It's an interesting question of who pays the hospital bill of an uninsured suspect brought to an emergency department by law enforcement.
If the person is in police custody, and someone notices the person has frostbite and needs treatment, does that agency pay for that uninsured patient, or the hospital? What if they're dropped off, and the officer says the person isn't in custody, but asks hospital personnel to call after they are treated and ready to be dismissed, and then arrests the patient?
Does the hospital get stuck with the bill?
"I brought the bill just so we could find out, well, who really is responsible, and when does custody start and when doesn't it start," said Sen. Mark Kolterman of Seward.
The bill (LB216) was suggested to Kolterman by the Nebraska Hospital Association because of complaints by some hospitals, especially in smaller communities.
But the questions come up in Lincoln, too.
"It's a big issue that either costs the taxpayers money through their nonprofit hospital or through law enforcement budgets," said Bryan Health Vice President Bob Ravenscroft.
He couldn't cite a cost to Bryan Health for patients without insurance brought in by law enforcement, he said. The hospital doesn't go back to track costs for patients who go right to the hospital from an incident to find out if they were later arrested.
"But we do know it happens," he said.
There are times when law enforcement from smaller towns bring a mentally ill person to Bryan because they have nowhere else to take them for care, he said.
The bill would prohibit law enforcement from releasing a person in custody to a health care provider so the agency can avoid the cost of medical services. Nebraska law says once a person is in custody, law enforcement is responsible for the cost of treatment unless the person has health insurance.
Some hospitals around the state are having problems with law enforcement dropping off people in custody at emergency departments for treatment, but claiming the person is not in custody, Kolterman said. It's happened in Cherry, Dawson, Nemaha, Valley, Saline, Lincoln and York counties, to name a few.
"The question is, are they doing this to specifically avoid paying for the cost of medical services," he said.
And then, if the person is violent or causes a problem, who is responsible for the patient?
Lincoln Police Capt. Jason Stille said the laws are pretty clear that if officers cause injuries to a person during apprehension or arrest, the agency is responsible for that person's hospital care.
The cost of medical bills for apprehensions and other injuries or treatments for people who medically cannot be confined, paid by the department, is sizable, he said.
There are a lot of variables that have to be considered on the issue of who pays for hospital care, he said. But offloading a suspect at a hospital and saying an officer will pick the person up later to avoid paying for treatment is not how the Lincoln Police Department operates, he said.
"For the most part I think things work the way that they should work here in Lincoln," Stille said. "We are very in tune to the needs of the hospital making sure that we don't leave a dangerous environment."
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Ravenscroft agreed that Bryan has a great relationship with local law enforcement.
Some hospitals in other areas have had instances, though, in which a person who was dropped off has physically harmed staff or other patients or caused property damage.
Kolterman said mental illness has played a role in this, as has the influence of drugs or alcohol.
Andy Hale, vice president of the Nebraska Hospital Association, said during a hearing on the bill that a person dropped off by law enforcement could run amok in a hospital when not handcuffed or guarded.
Hospitals in at least 10 counties have said it's a serious issue, he said.
A fiscal note attached to the bill estimates the cost to the Nebraska State Patrol resulting from the bill to be $200,000-$700,000 annually, based on recent incidents involving the apprehension of a suspect.
The cost could fluctuate significantly from year to year, the patrol said, and would vary in each law enforcement incident, depending on the severity of injuries or wounds sustained by a person being apprehended and taken into custody. The number of incidents would also affect the costs.
Mel McNea, CEO of Great Plains Health in North Platte, said at the hearing there's an increase in opioid use in Lincoln County, doubling since 2014. When people brought into the hospital are detoxing from drug or alcohol use, they can get violent, he said.
"We are not equipped to be a detox center, and there isn't (a detox center) in western Nebraska at all," McNea said.
When a person is admitted and not in custody, they have all the rights of a regular patient, he said. They must have access to a phone, the internet and visitors.
"We actually had one drug deal go down in our hospital because we could not prevent it," McNea said.
Paula Bagnell, representing hospital nurses, described an incident at Great Plains Health recently in which she came to work in a 32-bed unit of intensive care and progressive care beds at 5:30 a.m. A patient there had been transferred from the jail in the middle of the night because he'd had a seizure.
The patient — a muscular, 5-foot-11-inch, 250-pound man — was released from custody to be admitted to the hospital. Out of jail, he began calling friends and inviting them to his room.
The next afternoon, it appeared to Bagnell the patient had taken a hit of methamphetamine, she said. When she tried to address the issue, he backed her out of the room, her hands on his chest, down one hall and up another while she tried to get him controlled so he wouldn't hurt someone in the unit.
The incident lasted about 20 minutes, she said. Eventually the police showed up and took the patient back to jail.
"It was only by the grace of God that something bad didn't happen that day," Bagnell said.
Kolterman said the bill needs some work, and it probably won't be prioritized this session. He will talk to Judiciary Committee members and others involved over the interim to get the bill in shape for next session, he said.