Opinion ID: 1297458
Heading Depth: 1
Heading Rank: 2

Heading: Is Marquette School of Medicine a proper agency to carry out a public purpose?

Text: While the respondent states the government may appropriate money to reimburse a private corporation for expenditures incurred by it in accomplishing specified public purposes, he argues such an appropriation is invalid when paid to or through a private corporation which is not under proper governmental control and supervision. This proposition is undoubtedly true but, what is proper governmental control and supervision as used in State ex rel. Wisconsin Development Authority v. Dammann, supra ? This court stated in Wisconsin Industrial School for Girls v. Clark County (1899), 103 Wis. 651, 667, 79 N. W. 422, in considering the propriety of the use of a private corporation at public expense for the care and maintenance of needy children that the test to be applied was whether such agency was under reasonable regulations for control and accountability to secure public interests. The respondent argues, relying on State ex rel. American Legion 1941 Convention Corp. v. Smith, (1940), 235 Wis. 443, at p. 462, 293 N. W. 161, that there should be auditing safeguards before any expenses are incurred by such agency. It is also argued that Wisconsin Keeley Institute Co. v. Milwaukee County (1897), 95 Wis. 153, 70 N. W. 68, requires a private agency to be controlled and managed by the state. In Whipple the appropriation was struck down as unconstitutional, partly because no control or supervision existed in the town or taxpayers by way of postaudits, voice in management, and in other respects. The question of reasonable regulations for control and accountability to secure the public interest is one of degree and depends upon the purposes, the agency and the surrounding circumstances. Only such control and accountability as is reasonably necessary under the circumstances to attain the public purpose is required. Budgeting and auditing are, of course, basic and necessary controls; additional types of control vary with the demands or requirements of the circumstances. What would be sufficient control for daily operations may not serve for capital improvements and vice versa. What controls may be necessary for an agency to be formed may not be necessary for an agency which has been operating for many years and has established an acceptable policy and is under regulations and control of other governmental bodies. Likewise, controls which are sufficient today for this appropriation may not be sufficient tomorrow under different circumstances. The appropriation at issue is not for capital improvements or for long term future expenditures but to make up an expected deficit the next two years in the established normal operation of the school. This operation has been and is subject to review and approval of the accrediting authority for medical schools and of certain federal agencies. At least 50 percent of the expenditure of the medical schools in the United States are derived from federal funds. Task Force Report, page 23. A private agency cannot and should not be controlled as two-fistedly as a governmental agency. If such need for control is present, it might be better to use a governmental agency. A private agency is selected to aid the government because it can perform the service as well or better than the government. We should not bog down private agencies with unnecessary governmental control. The respondent argues the operational budget of the medical school needs to be submitted to the governor only at such times as he requests. We fail to see why this control is lacking merit unless one presumes the legislature will appropriate money without a budget or that the governor will fail to request a budget. As an additional safeguard, the budget must be submitted to the coordinating council of the state of Wisconsin for examination and evaluation and the council shall make an advisory report to the governor. There is a budgetary audit of the expenditure of the funds and the state of Wisconsin has a one-third representation on the board of trustees. It is true the majority of the board is not appointed by the governor with the consent of the senate, but the remaining members are citizens interested in public health and medical education and in no sense are proprietors or owners. They have no individual pecuniary interest in the medical school. We do not think it is necessary or required by the constitution that the state must legally be able to control the agency corporation in order to find sufficient regulations for control and accountability. The state is not interested in controlling the day-to-day operation of the medical school but in its end product. The insistence upon legal control of the school by the state would be the death of the independent and private agencies aiding the government in its welfare programs and would require all agencies to be in effect state agencies. The concept of a republican