A-9609, FEBRUARY 11, 1926, 5 COMP. GEN. 614

A-9609, FEBRUARY 11, 1926, 5 COMP. GEN. 614

MEDICAL TREATMENT - CARE OF INSANE VETERANS IN STATE HOSPITALS THERE IS NO AUTHORITY FOR THE USE OF APPROPRIATED MONEYS TO PAY OR REIMBURSE STATE HOSPITALS OR INSTITUTIONS FOR MEDICAL CARE AND TREATMENT FURNISHED INSANE VETERANS OF THE WORLD WAR PRIOR TO THE DATE THE DIRECTOR OF THE VETERANS' BUREAU AUTHORIZED THEIR HOSPITALIZATION, AND SUCH AUTHORIZATION MAY NOT BE CONSIDERED AS RETROACTIVELY EFFECTIVE TO COVER THE PERIOD OF TIME THE STATE HAD FURNISHED THE VETERAN HOSPITALIZATION WITHOUT ANY REQUEST, DIRECTION, OR AUTHORIZATION THEREFOR FROM THE VETERANS' BUREAU. 4 COMP. GEN. 999, AFFIRMED.

COMPTROLLER GENERAL MCCARL TO THE CHAIRMAN, STATE HOSPITAL COMMISSION OF NEW YORK, FEBRUARY 11, 1926:

I HAVE YOUR LETTER OF JANUARY 26, 1926, REQUESTING RECONSIDERATION OF DECISION OF MAY 26, 1925, 4 COMP. GEN. 999, DISALLOWING THE CLAIM OF THE BUFFALO STATE HOSPITAL FOR $6,010, REPRESENTING REIMBURSEMENT FOR HOSPITAL CARE OF INSANE VETERANS OF THE WORLD WAR PRIOR TO THE TIME THE UNITED STATES VETERANS' BUREAU ASSUMED JURISDICTION AND CONTROL OF THE PATIENTS AND AUTHORIZED THEIR HOSPITALIZATION IN THE STATE INSTITUTION.

