February25. 1987

HonorableBilly gay Stubblefield WilliamsonCountyAttorney P. 0.Drawer 1139 Georgetown,Texas 78627 OpinionNo. J-M-637

Re: Obligationof a limitedhospita1 authority to provide services under the Indigent Health Care and Treatment Act, article 4438f,V.T.C.S.

DearMr. Stubblefield:

You ask .severalquestions concerning hospitals that are public hospitalswithin themeaning of the IndigentHealth Care and Treatment Act, article 4438f. V.T.C.S., and the governmental entities that are obligated to provide health care services to indigent residents of certaincities.

Your first question iswhether a hospital operatedby a hospital authority which was created by a city. pursuant to article 4437e. V.T.C.S.. solely to allow the issuanceof tax freebonds is a “public hospital” obligated to provide services to the indigent residents of the city under Title 3 of the IndigentEealth Care and Treatment Act. Assuming that the answer toyour firstquestion is in theaffirmative, you wish to knowwhether the citywhich created thehospital authority Is liable for providinghealth care assistance for indigent residents of the city, notwithstandingthe city’s express representationat the time of creating the authority that it never would be liable for any financial support to the authority. It is our opinion that the hospital in question is a “publichospital” under Title 3 of the act and that the citywhich created thehospital authority is liable for sufficientfunding to thepublichospital or to thehospital authority toprovide thehealth care assistancerequiredby the act.

A city hospital authority created under article 4437e is an entity governedby its own board of directors. It may issue revenue bonds to provide funds for its purposes and may purchase, construct, equip, and operate a hospital. Unless its hospital is being leased, the hospital shall be operatedby the hospital authority for the use and benefit of the public. See V.T.C.S. art. 4437e, 514. 6, 7, 14. The issuanceof bonds for fun=to build a hospitalmay be the reason for creating a city hospital authoritybut that is not the hospital authority’ssole function.

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Section 1.02(10) of .the Indigent Realth Care Act expressly defines a publichospital as "a hospital owned, operated. or leasedby
a governmental entity." According to section 1.02(6),a governmental entity "includes a county, city, town, hospital authority, or other political subdivision of the state, but does not include a hospital district." The dominant consideration in construing a statute is the legislative intent. Minton v. Frank, 545 S.W.2d 442. 445 (Tex. 1976). The words of the statute are the best evidence of legislative intent, and, when a statute is plain and unambiguous, it will be enforced according to itswords. Anderson V. Penis, 161 S.W.2d 455. 459 (Tex. 1942); Sablne Pilots Assn. V. Lykes Brothers Steamship, Inc., 346 S.W.2d 166, 169 (Tex.Civ. App. - Austin 1961, no writ). It Is our opinion that ahospital authority is a governmentalentity as the term is defined by section 1.02 of article 4438f. Since the hospital in question is owned and operated by a hospital authority, we conclude that it is owned and operatedby a governmentalentity and is a public hospital within the meaning of the Indigent Health Care Act. As a public hospital, it has a duty to provide health care assistance to eligible residents of the city under Title 3 of the act. Since the city created thehospital authority, the city is liable for providing sufficient funding to thepublichospital or to thehospital authority to provide the health care assistance required by the act. See - V.T.C.S. art. 4438f. 1510.02, 12.03.

In our opinion, the legislature is not bound by representations of a city that the citywill never be liable for any financialsupport to the hospital authority. The legislativepower of Texas is vested in the Senate and Eouse of Representatives. Tex. Const. art. III, 41. The legislaturehas full power and discretion to enact laws, subject ouly to limitations contained in the state and federal constitutions. Even one session of the legislaturemay not limit the power of a subsequent legislature to enact laws. See Conley V. Daughters of the Re ublic. 156 S.W. &&%. App 197 (Tex. 1913);WaG V. Mann, 187S.W.2d 917, 924

. - Austin 1945,writ ref'd); Attorney General Opinion M-421 (1969). Not only Is the legislature not bound by representations of a city, but even a home rule city with its broad powersmay not in its charter or ordinances enact provisions inconsistent with the Texas Constitution or general laws of the state. If the legislature enacts a statute In conflict with a prior city ordinance, the city ordinance is rendered ineffective except as to certain vested rights which persons have acquired in their relationship with the
C&. Cities do not acquire vested rights against the state. See Tex. Const. art. XI, 55; V.T.C.S. art. 1165; City of Nassau Bay. City of Webster, 600 S.W.2d 905. 910 (Tex. Civ. App. - Bouston [lst Dist.]).writ ref'd n.r.e.. 608 S.W.2d 618 (Tex. 1980).

We conclude that the city is liable for providing health caret assistance to indigent residents of the city, notwithstanding the

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city's express representation that the city never would be liable for any financialsupport to the authority.

