Eonorable Mark 8. Dettman 

Midland County Attorney 

P. 0. Box 2559 

Midland, Texas 79702 

Opinion No. ~~-643 

Re: Liability of a county for 

medical care of indigent inmates 

of a county jail 

Dear Mr. Dettman: 

You inquire about liability for medical treatment for nonresident 

Indigent prisoners incarcerated in the Midland County jail. Specifically, you ask whether the term "welfare patient" as used in the act 

creating the Midland County Hospital District includes nonresident 

indigent prisoners indarcerated in the county jail when the prisoners' 

residences are in areas not served by a hospital district. We 

conclude that responsibility for medical treatment for a "welfare 

patient u incarcerated in the county jail whose residence is not within 

a hospital district is determined by article 104.002 of the Code of 

Criminal Procedure. 

The Midland County Hospital District is created under authority 

of article IX, section 9. of the Texas Constitution, by chapter 112, 

Sixty-fifth Legislature, 1977. See V.T.C.S. art. 4494q. The district 

includes all of Midland County. Section 19 of that act provides 

principally for liability for care and treatment of a patient residing 

within that hospital district who has been admitted to the district's 

facilities. It also contains the following provision: 

If a welfare patient is admitted to the district's 

facilities and is not a resident of the district, 

the district may seek reimbursement from the 

county of the residency of the patient and may sue 

for reimbursement. 

Acts 1977. 65th Leg., ch. 112, 519. at 242. 

The section-by-section analysis of the bill creating the Midland 

County Hospital District includes the following analysis of section 

19: 

Section 19. Board to inquire into patient's 

ability to pay with recourse as well to relatives. 

Inability to pay will cause the patient to become 

a charge on the District. Disputes, hearings, 

appeals. Board may seek reimbursement from 

p. 2917 
Eonorable Mark H. Dettman - Page 2 UM-643) 

indigents home county (indigent defined as welfare 

patient). May sue. 

See Bill Analysis to S.B. No. 

Intergovernmental Affairs, 

1210 prepared for House Committee on 

filed in Bill File to S.B. No. 1210, 

Legislative Reference Library. Hence, it seems clear that the 

legislature intends "welfare patient" in that act to be synonymous 

with "indigent patient." 

Expenses for prisoners confined In a county jail are the subject 

of article 104.002 of the Code of Criminal Procedure, which provides 

that: 

(a) Except as otherwise provided by this 

article, a county Is liable for all expenses 

incurred in the safekeeping of prisoners confined 

in the county jail or kept under guard by the 

county. If a prisoner is transferred to a county 

from another county on a change of venue. for 

safekeeping, or for a habeas corpus hearing. the 

county transferring the prlsoner'is liable for the 

expenses described by this article. 

Article 104.002 is a recodification of several procedural statutes, 

including articles 1037 and 1040 of the Code of Criminal Procedure 

(Vernon 19251, which governed the liability of a county for the 

medical care and treatment of indigent prisoners. Article 1037 

provided that: 

Each County shall be liable for all expenses 

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 keeping. (Emphasis added). 

Article 1040 provided in part as follows: 

For the safekeeping, support and maintenance of 

prisoners confined in jail or under guard, the 

sheriff shall be allowed the following charges: 

. . . . 

3. For necessary medical bill and reasonable 

extra compensation for attention to a prisoner 

during sickness, such an amount as the commissioners court of the county where the prisoner is 

confined may determine to be just and proper. 

(Emphasis added). 

p. 2918 
Eonorable Mark H. Dcttman - Page 3 (JM-643) 

Article IX, section 9, of the Texas Constitution, under which the 

Midland County Hospital Authority is created, provides, in part, that 

a hospital district created thereunder 

shall assume full responsibility for providing 

medical and hospital care for its needy inhabitants. . . . 

On several occasions, this office has considered the liability of a 

county for medical services provided to indigent persons incarcerated 

in county jails when the person is a resident of a hospital district. 

