Can the county that first transported a mental health patient out of county refuse to reimburse the sheriff or law enforcement agency that delivered them?

Subject

Opinion No. 13-07, Reimbursement of Secondary Transport Agencies under Tenn. Code Ann. § 33-6-901, February 1, 2013

Plain-English summary

A state representative asked a narrow follow-up question to an earlier AG opinion (12-88). Tennessee's mental-health transportation statute, Tenn. Code Ann. § 33-6-901, requires a sheriff (or a properly designated secondary transportation agent, such as a city police department) to transport people with mental illness or severe emotional disturbance for involuntary admission. When that transport crosses county lines, the "initial transporting county" gets the bill.

The earlier Op. 12-88 had established that a sheriff could designate municipal law enforcement agencies as secondary transportation agents and that the initial transporting county is responsible for reimbursing out-of-county transport costs while in-county transports are covered by the agencies' regular budgets. The new question was whether any circumstances existed where the initial transporting county could refuse to reimburse the secondary agent.

The AG's answer was a clean "No." The statute's plain language imposed an "unconditional" obligation on the initial transporting county to pay for any out-of-county transport by a duly appointed secondary agent. The General Assembly built in no exceptions. The AG cited Rogers v. Louisville Land Co. and In re Adoption of A.M.H. for the rule that an unambiguous statute is applied as written, and Harman v. University of Tennessee for the principle that the express mention of one thing implies the exclusion of others. Because § 33-6-901 expressly imposed the reimbursement obligation, it could not be read to allow the initial transporting county to refuse based on circumstances the statute didn't mention.

The opinion also recapped the basic mechanic of § 33-6-901(b): the initial transporting county remained responsible for "the remainder of such person's transportation requirements," even if the person was assessed in one county and then admitted to a treatment facility in a third county.

Currency note

This opinion was issued in 2013. Subsequent statutory amendments, court decisions, or later AG opinions may have changed the analysis. Treat this page as historical context, not current legal advice. Verify current law before relying on any specific rule, deadline, or remedy mentioned here.

Tennessee's mental-health transportation framework, including the secondary transportation agent designations and the reimbursement allocation, has been touched by later legislation. Anyone resolving an inter-county reimbursement dispute today should pull the current version of § 33-6-901 and check for amendments to the in-county/out-of-county split or to the way secondary agents are designated.

Background and statutory framework

Section 33-6-901 evolved from a long-running concern about who pays when a person experiencing a mental health crisis must be transported, sometimes to a facility in a distant county. Subsection (a) makes the sheriff the primary transporter unless certain other authorized entities perform the transport. Subsection (b) allocates costs.

The key text reads:

When a sheriff or secondary transportation agent is required to transport a person to a hospital or treatment resource for screening, evaluation, diagnosis or hospitalization, the county in which the person is initially transported by the sheriff or secondary transportation agent is responsible for the remainder of such person's transportation requirements. The initial transporting county is responsible for the continuing transportation of the person even if the person is assessed, diagnosed, screened or evaluated in a second county before being admitted to a facility, hospital or treatment resource in a third county. If the person is transported to a hospital or treatment resource by the sheriff or secondary transportation agent of a county other than the initial transporting county, the sheriff or secondary transportation agent actually providing transportation may bill the initial transporting county for transportation costs.

Op. 12-88 had earlier interpreted the in-county/out-of-county split: in-county transports were absorbed by the entity's annual budget, while out-of-county transports were billed to the initial transporting county. Op. 13-07 simply asked whether the initial transporting county could ever say no to a properly billed out-of-county transport. The AG read the statute as imposing an unconditional obligation; "The General Assembly provided no exceptions."

Common questions

Can the initial transporting county object to the cost?

The AG didn't address reasonableness or rate disputes directly. The opinion was about whether reimbursement was owed at all, and the answer was that it was. Reasonable disputes over the amount of the bill (mileage, staff time, whether the trip was actually required) would have been worked out between the agencies, and presumably ultimately in court if not resolved.

What if the secondary transportation agent wasn't properly designated?

The opinion's reimbursement holding assumed a "properly designated" secondary agent under the framework of Op. 12-88. If a city law enforcement agency hadn't been designated by the sheriff and just decided to perform the transport, the analysis would have been different and arguably outside the statute.

What if the patient ended up admitted in the same county where they started?

The statute's billing trigger keys on out-of-county transport: "If the person is transported to a hospital or treatment resource by the sheriff or secondary transportation agent of a county other than the initial transporting county..." The reimbursement obligation applies when an agent from a different county does the transport. If a city agency in the initial transporting county handled an in-county transport, Op. 12-88 had already established that the costs were absorbed by the agency, not billed back to the county.

What about cases involving more than two counties?

The opinion expressly addressed the three-county scenario: initial county does the pick-up, second county does the assessment, third county handles the admission. The initial transporting county remained responsible for "the remainder of such person's transportation requirements" through that whole chain.

Could counties contract around this?

The opinion didn't address interlocal agreements. As a practical matter, counties sometimes work out inter-county transport arrangements through Tenn. Code Ann. §§ 5-1-113 to -114 interlocal agreements. The statutory baseline is what § 33-6-901 says; an interlocal agreement could allocate costs differently between the participating counties, subject to the statute's framework.

