THE ATTORNEY GENERAI.
OF TEXAS
May 21. 1987
.JlYl.w.mTGx
A-RXEY GESERAI.
Bonorable Lowell C. Halt Opinion No. JM-705
Criminal District Attorney
P. 0. Box 730 I&: Whether a county is required to
Gilmer, Texas 75644 reimburse a stare-supported public
hospital for indigent health care of
a resident of that county
Dear Mr. Halt:
You ask whether a county that does not have a public hospital and
is not located within a hospital district is required to reimburse The
University of Texas Health Center at Tyler for health care of an
indigent resident of the county who was treated at the Eealth Center
for a heart condition. You advise us that the person was referred by
the county’s “contract doctor* to the Health Center for care.
Title 2 of the Indigent Health Care and Treatment Act, article
4438f, V.T.C.S., applies to and determines health care services and
assistance for a person who does not reside in the area that a public
hospital or hospital district has a legal obligation to serve. Art.
4438f. 52.01. Each county shall provide the health care assistance
prescribed by Title. 2 to each eligible resident of that county who
does nor reside within an area served by a public hospital or hospital
district. Id. 152.02,~3.01. A county may arrange co provide health
care servicethrough a local health department, a publicly owned
facility, a contract with a private provider, or through the purchase
of insurance for eligible residents. Id. $3.02. Also, a county may
select one or more providers of health care services and, when
medically appropriate, require its indigent residents to obtain care
from a mandated provider. Id. 03.03. Except as otherwise provided by
Title 2, and assuming thz there has been compliance with the
requirements of that title concerning the provision of health care
services by mandated providers and notification of and approval from
the county for emergency and nonemergency services, a county is
responsible for either paying for or for providing health care
services for which payment is not otherwise available. -2 See Id
513.03. 3.04, 3.05, 4.01(d).
A county is not liable under Title 2 for health care services
provided by a hospital to an eligible resident of the county if the
hospital providing the services has a Hill-Burton or state-mandated
p. 3261
Honorable Lowell C. Bolt - Page 2 (JM-705)
obligation to provide free services and the hospital is in
noncompliance with the obligation. Id. 14.01(c). Also, a county is
not liable under Title 2 for the coTof a mandatory health service
that is in excess of the payment standards for that service
established by the Texas Department of Human Services or in excess of
the limitation for each year prescribed by section 4.03 for each
See id. 94.02.
eligible resident of the county. --
In summary, and subject to the provisos and limitations In Title
2, a county is liable for payment for health care services provided
under Title 2 by any provider to an eligible resident of the county
who does not reside in an area served by a public hospital or hospital
district.
It has been suggested that heart disease is a chest disease and,
therefore, that the state. instead of the county, Is responsible by
statute for the expanse of treatment of a heart condition provided at
The University of Texas Health Center at Tyler for an indigent
resident of a county that does not have a public hospital or hospital
district. It is our opinion that the legislature has not provided
that the medical care of indigent patients with heart disease is an
expense to be paid by the Tyler Eealth Center out of state funds.
The hospital in question originally was a state tuberculosis
hospital which treated only tuberculosis cases. In 1977, the
legislature transferred the East Texas Chest Hospital to the Board of
Regents of The University of Texas System with authority to change its
name and use it as a teaching hospital. See V.T.C.S. art. 3201a-4.
112, 5. The name was changed to The University of Texas Health Center
at Tyler. Sections 1 and 7 of article 3201a-4 state the legislature's
intention that the hospital continue to serve as a state tuberculosis
hospital under the terms and provisions of the Texas Tuberculosis
Code, article 4477-11, V.T.C.S., and that The University of Texas
System provide and pay for the care and treatment of tuberculosis
patients in that hospital out of funds appropriated by the legislature
for the hospital to use for that purpose. Section 6 of article
32Ola-4 provides also that:
It shall continue to be the policy of the State
of Texas to provide a program of treatment of the
citizens of this state who are affected with chest
diseases, and in pursuance of that policy the East
Texas Chest Hospital shall among other functions
continue to serve as the primary facility in this
state to conduct research, develop diagnostic and
treatment techniques and procedures, provide
training and teaching programs, and provide diag-
nosis and treatment for both inpatients and out-
patients with respect to all chest diseases.
p. 3262
Honorable Lowell C. Ilolt- Page 3 (JM-705)
C
Section 9 of the Texas Tuberculosis Code provides in part that:
Patients admitted co state chest hospitals
shall be two (2) classes:
(1) Indigent public patients and
(2) Non-indigent public patients.
(a) Indigent public patients are those who
possess no property of any kind nor have anyone
legally responsible for their support, and who are
unable to reimburse the state. This class shall
be supported at the expense of the state.
It is our opinion, however, that the provisions of the Texas
Tuberculosis Code only apply to the care and treatment of persons with
tuberculosis. Senate Bill No. 868 of the Sixty-sixth Legislature in
1979 amended section 9 of the Code by changing the name "tuberculosis
hospitals" to "chest hospitals." The caption of Senate Bill No. 868
describes that bill as "an Act relating to the diagnosis and care of
parsons having tuberculosis." Section 2 of the Tuberculosis Code
expressly states that "[IIt is the purpose of this Code to provide
,- care and treatment for those afflicted with turberculosis, to
facilitate their hospitalization. and to enable them to obtain needed
care .n
We conclude that the provisions of the Tuberculosis Code.
including section 9, are applicable to the treatment of persons with
tuberculosis and do not apply to the treatment of heart conditions,
regardless of whether "heart conditions" might properly be called
"chest diseases" in other contexts. Under both article 3201a-4 and
the Tuberculosis Code, the treatment of tuberculosis patients in the
Health Center at Tyler is an expense of the Health Center to be paid
from state funds. Neither of those statutes nor any other statute of
which we are aware mandates treatment at the Health Center at state
expense for indigent persons suffering from a heart condition. Hence,
a county that arranges for care of a heart condition for its indigent
resident at the Health Center is responsible for payment for such
services under Title 2 of the Indigent Health Care and Treatment Act.
SUMMARY
A county which Is liable for health cara
assistance under Title 2 of the Indigent Health
Care and Treatment Act is responsible for paying
for or for providing health care services for which
payment is not otherwise available. The statutes
providing for care and treatment of tuberculosis in
p. 3263
Eonorable Lowell C. Halt - Page 4 (JM-705)
--Y
The University of Texas Health Center at Tyler for
indigent patients at state expense do not apply to
heart conditions. A county which arranges for care
at the Health Center for a heart condition of an
indigent residenr is responsible for paying the
Health Center for treatment of the heart condition.
JIM MATTOX
Attorney General of Texas
JACK HIGHTOWER
First Assistant Attorney General
MARYXZLLER
Executive Assistant Attorney General
JUDGE ZOLLIE STEAKLET
Special Assistant Attorney General
RICK GILPIN
Chairman, Opinion Committee
Prepared by Nancy Sutton
Assistant Attorney General
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p. 3264