IT IS APPARENT FROM YOUR LETTER THAT YOU HAVE EXAMINED THE DECISION OF MAY 26, 1925, OF WHICH RECONSIDERATION IS REQUESTED, AS WELL AS THE PRIOR DECISION OF OCTOBER 31, 1923, HENCE THERE IS NO NEED TO RESTATE IN FULL THE CONSIDERATIONS ON WHICH THOSE DECISIONS ARE BASED. THE CONCLUSION WAS REACHED THAT, AS BETWEEN THE STATE AND THE UNITED STATES, THE PRIMARY RESPONSIBILITY FOR CARE OF INSANE PERSONS ADMITTED TO STATE INSTITUTIONS WITHOUT ANY REQUEST OR AUTHORIZATION THEREFOR FROM THE UNITED STATES VETERANS' BUREAU IS THAT OF THE STATE. I ASSUME IT WILL NOT BE SERIOUSLY CONTENDED OTHERWISE. THIS IS TRUE REGARDLESS OF THE FACT THAT SUCH INSANE PERSONS MAY HAVE SERVED IN THE MILITARY OR NAVAL FORCES OF THE UNITED STATES. THE LEGAL OBLIGATION OF THE UNITED STATES GOVERNMENT FOR THE CARE OF INSANE PERSONS IS SUCH ONLY AS HAS BEEN EXPRESSLY ASSUMED BY UNITED STATES STATUTES. THE GOVERNMENT'S RESPONSIBILITY FOR THE CARE OF INSANE VETERANS OF THE WORLD WAR HAS BEEN DEFINED AND LIMITED IN THE PROVISIONS OF THE WAR RISK INSURANCE ACTS AND THE WORLD WAR VETERANS' ACT. THE APPLICATION OF THOSE PROVISIONS OF LAW TO THE STATE OF FACTS PRESENTED IN THE CLAIM OF THE BUFFALO STATE HOSPITAL WAS MADE IN THE DECISION OF MAY 26, 1925, AND THERE WAS NO ALTERNATIVE ON THAT BASIS BUT TO DENY THE CLAIM. THE RECORD BEFORE THIS OFFICE WHEN SAID DECISION WAS RENDERED DISCLOSED THAT THESE WORLD WAR VETERANS WERE PATIENTS IN THE STATE INSTITUTIONS AS PUBLIC CHARGES--- THAT IN SOME INSTANCES, AT LEAST, THEY HAD BEEN ADMITTED WITHOUT KNOWLEDGE ON THE PART OF THE STATE AUTHORITIES THAT THE DISABILITIES WERE SERVICE CONNECTED, OR EVEN THAT THE PATIENTS HAD SERVED IN THE WORLD WAR--- AND IT WAS UNDERSTOOD FROM THE RECORD THAT THE VETERANS WERE PUBLIC CHARGES BECAUSE OF THEIR STATUS UNDER THE STATE STATUTES RELATING TO "POOR" AND ,INDIGENT" INSANE PERSONS. YOU NOW CONTEND THAT THEY HAVE NEVER BEEN CONSIDERED AS "POOR" AND ,INDIGENT" PERSONS, AND THAT THE USE OF THOSE TERMS IN THE DECISION WAS ERRONEOUS. POSSIBLY THE TERMS "POOR" AND "INDIGENT" WERE NOT PROPERLY APPLIED IN THE DECISION OF THIS OFFICE, BUT, BE THAT AS IT MAY, THERE WOULD APPEAR TO BE NO DOUBT THAT THE VETERANS WERE PUBLIC CHARGES OF THE STATE PRIOR TO, AND AT THE TIME, THE UNITED STATES VETERANS' BUREAU ASSUMED JURISDICTION AND CONTROL OF THEM AND AUTHORIZED THEIR HOSPITALIZATION AT THE EXPENSE OF THE UNITED STATES GOVERNMENT. THIS APPEARS TO BE ADMITTED IN THAT PART OF YOUR LETTER OF JANUARY 26, 1926, WHICH READS:

THE NEW YORK INSANITY LAW PROVIDES THAT THERE SHALL BE HOSPITALS FOR THE CARE AND TREATMENT OF THE "POOR AND INDIGENT" INSANE OF THE STATE, WHO ARE CITIZENS THEREOF, WHICH ARE HEREBY DECLARED TO BE CORPORATIONS; OR OTHER INSANE PERSONS, WHO ARE CITIZENS OF THE STATE MAY BE ADMITTED WHEN THERE IS ROOM THEREIN FOR THEM.

IN COMPLIANCE WITH THIS PROVISION OF LAW IT IS THE DUTY OF THE STATE HOSPITAL COMMISSION TO PROVIDE FOR THE CARE AND TREATMENT OF ALL INSANE PERSONS COMMITTED TO ITS CARE WHO ARE CITIZENS OF THE STATE IRRESPECTIVE WHETHER THEY OR THEIR COMMITTEES OR RESPONSIBLE RELATIVES ARE ABLE TO PAY THE COST TO THE STATE FOR SUCH CARE AND TREATMENT. IT WAS IN COMPLIANCE WITH THIS PROVISION OF LAW THAT THE VETERANS OF THE WORLD WAR, CLAIMS FOR WHOSE CARE AND TREATMENT ARE UNDER DISCUSSION, WERE ADMITTED TO OUR HOSPITALS. WE RECOGNIZED THAT THEY NEEDED HELP AND WE GAVE IT TO THEM AND WE ALSO RECOGNIZED THAT THE HOSPITAL FACILITIES MAINTAINED BY THE FEDERAL GOVERNMENT WERE INADEQUATE TO TAKE CARE OF THEM AND WE KNEW THAT THE U.S. GOVERNMENT WAS PRIMARILY RESPONSIBLE FOR THE CARE AND MAINTENANCE OF ALL DISABLED BENEFICIARIES FROM THE TIME OF THEIR DISABILITY.

