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All members of the new 2007 model
Comanche County Commissioners Court were present for a lengthy first
meeting.
Judge James Arthur opened and conducted
the meeting with Commissioners Garry Steele, Kenneth Feist, Bobby
Schuman and Jimmy Dale Johnson present, and County Clerk Ruby Lesley
and County Auditor Joey Boswell also sitting at the table in the first
floor County Courtroom. A relatively large crowd of onlookers was
present.
The first substantive order of business
was a discussion of County Jail inmate medical services procedures as
requested by Evan Moore and the Hospital Board of the Comanche County
Consolidated Hospital District.
Moore stated that the hospital had set a
policy that all self-paying patients shall make a deposit prior to
obtaining health care either at the clinic or in the emergency room
for non-emergency services. He continued, "This has created a bit of a
problem for Sheriff Lambert because the inmates are responsible to pay
their own medical bills, so they are self pay. So, when an inmate is
brought to the hospital, we're requiring a deposit, if it's a
non-emergency. Well, an inmate has no money and can't pay. And, in
looking at this, I don't really think inmates should get a special
treatment over the rest of the citizens of this county. So, I don't
know if there is other means to require the inmates to pay restitution
of some type..."
Moore asked if there was some means the
County might have to enforce collections for non-emergency medical
services provided to inmates. He asked for suggestions and ideas.
In response to a query by Joey Boswell,
Moore said that truly indigent inmates were not the subject of his
inquiry. He added that it takes a lot more than available property
taxes to take care of indigent health care in Comanche County.
Moore was accompanied by Linda Moore, an
indigent care coordinator who processed the paperwork that determined
whether a patient, or inmate, was indeed indigent, or deserving of
charity care.
Sheriff Jeff Lambert responded to another
Boswell inquiry that he didn't believe that the County was paying for
any of the local inmates. "They are responsible for their own
medical," Lambert added.
Later Sheriff Lambert stated, "I have never heard of anybody making
inmates pay restitution for their medical care, so I'm not sure that's
legal." He then offered a suggestion that the County request an
opinion from the Attorney General's office.
County Attorney Charles Williams
responded that the courts could not serve as an instrument for
obtaining restitution since the matter was not a criminal matter.
Bobby Schuman inquired, "How much money
are we talking about?"
Linda Moore responded, "We can't
determine that, because they all come in as self pay." Evan Moore
quickly added, "They're not all separated out, so we can't really get
a number."
Jimmy Dale Johnson asked, "Well, if you
can't determine that, how do you know we've got a problem?"
Evan Moore responded that they knew that when the Sheriff's Office
showed up with a local inmate that they weren't going to get paid.
Sheriff Lambert said that his office had
taken 215 inmates to the hospital during the preceding year, and that
156 of that number were contract prisoners, where Comanche County paid
their hospital bill and was then reimbursed by their home county. That
left 59 visits by local inmates, where the County had not paid their
bill. Lambert had no knowledge of how many of that number were
indigent.
Linda Moore responded that there had been
only two inmates treated during the prior year who had been qualified
as indigent.
Charles Williams noted that payment for
inmate medical services was a common area of dispute across the state.
He said, "We're not in this alone. We're just one of the smaller
counties." He then drew a decision path on a blackboard beginning with
an inmate leaving the jail and going to the hospital.
The first decision branch Williams noted
was to determine whether the inmate's medical condition was a medical
emergency or not.
Williams said it is up to the hospital
emergency room staff to triage the patient and determine if the
medical condition meets the definition of an emergency. If not, the
hospital has the right to require a deposit before providing medical
services, whether in the emergency room or the clinic.
The next decision path determination
needed is whether the inmate meets the criteria to be deemed as
indigent. Again, that determination must be made by the hospital
staff, and in this case by Linda Moore.
Williams noted that the hospital needs to
have formal policies in place, follow them consistently and maintain
good documentation to avoid the threat of lawsuit. Evan Moore
indicated that the hospital was already compliant with that practice.
Williams commented that there are many,
and particularly among inmates, who go to the hospital recreationally.
He continued, noting that everyone has a right to emergency care,
whether or not they have the ability to pay.
Sheriff Lambert noted that the first step
before taking an inmate to the hospital is an examination by the jail
nurse. Only after the nurse determines the inmate needs further
medical treatment is the inmate taken to the hospital. Lambert added
that there were probably “thousands” of requests for trips to the
doctor made by inmates, but only were 215 granted.
Williams amended his decision path to
have the first step to be a determination of the inmate’s ability to
pay and whether or not covered by health insurance.
Evan Moore stated that the hospital
required a $60 deposit for a clinic visit and a $200 deposit for
emergency room services. He noted that the hospital was not required
to offer services to indigents, inmates or not, that are not offered
to other patients.
In response to Commissioner queries,
Linda Moore stated that if all the necessary paperwork is available,
she can immediately make a determination on whether someone is
indigent. However, it normally takes around two weeks to gather the
necessary information. She added that she would prefer that the
process of determining indigency status begin when an inmate is first
incarcerated.
