

“This has been a concern of mine since I’ve gotten here,” said NDOC Director James Dzurenda. “We have noticed a trend over the years of increasing medical costs and overnight hospital stays.”

Auditors’ suggestions for keeping costs under control included:

• Finding a third party administrator who can do “targeted case management” and ensure inmates staying at a hospital are getting only necessary treatments at the best rates. Oregon has implemented this system and reported saving 20 percent on hospital costs over two years.
• Reviewing prison medical payouts to ensure they match with the treatment that was authorized by the department’s Utilization Review Committee, which reviews requests for off-site medical care and prioritizes them.