You also askwhether, in the absence of an interlocal agreement or contract with the hospital, a county lawfullymay provide health
care assistanceat county expense to the indigentresidents of a city servedby a publichospital if thepublichospital fails to do so. It is our opinion that,while a county isnot obligated toprovidehealth careassistanceto residentsof an area servedby a publichospital, a county is not prohibited from doing so. We pointed out in Attorney General Opinion m-425 (1986) that the absence of a county's legal requirement to pay formedical servicesdoes not negate the existence of a legal power or authority to do so. It is important to distinguishbetween an obligationwhich is a legalduty and an authorizationwhich Ispermissionor legalpower.
The IndigentHealth Care Act expresslyprovides that a county is obligated to providehealth care assistance to eligible residentswho do not reside in an area servedby apublichospital. See art. 4438f, 952.02, 4.01(a). We conclude that the act deals only with the county's obligationand legal duty to providehealth care assistance, rather thanwith limiting a county's legal power to do so. The Bill Analysis to Senate Bill No. 1, Sixty-ninth Legislature, 1st Called Session, 1985, on file in the Texas Legislative Reference Library, states:
SCC. 2.02. GENERAL PROVISIONS. (a) Requires

each county to provide health care assistance as prescribed by this title to each eligible county resident not residing within the area a public hospital or hospital districthas a legal obligation to serve. (b)Establishesthat the county is thepayer of last resort and is required to provide assistance only if otherpublic or private sourcesof payment or assistanceare not available.

. . . .

sec. 4.01. GENERALPROVISIONS. (a)Establishes that a county is liable for services provided under this title by any provider, to an eligible county resident not residing within the area a public hospital or hospital district has a legal obligation to serve. (b)Sets forth that a county is not liable for payment for health care services provided by any

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provider to a county resident if the resident resides within au area a public hospital or hospital districthas a legalobligation to serve. (Emphasisadded).

We conclude that the legislaturedid not intend those provisions tobe a prohibition against a county providinghealth care assistance topersons residing in an area servedby a publichospital.

It is well established that a county has only the powers conferred either expressly or by reasonable implicationby the constitution and statutesof this state. SeeTex. Const. art.V. 518;Canales V. Laughlin, 214 S.W.Zd 451, 453 (Tex. 1948). The Texas Constitution does not require counties to provide indigent health care but merely authorizes them to do so. See Tex. Const. art. XVI, P8. A centuryold statute which has survived as article 2351, V.T.C.S., specifies certain powers of the conmissioners courts. Section 11 of article 2351, as it appears in Senate Bill No. 1, directs the counties to "provide for the support of paupers . . .residents of their county, who are unable to support themselves." "Support" as used in section 11, in previous section 10, has been interpreted by Texas courts to include medical care. See Monghou h Sisson V. Van Zandt County, 3 Willson 240 (Tax. Ct. Fp. 1886); Attorney General Opinion MW-33 (1979). However, section 4 of Senate Bill No. 1, Sixty-ninth Legislature, 1stCalled Session, amends section 11 of article 2351by adding a sentencewhich states that

[a] county is obligated to prwide health care assistance to eligible residents only to the extent prescribedby the Indigent Eealth Care and TreatmentAct. (Emphasisadded).

The Bill Analysis explains that Senate Bill No. 1 mends article 2351 by "adding a provision obligating a county to provide assistance only to the extent prescribed by the Indigent Health Care and Treatment Act." The amendment does not provide that a county is authorized to provide health care assistance only to the extent prescribed by the act.

It is our opinion that Senate Bill No. 1 speaks only to the obligation of a county and not to its authority. If the legislature intended to make it unlawful for a county to provide health care assistance that is not required by the Indigent Eealth Care Act, the legislature easily could have amended article 2351 to provide that a county way provide health care assistance only to the extent prescribedby the act. We conclude that Senate Bill No. 1 does not deny permissive authority to a county to provide health care assistance to its indigent residents who reside in an area served by a public hospital.

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SUMMARY

A hospital operated by a hospital authority which was created by a city solely to allow the issuance of tax free bonds is a public hospital obligated to provide services to the indigent residents of the city under Title 3 of the Indigent Health Care and Treatment Act. notwithstanding the city's representationwhen creating the authority that the city never would be liable for any financialsupport to the authority.

A county is not obligated to provide health care assistance to residents of an area servedby
a publichospitalbut isnot prohibited fromdoing
so.

JIM MATTOX AttorneyGeneral ofTexas

JACK HIGHTOWBR FirstAssistantAttorney General

MARYXBLLER ExecutiveAssistantAttorneyGeneral

RICK GILPIN Chairman,OpinionCommittee
Preparedby Nancy Sutton AssistantAttorneyGeneral

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