The San Diego police encountered the young man dressed in black in a parking lot. It was after midnight. They requested identification, which quickly turned into a standoff. According to the police account, Robert McBride then turned and ran before spinning around and brandishing what later proved to be a BB gun.
The officers shot him in the chest and called paramedics to take him to the hospital. Though it was their duty to make sure the suspect got medical care, police say it wasn't their duty to put him under arrest or pay his hospital bill.
Yet, because McBride wasn't under arrest, he was able to check himself out of the hospital days after the shooting, leading to a three-hour manhunt by police that included a police helicopter searching with an infrared camera. He remains in custody on a variety of charges, including battery, robbery and being under influence of a controlled substance.
When an individual is wounded or injured in the course of committing a crime — or otherwise being apprehended — law enforcement is responsible for seeking medical care for the suspect without hesitation. But just who picks up the tab has been the subject of a heated debate in California, with both sides citing different parts of the state penal code, and with a lot of money at stake.
Scripps Health President and CEO Chris Van Gorder said the McBride case cost his hospital nearly $300,000 in treating the gunshot wound for the uninsured patient. He said similar cases brought in by law enforcement are a growing fiscal problem for the $2.3 billion, not-for-profit, San Diego-based private health care system.
About 430 patients were admitted to Scripps facilities through law enforcement agencies in the last year, and the hospital was left to foot the bill in the majority of those cases, said Van Gorder.
"We're at the end of the food chain and there's nobody we can pass this on to — and nobody wants to be responsible for the economics," said Van Gorder.
The practice of police not arresting those they send for medical care is a threat to public safety because hospitals are then required to grant the full federal medical privacy rights of a private citizen to the suspect said Van Gorder.
"Technically, if a patient is not arrested, they have confidentiality rights so we actually don't even have the right" to report their discharge to law enforcement, said Van Gorder.
Hospitals point to a section of the California penal code that says sheriffs, police and local detention facilities can't "engage in practices designed to avoid payment of legitimate emergency health care costs for the treatment or examination of persons lawfully in their custody." But that section of the code is scheduled to be repealed in 2014.
In the McBride case, the hospital's argument was bolstered by the explanation of one San Diego officer who told media that McBride had not been arrested so that police could avoid footing the bill.
However, San Diego Police Department Lt. Andra Brown said that the officer's interpretation of the policy was incorrect. She said that though hospitals routinely attempt to bill the department for medical care for suspects, the department just as routinely rejects those bills. In fact, it uses a form letter.
The police letter cites a different section of the penal code that says law enforcement is under no obligation to pay for the medical care of someone who has been arrested "prior to being delivered to and received at the county jail or other detention facility for booking."
"Cities don't have to pay for medical costs prior to being booked in jail, and once they're booked in jail they become the responsibility of the county," said Brown.
That doesn't mean hospitals haven't tried to collect from law enforcement agencies through the courts, based on their interpretation of the law. Scripps joined a 2007 lawsuit brought by another San Diego area hospital, Sharps HealthCare, seeking payment from San Diego County incurred by those in police custody prior to being booked, but the court ultimately sided with law enforcement.
Nick Warner, legislative director of California State Sheriffs' Association says budget woes for law enforcement can't be overstated in California, but that saving lives and responding appropriately to injury is a top priority for any law enforcement officer who encounters a hurt person, criminal or not.
What makes dealing with hospitals difficult is the unpredictable cost of treatment, which can come as a shock to law enforcement agencies when they receive the bill, Warner said.
"Hospitals have very disparate billing practices for law enforcement agencies and public agencies than they do for insurance companies and individuals," said Warner, noting that in some instances law enforcement gets charged more than Medi-Cal or private insurers. "We've seen examples of the same service at the same agency being charged different rates."
Balancing medical costs against the cost of protecting the public daily has put tremendous stress on law enforcement, according to Warner, who notes that in the last year 1,000 deputies were laid off in California.
"We're struggling mightily statewide, so much so that the two places we're trying to focus on are keeping the worst of the worst incarcerated and responding to 911 calls because everything else is being dramatically reduced," said Warner.
The flipside of the problem, in which hospitals struggle to serve an uninsured populace brought in by police, is particularly acute at many border county hospitals, according to Steve Escoboza, who heads the Hospital Association of San Diego and Imperial County which represents 35 hospitals in the region.
There is a lack of county hospitals along the border, and many law enforcement agencies — including the Border Patrol, the FBI and DEA — to provide patients, according to Escoboza.
Van Gorder says the lasting problem at his San Diego hospitals is bad blood between hospitals and law enforcement.
Scripps' finance department struggles to get billing information on the patients once they're taken back into custody by law enforcement, because there is suspicion that the information will be used to bill the sheriff or police departments instead of the criminal who received care, said Van Gorder.
"I understand the governmental budget crises they face today but the problem is they're pushing the financial obligation downhill," said Van Gorder.