Criminal District Attorney

Bexar County Courthouse Re: Authority of the Bexar County SanAntonio, 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: Maythe Bexar County Hospital District fund the operation of aclinic for the poor and indigent at Villa Coronado in south Bexar County without taking over the operation andsupervision of the clinic?

“The Villa Coronado Clinic was originally set up and funded by aGovernment Grant (OEO) during the past year with the understanding that it (OEO)would only fund the clinic for one year. The Clinic is nowoperated 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 25miles. It is the Bexar County Hospital District’s contention since the transportation problem is so acute for these residences, that bythe 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 amonth to month basis without assuming anyoperation or supervision of the clinic andwithout acontract with the Southside Neighborhood Association Corporation.” Pursuant to the authority of Section 4of Article IXof 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 apopulation of 190,000 or more . . . maybe constituted aHospital District as hereinafter set out and

. . . mayprovide for the establishment of ahospital or hospital system to furnish medical aid andhospital care to the indigent and needy persons residing in said Hospital District.

. . .I’ Subsection (b) of Section 5bof that Article provides, in pertinent part, as follows:

,1

. . .(T)he (hospital district) Board of Managers, with the approval of the Commissioners Court, maycooperate 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 acontract is deemed expedient and advantageous to the hospital district under existing circumstances, and be for such fair andreasonable compensation and on such other terms andfor such length of time as maybe 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 2of 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 byvirtue of Subsection (b)(1) of Section 2of Article 4437f, which provides, in part, as follows :

II however ’ .Thedefinition of ‘hospital’ does,

include those facilities maintained or operited by lgovernmental’ or ‘governmental unit 1as 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 anyhospital 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, weassume that your statement concerning the Clinic’s falling without the purview of the definition of “hospital** is correct

weare aware that prior to the enactment of Article 4494n, the board of managers of ahospital 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 4of Article 4494n.

Inasmuch as the Villa Coronado Clinic is not the property of the Hospital District? the only waywhereby the Hospital District mayhave a legal connection with such Clinic is through rhe provisions of Section 5bof 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 ahospital 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 2of Article 443?f, quoted supra. Furthermore? no authority is found in Section 5bof Article 4494n whereby the District could contract with any clinic, as opposed to ahospital, in the District. Cf. Attorney -1’s Opinion No. M-85 (1967), and authorities cxed therein, whereby the right of ahospital district to pay private hos itals for medical care rendered to needy and indigent persons o -7T-hixty was upheld, where it was not practical to treat such persons in the hospital district’s ownfacilities.

Even if, arguendo , clinics fell within the purview of Subsection (b) of Section Sbof Article 4494n, it is manifest from the import, and specific terms,of that Subsection that the only waythe District could have arelationship with the Clinic would be by contract.

Your letter clearly states that the Hospital District is presently funding the Clinic, on amonth-to-month basis, through anon-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.

Weare unable to find any legal authority sanctioning the fact situation at issue in your request. You are advised that the Bexar County Hospital District maycontract 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 maycontract with the Clinic to render such medical services to the needy and indigent of the District as the Board of Managers deems necessary.

Nofunding of the operations of the Clinic, or of its parent non-profit corporation, maybe granted from funds of the Hospital District until acontract is executed between the District andthe parent corporation, whereby the District will assume appropriate responsibility for the operation andcontrol of the Clinic. Weare 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 andneedy persons residing in said District. Accordingly, you are further advised that the Hospital District mayacquire the facilities of the Villa Coronado Clinic if it deems such acquisition necessary to the proper performance of its constitutional andstatutory duties in this regard.

Inview 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 aclinic, or its parent non-profit corporation, unless: (a) the clinic meets the definition of “hospital” and (b) acontract is executed between the Hospital District and the parent corporation whereby the District will have anappropriate degree of supervision andcontrol over the operations of the funded facility. (2) TheHospital District has the constitutional and statutory duty to furnish medical and hospital care to the indigent andneedy persons residing in its District. (3) Pursuant to Subsection (a) of Section 5b of Article 4494n, Vernon’s Civil Statutes, the Hospital District mayacquire the Villa Coronado Clinic, andoperate the Clinic as a part of the Hospital District, if the Board of Managers of the District deems such acquisition necessary andproper to the effectuation of its duties. truly yours,

ey General of Texas Prepared by Austin C. Bray, Jr. Assistant Attorney General

-5633-Hon. TedButler, page i

APPROVED: OPINIONCOMMITTEE Kerns Taylor, Chairmaz W.E. Allen, Co-Chaizz John Banks Charles Lind John Reeves Scott Garrison SAMUEL

D. MCDANIEL Staff Legal Assistant ALFREDWALKER Executive Assistant NOLAWHITE First Assistant (M-1154)

-5634-