COUNTY HOSPITALS ‑- EMPLOYMENT OF RADIOLOGIST ‑- ADMISSION OF PATIENTS

COUNTY HOSPITALS ‑- EMPLOYMENT OF RADIOLOGIST ‑- ADMISSION OF PATIENTS. 

The Board of County Commissioners may employ a radiologist to serve a county hospital on a contract based on a fixed percentage of X-ray charges at such hospital.  While the county hospital's primary responsibility is to the indigent, it may also accept paying patients and must accept bona fide emergency patients.

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                                                                  March 27, 1953 

Honorable John Panesko
Prosecuting Attorney
Lewis County
Chehalis, Washington                                                                                                              Cite as:  AGO 51-53 No. 504

 Dear Sir:

            You have inquired:

             (1) Whether or not the commissioners of Lewis County may employ a radiologist and agree to pay him 40% of all X-ray charges made in the hospital, including both private and county patients.

             (2) Does the county have the legal right to operate a hospital for the primary purpose of taking care of private patients?

             (3) Who is entitled to enter a county hospital at public expense and receive care free of charge?

             (4) Is the county hospital required to accept every so-called emergency case and, if not, which ones can be refused by the hospital?

             It is our conclusion that your first question may be answered, yes; your second question, no.  Your third question, we would limit to the indigent sick, indigent injured, and indigent maternity cases, as defined in the analysis, infra.  As to  [[Orig. Op. Page 2]] the discretion of the hospital authorities to accept or reject emergency cases, it appears that the Board of County Commissioners is vested with authority to prescribe rules for admission, provided that preference be given to those unable to pay for private institutional care.

                                                                      ANALYSIS

             RCW 36.62.010, as derived from Laws of 1925, Ex. Sess., section 1, chapter 174, reads in part as follows:

             "The board of county commissioners of any county may establish, provide, and maintain hospitals for the care and treatment of the indigent, sick, injured, and maternity cases, and for this purpose the board may:

             "* * *

             "(3) Use county moneys, levy taxes, and issue bonds as authorized by law, to raise a sufficient amount of money to cover the cost of procuring the site, constructing and operating hospitals, and for the maintenance thereof and all other necessary and proper expenses; * * *"

             The value of X-ray equipment in modern medicine has long been recognized.  To secure the services of a competent radiologist on the most satisfactory terms is not only proper but vital to the proper staffing of any hospital.  Certainly, a radiologist in entering into a contract with a county hospital for an indeterminate amount of professional services to be rendered is entitled to be compensated for his services to the indigent as well as the paying patients.

             This office has consistently adhered to the position that a county may admit paying patients to the county hospital.  RCW 36.62.100 relates to the priority of admission of patients to county hospitals.  It provides in part as follows:

             "Patients shall be admitted to such hospitals in accordance with rules to be established by the board of county commissioners, but such rules shall provide that preference in the admission of patients shall be given to those unable to pay for their care in private institutions.  * * *"

              [[Orig. Op. Page 3]]

            The remainder of the cited section has to do with relative responsibility and recovery provisions and concludes with this provision:

             "* * * If the superintendent finds that the patient, or his relatives, are not able to pay, either in whole or in part, for his care and treatment in such hospital, he shall be admitted free of charge."

             However, hospitals of two hundred or more beds are managed by rules and regulations promulgated by a board of trustees appointed by the county commissioners under the provisions of RCW 36.62.110et seq., as derived from chapter 139, Laws of 1931.  The scope of this opinion is limited to county hospitals of less than two hundred beds.

             There appears to be no Washington case which defines the class of persons admissible to county hospitals.  InGoodall v. Brite, 11 Cal. App. (2d) 540, 54 P. (2d) 510, at 513, the court said:

             "'Indigent,' when used in connection with admissions to county hospitals, includes an inhabitant of a county who possesses the required qualifications of residence, and who has insufficient means to pay for his maintenance in a private hospital after providing for those who legally claim his support."

             The California cases hold that a county is authorized only to furnish hospitalization to those who cannot secure it elsewhere.  Goodall v. Brite, supra, andLatham v. Santa Clara County Hospital, 513 P. (2d) 513.  However, the California statute relating to admissions to county hospitals reads as follows:

             Every county and every city and county shall relieve and support all incompetent, poor, indigent persons and those incapacitated by age, disease, or accident, lawfully resident therein, when such persons are not supported and relieved by their relatives or friends, or by their own means, or by State hospitals or other State or private institutions."  Welfare and Institutions Code, section 2500.

             Thus, it appears that the California legislature has demonstrated an intention to limit the use of county hospitals to those persons who, by reason of lack of  [[Orig. Op. Page 4]] facilities or lack of means, cannot be accommodated elsewhere.  The county hospital sections of the Washington statutes indicate a legislative intention to admit all persons to our county hospitals provided that those least able to pay be given the preferential right to admission.  In both states emergency patients should be admitted immediately and required to pay, if able.  By definition, in an emergency case time is of the essence and there is no efficient substitute for the nearest available hospital.

 Very truly yours,
 DON EASTVOLD
Attorney General 

ANDY ENGEBRETSEN
Assistant Attorney General