COEUR d'ALENE - The Kootenai County commissioners need to iron out significant billing details with Kootenai Medical Center before they inject hundreds of thousands of dollars more into police hold funding, they determined at a meeting on Thursday.

"We just weren't aware of this issue, and it's coming more and more in to light," said Commissioner Jai Nelson of billing complications.

The commissioners had announced this week that nearly the entire fiscal year budget for involuntary police holds has already been depleted. Such holds involve individuals picked up by law enforcement over substance or mental issues being placed at KMC for sometimes days to stabilize.

The commissioners were informed on Thursday that KMC has been submitting bills years after holds occurred.

Pat Raffee, chief deputy clerk, stated that the Clerk's Office discovered this week that several bills from 2008, 2009 and 2010 were not submitted until June or December last year.

The bills total $7,100.

"These are the reason we only have $16,000," Raffee said after the meeting of the county's remaining involuntary hold budget. "Or part of (the reason)."

The shortfall halfway through the fiscal year could also be due to high medical costs for individuals in police holds.

County Finance Director David McDowell said the average cost for four-day holds - the maximum days the county is contracted to fund - is $5,500.

One hold had a total bill of $30,000, he said.

"These costs are extreme," McDowell said, adding that he advised a cap be placed on how much the county covers.

Capt. Dan Soumas with the sheriff's department said he believes the high bills could be due to additional treatment individuals receive during holds, like if they've undergone trauma.

Raffee also said the county had been charged for $700 group therapy sessions for individuals in police holds.

The commissioners agreed their staff needs to meet with KMC managers to renegotiate contract details, like when bills are submitted and where the county draws the line at coverage.

"We've had really good cooperation with the hospital," Commissioner Todd Tondee said of past efforts with KMC. "This is just one of those things we need to get together on and go from there."

Irwin Hurn, CFO of Kootenai Health, reported in a written statement that the organization seeks normal reimbursement for hold services, but receiving payment sometimes takes years.

"Part of the challenge is the complexity of connecting patients with governmental and private agencies that will help cover the cost of medical services," Hurn stated. "Kootenai Health is committed to helping all patients explore payment options."

Idaho law requires counties to fund police holds.

The county has spent $147,500 on holds this fiscal year.

Commissioner Nelson said she was in favor of adding an extra $250,000 to the hold budget now, as there are $82,000 worth of hold bills yet to pay.

"In the interim, you need some more funds," she said, reminding there is a contractual obligation to pay the bills within 60 days.

But Tondee and Dan Green both said they would prefer to meet with KMC first to find if there are other outstanding bills from past years.

"I don't want to do this piecemeal," Green said. "I acknowledge we have bills due, but I want to see the whole pie."