Prisoners in Louisiana are being treated and screened for illnesses, injuries and other ailments at lockups rather than hospitals more than ever before, a trend especially pronounced in the Baton Rouge area since the closure early last year of the Earl K. Long Medical Center.

But the change brought with it a host of new challenges, particularly for the East Baton Rouge Parish government. Many financial obligations for inmate medical treatment previously shouldered by the state through the LSU public hospital system now fall to the city-parish, creating a new and uncomfortable strain on its budget.

The state corrections department, on the other hand, saw an injection of millions of dollars previously allocated to inmate treatment at Louisiana’s public hospitals, which in 2013 were mostly turned over to private operators. The new corrections funding allowed for a revamp of the agency’s entire health care network — a change that officials say has improved public safety and cut down on waste.

“This new system is way more efficient than it used to be,” said Dr. Raman Singh, the medical and mental health director for the Louisiana Department of Public Safety and Corrections.

State prisoners with health problems travel less and spend fewer hours admitted to hospitals under the new system, which has reduced costs associated with inmate transport, security and overall health care, Singh said. In addition, the increased use of telemedicine, in which doctors examine patients remotely through video feeds, contributed to further transport savings and other conveniences that make the system more efficient, Singh said.

With the newfound resources, corrections officials recently hired more contract doctors and equipment vendors, built additional treatment facilities at several prisons and vastly expanded the types of health care offered inside some prisons.

While the changes appear to benefit the state, particularly financially, the gains haven’t yet bubbled over to the locals at the East Baton Rouge Parish Prison.

As is true for the state prisons, the Parish Prison over the past few years has beefed up its in-house medical capabilities, especially since the closure of Earl K. Long in April 2013.

But the transition has been tougher for Parish Prison, which had relied heavily on Earl K. Long before the hospital’s sooner-than-expected shuttering. Inmates would go to the hospital for a wide variety of treatments, including pregnancies, broken hands, late-night lacerations and a host of other ailments, said Linda Ottesen, the director of Prison Medical Services, the branch of EMS that handles medical care inside Parish Prison.

Not only was it convenient for the local jail because of the location, which was only a few miles away from Parish Prison, but also because the bills inevitably fell to the state.

Now, things are not quiet so easy.

“It’s been a transition,” Ottesen said. “We’ve been figuring it out.”

The state, via the Department of Corrections, still pays for the treatment of Parish Prison inmates in what are described as non-primary-care visits. In general, DOC officials say the state still covers emergency care and most major surgeries for local inmates, which consist mostly of people arrested and awaiting trial but also some convicts serving relatively short sentences.

However, some costs now fall into the lap of the parish’s Prison Medical Services. While the state covers baby deliveries, the city-parish must pay for prenatal and postpartum health care. The state also doesn’t pay for specialty HIV care or routine X-rays and eye exams — all treatment previously taken care of at hospitals like Earl K. Long free of charge for the city-parish.

“It puts a strain on not having funds for other necessary expenses,” Marsha Hanlon, the city-parish’s finance director, said of the rising costs for treating parish inmates. For example, Hanlon said, when this area of the budget increases, there is less money available to fund other worthwhile expenses such as compensation for police, firefighters and other public employees or infrastructure projects.

In the past two years, the portion of Prison Medical Services’ budget dedicated to “contractual services” rose more than 60 percent from about $568,000 in 2013 to a proposed amount of $921,570 in 2015. Also, the agency’s budget for “other professional services,” which includes payments to some personnel the facility didn’t need until Earl K. Long closed, has risen by about 25 percent since 2013, from about $400,000 to more than $500,000, budget records show.

Some other cost effects are less defined.

For instance, Parish Prison must transport inmates for most non-emergency specialty procedures to either the Lallie Kemp Medical Center, in Independence, which is still run by the state, or the privately-run Interim LSU Hospital in New Orleans. This occurred sometimes even before Earl K. Long closed, Ottesen said, but it definitely happens more frequently now.

In such cases, the DOC likely would bear the cost of treatment. But local government would have to handle the additional transportation expense.

The private hospitals in the Baton Rouge area do not provide inmates with primary care, but they do treat them in emergency situations.

Regardless of who pays for treatment, both the parish and the state said the quality of health care provided to their respective inmates has either improved or remained the same under the new system.

“The services haven’t changed,” Ottesen, the Prison Medical Services director, said. “It’s just where we do it that’s different.”

If everything falls into place with the state’s inmate health care overhaul, though, the locations of treatment could change again for some parish inmates.

As of now, the state doesn’t treat local parish inmates at state prisons. But phase two of the inmate health care overhaul includes provisions for treating some parish inmates at prisons such as the Louisiana State Penitentiary at Angola and the Elayn Hunt Correctional Center in St. Gabriel, Singh, the DOC’s medical director, said.

“The plan was to provide a replacement for the LSU system,” Singh said. “It’s more like continuity of care in a very different model.”

State officials hope the new model will benefit the state as a whole in the long run, Singh said.

Follow Ben Wallace on Twitter, @_BenWallace.