Honorable 0. B. Close opinion 100. C-334 

County Attorney 

Ochiltree. County Rer Eospltal care of Indigent 

Perryton, Texas 

Dear Mr. Closer 

You request our opinion pn the above subject mat& and 

eek the following quertionst 

tree County, Texas for indisent care? 

Can the Ochiltree Jio8pltal District pay 

private physiclane for in-patient and.outpatient care o? .lndigente 3.n Oohllt*ee C&My, ‘~ 

Texan? (3) Your general opinion a8 to the 

scope of responsibil.Sty and authority of the 

Hospit& District under the existing circumstances regarding indigent care?” 

‘You state in your request that pursuant to Article 4494q4, Vernonfs Ciiil Statutes, a hoepi& district wae created within the boundaries of Ochiltree County and.a bond election has been 

held, approving the Issuance of bonds for the construction of a 

hospltal.and .the Hospital District contemplates that the conetxuction of a hospital will be commenced within the year 1965 but It 

~5.11 not be operational for 801118 time. You further state that at 

the present time there are no public hospitals nithin the boundarlee of Ochlltree County and that the onI.. hospitals presently 

operating within the County are two privately owned hospitals. 

Sect3.m 9 OS Article IX of the Constitution of Texas provides for the creation of hospital districts, and provides in 

Part a8 fo&lowar 

II that after ita creation no other 

tnunicip.ilit~ or political oubdlv$sion ohall 

have the power to levy taxes or ‘lame bonkle 

or other obligations for hospital purpoeea 

or for providing medical care within the 

boundaries of the dietrict; . , .I 

- 1588- 
Hon. 0. R. ClOse, 

Section 13 

provide6 in part: 

page 2 (C-334) 

, 

o? Article 4494q-4, Vernon~s Civil Statutes, 

"Except as herein provided, no county 

that has been constituted a hospital district, 

and no city therein, &a31 thereafter levy any 

tax for hospital purposes; and such hospital 

district shall be deemed to have assumed ?ull 

respcmslbility ?or the ?urhishlng of medical 

and hospital care for the needy and Indigent 

perrrons residing- in said hospital district from 

the date that We6 are collected for the hoepita1 distr’lct.” ~. 

In kew'o? the facts &bxaltted in 

visions o? Sectlou 13 of Article 44g4q-4, 

ital District assumes.the same authority 

KS of tiedlcaI and hospital care for the ne 

603)s residing in the Xospltal District'as thereto?ore possessed 

by the Oommi66ioner6 Court of Ochiltree Couuty; etlcle 4438, 

Vernon's Clvi~Statutes, provides: 

*,I? ‘hers is a~ regular estebU6hed puillc 

hoepital'in the count ; the c&misdUner8 court 

shall provide ror.8e L the indigent sick o? 

. the county to such hospital. If more than one 

such hospital exists In the county, the indigent 

patient 6haIl have the right to select which one 

of theq he shall be sent to." 

(1942), 

In Attorney General's Opinion6 O-2179 (1940 

1 

.and. O-4633 

it was held that the comi6eioners ccurt:o a county did 

not have authority to pay items of hospital treatment tar indigent sick to any hospital outside o? the county. .Theee conclucrions were based upon the principle6 of law anuouuaed In WilIacyl 

, 29 S.W.2d 456 (Tex.Clv.ApP. 

"The power6 and duties of county commis6ioner61’court6, and the, obligatlon6 of the 

countlee to pauper6 are ?lxed by statute, and 

mg~z be enlarged upon by unnecessary impll- 

. .These powers and duties, in 60 far aa 

applicable, here are de?lr.ed in ,and rest icted 

by the provi6ion6 o? Articles 2351 and b43a 

Revised Statutes, 1925. . In Article'2351 it'16 

'i 

rovlded. that each' commibrloners~ court hell 

eubdivlslon 11) ‘piovide for the support o? 

paupers Y * + residents of their county, who 

-1389- 
HOG. 0. R. Close, page 3 (C- 334) 

are unable to support themselve.;', and (subdivision 12 

1 

'f'or the burial of paupers'. 

In Article 438 it is provided that 'if there 

is a regular established public hospital in 

the county, the commlssioners~ Icourt shall 

provide Sor sending the indigent sick * l * 

to such hospital'. In the latter provision, 

the duty and the authority of the camnissionersl 

court to send the Indigent sick to hospitals 

is limited to public hospital6 within the county, 

which provision, by necessary implication excludes any duty or authority to send such person6 to private hospitals, or to public hospitals without the county.&.Even I? Barbosa was 

within the class.defined,as 'Indigent sick,' 

the commissioners8 court-as a body, muchless 

the county judge-acting singularly, we6 under 

no duty, and was denied the au&hority to send 

Barbosa to a hospital, either public or private, outside the county. 

y+ iv* Under ,the provision6 of Article 

4438, the county was under no duty to send 

Rarbosa to any hospital, there being no public .' 

hospital in the county, and under the implied 

restrictions of this provision it is doubtful 

if the county could be bound by the coeaaiasionersl court, certainly not otherwise, to send 

him to a hospital without the county, at public 

expense." 

