New Rule: Go to Jail, Pay to See a Nurse

Los Angeles County jails have started charging sick inmates for visits to nurses, a practice that sheriff’s officials estimated would reap as much as $2 million a year.

Prisoners -- who generally face far worse medical problems than the rest of the population -- will be billed $3 for each visit that does not result in a referral to a doctor, sheriff’s officials said Wednesday.

The new charges are part of a major redesign of the way county jails provide medical care for those with non-life-threatening illnesses or injuries. Nursing clinics, where inmates can discuss their problems and have their vital signs checked, will replace the current system, in which they line up in their jail modules for a hurried nurse visit.

“It was a queue of people. It was totally unprofessional and didn’t meet the standards of the industry, and what we’re doing now does,” said Sheriff’s Chief Marc Klugman.

The charges, officials said, will apply only to those who can afford to pay and whose complaints could be easily treated with over-the-counter medications on sale at the jails. Indigent or seriously ill inmates sent to doctors will not be charged.

“If we can discourage anyone from going to the doctor if they don’t need to, then that’s what we’re going to do,” said Klugman, who heads the department’s Correctional Services Division. “We have a limited number of staff, and 6,000 inmates under a doctor’s care at any one time.”

Sheriff’s officials said the county jail’s medical budget has risen from roughly $70 million in 2001 to $100 million this year. Klugman said he did not know how much of that amount would be earmarked for the new clinics.

Scores of major jail systems across the country charge inmates for medical visits, partly to help meet escalating costs of jailhouse medical care and partly to reduce the number of visits considered frivolous.

“At first, it was controversial and it was debated, but it was like a bandwagon gathering momentum as it went along,” said Ken Kerle, a jail consultant who edits American Jails, a magazine of the American Jail Assn.

California law allows sheriffs to charge inmates up to $3 for medical visits as long as no one is denied medical care due to a lack of funds. Inmates cannot be billed for follow-up visits with doctors or for treatment of a life-threatening problem.

Orange County health officials are considering introducing a similar charge in their jails. San Diego County has been billing inmates for medical visits since 1995.

There, jail staff members initially saw a reduction in the number of inmates seeking visits with nurses but didn’t see other benefits they had expected, said Royanne Schissel, director of nursing for the San Diego County Sheriff’s Department.

“They thought that there would be a lot of money generated, but there wasn’t a significant amount,” Schissel said.

In Los Angeles, jail staff will deduct the fee from a trust account that each county inmate is given when booked into jail. Relatives and friends can donate money to the accounts, which prisoners use to buy candy, shaving supplies and over-the-counter medications from the jails’ commissaries and vending machines.

The fees were introduced 18 months ago in the women’s portion of the Twin Towers jail in downtown Los Angeles, which has five new clinics.

The department plans to roll out another clinic and similar charges at the 6,338-bed Men’s Central Jail within the next two months.

Sheriff’s officials acknowledged that the fees would fall far short of covering the additional expenses involved in operating the clinics. But they said improved services would be worth it, and the fees would deter unnecessary visits, freeing up nurses to spend their time on patients in need.

“It’ll allow us to treat those people better,” Klugman said.

Over the next three years, he said, the department plans to hire enough nurses and medical staff to put nursing clinics in each of the county’s six jails, which house 19,300 inmates.

Jody Kent, who monitors the county’s jails for the American Civil Liberties Union of Southern California, said she welcomed the new clinics as a way to improve healthcare in an institution often criticized for failing to meet the medical needs of inmates adequately.

“I’m certainly delighted that they’re going to do more than just stand behind a window and ask what’s wrong,” Kent said.

But she said she had received a few complaints from inmates who said they had been double-billed when they returned to a nurse after being left untreated or failing to get better.

In response, sheriff’s officials said they would take steps to better educate prisoners on how to appeal the charges.