North Carolina Department of Justice
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May 18, 1977 Mental Health; Centers for the Mentally Retarded; Liability of Parents or Guardians for Costs of Care, Treatment, Training and Maintenance of Minor Residents at Western Carolina Center



Requested By: The Honorable Bobby Lee Combs Member of the Senate North Carolina General Assembly


Question: Is it legal for Western Carolina Center, a facility operated by the Department of Human Resources, to charge some parents or guardians of patients fees while not charging other parents or guardians of patients?


Conclusion: Yes, so long as the determination as to liability for charges is made in conformity with Article 7, Chapter 143 of the North Carolina General Statutes and is predicated upon a financial ability to pay.


Article 7, Chapter 143 of the General Statutes contains provisions dealing with the assessment of costs for patients in the various hospitals and treatment facilities operated by the State of North Carolina. Western Carolina Center is included in the listing of facilities in G.S. 143-117, and succeeding Statutes contain directions dealing with the assessment of costs, litigation thereon, authority of the boards of directors or trustees of the various facilities to assess costs and compromise accounts at their facilities, the nature of actions as recover costs, responsibilities for instituting such actions, imposition of liens against property as the result of nonpayment, and disposition of funds collected. Two basic expressions of legislative intent are present throughout these Statutes: (1) assurance that no indigent person shall be denied services because of lack of ability to pay for them; and, (2) with certain exceptions dealing with long term patients, a desire to recover the actual costs of services when there is an ability to pay.

The Supreme Court of North Carolina has recently had an occasion to uphold the constitutionality of Article 7 under the Constitution of North Carolina and the Constitution of the United States. The following extract from that Supreme Court decision would appear to dispose of the present question:

"In present case, G.S. 143-117 declares the legislative policy that all persons admitted to our State institutions be required to pay for the actual cost of their care, treatment, maintenance and training. G.S. 143-118 sets forth the guidelines to be followed by the board and empowers it to fix the actual cost of maintaining an individual in a State institution. G.S. 143-118.1 and 123 empower the board to make a factual determination of whether a patient (or such other persons as may be legally responsible for the patient) is financially able to pay.

Under the statutes, the General Assembly has clearly stated its policy -- that all those who are financially able shall pay for their maintenance. The only determinations to be made by the board are of a factual nature -- the "actual cost" of care and who is financially able to pay. The statutes furnish sufficient guidelines to assist in these determinations. Thus, we hold that the General Assembly has properly delegated the powers conferred under G.S. 143-118, 118.1 and 120 to the board of trustees or directors . . ." (Hospital v. Davis, 292 NC 147, 158 (1977)).

The Davis case dealt with one of the mental hospitals rather than a mental retardation center. However, the governing Statute and the basic rationale involved in the decision are equally applicable to both mental hospitals and centers for the mentally retarded.

It is noted that the Supreme Court decision does not mention one statute which is of some pertinence. G.S. 143-127.1 contains additional provisions limiting the liability of parents or guardians of long-term patients -- i.e., one who is a patient in a North Carolina State facility in excess of 120 continuous days. The liability of the parents or adoptive parents for payment of these charges may not exceed the cost of caring for a normal child at home and liability for payment by the parents or adoptive parents of such long-term patient terminates when the patient attains the age of eighteen years. Thus, this Statute does place additional limitations on parental obligations but would not effect the conclusion arrived at in this Opinion.

Rufus L. Edmisten Attorney General

William F. O'Connell Special Deputy Attorney General