QBffice of toe Bttornep @eneral 

DAN MORALES 

.ATTORSEY GENERAL 

&ate of IEexae 

March 21, 1996 

The Honorable Patrick J. Fleming 

Parker County Attorney 

One Courthouse Square 

Weather-ford, Texas 76086 

Opinion No. DM-380 

Re: Whether the Parker County Hospital 

District is responsible for the payment of 

health care costs for inmates in the Parker 

County Jail who are “eligible residents” of 

the hospital district under chapter 61 of the 

Health and Safety Code and related 

questions (RQ-863) 

Dear Mr. Fleming: 

You ask several questions concerning the origin of payment for health care 

assistance of inmates of the Parker County Jail. Specificahy, you ask whether, in 

particular situations, the district, the jail, or some other entity is responsible for the 

payment of health care costs of county jail inmates. We assume you do not inquire about 

prisoners held for another jurisdiction pursuant to a contract between Parker County and 

the other jurisdiction. We will begin our analysis by examining statutes pertinent to the 

Parker County Hospital District (the “hospital district”). 

“Pursuant to the authority granted by the provisions of Section 9 of Article JX of 

the Constitution of the State of Texas,” the legislature authorized the creation of the 

hospital district in 1965. See Act of March 10, 1965, 59th Leg., RS., ch. 35, 3 1, 1965 

Tex. Gen. Laws 93, 93, amenakd by Act of May 28, 1975, 64th Leg., R.S., ch. 444, tj 1, 

1975 Tex. Gen. Laws 1186, 1187; Act of May 31, 1981.67th Leg., RX, ch. 472, 1981 

Tex. Gen. Laws 2081,2081-82; Act of April 27, 1989,71st Leg., RS., ch. 66, 1989 Tex. 

Oen. Laws 378, 378-80; Act of May 25, 1991, 72d Leg., R.S., ch. 705, $37, 1991 Tex. 

Cien. Laws 2520,2529. Section 1 of the hospital district’s enabling legislation establishes 

the hospital district’s boundaries as coextensive with the boundaries of Parker County and 

provides the hospital district “such rights, powers and duties as” the enabling act 

prescribes. Act ofMarch 10, 1965,59th Leg., R.S., ch. 35, 5 1, 1965 Tex. Gen. Laws 93, 

93. 

The enabling act establishes as one of the hospital district’s duties “‘full 

responsibility for providing medical and hospital care for needy inhabitants .” of the 

hospital district. Id. 9 2, at 94; see aZso Health & Safety Code $286.082(a) (requiring 

hospital district created by voter approval to provide, without charge, care and treatment 

of indigent patient). Moreover, section 20 of the enabling legislation provides as follows: 

After creation of the hospital district, neither Parker County, 

Texas, nor any city or town therein shall thereafter issue bonds or 
The Honorable Patrick J. Pleming - Page 2 (DM-380) 

other evidences of indebtedness for. . . medical treatment of indigent 

persons within such boundaries, nor shag such political subdivisions 

levy taxes for. . . such purposes. The said hospital district shah 

assume fbh responaibiity for the operation of all hospital facilities for 

the tinnishing of medical and hospital care of indigent persons within 

its boundaries. 

Act ofMarch 10,1965,69th Leg., RS., ch. 35, 5 20, 1965 Tex. Gen. Laws 93,99. 

The hospital district’s enabling act mirrors article IX., section 9 of the Texas 

Constitution, which authorizes the legislature to provide for the creation of hospital 

dis&ictssolongas”anydiatrictsocreated... assume[s] 111 responsibiity for providing 

medical and hospital care for its needy inhabiis.” After the creation of a hospital 

district, article Iy section 9 states, “no other municipality or political subdivision shag 

have the power to levy taxes or issue bonds or other obligations. . . for providing medical 

care within the boundaries of the district.” 

In addition to the hospital district’s enabling act and article IX, section 9 of the 

constitution, two statutes are &vant to your questions: the Indigent Health Care and 

Treatment Act, Health and Safety Code chapter 61. and Code of Criminal Procedure 

article 104.002. Chapter 61 of the Health and Safbty Code pertains to the provision of 

medical care. to “eligible” individuals, i.e., individuals who meet the income and resources 

requirements established by or in accordance with chapter 61. Health & Safety Code 

5 61.002(4). A hospital district must provide to a resident of the hospital district the 

he&h care services required under the Texas Constitution and the hospital district’s 

enabling act. Id. 5 61.055. (Siiarly, section 286.082 of the Health and Safety Code 

requires a hospital district created by voter approval to provide, without charge, necessary 

medical care and treatment to an indigent patient. See Act of March 10,1%5,59th Leg., 

RS., ch. 35,s 3, 1965 Tex. Gen. Laws 93.94). 

