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.

7 comments on “Medical Fees for Jail Inmates

  1. No inmate should have to be responsible for payment of medical, for in nc jail and prison does not get the proper medical care.

    • People who make bad decisions and wind up in jail should not receive a benefit from those decisions. The inmates should have a judgment filed against them, if found guilty, for all costs associated with their time in jail or prison. The burden of the medical costs should not be placed on the back of the taxpayers.

  2. Jail is for rehabilitation. How is an inmate to get back on their feet and positively contribute to society when the burden of their crime extends well beyond their sentence. Spunds like we are setting them for further crimes against society.

  3. Constitutionally, Estelle v. Gamble (1976) provides that inmates should have access to care at the same level as the general community. A further reading of the case shows that the state is responsible for care since the offender does not have free world access.

    • So my sister is currently in custody there and has an abscessed tooth, she has no money or representation; they (the jail) want to charge her for medical assistance. Is this legal?

  4. If the State is going to cage human beings they should have the responsibility to feed and clothe them and provide for their medical care, at NO charge to the inmate.How are they going to collect from indigent prisoners? The quality of medical care in most county jails is awful anyway. I knew a fellow who was a long term chronic pain patient as well as a senior citizen and was arrested for a cannabis offense and could not make bail. The local sheriff had a policy against allowing even legitimate pain meds to be given, likely due to the fact that one of his jailers was charged with stealing inmates meds , causing embarrassment to the sheriff. It took the accused mans family and doctor and lawyer days to create enough of a stink to get the meds to the patient. Are they going to charge for the distribution of meds and call it medical care? The whole system is unfair, and most in county jails are not even convicted. Disgusting abuse of people and their rights.

  5. The state should be the one responsible for medical fees. They should be treated equally like any other humans.