Request By:
Mr. Marvin R. O'Koon
General Counsel
Department for Human Resources
275 East Main Street
Frankfort, Kentucky 40601
Opinion
Opinion By: Robert F. Stephens, Attorney General; By: Charles W. Runyan, Assistant Deputy Attorney General
House Bill 50 of the 1979 Extraordinary Session [Ch. 21] amended KRS 441.010 to provide that medical care for prisoners [does not include federal prisoners] in county jail must be provided by the "unit of government" if the medical care is deemed to be necessary during confinement and if such prisoner is a needy person. The court of jurisdiction determines whether the prisoner is an indigent. KRS 31.120. A licensed physician determines whether the medical care is necessary during the prisoners confinement. KRS 441.010.
While the "unit of government" is not defined, we are on the opinion that the legislature intended to use the phrase as it is used in KRS 64.150, concerning who pays the dieting fees for county jail prisoners. In that statute the "unit of government" whose law, statute, ordinance or code a prisoner is charged with or convicted of violating shall be responsible for paying to the jailer the dieting fees. In drafting the bill we can assume the definition of the phrase was inadvertently omitted. But since KRS 64.150 and 441.010 both deal with the same general subject of expenses attributed to county jail prisoners, we can read the two statutes together under the doctrine of pari materia.
Economy Optical Co. v. Kentucky Board of Opt. Exam., Ky., 310 S.W.2d 783 (1958) 784. Absent this reasoning [the meaning of the phrase "unit of government" in KRS 64.150] we know of no other statute which would illuminate the question: What unit of government?
The bill [H.B. 50, 1979 Ex. Sess.] contained an amendment to the effect that "Such services shall not include psychological testing, evaluation or care; . . ." The Department of Finance has taken the position that "psychiatric care" is also excluded from coverage under the bill, based upon the foregoing exception.
Your question is whether or not psychiatric care is excluded from coverage under the bill.
The statutes contain no definition of "psychological testing, evaluation or care." (Emphasis added). Thus we necessarily must resort to dictionary definitions. See
George Wohrley, Inc. v. Commonwealth, Dept. of Rev., Ky., 495 S.W.2d 173 (1973) 174.
The term "psychological" is defined by Stedman's Medical Dictionary (4th Lawyers Ed.), p. 1165, as "relating to psychology; relating to the mind and its processes. " (Emphasis added). It must be noted that the statute contains the phrase "psychological testing, evaluation or care." It says nothing about "psychology" , which is a special scholarly discipline. See ibid. However, "psychology" is defined as "That branch of science which treats of the mind and mental operations, especially as they are shown in behaviour." Dorland's Illustrated Medical Dictionary (24th ed.) p. 1244. "Abnormal psychology" is defined as the study of derangements or deviations of mental functions." Ibid. "Psychiatry" is defined as "That branch of medicine which deals with disorders of the psyche" [human faculty for thought, judgment, and emotion; the mental life, including both conscious and unconscious processes]. Ibid., p. 1243.
In Attorney's Textbook of Medicine (3rd ed.), Gordy-Gray, Vol. 3B, P92A.52, this is written about psychological testing:
"Psychological examinations generally serve as a supplement to the clinical evaluation of the psychiatrist. Psychological testing is ordered by the psychiatrist who presents to the clinical psychologist his reasons for requesting the testing and some pertinent clinical facts regarding the patient. The psychologist then selects the tests that he feels will likely aid the psychiatrist in elucidating a clearer picture of the patient's mental function. A diagnosis is seldom made solely on the basis of these tests but they may clarify the physician's ideas.
"Certain tests have prognostic implications. For example, the results of intelligence testing may influence the psychiatrist in deciding which type of psychotherapy could best benefit the patient and offer the greatest likelihood for improvement. Some tests may elicit subtle signs and underlying psychotic processes which have implications for treatment planning.
"Aberrant performance on some tests may help to differentiate an organic causation in mental symptoms from a condition originating solely in disturbed psychological processes."
The terminology "psychiatric and psychological examination" of a defendant was employed by the court in
Pope v. United States (U.S.C.A. -8, 1967) 372 F.2d 710, 721.
"Psychological test" has been defined as any method used for measuring an individual's mental characteristics, as memory, intelligence, emotionality, intelligence or speed of reaction.
Calhoun v. Members of Bd. of Education, City of Atlanta (U.S.D.C. N.D. Ga., 1959) 188 F.Supp. 401, 409.
A psychiatrist is one who specializes in the treatment of mental, emotional, and behavioral disorders.
Nick v. Colonial National Bank of Garland, Tex., 517 S.W.2d 375 (1974) 377.
The practice of clinical psychology, as defined by KRS 319.010, includes the administration of tests for the purpose of psychological diagnosis, classification and evaluation and recognizes services involving the reeducation, guidance or readjustment of the patient.
Mosley v. Commonwealth, Ky., 420 S.W.2d 679 (1967) 680. But a psychologist licensed under KRS Chapter 319 is generally not a medical doctor.
A psychiatrist, of course, under KRS Chapter 311, is a medical doctor. Now this fundamental distinction between a psychologist and a psychiatrist leads us to examine KRS 441.010 as to its basic sense and purpose. Conceding the somewhat ambiguous exception to the statute, we must look to the letter and spirit of the statute as a whole.
City of Owensboro v. Noffsinger, Ky., 280 S.W.2d 517 (1955) 519. Here KRS 441.010, as amended, is designed to provide "medical care" , under the direction of a licensed physician, i.e., medical doctor, to indigent county jail prisoners requiring such services while in jail. "Medical" is defined as "pertaining, relating, or belonging to the study and practice of medicine, or the science and art of the investigation, prevention, cure, and alleviation of disease." Black's Law Dictionary (4th Ed.) p. 1133. Even though KRS 441.010(3)(b) refers to payments to physicians, hospitals, laboratories, or "other health care providers", the latter term in this total statutory context is restricted to the practice of medicine by physicians.
Since the statute relates to medical services only, the practice of clinical psychology, not done under the request or direction of a psychiatrist, is not involved in the application of the statute. The inclusion of the practice of clinical psychology alone in the exception is a useless redundancy and is inoperative to that extent. Thus if the exception is to have a legal and operative meaning, it can only relate to the practice of psychiatry, which could include any ordered psychological testing etc. It is well settled that a proviso or exception will be construed to restrain or qualify the generality of an enactment, but such exception must not be repugnant to the statute or defeat the intention of the legislature as shown by the act as a whole.
Head v. Jacobs, 150 Ky. 290, 150 S.W. 349 (1912) 350.
Based upon the overall purpose of the statute in providing medical care through a licensed medical doctor to needy county jail prisoners, it is our opinion that the exception includes psychiatric care as administered by a psychiatrist.