Medical Fees for Jail Inmates

Constitutionally and statutorily, the sheriff is responsible for the well-being of the jail inmates committed to his or her custody. “It is but just,” the supreme court once wrote, “that the public be required to care for the prisoner, who cannot, by reason of the deprivation of his liberty, care for himself.” Spicer v. Williamson, 191 N.C. 487 (1926). Still, a jail can charge certain fees.

When it comes to emergency medical services for jail inmates, the county is generally responsible for the cost. G.S. 153A-224(b). In the relatively rare case where an inmate has third-party insurance, the provider can bill the insurer first, leaving the county liable for whatever costs are not covered by the insurance. The statute then says the county may seek recovery from the insured inmate for any non-reimbursed medical services. No statute specifically authorizes a recovery for the costs of emergency medical care from an uninsured inmate.

For nonemergency medical care, the jail may establish a fee of not more than $20 per incident. The fee must be established as part of the jail medical plan required under G.S. 153A-225—developed in consultation with appropriate local officials, approved by the local health director, and adopted by the board of county commissioners.

The jail may also charge a fee of not more than $10 for a 30-day supply or less of a prescription drug. (I read the 30-day limit to refer to the medically necessary length of the prescription, not an arbitrary unit of measurement set by the jail. The jail could not, for example, say in its medical plan that it will charge $10 for every day’s worth of a prescription, on the theory that one day is less than 30.) There is no express statutory authorization to charge a fee for over-the-counter medications.

For both the up-to-$20 nonemergency fee and the up-to-$10 prescription drug fee, if the jail establishes them as part of its medical plan, it must also establish a procedure for waiving them for indigent inmates. Without the waiver procedure, the jail would risk violating the constitutional rights of an indigent inmate if necessary medical care were delayed for a non-medical reason. See, e.g., Archer v. Dutcher, 733 F.2d 14 (2d Cir. 1984).

Jails in North Carolina generally have a waiver provision for the medical fees, but it is not administered the same in every jail. Historically, some jails interpreted the waiver as more of a deferral, running a negative balance on an inmate’s account when the service or drugs were provided, and then debiting the account if money was added to the account later—perhaps during a future stint of confinement in the jail.

No North Carolina appellate case has ever considered the propriety of that interpretation, but a few years back, the Construction Section of the Division of Health Service Regulation of the N.C. Department of Health and Human Services—the administrative office responsible for inspecting jails—advised in a memo to the jails that the practice “is in direct violation of the statute.” Under that direction, a waiver ought to leave the inmate with no obligation to pay for the care or medication now or at any point in the future.