BILL ANALYSIS



C.S.H.B. 2979
By: Hamric
5-3-95
Committee Report (Substituted)


BACKGROUND

Currently, a non-indigent prisoner in county jail is responsible
for any medical services he or she receives except when they are in
a hospital under guard by the county.  The county is responsible
for guarding an individual who is injured during the act of a crime
or an arrest.  Then the inmate is taken to the appropriate medical
facility at the discretion of the emergency medical service.  When
the medical facility takes in the patient the county becomes
responsible, regardless of the arresting agency or financial
situation of the prisoner, for all medical costs incurred.

This has created a fiscally unsound situation for Harris county. 
The county is exposed to unlimited liability for the costs of
emergency and trauma medical care rendered by third party health
care providers to indigent and non-indigent prisoners.  Within the
past two years there have been 31 claims totaling 4 million dollars
filed against Harris County.  Twenty-seven are filed by just one
hospital.  

PURPOSE

The purpose of this legislation is to ensure that laws which relate
to the payment of prisoner health care are uniform in all
instances.  CSHB 2979 would require the prisoner, if financially
able, to pay for any medical services. 

In addition, it would require all indigent persons who are
prisoners in a county jail or kept under guard by the county to
receive medical services from a county jail, county hospital,
hospital district, or mandated provider as defined in Section
61.002, Health and Safety Code.  This would eliminate third party
health-care provider claims against the county and provide the
county with cost control over all medical services for which the
county is financially responsible.

RULEMAKING AUTHORITY

It is the committee's opinion that this bill does not expressly
grant any additional rulemaking authority to a state officer,
department, agency or institution.

SECTION BY SECTION ANALYSIS

     SECTION 1.  Amends Article 104.002, Code of Criminal
Procedure, by amending Subsection (d) and adding Subsection (e). 
Subsection (d) is amended to require prisoners who are kept under
guard by the county to be financially responsible for any medical,
dental, or health related services they receive.  In addition, this
subsection allows any health care provider which renders services
to a prisoner or person kept under guard to seek payment for those
services only from the prisoner or a person or a natural person who
is responsible for payment for the prisoner.

This Section deletes language which provides the county with the
"right of subrogation" for all prisoner health care costs.  It is
under this "right of subrogation" which the courts have interpreted
counties liable for all health care costs for persons or prisoners
under guard by the county.  

Subsection (e) is added to require all medical, dental, or health-related services provided to an indigent person who is in prison or
under guard by the county jail system public hospital, hospital
district or mandated provider.

     
     SECTION 2.  Effective Date.  This Act takes effect September
1, 1995.

     SECTION 3.  Emergency Clause.

COMPARISON OF ORIGINAL TO SUBSTITUTE

In Subsection (d), CSHB 2979 clarifies that a non-indigent prisoner
in a county jail kept under guard by the county in any medical
facility is financially responsible for all health-care costs,
regardless of the health care provider. 

In CSHB 2979, Subsection (e) is substituted to require that all
indigent prisoners who are in a county jail or kept under guard by
the county receive medical services from the facilities of a county
jail, county hospital, hospital district, or mandated provider as
defined by Health and Safety Code, Section 61.002. 

The original Subsection (e) did not require indigent prisoners to
be treated by the county hospital, hospital district, or mandated
provider, but said that the county would only pay for indigent
prisoners who were treated by these providers.  If third party
providers treated these indigent persons then they would seek
reimbursement as provided by Chapter 61, Health and Safety Code.

Subsection (f) is deleted from CSHB 2979.

SUMMARY OF COMMITTEE ACTION

HB 2979 was considered by the County Affairs Committee in a public
hearing on 4/26/95. Representative Hamric opened. The following
people testified for HB 2979: Dori Wind, representing herself and
Harris County and the Harris County Hospital District; and Angela
Mogan, representing herself; and Virginia Scott, representing
herself; and Mike Quinn, representing himself and Harris County
Sheriff Klevenhagan; and Leonard Spearman, representing Harris
County Judge Eckels and the commissioners court. The chair
recognized the following person to testify against HB 2979: Randal
Payne, representing himself and the Texas Hospital Association.
Representative Hamric closed. HB 2979 was left pending. HB 2979 was
considered by the County Affairs Committee in a public hearing on
5/3/95. The County Affairs Committee considered a complete
committee substitute. The substitute was adopted without objection.
HB 2979 was reported favorably, as substituted, with the
recommendation that it do pass and be printed and be placed on the
Local and Consent Calendar, by the record vote of 5 ayes, 0 nays,
0 pnv, 4 absent.