Honorable Tim Curry 

Criminal District Attorney 

Tarrant County 

Fort Worth, Texas 76102 

Dear Mr. Curry: 

Opinion No. H- 31 

Re: Whether Hospital District 

may assume duties and 

functions of city and county 

health departments and 

related questions concerning 

taxation and funding. 

The Tarrant County Hospital District was created by authority of 

5 4 of Article 9 of the Texas Constitution and Article 4494n, Vernon’s 

Texas Civil Statutes. By virtue of the authority contained in Article 3, 

s 64 of the Texas Constitution and Article 4413 (32c),(Vernon’s Texas 

Civil Statutes), the Interlocal Cooperation Act, Tarrant County has 

contracted to pay the City of Fort Worth $5.000.00 annually to compensate the City, for authorizing the City Health Officer to assume all 

duties and responsibilities of the County Health Officer. 

Among the services performed by the health departments of Fort 

Worth and Tarrant County are restaurant, meat, milk, sewage, water 

and other “regulatory” inspections. “Non-regulatory” services performed include the operation and maintenance of a venereal disease 

clinic, vaccinations for communicable diseases, etc. Officials of the 

City and the County are considering the possibility that the Hospital 

District may assume the health duties and services, thus prompting 

your questions, the first of which is: 

“Is Article 4494n, Vernon’s Ann. Civ. St. sufficiently 

broad to authorize the Tarrant County Hospital District 

to absorb the regulatory and non-regulatory health 

services currently being executed and enforced by the 

health departments of Fort Worth and Tarrant County? ‘I 

Your question cannot be given a categoric answer. Section 4 of 

Article 9 of the Constitution of Texas provides that the Legislature 

p. 130 
. . 

The Honorable Tim Curry, page 2 (H-31) 

may authorize the creation of county-wide hospital districts in counties 

having a population in excess of 190, 000 and in Galveston County with 

power to issue bonds for the establishment of “hospitals or hospital 

facilities”. Such a district must be authorized by an election and it 

must assume full responsibility for “providing medical and hospital 

care to needy inhabitants of the County”. 

The enabling law enacted pursuant to this constitutional provision 

is Article 4494n, Vernon’s Texas Civil Statutes. It too calls for 

creation of a hospital district to provide “for the establishment of a 

hospital or hospital system to furnish medical aid and hospital care 

to the indigent and needy persons residing in said hospital district”. 

Neither the Constitution nor Article 4494n defines what is a hospital 

or what constitutes providing “medical aid”, “medical care” or “hospital 

care”. 

The Texas Hospital Licensing Law (Article 4437f. Vernon’s Texas 

Civil Statutes) defines a general hospital as one offering services and 

facilities requiring “diagnosis, treatment or care for illness, injury, 

deformity, abnormality, or pregnancy” and maintaining various types 

of facilitie8. A special hospital is defined as one offering services, 

facilities, and beds for individuals who require services more intensive 

than room, board, personal services and general nursing care 

and which also has certain laboratory facilities, etc. 

It is our opinion that the Tarrant County Hospital District is limited 

to the furnishing of hospital services and the maintenance of hospital 

facilities and that, ecren if it could be so construed, Article 4494n cannot 

confer any greater authorization than that contained in the provisions of 

§ 4 of Article 9 of the Constitution. City of Wichita Falls v. Cooper, 

170 S. W. 2d 777 (Tex. Civ. App. , 1943, err. ref. ); Dickison v. Woodmen 

of the World Life Insurance Society, 280 S. W. 2d 315 (Tex. Civ. App. , 

1955, err. ref. ); 12 Tex. Jur. 2d, Constitutional Law, 5 13, pp. 361-362. 

