Ombudsman: County jails in Iowa should stop charging inmates without convictions for medical care

The Iowa Ombudsman’s Office on Thursday said county jails across the state should stop collecting money for medical expenses from inmates who haven’t been convicted of a crime.

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“Jail practices on this topic have been inconsistent for years, and my office continues to receive complaints,” Iowa Ombudsman Bernardo Granwehr said in a news release about the report.

“I hope this report starts a conversation that ultimately leads to consistency in how jails handle inmate health care costs.”

The Iowa Department of Corrections acknowledged the issue raised in the report and said it would bring the matter to the attention of the Iowa Sheriffs and Deputies Association, which advises the department and local sheriffs on points of law.

What the law, rules say

Iowa Code 356.7 states that jails may charge inmates for medical expenses if an inmate is 18 years of age or older and “has been convicted of a criminal offense or sentenced for contempt of court for violation of a domestic abuse order.”

If an inmate fails to pay the charge, the county can file a claim in court and, if the court approves the claim, the county can collect the money it is owed directly from the inmate’s jail account.

A rule in the Iowa Administrative Code — stating that the “responsibility for the costs of medical services and products remains that of the prisoner” — was never updated after Iowa law was changed in 2006 to clarify which prisoners can be charged for medical expenses.

Granwehr said in the report the administrative rule has caused confusion among county jails, which are not consistently in line with Iowa Code.

“An inmate’s due process rights should not vary based on the county in which he is incarcerated,” the report states.

Inmate complaints

The report highlights inmate complaints the Ombudsman’s Office investigated in four counties.

In 2020, a Wapello County inmate complained the jail had taken $130 directly from his account to pay for medical expenses before he had been convicted of a crime.

The jail declined to refund the $130 when asked by the Ombudsman’s Office, and the county attorney declined to seek corrective action against the jail, stating the jail did not need to file a reimbursement claim because the inmate had paid the administrative costs.

“We disagree with the county attorney’s assertion that the inmate ‘paid’ anything, as that would imply he gave the money willingly, as opposed to having the money taken without his consent,” the ombudsman’s report states. “For that matter, the jail should not have even told the inmate … that any medical costs were owed at the time, since the inmate had not yet been convicted.”

In 2020, an inmate in the Mills County Jail in southwest Iowa reported the jail had taken $155 from his jail account to pay for medical expenses without filing a reimbursement claim.

“The then-jail administrator said Mills County took inmates’ money for medical-related charges because, otherwise, the county would receive little or no money for those services. She told us that she believed inmates with medical needs should not be allowed to buy commissary products, as they would ‘spend their last dollar on a candy bar’ and the county would receive nothing,” the report states.

Mills County has since updated its practices to comply with Iowa Code. The jail now presents anyone leaving the jail with a form showing the amounts they owe for medical-related charges and room and board, as well as a proposed payment plan. If the payments are not made, the jail sends the paperwork to a private collection agency.

In 2022, a Scott County inmate in Eastern Iowa told the ombudsman that the jail took $98 from his account to pay for medical expenses before he was convicted, and another $20.50 after he was convicted, but without filing a reimbursement claim.

Another Scott County inmate, who was never convicted of the criminal charge he’d been arrested on, told the office in 2022 he had been charged $129 for medical services while in the jail. The inmate was sentenced and served time for two contempt-of-court charges related to child support payments, which are not criminal charges.

The Scott County Jail administrator told the Ombudsman’s Office that “it appears that you are correct that copays should be collected after conviction.” He declined to change the jail’s practices, however, stating it’s a gray area in how the law can be interpreted and he wants guidance from the Iowa State Sheriffs and Deputies Association and the Iowa Department of Corrections before making changes, according to the report.

The Ombudsman’s Office also investigated a complaint from an inmate at the O’Brien County Jail about the jail taking $197.54 from the inmate’s account for hospital fees without first filing a reimbursement claim. No date was given for the complaint.

The jail said the charge was justified because the inmate signed a waiver that is given to all inmates entering the jail. The waiver states “I understand I am financially responsible for all medical (mental, physical, and dental) costs which may incur during my incarceration and authorize the O’Brien County Sheriff’s Office to deduct money from my jail account to satisfy the debt incurred.”

The jail administrator told the Ombudsman’s Office, however, that the form is more of an acknowledgment than a waiver because the jail will take money from an inmate’s account even if the inmate does not sign the form.

Compliance survey

The Ombudsman’s Office surveyed seven other counties in addition to the four counties with complaints and found that of the 12, only three counties — Allamakee, Mahaska and Mills — were complying with the law in how they charge inmates for medical expenses. (Linn and Johnson counties were not among those surveyed.)

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