CITIES ‑- COUNTIES ‑- DEPARTMENT OF HEALTH ‑- JAILS ‑- JUVENILE DETENTION HOMES ‑- MEDICAL CARE

AGO 1953 No. 99 - Jul 24 1953

Attorney General Don Eastvold

CITIES ‑- COUNTIES ‑- DEPARTMENT OF HEALTH ‑- JAILS ‑- JUVENILE DETENTION HOMES ‑- MEDICAL CARE

1. When an inmate of a city or county jail becomes ill or is injured and requires medical attention, being unable to pay for the services and not a recipient of public assistance, the city or county, i.e., the confining authority, is responsible for furnishing the medical services required.

2. When a ward in a juvenile detention homes becomes ill or is injured and the juvenile's parents are not financially able to provide the medical care and the juvenile is not a recipient of public assistance, the juvenile detention home shall provide the necessary medical services.

3. In the absence of a city ordinance or county resolution requiring the city or county to do so, cities or counties are not bound to arrange emergency medical care for those without funds, but not recipients of public assistance, but may very properly do so, and if either does so the cost is to be borne by either the city or county actually arranging or contracting the emergency medical service.

- - - - - - - - - - - - -

July 24, 1953

Honorable Hugh H. Evans
Prosecuting Attorney
Spokane County
Spokane, Washington Cite as: AGO 53-55 No. 99

Dear Mr. Evans:

You have requested our opinion upon the following questions:

"1. When an inmate prisoner of a city or county jail becomes ill or is injured and requires medical attention and such prisoner is not financially able to pay for the services and is not a recipient of public assistance, who is responsible to furnish the medical services required?

"2. When a juvenile ward in the juvenile detention home becomes ill or is injured, who shall provide the necessary medical services in the event the juvenile's parents are not financially able to provide the medical care and the juvenile is not a recipient of public assistance?

"3. When the city police or the county sheriff find an ill or injured person requiring emergency medical care within the county and said person is without financial means to pay for medical service and is not a recipient of public assistance, who shall provide the required medical services and bear the costs thereof?"

[[Orig. Op. Page 2]]

Our answers to the respective questions may be summarized as follows:

1. The city or county, i.e., the confining authority.

2. The county juvenile detention home.

ANALYSIS

Question No. 1:

RCW 36.63.060 provides in part as follows:

"Jail rules prescribed by superior judge. The judges of the superior courts of the several counties may, from time to time, prescribe in writing, rules for the regulation and government of the jails, upon the following subjects:

"* * *

"(5) The employment of medical and surgical aid when necessary; * * *"

We believe the foregoing statute was intended to apply only to county jails.

The initial responsibility for paying for medical services rests with the person receiving them, even though he be an inmate of a city or county jail. If the confining authority does not arrange for medical services, and they are procured by the inmate, under the general rule, and in the absence of some expressed provision of law, the public would not be liable to the physician or surgeon for the services even though the inmate was insolvent and unable to pay for them himself. 41 Am.Jur. 900.

In answering the question posed, the realities and practical effects of confinement in a jail must be considered. The practicalities often make it necessary for persons taken into custody to be examined immediately by a physician. Some of the cities and some of the counties already have provision for this. In our opinion, it is incompatible with our present day social and governmental standards for a civil unit utilizing authority to take or maintain an individual in confinement to be unprepared to provide to a confined person, in the event of its necessity, medical care of the standards of availability and professional quality generally existing in the particular community.

This is not to say that a confinee to whom such service is not provided, or is negligently provided, shall be able to recover from the city or county in damages. The confinement of prisoners appears to be a governmental function [[Orig. Op. Page 3]] in the exercise of which state, county and municipal governments are afforded a large measure of immunity from suits.

You refer to chapter 5, Laws of 1953, extraordinary session, which has been considered. That law reads in part as follows:

"Section 1. On and after April 1, 1953, administrative responsibility for providing for needed medical, dental and allied services to recipients of public assistance and medical indigents shall be the responsibility of the state department of health. 'Medical indigents' are persons without income or resources sufficient to secure necessary medical services.

