This responds to your request for my opinion on the issue of whether emergency medical expenses are to be borne by the Department of Juvenile Justice (hereinafter “the Department”) or by the county of residence of a juvenile when the Department must seek emergency medical treatment for a juvenile detainee who is in the legal custody of a juvenile court, but in the physical custody of the Department (hereinafter “court detainees”). I understand that the Department provides basic medical services to all youths held by the Department, but that there are instances when youths held, including court detainees, require medical attention beyond the capabilities of the Department. I further understand that a disagreement exists between the Department and several counties over this issue which has resulted in some medical care providers refusing to provide service to juveniles being held by the Department. After a careful review of the relevant statutes, I conclude that the expense of emergency medical care for a juvenile who has not yet been committed to the Department under O.C.G.A. §§ 15-11-66 or 15-11-67 is appropriately charged to the funds of the county upon certification of the expense by the juvenile court having jurisdiction over the court detainee.

Georgia’s Juvenile Code, codified at O.C.G.A. §§ 15-11-1 through 15-11-177, provides that juveniles who are adjudged delinquent or unruly may be “committed” by a juvenile court to the legal custody of the Department. See O.C.G.A. §§ 15-11-66(a); 15-11-67; 49-4A-8. Once the Department has been given legal custody of a child or youth under Georgia’s Juvenile Code, the Department has “the right and duty to provide or obtain for a child or youth medical, hospital, psychiatric, surgical, or dental care or services as may be considered appropriate and necessary.” O.C.G.A. § 49-4A-7(b). Thus, the sole issue to be resolved is when does the Department obtain legal custody, as contrasted with mere physical custody, of a child or youth?

In addition to providing for “commitment” to the Department, the Juvenile Code provides for youths to be temporarily detained at a Department facility prior to final disposition hearings under O.C.G.A. §§ 15-11-66 or 15-11-67. For example, O.C.G.A. § 15-11-48(a)(3) allows for the detention of alleged delinquent or unruly children “in a detention home or center for delinquent children which is under the direction or supervision of the court or other public authority” (emphasis added). Further, O.C.G.A. § 15-11-65 permits the juvenile court to order that delinquent or unruly juveniles may be detained for up to 30 days between the adjudicatory hearing and the disposition hearing, and further permits the court to extend this period if necessary. It is my understanding that many youths are in the care of the Department under this Code section. Thus, the statutory scheme makes clear that the General Assembly envisioned and specifically provided for pre-commitment detention of juveniles by the Department when so ordered by a juvenile court. See, e.g., O.C.G.A. § 15-11-46.

In all interpretations of statutes the courts shall look diligently for the intention of the General Assembly, keeping in view at all times the old law, the evil, and the remedy. O.C.G.A. § 1-3-1. Further, Georgia courts have long recognized that in the construction of a statute the legislative intent must be ascertained from a consideration of the statute as a whole. The construction of language and words used in one part of the statute must be made in light of the legislative intent as found in the statute as a whole. Board of Trustees v. Christy, 246 Ga. 553, 554-55 (1980). “[A] statute must be construed in relation to other statutes of which it is a part, and all statutes relating to the same subject matter, briefly called statutes ‘in pari materia,’ are construed and harmonized wherever possible, so as to ascertain the legislative intendment and give effect thereto.” Butterworth v. Butterworth, 227 Ga. 301, 303-04 (1971), quoting Ryan v. Comm’rs of Chatham County, 203 Ga. 730, 731 (1948). Accordingly, Georgia's Juvenile Code must be read in pari materia with Chapter 4A of Title 49, setting forth the powers and duties of the Department of Juvenile Justice (formerly known as “the Board of Children and Youth Services”). The cardinal rule for the construction of statutes is to ascertain the intent of the General Assembly and the purpose in enacting the law, then give it that construction which will effectuate the legislative intent and purpose. City of Jesup v. Bennett, 226 Ga. 606 (1970); City of Roswell v. City of Atlanta, 261 Ga. 657 (1991).

Reading O.C.G.A. §§ 15-11-46, 15-11-48, 15-11-65, 15-11-66, 15-11-67, 49-4A-7(b), and 49-4A-8 in pari materia, the statutes clearly differentiate between formal commitment to the Department and temporary detention by the Department. This distinction is further clarified by referral to the Uniform Juvenile Court Rule 3.8, which identifies two separate forms – the “ORDER FOR DETENTION” (designated as Form JUV-13) and the “ORDER OF COMMITMENT” (Form JUV-15). The uniform “ORDER FOR DETENTION” reads in relevant part: “It is therefore ordered that said child be detained in the custody of the court until further order of the court or until released by a person duly authorized by the court.” Uniform Juvenile Court Rule 3.8 (Form JUV-13)(emphasis added). Thus, the Department does not obtain legal custody of a court detainee until the court, under the authority granted to it by O.C.G.A. §§ 15-11-65 or 15-11-66 and in conjunction with O.C.G.A. § 49-4A-8, has issued an order of commitment.

How expenses are to be handled while a matter is pending before a juvenile court is codified at O.C.G.A. § 15-11-8, entitled “Expenses charged to county; payment by parents on court order.” That Code section specifically empowers the juvenile courts to assess costs by providing that certain enumerated categories of expenses “shall be a charge upon the funds of the county upon certification thereof by the court.” O.C.G.A. § 15-11-8(a). Included in these enumerated expenses is “the expense of . . . transportation, subsistence, and detention of the child, and other like expenses incurred in the proceedings under this chapter.” O.C.G.A. § 15-11-8(a)(5) (emphasis added).

