Hon. James K. Walker Opinion No.M-171
County Attorney
Cochran County Courthouse Re: Whether Cochran County "
Morton, Texas Texas, has authority to pay
public owned hospitals out-
' side the county for hospital
and medical services render-
ed to indigent inhabitants
of the county.under the'cir-
Dear Mr. Walker: cumstances stated.
You have requested the opinion of this office as to
whether Cochran County, Texas, is authorized to pay for the
medical care of an indigent resident of Cochran County, Texas,
in a public hospital outside of Cochran County, Texas, after
the creation of the Cochran Memorial Hospital District, whose
boundaries are co-extensive with the boundaries of Cochran
County, Texas. You further state in your letter that a med-
ical doctor practicing in the Cochran County Memorial Hos-
pital has recommended that an indigent patient be sent to
the John Sealy Hospital for care and treatment which cannot
be supplied at the local hospital. Article IX, Section 9, of
the Texas Constitution provides as follows:
"Sec. 9. The Legislature niay by law pro-
vide for the creation, establishment, maintenance
and operation of hospital districts composed of
one or more counties or all or any part of one
or more counties with power to issue bonds for
the purchase, construction, acquisition, repair
or renovation of buildings and improvements and
equipping same, for hospital.purposes; providing
for the transfer to the hospital district of the
title to any land, buildings, improvements and
equipment located wholly within the district which
mav be lointlv or seoaratelv owned bv anv citv, town
or-county, providing-that any district so created
shall assume full responsibility for providing
rn9 nh rtants
and assume the outstanding indebtedness incurred
by cities, towns and counties for hospital pur-
poses prior to the creation of the district, if
same are located wholly within its boundaries,
.
. . :
Hon. James X. Walker, page 2, (M-171)
and a pro rata portion of such indebtedness based
upon the then last approved tax assessment rolls
of the included cities towns and counties if
less than all the territory thereof is included
within the district boundaries . . .II (Smphasis
added.)
Thereafter the Legislature.passed House Bill 1233,
Acts 60th Legislature, Regular Session 1967, Chapter 494,
page 1113 (Art. 4494q, V.C.S.), known as the Cochran Memorial
Hospital District Bill, pursuant to Article IX, Section 9,
and its pertinent provisions read as follows:
"Section 1. Authority to create. Pursuant to
authority granted by the provisions of Section 9,
Article IX, Constitution of the State of Texas,
Cochran Memorial Hospital District is hereby au-
thorized to be created and as created shall have
boundaries co-extensive with the boundaries of
Cochran County, Texas, and possess such rights,
powers, and duties as are hereinafter prescribed.
"Sec. 2. Purposes of district. The district
herein authorized to be created shall take over
and there shall be transferred to it title to all
lands, buildings, improvements, and equipment in
anywise pertaining to the hospitals or hospital
systems owned by Cochran County and any city or
town within such county, and thereafter the dis-
trict shall provide for the establishment of a
hospital system by the purchase, construction, ac-
quisition, repair or renovation of buildings and
equipment, and equipping the same and the admin-
debtedness which shall have been incurred by any
city or town or by Cochran County for hospital
purposes prior to the creation of said district.
II
. . .
"Sec. 9. Purchases and expenditures. The
board of directors of such district shall harthe
. :1 . . -1
.
Hon. James X. Walker, page 3, (W-171)
power to prescribe the method and manner of making
purchases and expenditures, by and for such hospi-
tal district, and also shall be authorized to pre-
scribe all accounting and control procedures and
to make such rules and regulations as may be re-
quired to carry out the provisions of this Act.
II
. . .
"Sec. 17. District alone to incur indebted-
II
. . . ' (Emphasis added.)
In addition to the above quoted provisions, the Act
provides for the levying of taxes not to exceed seventy-five
cents ($.75) on the One Hundred Dollar valuation; authorizes
bonds to be issued in accordance with general law for the
building of any facilities necessary to carry out its pur-
poses; states manner of engaging a depository bank for the
district: exempts the bonds from taxation: gives power of
eminent domain; and creates a framework for screening patients
as indigents.
