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California Slowed, But Not Barred from “Dumping” Sick, Indigent Parolees on Public Hospitals

On May 26, 2023, California’s Fifth Appellate District Court of Appeals largely agreed with a lower court’s ruling that barred the state Department of Corrections and Rehabilitation (CDCR) and its healthcare arm, California Correctional Health Care Services (CCHCS), from paroling prisoners with serious medical needs only to “dump” them on a public hospital. But the Court provided the prison system an off-ramp that will likely accomplish the same result: Stick the hospital with a poor, sick parolee, along with the bill for his treatment.

When parole eligibility arrives for a prisoner who is “medically compromised,” CDCR and CCHCS contact the prisoner’s family, the federal Veterans Administration, if applicable, as well as skilled nursing facilities and other resources to find suitable post-release housing. If unsuccessful, CDCR then searches out a local safety net hospital that provides care for indigent patients, sending the parolee there.

Four medically compromised prisoners were paroled to Kern County between August and December 2020, during the COVID-19 pandemic. All required skilled nursing care. CDCR and CCHCS staff contacted the county’s counsel seeking to place them at Kern Medical Center (KMC). Counsel replied that KMC is an acute care hospital which does not provide long-term or skilled nursing care. It is also not owned by the county—in fact the county operates no hospitals or nursing facilities. Moreover, only one of the parolees had previously lived in Kern County.

Nevertheless, the prisoners were paroled and dropped off at KMC’s emergency room—even though the hospital “did not accept a transfer of the parolees or agree to admit them, and [CDCR] did not arrange for their admission to KMC,” the Court later recalled. The parolees were admitted, though, since they could not care for themselves; one later died, while the hospital found long-term placements for the other three.

The Kern County Hospital Authority, which operates KMC, then sued CDCR in state superior court, which issued an injunction barring prison officials from transferring parolees to one of the Authority’s hospitals without making prior arrangements, except in cases involving an actual medical emergency. The same court later entered a permanent injunction after noting the CDCR “may not commit ‘illegal patient dumping’” by delivering parolees to an emergency room without the hospital’s prior agreement. CDCR appealed, arguing it did not need consent.

The Fifth Appellate District Court of Appeals affirmed the lower court’s conclusion, though it modified the injunction, finding it overbroad. The appellate court wrote that the California Code of Regulations, Chapter 12, title 22, § 79789, requires licensed CDCR medical facilities “to maintain written transfer agreements” with acute care hospitals, and provides that “[n]o patient shall be transferred … unless arrangements have been made in advance for admission to such a health facility.” CDCR also had its own regulations requiring that prisoner transfers include communication with the receiving medical care facility, with “written documentation accompanying the patient.”

CDCR argued that once medically compromised prisoners were paroled they must be released somewhere. Nevertheless the Court of Appeals found it was “undisputed [CDCR] did not comply with regulation 79789(b) when transferring the parolees to KMC.” That regulation, the Court held, applied both to “inmate patients” as well as parolees. Additionally, it requires a mutual agreement between CDCR and the hospital to admit a paroled prisoner.

To the extent that parolees have a right to be released from custody even if an agreement to accept them at a safety net hospital or skilled nursing facility cannot be obtained, the appellate court remanded the case to modify the injunction. Parolees may opt to remain in prison medical facilities as a patient until a skilled nursing or other medical facility agrees to accept them. Or they may decline further care at CDCR medical facilities when reaching release and request to be medically discharged; at that point CDCR can drop them off at an emergency room without the hospital’s consent. A request for the state Supreme Court to hear the case was then denied on August 16, 2023. See: Kern Cty. Hosp. Auth. v. Dep’t of Corr. & Rehab., 91 Cal. App. 5th 1313 (2023); and 2023 Cal. LEXIS 4531.

The ruling is a setback for public hospitals, allowing CDCR to continue “dumping” released prisoners with serious medical needs at emergency rooms if they ask to be discharged from CCHCS facilities—something CDCR has every incentive to encourage, since that shifts their high treatment costs from the prison system to a local hospital.   

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Related legal case

Kern Cty. Hosp. Auth. v. Dep’t of Corr. & Rehab.