The law requires prisons to provide adequate health care; and that mandate too often is ignored. The attitude of some of the sheriffs in this article is downright draconian.

It is clear to me that some of the sheriffs are violating state law and the Constitution, both of which demand they provide reasonable care.   There is sure to be  a lot of costly litigation over this.


Excerpts from the Article:

In Alabama, the county in which you’re arrested could be the deciding factor in who will be financially responsible for your medical bills behind bars.

In Baldwin County, known for its white-sand Gulf Coast beaches and waterfront communities, the sheriff’s office ensures that inmates in the county jail do not have to pay anything more than a $15 copayment for medical care. “Inmates are not billed for the full cost of any medical care either inside or outside” the jail, Sheriff Hoss Mack said in an email. “Alabama Code Title 14 assigns financial responsibility of inmates’ medical treatment to the department where they are being held.”

Just across the bay in Mobile County, home to one of the busiest ports in the U.S. and the eponymous city of nearly 200,000 people built around it, Sheriff Sam Cochran takes a different tack: Some of his inmates are personally on the hook for the full cost of medically necessary care they receive from outside doctors while incarcerated, even if they are awaiting trial.

The difference between the two sheriffs’ approaches demonstrates the unique power Alabama sheriffs have to set their own rules and answer only to voters. Legal experts and civil rights advocates say sheriffs like Cochran are likely violating both state law and the Eighth Amendment of the U.S. Constitution, which prohibits cruel and unusual punishment and excessive fines.

It’s not just happening in Mobile County. In multiple instances confirmed by and ProPublica, inmates have had medical bills sent to collections while they were still behind bars, damaging their credit and putting pressure on their family members to pay up to ensure the care continued.

Brandon DeLaFosse is among them. He was arrested on domestic violence, burglary and robbery charges and booked into the Mobile County Metro Jail in November 2018, three months after he underwent surgery on his inner ear. Since then, he has received bills totaling thousands of dollars for necessary follow-up appointments and tests, some of which have gone to collections while he remains behind bars. “He keeps getting bills in the mail,” said Alicia DeLaFosse, Brandon’s mother, who has paid hundreds of dollars for care he has received while in custody. “It’s all money he owes from going back and forth to the doctor.”

Like many inmates, DeLaFosse doesn’t have significant income or access to public or private insurance in jail.

Alabama law is clear: If an “inmate develops a medical condition which requires immediate treatment at a medical-care facility outside the county jail, the department shall be financially responsible for the cost of the treatment of the inmate.”

But Cochran said when the jail’s doctors determine inmates need care that goes beyond what in-house medical staff and contracted outpatient providers can handle, they are often taken to private medical professionals who do not have contracts with the jail. And he allows those medical providers to bill at least some of those inmates directly.

Alabama law states that “necessary clothing and bedding must be furnished by the sheriff or jailer, at the expense of the county, to those prisoners who are unable to provide them for themselves, and also necessary medicines and medical attention to those who are sick or injured, when they are unable to provide them for themselves.”

In another section of the state code, a definition of a county inmate includes an explicit reference to their health care being provided for: “any person being held in a public institution under the administrative control and responsibility of the county sheriff and for whom the county is responsible for the provision of medical care.”

Brandon Blankenship, an assistant professor of law and ethics at the University of Alabama at Birmingham, said that allowing inmates to be billed for care that they receive while incarcerated amounts to cruel and unusual punishment and that the bills are excessive fines. “I don’t think it’s ever been challenged in court in Alabama, but from where I’m sitting, the answer to me is that, no, it’s certainly not constitutional under the Eighth Amendment.”

That’s not the way inmate health care works in many county jails across Alabama. In Etowah County, northeast of Birmingham, inmates are never billed for care they receive while incarcerated, according to Sheriff Jonathon Horton.  We provide medical services for inmates in our care so they should not receive any bills,” Horton said. “They shouldn’t be billed. That’s my understanding.”

Lauderdale County Sheriff Rick Singleton said that he would love to have inmates in his jail in northwest Alabama foot the bill for certain types of medical care, but that he is not legally able to do so. For instance, he said he would like to have avoided the $300,000 the county once had to pay for open heart surgery for “the town drunk” arrested on a public intoxication charge.

“If they’re in jail on public intoxication and they’ve got preexisting health conditions, I don’t think the taxpayer should have to foot the bill to pay for it,” Singleton said. “If they get injured inside the jail or they get sick inside the jail, we of course pay for it. But my issue is with having to pay for preexisting conditions. But we have to do it.”

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