Citations

• Tenn. Code Ann. § 33-6-901(a), (b) (sheriff's transport obligation and inter-county reimbursement)
• Rogers v. Louisville Land Co., 367 S.W.3d 196 (Tenn. 2012) (plain-meaning statutory construction)
• In re Adoption of A.M.H., 215 S.W.3d 793 (Tenn. 2007) (plain-meaning statutory construction)
• Harman v. Univ. of Tenn., 353 S.W.3d 734 (Tenn. 2011) (expression of one thing implies exclusion of others)
• Tenn. Att'y Gen. Op. 12-88 (Sept. 20, 2012) (earlier opinion on in-county vs. out-of-county allocation)

Source

• Landing page: https://www.tn.gov/attorneygeneral/opinions.html
• Original PDF: https://www.tn.gov/content/dam/tn/attorneygeneral/documents/ops/2013/op13-007.pdf

Original opinion text

S T A T E O F T E N N E S S E E
OFFICE OF THE
ATTORNEY GENERAL
PO BOX 20207
NASHVILLE, TENNESSEE 37202

February 1, 2013

Opinion No. 13-07

Reimbursement of Secondary Transport Agencies under Tenn. Code Ann. § 33-6-901

QUESTION

Do any circumstances exist whereby an initial transporting county may refuse to reimburse a properly designated secondary transportation agency for expenses incurred in the out-of-county transport of persons suffering from mental illness or severe emotional disturbances?

OPINION

No.

ANALYSIS

This Office recently opined that pursuant to Tenn. Code Ann. § 33-6-901(a) a sheriff must transport all persons with mental illness or serious emotional disturbance for involuntary admission to inpatient care unless certain other authorized entities provide such transport, and that a sheriff has the authority to designate one or more municipal law enforcement agencies within the county to serve as secondary transportation agents to provide designated transport services for persons who are suffering from mental illness or severe emotional disturbances. Tenn. Att'y Gen. Op. 12-88 (Sept. 20, 2012). This Office further opined that Tenn. Code Ann. § 33-6-901(b) requires the initial transporting county to reimburse a secondary transportation agent for expenses incurred in the transport of such persons only where the person was transported to an out-of-county hospital or other treatment facility, reasoning as follows:

The sheriff or secondary transportation agent, including any municipal law enforcement agency so designated by the sheriff, "may bill the initial transporting county for transportation costs" if the person is transported to a hospital or treatment resource in a county other than the initial transporting county. Tenn. Code Ann. § 33-6-901(b). The initial transporting county is "the county in which the person is initially transported by the sheriff or secondary transportation agent," and that county remains responsible "for the remainder of such person's transportation requirements." Id. These provisions collectively evidence a legislative intent to place any costs of transport that occur after the initial transport to a county outside the initial transporting county on the initial transporting county and to allow the sheriff or secondary transportation agent to directly bill the initial transporting county for transports outside the county. However, these provisions do not allow the sheriff or the secondary transportation agent to bill for the initial transport, or any subsequent transport that is within the boundaries of the county itself. The costs of these transports are presumably covered by these entities' annual budgets. The failure to include reimbursement for these transports implies that the General Assembly did not intend to allow the sheriff or the secondary transportation agent to bill for these "in county" transports.

Tenn. Att'y Gen. Op. 12-88 at 3-4 (emphasis in original).

The question now posed is whether any circumstances would allow the initial transporting county under Tenn. Code Ann. § 33-6-901 to not pay a properly designated secondary transportation agent for expenses incurred in the out-of-county transport. Tenn. Code Ann. § 33-6-901(b) sets forth both the obligation of the sheriff or secondary transportation agent to continue to transport a mentally ill or severely emotionally disturbed patient after the initial transfer to a hospital or other medical facility and the obligation of the initial transporting county to pay any costs for any transport to an out-of-town county hospital or treatment resource, stating:

When a sheriff or secondary transportation agent is required to transport a person to a hospital or treatment resource for screening, evaluation, diagnosis or hospitalization, the county in which the person is initially transported by the sheriff or secondary transportation agent is responsible for the remainder of such person's transportation requirements. The initial transporting county is responsible for the continuing transportation of the person even if the person is assessed, diagnosed, screened or evaluated in a second county before being admitted to a facility, hospital or treatment resource in a third county. If the person is transported to a hospital or treatment resource by the sheriff or secondary transportation agent of a county other than the initial transporting county, the sheriff or secondary transportation agent actually providing transportation may bill the initial transporting county for transportation costs.

Tenn. Code Ann. § 33-6-901(b).

The plain language of Tenn. Code Ann. § 33-6-901 unambiguously imposes an unconditional obligation on the initial transporting sheriff or secondary transportation agent to transport a mentally ill or severely emotionally disturbed person to the necessary hospital or treatment facility. The statute also imposes an unconditional obligation upon the initial transporting county to pay the costs and expenses of any transport to any out-of-county hospital or treatment resource. Thus the General Assembly provided no exceptions to the initial transporting county's financial obligation to pay for any transport by a duly appointed secondary transportation agent to any out-of-county hospital or treatment facility. See Rogers v. Louisville Land Co., 367 S.W.3d 196, 214 (Tenn. 2012) (quoting In re Adoption of A.M.H., 215 S.W.3d 793, 808 (Tenn. 2007)) (stating general rule of statutory construction that if the statute is not ambiguous then "the plain and ordinary meaning of the statute must be given effect"); Harman v. Univ. of Tenn., 353 S.W.3d 734, 738-39 (Tenn. 2011) (stating that the express mention of one thing implies the exclusion of things that are not mentioned).

ROBERT E. COOPER, JR.
Attorney General and Reporter

WILLIAM E. YOUNG
Solicitor General

TROY A. MCPEAK
Assistant Attorney General

Requested by:

Honorable Charles M. Sargent, Jr.
State Representative
202 War Memorial Bldg.
Nashville, TN 37243