1. Sections 194.120 through 194.180, RSMo 1969, do not require that the State Anatomical Board accept the body of an indigent patient who dies in the State Chest Hospital. 2. When the State Anatomical Board is unable or unwilling to accept such body, the county court of the proper county is required to reimburse the State Chest Hospital for reasonable expenses incurred in the burial of such body. 3. The proper county within the meaning of Section 205.630, RSMo 1969, is that county in which the patient dies.

PAUPERS: INDIGENTS: COUNTY COURTS: 1. Sections 194.120 through 194.180, RSMo 1969, do not require that the State Anatomical Board accept the body of an indigent patient who dies in the State Chest Hospital. ANATOMICAL BOARD: 2. When the State Anatomical Board is unable or unwilling to ac- cept such body, the county court of the proper county is required to reimburse the State Chest Hospita: for reasonable expenses in- curred in the burial of such body. 3. The proper county within the meaning of Section 205 . 630, RSMo 1969, is that county in which the patient dies. March 28, 1973 Herbert R. Domke, M.D., Director Missouri Division of Health Department of Public Health and Welfare Broadway State Office Building Jefferson City, Missouri 65101 Dear Dr . Domke: OPINION NO. 31 Fl LE 0 /?.I ~ This is in response to your request for a formal Attorney Gen- eral's opinion regarding the following three questions: 1 . In the event of the death of a patient re- ceiving "free" treatment in the State Chest Hospital pursuant to Section 199.030, RSMo, can the State Anatomical Board refuse to ac- cept the body after it has been properly no- tified under Section 194.150 that said hospi- tal has custody of a pauper body? 2 . Assuming that the State Anatomical Board properly can refuse to accept the body of a pauper who died in the State Chest Hospital, does said hospital under Section 205 .630, RSMo, have authority to bill the county court for reimbursement of exoenses incurred in the bu- rial of such body? 3. Assumin~ that the State Chest Hospital is entitled to reimbursement for the expenses of such interment, which county is the "proper" county within the meanin~ of Section 205.630, RSMo, whose court is required to pay reasonable funeral expenses. Herbert R. Domke, M.D. With respect to your first question concerning whether the State Anatomical Board properly can refuse a pauper body, we must consider Section 194.150, RSMo 1969, which provides as follows: "1. Superintendents or wardens of penitentiaries , houses of correction and bridewells, hospitals, insane asylums and poorhouses, and coroners , sheriffs, jailers, city and county undertakers, and all other state, county, town or city offi- cers having the custody of the body of any de- ceased person required to be buried at public expense, shall be and hereby are required imme- diately to notify the secretary of the board, or the person duly desi~nated by the board or by its secretary to receive such notice, when- ever any such body or bodies come into his or their custody, charge or control, and shall , without fee or reward, deliver, within a period not to exceed thirty- six hours after death, ex- cept in cases within the jurisdiction of a cor- oner where retention for a longer. time may be necessary, such body or bodies into the custody of the board and permit the board or its a gent or agents to take and remove all such bodies, or otherwise dispose of them; provided, that each educational institution receiving a body from the board shall hold such body for at least thirty days, during which time any rela- tive or friend of any such deceased person or persons shall have the right to take and re- ceive the dead body from the possession of any person in whose charge or custody it may be found, for the purpose of interment, upon pay- ing the expense of such interment. " 2. Each educational institution securing a dead body shall pay all necessary expense in- curred in the delivery thereof, including cost of notice to the secretary of the board or his agent, which notice shall be by telegraph, when necessary to insure immediate notice. A cor- rect record of all such bodies, including the name and date of death, shall be kept in a book provided for that purpose by the county clerk of the county in which such person died, and by the city health commissioner of the city of St. Louis, and such record shall be promotly -2- Herbert R. Domke , M.D. furnished said officer by the person or per- sons reporting said bodies to the secretary of the board or his agent. "3. Whenever any person fails to give the no- tice and deliver the body of a deceased per- son as required by this section, and by rea- son of such failure such body shall become unfit for anatomical purposes, and is so cer- tified by the duly authorized officer or agent of the board, such body shall be buried at the expense of the person so failing to notify and deliver such body." This section requires notification to the State Anatomical Board, provides for payment of the delivery expenses by the educational institution receiving a cadaver, or payment of burial expenses by persons whose failure properly to notify the State Anatomical Board renders the body unfit for anatomical use. Section 194.120(1) desi~nates what persons constitute the State Anatomical Board. Subsection 2 states: "The board shall have exclusive charge and control of the disposal and delivery of dead human bodies, as described in sections 194. 