USA: Sheriffs release sick people from jail to avoid paying hospital bills

Michael Tidwell’s blood sugar reading was at least 15 times his normal level when sheriff’s deputies took him to the hospital. But before they loaded the inmate 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.

“I could barely stand up or keep my eyes open,” he recalled.

Tidwell said that he didn’t know what he was signing at the time, and that he lost consciousness a short time later. The consequences of his signature only became clear in the weeks that followed the 2013 medical emergency.

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.

It’s unclear whether Tidwell, who was uninsured at the time and in poor health afterward, was billed for his care or if the medical providers wrote it off. Neither Tidwell’s attorneys nor the hospital was able to say, and Tidwell was unable to get answers when he and a reporter called the hospital’s billing department.

What is clear is that the sheriff’s office avoided paying Tidwell’s hospital bills.

Tidwell had been on the receiving end of a practice referred to by many in law enforcement as a “medical bond.” Sheriffs across Alabama are increasingly deploying the tactic to avoid having to pay when inmates face medical emergencies or require expensive procedures — even ones that are necessary only because an inmate received inadequate care while incarcerated.

What’s more, once they recover, some inmates are quickly rearrested and booked back into the jail from which they were released.

Local jails across the country have long been faulted for providing substandard medical care. In Alabama, for instance, a mentally ill man died from flesh-eating bacteria 15 days after being booked into the Mobile County Metro Jail in 2000. And in 2013, a 19-year-old man died of gangrene less than a month after he was booked into the Madison County Jail. In both cases, officials denied wrongdoing and surviving relatives settled lawsuits alleging that poor jail health care contributed to their loved ones’ deaths.

But the use of medical bonds isn’t about inferior care. It’s about who pays for care.

While medical bonds have been a last resort in many states for more than 20 years, experts say they are employed in Alabama more often than elsewhere. Their use in some counties but not in others illustrates the vast power and latitude that sheriffs have in Alabama, which is the subject of a yearlong examination by AL.com and ProPublica.

Several Alabama sheriffs, including Washington County Sheriff Richard Stringer, said in interviews that they often find ways to release inmates with sudden health problems to avoid responsibility for their medical costs. Stringer denied any wrongdoing in his office’s handling of Tidwell’s emergency.

“We had a guy a couple of weeks ago with congestive heart failure. … The judge let him make bond so the county didn’t get stuck with that bill,” Lamar County Sheriff Hal Allred said in a March telephone interview. “We don’t have any medical staff in the jail. I wish we did, that would be great, but the way the county finances are, I won’t live long enough to see it.”

Typically the process works like this: When an inmate awaiting trial is in a medical crisis, a sheriff or jail staffer requests that a judge allow him or her to be released on bond just before, or shortly after, the inmate is taken to a hospital. If the request is granted, the inmate typically signs the document granting the release.

Michael Jackson, district attorney for Alabama’s 4th Judicial Circuit, said he is aware of multiple recent cases in which sheriffs released inmates on bond without first obtaining a judge’s approval. Jackson said he also worries about the risk of inmates reoffending after they receive medical treatment.

“I’m not saying there should be no situation where an inmate can get released early, but it shouldn’t be about money,” Jackson said in a phone interview this month. “No one’s watching them when they get out, and people might get robbed or their houses might get broken into.”

While judges usually sign off on bonds, lawyers who represent inmates and other experts say sheriffs are often the key decision-makers and can be held legally responsible for what happens after they release inmates via such methods.

If an inmate is already sick or injured when he or she is released, sheriffs are “not going to be able to avoid the liability just by opening the trap door and letting them go,” said Henry Brewster, one of Tidwell’s attorneys.

“They Have to Do Something”¶

Shortly after Tidwell was locked up for a probation violation in 2013, his sister Michelle Alford, a nurse at a Mobile hospital, said she brought his diabetes medications to the Washington County Jail and gave them to the guard on duty.

She says she explained to the staff that her brother is a “brittle” diabetic, meaning he needs frequent monitoring. She provided the jail with a two-page document that explained how often his blood sugar needed to be checked, what symptoms to watch for and the purpose of each medication.

