### THE ATTORNEY GENERAL OF TEXAS February 23, 1988

C Honorabl'eAshley Smith Opinion No. JR-864

Chairman Government Organization Re: Committee Authority ofAmarillo Hospital District todisTexas House ofRepresentatives pose of Northwest Texas P. 0. Box 2910 Hospital (RQ-1277) Austin, Texas 78769
Dear Representative Smith:
You ask several questions pertaining to the City of Amarillo Hospital District (AHD). TheAHD was authorized by article IX, section 5,of the Texas Constitution and created byActs 1957, 55th Leg., ch. 136, at 298. Because the creating statute predated the effective date of the ~constitutional amendment authorizing the district, the legislature Walidatedql the enabling statute by House Bill No. enacting

70byActs 1959, 56th Leg., ch. 32, at 59. House Bill No. 70was essentially a reenactment of the earlier statute with a fewamendments. The boundaries of theAHD are coextensive with the boundaries of the city ofAmarillo. Tex. Const. art. IX, 95(a). The constitutional provision as originally adopted authorized the legislature topermit Potter County to levy atax in that portion of the county outside the city limits ofAmarillo to render financial aid to the district. Art. IX, 55(b). A similar provision relating to Randall County was added to the constitution in 1987. Art. IX, 55(e). Thus, Potter andRandall County residents who are not residents ofahospital district may be served by theAHD.~ Acts 1957, 55th Leg., ch. 136, 516, at 304, asamended byActs 1959, 56th Leg., ch. 32, 516, at 66and Acts 1987, 70th Leg., 2nd C.S., ch. 71, 54, at 454.

1. Randall County has not yetheld an election on the question ofparticipating intheAHD.



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We restate your questions as follows:
1. Does theAHD board ofmanagers or the Amarillo City Commission own and operate the Northwest Texas Hospital?
2. Who has final authority to sell, lease, or close the hospital? Which entity, the hospital district board or the Amarillo City Commission, must determine that the sale, lease, or closure of the hospital is inthebest interest of the district's residents?
3. Isan election required to approve the sale or lease of the Northwest Texas Hospital to another entity?
4. If thehospital is sold, leased, or closed, what is the hospital district's responsibility to thepersons it serves? TheAHD operates theNorthwest Texas Hospital. Confusion about the authority of the board ofmanagers of the hospital district may stem from the fact that the governing body of the city ofAmarillo also has statutory responsibilities in relation to this hospital district. The district's enabling legislation provides inpertinent part:
Sec. 1. The City ofAmarillo, Texas, may

be constituted aHospital District . . . for the nurnose of ownina and oneratina a hospital or hOsnita1 svstem for indiaent and need!?nersons. . . .

. . . . Sec. 4. **a.** Any lands, buildinas or eouinment thatmay be jointly or separately owned by the City of Amarillo and the County of Potter, within thehospital district, and by which medical services orhospital care are furnished to the indiaent . . .shall become the nrooertv of the HosDital District: and title thereto shall vest in the HOSDital District. . . , Sec. 5.a. The aovernina bodv of the Citv ofAmarillo shall annoint aBoard ofHOSDital

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Manaaers . whose duties shall be to manaae. control and administer the hosnital gr hosDita1 svtem of the HOSDital District. . . . T:e Board is authorized to promula t rules and reculations for the 0DeratiEne of the hOSDita1 or hosoital svstem. . . . Sec. 6. The governing body ofthe City of Amarillo shall have the power to prescribe themethod andmanner ofmaking purchases and expenditures by and for such Hospital District . . .ormay delegate any or all such powers to the Board ofManagers. . . .

. . . . Sec. 9. a. The Hospital District . . . shallhave the right andpower of. eminent domain. . . . b. The HOSDital District shall have the power to take bypurchase or lease lands within or without thedistrict as may be required for itspurpose: and itmav sell or lease anv lands owned bv itat DUblic r private sale: nrovided. hwever. that io real estate mav be sold zr leased until titer there h sbeen adetermination bv the aovernina bodt of the Citv ofAmarillo that either the lands are 1 a rreouired f the nurnoses of the %.t% or that t:E arantee or lesseewill use the DroDertv for hOSDita1 nurnoses orourDOses incidental and JIecessarvto hosDita1 DurDoses. (Emphasis added.)
Acts 1957, 55th Leg., ch. 136as amended byActs 1959, 56th Leg., ch. 32.
Inanswer to your firstquestion, it isclear from the language quoted above insections 4, 5,and 9that the hospital district owns Northwest Texas Hospital and that the board ofmanagers operates the facility.
Next you ask about the authority to sell, lease, or close the hospital. Section 9(b) of the district's enabling statute quoted above addresses the sale ofm. However, article 4437c-2, V.T.C.S., isa later enactment of the legislature that is specifically concerned with the

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sale, lease, or closure ofhospitals. Inour opinion, this article answers your second and third questions. The statute provides inpertinent part:

Section 1. In thisAct, 'official action' means . . . a resolution adopted by the governing body ofahospital district. Section 2. (a) The governing body of

. . .ahospital district by official action may order the sale, lease, or closure of all or anypart of, including real property, a hospital owned and operated by the political subdivision. The official action must include a finding by the governing body that the sale, lease, or closure is inthe best interest of the residents of the political subdivision.

