Honorable C.W. Karisch

County Attorney Wailer County Hempstead, Texas Opinion No. M-379 Re: May Wailer County Hospital legally pay a charge for an autopsy performed in thehospital upon thebody of an expired patient? Dear Mr. Karisch: Ry recent letter youhave requested an opinion concerning the above stated matter. We quote, inpart, from your letter as follows:

"TheWaller 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 amember of the staff of visiting physicians of said Hospital, died. There was no question of foul play and no occasion for an inquest. (Thedoctor) determined that an autopsy was needed and onewas performed at the request of (thedoctor)and the Superintendent of the Hospital. The physician performing the autopsy has billed the Hospital forhis services and suchbill has been approved by the Superintendent of the Hospital, and photocopies of suchbill and approval by the Superintendent are attached hereto. The patient was in the Hospital under the Medicare Program, andbefore 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 aproper Medicare expense. However, the autopsy expense has not been charged to the patient's account and has notbeen charged to any other account. "Iassume 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 Iview the matter, it becomes a question ofwhether or not the expense of this autopsy was a reasonable and incidental expense to operating the Hospital which the Hospital had the implied authority to authorize, orwhether 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 thehospital superintendent's request and obvious approval for the autopsy inquestion upon thehospital's responsibility to pay for the costs of the autopsy. Article 4485, Vernon's Civil Statutes, details the authority and duties of thehospital superintendent. We quote, inpart, from this Article.

"The Superintendent shall be the chief executive officer of thehospital ...subject to ...the powers of the board ofmanagers. "He shall ...equip thehospital with ...all ... needed facilities for the care and treatment of patients, ... II

... "He shall cause a careful examination tobe made of the physical condition of all persons admitted to the hospital and provide for the treatment of each patient according tohis need; ..." (Emphasis added.) In addition to the above quoted language, Articles 4486 and 4487, Vernon's Civil Statutes, provide indetail 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 toprovide for "the care and treatment" of the patients, subject to the rules and regulation of the board ofmanagers. 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 iswhether 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 ofwhether the hospital may legally pay the expense inquestion. InAttorney 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:

"Itwill be noted from the foregoing statutes that authority isvested in theboard ofmanagers and the superintendent of a county hospital to incur necessary expenditures for the operation and maintenance of thehospital in a sum 'notexceeding the amount provided for such purposes in the commissioners court'. By the express terms ofArticle 4484, theboard ofmanagers must transmit allbills and accounts, including salaries andwages, to the commissioners court for payment 'inthe same manner as other charges against the county are paid'. Article 2351,V.C.S., provides that the commissioners court shall 'audit and settle all accounts against the county and direct their payment'. Inview of these provisions, the county treasurer may not issue warrants inpayment 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 management of the county hospital isvested in the board ofmanagers, the Commissioners court must approve all accounts. SeeAtt'y. Gen. Op. O-6433 (1945)."

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Hon. C.W. Karisch, page 4 (M-379)

Your second question iswhether 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 isquoted, inpart, as followsc

"TheCommissioners 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 isour opinion that the county cannot pay for an autopsy of ahospital patient dying of natural causes, under the facts set out inyour opinion request. Great American Indemnity Co. v. Dabney, supra. This opinion is limited to the facts submitted, andwhere aperson dies from uncertain causes, the Legislature has made provision inArticles 49.01, et seq.,Vernon's Code of Criminal Procedure, for autopsies tobe performed at county expense. SUMMARY

. A Commissioners Court operating a County hospital, pursuant to the provisions ofArticles 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 ofArticle 49.01, et seq., V.C.C.P.

C. MARTIN Prepared by James C. McCoy Assistant Attorney General of Texas ey General ofTexas

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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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