The jail’s employees, none of whom had any formal medical training, did not follow those instructions, according to Tidwell’s jailhouse medical records, a copy of which Alford provided to AL.com and ProPublica.

On his fourth day in the aging jailhouse, Tidwell became ill and vomited off and on for the ensuing 48 hours. He was unconscious for most of his final two days there, according to court and medical records.

Before he was taken to Washington County Hospital, Tidwell’s blood sugar reading was 1,500 mg/dl; a normal reading for him is 80 to 100 mg/dl. Over the less than seven full days he was incarcerated, he had lost at least 17 pounds, records show.

Tidwell’s release form bears his signature scrawled incomprehensibly outside the signature box, overlapping the typed prompt for “Signature of Defendant.” It does not match other examples of his signature on court documents reviewed by AL.com and ProPublica.

“If you’re in there and you get sick, they have to do something and get some medical attention,” he said. “But if you’re in so bad of shape that they’re trying to hold you up and get you to sign something, that’s wrong.”

Tidwell, who was 42 at the time, was assessed at the local hospital and taken to Springhill, a larger and better-equipped hospital, where he lay in a coma in the intensive care unit. He was suffering from renal failure and other complications related to his diabetes, according to the records.

During a conversation in his office in downtown Chatom, Stringer, the Washington County sheriff, said that he and his jail staffers are not medically trained. Instead, they “listen to what inmates are complaining about and examine them to determine if they need medical bond, because people will do anything to get out of jail.”

If they decide an inmate has a serious and potentially costly medical issue — and doesn’t pose a threat to the public — Stringer said he or the jail’s administrator will call a judge and request that the inmate be released.

Asked last week whether he believes Tidwell was legally able to provide consent to being bonded out, Stringer said: “They’ve got to be physically able to sign the bond. I’m sure he was conscious or he wouldn’t have been able to be bonded out. … It’s been so long ago it’s hard to remember all these things. I’m sure we did what needed to be done.”

But in an earlier interview, the sheriff provided an alternate explanation for Tidwell’s hospitalization.

“When someone comes in and says he’s a diabetic, we try to prepare a meal that will accommodate his diabetes,” Stringer said. “But now on commissary, they’re on their own there. I mean, you know you’re diabetic. Don’t order — he actually ordered 12 honey buns.”

Tidwell, who denies eating a dozen honey buns in the jail, recovered and was sent home from the hospital.

He filed a lawsuit against Stringer and several sheriff’s office employees in 2014; it was settled the following year. Stringer said he believes he and his employees would have been exonerated had the suit gone to trial, but because he said the settlement was for “something like $20,000 … it’s not worth fighting it.”

But Tidwell’s problems didn’t end there. Exactly three months after Tidwell was released on bond, a judge issued a bench warrant for his arrest on another probation violation.

“They’ll Lower the Bond”¶

AL.com and ProPublica have reviewed the cases or media reports of inmates in 15 of Alabama’s 67 counties who were issued last-minute bonds or released on their own recognizance just before they were hospitalized for emergencies.

In September 2018, for instance, a 38-year-old inmate at the Lauderdale County Jail was taken to a nearby hospital after he suffered a stroke that left him partially paralyzed and unable to communicate verbally, stand or perform daily tasks, state court records show. The inmate, Scottie Davis, was released from sheriff’s office custody on bond the following day, though he couldn’t sign the release document. Someone instead wrote the words “Unable to sign due to medical cond.” in the space for the inmate’s signature. Davis was responsible for the medical costs after he was bonded out.

Lauderdale County Sheriff Rick Singleton said when inmates are too ill to sign their names, sheriff’s officials notify a judge who decides whether to allow them to be released on bond.

And earlier last year, in Randolph County, an inmate was released on a medical bond before going to the hospital for surgery, according to The Randolph Leader, a local newspaper. When he wasn’t able to immediately get the procedure, he was rearrested on a new misdemeanor charge and booked back into the Randolph County Jail.

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