. . . . (c) The sale or closure of ahospital is contingent on the right of the voters by petition to require a referendum on the issue. The sale or closure may not take effect sooner than the expiration of the time for apetition to be filed under Section 3of this Act and, if avalid petition is filed, the sale or closure is contingent on voter approval.

. . . . Section 3. (a) Ifbefore the 31st day after the date onwhich the governing body orders that ahospital be sold or closed the governing body receives apetition signed by at least 10percent of the qualified voters of the political subdivision requesting an election on the question, the governing body .shallorder and conduct an election. (b) . . .Ifamajority of the qualified voters voting on the question approve the sale or closure, thehospital may be sold or closed.
V.T.C.S. art. 4437c-2.

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Pursuant to article 4437c-2, V.T.C.S., the board of managers of thehospital district has authority to sell, lease, or close the Northwest Texas Hospital after the board determines that such action is in thebest interest of the district's residents. Article 4437c-2, V.T.C.S., does not give the city of Amarillo's governing body any authority to participate in adecision **by** the hospital district's board ofmanagers to sell, lease, or close itshospital facility. If the proposed action .isa sale or closure of the facility, the voters may petition for an election on the issue of approving ordisapproving theproposed sale or closure. An election isnot required unless the petition reguirements ofarticle 4437c-2, V.T.C.S., are satisfied. See Jackson Countv Hosrdtal District v. Jackson County Citizens For Continued HOSDital Care, 669 S.W.2d 147 (Tex. APP. -Corpus Christi 1984, nowrit). Finally, you ask about the hospital district's responsibility to thepersons it serves if the Northwest Texas Hospital is sold, leased, or closed. The constitutional provision and statute governing theAHD require the district to provide medical care to the needy inhabitants of the district and to residents of Potter County who are outside the district's boundaries. Tex. Const. art. IX, 55;Acts 1957, 55th Leg., ch. 136, asamended. If apprpved by thevoters ofRandall County, the district will also be responsible forthe care ofRandall County residents who do not reside inahospital district.
Pursuant to the Indigent Health Care and Treatment Act (article 4438f, V.T.C.S.) ahospital district has a mandatory duty to provide the health care services required under the Texas Constitution and the statute creating the district. V.T.C.S. art. 4438f, 511.02. In accordance with section 11.03 of the Indigent Health Care and Treatment Act, ahospital district may arrange to provide health care services through other public facilities, by contracting with a private provider, or through thepurchase of insurance for eligible residents. The district may also affiliate with other public hospitals, hospital districts orgovernmental entities to provide regional administration anddelivery of health care services. &S Attorney General Opinion JM-858 (1988). Regardless of the method chosen by the hospital district toprovide services to its eligible recipients, the district is liable for thehealth care services as

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provided **by** the constitution and its statute. V.T.C.S. art. 4438f, 512.01(b). Thus, the sale, closure, or lease of the Northwest Texas Hospital will have no effect on the - legal responsibility that theAHDhas towards the persons it serves.
SUMMARY

The City of Amarillo Hospital District owns theNorthwest Texas Hospital. The board ofmanagers of thehospital district operates .the facility.
Pursuant to article 4437c-2, V.T.C.S., the hospital district's board ofmanagers may sell, lease, or close a hospital after a finding that such action is in the best interest of the district's residents. The voters of the district may petition for an election on the issue of selling or closing a hospital.
If theNorthwest Texas Hospital is sold, leased, or closed, the City of Amarillo Hospital District continues to be legally responsible for providing medical care pursuant to the Indigent Health Care and Treatment Act. Very truly yo , 

# LlhtJ%

/L JIM MATTOX Attorney General of Texas
MARY KELLER First Assistant Attorney General
LOUMCCREARY Executive Assistant Attorney General
JUDGE ZOLLIE STEAKLEY Special Assistant Attorney General
RICK GILPIN Chairman, Opinion Committee Prepared by Karen C.Gladney Assistant Attorney General ,-.

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