February 25, 1987
Julie T. Lovrien
Brown County Deputy State's Attorney
Brown County Courthouse
Aberdeen, South Dakota 57401
OFFICIAL OPINION NO. 87-07
Indigent Hospital Care
Dear Ms. Lovrien:
You have requested an official opinion from this office based upon the following factual situation:
FACTS:
We have been having a lot of medical bills brought to the county by indigents. One of our county requirements is that we obtain the least expensive alternative. If a person is eligible to receive benefits at the Veterans Hospital, that is where the treatment is supposed to occur unless it is an emergency situation. We had an individual who was involved in a motorcycle accident and was taken to the hospital for immediate attention. He sustained a broken leg, and this was treated and he was hospitalized for some other injuries. The doctor said that they were not of an emergency situation, and he could have been transferred. The individual was released some days later and had to go back in for further surgery about two weeks after that. At the time of the hospital admission, he indicated that he had insurance. Nothing was done to ascertain whether or not he qualified for any other services. As it turned out, he was, in fact, a veteran and would have qualified for treatment at the Veterans Hospital. The hospital did give us notice that he was admitted under an emergency treatment. As I stated earlier, the doctor advised us that he, in fact, was stable enough and could have been transferred.
Based upon these facts, you have asked the following question:
QUESTION:
Is the hospital under an obligation to ascertain whether or not services were available elsewhere?
For the purposes of this opinion, I will assume the accident victim to whom you refer was poor and indigent. Every county has a duty to relieve and support such persons who reside within its boundaries. This duty flows from state statute, not the common law. Sioux Valley Hospital Assn. v. Bryan, et al., No. 15359 (S.D. January 14, 1987). "Any liability of County for care provided to these indigents must be found in the applicable statutes or not at all." Sioux Valley Hospital Assn. v. Davison County, 298 N.W.2d 85, 87 (S.D. 1980).
Said statutes impose a specific duty on the counties to provide hospitalization, medical care and treatment for poor persons. Sioux Valley Hospital Assn. v. Bryan. et al., slip op. at 3, citing SDCL 28-13-27. This is accomplished through a statutory scheme whereby counties reimburse hospitals for their costs incurred in treating indigents. See SDCL ch. 28-13.
Your facts establish initial emergency hospitalization of an indigent person. In such a case, the county will not be held liable unless it receives notice of said hospitalization within fifteen days of admittance. SDCL 28-13-34. Such notice must include the name of the attending physician as well as an application for poor relief assistance. Id. In turn, the application must contain the location
of the services to be provided. SDCL 28-13-32.2. You indicate, and I will presume, that the county received this notice. Thereafter, if the county, through any duly authorized officer or employee, makes a reasonable arrangement for adequate and suitable care and removal of such indigent person elsewhere and notifies the hospital in writing, and if the hospital unreasonably fails or refuses to extend cooperation to effect such changed arrangement, the county will not be liable for any hospitalization subsequent to the hospital's failure or refusal to cooperate. SDCL 28-13-35.
Thus, it is the county's, not the hospital's, burden to arrange substitute hospitalization. Inasmuch as there is no statute to the contrary, I believe the county bears the concomitant burden of ascertaining whether an indigent qualifies for other treatment which would give rise to such substitute hospitalization.
Arguably, the county could contend that the subsequent nonemergency care was controlled by SDCL 28-13-32.1. That statute sets forth:
In order for a person to be entitled to poor relief assistance in non-emergency cases, as defined in ยง28-13-27, 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.
However, the very application referred to had presumably already been submitted under the emergency circumstances and SDCL 28-13-34. In any event, the board of county commissioners receives the application and applies its discretion thereto. This indicates to me that the county must shoulder the burden of investigating the applicant. In the words of my predecessor, "[I]t is the obligation of county commissioners to act on applications; delays in making decisions can only further confuse the problems." Official Opinion No. 78-08.
Thus, whether the board of county commissioners received notice in an emergency or nonemergency situation, the burden remained on the county to determine if the indigent qualified for adequate and suitable services available elsewhere. Once such a determination is made, the county may go ahead and choose the means by which hospitalization, medical care and treatment are to be provided. Jerauld County v. St. Paul-Mercury Indemnity Co., 76 S.D.1, 71
N.W.2d 571, 574 (1955), citing the predecessor of SDCL 28-13-16.
Such a position is consistent with other sections of Chapter 28-13 and judicial interpretations thereof. SDCL 28-13-28 requires hospitals to file a Statement of Reimbursement Costs with the Secretary of Health. This statement shows the costs to the hospital of standard quarters, board and hospital services furnished to patients. SDCL 28-13-28. Such costs as set forth in the statement
will be deemed the "actual costs" for the purposes of Chapter 28-13. In turn, the county must reimburse the hospital for its "actual costs." Sioux Valley Hospital Assn. v. Davison County, at 87. In doing so, the county will be bound by the figures in the hospital's statement of reimbursement costs, unless it has objected to said figures under SDCL 28-13-32. Sioux Valley Hospital Assn. v.
Bryan. et al., slip op. at 6. Thus, it is only prudent for the county to promptly ascertain if an applicant for poor relief is entitled to other, less expensive treatment.
Based on the foregoing, the answer to your question is no.
Sincerely,
Roger A. Tellinghuisen
ATTORNEY GENERAL
