No. 88-91 

IN THE SUPREME COURT OF THE STATE OF MONTANA 

1988 

MONTANA DEACONESS MEDICAL CENTER, 

a non profit corporation, 

Plaintiff and Respondent, 

-vsCARL E. JOHNSON, 

Defendant and Respondent, 

and 

CITY OF GREAT FALLS, MONTANA, 

Defendant, Third-Party Plaintiff 

and Appellant, 

-vsCOUNTY OF CASCADE, MONTANA, 

Third-Party Defendant and Respondent. 

APPEAL FROM: District Court of the Eighth Judicial District, 

In and for the County of Cascade, 

The Honorable Joel Roth, Judge presiding. 

COUNSEL OF RECORD: 

For Appellant: 

David V. Gliko, City Attorney, Great Falls, Montana 

For Respondent: 

Sharon M. Anderson, Great Falls, Montana 

Patrick L. Paul, County Attorney, Great Falls, Montana 

For Amicus Curiae: 

David J. Patterson, (MACO) , Missoula, Montana 

James T. Harrison, Jr., (Sheriffs), Helena, Montapa 

Jim Nugent, (MT League of Cities & Towns), Missoula, 

Montana 

Submitted on Briefs: May 26, 1988 

Decided: July 7, 1988 

Filed: 

luc 7 - @ fw~ r".lC -.xPL%r- s.c' 

Clerk 
Mr. Justice John C. Sheehy delivered the Opinion of the 

Court. 

In this case we are asked to determine whether the City 

of Great Falls (City) or the County of Cascade (County) is 

ultimately responsible for medical costs incurred by a person 

in the custody of City Police Officers as a result of a 

felony arrest. The District Court of the Eighth Judicial 

District, Cascade County, determined that the controlling 

factor was the City's custody over Johnson at the time the 

medical expenses were incurred and issued an order dismissing 

the City's third party complaint against the County. We 

reverse. 

The facts, as stipulated by the parties, are as follows: 

1. On January 4, 1987, Johnson was arrested by 

City Policemen. 

2. The officers immediately determined Johnson's 

life was in jeopardy as a result of his ingestion 

of a quantity of prescription pills. 

3. The officers requested an ambulance which 

arrived at the scene of the arrest and transported 

Johnson to Montana Deaconess Medical Center 

(Deaconess) . 

4. Deaconess was advised Johnson was under arrest 

when Johnson arrived. 

5. Johnson incurred reasonable medical charges 

from January 4, 1987, until his release on January 

5, 1987, in the amount of $2,193.13, after two days 

in Deaconess's Intensive Care Unit. 

6. Deaconess made demand for full payment to 

Johnson and Third Party Plaintiff City, and to 

Third Party Defendant County. 

7. The City and County have refused to pay said 

bill. 
8. Johnson admits liability for Deaconess's claim 

but he is indigent and has no present or future 

means to pay the charges. 

9. Johnson was "booked in" in absentia at the 

Police Department on January 4, 1987. 

10. Johnson was released by Deaconess on January 

5, 1987, and transported to the City Police 

Department. 

11. Johnson was detained at the City Police 

Department until his initial appearance on January 

6, 1987, before the County Justice of the Peace and 

subsequently detained in the County Jail. The 

County Jail is operated and managed by the County 

Sheriff's Department. 

12. Initial charges of aggravated assault, 

aggravated kidnapping and sexual intercourse 

without consent, all felony offenses under the 

Montana Criminal Code, were filed in the County 

Justice of the Peace Court (later transferred to 

the District Court) and accepted by the County 

Attorney. No misdemeanor or felony charges of any 

kind were filed with the City Court. 

Generally, persons under official detention have a 

constitutional right to adequate medical care, regardless of 

their ability to pay. City of Revere v. Massachusetts 

General Hospital (1983), 463 U.S. 239, 103 S.Ct. 2979, 77 

L.Ed.2d 605 (due process demands that persons detained by 

government agencies receive adequate medical care; 

responsibility for costs is a matter of state law). 

Consistent with the mandate of the United States Supreme 

Court, the Montana Legislature has adopted legislation 

providing for the care of prisoners. Section 7-32-2222, MCA, 

provides : 

Health and safety of prisoners. (1) When a county 

jail or building contiguous to it is on fire and 

there is reason to believe that the prisoners may 

be injured or endangered, the sheriff, jail 

administrator, or private party jailer must remove 
them to a safe and convenient place and there 

confine them as long as it may be necessary to 

avoid the danger. 

(2) When a pestilence or contagious disease breaks 

out in or near a jail and the physician thereof 

certifies that it is likely to endanger the health 

of the prisoners, the district judge may by a 

written appointment designate a safe and convenient 

place in the county or the jail in a contiguous 

county as the place of their confinement. The 

appointment must be filed in the office of the 

clerk and authorize the sheriff, jail 

administrator, or private party jailer to remove 

the prisoners to the designated place or jail and 

there confine them until they can be safely 

returned to the jail from which they were taken. 

