HEALTH CARE CLINICS

SCHOOL DISTRICTS ‑- STATUTORY AUTHORITY ‑- HEALTH CARE CLINICS

School districts do not, under current state law, have authority to operate adolescent health care clinics, or to provide public funds or school facilities for such clinics.

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                                                                 February 1, 1988

Honorable Mike Padden
State Representative, Fourth District
East 13021 Ninth Avenue
Spokane, WA 99126

Cite as:  AGO 1988 No. 2                                                                                                                  

 Dear Representative Padden:

             By letter previously acknowledged, you have requested our opinion on the following questions which we have paraphrased:

             1.         Do school districts have authority to establish adolescent health care or health improvement programs, as contemplated by House Bill 376 and House Bill 955 introduced in the 1987 regular session of the 50th Legislature, either integral with or separate from the public school system?

             2.         Assuming an affirmative answer to question 1, may the facilities of the school district be used for this purpose?

             3.         May school district funds be used for the operation of such programs and for the construction, remodeling, lease, or rental of facilities to house such programs?

             4.         May school districts contract with private or other public agencies to provide such programs, either in school district facilities or elsewhere?

             We answer questions one, three, and four in the negative and question two in the manner set forth in our analysis.

              [[Orig. Op. Page 2] ]

                                                                      ANALYSIS

             Before we discuss your specific questions, we want to make clear our understanding of the terms "adolescent health care" and "adolescent health improvement programs."  These terms were used in House Bill 376 and House Bill 955, referred to in your question, two bills that were introduced in the 1987 Legislature but did not pass.

             House Bill 376 would have authorized the creation of school-based health clinics to enable local communities to provide health care services or referral, or both, to teenagers.  These clinics would have provided health education and general health care to prevent or intervene early to minimize long-term consequences from:  (1) substance abuse, (2) abuse and neglect, (3) mental or emotional difficulties, (4) nutritional and health care deprivation, (5) sexual activity, (6) sexually transmitted diseases, (7) teen pregnancy, (8) low-birth-weight babies, (9) infant mortality, and (10) disruption of the family unit.  House Bill 376, 50th Legislature (1987).

             House Bill 955 sought to address the same health concerns regarding adolescents as those listed in House Bill 376.  This bill sought to establish the adolescent health improvement program.  This program also would have been administered by the Department of Social and Health Services.  Grants could have been awarded to either schools, school districts, health care agencies, or youth services agencies, or to combinations of these.  House Bill 955, 50th Legislature (1987).

             These bills would not have specifically authorized school districts to provide adolescent health care services.  Instead, the bills would have established adolescent health clinics or programs in the schools, to be initially administered by the Department of Social and Health Services.  We understand your question to be whether school districts have independent authority to establish clinics providing health care and education to teenagers, along the lines contemplated in those two bills, using school district funds.

             Question 1:

                         Do school districts have authority to establish adolescent health care or health improvement programs, such as those contemplated by House Bill 376 and House Bill 955 introduced in the 1987 regular session of the 50th Legislature, either integral with or separate from the public school system?

              [[Orig. Op. Page 3] ]

             School districts in Washington are considered to be municipal or quasi-municipal corporations.  RCW 28A.58.010;Noe v. Edmonds Sch. Dist. 15, 83 Wn.2d 97, 515 P.2d (1973);Howard v. Tacoma Sch. Dist. 10, 88 Wash. 167, 152 P. 1004 (1915).  They are created by the Legislature and can exercise only such powers as the Legislature has granted in express words, or those necessary or fairly implied in, or incident to, powers expressly granted or those essential to the declared objects and purposes of such district.  Seattle High Sch. Chapter 200 v. Sharples, 159 Wash. 424, 293 P. 994 (1930).

            Our review of Title 28A RCW indicates that there is no express statutory authority for school districts to conduct adolescent health care clinics or programs.  The issue then is whether such power can be implied from powers expressly granted to school districts.

            The general powers of the board of directors of a school district are found in chapter 28A.58 RCW.  A school district possesses all the usual powers of a public corporation.  RCW 28A.58.010.1/

             In addition, a first class school district has the authority:

             To appoint a practicing physician, resident of the school district, who shall be known as the school district medical inspector, and whose duty it shall be to decide for the board of directors all questions of sanitation and health affecting the safety and welfare of the public schools of the district who shall serve at the board's pleasure; he or authorized deputies shall make monthly inspections of each school in the district and report the condition of the same to the board of education and board of health: PROVIDED, That children shall not be required to submit to vaccination against the will of their parents or guardian.