With regard to an eligible individual who does not reside within the service area of 

a hospital district, a county is responsible for the provision of health care assistance to the 

individual if the individual resides within the county and has no other adequate source of 

payment. Health & Safety Code 4 61.023(a); see ah id. 5 61.022 (requiring county to 

provide health care assistance to eligible county residents). A county may, however, 

establish a less restrictive standard of eligibility. Id. 0 61.023(b). 

Thus, whether a hospital district or a county bears the cost of an eligible 

individual’s health care assistance depends primarily on the individual’s place of residence. 

“[A] person is presumed to be a resident of the govemmentaJ entity in which the person’s 

home or fixed place of habitation to which the person intends to return after a temporary 

absence is located. . . . [Jlf a person’s home or 6xed place of habitation is located in a 

hospital district, the person is presumed to be a resident of that hospital district.” Id. 

5 61.003(a). The Department of He&h is the arbiter of any disputes between a provider 

of assistance and a governmental entity or hospital district regarding an individual’s 

residence. Id. § 61.004(a). 

p. 2065 
The Honorable Patrick J. Fleming - Page 3 (DM-380) 

Article 104.002 of the Code of Criminal Procedure specifically per&s to the 

provision of medical, dental, or health-related services to prisoners confined in a county 

jail. 

(a) Except as otherwise provided by this article, a county is 

liable for all expenses incurred in the safekeepii of prisoners 

confinedinthewuntyjailorkeptundaguardbythccounty.. . . 

(b) If a county incurs eqenses for the safekeeping of a prisoner 

from another county, the shetifF shall submit to the county judge an 

account of acpmses incurred by the county for the prisoner. The 

county judge shall approve the amount he determines is a correct 

statement of the expend and sign and date the account. 

(c) The county judge shall submit to the wmmissioners court of 

the wunty for which the prisoner was kept, at a regular term of the 

court, his signed statement of the account described by Subsection 

(b). If the wmmissione-rs court determines that the account is in 

accordance with the law, it shall order the county treasurer to issue 

to the she-r8 of the wunty submitting the statement a drag in an 

amount approved by the court. 

(d) A person who is or was a prisoner in a county jail and 

received medical, dental, or health related services from a county or a 

hospital district shall be required to pay for such services when they 

are rendered. If such prisoner is an eligible county resident as 

de&ted in Section 61.002, Health and Safety Code, the county or 

hospital district providing the services has a right of subrogation to 

the prisoner’s right of recovery from any source, limited to the cost 

of WV&S provided. A prisoner, unless the prisoner tidly pays for 

the cost of services received, shall remain obligated to reimburse the 

wunty or hospital district for any medical, dental, or health services 

provided, and the. county or hospital district may apply for 

reimbursement in the manner provided by Chapter 61. Health and 

Safkty Code. A wunty or hospital district shall have authority to 

recover the amount expended in a civil action.1 [Footnote added.] 

In Attorney General Opiion DM-225 this office considered whether the Kames 

County Jail or the Kames County Hospital District is liable for the costs of health care 

assistance rendered to inmates of the Kames County Jail who are eligible for such 

assistance under chapter 61 of the Health and Safety Code. Attorney General Opinion 

‘See Act of April 25,1995,74th Leg., RS., ch. 76,§ 3.22, 1995 Tar. Ses Law Serv. 458,469. 

p. 2066 
The Honorable Patrick J. Pleming - Page 4 (DM-380) 

DM-225 (1993) at 1. The opinion 6rst addresses the responsibiity of the Kames County 

Hospital District for eligible individuals who reside in the hospital district: 

[Slection 61.055 of the Indigent Health Care and Treatment 

Act . provides that a hospital district must provide the health care 

services and treatment required by the wnstitution and the district’s 

enabling legislation. . . . [Tlhe Karnes County Hospital District has 

been created in Kmnes County and is coextensive with the 

county. . The district’s enabling act and the wnstitution require 

the district to provide medical care for its needy residents . . . . Prior 

opinions of this office have wnsistently opined that a hospital 

district’s duty to provide medical care for their indigent residents 

extends to such residents when they are held in county jails. 