The responsibilities of the commissioners court in
Article 2351, Vernon's Civil Statutes, and Article 4438, Ver-
non's Civil Statutes, are now the duties of Cochran Memorial
Hospital District. Attorney General's Opinion No. C-334:(1964).
The question therefore necessarily arises as to the authority
of the hospital district to pay for indigent care in a public
institution outside of its boundaries, either under its assumed
powers of the commissioners court or powers given to it under
the Constitution and statute creating it.
The leading case prohibiting the payment by com-
missioners courts for medical treatment of an indigent out-
-820.
.I . . _.
.
Hon. James X. Walker, page 4, (d-171)
side of the county in a private hospital is Willacy County v.
Valley Baptist Hospital, 29 S.W.2d 456 (Tex.Civ.App. 1930, no
writ history). The Court stated on page 458:
11
. . .
"Under the provisions of article 4438, the
county was under no duty to send Barbosa to any
hospital, there being no public hospital in the
county, and under the implied restriction of this
provision it is doubtful if the county could be
bound by the commissioners' court, certainly not
otherwise, to send him to a hospital without the
county, at public expense.
II
. . . But the liabilities of counties are
fixed by law and cannot be extended by the courts
beyond the plain authority of the statutes.
I,
. . .I,
The Court's opinion above noted is controlling as
to the interpretation of the law, on the facts and law that
were presented to the court at the time of the decision.
It is our opinion, however, that Article IX, Sec-
tion 9, of the Constitution has enhanced the powers and duties
of the hospital district, as opposed to the commissioners
courts, and this is carried forward in the enabling legisla-
tion. The oertinent orovision of Article IX. Section 9. is:
"that any district so-created shall assumesfull responsibility
for providing medical and hospital care for its needy inhab-
itants . . .' (Emphasis added.) Similar language is con-
tainea in Section 2 of H.B. 1233 providing purposes of the
district, as follows: ". Such district shall assume full
responsibility for providing'medical and hospital c~arefor its
needy inhabitants . . .* (Emphasis added.)
Specifically, it is our opinion that when a hospital
district is created, it is no longer bound by the distinctions
betweena pauper, an indigent and other restrictions which con-
tinue to be valid for county purposes. The Willacy County case,
although binding on commissioners courts in counties where
countywide hospital districts have not been created, is not
applicable to a hospital district. Limitations on the au-
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_ .
Hon. James K. Walker, page 5, (M-171)
thority of a hospital district are determined by the constitu-
tional provision and statute whereunder it was formed and not
by the statutory powers and limitations thereof of commissioners
courts.
i.t.
kgseargl from yaw letter, that there is no public
hospital in COchran C'ountywhich can "care" for the needy
inhabitant, either medically or as a hospital. The district's
responsibility for providing such care can be exercised in
sending such needy inhabitant to a public hospital outside
of the district and under such circumstances would have the
authority to'pay for the same.
SUMMARY'
The Cochran Memorial Hospital District, by
virtue of the provisions of Article IX, Section
9 of the Constitution.of Texas, and Section 2 of
House Bill 1233, 60th Legislature, R.S. 1967, (Art.
4494q, V.C.S.) has the full responsibility for pro-
viding medical and hospital care for the needy in-
habitants of such hospital district. Where the hos-
pital district cannot discharge its full responsi-
bility to such needy inhabitant within the hospital
district be,causeof a lack of sufficient medical or
hospital facilities, it may send the inhabitant to
a hospital facility outside the district and legally
pay for such expense.
6 very truly,
ai==
. MARTIN
enerai of Texas
Prepared by Pat Cain
Assistant Attorney General
APPROVED:
OPINION COMMITTEE
Hawthorne Phillips, Chairman
Kerns Taylor, Co-Chairman
W. V. Geppert
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I.. .
. . . _
Hon. James X. Walker, page 6, (M-171)
Pat Bailey
Brock Jones
Bill Allen
A. J. CARUBBI, JR.
Staff Legal Assistant
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