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The Attorney General of Texas 

November 24, 1981 

MARK WHITE 

Attorney General 

Supreme Court Bullding 

P. 0. Box 12546 

A&in. TX. 76711 

5121475.2501 

Telex 9101674-1367 

Telecomer 512M750266 

1607 Main St.. Suite 1400 

Dallas. TX. 75201 

2141742-6944 

4624 Alberta Ave.. Suite 160 

El Paso. TX. 79905 

9 1 w.33.3164 

1220 Oallas Ave.. Suite 202 

Houslon, TX. 77002 

7131650-0666 

606 Broadway. Suite 312 

Lubbock. TX. 79401 

6061747.5238 

43W N. Tenth. Suite B 

McAlle”. TX. 76501 

512!662-4547 

200 Mam Plaza. Suite 400 

San Anlonw,. TX. 76205 

5121225.4191 

Honorable Dan W. Heard 

Criminal District Attorney 

Calhoun County Courthouse 

Port Lavaca, Texas 77979 

Opinion No. NW-393 

Re: Payment of COUllty 

hospital medical staff for 

treatment of indigent 

patients at the hospital 

Dear Mr. Heard: 

You have requested our opinion on the following question: 

Is it proper for a county or a county hospital to 

pay doctors on the medical staff of the county 

hospital for treating indigent patients at the 

hospital? 

SCamtori provisions governing county hospitals are found in V.T.C.S. 

article 4470, et. seq. 

General management and control of a county hospital is vested in 

a board of managers under article 4480. V.T.C.S.. which provides, in 

part, as follows: 

The board sball also appoint a staff of visiting 

physicians who shall serve without pay from the 

county I and who shall visit and treat hospital 

patients at the request either of the managers or 

of the superintendent. 

Said board shall fix the salaries of the 

superintendent and all other officers and 

employees within the limit of the appropriation 

made therefor by the commissioners court. and such 

salaries shall be compensation in full for all 

services rendered. 

The statutory scheme of article 4480 thus contemplates two 

potential classes of physicians who may be on the medical staff of a 

county hospital: physicians who are employees of the hospital and 

visiting physicians. With regard to the former class, article 4480 

makes cLe;lr that their salaries art cull compensation for all services 

p. 1335 
. 

Ilt,nornbIe Dnn W. Heard - Page 2 ofw-391, 

rendered, regardless of the financial status of the patients receiving 

CllC services. 

In Attorney General Opinion O-2422 (1940), this office held that 

the board of managers of a county hospital could not allow claims of 

physicians and surgeons for services rendered to charity patients in a 

hospital. This opinion has not been overruled by this office or 

modified by the legislature. We believe it is dispositive of your 

qucscion. 

It has been suggested that the Professional Services Procurement 

Act. article 664-4. V.T.C.S., impliedly repeals article 4480, 

V.T.C.S., and requires that a county pay reasonable fees~to doctors on 

the medical staff. Article 664-4. V.T.C.S.. provides in pertinent 

part: 

Sec. 2. For purposes of this Act the term 

‘professional services’ shall nean those within 

the scope of the practice of accounting. 

architecture. optometry, medicine or professional 

engineering as defined by the laws of the State of 

‘Texas or those performed by JnY licensed 

architect, optometrist, physi~cian, surgeon, 

certified public acccuntant or professional 

ong’ineer in connection with his professional 

employment or practice. 

sec. 3. No state agt?ncy , political 

subdivision, county, municj~pality, district, 

authority or publicly-owned utility of the State 

of Tcsas shall mtikc any contr:lct for, or cngilge 

cite professional services 0i. 3n~ 1 icensed 

physicinn, optometrist, surgeon, architect, 

cerl i Tied public accountnnc or registered 

enp i lw*r, or any group or association ch?r.$of, 

selt!c~tcd u,, the basis of competitive bids 

submitted fur such contract or for such services 

to be performed. but shall select and award such 

contracts and enenge such scrviccs on the basis of 

demonstrated competence and qualifications for the 

type of professional services to be performed and 

at fair and reasonable prices, as long as 

professional fees are consistent with and not 

higher than the .published recommended practices 

and fees of the various applicnble professional 

associations and do not exreed the maximum 

provided by any state lav. 