The regulatory services which you describe in your letter, including 

restaurant, meat, milk, sewage and water inspections, would not appear 

to fall within any definition of hospital care or facilities and, in our 

opinion, are services which legitimately could not be performed by a 

hospital district organized under the provisions of § 4 of Article 9 of the 

Constitution and Article 4494n of the Civil Statutes. 

p. 131 
The Honorable Tim Curry, page 3 (H-31) 

The non-regulatory services which you specify, i. e., operation and 

maintenance of venereal disease clinic, vaccinations for communicable 

diseases, etc., may well be functions falling within the meaning of 

“hospital care” and might properly be performed by the hospital. 

Certainly 5 64 of Article 3 of the Constitution would authorize the 

Hospital District to contract with the county government or other 

political subdivisions for the performance of governmental functions 

which the Hospital District would otherwise be authorized by the 

Constitution to perform. Article 4413( 32c), the Interlocal Cooperation 

Act and the enabling act adopted under 5 64 of Article 3 of the Constitution, 

specifically includes “public health and welfare” in the definition of 

“governmental functions and services”. 

However, 0 64 of Article 3 is a general authorization while 5 4 

of Article 9 is a specific authorization of the creation of hospital districts. To the extent there is any conflict between the provisions, the 

special provision will prevail. 12 Tex. Jur. 2d, Constitutional Law, 

5 28, pp. 372-373 and cases cited. 

Our answer to your first question asking whether Article 4494n is 

sufficiently broad to authorize the District to absorb both regulatory 

and non-regulatory health services currently being executed and 

enforced by the health departments of Fort Worth and Tarrant County, 

is “No”, although it is broad enough to authorize absorption of those 

which are hospital functions, as indicated above. 

Your second question is whether the revenues of the Hospital District from taxes levied pursuant to Article 4494n may be spent by the 

District in rendering regulatory and non-regulatory health services. 

It is our opinion the taxes levied pursuant to Article 4494n must be 

limited in their expenditure to purposes within the scope of that 

Article and g 4 of Article 9, i. e. , providing of hospitals and hospital 

facilities, medical or hospital care, etc. , and to the extent, that any 

of the regulatory or non-regulatory health services do not fit within 

that definition, the taxes may not be used to provide them.See, for 

instance, Baylor County Hospital District v. Crosby, 327 S. W. td 445 

(Tex. 1959). 

. 

p. 132 
.- 

The Honorable Tim Curry, page 4 (H-31) 

Your third question asks whether revenues of the District from 

non-tax sources might be spent in the execution of regulatory and 

non-regulatory health services. In view of our answer to your first 

question, that we do not believe the District to be authorized to 

engage in activities other than those specified in the Constitution, 

our answer to question three is “NO”, 

Your fourth question asks whether Tarrant County and the City 

of Fort Worth (and other cities or political subdivisions) could 

spend taxes from their general funds to contract with the District 

under § 64 of Article 3 of the Constitution and Article 4413(32c)of the 

statutes to pay contractual sums to the Hospital District in exchange 

for its assumption of various health services. 

Again, in view of our answer to the first question, limiting as it 

does the scope of functions which can properly be performed by the 

Hospital District, our answer to the fourth question must be similarly 

limited. Furthermore, § 4 of Article 9 of the Constitution specifically 

provides that a hospital district created thereunder “Fhall assume 

full responsibility for providing medical and hospital care to needy 

inhabitants of the county, and thereafter such counties and cities 

shall not levy any other tax for hospital purposes . . . “. (Emphasis 

added). This, in our opinion, precludes the expenditure of any other 

tax revenues for purposes falling within the allowable scope of 

functions to be performed by a hospital district. 

SUMMARY 

A hospital district organized under the authority of 

5 4 of Article 9 of the Constitution may engage only in 

those activities specifically authorized by the Constitution 

and may not, by contract or otherwise, assume to render 

services which are not among those ordinarily rendered 

by a hospital such as the regulatory inspection of restaurants, 

meat, milk, sewage, and water. 

Very truly yours, 

HN L. HILL 

ttorney General of Texas 

p. 133 
The Honorable Tim Curry, page 5 (H-31) 

DAVID M. KENDALL, Chairman 

Opinion Committee 

p. 134