March 30. 1966 

Honorable Joe Resweber 

County Attorney 

Harris County 

Houston, Texas 

Dear Sir: 

Opinion No. C-641 

Re: Responsibility for the 

cost of operating the 

Harris County Convalescent Ward. 

This is in reply to your letter, with memorandum 

brief attached, in regard to the above matter. Pertinent 

facts from your letter and brief are quoted as follows: 

"This office was requested by Mr. S. B. 

Bruce, County Auditor of Harris County, to 

render an opinion as to whether or not the 

cost of operation of the County's Convalescent Ward is one for which Harris County may 

legally budget funds, or whether responsibility 

for such cost now rests with the newly created 

Harris Count Hospital District, In the light 

of Article 4 1 q&n, V.A.C..S., the statute authorizing 

the creation of such District. 

"The Harris County Convalescent Ward is 

located . . .in the City of Houston, Texas, In 

a building jointly owned by the City of Houston, 

and Harris County. . . . 

11 

. . . 

"Only Indigent persons in need of therapy-- 

any number of sources, direct from the charity 

hospitals In the City upon their discharge or 

release, from nursing homes or upon recommendation 

of social workers within the Welfare Deoartment 

and from various and sundry other sources. 

erson admitted to the Ward Is first processe %= 

hrough the Ben, Taub General Hospital, the newest 

-3111- 
Hon. Joe Resweber, page 2 (C-641) 

of the two charity hospitals comprising the Hospital 

District, for the purpose of being assigned a clinic 

number and having a file made for him, should the 

contingency arise necessitating his Immediate transfer to the hospital under emergency conditions. 

11 

. . . 

"In light of the above and foregoing facts, 

the question which thus presents itself for which 

an answer Is sought is whether or not the accompllshments and goals of the Convalescent Ward are such 

as envisioned by the Legislature to be assumed by 

the newly created Harris County Hospital District 

In the light of Article 449&n, V.A.C.S., . . , 

1, 

. . . 

~"The further question thus arises as to 

whether or not the Convalescent Ward is a 

nursing home In the light of the definition 

set out above from Article 4442c, and if so, 

does this fact take It out of the scope of 

application of Article 449&n, . . .'I (Emphasis 

added throughout). 

An analysis of your letter and brief discloses several 

questions. First, whether the Harris County Convalescent Ward 

is a Convalescent or Nursing Home, etc., as defined and governed. 

by Article 4442c, Vernon's Civil Statutes. And secondly, If it 

is a Convalescent or Nursing Home, etc., as defined by Article 

444&z, does this fact take it out of the scope of Article 449&n, 

Vernon's Civil Statutes. And lastly, whether responsibility for 

operation costs of the Harris County Convalescent Wards remains 

with Harris County or now rests with the newly created Hospital 

District. 

The first question, above, requires an analysis of 

Articles 4442~ and 4437f, Vernon's Civil Statutes. Article 4442~ 

pertains to licensing and control of convalescent or nursing homes, 

etc., as defined In the Article. Article 4437f pertains to the 

licensing and control of hospitals , as defined In the Article, 

operating under Texas law. Section 2(a) of Article 4442c, provides 

In part as follows: 

"'Institution' fionvalescent and nursing 

homes and related ln%itutiona7means an establishment which furnishes (rn single or multiple facilities) food and shelter to four (4) 

-3112- 
1 

Hon. Joe Resweber, page 3 (C-641) 

or more persons unrelated to the proprietor, 

ad, in addltlon, provides minor treatment 

under the direction and. supervision of a 

physician licensed by the Texas State Board 

of Medical Examiners, or services which meet 

some need beyond the basic provision of food, 

shelter, and laundry. .And provided further, that the provisions'of this act shall 

not apply to any hospital as that term is 

defined in the Texas Hospital Licensing Law. 

. . . 

11 

. . .nor shall It include general or 

special hospitals licensed in pursuance of or 

as those terms are defined In the Texas Hospital 

Licensing Law." 

Section 2(b) of Article 4437f provides as follows: 

'For the purpose of this Act: 

I, 

. . . 

"The term ' means any 

establishment o facilities, 

and beds for use beyond twenty-four (24) hours 

for two (2) or more non-related Individuals requiring diagnosis, treatment or care for Illness, 

injury, deformity, abnormality, or pregnancy, and 

regularly maintaining at least clinical laboratory 

services, diagnostic X-ray services, treatment 

facilities which would Include surgery and/or obstetrical care, and other definitive medical and 

surgical treatment of similar extent." 