form of government does not require that all public health must directly be effectuated at a government office. It is only when the difficulty which individuals have in providing for themselves is insurmountable that the government should step in; but that step should be no more than is necessary and should not supplant private agencies if such agencies can be used as a means to attain the public purpose. We conclude there is sufficient control and supervision of the medical school under present conditions for the purpose of the appropriation for this biennium. While not conclusive or even authoritative but rather as illustrative, the legislature has in the past made appropriation to private organizations to attain stated public goals with no more and perhaps less control than ch. 3, Laws of 1969. For instance, sec. 45.40, Stats., authorizes the transfer of $50,000 to the American Legion for the purpose of purchasing and maintaining a camp for disabled veterans and their dependents. Ch. 51, Laws of 1967, appropriated $50,000 to the American Legion to defray the expenses of holding their national convention in Milwaukee. Sec. 51.38 (4) provides for state aids to nonprofit corporations operating day-care centers for mentally handicapped. State aids are provided for commitments to private tuberculosis sanitoriums and private insane asylums by secs. 58.06 (2) and 58.05 (2), and 50.04. Scholarship grants are provided in secs. 39.30 and 39.31 to aid Wisconsin residents in attending nonprofit public or private institutions of higher education in Wisconsin, some of which institutions are sectarian. Other states have also used private institutions to attain a public purpose. We recognize that the out-ofstate cases may be construing different constitutional language, but they are interesting in evaluating what is the legitimate relationship between government and private agencies to attain public purposes. In respect to hospitals, the following courts have upheld the constitutionality of laws or other enactments subsidizing private agencies to carry on a public purpose. Truitt v. Board of Public Works (1966), 243 Md. 375, 221 Atl. 2d 370; Lien v. City of Ketchikan (Alaska 1963), 383 Pac. 2d 721; Abernathy v. Irvine (Ky. 1962), 355 S. W. 2d 159; Kentucky Building Comm. v. Effron (1949), 310 Ky. 355, 220 S. W. 2d 836; Lazarus v. Board of Commissioners (1966), 6 Ohio Misc. 254, 217 N. E. 2d 883. We think the basic concern of these courts in using the public, private or sectarian institutions, was a recognition of health as a public purpose and of the institution as a proper means of attaining the purpose. School buildings and nursing education have also been the subject of approval. Horace Mann League v. Board of Public Works (1966), 242 Md. 645, 220 Atl. 2d 51, and Opinion of the Justices (1955), 99 N. H. 519, 113 Atl. 2d 114. The care and education of orphans, delinquents, and the elderly, is easily accepted as a public purpose and as requiring private agencies as proper means, especially in respect to the elderly. Grants in aid for these purposes to private institutions have been considered as fostering a public purpose without the requirement of very much control or supervision to see how the aid is spent. The operation and reputation of the institution seem to be sufficient. Dunn v. Addison School (1917), 281 Ill. 352, 117 N. W. 993; Murrow Indian Orphans Home v. Childers (1946), 197 Okla. 249, 171 Pac. 2d 600; Schade v. Allegheny County Institution Dist. (1956), 386 Pa. 507, 126 Atl. 2d 911; Community Council v. Jordan (1967), 102 Ariz. 448, 432 Pac. 2d 460. At least five states now provide support to 16 nonmedical or about one third of the nonstate operated schools. Florida subsidizes the University of Miami to the extent of $4,500 per student who is a resident of Florida. Pennsylvania, in effect, pays the deficit of Temple University, the University of Pittsburgh, and the Pennsylvania State University, and pays a subsidy on a base of $3,900 per student to Hahnemann Medical College of Philadelphia, Jefferson Medical College of Philadelphia, the University of Pennsylvania School of Medicine, and Woman's Medical College of Pennsylvania. North Carolina grants a subsidy of $2,500 for each student who is a resident of that state to Duke University School of Medicine and Bowman Gray School of Medicine of Wake Forest University. Ohio grants a subsidy of about $4,900 per student to Case Western Reserve University School of Medicine. The state of New York subsidizes all private colleges and universities. The average for a doctor's degree is about $2,000. There are six private medical schools in New York:Albany Medical College of Union University, Columbia University College of Physicians and Surgeons, Albert Einstein College of Medicine of Yeshiva University, New York Medical College, New York University School of Medicine, and the University of Rochester School of Medicine and Dentistry. See Exhibit 6, brief of State Medical Society of Wisconsin.