(1940): 

Likewise, It was held in Attorney General's Opinion 0-2633 

"You are therefore respectfully advised 

that it is the opinion of this department that 

if the commissioners~ court determines that an 

. indigent is a pauper it may furnish medical aid 

and medicines to him as such, regardless of nhether or not he has been placed upon the pauper 

roll of the county, inasmuch 11s there~is no statutory requirement for the making up of a county 

pauper roll. It is the furthc:r opinion of this 

department that the commissiol;ers' court has the 

authority to aid 'indigent sick', who may or may 

not be 'paupers', by sending such 'indigent sick' 

to 'public' hospitals within :.he county. The 

question of 'indigency' is also a question of 

fact to be determined by the commissioners' court." 
Ron. C. R. Close, page 4 (C-334) 

In Attorney General’s Opinion C-246 (1964),‘it was polnted out: 

“Somewhat similar to the preceding queetlon, your sixth question also concerns the 

contractual power and authority of the Comniselonere Court of Tarrant County. Ae etated 

In answering your first question, where a duty 

is Imposed or e power conferred upon a commiesloners court, then the commlssioncre court hae 

implied authority to exercise broad discretion 

to ecccmplieh the purporee intended. When the 

comleelonere courtr were expreealy given the 

power end duty ‘to provide for the rupport of 

peupers,t by necessary implication they were 

clothed with the authority to do all the lncidental thinga necessary to provide for their 

support. Thus, while the commlsnionere court 

Is not under e duty to place lndigente In a prlvet8 iecility a 

County v. Valley 

(T Ci A 

ltB%s,l~tpi 

gents whom it placea in e .prlvate facilifiy. Here, 

of couree, the contractual term miust not be 

such es to amount to a donation by the County 

to the Individual or corporation providing the 

care, nor can the contract provide for payment.8 

by the County out of future revenuem.” 

,It wae pointed out in Attorney Gcneral’e Opinion C-246 

that: 

“Your first end second questions can be 

answered together. Under the provlefonrr of 

Section 11, Article 2351, Vernonls Civil Statutes, the Conunlseloncre~ Court has the duty to: 

“‘11. Provide for the support of paupers 

and such idiots and lunatics aa cannot be admltted Into the lunatic asylum, residents of their 

county, who are unable to eupport themeelvce. 

. . . I 

‘While it Is true that the Comieeioners8 

Court is a court of limited juriediction, it 

Is also true that where a duty Is imposed or a 

power conferred by statute upon e commiseioners 

court within the boundaries of power which the 

Constitution has created, then the commlseloners 

-1591- 
b 

i 

c 

Hon. G. R. Close, page 5 (C-334) 

court has implied authority to exercise broad ( 

discretion to accomplish purposfs Intended by 

such statute. El Paso County v. Elam, 106 

S.W. 26 393 

Q 

Tex.Clv.App. 19 :TEGon v. 

Marshall, 11 

Orror d3r 

S.W.2d 621 (Te%.vw938, 

152 s.w.Et' 

* Anderson v. Wood, 137 Tex. 201, 

684-(pSl) . 

"Under the provisions of Section 11, Artlcle 2351, a duty to provide for the support of 

paupers, which Includes the Indigent aged, Is 

lmposed'upon the Commissioners Court.' 

In view of the foregoing, if the Indigent care referred 

to In your request constitutes the support of paupers within the 

meaning of Section 11 of Artlcle.2351, Vernon's Civil Statutes, 

the Hospltal.Distrlct, under theauthority of Section 13 of 

Article 4494q-4, ma make payments to private hos ltals within 

Ochlltree County 

-# 

ttorney General's Opinion C-24 8 

themedical care or Indigents does not constitute 

$196417. If 

the support 

of paupers" within the meaning of Section 11 of Article 2351, 

the Hospital District may not make payments to privets hospitals 

within Ochlltree County, but such care must be limited to.such 

hospital treatment as authorized by Article 4438, Vernon's Civil 

Statutes, In public hospitals. Wlllacy County v. Valley Baptist 

Hospital, 29 S.W.2d 456 (Tex.Clv.App. I-930). 

SUMMARY 

A hospital district created under the provisions of Article tig%-4, Vernon's Civil Statutes, assumes the same responsibility for the 

medical care of indigents within said district 

as that previously Imposed on the ccmmlssloners 

court under the provisions of Section 11 of Artlcle 2351, Vernon's Civil Statutes and Article 

4438, Vernon's Civil Statutes. 

Yours very truly, 

WAGGONER CARR 

Attornc\y General 

JR:ms 

. ,:4 - :&& 

By/rd’ yc) 

,;' ,1’ -John Reeves 

Assistant 

-1592- 
HOG: 0. R. Close, page 6 (c-334) 

APPROVED: 

OPINION COMMITTEE 

W. V. Geppert, Chairman 

Malcolm ,Quick 

George Black 

Ralph Rash 

APPROVEDFORTIB ATTORNEXQENERAL 

BY: Roger Tyler 

. . 

._ .~._ 

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