Vol. 22 No. 19- Medical costs of arrestees – who pays before booking?


On November 15, 2007 the California Court of Appeal, Fourth District, issued a ruling which substantially changes what had been law, and practice, in California for many years.  In the case of Sharp Healthcare, et al, v. County of San Diego, 2007 Cal. App. LEXIS 1858, the court held that “.the County is not liable for the medical care expenses of a person arrested and treated at a hospital before the arrestee is committed to the county jail.”  The Court ruled that a city is not liable for those costs, either.

The Court stated, “in addition to precluding imposition of liability on a county, subdivision (c) of [Penal Code] section 4015 precludes holding a city liable for the medical cost expenses when city personnel transport the arrestee to the hospital.” The Court noted that, in 1992, the Legislature significantly amended Pen. Code § 4015 and included, among other changes, subdivision (d) which states that “it is the intent of the Legislature . to ensure that the costs associated with providing medical care to an arrested person are borne by the arrested person’s private medical insurance or any other source of medical cost coverage for which the arrested person is eligible.”

The Court also refers to a letter from the Governor, published in the Senate Journal, which stated, in part, that the amended “legislation would . clarify that cities shall not be liable for medical costs which accrue as a result of a city peace officer transporting an arrested person to the hospital prior to booking them into the county jail..”

Sharp Memorial Hospital sued the San Diego County Sheriff and the County of San Diego after being notified that the County, despite a long history of so doing, would no longer pay for medical care of those persons arrested by law enforcement agencies and treated at a hospital before the arrestee is committed to the county jail.  The court noted that, “the fact that after the amendment the County continued to voluntarily . pay for their hospital expenses does not translate into a duty to do so..”

A County’s Obligation

It was generally agreed that, prior to July 2003, “when an arrestee was in need of medical care before being booked into county jail, the County booked the arrestee ‘in absentia’ and paid for the arrestee’s hospital expenses.”  Additionally, the County did not dispute that it was legally required, pursuant to Pen. Code § 4015, to pay for the medical care of arrestees after they were booked into the county jail.  The primary issue was whether the 1992 legislative changes to that section changed the county’s obligation or choice to cover those expenses?

In 1968, in Washington Township Hospital District v. County of Alameda, 263 Cal. App. 2d 272, the Court of Appeal had ruled that Gov. Code § 29602 provided statutory authority to hold counties responsible for medical expenses of an arrested person who was sent to a hospital for treatment before being committed to the county jail.  Gov.Code § 29602 sets forth county charges associated with jail inmates, and criminal proceedings, and defines those charges as including “expenses necessarily incurred in the support of persons charged with or convicted of a crime and committed to the county jail….” (Emphasis added.)

In 1963, the California Attorney General issued an opinion concluding that, under Gov.Code § 29602, a county was responsible for an arrestee’s medical expenses even though the arrestee had not yet been actually “committed” to the jail.

The Sharp court noted that, “the Attorney General reasoned that because the sheriff had a dutyunder section 4015 to receive arrested persons taken to the jail , and because a county’s duty to support inmates under Gov. Code § 29602 applied to medical care, the county should be responsible for the arrestee’s hospital expenses even though he had not yet been committed to the jail.” (Emphasis added.) Furthermore, “in a 1975 Attorney General opinion citing [theWashington Township rule], the Attorney General noted that [it’s opinion] was derived from a liberal interpretation of Gov. Code § 29602 and predicated on a county’s duty to receive, support, and maintain arrested persons.”

Current Law

The 1992 amendments to section 4015, however, removed the previous obligation for a sheriff to accept an arrestee who was in need of medical assistance.  As the Sharp court states, “we agree that the 1992 amendment evinces a legislative intent to eliminate the County’s duty to provide for the medical care of pre-commitment arrestees.”  In addition, in 1992, the Legislature amended Gov. Code § 29602 to allow counties to seek reimbursement from a jail inmate’s private medical insurance for the county’s payment of the inmate’s medical expenses.

The Court holds that, “by stating that an arrestee’s medical costs be paid by private insurance, or other sources of coverage, the Legislature has confirmed that the elimination of a county’s duty to receive arrestees in need of immediate medical care abrogates the Washington Township rule requiring the county to pay for these expenses.”

The Court also acknowledges that there will be instances where an arrestee will not have any source of medical expense coverage, and that the Legislature did not address what happens in those cases, nonetheless the amendments to Gov. Code §4015 preclude “.imposing a mandatory obligation on a county to pay for these expenses.”


If, in the past, your agency has budgeted for such medical expenses, that will no longer be necessary.  Neither the city arresting the person in need of medical treatment, nor the county “receiving” the arrestee, are liable for the medical costs incurred prior to booking the arrestee into the county jail.

So, who pays?  According to the court – private insurance will pay the bill.  But, as noted above, the court also recognizes that many, if not most, arrestees will not have access to private medical insurance.  Nonetheless, Health & Saf. Code § 1317 requires that hospitals with emergency rooms provide care to any person who “is in danger of loss of life, or serious injury or illness….”

Section 1317 further states that “emergency services and care shall be rendered without first questioning the patient or any other person as to his or her ability to pay therefore.” It is up to the hospital “to determine whether an emergency exists” and if that hospital does not maintain an emergency department it must direct the person needing emergency care to a nearby facility which can provide such service.

It appears, therefore, that the burden is on the hospital to provide emergency service to pre-commitment arrestees who meet the definition set forth above, and/or refer them to a hospital with an emergency room. Subsequently the hospital can seek to recover costs incurred from the arrestee’s insurance coverage, if it exists. In any event the cost of such medical treatment for pre-commitment arrestees is not the obligation of a county or city.

As always, it is imperative to seek the advice and guidance of your individual legal counsel when confronted with legal issues. However, if you wish to discuss the case set forth above, in greater detail, feel free to contact me at (714) 446 – 1400 or by e-mail at mjm@jones-mayer.com.