March 30. 1966

Honorable Joe Resweber CountyAttorney Harris County Houston, Texas Dear Sir: Opinion No. C-641 Re: Responsibility for the cost of operating the Harris County ConvalescentWard. 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:

"Thisoffice 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 Countymay legallybudget funds, or whether responsibility for such cost now rests with the newly created Harris Count Hospital District, In the light of Article 4 q&n,

1 V.A.C..S.,the statute authorizing the creation of such District. "TheHarris County ConvalescentWard 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 theWard Is first processe hrough the Ben,Taub General Hospital, the newest

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of the two charityhospitals comprisingthe Hospital District, for the purpose of being assigned a clinic number and having a filemade for him, shouldthe contingencyarise necessitatinghis Immediate transfer to the hospitalunder emergency conditions. 11

. . . "In light of the above and foregoing facts, the questionwhich thus presents itself for which an answer Is sought iswhether or not the accompllshments and goals of the ConvalescentWard are such as envisionedby the Legislature to be assumedby the newly createdHarris CountyHospital District In the light of Article 449&n,V.A.C.S.,
. . , 1,

. . . ~"Thefurther question thus arises as to whether or not the ConvalescentWard is a nursinghome 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 ConvalescentWard is a Convalescent orNursing Home, etc., as defined and governed. by Article4442c, 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 ConvalescentWardsremains with Harris County or now rests with the newly createdHospital 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 licensingand control of hospitals, as defined In the Article, operatingunder Texas law. Section 2(a) of Article 4442c, provides In part as follows:

"'Institution'fionvalescent and nursing homes and related ln%itutiona7means an establishmentwhich furnishes (rn single ormultiple facilities) food and shelter to four (4)

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

ormore persons unrelated to the proprietor, ad, in addltlon, providesminor treatment under the direction and.supervision of a physician licensedby the Texas State Board of Medical Examiners, or serviceswhichmeet some need beyond the basic provision of food, shelter, and laundry. .Andprovided 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 specialhospitals 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) ormore non-related Individualsrequiring diagnosis, treatment or care for Illness, injury, deformity, abnormality, or pregnancy, and regularlymaintaining at least clinical laboratory services,diagnosticX-ray services, treatment facilitieswhich would Include surgery and/or obstetrical care, and other definitivemedical and surgical treatment of similar extent." Section 2 (b)(l) of Article 4437f, provides as follows: "The term 'specialhospital'means any establishment offering services, facilities and 'bedsfor use beyond twenty-four (24)hours for two (2) ormore non-related individualswho are regularly admitted, treated and discharged and require servicesmore intensive than room, board, personal servicesand general nursing care and which has clinical laboratory facilities, diagnostic X-ray facilities, treatment facilities and/or other definitivemedical treatment and has a medical staff In regular attendance, and maintains records of the clinicalwork performed for each patient.

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

"Thedefinition of 'hospltalfdoes not lnelude those facilities licensedpursuant 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 ConvalescentWard, It Is our opinion that the Harris County ConvalescentWard is an "Institution"as definedby Article 4442~.

The next question then is whether the Ward, being subject to Article 444% and not a hospital, fallswithin the scope of Article 449&n. In otherwords did the Legislature intend for Institutions,operated just as the Harris County ConvalescentWard Is operated, to be a part of a county-widehospital district createdunder Article &494n?

Pursuant to Section 4 ofArticle IX of the Constitution of Texas, the Legislature enactedArticle &I&n, which provides for the creation of a.county-widehospital district.

Section 1 of Article 449&n provides, in part, as follows: 'Any Countyhaving a population of 190,000 ormore, 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 indigentand 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 separatelyowned by such countyand city, and by whichmedical services or hospital care, includinggeriatric care, are furnished to the Indigent or needy persons of '&hecity and county, shallbecome 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;

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and suchHospital District shallbe deemed to have assumed full responsibility for the furnishing of medical and hospital care for the needy and indigent persons residing in saidHospital D s ric -itd For theRospitaleDiitzict." 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 otherwords, the hospital district would take over all medical or hospital care of the Indigentand needy within the county.

In Attorney General's Opinion No. C-382 (1965) it was stated inpart as follows:

.Ahospital district establishedunder Article 449&n takes over the count% systempreviously establishedunder Article 478, and the hospital district thenceforth carries out all the duties and obligations the county previously had for the care Andytreatment of 'persons'suffering from any illness,disease or injury. "Itmust 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 functionmust cake precedence over all others." In a case involving the Bexsr County Hospital District, which was createdunder ATtlcle 449&n, the Texas Supreme Court stated, (page 447), that
. . .theentire function ofmaintaining and operating hospitalswas transferred to a d erent governmental w3i7.s:W.Bexar County.HospitalDistrict v?f6rosby, lb0Tex.

The Legislature,by express language, provided that a newly created hospital districtwould 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 ConvalescentWard, Article 4494n. fall within the scope of

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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 ConvalescentWard now rests with the newly createdHarris County Hospital District. SUMMARY

The responslblllty for the operation costs of the Harris County ConvalescentWard now rests with the Harris CountyHospital 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 APPROVEDFOR THE ATTORNEY GENERAL BY: T. B. Wright

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