In all statutory interpretation, “words in a statute should be given ‘their ordinary and everyday meaning.’” Risser v. City of Thomasville, 248 Ga. 866 (1982) (quoting O.C.G.A. § 1-3-1(b)). The word “subsistence” is not defined anywhere in the Georgia Code; however, elsewhere in the Juvenile Code “subsistence” is used in the definition of a “deprived child.” Under O.C.G.A. § 15-11-2(8) (emphasis added), deprived child means “a child who is without proper parental care or control, subsistence, education as required by law, or other care or control necessary for the child’s physical, mental, or emotional health or morals.” Cases seeking termination of parental rights due to deprivation of a child have cited medical neglect as important evidence justifying a finding of deprivation. For example, in In Re M.L.G., the Georgia Court of Appeals “agree[d] with the juvenile court that M.L.G. was a deprived child because of the parents’ failure to provide the special care required by the child’s . . . medical condition.” 170 Ga. App. 642, 646-47 (1984).1

The legislative intent to include medical care as a component of “subsistence” is further supported by juvenile law decisions from other states. For example, in construing the statutory language “care and custody” of a juvenile, the Kansas Court of Appeals held “we are of the opinion that, arguably, expenses of the care and custody of a juvenile offender would include such expenses as the cost of food, shelter, education, and ordering medical care . . . . ” Shelter Mut. Ins. Co. v. Williams, 788 P.2d 1344 (Kan. Ct. App. 1990); see KAN. STAT. ANN. § 38-1616 (2001). Finally, it must be remembered that “[t]he Juvenile Court Code of Georgia ‘is to be liberally construed toward the protection of the child whose well-being is threatened.’” Moss v. Moss, 135 Ga. App. 401, 405 (1975) (citing former GA. CODE ANN. § 24A-101, now codified at O.C.G.A. § 15-11-1). Bearing in mind the General Assembly’s explicit emphasis on the well-being of the juvenile, it must be concluded that, when providing in O.C.G.A. § 15-11-8 for the expenses of subsistence and detention of a court detainee, the General Assembly implicitly included necessary medical care.

Additional support for this conclusion is found in an attempt to change the law in this regard during the 2002 session of the General Assembly. House Bill 642, as initially introduced, was concerned with discovery in juvenile cases. It was amended during the legislative process to include a requirement that the cost of care and support of a child temporarily placed in the Department’s custody be borne by the Department. The Governor vetoed House Bill 6422, but the attempted enactment into law is significant. The courts have stated that “it may be presumed that the General Assembly did not undertake a meaningless act” when the wording of an existing statute is altered. Webb v. Echols, 211 Ga. 724 (1955); see also Houston v. Lowes of Savannah, 235 Ga. 201, 204 (1975). “It is well settled in this jurisdiction that all statutes are presumed to be enacted by the legislature with full knowledge of the existing condition of the law and with reference to it.” Buice v. Dixon, 223 Ga. 645, 647 (1967); see also Asberry v. State, 220 Ga. App. 40 (1996); State v. Camp, 189 Ga. 209, 210 (1939). Clearly, both the General Assembly in passing the legislation and the Governor in vetoing it understood that the counties are primarily liable for these medical costs. If the counties were not liable for the medical expenses incurred on behalf of a court detainee, the amendment to HB 642 would have been superfluous.

It is important to point out that the juvenile courts are authorized under paragraph (b) of O.C.G.A. § 15-11-8, following a hearing, to order the parents or other persons legally obligated to care and support the child either to pay these costs up front or to reimburse the county or other public care providers for all such expenses incurred on behalf of the child. “Unless otherwise ordered, payment shall be made to the clerk of the court for remittance to the person or agency, including the Department of Human Resources, to whom compensation is due or, if the costs and expenses have been paid by the county, to the appropriate officer of the county.” O.C.G.A. § 15-11-8(b). Thus, if the parents or other legally obligated persons are financially able, all pre-commitment expenses incurred on behalf of the child are ultimately to be borne by those persons, upon order of the court. Because the need for medical care is sometimes an emergency, it is likely that the county would be required to pay those expenses initially and then seek reimbursement through the procedures established in paragraph (b) of O.C.G.A. § 15-11-8.

For all of the reasons set forth above, it is my official opinion that all costs related to subsistence and detention, including emergency medical costs, incurred on behalf of juveniles held in Department facilities prior to a formal commitment to the Department are properly assessed to the counties. However, the juvenile court having jurisdiction over the juvenile should certify those costs before county funds can be charged.

Prepared by:

Assistant Attorney General

1 The inclusion of medical care as a component of “subsistence” as used in the Juvenile Code is supported by the dictionary definition of the term, which is “the minimum (as of food and clothing) necessary to support life.” New Merriam-Webster Dictionary 714 (4th ed. 1989). 2 In Veto Number 11 (2002), the Governor noted that “an unrelated amendment was added which would shift the cost to the Department of Juvenile Justice of care and support of a child temporarily placed in or committed to the custody of the Department. Currently the cost of such temporary commitment is borne by the child’s county of domicile. The estimated cost to the Department for this amendment is in excess of $3.7 million per year and no budgetary provision has been made for such costs. Therefore . . . I VETO House Bill 642 and encourage the General Assembly to reenact it without costly riders.”