February 7, 1984

Mr. Glenn L. Roth 
Hutchinson County State's Attorney 
Box 137 
Olivet, South Dakota 57052

OFFICIAL OPINION NO. 84-10

County liability for out-of-state medical expenses of indigent county resident

Dear Mr. Roth:

You have requested an official opinion from this office based on the following factual situation:

FACTS: 

The Hutchinson County Board of Commissioners was presented with hospital and clinic bills from an out-of-state hospital and medical clinic for the treatment of a Hutchinson County resident, who was hospitalized and treated for cancer at their facilities.  The Hutchinson County resident is indigent and thus qualified for county poor relief, pursuant to SDCL ch. 28-13.  The out-of-state hospital and clinic applied for reimbursement for services rendered for the care and treatment of the resident indigent.  A local physician referred the patient to the out-of-state hospital and clinic. 

Pursuant to SDCL 28-13-27, a "hospital" is defined as follows: 

"Hospital," any hospital in the state of South Dakota, duly licensed by the state department of health, serving the public as such, and providing hospitalization for the sick and injured. 

Nowhere under SDCL ch. 28-13 does it require that a county in the State of South Dakota pay for medical and hospital expenses incurred outside the State of South Dakota and thus, it would seem that an out-of-state hospital or clinic would not be entitled to receive any reimbursement from the county pursuant to the county poor relief statutes.

Based on the above factual situation, you have asked the following questions:

QUESTIONS: 

1.  Is Hutchinson County obligated to reimburse an out-of-state hospital and clinic for the care and treatment of an indigent resident under SDCL ch. 28-13, county poor relief statutes? 

a)  Would it make a difference if a local physician had referred the resident to an out-of-state hospital or clinic? 

2.  If Hutchinson County is not obligated to pay for these costs of hospitalization and treatment, then can an out-of-state hospital or clinic refuse to admit or administer treatment to an out-of-state indigent, who is in need of a care and treatment?

There is nothing in the above factual situation that indicates that the out-of-state hospital and clinic provided emergency medical care.  Therefore, this opinion will deal with the provisions of ch. 28-13 as they pertain to non-emergency treatment only.

SDCL 28-13-32.1 provides as follows: 

In order for a person to be entitled to poor relief assistance in non-emergency cases, as defined in § 28-13-27, he must make or there must be made, on his behalf, an application to the board of county commissioners. The application must be made prior to the time the care is provided or as soon thereafter as the person providing the care becomes aware that the  patient may be eligible for poor relief assistance under this chapter.  The board of county commissioners may approve, reject or modify any application for poor relief.

In addition, SDCL 28-13-32.2 provides that: 

The application required in §28-13-32.1 shall include, but is not limited to, the following: 

(1)  Nature and degree of severity of the illness; 

(2)  Anticipated diagnostic or therapeutic services required, the      location the services are to be provided, and estimated cost of services based on the information available at the time   of the application. (Emphasis added.)

It is apparent that the Board of County Commissioners may reject any application for non-emergency medical assistance.  In addition, the indigent's application for medical treatment must include the above information. Accordingly, assuming that the situation presented in this matter was not an emergency, that the county commissioners were not notified prior to the provision of medical services that such services would be provided by out-of- state facilities, and that the county commissioners did not approve such services prior to their provision to the county resident, Hutchinson County is not required to pay.

In answer to Question No. 1, Hutchinson County is not obligated to reimburse  an out-of-state hospital or clinic for the care and treatment of an indigent resident under SDCL ch. 28-13, county poor relief statutes.  As to Question No. 1a, the fact that a local physician had referred the resident to the out-of- state hospital or clinic does not obligate the county to pay unless, of course, the county commissioner were notified of and approved payment for the out-of- state services prior to their provision.

Finally, in answer to Question No. 2, as Hutchinson County is not obligated to pay for these costs of hospitalization and treatment, an out-of-state hospital or clinic may refuse to admit or administer treatment to an out-of- state indigent in need of medical care.

Respectfully submitted,

Mark V. Meierhenry
Attorney General