Guidelines for implementing inmate medical fees.

Author:Clark, John

On Nov. 9, 1994, several inmates at the Berks County Prison in Pennsylvania instituted a class action suit alleging that the prison's policy of charging inmates for medical care deprived them of their civil rights.

During litigation, the plaintiffs argued that charging a fee for medical services was a barrier to medical care, and claimed that such a program severely compromised inmates' health and welfare - specifically for those with chronic diseases. The defendants argued that this was not an issue, since the Berks County Prison inmate handbook clearly articulates that services for chronic diseases which require follow-up (such as HIV disease, hypertension, diabetes, etc.) are exempt.

Fortunately, the Berks County Prison's Inmate Fee for Medical Services Program had in place appropriate policies and procedures to ensure that inmates would not be denied medical care because they lacked money. When the medical records for each of the class members were reviewed, they demonstrated that policies had been followed, and that none of the class members had been denied care. Moreover, records showed that inmates with chronic medical problems had not been billed for ongoing care.

Because the Berks County Prison's Medical Services Program was well-structured, with ample documentation supporting it, the court ruled in favor of the defendants. Having such a program in place is important these days, especially considering that the most frequently discussed correctional health issue during the past five years, second only to tuberculosis, has been whether or not to charge a fee for medical care provided in jails and prisons. Such discussions have intensified of late, and recent concerns have addressed many factors, including state and county funding, national health care reform, overuse of inmate medical services, jail/prison crowding and patient responsibility in seeking health care. Regardless of the basis for implementing an inmate fee for medical care, there has been a wide range of positions on its effectiveness.


Several years ago, a focus group sponsored by the California Medical Association's Corrections and Detention Committee (CMA/CDC) was charged with developing a position paper on the issue of inmate co-payment for medical services. The group neither endorsed nor opposed the concept of charging inmates for health care. Members did, however, believe that decision-makers could be called upon to implement "co-payment" programs...

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