BILL ANALYSIS �
SENATE COMMITTEE ON PUBLIC SAFETY
Senator Loni Hancock, Chair A
2011-2012 Regular Session B
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AB 2261 (Valadao) 1
As Amended April 18, 2012
Hearing date: June 12, 2012
Penal Code
SM:mc
COUNTY JAIL INMATES: FEE FOR MEDICAL VISITS
HISTORY
Source: Author
Prior Legislation: AB 1487 (Hill) - amended to address another
subject, 2009
SB 163 (Presley) - Chap. 1070, Stats. of 1994
Support: California State Association of Counties; California
State Sheriffs' Association; Kings County Sheriff;
Regional Council of Rural Counties
Opposition:Californians United for a Responsible Budget; Drug
Policy Alliance; Friends Committee on Legislation of
California; Legal Services for Prisoners with Children;
one citizen
Assembly Floor Vote: Ayes 69 - Noes 0
KEY ISSUE
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SHOULD THE CURRENT AMOUNT THAT COUNTY JAIL INMATES MAY BE
CHARGED FOR MEDICAL VISITS BE INCREASED FROM $3 TO $5?
PURPOSE
The purpose of this bill is to raise the current amount that
county jail inmates may be charged for medical visits from $3 to
$5.
Existing law provides that in county and city jails and holding
facilities, the facility administrator shall have the
responsibility to ensure provision of emergency and basic health
care services to all inmates. Medical, dental, and mental
health matters involving clinical judgments are the sole
province of the responsible physician, dentist, and psychiatrist
or psychologist respectively; however, security regulations
applicable to facility personnel also apply to health personnel.
(Title 15 Cal. Code of Regs., � 1200.)
Existing law provides that a county or a city is authorized to
make claim for and recovery of the costs of necessary hospital,
medical, surgical, dental, or optometric care rendered to any
prisoner confined in a county or city jail, or any juvenile
confined in a detention facility, who would otherwise be
entitled to that care under the Medi-Cal Act and who is eligible
for that care on the first day of confinement or detention, to
the extent that federal financial participation is available, or
under the provisions of any private program or policy for that
care, and the county, city, or the Department of the Youth
Authority shall be liable only for the costs of that care as
cannot be recovered pursuant to this section. (Penal Code �
4011.1.)
Existing law provides that, notwithstanding any reimbursement
available through section 4011.1, a sheriff, director of
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corrections, or chief of police is authorized to charge a fee in
the amount of $3 for each inmate initiated medical visit of an
inmate confined in a county or city jail. (Penal Code �
4011.2(a).)
Existing law states that the fee shall be charged to the
inmate's personal account at the facility. If the inmate has no
money in his or her personal account, there shall be no charge
for the medical visit; the inmate shall not be denied medical
care because of a lack of funds in his or her personal account
at the facility. (Penal Code � 4011.2(b) and (c).)
Existing law provides that the medical provider may waive the
fee for any inmate-initiated treatment and shall waive the fee
for any life-threatening or emergency situation, defined as
those health services required for alleviation of severe pain or
for immediate diagnosis and treatment of unforeseen medical
conditions that if not immediately treated could lead to
disability or death. (Penal Code � 4011.2(d).)
Existing law requires that all moneys received for inmate
initiated medical visits received by a sheriff, director of
corrections, or chief of police be transferred to the county or
city general fund. (Penal Code � 4011.2(f).)
This bill would raise the current amount that county jail
inmates may be charged for medical visits from $3 to $5.
RECEIVERSHIP/OVERCROWDING CRISIS AGGRAVATION
("ROCA")
In response to the unresolved prison capacity crisis, since
early 2007 it has been the policy of the chair of the Senate
Committee on Public Safety and the Senate President pro Tem to
hold legislative proposals which could further aggravate prison
overcrowding through new or expanded felony prosecutions. Under
the resulting policy known as "ROCA" (which stands for
"Receivership/Overcrowding Crisis Aggravation"), the Committee
has held measures which create a new felony, expand the scope or
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penalty of an existing felony, or otherwise increase the
application of a felony in a manner which could exacerbate the
prison overcrowding crisis by expanding the availability or
length of prison terms (such as extending the statute of
limitations for felonies or constricting statutory parole
standards). In addition, proposed expansions to the
classification of felonies enacted last year by AB 109 (the 2011
Public Safety Realignment) which may be punishable in jail and
not prison (Penal Code section 1170(h)) would be subject to ROCA
because an offender's criminal record could make the offender
ineligible for jail and therefore subject to state prison.
