July 27, 1987
Mr. Douglas N. Papendick
Davison County State's Attorney
Davison County Courthouse
Mitchell, South Dakota 57301
OFFICIAL OPINION NO 87-26
Indigent hospital care
Dear Mr. Papendick:
You have requested an official opinion from this office based upon the following factual situation:
FACTS:
An individual was admitted to Methodist Hospital (Methodist) on March 1, 1987, with chest pains. On March 4, 1987, after the person was stabilized, he was transferred to Sioux Valley Hospital (Sioux Valley). At this time, neither Methodist nor Sioux Valley notified Davison County (County) of the potential indigency of the person.
On March 9, 1987, the person was discharged from Sioux Valley. Subsequently, County received notice from Methodist indicating that a potentially indigent person had been hospitalized. However, no notice has been received from Sioux Valley.
On March 27, 1987, the person came to the County Welfare Office to apply for county assistance. At this time, it was found that he was a veteran and could have been transferred to a veteran's hospital rather than Sioux Valley when he was no longer in a life threatening situation.
Based upon these facts, you have asked the following questions:
QUESTIONS:
1. Is a hospital under an obligation to notify the county when the potentially indigent person is no longer in a life threatening situation so that the county can determine if he qualifies for adequate and suitable services available elsewhere?
2. If so, does the county have any obligation to pay the bill incurred at Sioux Valley Hospital?
INTRODUCTION:
Initially, I believe a statement made by Attorney General Janklow remains applicable today:
I fully recognize that the implementation of these poor relief laws have not been easy or uniform across the state in the past. Much of this is due, in my view, to the lack of specificity in chapter 28-13, which creates too many murky gray procedural areas to wonder about. I would support clarifying legislation in this area and would be willing to help anyone interested in promoting legislation to deal with these problems.
For instance, question No. 1 presupposes that substitute arrangements for indigent patients, as set forth in SDCL 28-13-35, are an option available to the county in nonemergency situations. Based upon a strict construction of chapter 28-13, however, I question whether such an option is available in any situation other than emergency care. If not, I question whether the legislature intended such a result. If so, how may a county utilize substitute arrangements when the application for relief is made after the provider has rendered non-emergency care under SDCL 28-13-32.1? These are just a few of the questions chapter 28-13 leaves unanswered.
IN RE QUESTION NO. 1:
Assumptions:
To properly answer question No. 1, I must make several assumptions these include:
1. That the patient at issue was poor and indigent;
2. That Sioux Valley rendered nonemergency care;
3. That Methodist's notice made no mention of said care provided at Sioux Valley following stabilization of the patient;
4. That, at some point, Sioux Valley became aware that the patient was eligible for poor relief assistance.
Discussion:
Rights and duties in the relief and support of poor persons flow from state statute, not from the common law. Sioux Valley Hospital Ass'n v. Bryan, et al., 399 N.W.2d 352, 354 (SD 1987); Sioux Valley Hospital Ass'n v Tripp County, 404 N.W.2d 519, 520 (SD 1987), quoting St. Paul Ramsey v. Pennington County, 402 N.W.2d 340, 342 (SD 1987), quoting: Sioux Valley Hospital Ass'n v. Davison County, 298 N.W.2d 85, 86 (SD 1980); State of North Dakota v. Perkins County, 69 S.D. 270, 9 N.W.2d 500, 501 (1943); Hamlin County v. Clark County, 1 S.D. 131, 45 N.W. 329, 331 (1890). The statutes impose a specific duty on the counties to provide hospitalization, medical care, and treatment for poor persons. Sioux Valley Hospital Ass'n v. Bryan, et. al., 399 N.W.2d at 354, citing SDCL 28-13-27. That these statutes will be strictly construed is apparent. Sioux Valley Hospital Ass'n v. Tripp County, 404 N.W.2d 519; St Paul Ramsey v. Pennington County, 402 N.W.2d 340; Sioux Valley Hospital Ass'n v. Davison County, 298 N.W.2d 85.
There simply is no provision within chapter 28-13 which obligates a provider to notify the County when a potentially indigent person is no longer in a life threatening situation. Thus, even assuming substitute services were available to the County in this nonemergency situation, the answer to question No. 1, as framed, is NO.
At the same time, however, it is my opinion that the unique facts set forth herein obligated Sioux Valley to notify the County of:
1. The nature and degree of severity of the illness, and
2. The anticipated diagnostic or therapeutic services required, the location the services are to be provided, and the estimated cost of the services.
SDCL 28-13-32.2 Sioux Valley, not Methodist, provided the nonemergency care. As such, Sioux Valley was obligated to provide the above-described in the formation in the form of an application for poor relief assistance under SDCL 28-13-32.1. The application should have been made prior to the time the care was provided or as soon thereafter as Sioux Valley became aware that the patient was eligible for poor relief assistance. Id.
Thus, while chapter 28-13 does not specifically require a provider to notify the County when a potentially indigent person is no longer in an emergency situation, for all practical purposes Sioux Valley was bound to notify the County of the patient's condition and the services required as a result thereof. You indicate that Davison County has received no such notice.
IN RE QUESTION NO. 2:
Sioux Valley's ability to recover costs is entirely governed by statute. Sioux Valley Hospital Ass'n v. Tripp County, 404 N.W.2d at 522. Just as a hospital must furnish notice to the County following emergency hospitalization in compliance with SDCL 28-13-34, Sioux Valley Hospital Ass'n v. Jones County, 309 N.W.2d 835, 837 (SD 1981), so too must Sioux Valley furnish notice in nonemergency situations under SDCL 28-13-32.1. Through no fault of its own, the County did not receive the notice required by our Legislature.
At issue is the expenditure of public funds. Because County was not given notice, there is no statutory provision authorizing the county commissioners to expend funds to pay for any portion of the nonemergency hospitalization rendered by Sioux Valley. Sioux Valley Hospital Ass'n v Tripp County, 404 N.W.2d at 521. Absent a statute authorizing the reimbursement, no liability exists. Id. at 520, quoting St. Paul Ramsey v. Pennington County, 4O2 N.W. at 342, quoting Sioux Valley Hospital Ass'n v Davison County, 298 N.W.2d at 86, quoting State of North Dakota v. Perkins County, 9 N.W.2d at 501.
Sioux Valley may argue that equity requires the County to shoulder the burden of financial responsibility, especially in light of the timely notice of emergency treatment filed by Methodist. Indeed, I recently expressed the opinion that, once the County receives notice of emergency hospitalization, it carries the burden of ascertaining the availability of substitute arrangements. See Official Opinion No. 87-07. I cannot find a similar burden here in light of the County's complete lack of notice regarding care provided by Sioux Valley. In this respect, the two opinions are distinguishable. In any event, Sioux Valley's equitable arguments are best reserved for the legislature. Sioux Valley Hospital Ass'n v. Tripp County, 404 N.W.2d at 522; St. Paul Ramsey v. Pennington County, 402 N.W.2d at 343. See also, Sioux Valley Hospital Ass'n v. Davison County, 298 N.W.2d at 87.
Based on the above, it is my opinion that the County has no obligation to pay the bill incurred at Sioux Valley. While this may be a bitter pill for Sioux Valley to swallow, our Supreme Court has both recognized and condoned draconian ramifications resulting from strict interpretations of chapter 28-13. Sioux Valley Hospital Ass'n v. Tripp County, 404 N.W.2d at 522.
Sincerely,
Roger A. Tellinghuisen
ATTORNEY GENERAL