’ I 

.’ 
llonornhle I)~III W. Ilr:ard - PnRc I (Mu-‘I’)3 t 

Contracts entered into in vi~~latio,n oi this statute arc void as 

contrary to public policy. V.T.C.S. art. hb4-4, 54. 

In our opinion, the put-pose of this statute was to ensure that 

competitive bidding statutes would wt be applied to the employment of 

persons in the enumerated professions. The emergency clause ciearly 

expresses this intent: 

Sec. a. The fact that tile selection of 

certified public acco”ntants. architects, 

physicians. optometrists. surgeons and 

professional engineers on the basis of the lowest 

bid places a premium on incompetence and is the 

most likely procedure for -selecting the least able 

or qualified and the most incompetent practitioner 

for the performance of services vi,tally affecting 

the health, welfare and safety of the public and 

that, in spite of repeated expressions of the 

legislature excepting such professional services 

from statutes providing for competitive bidding 

procedures, some public officers continue to apply 

competitive bidding procedures to the selection of 

such professional personnel, cr‘eaten an emergency 

of the greatest public importance to the health. 

safety and welfare of the people of Texas and an 

imperative public necessity requiring that the 

Consritutional Rule that bills be read on three 

several days in each House bc suspended. and such 

Rule is hereby suspended, and this Act shnil take 

eii-,tct from ;~nd after its pnssngc. and it is so 

enacted. 

Acts 1971, h.‘nd I.ef., ch. 38, $8, at 72. The c:;;erRt’ncy c Lnusc nay be 

considered in ascertaining the legi~slativc intent .ZXpr~SSed in a 

statute. Houston Belt Terminai & Ry. Co. v. Clark, 143 S.W.Zd 373 

(Tex. 1940). 

Article htG+-4. V.T.C.S.. did not impliedly repeal every statute 

authorizing the appointment of a physician to a pclblic service 

position carrying little or no compensation. See. e.g., ?ledical 

Practices Act, 552.05, 2.06, Acts 1981, 1st C.S., ch. 1, §l 

(qualifications nnd compensation of members of Board of tledicnl 

I:.xamiuers). Section 3 of article bh4-4, V.T.C.S.. clearly states that 

professional Fees must not “exceed the maximum provided by any state 

law.” Article 44RO, V.T.C.S., pl-ov:ides that visiting physicians shall 

scrvc withalt p%~y irom the county. ‘l‘tlnl~, the provisions of article 

664-4, V.T.C.S., 2nd article i4t40, v.1‘.c:.s., m;,” hr cvnstrued in 

harwny . hrtirlc 664-4, V.T.C.S., prcvtwts puhiic officials from 

cnRag:i ng tt,t: :,t.ltnl professional SL~TV ic.vs aw crmkp<‘t i tive hids and 
Honorable Dan V. Heard - Page 0 (MU-393) 

restricts their discretion in setting compensation by requiring 

reasonable fees. It has no bearing where the legislature has enacted 

a statute setting or denying compensation for physicians and other 

professionals. 

We conclude that the board of managers of a county hospital may 

not pay physicians for treating indigent patients at the hospital. 

SUMMARY 

Article 4480. V.T.C.S., prevents a county 

from paying doctors on the medical staff of the 

county hospital for treating indigent patients at 

the hospital. 

,&m 

Attorney General of Texas 

JOHN W. FAINTER, JR. 

First Assistant Attorney General 

RICHARD E. GRAY III 

Executive Assistant Attorney General 

Prepared by Susan L. Garrison 

Assistant Attorney General 

APPROVED: 

OPINlON COMMITTEE 

SUSJll II. Cnrrison, Chairman 

Jon I!ible 

Rick Cilpin 

J im Moe 11 inger 

firuse Youngblood 

p. 133x