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Medical costs for county, state prisoners
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Is your county paying the government rate?
cross the country, inmate medical costs are estimated to be about $3 billion. Medical care for inmates is such a major cost that the state of California had to reduce its prison population by 30,000 prisoners, or by about 20 percent, due to the inability to provide medical care to its massive prison populations. The United States Supreme Court held in Brown vs. Plata that the California prison system failed to deliver access to minimal care for prisoners with serious medical and mental health problems and produced “needless suffering and death” in violation of the Eighth Amendment of the United States Constitution’s prohibition on cruel and unusual punishment. There are significant challenges to reigning in the costs of medical care provided to inmates. Seeking out cost-saving arrangements for medical expenses should be a priority matter for the AAC, the Arkansas Sheriffs Association and each county. A major problem arises from medical services rendered by hospitals to inmates. Fortunately, some local hospitals provide care to indigent inmates free of charge. Traditionally, hospitals in the United States were mostly nonprofit or charitable institutions supported by governments or religious organizations. However, recently more for-profit hospitals have emerged. Hospitals situated in countyowned buildings or supported by local property taxes should have prudent county officials negotiating for agreements for medical care for indigent inmates free of charge or at reasonable government rates, such as Medicaid. Does your county have an agreement with your local hospital? The Emergency Medical Treatment and Active Labor Act of 1986 (“EMTALA”) provides that any patient who comes to the emergency department requesting examination or treatment must be provided with an appropriate medical screening examination to determine that the person is suffering from an emergency medical condition. The intent of the legislation is to prevent a hospital in the United States from “patient dumping” and transferring patients in need of emergency medical attention and treatment to a charitable hospital or county hospital. However, once the person is admitted and stabilized, the obligations under EMTALA 18
end. A catastrophic illness or overnight stay by an inmate can destroy a county jail budget. County officials and the general public alike lack access to information to ascertain if the invoice from the medical provider is based on costs, and the invoice may be excessive. Health Reform Watch, a blog of Seton Hall University School of Law, reported that when patients do not have the benefit of insurance, that hospitals and doctors “routinely double, triple or even quadruple the price for unprotected patients.” The authors of the report concluded that: “such huge mark-ups can only be regarded as price-gouging — exploiting market power to charge price virtually unrelated to actual costs.” Arkansans can rightly consider it unconscionable that a medical provider would price-gouge their aunt or uncle or any person. Do you have personal experience of receiving an inflated medical bill? A friend? A loved-one? Consumer watchdogs tell us to notify the prosecuting attorney or the Attorney General to determine if the acts are illegal or violate the “Arkansas Trade Practices Act.” Are adequate laws and enforcement in place in Arkansas to protect the sick from exploitation? Apparently not. In fact, there is no law in Arkansas to ensure that local governments are not price-gouged or sent inflated invoices on inmate medical costs. The Legislatures of Kansas (K.S.A. § 224612) and Colorado (C.R.S.17-26- 104.5) have enacted civil laws to assure their local gov-
Research Corner
ernments pay government rates, Medicaid rates, for inmate medical services. State Senator Jim Luker, Mark Whitmore Chairman of AAC Chief Counsel Senate Judiciary Committee, courageously filed similar legislation (SB 847 of 2011) which has been submitted to interim study. The Colorado statute recognized that hospitals that receive state money should not bill the government in excess of the government rate. Many hospitals in Arkansas receive financial support from state and local governments. In 2009 the Arkansas General Assembly adopted a tobacco tax to fund trauma and emergency medical care systems in Arkansas. Given the state government funding and EMTALA (above), why should county government subsidize the state trauma system or state or local hospital emergency departments? Arkansans and the members of the General Assembly may find it unconscionable that a hospital or medical provider would invoice local or state government in excess of the government rate — Medicaid — for services rendered to a county or state inmate. It’s plain that payments in excess of the government rates are wasteful. The government should simply pay only the government rate.
Dollars & Sense
Do you know what rate your county pays for medical services for inmates? Counties are not all invoiced at a government rate or even a consistent rate for medical services rendered to county inmates. COUNTY LINES, WINTER 2012
