June 17, 1987
Eonorable Robert E. (Bobby) Bell Opinion No. JM-722
Criminal District Attorney
115 w. Main Re: Whether Jackson County is
Edna, Texas 77957 required to provide services under
the Indigent Health Care Act where
the county is encompassed within a
hospital district
Dear Mr. Bell:
You ask whether Jackson County is liable under the Indigent
Health Care and Treatment Act for health care services for indigent
residents of that county. We conclude that the county is not liable
for either Inpatient or outpatient health and medical services.
The Jackson County Hospital District is created under authority
of article IX, section 9, of the Texas Constitution, by chapter 275,
66th Legislature, 1979, which is known as the Jackson County Hospital
District Act. Se& V.T.C.S. art. 4494q. The district includes all of
Jackson County.-Hence, all indigent residents of the county are
residents of the hospital district.
section 9, of article IX, of the Texas Constitution provides in
part that:
The Legislature may by law provide for the
creation, establishment, maintenance and operation
of hospital districts . . . providing that any
district so created shall assume full responsl-
bility for providing medical and hospital care for
its needy inhabitants . . . providing that after
its creation no other municipality or political
subdivision shall have the power to levy taxes or
issue bonds or other obligations for hospital
purposes or for providing medical care within
the boundaries of the district. . . . (Emphasis
added).
The Jackson County Hospitai District Act provides in part that:
Sec. 16. Whenever a patient residing within
the district is admitted to the facilities of the
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Honorable Robert E. (Bobby) Bell - Page 2 (JM-722)
district, the administrator for the hospital to
which the patient is admitted may have an inquiry
made as to his or her circumstances and those of
the relatives of the patient legally liable for
his or her support. . . . If the administrator
finds that the patient or his or her relatives are
not. able to pay either in whole or in part for
care and treatment in the hospital, they shall
become a charge on the hospital district as to the
amount of the inability to pay. . . .
. . . .
Sec. 20. . . . The board shall provide for the
administration, maintenance, and operation of
both hospitals transferred to the district on its
creation so as to furnish adequate hospital and
medical care within the district and to ensure
that each hospital is provided with sufficient
funds, personnel, and equipment to the end that
residents of the district have access to quality
and competent health facilities; and no other
municipality or political subdivision may levy
tames or issue bonds or other obligations for
hospital purposes or for providing medical care
within the boundaries of the district. The
district shall assume full responsibility for
providing medical and hospital care for its needy
inhabitants. (Emphasis added).
Acts 1979. 66th Leg., ch. 275, at 595-98.
When a hospital district is created ,for the county pursuant to
article IX, section 9, of the Texas Constitution, the county constitu-
tionally does not have the power to levy or use taxes to provide for
medical services for indigent residents of the hospital district, as
such power and obligation rests exclusively on the hospital district.
Attorney General Opinion C-646 (1966). See also Attorney General
Opinion Nos. M-870 (1971); C-334 (1964).
The provisions of the Indigent Eealth Care and Treatment Act,
article 443Sf. V.T.C.S., are consistent with, and adopt by reference,
the provisions of both article IX, section 9, of the Texas Constitu-
tion and the Jackson County Eospital District Act. Title 2 of the
Indigent Health Care Act specifies the responsibility of a county for
health care assistance to the county's eligible residents who do not
reside in an area served by a public hospital or hospital district.
Sets. 2.01, 2.02(a), 3.01, .4.01. Since all of Jackson County Is
served by the hospital district, the provisions of Title 2 fixing
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Honorable Robert E. (Bobby) Bell - Page 3 (JM-722)
liability of a county for indigent health care have no application to
Jackson County.
Title 3 of the act applies to and determines liability for health
care for persons who reside in an area served by a public hospital or
hospital district. Sec. 10.01(a). We note that, under the Indigent
Health Care Act, a hospital district is not a "governmental entity."
Sec. 1.02(6). Hence, a facility of a hospital district is not a
"public hospital" within the meaning of that act and the provisions
of the act that apply to "public hospitals" are not applicable to
hospital districts.
Section 11.02 of Title 3 provides that "[a] hospital district
shall provide the health care services required under the Texas
Constitution and the statute creating the district." Section 12.01(b)
states that "[a] hospital district is liable for health care services
as provided by the Texas Constitution and the statute creating the
district."
The Indigent Health Care Act does not alter, or attempt to alter,
the responsibility of a hospital district for all health care required
by article IX, section 9, of the Texas Constitution and the Jackson
County Hospital District Act. It is not an attempt by statute to make
Jackson County liable for inpatient or outpatient health and medical
services for indigent residents of that county.
-SUMMARY
In a county in which a hospital district
encompasses the entire county, the county is not
liable for health care services to indigent resi-
dents of the county under any of the provisions
of the Indigent Eealth Care and Treatment Act.
Instead, the act specifies that, for indigent
persons who reside within a hospital district,
the hospital district is liable for health care
services as provided by the Texas Constitution and
the statute creating the hospital district.
-Jf&
MATTOX
Attorney General of Texas
JACK BIGBTOWER
First Assistant Attorney General
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Ronorable Robert E. (Bobby) Bell - Page 4 (JM-722)
MARYKELLER
Executive Assistant Attorney General
JUDGE ZOLLIE STEAKLEY
Special Assistant Attorney General
RICK GILPIN
Chairman, Opinion Committee
Prepared by Nancy Sutton
Assistant Attorney General
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