Criminal District Attorney 

Bexar County Courthouse Re: Authority of the Bexar County 

San Antonio, Texas 78204 Hospital District, pursuant 

to Section S(b) of Article 

4494n, Vernon’s Civil Statutes, 

to fund the operation of a 

clinic for the poor and indigent without assuming responsibility for control and 

Dear Mr. Butler: supervision of such clinic. 

Your recent letter requesting the opinion of this office 

concerning the referenced matter states, in part, as follows: 

“This office requests your opinion concerning the following question: May the Bexar 

County Hospital District fund the operation of 

a clinic for the poor and indigent at Villa 

Coronado in south Bexar County without taking 

over the operation and supervision of the clinic? 

“The Villa Coronado Clinic was originally 

set up and funded by a Government Grant (OEO) 

during the past year with the understanding 

that it (OEO) would only fund the clinic for 

one year. The Clinic is now operated by a 

non-profit organization, “Southside Neighborhood Association Corporation”. The Clinic’s 

first year funds were expended on February 1, 

1972. At this time the Bexar County Hospital 

District decided to fund the operation since 

the persons attended by the Clinic would ordinarily be cared for by the Bexar County 

Hospital District facilities except for a 

transportation problem of about 25 miles. It 

is the Bexar County Hospital District’s contention since the transportation problem is 

so acute for these residences, that by the 

time the patients from Villa Coronado finally 

-5629- 
Hon. Ted Butler, page 2 (M-1154) 

came to the Bexar County Hospital District 

facilities they would be so advanced in their 

illnesses that they would become in-patients 

of the hospital instead of clinical out-patients. 

The Bexar County Hospital District is funding 

this clinic through the non-profit corporation 

(SSNAC) on a month to month basis without 

assuming any operation or supervision of the 

clinic and without a contract with the Southside Neighborhood Association Corporation.” 

Pursuant to the authority of Section 4 of Article IX of 

the Constitution of Texas, the Bexar County Hospital District was 

established by Article 4494n, Vernon’s Civil Statutes. Section 1 

of that Article provides, in part, that: 

“Any county having a population of 

190,000 or more . . . may be constituted 

a Hospital District as hereinafter set out 

and . . . may provide for the establishment 

of a hospital or hospital system to furnish 

medical aid and hospital care to the indigent 

and needy persons residing in said Hospital 

District. . . .I’ 

Subsection (b) of Section 5b of that Article provides, 

in pertinent part, as follows: 

,1 

. . .(T)he (hospital district) Board of 

Managers, with the approval of the Commissioners 

Court, may cooperate and contract with . . . any 

privately owned or operated 

or otherwise, 

hospitilircz;E;;;;; 

which privately owne 

hos ital is situated in the hospital district; 

p& in . the opinion of the Board of Managers 

and of tie Commissioners Court, such a contract 

is deemed expedient and advantageous to the 

hospital district under existing circumstances, 

and be for such fair and reasonable compensation 

and on such other terms and for such length of 

time as may be deemed to further and assist the 

hospital district in performing its duty to 

provide medical and hospital care to needy inhabitants of the county.” (Emphasis added). 

-5630- 
Hon. Ted Butler, page 3 ‘M-l 154) 

i 

Section 2 of Article 4437f. Vernon’s Civil Statutes, 

(the Texas Hospital Licensing Law) 9 defines the term “hospital.” 

That Act’s definition of the term “hospital” is expressly made 

applicable to the Bexar County HosPltal District by virtue of 

Subsection (b) (1) of Section 2 of Article 4437f, which provides, 

in part, as follows : 

II 

however ’ 

. The definition of ‘hospital’ does, 

include those facilities maintained 

or operited by lgovernmental’ or ‘governmental 

unit 1 as those terms are defined in Section 2, 

Subsection (d) of this Act.” 

Subsection (d) , referred to in the foregoing statutory 

provision, provides, in part, that 

“The term ‘governmental ’ Or 'governmental 

unit ) means any hospital district . . .” 

(Emphasis added). 

your letter has also advised US that the Villa Coronado 

Clinic, the funding of which is at issue in your request, does 

not fall within the definition of “hospital” set forth in Article 

4437f, and, therefore, applicable to Article 4494n. For purposes 

of this opinion, we assume that your statement concerning the Clinic’s 

falling without the purview of the definition of “hospital** is correct 

we are aware that prior to the enactment of Article 4494n, 

the board of managers of a hospital district, pursuant to Articles 

4478 and 4481, Vernon’s Civil Statutes, had authority to establish 

clinics similar to the nature of the Villa Coronado Clinic. If the 

Villa Coronado Clinic had been extant at the time of the enactment 

of Article 4494n (1953), which it.was not, it would have become the 

property of the Bexar County Hospital District, by virtue of the provisions of Section 4 of Article 4494n. 