Those opinions concluded that the hospital district of which an 

indigent prisoner Is a resident, rather than the county of incarceration, is liable for the medical care and treatment of an indigent 

prisoner. See Attorney General Opinions JM-487 (1986); H-703 (1975); 

M-870 (1971r The rationale for that conclusion is that articles 1037 

and 1040 of the Code of Criminal Procedure must yield to the express 

broad language in article IX, section 9, of the Texas Constitution. 

Subject to constitutional provisions, the liability for care and 

treatment of indigent persons and Indigent prisoners is now governed 

by article 104.002 of the Code of Criminal Procedure and the Indigent 

Health Care and Treatment Act. codified as article 4438f, V.T.C.S. 

Under the Indigent Health Care Act, (1) a county is liable for health 

care assistance of its eligible residents who do not reside in an 

area served by a public hospital or hospital district, (2) a public 

hospital is responsible for health care assistance to eligible 

residents of the area served by the hospital, and (3) a hospital 

district is liable for.health care services as provided by the Texas 

Constitution and the statute creating the hospital district. 

The Indigent Health Care Act does not expressly amend or repeal 

any part of articles 1037 and 1040. A repeal of statutes by implication is never favored or presumed. It has long been well established 

that a repeal by implication will be adjudged only if that result is 

inevitable or is plainly intended by the legislature. See Texas 6 

N.O. Railway Co. v. Kelso Building Material Co., 250 S.W.2d426, 430 

(Tex. Civ. App. - Galveston 1952, writ ref'd n.r.e.); Berry V. State, 

156 S.W. 626, 635 (Tex. Grim. App. 1913); Parshall V. State, 138 S.W. 

759. 765 (Tex. Grim. ADD. 1911). Statutes which deal with the same 

general subject and ha-& the same general purpose are considered as 

in para materia and must be construed together and harmonized. if 

possible, so as to give effect to both statutes, with a special 

statute governing a general statute in the event of any conflict. See 

Lingner v., Haley, 277 S.W.2d 302, 306 (Tex. Civ. App. - Amarillo 1954, 

writ dism d); Hines V. State, 515 S.W.2d 670, 675 (Tex. Crim. App. 

1974). 

The Indigent Health Care Act, article 4438f. is a broad statute 

providing for the expenses of health care for indigent persons in 

general. Article 104.002 of the Code of Criminal Procedure deals 

specifically with expenses incurred in the safekeeping of prisoners 

p. 2919 
Honorable Mark H. Dettman - Page 4 (JM-643) 

confined in a county jail. A general law will not ordinarily be held 

to have repealed by implication a particular or special law although 

both relate to the same subject. The more particular law usually is 

construed as constituting an exception to the general law. American 

Canal Co. of Texas v. Dow Chemical Co., 380 S.W.2d 662, 666 (Tex. Civ. 

APP. - Houston 1964. writ dism'd). 

We conclude that article 104.002, which provides that the county 

of incarceration is liable for all expanses including medical care of 

an indigent prisoner, constitutes an exception to the Indigent Realth 

Care Act for an indigent person who is not a resident of a hospital 

district. It follows that the provision of the Midland County 

Eospital District Act which authorizes the hospital district to sue 

for reimbursement from the county of residence of an indigent patient 

who is not a resident of the Midland County Eospital Dfstrict is not 

applicable to an indigent prisoner in the Midland County jail whose 

residence is in an area not within a hospital district and, hence, not 

governed by article IX, section 9 , of the Texas Constitution. 

SUMMARY 

Medical care and treatment for a nonresident 

indigent prisoner in a county jail who is a 

resident of an area within a hospital district is 

the responsibility of the hospital district, as 

provided by article IX, section 9. of the Texas 

Constitution. Medical care and treatment for a 

nonresident indigent prisoner In a county jail 

whose residence is not within a hospital district 

is the responsibility of the county of incarceration, as provided by article 104.002 of the Code 

of Criminal Procedure. 

Very 

Ll 

truly yours, 

A 

JIM MATTOX 

Attorney General of Texas 

JACK HIGHTOWKR 

First Assistant Attorney General 

MARY KELLER 

Executive Assistant Attorney General 

RICK GILPIN 

Chairman, Opinion Committee 

Prepared by Nancy Sutton 

Assistant Attorney General 

p. 2920