Who Pays The Medical Bills For Inmates In The County Jail?

Is the county responsible for providing necessary medical care to prisoners housed in the county jail or workhouse?
Yes. Under T.C.A. § 41-4-115(a), all counties are required to provide medical care to prisoners incarcerated in the county jail. Also, the United States Supreme Court has held that prisoners have a constitutional right to receive necessary medical care while in custody. City of Revere v. Massachusetts General Hospital, 463 U.S. 239 (1983). If the county fails to provide necessary medical care, it may be liable under 42 U.S.C. § 1983 for any injuries the prisoner may suffer as a result of lack of medical care. Op. Tenn. Atty. Gen. U90-134.

Does providing medical care include payment for the treatment?
Not necessarily. The county has fulfilled its constitutional obligation by seeing that the inmate is taken promptly to a hospital or other appropriate facility that provides the necessary treatment, and as long as the county ensures that the medical care is provided, the Constitution does not dictate how the cost of the care should be allocated as between the county and the medical provider. That is a matter of state law. See City of Revere v. Massachusetts General Hospital, 463 U.S. 239 (1983). The state statute requires only that the county ensure that the medical treatment is provided; it does not require that the county pay for the treatment. See Williams v. Anderson County, et al., an unpublished opinion of the Tennessee Court of Appeals issued December 20, 1988. The county's obligation is to ensure that the inmate receives the necessary medical treatment. If the only way the county can fulfill this obligation is to agree to pay for the services, then the county must do so.

If a prisoner has a pre-existing condition which requires treatment, must treatment be provided?
Yes. If an inmate enters a jail or workhouse with a pre-existing condition that requires treatment, the county is responsible for providing the care. Op. Tenn. Atty. Gen. U90-134 (9/20/90).

If an inmate has health insurance, can the insurance carrier be required to pay?
Yes, if the claim is covered by the insurance policy. There appears to be no law that would allow an insurance company to refuse to pay the claim solely because the insured is incarcerated. Op. Tenn. Atty. Gen. 96-008 (2/8/96).
Can the county require the inmate to pay?
The county is permitted to collect from a non-indigent inmate housed in the county jail the cost of providing needed medical or dental care. If the inmate is indigent, the responsibility for payment is a matter to be decided between the county and the medical provider. The county may attempt to recover the costs from the prisoner after the prisoner is released from jail. Op. Tenn Atty. Gen. 95-095 (9/15/95). The county cannot, however, require the prisoner to serve a longer sentence to pay the medical costs. Op. Tenn. Atty. Gen. U90-37 (1/1/90).

How can the county determine whether an inmate is indigent?
There are no specific guidelines to determine indigence, but the county could have the inmate sign a pauper's oath similar to the one set out in T.C.A. § 20-12-127. Op. Tenn. Atty. Gen. U90-134 (9/20/90).

Who pays the medical expenses of state prisoners housed in the county jail?
The state is liable for expenses incurred for emergency hospitalization and medical treatment, provided that the prisoner is admitted to the hospital. For non-emergency treatment, payment is a matter to be resolved between the county and the medical provider. If the county does incur non-emergency medical expenses on behalf of a state prisoner, the county may seek reimbursement from the prisoner. Op. Tenn. Atty. Gen. 89-133 (10/4/89).

Who pays the medical expenses of persons arrested by city police for violation of a municipal ordinance and placed in the county jail?
There is no general statutory authority in Tennessee for either the pre-trial or post-trial incarceration of persons arrested solely for municipal ordinance violations, and in the absence of a private act or a valid contract between the city and the county providing for such incarceration, the incarceration of these prisoners would be unauthorized by law. Op. Tenn. Atty. Gen. 90-94 (10/9/90); Op. Tenn. Atty. Gen. 84-308 (11/19/84); Op. Tenn. Atty. Gen. U85-065 (12/2/85). Since a county is not required by general law to accept municipal ordinance violators, the liability for medical expenses is a matter which should be addressed in the private act or contract authorizing the incarceration. If it is not, the county will be responsible for payment because the governmental entity with custody of the person at the time treatment is given is financially responsible for the medical treatment, absent an agreement to the contrary. See Op. Tenn. Atty. Gen. U91-01 (1/7/91).

Is the county responsible for medical care to persons in the custody of a city?
No. Unless and until the prisoner has been delivered into the custody of the county, the county is not responsible. If a city officer takes a prisoner to the hospital prior to delivering the prisoner to the county jail, the county is not responsible for payment of the medical costs. Similarly, the county is not responsible for medical care provided to prisoners held in a city jail. See Op. Tenn. Atty. Gen. U91-01 (1/7/91) (discussing responsibilities of county and city with regard to medical care of prisoners, and stating that the governmental entity with custody of the person at the time treatment is given is financially responsible for the medical treatment, absent an agreement with the provider).

Can a county require an arresting city officer to take a prisoner for medical examinations prior to accepting the prisoner at the county jail?
No. Once a mittimus has been issued, the county must accept the prisoner. Op. Tenn. Atty. Gen. U91-01 (1/7/91) and Op. Tenn. Atty. Gen. 89-65 (4/28/89). It appears that the county also must accept a prisoner arrested on a state charge, prior to the issuance of a mittimus. Op. Tenn. Atty. Gen. 94-041 (3/31/94).

What can a county do to reduce its costs for medical care for prisoners?
Review current procedures relative to prisoners' medical care with the county attorney to determine what changes need to be made. Check any agreement you may have with a city for incarceration of municipal offenders and make certain that the city is required to to pay the cost of medical treatment. Talk with your local hospital and others who provide treatment for your prisoners. Try to work out an agreement whereby the hospital or other provider will attempt to determine if an inmate has insurance or other means of payment for treatment and if so, attempt to collect from the inmate. For indigent inmates for whom the county must pay, follow up after the prisoner’s release and attempt to collect the cost of medical care provided. Talk with your county attorney about collection procedures.