120 to 194.180, to and among such educational institutions as under the provisions of said sections are entitled thereto." Initially it would appear that the words "shall have exclusive charge and control" could be interpreted in the manner which would preclude the State Anatomical Board from refusing the body of a pauper. However, that "exclusive charge and control" is restricted to "disposal and delivery of dead human bodies" to and among the educational institutions entitled to receive them. It is our opin- ion that this language merely provides that the State Anatomical Board is the sole agency authorized to determine which educational institution is to receive a cadaver. A conclusion that Section 194.120 prohibits refusal of pauper bodies is not supported by the language of this section. Section 194.170, however, provides as follows: "Bodies required to be buried at public expense shall be under the exclusive custody and con- trol of the board. It is hereby declared un- lawful for any person or persons to hold any -3- Herbert R. Domke, M.D. autopsy on any dead human body subject to the provisions of sections 194.120 to 194.180 with- out first havin~ obtained the consent of the secretary of t~e board or his accredited agent. The consent of any person for an autopsy on his or her body shall not in any way prevent or af- fect the application of sections 194.120 to 194.180." Again, because of the phrase "exclusive custody and control," it would appear that under this section the State Anatomical Board cannot refuse a pauper body. However, the title and the remainder of the section indicate that the legislature meant only to require that the secretary of the State Anatomical Board consent to an au- topsy on a pauper body over which the State Anatomical Board was in fact exercising control. This interpretation is in consonance with the apparent purpose of Sections 194.120 through 194.180; that is, to establish an orderly method by which bodies can be distri- b~ted on a proportional basis to educational institutions in which human anatomy is taught. In the event that the educational insti- tutions are not in need of cadavers as they become available, it is our view that the State Anatomical Board can refuse to take custody of the body, even though the board has been notified prop- erly under Section 194.150. This view is consistent with the view expressed in Opinion No. 33 dated March 23, 1966, directed to Paul McGhee, a copy of which is enclosed. Regarding your second question dealing with the authority of the State Chest Hospital to bill the county court for burial ex- penses of paupers, we must examine Section 205.630, RSMo 1969, which provides as follows: "The county court of the proper county shall allow such sum as it shall think reasonable, for the funeral expenses of any person who shall die within the county without means to pay such funeral expenses." A practical interpretation of this section in conjunction with the provisions concerning disposition of pauper bodies through the State Anatomical Board indicates that the state, county, city or town of- ficers, as well as the superintendents or wardens of the institu- tions and agencies designated in Section 194.150, must notify the State Anatomical Board whenever a pauper body comes into their cus- tody, charge or control. Once notified, the board, whose respon- sibility it is to distribute those bodies, is entitled to determine that none are needed in the educational institutions and therefore refuse to accept the bodies so offered. Under those circumstances, -4- Herbert R. Domke, M.D. of course, someone is responsible for the disposition of the body. The provisions of Section 205.630 clearly require that the county court pay the expenses of burial for those persons dying without means. It is our view that when a free patient dies in the State Chest Hospital, the superintendent thereof must notify the State Anatom- ical Board pursuant to Section 194.150. If the State Anatomical Board is unable or unwilling to accept the body offered, the body can be interred in the hospital cemetery. Since the county court of the proper county is required to pay the funeral expenses of per- sons dying without means within the county, it would be appropriate for the State Chest Hospital to bill the proper county court for re- imbursement of burial expenses. In order to consider your third question, concerning which county is the proper county, it would be hel pful to reexamine Sec- tion 205.630 which states as follows: "The county court of the proper county shall allow such sum as it shall think reasonable, for the funeral expenses of any person who shall die within the count~ without means to pay such funeral expenses. (emphasis added) By virtue of the phrase "funeral expenses of any person who shall die within the county," it would appear that the county court responsible to pay funeral expenses would be that county in which the indigent died. Applied to the factual context of your opin- ion request, that would m~an that the burial expenses of all per- sons who die without means in the State Chest Hospital whose bodies are refused by the State Anatomical Board will be borne by the county court of Lawrence County. CONCLUSION It is the opinion of this office concerning indigent patients who die in the State Chest Hospital that: 1. Sections 194.120 through 194.180, RSMo 1969, do not re- quire that the State Anatomical Board accept a pauper body . 2. When the State Anatomical Board is unable or unwilling to accept a pauper body, the county court of the proper county is re- quired to reimburse the State Chest Hospital for reasonable expenses incurred in the burial of such body. 3. The proper county within the meaning of Section 205.630, RSMo 1969, is that county in which the patient dies. -5- Herbert R. Domke, M.D. The foregoing opinion, which I hereby approve, was prepared by my assistant, Karen Harper. Enclosure: Op. No. 33 3-23-66, McGhee Yours very truly, ~· .J~ JOHN C. DANFORTH Attorney General -6-