October I, 1975
The Honorable George N. Rodriguez, Jr. Opinion No. H- 703
County Attorney
El Paso County Re: Liability of a hospital district
Room 201, City-County Building for the costs of medical care of
El Paso, Texas 79901 indigent prisoners.
Dear Mr. Rodriguez:
You have requested our opinion concerning the circumstances under
which a hospital distr’ict would be liable for the costs of medical care of indigent
prisoners. You note that “the issue is not whether prisoners shall receive medi-
cal-hospital care, ” for the Federal Constitution requires prisoners to be given
necessary medical care. Neuman v. Alabama, 503 F. 2d 1320 (5th Cir. 1974),
cert. den. 43 U.S. L. W. 31i84 (4-29-’ 75): Fitzke v. Shappell, 468 F. 2d 1072 (6th
Cir. 1972); Tolbert v. Evman, 434 F. -id 625 (9th Cir.. 1970); United States ex
rel. Ingram v. Montgomery County Prisoner Board. 369 F. Suuo. 873 (K . D . P a.
1974t). Your Question is which pal-itical subdivision, if any, is-liable fir the costs
of such medical care.
The El Paso County Hospital District was created under article 4494%
V. T. C. S. , pursuant to authority granted in article 9, section 4 of the Texas
Constitution. Both article 9, section 4 and article 9, section 9 provide that hospi-
tal districts:
shall assume full res onsibility for providing medical
and hospital care [to P needy inhabitants [of the district]
“Inhabitant” has been held to signify a person who occupies:
something more or less permanent, an abode amino
manendi, a place where a person lives or has his
home, to which, when absent, he intends to return,
and from which he has no present purpose to depart.
Struble v. Struble, 177 S. W. 2d 279, at 283 (Tex.
Civ. App. -- Amarillo 1943, no writ).
We have discovered no Texas case offering a definition of “needy;”
howevenit is generally accepted to mean “indigent, necessitous, very poor. ”
Black’s Law Dictionary, 4th Ed. ; Ballentine’s Law Dictionary, 3rd Ed. ; Moore v.
State Social Security Commission, 122 S. W. 2d 391 (Mo..App. 1938); see also
Nichols v. State Social Security Commission of Missouri, 164 S. W. 2do.
1942) Moses v. Olson, 255 N. W. 617 (Minn. 1934); Juneau County v. Wood County,
85 N.‘v. 387 (Wis. 1901). We believe the word “needy” as contained in article 9,
sections ‘4 and 9, should be given its normal meaning, indigent. In our view a
p. 3041
The Honorable George N. Rodriguez, Jr. - Page 2 (H-703)
translation of indigency into precise income levels involves factual matters.
Under article 9, sections 4 and 9, we believe that in the first instance
a hospital district should reasonably determine this figure. Where a reasonable
standard of indigency is in use by a hospital district, that same standard would
be applicable to article 9, sections 4 and 9. Otherwise the district would be
classifying similarly situated persons differently, and in the absence of a rational
basis would be in violation of the equal protection clause of the 14th amendment.
Thus, the hospital district is constitutionally responsible for the care
of indigent prisoners who are residents of the district. See Attorney General
Opinion M-870 (1971); Ritch v. Tarrant County Hospital District, 4i6 S. W. 2d
950 (Tex. Civ. APP. --Fort Worth 1972). affirmed 480 S. W. 2d 622 (Tex. SUP.
i974); Arseneau v. Tarrant County H&?p&l District, 408 S. W. 2d 802 (Tex. civ.
App. --h’ort Worth 1966, writ ref’d n. r. e. ). Where the prisoner is an indigent res-
ident of another hospital district, in our opinion the district of which he is a res-
ident is constitutionally responsible for his care and is liable therefor. Attorney
General Opinion M-870 (1971). If the prisoner is a resident of a county not
within a hospital district, that county is liable for his care in the circumstances
set out in section 5 of article 449411, which provides in part:
The Board of Managers, with the approval of the
Commissioners Court shall be authorized to contract
with any county for care and treatment of such county’s
sick, diseased and injured persons. . . .