Inasmuch as the Villa Coronado Clinic is not the property 

of the Hospital District? the only way whereby the Hospital District 

may have a legal connection with such Clinic is through rhe provisions 

of Section 5b of Article 4494n, quoted supra. 

pursuant to Subsection (a) of Section Sb, the “ospital 

District could elect to purchase the Clinic to effectuat? its duty 

of providing for “the establishment of a hospital or hosFita1 system 

to furnish medical aid and hospital care to the indigent and need? 

-q631- 
Hon. Ted Butler, page 4 (M-1154) 

persons” residing in the District. 

However, the District cannot , pursuant to Subsection 

(b) of Section Sb, contract with the Clinic, inasmuch as it is 

not a “hospital” as that term is used in Subsection (b), by virtue 

of the provisions of Subsection (b)(l) of Section 2 of Article 

443?f, quoted supra. Furthermore? no authority is found in Section 

5b of Article 4494n whereby the District could contract with any 

clinic, as opposed to a hospital, in the District. Cf. Attorney 

-1’s Opinion No. M-85 (1967), and authorities cxed therein, 

whereby the right of a hospital district to pay private hos itals 

for medical care rendered to needy and indigent persons -7T-hixty o 

was upheld, where it was not practical to treat such persons in the 

hospital district’s own facilities. 

Even if, arguendo , clinics fell within the purview of 

Subsection (b) of Section Sb of Article 4494n, it is manifest from 

the import, and specific terms,of that Subsection that the only 

way the District could have a relationship with the Clinic would 

be by contract. 

Your letter clearly states that the Hospital District 

is presently funding the Clinic, on a month-to-month basis, through 

a non-profit corporation, and that the District neither assumes any 

operation or supervision of the Clinic, nor does it have any contract with the parent non-profit corporation. 

We are unable to find any legal authority sanctioning the 

fact situation at issue in your request. You are advised that the 

Bexar County Hospital District may contract only with those entities 

set forth in Subsection (b) of Section 5b of Article 4494n. If the 

Villa Coronado Clinic meets the definition of “hospital” (as that 

term is used in Article 4437f, quoted supra), you are further advised that the Hospital District may contract with the Clinic to 

render such medical services to the needy and indigent of the 

District as the Board of Managers deems necessary. 

No funding of the operations of the Clinic, or of its 

parent non-profit corporation, may be granted from funds of the 

Hospital District until a contract is executed between the District and the parent corporation, whereby the District will assume 

appropriate responsibility for the operation and control of the 

Clinic. 

We are mindful of the fact that the Bexar County Hospital 

District has the constitutional and statutory duty to furnish medical 

-5632- 
Hon. Ted Butler, page 5 (M-1154) 

aid and hospital care to the indigent and needy persons residing 

in said District. Accordingly, you are further advised that the 

Hospital District may acquire the facilities of the Villa Coronado 

Clinic if it deems such acquisition necessary to the proper performance of its constitutional and statutory duties in this regard. 

In view of the foregoing, your question is answered in the 

negative. 

SUMMARY 

(1) Pursuant to Subsection (b) of Section 

5b of Article 4494n, Vernon’s Civil Statutes, 

the Bexar County Hospital District has no authority to fund the operations of a clinic, or 

its parent non-profit corporation, unless: (a) 

the clinic meets the definition of “hospital” 

and (b) a contract is executed between the 

Hospital District and the parent corporation 

whereby the District will have an appropriate 

degree of supervision and control over the 

operations of the funded facility. 

(2) The Hospital District has the constitutional and statutory duty to furnish medical 

and hospital care to the indigent and needy 

persons residing in its District. 

(3) Pursuant to Subsection (a) of Section 

5b of Article 4494n, Vernon’s Civil Statutes, 

the Hospital District may acquire the Villa 

Coronado Clinic, and operate the Clinic as a 

part of the Hospital District, if the Board of 

Managers of the District deems such acquisition 

necessary and proper to the effectuation of its 

duties. 

truly yours, 

ey General of Texas 

Prepared by Austin C. Bray, Jr. 

Assistant Attorney General 

-5633- 
Hon. Ted Butler, page i 

APPROVED: 

OPINION COMMITTEE 

Kerns Taylor, Chairmaz 

W. E. Allen, Co-Chaizz 

John Banks 

Charles Lind 

John Reeves 

Scott Garrison 

SAMUEL D. MCDANIEL 

Staff Legal Assistant 

ALFRED WALKER 

Executive Assistant 

NOLA WHITE 

First Assistant 

(M-1154) 

-5634-