Attorney Cienet-al Opiions lM-643 (1987); I’M-487 (1986); H-703 

(1975). Thus, it is our opinion that the Kames County Hospital 

District is responsible for the medical costs of an indigent jail inmate 

who is a resident of that district. 

Id. 

The opinion next determines that, for an eligible inmate residing in another hospital 

district or the service area of a public hospital,s that hospital district or public hospital is 

liable for the costs of health care assistance rendered to the inmate. Id. at 2. The opinion 

expressly does notconsider, however, the responsibility of costs for health care assistance 

rendered to inmates who are not residents of Texas. Id. at 3. 

The opinion finally contemplates an indigent inmate of the Kames County Jail who 

does not reside in Kames County, nor within any hospital district or public hospital service 

area. Id. at 2. Construing section 61.022 of the Health and Safety Code together with 

article 104.002(d) of the Code of Criminal Procedure, the opinion determines that the 

inmate’s county of residence is ultimately responsible for the costs of health care 

assistance provided to such an inmate. Id. at 3. 

(1) thebasicirComcand lraommarcquiromentscstahliihythc~cws 

Dqytmmt of Health] mtder Sections 61.006 and 61.008 and in effect when the 

assrstancc is rqxstcd; or 

(2) a less restrib income and --adoptcdbyti 

hospital serving the ama in which the paxon ES&S. 

Id. 8 61.052(a). 

p. 2067 
The Honorable Patrick J. Fleming - Page 5 (DM-380) 

Attorney General Opiion DM-225 resolves some of your questions. You tirst ask 

whether the hospital district or the county is responsible for the payment of health care 

costs, “including outpatient and inpatient care, dental care and p harmacmtical wstq” for 

indigent prisoners in the Parker County Jail who are residents of Parker County. Because 

the boundaries of the hospital district are coextensive with Parker County, a resident of 

the county is a resident of the hospital district. Under the hospital district’s enabling act, 

the hospital district must assume. “thll responsibiity for providing medical and hospital 

care for its needy inhabitants . . . .” Act of March 10, 1965, 69th Leg., RS.. ch. 35, 8 2, 

1965 Tex. Gen. Laws 93, 94; see a%0 Tar. Const. art. IX, 8 9. The hospital district’s 

duties extend to its eligible residents housed in the county jail. See Attorney General 

Opiion DM-225 (1993) at 1. Accordingly, the hospital district either must provide such 

imnates necessary medical and hospital care or recompense the providers of the care.’ See 

Act of March 10, 1%5, 69th Leg., RS., ch. 35, 5 2, 1%5 Tex. Gut. Laws 93. 93-94; 

Health & Safety Code 48 61.055,286.082(a); Attorney General Opiion DM-225 (1993) 

at 1. 

Whether the “medical and hospital care” the hospital district must provide includes 

outpatient and inpatient care, dental care, and pharmaceutical costs is a matter left to the 

discretion of the hospital district’s governing body. Attorney General Opiion DM-37 

(1991) at 5 (quoting Attorney General Opiion JM-1052 (1989) at 4). 

Certainly, the Texas Constitution and statutory law require 

hospital districts to provide at least essential medical services to their 

indigent residents. Whether a hospital district must provide a specific 

service., however, is a matter that the legislature has chosen by 

default’ to leave to the governing body of a hospital district. 

Id. (footnote added). 

You ask whether the hospital district or Parker County is responsible for the 

payment of health care costs incurred by an eligible inmate of the Parker County Jail who 

resides in another county. As we determined in Attorney General Opiion DM-225, the 

inmate’s county of residence is ultimately responsible for the wsts of health care 

assistance provided to the inmate if the inmate resides outside the bounds of a hospital 

district or public hospital service area. Attorney General Opiion DM-225 (1993) at 3. 

p. 2068 
The Honorable Patrick J. Fleming - Page 6 (DM-380) 

Lilrewise, if the eiigible inmate resides in another hospital district, the inmate’s home 

hospital district is liable to the Parker County HospitaJ District for all health care services 

the hOme hospital district is required to provide, as well as additional services the home 

hospital district regulady provides. 