(3) If in the opinion of the sheriff, jail 

administrator, or private party jailer any 

prisoner, while detained, requires medication, 

medical services, or hospitalization, the expense 

of the same shall be borne by the agency or 

authority at whose instance the prisoner is 

detained when the agency or authority is not the 

county wherein the prisoner is being detained. The 

county attorney shall initiate proceedings to 

collect any charges arising from such medical 

services or hospitalization for the prisoner 

involved if it is determined the prisoner is 

financially able to pay. 

Although the City contends that 5 7-32-2222 (3), MCA, 

when viewed in its entirety, indicates that persons charged 

with violations of state law occurring within a county are 

the financial responsibility of that county, we do not find 

the statute to be controlling. By its terms, 5 7-32-2222(3), 

MCA, is not triggered until such time as "the sheriff, jail 

administrator, or private party jailer" determines that a 

detained person requires medical care. In addition, the 

statute, when read as a whole, assumes incarceration in the 

county jail at the time the need for medical care arises. 

Such is clearly not the situation in the instant case. 
Moreover, § 7-32-2222 (3) , MCA, is obviously designed to 

fix financial responsibility for medical costs on the agency 

for which the prisoner is being detained in the county jail. 

This section recognizes that frequently county jails in 

Montana are used to house federal prisoners or persons held 

for violations of municipal laws. 

When confronted with the issue now before us, the courts 

of other jurisdictions have split along two lines of 

reasoning. Under the minority "custody and control" 

approach, the financial responsibility for medical costs is 

determined on the basis of which agency had custody at the 

time the treatment is provided. See e.g. Sisters of the 

Third Order of St. Francis v. Tazewell County (111.App. 

1984), 461 N.E.2d 1064. "[If] physical control is 

[subsequently] transferred [during the course of the 

treatment] the responsibility is transferred along with it 

and the cost of care [is] prorated." Cuyahoga County 

Hospital v. City of Cleveland (Ohio App. 1984), 472 N.E.2d 

757, 759. Few jurisdictions have followed the lead of the 

Ohio and Illinois courts, however. 

The majority "nature of the crime" approach determines 

financial responsibility not on the basis of which agency 

first takes a person into custody, but rather on the basis of 

the crime ultimately charged. See Wesley Medical Center v. 

City of Wichita (Kan. 1985), 703 P.2d 818; L. P. Medical 

Specialists v. St. Louis County (Minn. App. 1985), 379 N.W.2d 

104; Zieger Osteopathic Hospital v. Wayne County (Mich. App. 

1984) , 363 N.W.2d 28; Albany General Hospital v. Dalton (Or. 

App. 1984), 684 P.2d 34; St. Mary of Nazareth Hospital v. 

City of Chicago (Ill. App. 1975), 331 N.E.2d 142; Washington 

Township Hospital District of Alameda County v. County of 

Alameda (1968), 263 Cal.App.2d 272, 69 Cal.Rptr. 442. After 
carefully considering the arguments and authority supporting 

both positions, the Supreme Court of Kansas recently held: 

. . . We have concluded that a city is not 

responsible for the payment of medical expenses 

incurred by an indigent person who is arrested by 

city police and subsequently charged with a 

violation of state law and who, before being 

physically transferred to the county jail, is taken 

to a hospital for necessary medical treatment. We 

hold that so long as an offender is arrested for 

violation of a state law and in due course is 

charged with a state crime and delivered to the 

county jail for confinement, the medical and other 

incidental expenses incurred as a consequence of 

and following his arrest, and until his transfer to 

such facility, are chargeable to the county. We 

further hold that a county's liability for charges 

and expenses for safekeeping and maintenance of the 

prisoner, including medical expenses, does not 

depend on which police agency happens to be called 

to the scene of the alleged crime or whether such 

expenses were incurred before or after he is placed 

in a county jail. The controlling factor is that 

the prisoner was arrested and subsequently charged 

with violation of a state law. 

Wesley Medical Center, 703 P.2d at 824. We agree. 

A county is the largest subdivision of the state. 

Section 7-1-2101, MCA. Consequently, the county is vested 

with the primary responsibility of enforcing the laws of the 

state and maintaining facilities in furtherance of that task. 

See, SS 7-4-2716, 7-32-2201, MCA. Sound reasoning dictates 

that the performance of the county's task necessarily 

includes the assumption of the associated financial burden. 

We, therefore, hold that the county is financially 

responsible for medical costs incurred by a detained person 

ultimately charged with a violation of state law but who is 

unable to pay. The judgment of the District Court is 

reversed and remanded for proceedings consistent with this 

Opinion. 
We Concur: A' 

Chief 'Justice 

,A&- e &AJustice