"Sec. 2. The determination of eligibility of recipients for public assistance shall be the responsibility of the department of public assistance and that department shall promptly notify the department of health of the names of persons who are eligible and those who are no longer on the eligible list. Eligible persons shall be entitled to medical services as defined by the welfare medical care committee.

"The determination of eligibility of medical indigents shall be the responsibility of the department of health in accordance with the standards established by the welfare medical care committee. The department of health is empowered to employ the necessary personnel to carry out the standards established."

The responsibility of the Department of Health to provide medical care for any individual normally does not commence until the individual has been found and declared eligible either by the Department of Public Assistance, or by the Department of Health as a medical indigent, pursuant to the standards presently or hereafter established by the Welfare Medical Care Committee. An examination of the regulation promulgated by that Committee indicates that the committee did not intend to provide medical care for persons confined in city or county jails. An example indicating that this type of service was not considered to be within the contemplation of the state medical care program is the regulation that an applicant for medical care only shall not be eligible if the estimated cost of the needed care is less than $50. Probably the needed care for most individuals confined in jail would be less in cost than the eligible figure mentioned.

Clearly there was no intention by the legislature in adopting chapter 5, Laws of 1953, extraordinary session, to transfer from the many institutions maintained by the state and other governmental units to the State Health Department, responsibility for the medical care of the inmates of all those institutions.

Accordingly, it is our conclusion that general considerations of public welfare require a civil confining authority to have available medical care of the standards of availability and professional quality generally existing in the particular community, for its prisoners, and if the particular prisoner [[Orig. Op. Page 4]] is not financially able to pay for the services and is not a recipient of public assistance, that such services should be paid for by the confining authority.

Question No. 2:

When children are found to be delinquent and dependent, "their persons shall be subject to the custody, care, guardianship and control of the court as hereinafter provided." RCW 13.04.020. Subsequent sections of the statute provide for the payment of the juvenile probation officers, financial support for the child, and the acquisition and maintenance of staff and facilities for the care of wayward children by the counties. RCW 13.04.050, 13.04.100 and 13.16.040.

In view of these statutes and the considerations set out in the discussion of Question No. 1, we conclude that when a ward in a juvenile detention home becomes ill or is injured, the county, through the juvenile detention home, shall provide the necessary medical services in the event the juvenile's parents are not financially able to provide the medical care and the juvenile is not a recipient of public assistance.

Question No. 3:

RCW 74.04.040 provides in part:

"The several counties of the state are charged with the responsibility, through their respective board of county commissioners, for the administration of public assistance to (needy) persons, but they shall be subject to state supervision as in this chapter provided."

The foregoing statute refers to recipients of public assistance. This category of persons is specifically excluded from all three questions upon which an opinion was requested.

RCW 36.39.020 provided that a county should be responsible for the medical and other care of any person not a pauper who fell ill in the county. Sweet Clinic v. Lewis County, 154 Wash. 416 (1929); St. Luke's Hospital v. Stevens County, 181 Wash. 360 (1935). This statute was expressly repealed in section 16, chapter 5, Laws of 1953, extraordinary session. Accordingly, it appears that there presently is no statute expressly designating any responsibility for emergency medical care, unless the ill or injured person is a recipient of public assistance or meets the eligibility standards established by the Welfare Medical Care Committee, pursuant to chapter 5, Laws of 1953, extraordinary session. However, even while RCW 36.39.020 was in effect, some cities did, and still do, maintain facilities and provide emergency medical care for those suffering accident or injury in the city. This clearly appears to be a right, but apparently not an expressed duty, of both cities and counties and is in the interest of the general welfare.

In view of these considerations, it is our opinion that, in the absence of a city ordinance or county resolution, cities or counties are not bound to arrange emergency medical care for those without funds but not recipients of [[Orig. Op. Page 5]] public assistance, but either may very properly do so, and if either does so that the cost is to be borne by either the city or the county actually arranging or contracting for the emergency medical service.

Any prior opinions inconsistent herewith are hereby overruled.

Very truly yours,

DON EASTVOLD
Attorney General

HENRY HECKENDORN
Assistant Attorney General