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‘Medical Bonds’ Save Money For Jails. Their Use Shows How Often We Jail People Who Need Care

Photo illustration by Anagraph. Photo by Jose Luis Pelaez Inc.

‘Medical Bonds’ Save Money For Jails. Their Use Shows How Often We Jail People Who Need Care


In Alabama, according to an ongoing investigation on the power of sheriffs from ProPublica and AL.com, it is becoming increasingly common for sheriffs to request “medical bonds,” which permit the release of people from jail on medical grounds. To avoid paying for medical care, sheriffs in Alabama and other states seek the bonds at the moment that people in jail are experiencing medical emergencies or when they need medical procedures. In some cases, they seek the person’s arrest again later. The requests for release can leave people with huge bills for care that was necessary only after medical neglect in jail. The effort to release people in order to avoid costs also raises broader questions about why these individuals, if they could be safely released when it was advantageous to sheriffs and counties, were jailed in the first place.

(The Appeal: Political Report’s series The Badge looks at how sheriffs nationwide operate with enormous discretion but little accountable for their failures, including the jail deaths that happen with alarming regularity.)

Connor Sheets describes the case of Michael Tidwell. After a week in jail in 2013, Tidwell had to be rushed to the hospital after staff failed to monitor his diabetes and follow instructions regarding the administration of his medication. As they were loading him into the back of a car, “deputies propped up his slumping body and handed him a pen so he could sign a release from the Washington County Jail.” Tidwell lost consciousness shortly after and had no memory of signing the paper. But from the perspective of the sheriff’s office, it worked. “By signing the document, which freed him on bond from the small jail in south Alabama, Tidwell had in essence agreed that the Washington County Sheriff’s Office would not be responsible for his medical costs, which included the two days he spent in a diabetic coma in intensive care at Springhill Medical Center in Mobile.”

Sheets found that, in several cases, people appeared to have experienced medical emergencies because of the negligence and lack of care available in jail. Then, when they were in urgent need of care, jail staff delayed transferring them to a hospital while figuring out who would be responsible for the costs. Once people were finally in a hospital, they received the care they needed but later discovered they were responsible for enormous medical bills, often because their conditions had worsened while in jail.

These Alabama jails and counties may be unusual in the lack of jail-based healthcare and the increased use of medical bonds to avoid covering the costs of care. There are two broader issues at play, however, that affect people in jails around the country.

The first issue is the Medicaid exclusion policy that affects all incarcerated people. Because of this policy, a person on Medicaid who is sent to jail or prison will have their insurance suspended or terminated for the duration of their incarceration. It also means that an incarcerated person who wishes to apply for Medicaid coverage is ineligible for coverage until release (although some states have adopted policies to enable incarcerated people to apply in advance of release).

The effect is that counties and the states bear the cost of medical care. The result is that jurisdictions, such as the Alabama counties that are the subject of the AL.com and ProPublica investigation, go to great lengths to avoid the expense. A 2019 presentation by the National Association of Counties looked at the Medicaid exclusion policy and its effect on the health of people in jail, their health and legal system outcomes once released from jail, and the financial impact on counties responsible for their care.

The second, broader issue is the cycle of arrests and incarceration and who is targeted. A recent report by the Prison Policy Initiative supplied the numbers for understanding the scale of arrests, jailing, and rearrests. At least 4.9 million people are arrested and sent to jail each year. At least 1 in 4 of these people will be rearrested in the same calendar year. An analysis of arrest data by the Vera Institute of Justice found that in 2016, the most recent year for which the data was available, police made over 10.6 million arrests. Less than 5 percent were for violent crimes.

The PPI report makes clear what a visit to a jail or an arraignment courtroom would reveal—that those who face arrests and time in jail are disproportionately poor people, people with mental illness, people with chronic medical conditions, and people with substance use disorders.

People with these vulnerabilities (what the sociologist Bruce Western describes as “human frailty”) are especially likely to be rearrested. PPI researchers found that “repeated arrests are related to race and poverty, as well as high rates of mental illness and substance use disorders. Ultimately, we find that people who are jailed have much higher rates of social, economic, and health problems that cannot and should not be addressed through incarceration.”

Even worse, jails, by and large, fail to provide the care people with acute or chronic medical or mental health needs, making these conditions worse.

The stories from Alabama reveal the consequences of this cycle: The underfunding of community healthcare, substance use treatment, and mental healthcare leads to the use of police to round up the poor and the sick. Once in jail, people’s medical needs, which may have made them vulnerable to being jailed in the first place, are ignored. If they worsen as a result of this negligence, sheriffs who want to avoid paying for treatment delay bringing people to hospitals. The result is severe, sometimes permanent, medical consequences. And then people are released to communities where they will once again lack access to stable care and be vulnerable to rearrest.

Sheriffs’ pursuit of medical bonds underscore how unnecessary these incarcerations were in the first place. As Sheets writes: “If sheriffs and other officials claim” that people “must be jailed to prevent them from harming others, punish them for wrongdoing and deter would-be criminals, why are those officials so quick to abandon those goals in order to avoid paying their medical bills?”