Section 2 (b)(l) of Article 4437f, provides as follows: 

"The term 'special hospital' means any establishment offering services, facilities and 

'beds for use beyond twenty-four (24) hours for 

two (2) or more non-related individuals who are 

regularly admitted, treated and discharged and 

require services more intensive than room, board, 

personal services and general nursing care and 

which has clinical laboratory facilities, diagnostic 

X-ray facilities, treatment facilities and/or other 

definitive medical treatment and has a medical staff 

In regular attendance, and maintains records of the 

clinical work performed for each patient. 

-3113- 
. 

Hon. Joe Resweber, page 4 (c-641) 

"The definition of 'hospltalf does not lnelude those facilities licensed pursuant to the 

provisions of Article 4442c, Acts 1953 Legislature, 

Page 1005, Chapter 413." 

Based upon the facts in your memorandum brief concerning the operation and equipment of the Harris County Convalescent Ward, It Is our opinion that the Harris County Convalescent Ward is an "Institution" as defined by Article 4442~. 

The next question then is whether the Ward, being 

subject to Article 444% and not a hospital, falls within the 

scope of Article 449&n. In other words did the Legislature intend for Institutions, operated just as the Harris County Convalescent Ward Is operated, to be a part of a county-wide hospital 

district created under Article &494n? 

Pursuant to Section 4 of Article IX of the Constitution 

of Texas, the Legislature enacted Article &I&n, which provides 

for the creation of a.county-wide hospital district. 

Section 1 of Article 449&n provides, in part, as 

follows: 

'Any County having a population of 190,000 

or more, and Galveston County that does not 

own or operate, or that does iwn and operate a 

hospital or hospital system, by itself or jointly 

ith it f indigent and needy persons, may 

Ee co&~itu"~ea"~ Hospital District . . . and may 

take over the hospital or hospital system, . . .' 

Section 4 of Article &4$&n provides In part as follows: 

"Any-lands, buildlngs or equipment that 

may be jointly or separately owned by such 

county and city, and by which medical services 

or hospital care, including geriatric care, are 

furnished to the Indigent or needy persons of 

'&he city and county, shall become the property_ 

of the Hospital District; . . .I' 

Section 13 of Article 449&n provides in part as 

follows: 

"NO county that has been constituted a 

Hospital District, and no city therein, shall 

thereafter levy any tax for hospital purposes; 

-3114- 
Hon. Joe Resweber, page 5 (c-641) 

and such Hospital District shall be deemed to 

have assumed full responsibility for the furnishing of medical and hospital care for the needy 

and indigent persons residing in said Hospital 

D -itd s ric 

For the RospitaleDiitzict." 

It seems clear, from the above quoted, that the 

Legislature Intended to include all medical services, hospital 

care and geriatric care for the Indigent and needy within the 

scope of Article &Q&n. In other words, the hospital district 

would take over all medical or hospital care of the Indigent and 

needy within the county. 

In Attorney General's Opinion No. C-382 (1965) it was 

stated in part as follows: 

.A hospital district established under 

Article 449&n takes over the count 

% 

system previously established under Article 478, and the 

hospital district thenceforth carries out all the 

duties and obligations the county previously had 

for the care Andy treatment of 'persons' suffering 

from any illness, disease or injury. 

"It must be here noted that the primary function of the Hospital District Is the furnishing of 

medical and hospital care for the Indigent and the 

needy of the county, and that such function must 

cake precedence over all others." 

In a case involving the Bexsr County Hospital District, 

which was created under ATtlcle 449&n, the Texas Supreme Court 

stated, (page 447), that . . .the entire function of maintaining 

and operating hospitals was transferred to a d erent governmental 

w3i7.s:W.Bexar County.Hospital District v?f6rosby, lb0 Tex. 

The Legislature, by express language, provided that a 

newly created hospital district would take over a previously owned 

or hospital service, 

ersons In the 

orbids the County 

purposes, after 

the creation of such a district. Therefore, it is our opinion 

that "Institutions" operated for the indigent and needy, just as 

the Harris County Convalescent Ward, 

Article 4494n. 

fall within the scope of 

-3115- 
. 

Hon. Joe Resweber, page 6 (C-641) 

In answer to Question #3, it Is our opinion that the 

responsibility for the operation costs of the Harris County Convalescent Ward now rests with the newly created Harris County 

Hospital District. 

SUMMARY 

The responslblllty for the operation costs 

of the Harris County Convalescent Ward now rests 

with the Harris County Hospital District. 

Very truly yours, 

WAGGONER CARR 

Attorney Qeneral 

JCMcC:mkh 

APPROVED: 

OPINION COMMITTEE 

W. V. Geppert, Chairman 

John Reeves 

Malcolm Quick 

Jack Goodman 

Marietta Payne 

APPROVED FOR THE ATTORNEY GENERAL 

BY: T. B. Wright 

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