February 25. 1987 

Honorable Billy gay Stubblefield 

Williamson County Attorney 

P. 0. Drawer 1139 

Georgetown, Texas 78627 

Opinion No. J-M-637 

Re: Obligation of a limited hospita1 authority to provide services under the Indigent Health 

Care and Treatment Act, article 

4438f, V.T.C.S. 

Dear Mr. Stubblefield: 

You ask .several questions concerning hospitals that are public 

hospitals within the meaning of the Indigent Health 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 

certain cities. 

Your first question is whether a hospital operated by a hospital 

authority which was created by a city. pursuant to article 4437e. 

V.T.C.S.. 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 Eealth Care and Treatment Act. 

Assuming that the answer to your first question is in the affirmative, 

you wish to know whether the city which created the hospital authority 

Is liable for providing health care assistance for indigent residents 

of the city, notwithstanding the city’s express representation at 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 “public hospital” under Title 3 of the act 

and that the city which created the hospital authority is liable for 

sufficient funding to the public hospital or to the hospital authority 

to provide the health care assistance required by the act. 

A city hospital authority created under article 4437e is an 

entity governed by 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 operated by the hospital authority for the use 

and benefit of the public. See V.T.C.S. art. 4437e, 514. 6, 7, 14. 

The issuance of bonds for fun=to build a hospital may be the reason 

for creating a city hospital authority but that is not the hospital 

authority’s sole function. 

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Ronorable Billy Ray Stubblefield - Page 2 (JM-637) 

Section 1.02(10) of .the Indigent Realth Care Act expressly 

defines a public hospital as "a hospital owned, operated. or leased by 

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 its words. 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 a hospital authority is a governmental entity 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 operated by a governmental entity 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 the hospital authority, the city is liable for providing 

sufficient funding to the public hospital or to the hospital 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 city will never be liable for any financial support 

to the hospital authority. The legislative power of Texas is vested 

in the Senate and Eouse of Representatives. Tex. Const. art. III, 41. 

The legislature has full power and discretion to enact laws, subject 

ouly to limitations contained in the state and federal constitutions. 

Even one session of the legislature may 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, 187 S.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 powers may 

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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Honorable Billy Ray Stubblefield - Page 3 (m-637) 

city's express representation that the city never would be liable for 

any financial support to the authority. 

You also ask whether, in the absence of an interlocal agreement 

or contract with the hospital, a county lawfully may provide health 

care assistance at county expense to the indigent residents of a city 

served by a public hospital if the public hospital fails to do so. It 

is our opinion that, while a county is not obligated to provide health 

care assistance to residents of an area served by a public hospital, 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 for medical services does not negate the existence 

of a legal power or authority to do so. It is important to distinguish between an obligation which is a legal duty and an authorization which Is permission or legal power. 

The Indigent Health Care Act expressly provides that a county is 

obligated to provide health care assistance to eligible residents who 

do not reside in an area served by a public hospital. See art. 4438f, 

952.02, 4.01(a). We conclude that the act deals only with the 

county's obligation and legal duty to provide health care assistance, 

rather than with 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 district has a legal obligation to serve. 

(b) Establishes that the county is the payer of 

last resort and is required to provide assistance 

only if other public or private sources of payment 

or assistance are not available. 

. . . . 

sec. 4.01. GENERAL PROVISIONS. (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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Eonorable Billy Bay Stubblefield - Page 4 (JM-637) 

provider to a county resident if the resident 

resides within au area a public hospital or hospital district has a legal obligation to serve. 

(Emphasis added). 

We conclude that the legislature did not intend those provisions 

to be a prohibition against a county providing health care assistance 

to persons residing in an area served by a public hospital. 

It is well established that a county has only the powers conferred either expressly or by reasonable implication by the constitution and statutes of this state. See Tex. 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, 1st Called Session, amends section 11 of article 2351 by 

adding a sentence which states that 

[a] county is obligated to prwide health care 

assistance to eligible residents only to the 

extent prescribed by the Indigent Eealth Care and 

Treatment Act. (Emphasis added). 

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 prescribed by 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. 

p. 2885 
Bonorable Billy Ray Stubblefield - Page 5 (JM-637) 

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 representation when creating 

the authority that the city never would be liable 

for any financial support to the authority. 

A county is not obligated to provide health 

care assistance to residents of an area served by 

a public hospital but is not prohibited from doing 

so. 

JIM MATTOX 

Attorney General of Texas 

JACK HIGHTOWBR 

First Assistant Attorney General 

MARYXBLLER 

Executive Assistant Attorney General 

RICK GILPIN 

Chairman, Opinion Committee 

Prepared by Nancy Sutton 

Assistant Attorney General 

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