Under these principles, ROCA has been applied as a
content-neutral, provisional measure necessary to ensure that
the Legislature does not erode progress towards reducing prison
overcrowding by passing legislation which could increase the
prison population. ROCA will continue until prison overcrowding
is resolved.
For the last several years, severe overcrowding in California's
prisons has been the focus of evolving and expensive litigation.
On June 30, 2005, in a class action lawsuit filed four years
earlier, the United States District Court for the Northern
District of California established a Receivership to take
control of the delivery of medical services to all California
state prisoners confined by the California Department of
Corrections and Rehabilitation ("CDCR"). In December of 2006,
plaintiffs in two federal lawsuits against CDCR sought a
court-ordered limit on the prison population pursuant to the
federal Prison Litigation Reform Act. On January 12, 2010, a
three-judge federal panel issued an order requiring California
to reduce its inmate population to 137.5 percent of design
capacity -- a reduction at that time of roughly 40,000 inmates
-- within two years. The court stayed implementation of its
ruling pending the state's appeal to the U.S. Supreme Court.
On May 23, 2011, the United States Supreme Court upheld the
decision of the three-judge panel in its entirety, giving
California two years from the date of its ruling to reduce its
prison population to 137.5 percent of design capacity, subject
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to the right of the state to seek modifications in appropriate
circumstances. Design capacity is the number of inmates a
prison can house based on one inmate per cell, single-level
bunks in dormitories, and no beds in places not designed for
housing. Current design capacity in CDCR's 33 institutions is
79,650.
On January 6, 2012, CDCR announced that California had cut
prison overcrowding by more than 11,000 inmates over the last
six months, a reduction largely accomplished by the passage of
Assembly Bill 109. Under the prisoner-reduction order, the
inmate population in California's 33 prisons must be no more
than the following:
167 percent of design capacity by December 27, 2011
(133,016 inmates);
155 percent by June 27, 2012;
147 percent by December 27, 2012; and
137.5 percent by June 27, 2013.
This bill does not aggravate the prison overcrowding crisis
described above under ROCA.
COMMENTS
1. Need for This Bill
According to the author:
Under existing law, a sheriff, director of
corrections, or chief of police is authorized to
charge a fee in the amount of $3 for each inmate
co-pay in a county or city jail for medical care. The
Legislature set this $3 co-pay in 1994 and has not
increased it since, even though health care costs have
skyrocketed over the past 18 years. The fee is
necessary to reduce frivolous requests, staff time,
and hold the inmate responsible to participate in
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their own health needs. Since the cost of a medical
visit for a county inmate is so low it causes some
inmates to abuse the system, for example, some common
reasons to seek a non-medical visit are drug seeking,
wanting to see a specific person, wanting to get out
of his/her cell, and now with overcrowding some
inmates just want to have some privacy. AB 2261 will
increase the co-pay from $3 to $5 which will better
align the amount charged to them with the cost of care
while deterring unnecessary and frivolous use of
medical services. This small increase will also bring
the co-pay to the current $5 fee that inmates
currently pay in prison and would have paid if it were
not for realignment. AB 2261 is an important first
step towards reducing frivolous access to care in our
county jails.
2. Raising the Fee for Inmate Medical Visits
This bill is substantially similar to AB 1487 (Hill) 2009, which
also proposed to raise the fee for county jail inmate medical
visits. That bill was gutted and amended in this Committee to
address a different subject. The Committee analysis of that
bill stated:
The Los Angeles County Sheriff's Department has
informed Committee staff that legislation regarding
nursing practices enacted in 2000 has made such inmate
medical visits more time-consuming and expensive by
requiring an assessment and documentation to take
place for each visit. In many cases, after seeing the
doctor or nurse, the inmate ends up just being given
an over-the-counter remedy. The proposed increase in
the inmates' "co-pay" is intended to encourage inmates
to use over-the-counter remedies that are made
available in vending machines in lieu of the more
expensive and time-consuming medical visit. Whether
all inmates have access via vending machines to
over-the-counter remedies at the LA County Jail is not
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clear. Whether inmates at other, smaller jails have
any such access to over-the-counter remedies is
doubtful.
