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 54 ofArticle 9 ofthe Texas Constitution and Article 4494n, Vernon’s Texas Civil Statutes. By virtue ofthe authority contained inArticle 3, s

### 64of 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 avenereal 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 ofwhich 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 ofFort Worth and Tarrant County? ‘I
Your question cannot be given a categoric answer. Section 4 of Article 9of the Constitution ofTexas provides that the Legislature

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

may authorize the creation of county-wide hospital districts incounties having apopulation 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. Ittoo calls for creation of ahospital 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 ahospital 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 offacilitie8. 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 ofhospital services and the maintenance of hospital facilities and that, ecrenif it could be so construed, Article 4494n cannot confer any greater authorization than that contained inthe provisions of §4ofArticle 9 of the Constitution. City ofWichita 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. ); 12Tex. Jur. 2d, Constitutional Law, 513, pp. 361-362. The regulatory services which you describe inyour letter, including restaurant, meat, milk, sewage and water inspections, would not appear to fall within any definition ofhospital care or facilities and, inour opinion, are services which legitimately could not be performed by a hospital district organized under the provisions of §4 ofArticle 9 ofthe Constitution and Article 4494n of the Civil Statutes.

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

The non-regulatory services which you specify, i. e., operation and maintenance ofvenereal 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 564 ofArticle 3ofthe 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 564 ofArticle 3ofthe Constitution, specifically includes “public health andwelfare” inthe definition of “governmental functions and services”

. However, 064 ofArticle 3is a general authorization while 54 ofArticle 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. 12Tex. Jur. 2d, Constitutional Law, 528, 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 ofthose 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. Itis our opinion the taxes levied pursuant to Article 4494n must be limited intheir expenditure to purposes within the scope ofthat Article and g4 ofArticle 9, i.e. , providing ofhospitals 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).

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

Your third question asks whether revenues of the District from non-tax sources might be spent inthe execution of regulatory and non-regulatory health services. Inview of our answer to your first question, that we do not believe the District to be authorized to engage inactivities other than those specified inthe 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 ofArticle 3of the Constitution and Article 4413(32c)of the statutes to pay contractual sums to the Hospital District in exchange for its assumption ofvarious health services. Again, inview of our answer to the first question, limiting as it does the scope offunctions which can properly be performed by the Hospital District, our answer to the fourth question must be similarly limited. Furthermore, §4 ofArticle 9ofthe Constitution specifically provides that a hospital district created thereunder “Fhall assume full responsibility for providing medical and hospital care to needy inhabitants ofthe 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 Ahospital district organized under the authority of 54 ofArticle 9 ofthe 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 ahospital such as the regulatory inspection of restaurants, meat, milk, sewage, andwater. Very truly yours,

HN L. HILL ttorney General of Texas
p. 133The Honorable Tim Curry, page 5 (H-31)

DAVID M. KENDALL, Chairman Opinion Committee

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