 RCW 28A.59.180(12).

              [[Orig. Op. Page 4] ]

             InMcGilvra v. Seattle Sch. Dist. 1, 113 Wash. 619, 194 P. 817 (1921), the court discussed the extent of the authority granted under the identical predecessor statute to RCW 28A.59.180(12).  See Laws of 1919, ch. 90, § 9, p. 213. The school district established a clinic for medical, surgical, and dental treatment of students whose parents were financially unable to provide such treatment.  Nurses examined each child once per year to determine whether such child had any physical or mental defect interfering with his or her school work.  School district funds and facilities were used.

             The court held that a school district did not have authority to render free medical services to students.  The court interpreted the statute as authorizing a school district only to inspect buildings and premises of the district with a view to making them sanitary and healthful and to inspect persons with a view to excluding those afflicted with contagious diseases.

             After reviewing the powers granted to school districts, the court held that the school district did not possess the power it was seeking to exercise.  The court stated:

             The rendering of medical, surgical and dental services to the pupils, however, is, and always has been, we think, so foreign to the powers to be exercised by a school district or its officers that such power cannot be held to exist in the absence of express legislative language so providing.

 113 Wash. at 627.

             There are other statutory provisions dealing with the health of school children.  Chapter 28A.31 RCW sets forth the health measures authorized to be taken by school districts.  These provisions deal specifically with contagious diseases, visual and auditory screening, immunization programs, and screening programs for scoliosis.  None of these provisions expressly authorize school districts to operate adolescent health care clinics, nor can the authority to do so be implied therefrom.  The services contemplated exceed those permitted under chapter 28A.31 RCW.

             RCW 28A.05.010 provides that all common schools shall give instruction in "physiology and hygiene with special reference to the effects of alcoholic stimulants and narcotics on the human system."  All high schools also must emphasize "the work of  [[Orig. Op. Page 5] ] physical education."  RCW 28A.05.040.  This opinion does not limit school districts to the extent they are authorized to provide health care instruction and education under these provisions.  However, school districts' power to provide medical services cannot be implied from this express statutory authority.  SeeMcGilvra v. Seattle Sch. Dist. 1, 113 Wash. 619, 194 P. 817 (1921).

             Additionally, second class districts may employ a regularly licensed physician or a licensed public health nurse for the purpose of protecting the health of children in the district.  RCW 28A.60.320.  This provision might be interpreted to authorize a physician or nurse to provide general health education and services, as contemplated by House Bill 376 and House Bill 955.  However, based on the court's reasoning in McGilvra v. Seattle Sch. Dist. 1, 113 Wash. 619, 194 P. 817 (1921), we conclude that the authority to establish a school-based health clinic as contemplated in House Bill 376 and House Bill 955 cannot reasonably be implied from the authority granted in RCW 28A.60.320.  Providing medical services through a team of physicians and/or nurses is beyond the authority possessed by a school district, absent express statutory language.

             Therefore, we conclude that absent express authority to operate health clinics or health improvement programs, school districts cannot do so, either integral with or separate from the public school system.

             Question 2:

                         Assuming an affirmative answer to question 1, may the facilities of the school district be used for this purpose?

             Having concluded in question 1 that school districts lack authority to establish a health care clinic without express statutory authority, we do not reach this question.

             Question 3:

                         May school district funds be used for the operation of such programs and for the construction, remodeling, lease, or rental of facilities to house such programs?

              [[Orig. Op. Page 6] ]

             Absent express authority for such an expenditure, we must answer in the negative.  School districts have only such authority as is explicitly granted by statute or necessarily implied from an explicit grant of authority.  State ex rel. School Dist. 301 v. Clausen, 109 Wash. 37, 186 P. 319 (1919).

             Question 4:

                         May school districts contract with private or other public agencies to provide such programs, either in school district facilities or elsewhere?

             Absent express authority to contract to provide such services, a school district cannot establish a health clinic by contracting with private or public agencies for that purpose. 2/

             We trust the foregoing will be of assistance to you.

 Very truly yours,
 KENNETH O. EIKENBERRY
Attorney General 

NOELLA HASHIMOTO
Assistant Attorney General