The liability that individuals have for their spouse’s medical expenses is a common question for creditors with accounts consisting of medical debt. In the course of our practice in Ohio, Kentucky, and Indiana we have found that liability varies by state and depends upon the courts’ interpretation of common law doctrines and state statutes.

The theory for spousal liability for medical debts is based on the Necessaries Doctrine found in most states’ statutes or common law. Through the last century, the common law theory of coverture prevented women from having independent legal rights to contract or procure food, shelter, or medical services on credit separate from their husbands. O’Daily v. Morris, 31 Ind. 111. To counterbalance these legal disabilities, the Necessaries Doctrine was established to create a duty on the husband to provide all necessities for his wife. Should he fail to do so, the wife was authorized to procure necessities on credit and the husband would be liable to the supplier for their costs. Watkins v. DeArmond, 89 Ind. 553.

With the elimination of coverture and the equalization of women’s economic potential and legal rights, states have taken a mixed approach to the Necessaries Doctrine. Some states, including Alabama and Virginia, have eliminated the doctrine entirely and thus spousal liability for medical debts no longer exists. See Emanuel v. McGriff, 596 So.2d 578; Schilling v. Bedford County Memorial Hosp., Inc., 303 S.E.2d 905. Other states’ courts, including Kansas and New Jersey, have extended the doctrine to both spouses. Regional Medical Ctr., Inc. v. Bowles, 836 P.2d 1123; Jersey Shore Medical Ctr.-Fitkin Hosp. v. Estate of Baum, 417 A.2d 1003. State legislatures have taken similarly varied approaches. North Dakota notably extended the doctrine to both spouses but narrowed the definition of necessaries, leaving out medical care. N.D. Cent. Code § 14-07-08. The states in our practice area of Ohio, Kentucky, and Indiana have mirrored the national trend, each taking a different approach to spousal debt liability.

Ohio codified its common law Necessaries Doctrine in R.C. 3103.03 by requiring husbands to support their wives and establishing liability towards third parties that provide their wives necessaries. The statute limited required support to wives who were unable to support themselves and only to the extent the husband was able. The Ohio Supreme Court in Ohio State Univ. Hosp. v. Kinkaid, relying on R.C. 3103.01 which establishes that the marriage contract creates mutual obligations of support, found the duty extended to both spouses. 549 N.E.2d 517. The Court also found that medical expenses are necessaries as defined by the statute, thus establishing that where a married person is unable to provide for their own support, the spouse must aid in the support to the extent that they are able. Ohio subsequently amended their statute by removing all references to husband and wife and used the term “married person” to explicitly extend liability to both spouses. Ohio has established clear liability for the medical debts of a debtor spouse when the debtor spouse is unable to pay the debt, to the extent that the other spouse is able.

Kentucky enacted KRS § 404.040 which established a husband’s liability for necessaries provided to his wife after marriage. The Kentucky Supreme Court has not taken up the issue, but several courts of appeals have found that husbands are liable for their wives’ medical expenses without creating a limit based on their ability to pay. See Rhodus v. Proctor, 433 S.W.2d 625; Carpenter v. Hazelrigg, 45 S.W. 666, Atkins v. Atkins’ Adm’r, 262 S.W. 268. Kentucky courts have found that the statute does not extend liability to a wife for her husband’s necessary expenses and have also taken steps to avoid striking the statute as unconstitutional, though lower courts have found it to violate the equal protection clause. See Somerset Manor, LLC v. Rees, 2011 Ky. App. Unpub. LEXIS 532; Adams v. Riddle, 2010 Ky. App. Unpub. LEXIS 151. An amendment extending the statute to both spouses was introduced in 2011 but has not yet been passed by the Kentucky legislature. Currently in Kentucky, a husband is fully liable for his wife’s medical expenses regardless of their respective financial situations but the wife is not similarly liable for her husband’s.

Indiana never codified the Necessaries Doctrine into its state statutes. The common law doctrine survived the elimination of coverture however and Indiana courts became split on its subsequent application. The Indiana Supreme Court in Barstrom v. Adjustment Bureau, Inc. established the current complicated implementation of the doctrine by extending “secondary liability” to both spouses and found medical expenses to be a necessary expense. 618 N.E.2d 1. The debtor spouse retains primary liability for necessary expenses and is responsible for the entire medical debt they incur. If the cost of medical care exceeds the debtor spouse’s separate funds and the debtor spouse is dependant on a financially superior spouse, then secondary liability is imposed on the non-debtor spouse. This secondary liability imposes liability only for the portion of the medical debt that exceeds the debtor spouse’s available funds. However, the secondary liability imposed cannot exceed the non-debtor spouse’s ability to pay at the time the debt was incurred. Indiana courts current implementation of the doctrine now requires a fact-intensive investigation into both spouses’ financial positions to determine secondary liability for a spouse’s medical debt. Porter Mem. Hosp. v. Wozniak, 680 N.E.2d 13.

Creditors with claims for medical expenses face a patchwork of regimes in determining spousal liability. Ohio imposes clear spousal liability for medical debts to the extent that the non-debtor spouse is able to pay. Kentucky currently gives full liability for a wife’s medical expenses to the husband but not the reciprocal. Indiana imposes secondary liability on non-debtor spouses for medical debts but requires a fact-intensive evaluation of both spouses’ financial situation to determine its extent. The status of spousal liability in the area continues to evolve and the states have not yet established a majority rule on the issue.

Many thanks to William Abbey for his contributions to this article.  William is a law clerk with Slovin & Associates Co., L.P.A. and student at the University of Cincinnati College of Law.