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One issue this proposal raises is that the increased
disincentive to seek medical care might convince some
inmates who may have a more serious disease, perhaps a
communicable one, as well as to those with just a
cold, to forego seeking medical treatment. Under
existing law, and under the bill, "�i]f the inmate has
no money in his or her personal account, there shall
be no charge for the medical visit." (Penal Code �
4011.2(b).) And, "�a]n inmate shall not be denied
medical care because of a lack of funds in his or her
personal account at the facility." (Penal Code �
4011.2(c).) Nonetheless, many inmates may have only
$10 or $20 dollars on their books. If the inmate
starts experiencing symptoms of illness, he or she may
then be faced with a choice between buying something
to eat from the commissary or seeing the nurse. It is
conceivable that an inmate faced with that choice
might forego the medical visit in favor of a cup of
ramen noodles.
If inmates showing the first symptoms of infectious
disease like the flu are discouraged from seeing the
doctor in favor of getting something to eat, this
could have the unintended adverse consequence of
allowing the disease to spread throughout the jail.
The existing law, which the bill does not change,
states:
The medical provider may waive the fee for any
inmate-initiated treatment and shall waive the
fee in any life-threatening or emergency
situation, defined as those health services
required for alleviation of severe pain or for
immediate diagnosis and treatment of unforeseen
medical conditions that if not immediately
diagnosed and treated could lead to disability
or death. (Penal Code � 4011.2(d).)
The problem with this provision is that, in many
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instances, the inmate may not know when they put in the
request for a medical visit, whether their symptoms are
related to a condition that would result in a fee
waiver.
Another issue this bill raises is whether charging this
increased fee for health care, to be taken from any money a
county jail inmate might have on deposit with the Sheriff, is in
essence a tax on the inmates' families. Most county jail
inmates are indigent and any money they have on the books is a
small amount deposited there by family members to allow the
inmate to buy a few commissary items. While government at all
levels is strapped for funds to provide essential services and
many attempts are being made to find new revenue sources to pay
for these, members may wish to consider whether the effect of
this bill would be to shift the tax burden required to
adequately fund government agencies onto some of the poorest
families in the state.
3. Statement in Support
The California State Association of Counties states:
As you are well aware, with the recent 2011 criminal
justice realignment, detention costs and jail
populations are rising; prior to realignment becoming
effective last fall, 32 county jails were already
either under a federally imposed or self-imposed
population cap. Your measure - authorizing sheriffs
to increase fees where applicable - would assist
county sheriffs across the state in ensuring that they
have the necessary resources to meet the basic needs
of all county jail inmates as required by law.
Further, Penal Code Section 4011.2 clearly specifies
when an inmate can be charged a fee for a medical
visit. This measure does not amend those provisions
but merely authorizes a county sheriff's department to
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increase the existing fee by two dollars. Inmates who
do �not] have funds in their accounts will not be
charged a fee, nor will inmates in life-threatening
situations or those in need of emergency medical care.
4. Statement in Opposition
The Friends Committee on Legislation states:
While raising co-pays may discourage frivolous visits
to the doctor by county jail prisoners, this
legislation will discourage legitimate medical visits
and potentially result in serious consequences for the
health of prisoners. Given the much higher prevalence
of communicable diseases in jails and prisons - and
among prisoners being released into the community - as
documented by the Centers for Disease Control and
National Commission on Correctional Health Care, the
general public and correctional staff could also be
placed at risk.
The $5 co-pay may seem insignificant for most of us;
however, county prisoners lack the means to earn money
during their incarceration. Raising co-pays may
dissuade them from seeking necessary medical treatment
in order to make canteen purchases.
Given the health risks this bill should be carefully
vetted with input from public health professionals.
Any fiscal savings resulting from increasing co-pays
should be weighed against the potential public health
consequences, which may result in the need for more
intensive and widespread medical care.
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