News stories that quote inmates griping about medical care at the Merrimack County jail really burn jail Superintendent Ron White.

He says those attacks cloud the real story: County taxpayers spend more than $1.3 million a year giving inmates, many of them in poor health, what White says is likely the best medical care they've ever received.

That care ranges from treating the common cold and prenatal pregnancy needs to serious illness and heart operations. The jail cannot refuse to treat a medical need. And if the inmate doesn't have insurance or the means to pay, which most don't, the county is obligated to pick up the tab.

Three years ago, that care cost the county more than $760,000. This year, that sum is already at $1.2 million with a month to go. And those numbers don't include the salaries of the several nurses on staff. Often, White said, taxpayers complain to him that they can't afford such good treatment.

"We are charged with taking care, custody and control of inmates," White said during a recent tour of the jail's medical unit. "We take it very seriously, and for us, the care component is huge."

Inmates are questioned as soon as they arrive at the jail about health concerns, both the serious and routine. Serious complaints are treated immediately, said Trish Lee, a physician assistant and head of the medical unit. But all inmates, she said, get a full exam within in their first 24 hours at the jail.

The jail must contend with whatever ailment an inmate arrives with. "There is no right of refusal," White said. "Once they become our charges, we are totally responsible for them."

The medical unit at the new jail, which opened in August 2005, is far superior to the old one, Lee said. There are multiple exam rooms instead of just one. There is a doctor always on call and several nurses and physician assistants on staff day and night.

There are sick rooms for inmates with infectious diseases who cannot be cared for on their unit. A mental health clinician and drug and alcohol counselor see inmates regularly, individually and in groups. Nursing and physician assistant students are doing internships in the unit because the variety of the treatment experience is considered so valuable.

Pregnant inmates are monitored daily, Lee said, and seen in the medical unit at least weekly for prenatal care. The care includes nutritional monitoring for mother and child, she said. On the outside, she said, pregnant women don't see their care provider nearly as often.

Nurses pass through the units four times a day with medications, and inmates can submit a request during any of those visits for an appointment in the medical unit. Diabetics and asthmatics are treated for their condition but also educated on diet and exercise.

"For many (inmates) this is the first medical practice they've interacted with on a regular basis," Lee said. That means they often arrive sick and with bad habits like tobacco, alcohol or drug addictions. It can be a lot to treat, especially when many inmates are at the jail for a year or less.

But Lee said she enjoys it. She gave up a position with a family practice nearly six years ago to work inside the jail. She still finds it rewarding.

"I like the challenge," she said. "It's really nice that I can see someone start from ground zero (with health problems) and see that person on a regular basis and see success. It's exactly what I was looking for when I went to school to be a physician's assistant."

But the complaints and lawsuits come, just the same.

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