If,ontheotherhand,theinmateresideswithintbeeaviceareaofapublichospitrZ 

we believe the Parker County HospitaJ District must look to two entities fbr 

rehbumme-nt. A public hospital is required to provide only inpatient and outpatient 

hospital services. See Health & Safety Code 05 61.028(a)(l), .054(a). Thus, the inmate’s 

home public hospital is liable to the Parker County Hospital District only for the cost of 

such setvices rendered to the inmate. The public hospital may be liable for other health 

care servica if it mgtdarly provides such setvices to its eligible residents. See id 

§ 61.054(b), (c). The county of the eligible inmate’s residence is liable for all health care 

costs not covered by the public hospital ( assuming the county is required to provide such 

setvices under section 61.028(a) of the Health and Safety Code or regularly provides such 

services under section 61.028(b)). 

The- statutes do not indicate how a provider of health care assistance is to receive 

reimbursanent ikom the governmental entity that is ultimately gable for an eligible 

inmate’s health care costs. If the hospital district provides health care services to an 

eligible imnate of the Parker County Jail who resides in another wunty, hospital district, 

or public hospital service area, we believe the hospital district may bill the governmental 

entity or entities that is ultimately liable for the wsts. Because you do not inquire as to 

the propriety of any other methods, we do not address other possible methods. 

You ask whether the hospital district or Parker County is responsible for the 

payment of all health care costs of an eligible prisoner in the wunty jail who resides in 

another state.5 As we mentioned, Attorney General Opinion DM-225 expressly mserves 

this question. Under article 104.002(d) of the Code of Criminal Procedure, the hospital 

district must require an inmate to pay for medical, dental, or health related services at the 

time the serviws are rendered. If, however, the inmate is “an eligible county resident as 

de&ted in Section 61.002, Health and Safety Code,” the hospital district has a right of 

subrogation to the prisoner’s right of recovery from any source. Code Crim. Proc. art. 

104.002(d). The hospital district may apply for reimbursement as permitted by Health and 

Safety Code chapter 61, the Jndigent Health Care and Treatment Act. 

We believe chapter 61 of the Health and Safety Code pertains only to the costs of 

medical treatment for Texas residents. Nothing in chapter 61 appears to contemplate an 

indigent resident of another state. For example, section 61.003(a) of the Health and 

Safbty Code presumes a person to reside in “the governmental entity” in which the 

~You¬~~wc¬,thcnforr,EohFida,wwhichcntityisLiaMcforthcEostsofhcaltb 

cerr~rradendmweligiMeinmatcwhoisaeili+cn~aoothcrcarntry. ButseeAttomy 

Gcwml Opiioo JM-1021 (1989) at 4-5 (sqgcsting tbat Indigent Health Care ad Treatmat Act dog 

not exclude illcpl immigrants from coverage iftbcy meet midauq and eligibility rapircmnt). 

p. 2069 
The Honorable Patrick J. Pleming - Page 7 (DM-380) 

person’s home is located. “Governmental entity” is defined to include a county, 

municipality, or other political subdivision of the me. In addition, section 61.002(4) 

requires the Department of Human Services to mandate that every applicant for health 

care inform the department of, among other things, the applicant’s “wunty of residence.” 

Nothing in section 61.007 requires the Department of Human Services to obtain 

information regarding the applicant’s state of residence. If the legislature had considered 

that an indigent applicant may be i?om another state, we believe the legislature would have 

provided in these two sections, or elsewhere, for a county, hospital district, and public 

hospital to determine the applicant’s state of residence. Accordingly, we believe article 

104.002(d) of the. Code of CriminaJ Procedure provides a hospital district a right of 

subrogation to an inmate’s right of reimbumemem only when the inmate is an eligible 

resident of Texas. When an indigent inmate resides in another state, section 104.002(d) 

permits a hospitaJ district to seek reimbursement only from the inmate. 

You ask whether the hospital district may establish an indigent he&h care policy 

that provides fewer medical services than the amount of medical services an indigent 

prisoner is entitled to under federal or state laws. Under section 61.055 of the Health and 

Safety Code, the hospital district must provide all health care services required under the 

Texas Constitution and the hospital district’s enabling act. As we stated above, the 

hospital district must provide, at the least, ail essential medical services to its eligible 

residents. See Attorney General Opinion DM-37 (1991) at 5 (quoting JM-1052 (1989) at 

4); supra p. 5. E, as you suggest, federal Jaw indeed requires a hospital district to provide 

additional medical services, the hospital district must provide such services.6 Whether a 

hospital district must provide any other, nonrequired services is within the discretion of 

the hospital district’s governing body. See Attorney General Opiion DM-37 (1991) at 5 

(quoting JM-1052 (1989) at 4); supra p. 5. 

