NORTH COUNTY —— The San Diego County Sheriff's Department is fighting with several local hospitals about how much the Sheriff's Department pays for medical care for jail inmates.

A handful of North County hospitals have sued the department, claiming the sheriff should pay them more for inmate care. Disputes over paying for inmate patients is also the subject of a proposed bill that state lawmakers are scheduled to consider Tuesday in the state Senate's public safety committee.

Millions of dollars are at stake, officials said.

State law requires sheriff's departments to pay for the medical care of jail inmates. The San Diego County Sheriff's Department's $450 million budget includes $33 million to $36 million for inmate medical care, including hospital costs and services provided at the jail, said sheriff's Commander Brian Roberts. Roberts oversees medical services for all of the jails in San Diego County.

The Sheriff's Department has a contract with UCSD Medical Center, to provide medical care.

But sometimes inmates must be taken to emergency rooms at other hospitals that don't have contracts with the department, and that can create disputes over how much the department will pay, said Sherreta Lane, vice president of reimbursement and economic analysis for the California Hospital Association.

"Without a contract, there are a lot of problems, as evidenced in San Diego, as to what the appropriate rate is," Lane said.

Local hospitals sue

Four medical groups with hospitals in Escondido, Poway, Oceanside and Encinitas are suing the Sheriff's Department, contending that their hospitals should be paid their full charges because no contracts exist that provide a discount to the sheriff.

The San Diego County Sheriff's Department has said that at hospitals with which the department has no contract, it will limit the amount it pays for inmate care to the same rate County Medical Services pays to cover medical care for some uninsured county residents, plus 25 percent, officials said.

Roberts said that Sheriff Bill Kolender decided about a year ago that the department would pay non-contract hospitals that rate, and notified all of the hospitals of that decision.

"I think the vast majority of hospitals think that's reasonable," Roberts said. "Would they like more money? Sure. Are they strapped? Sure. We all are."

Mark Johnson, an attorney who represents several local hospitals in the lawsuit against the Sheriff's Department, said the amount the Sheriff's Department is willing to pay is below the rates paid by Medi-Cal, the state's insurance system for poor patients.

Lane said Medi-Cal "doesn't even come close to covering the costs" of emergency room care.

In August, Johnson filed a lawsuit against the Sheriff's Department and the county on behalf of Palomar Pomerado Health System, which operates Palomar Medical Center in Escondido and Pomerado Hospital in Poway; Scripps Health and four of its hospitals, including Scripps Memorial Hospital, Encinitas; and Sharp Healthcare and three of its hospitals outside of North County. Tri-City Medical Center in Oceanside joined the case in February.

The hospitals allege hat the Sheriff's Department initially contracted with them to provide care for inmates at lower costs, but in 2003 notified each of them that the department would pay less for medical care than the contracts required.

The Sheriff's Department terminated its contract with Sharp in 2003. Palomar Pomerado terminated its contract with the department in 2002, according to the suit.

The hospitals subsequently submitted "full-billed charges" for medical services provided, but the Sheriff's Department has underpaid the hospitals, the lawsuit alleges.

Johnson said the lawsuit involves "well over a couple of million dollars."

An attorney for the Sheriff's Department and the county has filed court documents denying the allegations.

Johnson said another issue in the lawsuit is whether the Sheriff's Department is responsible for the medical costs of people who have been arrested and have to go to the hospital before they are booked into the jail.

Johnson said the Sheriff's Department has taken the position that it does not have to pay for people who have been arrested but are not jail inmates yet, and has not paid anything for medical care for those people since March 2003.

Roberts said the "vast majority" of incidents in which a person is taken to a hospital before being booked involve drunken driving suspects or people who have crashed their cars.

"The Sheriff's Department is not responsible for the costs of someone who crashed his car," Roberts said. "It's the car insurance company's and that individual's responsibility to pay that, not the public's."

The hospitals' lawsuit against the Sheriff's Department is scheduled to go to trial in September, Johnson said.

Legislators consider action

September is also when the state legislative year ends, and state lawmakers may take action on a proposed bill addressing the issue of inmate medical costs by then, said Becky Warren, a spokeswoman for state Sen. George Runner, R-Antelope Valley.

Runner introduced a bill in February that would cap the amount hospitals can charge sheriff's departments unless they have contracts with the department in their counties.

Sponsored by the California State Sheriff's Association, the bill would limit the amount sheriffs pay hospitals to the "reasonable and allowable costs" for medical services, as specified in the laws and regulations governing Medicare and Medi-Cal.

Lane said the bill would mean hospitals wouldn't be paid enough to cover the expenses of inmate care.

"That would not cover the costs of providing the care for these individuals," Lane said.

Nick Warner, legislative director for the sheriff's association, said the bill was motivated by reports from sheriff's of "isolated examples of hospitals gouging county sheriffs."

The association heard from sheriffs that hospitals sometimes were charging sheriffs' departments far more than what other patients were charged, Warner said.

However, many hospitals in the state are "good" and have shown that it is possible to charge sheriff's departments a fair rate and still make a profit for the hospital, Warner said.

Warner said the sheriffs recognize that it is appropriate to charge more than Medi-Cal rates to cover the additional costs of security associated with inmate patients.

"What the bill is looking to do is require hospitals and sheriff's departments to enter into contractual agreements," Warner said. "The bill is about protecting taxpayers and also ensuring inmates have access to affordable health care."

In San Bernardino County, the sheriff has contracts with all of the hospitals that call for his department to pay the Medi-Cal rate, plus 25 percent, and it is working "exceptionally well," Warner said.

Officials from the sheriff's association and the hospital association said they are trying to reach some kind of agreement on the proposed bill.

"We're not trying to roll over the hospitals," Warner said.

The state Senate public safety committee could vote on the bill this week. If it passes in the committee, it will proceed to the senate appropriations committee and then to the full Senate for a vote, Warren said.

If it passes in the Senate, the bill then will proceed to the state Assembly for similar committee reviews before potentially being passed and sent to the governor to sign into law sometime later this year, Warren said.

"We want to work and find something that's equitable and fair for taxpayers," Warren said.

Contact staff writer Scott Marshall at (760) 631-6623 or smarshall@nctimes.com.