THE ATTORNEY GENERAI. 

OF TEXAS 

May 21. 1987 

.JlYl .w.mTGx 

A-RXEY GESERAI. 

Bonorable Lowell C. Halt 

Criminal District Attorney 

P. 0. Box 730 

Gilmer, Texas 75644 

Opinion No. JM-705 

I&: Whether a county is required to 

reimburse a stare-supported public 

hospital for indigent health care of 

a resident of that county 

Dear Mr. Halt: 

You ask whether a county that does not have a public hospital and 

is not located within a hospital district is required to reimburse The 

University of Texas Health Center at Tyler for health care of an 

indigent resident of the county who was treated at the Eealth Center 

for a heart condition. You advise us that the person was referred by 

the county’s “contract doctor* to the Health Center for care. 

Title 2 of the Indigent Health Care and Treatment Act, article 

4438f, V.T.C.S., applies to and determines health care services and 

assistance for a person who does not reside in the area that a public 

hospital or hospital district has a legal obligation to serve. Art. 

4438f. 52.01. Each county shall provide the health care assistance 

prescribed by Title. 2 to each eligible resident of that county who 

does nor reside within an area served by a public hospital or hospital 

district. Id. 152.02,~3.01. A county may arrange co provide health 

care servicethrough a local health department, a publicly owned 

facility, a contract with a private provider, or through the purchase 

of insurance for eligible residents. Id. $3.02. Also, a county may 

select one or more providers of health care services and, when 

medically appropriate, require its indigent residents to obtain care 

from a mandated provider. Id. 03.03. Except as otherwise provided by 

Title 2, and assuming thz there has been compliance with the 

requirements of that title concerning the provision of health care 

services by mandated providers and notification of and approval from 

the county for emergency and nonemergency services, a county is 

responsible for either paying for or for providing health care 

services for which payment is not otherwise available. See Id -2 

513.03. 3.04, 3.05, 4.01(d). 

A county is not liable under Title 2 for health care services 

provided by a hospital to an eligible resident of the county if the 

hospital providing the services has a Hill-Burton or state-mandated 

p. 3261 
Honorable Lowell C. Bolt - Page 2 (JM-705) 

obligation to provide free services and the hospital is in 

noncompliance with the obligation. Id. 14.01(c). Also, a county is 

not liable under Title 2 for the coTof a mandatory health service 

that is in excess of the payment standards for that service 

established by the Texas Department of Human Services or in excess of 

the limitation for each year prescribed by section 4.03 for each 

eligible resident of the county. See id. 94.02. -- 

In summary, and subject to the provisos and limitations In Title 

2, a county is liable for payment for health care services provided 

under Title 2 by any provider to an eligible resident of the county 

who does not reside in an area served by a public hospital or hospital 

district. 

It has been suggested that heart disease is a chest disease and, 

therefore, that the state. instead of the county, Is responsible by 

statute for the expanse of treatment of a heart condition provided at 

The University of Texas Health Center at Tyler for an indigent 

resident of a county that does not have a public hospital or hospital 

district. It is our opinion that the legislature has not provided 

that the medical care of indigent patients with heart disease is an 

expense to be paid by the Tyler Eealth Center out of state funds. 

The hospital in question originally was a state tuberculosis 

hospital which treated only tuberculosis cases. In 1977, the 

legislature transferred the East Texas Chest Hospital to the Board of 

Regents of The University of Texas System with authority to change its 

name and use it as a teaching hospital. See V.T.C.S. art. 3201a-4. 

112, 5. The name was changed to The University of Texas Health Center 

at Tyler. Sections 1 and 7 of article 3201a-4 state the legislature's 

intention that the hospital continue to serve as a state tuberculosis 

hospital under the terms and provisions of the Texas Tuberculosis 

Code, article 4477-11, V.T.C.S., and that The University of Texas 

System provide and pay for the care and treatment of tuberculosis 

patients in that hospital out of funds appropriated by the legislature 

for the hospital to use for that purpose. Section 6 of article 

32Ola-4 provides also that: 

It shall continue to be the policy of the State 

of Texas to provide a program of treatment of the 

citizens of this state who are affected with chest 

diseases, and in pursuance of that policy the East 

Texas Chest Hospital shall among other functions 

continue to serve as the primary facility in this 

state to conduct research, develop diagnostic and 

treatment techniques and procedures, provide 

training and teaching programs, and provide diagnosis and treatment for both inpatients and outpatients with respect to all chest diseases. 

p. 3262 
Honorable Lowell C. Ilolt - Page 3 (JM-705) 

C 

Section 9 of the Texas Tuberculosis Code provides in part that: 

Patients admitted co state chest hospitals 

shall be two (2) classes: 

(1) Indigent public patients and 

(2) Non-indigent public patients. 

(a) Indigent public patients are those who 

possess no property of any kind nor have anyone 

legally responsible for their support, and who are 

unable to reimburse the state. This class shall 

be supported at the expense of the state. 

,- 

It is our opinion, however, that the provisions of the Texas 

Tuberculosis Code only apply to the care and treatment of persons with 

tuberculosis. Senate Bill No. 868 of the Sixty-sixth Legislature in 

1979 amended section 9 of the Code by changing the name "tuberculosis 

hospitals" to "chest hospitals." The caption of Senate Bill No. 868 

describes that bill as "an Act relating to the diagnosis and care of 

parsons having tuberculosis." Section 2 of the Tuberculosis Code 

expressly states that "[IIt is the purpose of this Code to provide 

care and treatment for those afflicted with turberculosis, to 

facilitate their hospitalization. and to enable them to obtain needed 

care .n 

We conclude that the provisions of the Tuberculosis Code. 

including section 9, are applicable to the treatment of persons with 

tuberculosis and do not apply to the treatment of heart conditions, 

regardless of whether "heart conditions" might properly be called 

"chest diseases" in other contexts. Under both article 3201a-4 and 

the Tuberculosis Code, the treatment of tuberculosis patients in the 

Health Center at Tyler is an expense of the Health Center to be paid 

from state funds. Neither of those statutes nor any other statute of 

which we are aware mandates treatment at the Health Center at state 

expense for indigent persons suffering from a heart condition. Hence, 

a county that arranges for care of a heart condition for its indigent 

resident at the Health Center is responsible for payment for such 

services under Title 2 of the Indigent Health Care and Treatment Act. 

SUMMARY 

A county which Is liable for health cara 

assistance under Title 2 of the Indigent Health 

Care and Treatment Act is responsible for paying 

for or for providing health care services for which 

payment is not otherwise available. The statutes 

providing for care and treatment of tuberculosis in 

p. 3263 
Eonorable Lowell C. Halt - Page 4 (JM-705) 

--Y 

The University of Texas Health Center at Tyler for 

indigent patients at state expense do not apply to 

heart conditions. A county which arranges for care 

at the Health Center for a heart condition of an 

indigent residenr is responsible for paying the 

Health Center for treatment of the heart condition. 

JIM MATTOX 

Attorney General of Texas 

JACK HIGHTOWER 

First Assistant Attorney General 

MARYXZLLER 

Executive Assistant Attorney General 

JUDGE ZOLLIE STEAKLET 

Special Assistant Attorney General 

RICK GILPIN 

Chairman, Opinion Committee 

Prepared by Nancy Sutton 

Assistant Attorney General 

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p. 3264