In a related vein, you ask whether the hospital district may “establish an application 

for indigent health care that requests so much information that it is impossible for an 

inmate to complete the. application in order to be considered for indigent health care 

setviws.” You also ask who determines an inmate’s eligibility to receive health care 

assistance under chapter 61 of the Health and Safety Code, and whether the decision 

maker may “do so in such a fashion that deprives the imnate of health care as required by 

law.” We will answer these questions together. 

The hospital district makes the determination as to whether a particular applicant 

for health care assistance is eligible for such assistance. Section 286.082(b) of the Health 

and Safq Code requires a hospital district annuahy to adopt an application procedure to 

determine eligibility for assistance. See ah Health & Safety Code 3 61.053(a) (requiring 

hospital district to adopt application procedure). Section 286.082(c) authorizes the 

hospital district administrator to “have an inquiry made into the financial circumsmnces of 

p. 2070 
The Honorable Patrick J. Pleming - Page 8 (DM-380) 

the applicant patient and a relative of the patient who is legally responsible for the 

patient’s support. See also Act of March 10, 1965, 59th Leg., RS., ch. 35, 5 18, 1%5 

Tar. Cert. Laws 93, 99 (requiring administrator of hospital district to inquire into 

chmstanccs of patient residing within hospital district). 

Although a hospital district need not comply with the eligibiity standards and 

application, documentation, and verification procedures the Department of Health has 

adopted pursuant to section 61.006 of the Health and Safety Code, the hospital district 

may use the standards and procedures as guidance in developing its own standards and 

procedures. See Attorney General Opiion JM-858 (1988) at 3; see aLF0 supra note 4 

(descrii adoption of Texas Constitution article IX, section 9A). The. hospital district 

alsomryrefertothelistofinformation~~pti~fOTIISSi~fiomacOuntymust 

provide. See Health & Safes Code 8 61.007;7 40 T.A.C. $15607(c). 

A hospital district may not adopt eligibility standards or application procedures 

that are inconsistent with its enabling act. Moreover, we do not believe a hospital district 

may establish standads or procedures that ckumvent the hospital district’s wnstitutional 

duty to provide “medical and hospital care for its needy inhabitants.” See Tex. Const. art. 

IX, 8 9. Whethex pticular standards or procedures circumvent a hospital district’s 

wnstuutional duty is a question involving the resolution of fact issues; such a question is 

inappropriate to the opinion process. See, e.g., Attorney General Opinions DM-98 (1992) 

at 3, H-56 (1973) at 3, M-187 (1%8) at 3,0-2911 (1940) at 2. 

You ask which go vemnmtal entity is responsible for medical costs incurred by an 

indigent inmate in the county jail who is a state prisoner. Article 104.002 of the Code of 

Criminal Prowdure refbrs only to a prisoner in a county jail, without distinguishing 

(1) the applicant’s ml name and addmsq 

(2) the appIicaat’6 SociaI swmi@ mmlbcr, if available; 

(3) tknumherdpusoastnthsappIka&heaseheId,exclexdudingpersmu 

raxiviq AFDC, SSI, or I&&aid bandits; 

(4) tkapp~sanmlyof-; 

(5) tbeexistwwofiosmwwmwycorahcrborpitiM~~- 

berdts for which tk applicant is eligible; 

(6) aaylmasferdtitIetcmaIpmpntylbattka@icaathasmadeIathc 

prowding 24 monIb& 

(7) the appIiwnt’s ammal bus&old income, eacI* the inanne efaay 

bouschold member tuxiviq AFDC, SSI, er Medicaid bet&S: aad 

(8) theamountofthcapplicant,sLiquidrpEas~tbeequityvalucdtbe 

appIicanI’s car and mal propmy. 

p. 2071 
The Honorable Patrick J. Fleming - Page 9 (DM-380) 

between those prisoners who are prisoners of the wunty or prisoners of the state. See 

Attorney General Opiions JM-730 (1987) at 2, Jh4-743 (1987) at 2. Furthermore, we 

find no statute that expressly encumbers the state with the responsibiity of medical care 

for state prisoners housed in county jails. See Gov’t Code $493.001; cfl Attorney 

General Opiion JM-743 (1987) at 2 (wnstndng statutory predecessor to Gov’t Code 

5 493.001, men&dby Act of March 25, 1991, 72d Leg., RS.. ch. 16. 8 10.01(a). 1991 

Tex. Gen. Laws 244, 274). Consequently, if the hospital district renders health care 

asaktance to an eligible state prisoner housed in the county jail, the hospital district is paid 

for the services in accordance with article 104.002(d) of the Code of Criminal Procedure 

and chapter 61 of the Health and Safety Code. 