REGARDLESS OF ANY KNOWLEDGE THE STATE HOSPITAL AUTHORITIES MAY HAVE HAD AS TO THE FORMER SERVICE OF THE VETERANS ADMITTED TO THEIR INSTITUTIONS, OR OF ANY HOPE SAID AUTHORITIES MAY HAVE ENTERTAINED OF OBTAINING REIMBURSEMENT FROM THE FEDERAL GOVERNMENT, THE FACT REMAINS THAT THE MEN WERE ADMITTED AND TREATED AS STATE OR PRIVATE PATIENTS, WITHOUT ANY DIRECTION, REQUEST, OR AUTHORIZATION FROM THE UNITED STATES VETERANS' BUREAU.

I FIND NO BASIS IN THE STATUTES FOR YOUR STATEMENT "THAT THE UNITED STATES GOVERNMENT WAS PRIMARILY RESPONSIBLE FOR THE CARE AND MAINTENANCE OF ALL DISABLED BENEFICIARIES FROM THE TIME OF THEIR DISABILITY.' SECTION 302 OF THE WAR-RISK INSURANCE ACT AS AMENDED BY THE ACT OF MARCH 4, 1923, QUOTED IN THE DECISION OF OCTOBER 31, 1923, AUTHORIZED THE FURNISHING OF "SUCH REASONABLE GOVERNMENTAL MEDICAL, SURGICAL, AND HOSPITAL SERVICES * * * AS THE DIRECTOR MAY DETERMINE TO BE USEFUL AND REASONABLY NECESSARY," AND THE ACT OF AUGUST 9, 1921, 42 STAT. 150, ALSO QUOTED IN SAID DECISION, PROVIDED THAT WHEN THE GOVERNMENT HOSPITAL FACILITIES AND OTHER HOSPITAL FACILITIES ARE NOT AVAILABLE OR ARE NOT SUFFICIENT THE DIRECTOR OF THE VETERANS' BUREAU MAY CONTRACT WITH STATE, MUNICIPAL, AND PRIVATE INSTITUTIONS "FOR SUCH MEDICAL, SURGICAL, AND HOSPITAL SERVICES AND SUPPLIES AS MAY BE REQUIRED.' SUCH STATUTES DID NOT, HOWEVER, NOR DID ANY OTHER STATUTES, IN ANY EVENT AUTHORIZE THE USE OF FUNDS OF THE FEDERAL GOVERNMENT TO REIMBURSE STATE HOSPITALS FOR CARE OR TREATMENT NOT REQUIRED OR AUTHORIZED IN ADVANCE BY THE DIRECTOR OF THE VETERANS' BUREAU, OR SOME ONE UNDER HIS DIRECTION. IN THE DECISION OF MAY 26, 1925, IT WAS POINTED OUT THAT PRIOR TO JUNE 7, 1924, THERE WAS NO CLEAR STATUTORY AUTHORITY FOR REIMBURSING FOR MEDICAL TREATMENT PROCURED THROUGH PRIVATE SOURCES BY OR ON BEHALF OF BENEFICIARIES BUT THAT THE DOUBT IN THE MATTER WAS RESOLVED BY THE ACCOUNTING OFFICERS IN FAVOR OF THE BENEFICIARIES AND PAYMENT WAS AUTHORIZED OF CLAIMS FOR SUCH REIMBURSEMENT FOR A PERIOD FROM THE EFFECTIVE DATE OF THE COMPENSATION AWARD IN EMERGENCY CASES, AND THAT SECTION 202 (9) OF THE WORLD WAR VETERANS' ACT OF JUNE 7, 1924, 43 STAT. 620, GAVE RECOGNITION AND APPROVAL TO THESE PRIOR DECISIONS BY AUTHORIZING CONTINUATION OF THE PRACTICE ONLY SO FAR AS REIMBURSEMENT TO BENEFICIARIES WAS CONCERNED. ANY DOUBT WHICH MIGHT THERETOFORE HAVE EXISTED AS TO THE CORRECTNESS OF THE DECISIONS TO THE EFFECT THAT REIMBURSEMENT IS NOT AUTHORIZED TO STATE HOSPITALS FOR TREATMENT IN SUCH CASES AS ARE HERE INVOLVED HAS NOW BEEN REMOVED BY THE RESTRICTIVE TERMS OF SAID PROVISION IN THE ACT OF JUNE 7, 1924. THIS OFFICE CAN NOT ALLOW WHAT THE STATUTES DO NOT AUTHORIZE. PROVISION HAS BEEN MADE BY SPECIFIC LEGISLATIVE ENACTMENT FOR AWARDING DISABILITY COMPENSATION EFFECTIVE FROM THE DATE OF THE DISABILITY, SUBJECT TO CERTAIN PRESCRIBED CONDITIONS, BUT THE ONLY PROVISION MADE FOR PAYING THE EXPENSE OF HOSPITALIZATION NOT SPECIFICALLY REQUIRED OR AUTHORIZED IN ADVANCE BY THE VETERANS' BUREAU IS THE PROVISION IN THE ACT OF JUNE 7, 1924, 43 STAT. 620, WHICH READS:

