Opinion letter to Herbert R. Domke , M.D.

March 11, 1975 Herbert R. Domke, l-1. D. , Director Missouri Division of Health Broadway State Office Building J efferson City, Missouri 65101 Dear Dr . Domke: OPINION LETTER NO. 12 Answer by letter-Card F l LE 0 /;)_ This official opinion is in response to your request for this office's opinion on the following: "The Division of Health is directed by Sec- tion 192.050 RSMo to maintain various bureaus, including a bureau of laboratories, and to formulate orders and findings for the proper conduct of such bureaus. Should the services of medical laboratories operated by the Divi- sion of Health be made available to chiroprac- tors licensed under Chapter 331 RSMo?" You advise that the Division of Health operates medical lab- oratories in Jeffe.rson City, Springfield, Poplar Bluff, and Hount Vernon. These laboratories test specimens submitted from through- out the state by physicians, hospitals, veterinarians, and public health offices as part of a various infectious, dangerous , communi- cable, and contagious disease program conducted by the Division. The diseases for which specimens are submitted and laboratory tests conducted are as follows: Meningicoccal meningitis Other bacterial meningitis Infectious mononucleosis Salmonellosis Shigellosis Infant enteritis Food borne illness Herbert R. Domke, z.t. D. Other GI tract infections Conjunctivitis Skin fungus infections Tick borne fever Other zoonoses Influenza Viral pneumonia Tuberculosis Chicken pox Rubella Gonorrhea Viral central nervous system diseases Infectious hepatitis A Serum hepatitis B Rubeola Whooping cough Septicemia (Gram Neg.) Septicemia (Gram Pos.) All other bacterial infections Impetigo Tularemia Rabies Streptococcus infections Bacterial pneumonia Other upper respiratory illness Fungus infections r-tumps Syphilis Sections 192.020 and 192.050, RSMo 1969, provide as follows: "It shall be the general duty and responsibil- ity of the division of health to safeguard the health of the people in the state and all its subdivisions. It shall make a study of the causes and prevention of diseases. It shall designate those diseases which are infectious, contagious, communicable or dangerous in their nature and shall make and enforce adequate or- ders, findings, rules and regulations to pre- vent the spread of such diseases and to deter- mine the prevalence of such diseases within the state. It shall have power and authority, with approval of the director of public health and welfare, to make such orders, findings, rules and regulations as will prevent the en- trance of infectious, contagious and communi- cable diseases into the state." (Section 192 . 020, RSMo 1969) -2- Herbert R. Domke, M.D. "The division of health shall maintain a bu- reau of vital statistics, a bureau of labora- tories, a bureau of communicable diseases, a bureau of food and drug inspection, a bureau of child hygiene, a bureau of public health nursing, a bureau of tuberculosis control, a bureau of cancer control, a bureau of dental health, and other bureaus as may be necessary from time to time. The division, with the ap- proval of the director of the department, shall formulate orders and findings for the proper conduct of the bureaus." (Section 192.050, RSMo 1969) Unless required by other statutes, we believe that these pro- visions delegate to the Division of Health discretion as to what laboratory services to provide and to whom these services should be provided. The only provisions which we have found compelling the Division of Health to perform certain specific laboratory tests are Section 451.050(3), RSMo 1969 (premarital serological tests for syph- ilis) and Section 210.030, RSMo 1969 (prenatal serological tests for syphilis) which provide: "3. Laboratory tests shall be made free of charge by the laboratory of the division of health or by such other public health labora- tories wherever maintained in the state of Missouri, upon the request of a physician or by an applicant." (Section 451.050(3), RSMo 1969) "Every licensed physician, midwife, regis- tered nurse and all persons who may undertake, in a professional way, the obstetrical and gy- necological care of pregnant women in the state of Missouri shall, if the woman consents in the case of each woman so attended, take or cause to be taken a sample of venous blood of such wo- man at the time of the first examination, or not later than twenty days after said first examina- tion, and subject such sample to an approved and standard serological test for syphilis. An ap- proved and standard test for syphilis shall mean a test made in a laboratory approved by the divi- sion of health of the department of public health and welfare. Such test shall be made free of -3- Herbert R. Domke, M.D. charge by the division of health on request." (Section 210.030, RSMo 1969) In light of Section 334.021 which provides that whenever other statutes of this state use the term "physician," it shall be con- strued to mean physicians and surgeons licensed under the provisions of Chapter 334, we are of the opinion that the legislature did not intend the word "physician" in the above two sections to include a licensed chiropractor. We have not been able to find any statute which either autho- rizes or requires the Division of Health to perform laboratory tests at the request of a licensed chiropractor. But, as we understand, the primary purpose of maintaining and operating the various labo- ratories is as an adjunct to the state's efforts at controlling con- tagious and communicable diseases. Since the Division has the dis- cretion as to how it is going to operate the laboratories, we are of the opinion that the Division, regardless of the source, has the authority to test any specimen submitted to it to determine whether a contagious or communicable disease is present. We further believe that it is within the discretion of the Division of Health to decide to whom the results of the various laboratory tests performed on any sample submitted are to be divulged. -4- Yours very truly, JOHN C. DANFORTH Attorney General