You a& whether Parker County may levy and wllect taxes for the costs of 

medical care for eligible prisoners in the Parker County Jail. As we have stated above, the 

hospital district’s enabrmg act prohibits the county from issuing “bonds or other evidences 

of indebtedness for. medical treatment of indigent persons within [the] boundaries” of 

the hospital district, see Act ofMarch 10, 1%5,69th keg., R.S., ch. 35, 5 20, 1%5 Tex. 

Gen. Laws 93,99; in addition, the. enabling act prohibits the county from levying taxes for 

such purposes, id Furthermore, article JX, section 9 of the Texas Constitution deprives 

any other political subdivision, including a county, of wle power to levy taxes or issue 

bonds or other obligations . for providing medical care within the boundaries of the 

district.” Tex. Const. art. JX, § 9. 

The hospital district’s responsibiity to provide medical and hospital care extends 

only to residents of the hospital district. See Tex. Const. art. JX, 5 9; Health & Safety 

Code $61.055; Act ofMarch 10, 1965, 69th Leg., RS., ch. 35, $20, 1965 Tar. Gen. 

Laws 93, 99. Thus, neither the enabling act nor article JX, section 9 of the Texas 

Constitution precludes Parker County from raising revenue, through the wllection of 

taxes, to pay medical costs of eligible inmates who are not residents of the hospital 

district.* But see Tex. Const. art. VI& 3 3 (mandating that taxes shag be levied and 

*Acotmtymaylevytaxesonlyinammian~ tilhtheamybodgu. .%eLccalGov’tcIxk 

8 111.010(a). Section 111.OlOofthc Local Govmmeot Code applies only to a cotmty with a population 

oT225,oooor1tssthatQcsnotopaatcundcrchapa111,subchapercoftheLocalGovernmmtcodc. 

LocalGov’tC&~111.001. Acarntywithapopllationgnatcrthan125.000maychowctocpaatc 

mxler snhcbapter C. Id. 5 111.061. Parker Comtty has a population of64,785. U.S. Dcpartmnt of 

-, 15’5’0 thWJS OF POpULATION: G- POPULATION cltARACTERISllCS: 'fEXAS 3(1%)). 

Thos,hkerthnymnstoperateinacaMkwe with chapter 111. dchaptu A, of which section 

111.010isapart. 

p. 2072 
The Honorable Patrick J. Fleming - Page 10 (DM-380) 

wkted for pub;: : purposes only); see ah id. art. IJJ. 8 52(a) (Prohibiting expenditure of 

public lunds for nonpublic purposes). 

We question the necessity of raising revenues to cover the costs of providing 

health care assistance to county jail inmates who do not reside in Parker County, however, 

because subsection (d) of article 104.002 of the Code of Criminal Procedure appears to 

abv the provider of medical se&es to recoup its costs. See Hearings on H.B. 2308 

Before the House Comm. on County AlGim, 70th Leg. (Apr. 7.1987) (statement of Dan 

Smith, Beg County Sheriff) (tape available from House Video/Audio !&&es Oflice) 

(stating that House Bii 2308, which became article 104.002(d) when enacted, provided 

various methods 6om mrmbmxment of medical costs counties pay for county jail 

itUtUS). 

You finally ask what retnedies may be taken against the hospital district or its 

board, either as a whole or as separate individuals, if the hospital district fails to cany out 

its wdtutional and statutory duty to provide “medical and hospital care for its needy 

inhabitants.“s Tex. Const. art. IX, 8 9; Act of March 10, 1%5,69th Leg., RS., ch. 35, 

8 2,1%5 Tex. Gen. Laws 93,93-94. You list mandamus, criminal prosecution for official 

miawnduct, removal from office, and joining the hospital district in a civil rights action for 

fiihtre to provide adequate health care. to eligible imnates. Whether a particular remedy is 

available or appropriate depends on the facts of the particular situation. The issue is, 

therefore, fact-based and inappropriate to the opinion process. E.g., Attomey General 

Opiions DM-98 (1992) at 3, H-56 (1973) at 3, M-187 (1968) at 3.0-2911 (1940) at 2. 

