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 

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 performed at the request of (the doctor)and the Superintendent 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 

-1873- 
. . 

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 implied 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. 

-1874- 
. . 

_ . 

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 statutes that authority is vested in the board of managers 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 commissioners 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'. Article 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 management 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)." 

- 1875 - 
. - 

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 

Prepared by James C. McCoy 

Assistant Attorney General of Texas 

ey General of Texas 

- 1876 - 
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 

- 1877 -