REGULATION AND CONTROL OF COUNTY HOSPITALS -- POWERS OF THE BOARD OF COUNTY COMMISSIONERS

AGO 1951 No. 68 - Jun 11 1951

Attorney General Smith Troy

REGULATION AND CONTROL OF COUNTY HOSPITALS -- POWERS OF THE BOARD OF COUNTY COMMISSIONERS.

1. The board of county commissioners has the power to sell, close or lease a county hospital without any restriction other than the general statutory restrictions placed on the board in handling county properties.

2. Section 7, chapter 1, Laws of 1951, in no way places a limitation on the board of county commissioners to establish rules for the admission of private patients into county hospitals under section 1, chapter 62, Laws of 1945.

3. The board of county commissioners has the responsibility for financing capital improvements and major repairs and determining the general administration and policy of county hospitals.

4. The state department of health may not achieve sufficient flexibility by means of rules and regulations so that a higher percentage of patients eligible for necessary medical service may use private hospitals where county hospital facilities exist without violating the provisions of section 7, chapter 1, Laws of 1951.

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June 11, 1951

Honorable Tom A. Durham
Prosecuting Attorney
Whatcom County
Court House, 311 Grand Avenue
Bellingham, Washington Cite as: AGO 51-53 No. 68

Attention: !ttMr. Jack Rowles, Deputy Prosecuting Attorney

Dear Sir:

You have requested an opinion of this office on the following questions:

[[Orig. Op. Page 2]]

"1. Do the County Commissioners have the power to close the county hospital completely and dispose of its assets by sale or lease? If they have such power, are there any restrictions on it or necessity for justification of their action?

"2. In view of the provisions of Initiative 178, particularly section 7 (a) (5) and (g), do the County Commissioners have any jurisdiction to establish rules and regulations for the county hospital independently of, and perhaps contrary to, those established by the State Department of Health or the local health officers? (Specifically, we refer to the possibility of a regulation prohibiting the county hospital from accepting private patients.)

"3. Does the Board of County Commissioners have any responsibility for financing capital improvements or major repairs on the county hospital, or determining the general administration and policy of the county hospital?"

Our conclusions may be summarized as follows:

3. The board of county commissioners has the responsibility for financing capital improvements and major repairs and determining the general administration and policy of county hospitals.

ANALYSIS

Section 1, chapter 61, Laws of 1947 (§ 4056, Rem. Supp. 1947), which sets out the general statutory powers given to a board of county commissioners in this state authorizes and requires them "To have the care of county property and the management of the county funds and business, * * *." Care of [[Orig. Op. Page 3]] county property by the board of county commissioners includes both the power to sell and the power to lease. Section 3, chapter 172, Laws of 1945 (§ 4007, Rem. Supp. 1945); chapter 87, Laws of 1901 (Rem. Rev. Stat. § 4019). It cannot be questioned but that a county hospital is county property and is controlled and managed by the board of county commissioners. Section 1, chapter 228, Laws of 1947 (§ 6090-1, Rem. Supp. 1947) provides that:

"The Board of County Commissioners of any county shall have the power to establish, provide and maintain * * * hospitals * * * to use county moneys, levy taxes and to 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 herein authorized for shall be paid; * * * "

Under these provisions the board has full power to close the county hospital completely, dispose of its assets by sale or to lease the property. Any restrictions placed on the power of the commissioners to handle county property or justification for action taken in regard to the disposition of county property are found, or to be inferred from the general statutory provisions relating to the powers and duties of the board of county commissioners and the statutory procedure and requirements relating to the sale or leasing of county properties.

Section 7 (a) (5) and section 7 (g) of chapter 1, Laws of 1951, have been cited in your letter of inquiry as possible statutory provisions which would place a limitation on the power of the board of county commissioners to establish rules and regulations for the admission of private patients into county hospitals.

Section 7 (a) (5) merely requires the state department of health to provide hospitalization and other related services as part of the medical care given by the state to recipients of public assistance and to other persons without income and resources sufficient to secure them, and has no application to the question of admission of private patients into county hospitals. Section 7 (g) of the act designates the duties of the local health officer in relation to county hospitals under the medical care program.

[[Orig. Op. Page 4]]

"The local health officer shall have supervision over county hospitals and other public institutions utilized in providing medical services to the eligible persons. * * *"

This particular section of the act has been interpreted by this office in the opinion of November 20, 1950, addressed to the Honorable Charles O. Carroll, Prosecuting Attorney of King County [[Opinion No. 49-51-386]]. The pertinent language of that opinion is quoted as follows:

"For the first time the legal responsibility for providing medical care and health services to recipients of public assistance and medically indigent persons is transferred to the Department of Health from the Department of Social Security. Accordingly, all duties and authority given to the Department of Health under section 15 are necessarily those which will enable the department to carry out its functions under the Initiative. For example, it has complete authority to determine how the medical care shall be provided to recipients, and the standards for such medical care. In addition, there are two provisions which have been previously pointed out which require the Department of Health to make full use of public and free facilities and services in providing such medical care. It would appear that the only responsibility the local health officer would have over any of the county hospitals, therefore, and particularly those operating under boards of trustees in Pierce and King Counties, would be to determine whether or not recipients of public assistance and medically indigent persons are receiving medical care according to the standards and rules and regulations established by the State Board of Health, and where such is not the case, to require conformance with said standards as to such persons.

[[Orig. Op. Page 5]]

"Accordingly, you are advised that it is the opinion of this office that there has been no repeal by implication of chapter 139, Laws of 1931, by section 15 of Initiative 178. The Board of Trustees in 200 bed hospitals will continue in the future to operate under the 1931 act and the local county health officer will have the authority to determine whether or not recipients of public assistance and medically indigent persons are receiving medical care according to the State Board of Health's standards and rules and regulations. Where it appears that said rules and standards are not being complied with said officer will have the authority to require conformity with said rules and standards as to such persons."

Section 1, chapter 62, Laws of 1945 (§ 6090-8, Rem. Supp. 1945), places the responsibility of enacting rules for the admission of patients into county hospitals in the hands of the board of county commissioners. This section which is quoted in part as follows, presupposes that private patients may be admitted into county hospitals.

"Patients shall be admitted to such hospitals in accordance with the 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. * * *"

It is the opinion of this office that neither of the above discussed provisions of the Citizens' Security Act gives the state department of health or the local health officers any jurisdiction to establish rules and regulations regarding the admission of private patients into county hospitals nor do they in any way limit the authority of the board of county commissioners to pass rules concerning the admission of patients into county hospitals under section 1, chapter 62, Laws of 1945.

"Section 15 of Initiative 178 does not repeal chapter 139, Laws of 1931. The Board of Trustees is still responsible for the admission, supervision and operation of such county hospitals."

[[Orig. Op. Page 6]]

While the above quoted conclusion of the opinion of this office of November 20,supra, refers specifically to county hospitals of 200 beds or more, it has equal application to county hospitals of less than 200 beds which are under the direct maintenance and control of the board of county commissioners. There has been no repeal by implication of section 1, chapter 228, Laws of 1947, (§ 6090-1 Rem. Supp. 1947) which states that the board of county commissioners shall maintain the county hospital. Therefore, it is the opinion of this office that the board of county commissioners has the responsibility for financing capital improvements and major repairs and determining the general administration and policy of county hospitals of less than 200 beds.

Very truly yours,

SMITH TROY
Attorney General

BARBARA L. OHNICK
Assistant Attorney General