Past due bills for healthcare services provided to prisoners of the Texas County jail totaling $196,744.02 were the main topic of discussion at the monthly meeting of the Texas County Memorial Hospital board of trustees on Tuesday.
Wes Murray, TCMH chief executive officer, filled board members in on a recent meeting with the Texas County Commission and county sheriff’s department to discuss the payment delinquencies. Murray has also received counsel on the matter from the hospital attorney.
“For decades, the county has brought prisoners to the hospital for routine and emergency healthcare services, and our staff has also gone to the jail to assist with blood draws on prisoners when needed,” Murray said. He stressed, “We have never had an issue with the county paying the bills for services provided to county prisoners or to the jail.”
Murray explained that if the prisoner receiving services at TCMH has private insurance, Medicare, or Medicaid, TCMH bills the insurer first. The remainder of any prisoner bills not covered by insurance, the bills of any uninsured prisoners, and bills for prisoner blood draws done at the jail are sent to the sheriff’s department. TCMH has also always made arrangements to reduce the bills by 50 percent as a service to the county.
According to Murray, delinquent bills incurred by the sheriff’s department go back to January 2014 and include county prisoners receiving healthcare at TCMH and blood draws of county prisoners which are provided by TCMH personnel at the county jail. Bills for those services were sent to the sheriff’s department.
TCMH learned that the sheriff’s department made a decision to stop paying for healthcare service from TCMH in 2014, and the bills to the sheriff’s department were apparently not forwarded on to the County Commission for payment.
“According to Missouri statute, the sheriff’s department is required to provide healthcare services to prisoners of the county when needed, and state law allows the sheriff’s department to collect payment from the prisoners for their medical bills while in custody,” Murray said, adding that TCMH legal counsel agrees with this interpretation of this statute.
Murray cited state statute RSMo 221.120: If any prisoner confined in the county jail is sick and in the judgment of the jailer, requires the attention of a physician, dental care, or medicine, the jailer shall procure the necessary medicine, dental care or medical attention necessary or proper to maintain the health of the prisoner. The costs of such medicine, dental care, or medical attention shall be paid by the prisoner through any health insurance policy as defined in subsection 3 of this section, 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 county commission of the county may at times authorize payment of certain medical costs that the county commission determines to be necessary and reasonable.
Currently, the Texas County sheriff’s department contracts with a physician that sees prisoners one day a week and a nurse that provides care for prisoners three days a week at the jail. The physician and nurse services are paid for through the sheriff’s budget. Routine or emergency healthcare services needed outside the jail are provided by TCMH.
“Although these bills were incurred by the sheriff’s department, the county is responsible for paying the bills,” Murray said, reminding board members that TCMH does not receive any portion of county tax dollars.
In Murray’s meeting with the Texas County Commission and the sheriff, TCMH was asked to negotiate the outstanding bills to an amount below 50 percent, or to something less than $98,0000.
Before agreeing to further reduce the outstanding bills below 50 percent, Murray asked if the county would pay any TCMH bills incurred by the jail going forward.
“They would not provide answer regarding their willingness to pay healthcare bills going forward, so I believe we are at a point where we have to make a decision as a hospital about providing routine healthcare services for prisoners of Texas County and allowing our staff to go to the jail to do blood draws on prisoners,” Murray said.
Murray did not agree to reduce the delinquent bills below the standard 50 percent charge either.
“After consulting with our attorney, this seems to be an isolated issue between our hospital and our county,” Murray said.
Dr. Jim Perry, DO, chairperson of the TCMH board of trustees, asked how other county hospitals handled county prisoners and how TCMH handles prisoners from counties without a jail.
Murray explained that other nearby county hospitals provide care for the prisoners of those county jails or the prisoners of county jails that do not have a county hospital. Occasionally Wright or Shannon county prisoners also receive healthcare services at TCMH. There are no known delinquent bills.
“It’s risky to interpret the state statute in ways that no one else interprets it,” Murray said, adding, “There seems to be disconnect of responsibility.”
“We make an effort to collect payment from any citizens of the county that receive healthcare services at TCMH,” Omanez Fockler, TCMH board member, said. “Giving free healthcare to prisoners of the sheriff’s department doesn’t seem fair for the citizens of Texas County that are not in trouble with the law.”
Murray explained that the Texas County sheriff’s department could take prisoners to healthcare facilities in other counties for routine outpatient care if TCMH is unwilling to provide routine care at no charge.
“The expense of care would be a lot higher in Rolla,” Dr. Jonathan Beers, TCMH chief of staff, said.
“Would that be a good use of taxpayer dollars to take patients to Rolla or elsewhere?” Fockler asked.
Murray noted that it was stated at the meeting of the Texas County Commission that prisoners could just be released in the parking lot of the hospital to seek their own medical care, releasing the county from responsibility.
“I don’t think the county citizens would like to have prisoners released in our parking lot because the sheriff’s department doesn’t want to pay for the prisoners’ healthcare services,” Murray said.
According to Murray, to avoid medical bills incurred by county prisoners, the sheriff’s department has a history of releasing prisoners from county custody after the prisoner is registered at the hospital or when a prisoner required an overnight or inpatient stay.
“When the prisoners realize they are no longer in the custody of the sheriff’s department, they leave against medical advice,” Murray said. “Due to patient privacy laws, there is nothing we can do about it.”
The meeting between Murray and the Texas County Commission did allow the hospital and the county to work through some procedural issues that may help in reaching a better resolution, according to Murray.
Hospital board members requested additional information gathering from Murray and a possible meeting with the Texas County Commission at the November hospital board meeting.
In other news, Murray reported that a $90,000 Federal Emergency Management Association grant request for a new generator to power the surgery department under construction at TCMH has gone to the second round of consideration.
“The grant would cover 75 percent of the cost of the new generator,” Murray said. “We will not know anything more about our request until June of next year.”
The new department, located between the Jayson Gentry Community Safe Room and the East wing of the hospital, will have two operating rooms, an endoscopy suite and seven private pre-surgical and post-surgical rooms for patients. The area is 6,091 square feet in size.
Construction work on the surgery department should be complete in 2018.
Linda Pamperien, TCMH chief financial officer, presented the financial statement for the month of September.
Inpatient volumes and outpatient revenues were dramatically down for the month. Expenses were also down for the month of September, but not enough to offset losses. TCMH finished the month with a negative bottom line of $353,228.35 and a negative year to date balance of $685,127.44.
“Almost all of our providers were on vacation in the month of September, and that definitely affected our bottom line,” Pamperien said. She noted that 2017 is still shaping up as better financial year than 2016.
Present at the meeting were: Murray; Beers; Pamperien; Doretta Todd-Willis, chief nursing officer; Joleen Senter Durham, director of public relations; Amanda Turpin, quality management director, and board members, Perry, Fockler, Janet Wiseman and Jay Loveland.
TCMH board member, Mark Hampton, was not present at the meeting.
The next meeting of the TCMH board of trustees is Tue., Nov. 28th at 12 p.m. in the TCMH board room.