Sheriff Lambert responded that it would
be impractical to begin an indigency qualification process on all
local jail inmates, adding that many do not stay in jail for very
long.
Garry Steele commented to Evan Moore,
“You realize, of course, that we cannot give prisoners cash to take
out there to the hospital. We don’t operate that way.”
Moore responded, “I know.” Moore added
that he thought that everyone needed to work together and that the
hospital was more than willing to work out special pricing for medical
services for inmates.
A general discussion of hospital tax
receipts, bad debt and charity care costs, insurance and
Medicare/Medicaid cost reimbursement practices and health care
alternatives followed.
The problem of non-indigent,
non-emergency medical care costs was never fully resolved, however.
Sheriff Jeff Lambert commented that his office did not have the
resources to be chasing the paperwork needed for indigent
qualification.
Charles Williams said that it seemed to
him that if an inmate was non-emergency and non-indigent, that a trip
to the hospital could be denied.
Sheriff Lambert responded that he was not
sure, but that he believed that Texas jail standards required that
health care services be provided to jail inmates.
Williams asked Lambert if the jail
standards were referring only to emergency health care.
Lambert said he was not sure but would need to investigate.
Linda Moore noted that indigent health
care services only covered basic health care as provided by a
Physician’s Assistant or Nurse Practitioner, and that was not much
more than could be provided by the jail nurse.
The difficulties of the County receiving
reimbursement from inmates for health care services was discussed.
Charles Williams noted that if the money was not received early in the
process, that it would be very difficult.
Evan Moore posed the question, “If they
can come up with money for smokes, and they can come up with money for
other things, why should we as taxpayers be required to pay for their
health care?”
Joey Boswell asked Sheriff Lambert if
funds in the inmate’s commissary account could be used to pay for the
hospital deposit.
Lambert responded that he didn’t know the
answer and would have to check with the Jail Standards Commission.
Everyone agreed that some answers were
needed.
Garry Steele asked for clarification,
“What is the hospital asking from the County, exactly?”
Evan Moore responded, “What we are really
requesting is to have this discussion and to see if there is anything
we can do together to make these people pay some of their own bills,
rather than having the hospital or the county take care of it. I think
what we really want to do is to be aggressive in trying to make them
pay for their health care, more aggressive than we have been, and also
to work together to see if there is a better way of doing this that is
less expensive to both of us.” Moore added that just transporting
inmates to the hospital and staying with them while they are there is
costing the County a lot of money, even before consideration of the
cost of services provided.
Moore reiterated his willingness to
provide the County with a lower charge for medical services provided
to inmates because it is all taxpayer money.
Sheriff Lambert noted that most of the
hospital and clinic bills he approves for contract, out-of-county
inmates run less than $100.
The Commissioners and Evan Moore
calculated that given the number of hospital visits by local inmates
in the preceding year that the total cost for medical services that
was being discussed was probably around $6,000.
Sheriff Lambert agreed to check with the
Jail Standards Commission regarding its requirements for providing
health care to inmates and the County’s ability to access funds in the
inmate’s commissary account to fund the costs of their hospital
visits.
The matter was requested to be placed on
the agenda for the next meeting on January 22.
It was noted that the County did not want
to do anything that would endanger its current good standing with the
Jail Commission and consequently adversely affect its out-of-county
jail inmate housing revenue stream.
Charles Williams noted that he believed
that there was not complete agreement between applicable state laws
and the rules of the State Jail Commission.
In other business, the Commissioners:
• Discussed the budget and bond costs for
the new County Fire Marshall, Chris Hill, and whether a County Fire
Marshall was truly needed and worth the expense. Both Sheriff Lambert
and Comanche Fire Marshall Kevin Burch spoke in favor of the need for
a County Fire Marshall to conduct arson investigations and to make the
required inspections of foster homes outside of city limits.
The Commissioners approved on unanimous
vote, a motion by Bobby Schuman to formally establish the County Fire
Marshall office as a law enforcement agency.
• Voted unanimously to approve two
requests to lay waterlines in county road right-of-ways.
• Approved a list of names of citizens to
serve as members of the Comanche County Historical Commission. Those
approved to serve include Dorothy Robertson, Ben Evridge, Wayne
Parsons, James Rucker, Preston Cox, Curtis Lesley and Nancy Wilkerson.
• Conducted a drawing of names from the
2006 Grand Jury roster to serve as members of the Salary Grievance
Committee for 2007. The names drawn included Juvenile Sierra, David
Ripley, Bess Moore, Brian Bingham, LaNell Williams, Sam Sparger, Clay
Sears, Keith McIlvain and Mickey Robinett.
• Heard Judge Arthur read a letter from
the Texas Department of Public Safety listing some needed improvements
at the Courthouse Annex, some of which had already been completed. The
Commissioners discussed completing the remaining items.
• Heard a request from Sheriff Jeff
Lambert for the Commissioners to designate a site in each Precinct for
a roll-off trash dumpster to be located where materials from illegal
dumps could be taken. Lambert also discussed how that Environmental
Deputy Rhonda Alderman was working to get a particularly bad site on
the eastern edge of Comanche cleaned up. |