SUMMARY 

Tbe Parker County Hospital District must provide necessaq 

medical and hospital care to inmates of the county jail who reside in 

Parker County. In the alternative, the hospital district may reimburse 

the providers of such care. Whether the medical and hospital care 

the hospital district must provide includes outpatient and inpatient 

care, dental care, and pharmaceutical coats is a matter letI to the 

discretion of the governing body of the Parker County Hospital 

District, except that the hospital district may not provide fewer 

servicu than required by law. 

With respect to M inmate of the Parker County Jail who resides 

in another county, outside the boundaries of a hospital district or the 

service area of a public hospital and who is eligible for health care 

assistant under chapter 61 of the Health and Safety Code, the 

pYoualsoaskwhcthcr.iflbchc6pitaldistrbbsnmdcmdmcdical smiwatoapriwwrwhois 

~~~leundnchapta61tbeHcalthendsaf*ycode,~~bospitaldistriaEbarldraLpaymmtfrom 

that prisoner or the coomy. We have pmdiag More as woUws opinion tequcs& number RQ-685, that 

cams&rsmldwill answw that qnestion. 

p. 2073 
TheHonorablePatrick J. Fleming - Page 11 (DM-380) 

inmate’s county of residence is responsible for the costs of health 

cm assistance provided to the inmate. If the inmate resides within 

the boundaries of another hospital district, that hospital district is 

responsible to the Parker County Hospital District for the costs of 

any health care services the. home hospital district is required to 

provide, as well as any additional services the home hospital district 

regularly provides. Jf the inmate resides within the service area of a 

public hospital, the public hospital must reimburse. the Parker County 

Hospital District for the costs of inpatient and outpatient hospital 

services provided to an eligible inmate of the Parker County Jail, as 

well as the costs of any other health care amistance the home public 

hospital reguMy provides. Oenerally, the inmate’s wunty of 

residence is responsible for the remaining costs of health care 

assistMce. 

If the Parker County Hospital District provides health care 

assistance to an inmate in the Parker County Jail who is eligible for 

assistance under chapter 61 of the Health and Safety Code and who 

resides in another county, hospital district, or the service area of a 

public hospital, the hospital district may bii the govemmental entity 

or entities that is ultimately liable for the costs. 

An indigent inmate who resides in another state is ultimately 

liable for the costs of the medical services he or she has enjoyed. A 

hospital district may not subrogate itself to the right of an eligible 

inmate to reimbursement ifthe inmate resides outside the state. 

The Parker County Hospital District must provide to M eligible 

imnate of the Parker County Jail who is a resident of Parker County 

all essential medical care. The hospital district also must provide all 

health care assistance the federal law requires it to provide. Whether 

a hospital district provides other services is within the discretion of 

the hospital district’s governing body. 

In developing its own eligibility standards and application, 

documentation, and verilication procedures, a hospital district may 

refer for guidance to the standards and application, documentation, 

and verification procedures the Department of Health has adopted 

pursuant to Health and Safety Code section 61.006. The hospital 

disttict also may refer for guidance to the list of information an 

applicant for health care assistance from a county must provide, 

pursuant to Health and Safety Code section 61.007. A hospital 

district may not adopt eligibility standards or application, 

documentation, and verification procedures inwnsistent with its 

enabrmg act, nor may a hospital district establish standards and 

p. 2074 
The Honorable Patrick J. Fleming - Page 12 ~-380) 

proceduresthat ciraunvent the hospital district’s wnstitutional duty 

under title IX, section 9 of the Texas Constitution. 

If a hospital district renders health care aa&ance to M eligible 

state prisoner housed in the county jail, the hospital district is paid 

for the services in accordance with Code of Criminal Procedum 

article 104002(d) and Health and Safbty Code chap&r 61. 

A county may levy taxes for medical wsts incurred by eligible 

inmatesofthewuntyjailwhoresideinanothawuntyifthetwisin 

accordance with the county budget. The wunty wmmissioners 

court must determine that the imposition of the tax for this purpose 

serves a public purpose. 

Whether a particular cause of action is available or appropriate 

to protest a hospital district goveming board’s dereliction of duties 

depends upon the facts of the situation. 

DAN MORALES 

Attorney General of Texas 

JORGE VEGA 

Fii Assistant Attorney Gene-ral 

SARAH J. SHJRLEY 

Chair, Opiion Committee 

Prepared by Kymberiy K. Oltrogge 

Assistant Attorney General 

p. 2075