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In Legal Terms - Fall Issue 2002
Medical Care for Inmates Huge Burdon
to Counties
The long battle with the Department
of Corrections over state inmates in county jails continues
- and unfortunately, overshadows many other issues related
to management and funding of the jails. I am not going
to write about the overcrowding issue again - but I do
want to focus on another important jail-related issue
- the cost of medical care for inmates housed in the county
jail.
Code of Alabama 1975,
§ 14-6-19 states that the county must provide necessary
medicines and medical attention to those county inmates
who are sick or injured "when they are unable to provide
them for themselves". Counties understand and accept this
as part of their responsibility for funding the county
jail and providing for the inmates.
However, the cost of medical
care does not fall solely on the county commission.
The law requires county payment only when the inmate cannot
pay his or her own cost, and as will be discussed in more
detail, generally only requires payment for county, not
state, prisoners, housed in the county jail. Alabama law
provides avenues for reimbursement of some or all medical
costs for inmates, and in some instances, transfers full
responsibility to the Alabama Department of Corrections.
Therefore, this article will focus on how counties can
obtain help in meeting this sometimes very costly expense,
which by law should be shared by the inmates and by the
state.
State law requires that the
sentencing court order a defendant convicted of a misdemeanor
to pay housing costs of up to $20.00 per day plus
actual medical costs incurred during incarceration,
unless it would create a great hardship on the inmate
or his or her family. See, Code of Alabama 1975,
§ 14-6-22(a).1 While many
county inmates are, in fact, indigent, that fact should
be proven, not assumed. Moreover, some inmates may have
health insurance, which can and should cover some of these
costs. That information should be made available to the
county and jail staff to ensure that, where possible,
the inmate, and not the county, is covering his or her
medical costs. Additionally, judges and district attorneys
should be urged to enforce this statute, where appropriate,
and all local county officials (commissioners, judges,
DAs, and sheriffs), should work together to have the law
properly applied. It certainly will not ease the entire
financial burden on the county, but every little bit helps
- and it is the law.
There is another important
state law addressing payment for medical costs which counties
should be aware of - and should also aggressively push
to have enforced. Code of Alabama 1975, § 14-3-30,
(the section which requires the Department of Corrections
to accept state prisoners into its system following conviction),
also provides that when a state inmate is housed in the
county jail, the Department of Corrections shall be financially
responsible for necessary medical treatment at a facility
outside of the jail, and shall accept the prisoner into
its custody within three days when the condition requires
treatment or a procedure exceeding $2000. Section 14-3-30
states, in pertinent part:
"When [a state] inmate . . . is being
housed in a county jail, and the inmate develops a medical
condition which requires immediate treatment at a medical-care
facility outside the county jail, the department shall
be financially responsible for the cost of the treatment
of the inmate . . . . When [a state] inmate . . . develops
a medical condition or has been diagnosed as having
a medical condition which, in the opinion of a physician
licensed in Alabama, would require treatment or a medical
procedure or both, involving a cost of more than two
thousand dollars ($2,000), the inmate shall be transferred
within three days to a state owned or operated correctional
facility or to the physical custody of the department
as determined by the Commissioner of the Department
of Corrections."
In other words, when it becomes
necessary to take a state inmate in the county jail to
a hospital or other medical facility, the Department of
Corrections - and not the county commission - is responsible
for the full cost of treatment. Furthermore, if the inmate's
condition requires treatment which will cost over $2000,
the Department of Corrections is required to take that
inmate into state custody within three days and thereafter
assume full responsibility for the inmate and his or her
medical care.
The law does not set out any
specific procedures for the "transfer" of responsibility
for medical care and its costs, and I was unable to obtain
any written procedures from the Department of Corrections
for this article regarding how the process works. However,
the Department takes the position that it will reimburse,
rather than pay these costs up front, and there is at
least some indication from around the state that obtaining
reimbursement is sometimes as difficult as having the
Department accept its prisoners held in county jails more
than thirty days.
I am not convinced that the
statute contemplates reimbursement only. The law provides
that the Department will be financially responsible and
makes clear that it will receive any contractual discounts
it may have with a particular facility. It would seem
that this section completely relieves the county of this
financial burden, but I suppose that is an issue for a
court to decide. In the meantime, it is imperative that
counties aggressively pursue reimbursement in appropriate
cases, and require compliance with the provision mandating
that the Department accept into its custody prisoners
requiring medical treatment in excess of $2000.
The only information which
I was able to obtain from the Department regarding the
payment of medical costs was that requests for reimbursement
are to be sent to the Director of Treatment along with
any documentation verifying the expense. This office apparently
"reviews" the documentation to determine that it is an
appropriate expense - i.e., that the inmate's condition
required immediate treatment at a facility outside the
jail. Therefore, where possible, counties should include
any documentation verifying the need, such as a statement
from a nurse, physician, or jail personnel. Keep in mind
though that this statutory provision is mandatory, not
permissive. Therefore, the Department's judgment or opinion
regarding whether the treatment was necessary or immediate
should not control, and if the Department rejects a request
for reimbursement, I recommend that the matter be referred
to the county attorney, who should pursue and demand full
and immediate payment as required by law.
With regard to the Department’s
statutory duty to accept into its custody a state inmate
where medical costs will exceed $2000, the county must
again take the initiative and be aggressive in demanding
that the Department comply with the law. The Department
should be contacted (probably by the sheriff or his or
her staff) immediately once it is determined that the
inmate will require medical treatment in excess of $2000,
and arrangements made to transfer the inmate to state
custody. And again, where there are any problems in obtaining
cooperation from the Department of Corrections, the county
attorney should be brought in to fight for compliance
with the law.
Obviously, it is important
that the sheriff and his or her jail personnel be familiar
with this law so that they can take appropriate action
to assist the county in obtaining reimbursement of costs
or, where appropriate, the inmate's transfer to state
custody. If there is not already a process in place, county
commissioners (and administrators) should meet with the
sheriff and jail staff to establish a procedure for handling
the medical care and costs of state inmates so as to ensure
that the Department accepts its responsibility in this
area and alleviates, to the full extent possible, the
burden of the medical expenses of inmates housed in the
county jail.
The responsibility for funding
the county jail is a major financial burden for the county
commission, increased significantly in many areas by the
added expense of housing state inmates. The cost of medical
care is not only a huge portion of the jail's expense,
but to a large extent, one difficult to budget for due
to the uncertainty of the annual cost. It certainly is
helpful that the legislative branch of government has
seen fit to provide the county with some assistance in
this area by mandating that the responsible party (be
it the inmate or the state) assume the financial responsibility
for appropriate medical costs. However, the burden unfortunately
falls on the county commission, with the help of the sheriff,
to ensure that the other branches of government enforce
and comply with these important laws.
1
A more detailed discussion of this Code provision appears
in the July/August 1999 issue of The County Commissioner,
which is available on the ACCA's web site.
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