If care or treatment is given to a resident of a
county outside the Hospital District which has not con-
tracted with the Board of Managers for such services,
and said non-resident is wholly without financial means
except such as are derived from charity, that County
shall, upon presentation of a certified statement that
care or treatment was necessary for the preservation of
human life and was actually performed, be obligated to re-
imburse the Hospital District in an amount not to exceed
the actual cost of the service rendered.
Where the treatment of a, prisoner does not fall within this provision,
and no hospital district is responsible for his care, we believe the county of in-
carceration is liable for such care under articles 1037 and 1040, T. C. C. P.
Article 1037 provides:
Each county shall be liable for all expense incurred on
account of the safe keeping of prisoners confined in jail or
kept under guard, except prisoners brought from another
county for safe keeping, or on habeas corpus or change of
venue; in which cases, the county from which the prisoner
is brought shall be liable for the expense of his safe keep-
ing.
p. 3042
The Honorable George N. Rodriguez, Jr.-Page 3 (H-703)
Article 1040 provides in part:
For the safe keeping, support and maintenance of
prisoners confined in jail or under guard, the sheriff
shall be allowed the following charges:
. . .
For necessary medical bill and reasonable extra
compensation for attention to a prisoner during sick-
ness, such an amount as the commissioners court of
the county where the prisoner is confined may deter-
mine to be just and proper.
In Attorney General Opinion M-870 (1971) it was noted that article
9, section 9 provides that:
after1 a hospital district’s] creation no other munici-
pality or political subdivision shall have the power to
levy taxes. . . for hospital purposes or for providing
medical care within the boundaries of the district. . . ?
Article 9. section 4 provides in part:
counties and cities [within a hospital district] shall not
levy any other tax for hospital purposes. . . .
Thus it was stated in M-870 that:
the provisions of Articles 1037 and 1040.. . . . . must
yield to the express broad language of Section 9
of article 9 . . . .
M-870 dealt with a prisoner who, was an inhabitant of a hospital dis-
trict which was therefore constitutionally responsible for his care. So limited
we believe the resolution of that opinion to be correct. w see Attorney General
Opinion H-454 (1974). However, we do not believe that article 9, sections 4 and 9
were intended to require a hospital district to be responsible for the care of prison-
ers who are not needy inhabitants of the district. This would be beyond the con-
stitutional responsibility of the district. In Attorney General Letter Advisory No.
97 (1975).we dealt with a similar restriction on the use of state funds and stated:
we believe sections 4 and 9 were not intended to prevent
exchanges of consideration between state agencies and
hospital districts where a district contracts to provide
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The Honorable George N. Rodriques, Jr. - Page 4 (H-703)
services to the State which it is otherwise under no
duty to provide.
In our view this statement is also applicable to a situation where a hospital
district provides services to a county which it is under no constitutional ob-
ligation to provide. The restrictions on a county’s taxing power contained in
sections 4 and 9 should in our opinion be construed as complementary to the pro-
visions establishing the constitutional responsibilities of hospital districts, and
should not be interpreted as denying the county the authority to satisfy its ob-
ligations to prisoners under articles 1037 and 1040 as well as under the Federal Con-
stitution. However, we believe the county of incarceration is liable only when no
other political subdivision is statutorily or constitutionally responsible for the
prisoner’s care.
SUMMARY
A hospital district is liable for the medical care of
its needy inhabitants, that is, its indigent residents.
The district must either provide such care to prisoners
within this class or must recompense the parties who do
provide such care.
Where a prisoner is not a resident of a hospital dis-
trict, and section 5 of article 4494n, V. T. C. S., is in-
applicable, the county of incarceration is liable for his
medical care under articles 1037 and 1040, T. C. C. P.
Very truly yours,
Attorney General of Texas
APPROVED:
Opinion Committee
jad:
p. 3344
Untitled Texas Attorney General Opinion
Combined Opinion