Honorable C. W. Karisch Opinion No. M- 379
County Attorney
Wailer County Re: May Wailer County Hospital
Hempstead, Texas legally pay a charge for
an autopsy performed in
the hospital upon the body
of an expired patient?
Dear Mr. Karisch:
Ry recent letter you have requested an opinion concerning
the above stated matter. We quote, in part, from your letter
as follows:
"The Waller County Hospital was organized, and
operates, under Articles 4478-4494, R.C.S. A patient
of the Hospital who was being cared for by(a doctor)
who is a member of the staff of visiting physicians
of said Hospital, died. There was no question of
foul play and no occasion for an inquest. (The doctor)
determined that an autopsy was needed and one was per-
formed at the request of (the doctor)and the Superin-
tendent of the Hospital. The physician performing the
autopsy has billed the Hospital for his services and
such bill has been approved by the Superintendent of
the Hospital, and photocopies of such bill and approval
by the Superintendent are attached hereto. The
patient was in the Hospital under the Medicare Program,
and before authorizing or ordering an autopsy, officials
of the Hospital ascertained from some supposed official
with the Medicare Program that autopsies in cases such
as this was a proper Medicare expense. However, the
autopsy expense has not been charged to the patient's
account and has not been charged to any other account.
"I assume that the bill is reasonable, at least
no question in that regard has been raised. No reason
for the autopsy has been advanced other than to determine
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. .
Hon. C. W. Karisch, page 2 (M-379)
the cause of death. As I view the matter, it becomes a
question of whether or not the expense of this
autopsy was a reasonable and incidental expense to
operating the Hospital which the Hospital had the im-
plied authority to authorize, or whether the expense
should have been the expense of the patient's
estate." (Parenthesis ours.)
At the outset we are met with the consideration of the
effect of the hospital superintendent's request and obvious
approval for the autopsy in question upon the hospital's
responsibility to pay for the costs of the autopsy.
Article 4485, Vernon's Civil Statutes, details the authority
and duties of the hospital superintendent. We quote, in part,
from this Article.
"The Superintendent shall be the chief executive
officer of the hospital .. . subject to . .. the powers
of the board of managers.
"He shall ... equip the hospital with ... all ...
needed facilities for the care and treatment of
patients, ...
II. ..
"He shall cause a careful examination to be made
of the physical condition of all persons admitted to
the hospital and provide for the treatment of each
patient according to his need; ..." (Emphasis added.)
In addition to the above quoted language, Articles 4486
and 4487, Vernon's Civil Statutes, provide in detail the
authority of the superintendent on the procedure for admission,
and support of individuals admitted as patients. Both of
those Articles and the above quoted Article (4485) limit the
superintendent's authority to provide for "the care and
treatment" of the patients, subject to the rules and regulation
of the board of managers. None of the statutes involved
specifically authorize a superintendent to request or approve
an autopsy.
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. .
_ .
Hon. C. W. Karisch. page 3 (M-379)
So the question then is whether the "care and treatment"
of patients also encompasses autopsies of deceased patients.
In our opinion "care and treatment" does not include an
autopsy of a deceased patient. Great American Indemnity Co.
v. Dabnev, 128 S.W.Zd 496 (Tex. Civ. App. 1939, error dism.,
judgm. car.). Consequently, the superintendent has no
authority to request or approve an autopsy, and in the present
case, the request and approval would have no effect upon the
question of whether the hospital may legally pay the expense
in question.
In Attorney General's Opinion V-12Q'5 (1951). this office
ruled that charges against the county hospital are subject to
the aontrol of the Commissioners Court. We quote from that
opinion as follows:
"It will be noted from the foregoing stat-
utes that authority is vested in the board of man-
agers and the superintendent of a county hospital to
incur necessary expenditures for the operation and
maintenance of the hospital in a sum 'not exceeding
the amount provided for such purposes in the com-
missioners court'. By the express terms of Article
4484, the board of managers must transmit all bills
and accounts, including salaries and wages, to the
commissioners court for payment 'in the same manner
as other charges against the county are paid'. Arti-
cle 2351, V.C.S., provides that the commissioners
court shall 'audit and settle all accounts against
the county and direct their payment'. In view of
these provisions, the county treasurer may not issue
warrants in payment of bille and accounts of the
hospital until the commissioners court has approved
them for payment in the same manner as other charges
against the county are paid. Although the manage-
ment of the county hospital is vested in the board
of managers, the Commissioners court must approve
all accounts. See Att'y. Gen. Op. O-6433 (1945)."
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. -
Hon. C. W. Karisch, page 4 (M-379)
Your second question is whether the Commissioners Court
is authorized to pay this autopsy expense.
Article 4478a. Vernon's Civil Statutes, provides the
enabling legislation for the creation of a county hospital.
This Article is quoted, in part, as followsc
"The Commissioners Court of any county shall
have power to establish a county hospital . .. for the
care and treatment of persons suffering from any
illness, disease or injury . .." (Emphasis added.)
In the above quoted provision, we find the same limitation
of authority of the Commissioners Court, relative to patient
care and treatment, a6 is found relative to the authority of
the hospital superintendent, i.e., "care and treatment".
Therefore, it is our opinion that the county cannot pay for an
autopsy of a hospital patient dying of natural causes, under
the facts set out in your opinion request. Great American
Indemnity Co. v. Dabney, supra.
This opinion is limited to the facts submitted, and where
a person dies from uncertain causes, the Legislature has made
provision in Articles 49.01, et seq., Vernon's Code of Criminal
Procedure, for autopsies to be performed at county expense.
SUMMARY
.
A Commissioners Court operating a County
hospital, pursuant to the provisions of Articles
4478, et seq., V.C.S.. may not legally pay a
charge for an autopsy unless ordered by the proper
authorities pursuant to the provisions of Article
49.01, et seq., V.C.C.P.
C. MARTIN
ey General of Texas
Prepared by James C. McCoy
Assistant Attorney General of Texas
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Hon. c. W. Karisch, page 5 (M-379)
APPROVED:
OPINION COMMITTEE
Kerns Taylor, Chairman
George Kelton, Co-Chairman
Larry Craddock
Jerry Roberts
Bill Craig
Bob Crouch
W. V. GEPPERT
Staff Legal Assistant
HAWTHORNE PHILLIPS
Executive Assistant
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