THAT WHERE A BENEFICIARY OF THE BUREAU SUFFERS OR HAS SUFFERED AN INJURY OR CONTRACTED A DISEASE IN SERVICE ENTITLING HIM TO THE BENEFITS OF THIS SUBDIVISION, AND AN EMERGENCY DEVELOPS OR HAS DEVELOPED REQUIRING IMMEDIATE TREATMENT OR HOSPITALIZATION ON ACCOUNT OF SUCH INJURY OR DISEASE, AND NO BUREAU FACILITIES ARE OR WERE THEN FEASIBLY AVAILABLE AND IN THE JUDGMENT OF THE DIRECTOR DELAY WOULD BE OR WOULD HAVE BEEN HAZARDOUS, THE DIRECTOR IS AUTHORIZED TO REIMBURSE SUCH BENEFICIARY THE REASONABLE VALUE OF SUCH SERVICE RECEIVED FROM SOURCES OTHER THAN THE BUREAU.

ACCORDINGLY, UNDER EXISTING LAW, IT MUST BE HELD THAT THE USE OF APPROPRIATED MONEYS OF THE FEDERAL GOVERNMENT IS NOT AUTHORIZED TO PAY OR REIMBURSE STATE INSTITUTIONS FOR HOSPITALIZING VETERANS IN STATE INSTITUTIONS FOR ANY PERIOD PRIOR TO THE DATE THE DIRECTOR OF THE VETERANS' BUREAU, OR THOSE ACTING UNDER HIS DIRECTION, AUTHORIZED THE HOSPITALIZATION, WHICH AUTHORIZATION COULD NOT BE CONSIDERED AS RETROACTIVELY EFFECTIVE TO COVER A PERIOD OF TIME THE STATE HAD FURNISHED THE VETERANS HOSPITALIZATION WITHOUT ANY REQUEST, DIRECTION, OR AUTHORIZATION THEREFOR FROM THE VETERANS' BUREAU.

THE MATTER IN QUESTION IS NOT ONE INVOLVING A DISCRETION IN THIS OFFICE BUT IS MERELY ONE FOR APPLYING THE CLEAR ENACTMENTS OF THE CONGRESS TO THE UNDISPUTED FACTS, AND AFTER MOST CAREFUL CONSIDERATION OF ALL MATTERS FOUND IN YOUR LETTER I AM UNABLE TO FIND A LEGAL BASIS FOR MODIFYING THE DECISION MENTIONED BY YOU. IT MUST BE AND IS ADHERED TO. ..END :