"Take a pill out of a bottle, put it in a little delivery cup and make sure it's taken. That's not very hard to do," says Williams County Sheriff Scott Busching.

Delivery of medications in correctional facilities is becoming a big issue as county and regional jails scramble to comply with a state law that's been more or less overlooked for more than a decade. An attorney general's opinion, based on a question raised by Burleigh County State's Attorney Richard Riha, is forcing jails to re-evaluate their delivery of medications.

The issue got its start in 2003 when a jailer at the Burleigh County Detention Center brought up the issue of liability in delivery of medications to prisoners with the county's human resources department. The question was then taken to Riha, who in turn took it to the attorney general.

"Basically, the attorney general's opinion said that the administration of medication was primarily a nursing function," Riha said.

It was determined that detention staff could deliver medications, but only if they were trained and certified by a nurse supervising the jail's health administration as required by law (Century Code 12-44.01).

Not a 'big deal'

Steve Engen is the North Dakota Department of Corrections' director of training and facilities along with being a jail inspector. In 2006, the corrections department will be making sure that the 30 jails in the state have an acceptable medication delivery system.

"The Department of Corrections doesn't have an opinion one way or another on the issue," Engen says. "We've been put in a position to make sure the law is followed by county facilities and we'll do that in 2006."

Engen feels that compliance is neither a "big deal" nor a "huge endeavor" on the part of correction facilities and that it substantially reduces liability issues.

Jails have options in complying with state law, much of it based on the size of the facility and the number of inmates it handles.

In the case of the Burleigh County jail, Sheriff Steve Berg decided the best alternative was to contract with a local medical care facility to provide full nursing coverage, 24 hours a day, seven days a week. But this is an expensive method, with an annual bill for $150,000. Detention staff don't touch medications, and nurses handle setup of drugs and delivery.

Berg says the decision was based on the number of inmates the correction center handles each day. Numbers at his jail are 120 to 130 prisoners a day, with several medical appointments made every day.

"Being the second largest facility in the state means a lot more goes on here. There is more turnover in inmates, more court appearances, more unpredictable medical conditions," Berg says. "We made our health administration similar to Cass County's (largest in the state), where they have a jail medical staff.

"It's the right thing to do for the right reasons. These are people, human beings, and they deserve good medical care," Berg adds. "By taking care of them correctly, you save money, because if you let their health deteriorate it ends up in a heck of a big hospital bill."

Different at smaller jails

But smaller jails don't need the intensive coverage the larger facilities deem necessary.

"If you've got a 20-person jail, a nurse probably wouldn't have to work more than three to four hours a week, eight to 10 hours tops," Engen says. "Once the medical policies are in place and the medical training and certification of detention personnel is done."

Engen says Busching initiated a system which has gotten medical administration issues "squared away and is going to make it work."

The system "is in its infancy," according to Busching. Most of the staff has been trained in phase one medical delivery. Prescription drugs belonging to prisoners are secured as personal property and are handed out by detention officers as prescribed by the doctor.

"We've always had medical oversight and have a contract with the Northwest Human Resource Center. But that may not continue because the attorney general's opinion calls for more work than we contracted for,"Busching says. "We're not prepared to pay a nurse yet; those changes have to go through county commissioners."

Morton County Sheriff Bob Erhardt, following the recommendation of Custer District Health, is attempting to secure a full-time nurse who will be a county employee and administer the health program. His jail handles about 30 inmates daily.

Erhardt is hoping to have the situation managed by the end of the month, but his search for a nurse willing to take on the job and associated liability has been difficult.

Berg said Burleigh County commissioners also were considering hiring a nurse, but his research indicated it would be too demanding for one person because of the size of the jail.

Training provided

Kathy Bachmeier, director of medical services at the State Penitentiary, has been instrumental in setting up training programs being made available to correction facilities.

"We (NDDOC) realized our counties needed help, and I was asked to put a course together and make it user friendly," Bachmeier says.

The program, approved by the North Dakota Board of Nursing, trains detention officers as unlicensed assistive person and medication assistant I. Further training leads to a medication assistant II classification. This training is certified by the registered nurse supervising a facility's medical administration.

"Any sheriff's department is able to access the program and get people trained," says Constance Kalanek, executive director of the State Board of Nursing.

Kalanek says jails have alternatives and programs can be tailored to the needs of a facility. She thinks there are nurses out there willing to take on the duties.

"In Morton County, I think they just need to give it a little more time. They advertised over the holidays and that's a bad time of year. I think if they put it out there and have some reasonable job expectations, they'll have some interest," Kalanek says. "They do need to hire a registered nurse who are able to make assessments and work independently with medications."

Kalanek suggests jails first contact local health districts to find a nurse to train people and provide overview. "I'm not suggesting jails have to provide 24-hour coverage with nurses. That is one option, but smaller jails likely won't need it," she says.

Effort to change law

Engen feels the requirements placed on the correctional facilities "are not an undoable task," and the professional education being provided jailers means better service.

But Busching feels the training is fine, but having to have a registered nurse on staff to train and supervise is overkill. He notes that day cares and schools are exempt from having to have a registered nurse on duty, but they provide distribution of medications to children.

Busching is the state's sheriff organization's legislative liaison, and has been talking with legislators about changing the law.

"We're still in the early stages, but I've talked to several legislators and we expect to address the issue at the next session," Busching says. "The law is a pain in the rear end."

Kalanek says the Board of Nursing feels all institutions, such as schools, should have nurses, but realizes the expense is overriding. She also said schools rely on parental oversight, which is not the case for adults at a corrections center.

(Reach reporter Gordon Weixel at 250-8255 or gordon.weixel@;bismarcktribune.com.)