The Attorney General of Texas
JIM MAlTOX October 6, 1986
Attorney General
Supreme Court Building JM-552
Honorable Carl M. Anderson Opinion No.
P. 0. Box 12548
Austin, TX. 78711. 25u)
Nolan County Attorney
5121475.2501 P. 0. Box 1201 Ret Whether the city of Sweetwater
T~I~X 9iofa74.l387 Sweetwater, Texas 79556 is required to share the expense of
Telecopier 512i47502Sa health care for indigent residents
of Nolan~County
714 Jackson, Suite 700
Dallas, TX. 752024506 Dear Mr. Anderson:
214/742-a944
You inquire whether, under the Indigent Health Care and Treatment
Act, the city of Sweetwater is required to share the expense of health
4824 Alberta Ave.. Suite la0
El Paso, TX. 79905.2793 care services for indigents who are residents of Nolan County. We
9151533.3484 conclude that such expense is a joint responsibility of the county and
the city. We are asked the following specific questions:
1001 Texas. Suite 700
1. Within the provisions of article 4438f.
Houston. TX. 77002.3111
V.T.C.S., is an eligible resident,of Nolan County,
713x223-5886
Texas a person who does not reside uithin the area
that a Iublic hospital or hospital district has a
808 Broadway. Suite 312 legal obligation to serve?
Lubbock. TX. 79401-3479
8081747.5238
2. If the answer to the foregoing is in the
negative then, under the provisions of section
4309 N. Tenth, Suite B 12.03 of article 4438f, Is the city of Sweetwater,
McAllen, TX. 78501-1685 Texas, a governmental entity that created or
5121682.4547
authorized the creation of a 'hospital authority'
as that term is used in section 12.03?
200 Main Plaza, Suite 400
San Antonio, TX. 782052797 The only hospital in Nolan County is operated by a joint county-
512/2254191 city hospital board created under article 44941-l. V.T.C.S. Such a
board is a separa'x!entity which acts independently but operates the
An Equal Opportunity/
hospital as a joint agent of the county and the city. V.T.C.S. art.
Affirmative Action Employer 44941-l. 62. The board may not encumber, sell, lease, or convey real
or personal property without prior approval of the commissioners court
and the governing body of the city. Art. 4494i-1, ,65. The board may
issue revenue bonds, but it may not deliver bonds unless the issuance
is approved by the comissioners court and the governing body of the
city. Art. 4494i-1, 506. 8. Section 5 also expressly authorizes the
county and the city to contract with the board for the care of
indigent persons with both the county and the city making payments to
the board pursuant to such a contract from any of their funds or
resources.
p. 2450
Honorable Carl M. Anderson - Page 2 (JM-552)
Prior to the enactment of the Indigent Health Care and Treatment
Act, which is codified as article 4438f. V.T.C.S., Attorney General
Opinion MW-33 (1979) detenained that the commissioners court of each
county was required by sta:ute to provide necessary medical care for
its indigents and that a county was liable for expenses of an indigent
resident incurred at a joint county-city hospital unless the county
contracted with the city J:CIshare such expenses under section 5 of
article 44941-l. The Indigent Health Care and Treatment Act changes
the law expressed in that opinion.
Under the Indigent Health Care Act, each county shall provide
health care assistance to i.tseligible residents who do not reside in
the area that a public hospital or hospital~district has a legal
obligation to serve. V.T.C.S. art. 4438f, 92.02(a). Each public
hoapital shall provide health care assistance to the eligible
residents of the area that the hospital has a legal obligation to
serve, and each governmentxl entity that owns, operates, or leases a
public hospital shall provid,esufficient funding to allow the hospital
to provide that health ca:re assistance. Art. 4438f, 110.02(a). A
public hospital is liable for health care services provided by any
provider, including another public hospital, to an eligible resident
of the area that the hospital has a legal obligation to serve. Art.
4438f. 512.01(a). Sectior. 12.03 of the Indigent Health Care Act
provides that
[elach governmental entity that ,owns, operates, or
leases a public hospital shall provide sufficient
funding to thenho:spital to provide the health care
assistance require'd by this Act. If a public
hospital is owned, operated, or leased by a hospital
authority, the governmental entity that created or
authorized the creation of the authority shall
provide sufficient funding to the public hospital or
hospital authority to provide the health care assis-
tance required by this Act.
You first ask whether an eligible resident of Nolan County is a
person who resides within the area that a public hospital or hospital
district has a legal obligation to serve. Health care assistance to a
person who does not reside in such an area is provided by the county.
It is our opinion, however, that an eligible resident of Nolan County
resides in anarea that a public hospital has a legal obligation to
serve.
The hospital in Nolan County operated by the joint county-city
hospital board is a public hospital as that term is used in the
Indigent Health Care Act. The act defines a public hospital as "a
hospital owned. operated, or leased by a governmental entity" and a
governmental entity includes a county, city, town, hospital authority,
or other political subdivis,lonof the state, but does not include a
hospital district. Art. 4438f. 01.02(6)(10). The hospital in
quest-ionhas a legal obligation to serve the area of the county and
p. 2451
Honorable Carl M. Anderson '-Page 3 (JM-552)
the city. Under the Indigent Health Care Act, the public hospital in
Nolan County provides health care assistance to indigent residents of
Nolan County.
Your second question ::I;whether, by creating the joint hospital
board with the county, the city is a governmental entity that created
or authorized the creation of a hospital authority as that term is
used In section 12.03 of th,zIndigent Health Care Act.
The Indigent Health Cars Act does not define "hospital authority"
for purposes of the act. .i joint county-city hospital board created
under article 44941-l and hospital authorities created by a city
under article 4437e. V.T.C.S., and by a county under article 4494r,
V.T.C.S.. have both similar and dissimilar characteristics. Neither a
hospital authority nor a joint county-city hospital board has taxing
power. Both a hospital authority and a joint county-city hospital
board are entities separate from the governmental entity that created
them and may construct, enlarge, furnish, equip, operate, and maintain
their respective hospitals. V.T.C.S. art. 4437e. 56(a); art. 4494r,
56(a); art. 44941-l. 54. A hospital authority may Issue revenue bonds
after an election to approvszthe bonds if ten percent of the qualified
voters request such an election and without an election if the voters
do not request it. A jo,Lnt county-city hospital board may issue
revenue bonds, but all such bonds must be approved by both the county
and the city that created the joint board. Art.' 44941-l. 58. By
statute, hospital authorities are a "body politic and corporate" and,
in the case of a county hos:pitalauthority, a "political subdivision
of the State," as distinguished from a joint county-city hospital
board which constitutes a '"public agency and body politic." Art.
4437e. 53; art. 4494r. $3;