County stuck with inmate hospital bills

Bill to set limits on how much hospitals can bill died in the House as the burden grows.


Published: Saturday, May 1, 2010 at 11:42 p.m.
Last Modified: Saturday, May 1, 2010 at 11:42 p.m.

The legislative session in Tallahassee ended Friday without any relief for one of Alachua County government's more vexing budget issues: the hospitalization costs for jail inmates.

A watered-down version of a bill setting uniform statewide limits on how much hospitals may bill counties passed in the Florida Senate, but a similar bill did not make it through in the House.

"That bill's dead this year," State Rep. Ed Hooper, R-Clearwater, said in a phone message Thursday. "I just was unable to get the hospitals to agree to any type of concession, or number or compromise. But we'll file it again next year and hopefully do a better job and get it passed on both sides."

In the 2008-09 fiscal year, Alachua County paid more than $3 million for inmate hospital stays at North Florida Regional Medical Center and Shands at the University of Florida.

Add in approximately $4 million for the contract with Prison Health Services - the firm in charge of medical care at the jail infirmary and billing and other administrative duties involving hospitalized inmates - and the cost to treat inmates exceeded $7 million.

Through mid-April of this fiscal year, the hospitalization costs were nearly $1.3 million. By comparison, the cost was $856,000 in the 2005-06 fiscal year.

"It is an increasing burden on the general fund and it's one the taxpayers don't recognize," County Manager Randall Reid said. "They're in jail and the county is responsible. If they are arrested by another agency or city, we are responsible."

Supported by the Florida Sheriffs Association and the Florida Association of Counties, the two bills in the Legislature would have set statewide caps on what counties are obligated to pay for inmate hospitalization. Right now, those rates are negotiated with individual hospitals.

While taxpayers ultimately pick up the tab, the rates North Florida Regional and Shands charge the county for inmate care are not open to public inspection. Instead, they are treated as trade secrets - competitive business information exempt from Florida's public records law under Florida Statute 815.045. The first proposal in the Legislature would have capped reimbursement at the Medicaid rate. An amended proposal, which passed in the Senate, would have set the cap at 110 percent of the Medicare reimbursement rate.

Rick Mills, Alachua County's legislative affairs director, said that actually divided the state's 67 counties because some already had a better deal. Alachua County was not one of them.

Ron Akins, Alachua County's administrative support manager, said if the county had paid Medicaid rates in 2008-09, the bill would have been in the range of $300,000, instead of $3 million. Akins added that hospitals lose money on a Medicaid rate reimbursement.

The Florida Hospital Association opposed the legislative caps on reimbursement.

"We understand that they (counties) have a budget to meet and trying to make it smaller," said FHA President Bruce Rueben. "But hospitals have a budget to meet, too. The problem is Medicaid and Medicare both pay below what it costs to take care of a patient. That unmet cost has to be shifted to other people who have commerical insurance or hospitals start cutting services."

Although the bills did not pass, Akins said the county is attempting to reduce costs through negotiations. North Florida Regional Medical Center signed a revised contract in early March, and negotiations with Shands continue, Akins said. He said the county would like to reduce its budgeted costs for inmate medical hospitalization to $1.2 million next fiscal year. Shands released a statement Friday saying the hospital is working "diligently for a mutually acceptable agreement with the county."

A state law passed in 1983 obligated county general funds to cover hospital bills for inmates who are arrested for violations of state law or county ordinances and who lack health insurance or other means of covering their medical costs. That obligation includes medical bills for injuries sustained during arrests and expensive treatment for pre-existing diseases and illnesses such as cancer or HIV. By law, the county is still responsible when another law enforcement agency makes the arrest.

The most high-profile local example of the law's effect on the county has been the case of Kofi Adu-Brempong, the University of Florida doctoral student shot in the face by a campus police officer on March 2 and arrested and charged with aggravated assault on an officer and resisting arrest with violence. Before his release from Shands, medical bills for Adu-Brempong's care were at least $290,000.

The County Commission has asked UF to contribute toward the payment and university officials have indicated that they need to wait until all investigations are completed to officially respond to the request, Reid said.

The County Attorney's Office has issued an opinion stating that the county, under state law, has no legal grounds to sue UF to cover Adu-Brempong's bill. Instead, under Florida Statute 901.35, if Adu-Brempong were to receive a settlement from UF that includes medical costs, the county would have to seek reimbursement from him, the opinion stated.

Akins said the county was seeking an advisory legal opinion from the state on whether the county is obligated to pay Adu-Brempong's medical costs if the charges against him are dropped.

County records showed other large bills in recent years. They included six bills in excess of $68,000. The county paid $292,335.38 for the hospitalization and chemotherapy treatments of an inmate with leukemia, and $276,565 for the hospitalization and treatment of two inmates, one with HIV and rectal cancer and another who had gunshot wounds to the chest and spent 19 days on a ventilator.

Contact Christopher Curry at 374-5088 or chris.curry@gvillesun.com.

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