The county is generally responsible for the cost of emergency medical care for jail inmates. G.S. 153A-224(b). It’s not always clear what constitutes an emergency, but state regulations include things like “severe bleeding, unconsciousness, serious breathing difficulties, head injury, severe pain, suicidal behavior or severe burns.” 10A N.C. Admin. Code 14J.0101(14). The rules also mention “dental care, chemical dependency, pregnancy and mental health” in a later discussion of emergency medical problems. Id. § 14J.1001(b)(4). Suffice it to say, the definition is broad. If an inmate is insured, the medical provider can bill the insurer first. G.S. 153A-224(b). But many inmates don’t have insurance, leaving the county to foot the bill.
With that backdrop in mind, jails understandably look for ways to limit their liability for inmates’ medical expenses. One way they do that is to seek to have an inmate released, either through the unsecuring of a bond or some kind of reduction in sentence. I know many judicial officials have received a late night call asking for an order to allow for a sick inmate’s release.
There are some potential problems with that sort of thing.
First, the judicial official involved needs to comply with the relevant rules of law and judicial conduct when evaluating any change to the defendant’s bond or sentence. For a pretrial detainee, the prosecutor and the defendant and his or her lawyer would need to be present for a proper hearing in front of the proper judge under the bail article. It would seem that the judicial official would need to consider how the information about the inmate’s medical status changes the evaluation of his or her dangerousness and flight risk. Ultimately, it’s possible that the defendant might not agree to the change to his or her bond, which may leave a dismissal of charges as the only surefire way to effectuate a release. For a sentenced inmate, a judge generally lacks authority to modify a sentence once a court session ends. A judge can shorten a contempt sentence under G.S. 5A-12(c) and a probationary split sentence under G.S. 15A-1344(d), but aside from those situations, a sentence can only be shortened by the governor or through some other form of post-conviction relief.
Second, the jail must take care to follow its medical plan when an inmate falls ill. Under G.S. 153A-224(b), “[i]n a medical emergency, the custodial personnel shall secure emergency medical care from a licensed physician according to the unit’s plan for medical care.” Failure to follow the plan is a crime, and having a policy or routine practice of releasing sick or injured inmates could give rise to civil liability. Cf. Marsh v. Butler County, Ala., 268 F.3d 1014 (8th Cir. 2001) (discussing the issue but finding no liability on the facts of the particular case).
Third, it is incorrect to assume that the county is always relieved from liability for the costs of a person’s case upon that person’s release from custody. In University of North Carolina v. Hill, 96 N.C. App. 673 (1990), for example, a pretrial detainee being held on a $1,500 secured bond became very sick. When he was diagnosed with spinal meningitis, the sheriff’s office contacted a magistrate, who in turn contacted a district court judge to get the inmate’s bond unsecured. Though the inmate was unconscious, the judge ordered the man “released without the necessity of signing bond.” The hospital sued the county for the man’s $100,000 medical bill. The county argued that it should not have to pay once the man was no longer in custody.
The court of appeals ruled in favor of the hospital, finding “nothing in the statutes to support [the county’s] argument that the General Assembly intended that a county . . . could avoid its statutory obligation by releasing from its custody an unconscious prisoner in need of emergency care.” To the contrary, the appellate court concluded, the county “remained duty bound” to secure and pay for the care. Id. at 675. In general a county’s obligation to pay for care ceases when an inmate is released, but Hill shows that liability can continue in certain (seemingly extreme) circumstances.
The bottom line is that judges and jail administrators alike should exercise caution when seeking an inmate’s release for medical reasons. There is no medical emergency exception to the ordinary rules of procedure, ethics, or sentence administration. A related cost-control strategy is for the jail to refuse inmates at the outset, requiring instead that they receive medical attention before being accepted into the facility. There are some issues with that practice as well, which I’ll cover in a future post.