Howard County Sheriff Mike Neal disputes a claim by the Howard County Ambulance District that his department is responsible for ambulance bills incurred by inmates of the county jail. He cites a state statute that requires inmates to pay for their own medical costs.

An article in the February 19, 2020 Fayette Advertiser detailed complaints by the ambulance service with regard to unpaid bills for service calls to the jail. During the Ambulance District’s board meeting on Thursday, February 16, members discussed what to do about 10 unpaid bills for calls to the Howard County Jail, amounting to an average of about $1,200 apiece. The district’s office manager Wendy Duran said that she could bill the inmates’ insurance companies or Medicare if the department would provide the necessary information.

Ambulance Director Frank Flaspohler said during that meeting that the county is responsible for providing food and medical care to inmates. However, Missouri Statute 221.120 stipulates that while the jailer is required to procure the necessary medical care, the costs of medicine or medical services shall be paid by the prisoner through any health insurance policy from which the prisoner is eligible to receive benefits. “If the prisoner is not eligible for such health insurance benefits then the prisoner shall be liable for the payment of such medical attention, dental care, or medicine, and the assets of such prisoner may be subject to levy and execution under court order to satisfy such expenses in accordance with the provisions of section 221.070, and any other applicable law,” the statute reads.

This statute serves to keep taxpayers from footing medical bills of jail inmates, who would otherwise be responsible for their own health services.

Flaspohler points to state statute 221.070 which requires jailers to provide necessary medical treatment under the Eighth Amendment to the United States Constitution, which prohibits cruel and unusual punishment on the part of the state. An opinion by U. S. Attorney General John Ashcroft in 1982 surmised that cities or counties are responsible for the initial payment for necessary medical services when such payment is required “prior to medical care being provided.” But since the ambulance service does not require payment in advance, this interpretation of the statute would appear moot in this instance.

Until recently, counties could apply these medical expenses to an inmate’s court costs. Inability to pay these costs could keep them locked up indefinitely. However, the laws changed in March of 2019 when the Missouri Supreme Court unanimously ruled that courts cannot threaten defendants with additional jail time if a defendant fails to pay bills charged for any prior jail stays. Such bills could include boarding costs by the jail and medical expenses. “While persons are legally responsible for the costs of their board bills under section 221.070, if such responsibilities fall delinquent, the debts cannot be taxed as court costs and the failure to pay that debt cannot result in another incarceration,” wrote Judge Mary R. Russell in the high court’s nine-page decision.

The Howard County Ambulance Service has been in this situation with the sheriff’s department before. It successfully sued the county commission in 2008. Judge Donald Barnes found in favor of the ambulance service. He wrote in his conclusion that “under Sec. 221.120 RSMo, which arguably imposes a duty on the Sheriff and by extension the County to not only procure but compensate for medical care (for there is no other practicable way to procure such services, medical providers not being likely to provide such services if they know they have no practical way to be paid)...”

The judge further wrote, “To require the jailer to procure reasonable and necessary medical care necessarily implies the duty reasonably to compensate for such care.”