Suspect medical bills a hot topic with MACo
by JOHN CRAMER - Ravalli Republic
Nine months after starting negotiations, Montana’s county governments, hospitals and law enforcement agencies have deadlocked over who should pay the rising medical bills of people injured in encounters with law enforcement officers.
More than 150 county commissioners heard an update Monday on a proposed bill at the annual meeting of the Montana Association of Counties in Hamilton.
The complex debate centers not on inmates but on people who are injured during a high-speed chase or other encounter with police before they are actually arrested.
It’s not clear how much counties and hospitals have been paying for suspects’ medical bills in Montana - neither side has comprehensive numbers - but rising health care costs and a handful of expensive cases have put the issue in the spotlight.
The proposed bill is an effort to clarify responsibility for a person’s medical costs when he or she is injured while being pursued and detained by local law enforcement.
The bill is technically dead at this point, but two state legislators from Ravalli County - Rep. Ron Stoker, R-Darby, and Sen. Jim Shockley, R-Victor - have reserved a spot in the January session for a new bill to be introduced if the two sides can not come up with a compromise.
That’s left county government and hospital lobbyists jockeying for position in the minds of state legislators and the public. Both parties argue they shouldn’t be saddled with the entire bill. Both say the other side isn’t interested in discussing solutions.
Under current state law, law enforcement agencies pay medical costs for inmates who don’t have money or insurance regardless of whether they were arrested by county, city, tribal or state law enforcement agencies.
But the law doesn’t mention suspects, meaning hospitals often have to cover their bills.
In January, the Law and Justice Interim Committee of the Montana Legislature took up a proposed bill that was backed by the Montana Hospital Association, who said its members were being unfairly stuck with suspects’ bills.
The committee, which includes state senators and house members, chose not to move forward with the bill, but Stoker and Shockley reserved a spot for a bill to be introduced in January.
Stoker said hospitals shouldn’t underwrite suspects’ care and that shifting the entire burden to the state “isn’t going to fly.”
He said MACo lobbyists have “gotten very aggressive, but all parties have to start honestly and forthrightly negotiating instead of squabbling.”
The parties include MACo, MHA, the Montana Sheriffs and Peace Officers Association and county attorneys.
“I’m not inclined to carry legislation that all parties oppose, but if they all get a little heartburn, then we’d be close to the right solution,” Stoker said.
The latest version of the bill, which has gone through more than a half dozen drafts, would shift the burden of payment to the counties and require counties to pay up within 30 days if the suspects could not pay or had no insurance, MACo officials said.
County commissioners say that could bankrupt some small localities and make it impossible to craft an annual budget when they don’t know whether medical bills will be a few thousand dollars or hundreds of thousands of dollars.
Counties could take out insurance policies or offer voters a levy to pay for suspects’ medical bills, but taxpayers wouldn’t like either option, several commissioners and MACo officials said.
“It’s a Pandora’s box,” said Sheryl Wood, associate director for MACo. “It just opens the door for the counties paying everything. Is it a suture or intensive care for a week or life-support for the rest of their lives?”
Mike Foster, a spokesman for St. Vincent Healthcare in Billings, said county governments should pay suspects’ medical bills. He said several hospitals statewide have reported having to write off suspects’ big bills as bad debt or charity care.
“While the issue was triggered by one particular incident that was pretty glaring by the size of the dollars involved, the situation as a whole is something hospitals are concerned about across Montana,” he said. “We’re sensitive to the budget concerns of local governments, but at the same time it’s not fair for hospitals to get stuck with the bills.”
The proposed bill was prompted by a 2007 incident in Yellowstone County in which a murder suspect was shot by officers and wracked up extensive medical bills before he was arrested and charged, leaving St. Vincent to pay the bill.
St. Vincent had 27 cases of unpaid suspects’ bills costing about $310,000 from June 2007 to May 2008, Foster said.
MACo officials said Yellowstone County and St. Vincent Healthcare should settle the matter themselves at the negotiating table or in court.
MACo officials said a possible solution for parties across Montana is a statewide insurance pool to which all local governments would contribute based on their populations and past suspects’ medical bills. Hospitals and the state government also would contribute to the pool.
“Why should all counties be penalized?” said Carl Seilstad, a MACo first vice president.
Ravalli County commissioners Carlotta Grandstaff, Greg Chilcott and Kathleen Driscoll said local taxpayers shouldn’t be the first choice in paying suspects’ health care bills.
“We don’t know what this could cost,” Chilcott said. “That’s the big question. It could be the tip of the iceberg.”
Ravalli County Attorney George Corn said the state should pony up more money for suspects’ medical care.
“I think the state should pay more because the counties are enforcing state laws,” he said. “If the counties have to pay more because the state won’t, then that will reduce local law enforcement services.”
Reporter John Cramer can be reached at 363-3300 or johncramer@ravallirepublic.com
Reader's Comments >>
Concerned wrote on Sep 23, 2008 9:10 AM: