Hon. James K. Walker 

County Attorney 

Opinion No.M-171 

Cochran County Courthouse Re: Whether Cochran County " 

Morton, Texas Texas, has authority to pay 

public owned hospitals out- 

' side the county for hospital 

and medical services rendered to indigent inhabitants 

of the county.under the'cirDear Mr. Walker: cumstances stated. 

You have requested the opinion of this office as to 

whether Cochran County, Texas, is authorized to pay for the 

medical care of an indigent resident of Cochran County, Texas, 

in a public hospital outside of Cochran County, Texas, after 

the creation of the Cochran Memorial Hospital District, whose 

boundaries are co-extensive with the boundaries of Cochran 

County, Texas. You further state in your letter that a medical doctor practicing in the Cochran County Memorial Hospital has recommended that an indigent patient be sent to 

the John Sealy Hospital for care and treatment which cannot 

be supplied at the local hospital. Article IX, Section 9, of 

the Texas Constitution provides as follows: 

"Sec. 9. The Legislature niay by law provide for the creation, establishment, maintenance 

and operation of hospital districts composed of 

one or more counties or all or any part of one 

or more counties with power to issue bonds for 

the purchase, construction, acquisition, repair 

or renovation of buildings and improvements and 

equipping same, for hospital. purposes; providing 

for the transfer to the hospital district of the 

title to any land, buildings, improvements and 

equipment located wholly within the district which 

mav be lointlv or seoaratelv owned bv anv citv, town 

or-county, providing-that any district so created 

shall assume full responsibility for providing 

rn9 nh rtants 

and assume the outstanding indebtedness incurred 

by cities, towns and counties for hospital purposes prior to the creation of the district, if 

same are located wholly within its boundaries, 

. 
. . : 

Hon. James X. Walker, page 2, (M-171) 

and a pro rata portion of such indebtedness based 

upon the then last approved tax assessment rolls 

of the included cities towns and counties if 

less than all the territory thereof is included 

within the district boundaries . . .II (Smphasis 

added.) 

Thereafter the Legislature.passed House Bill 1233, 

Acts 60th Legislature, Regular Session 1967, Chapter 494, 

page 1113 (Art. 4494q, V.C.S.), known as the Cochran Memorial 

Hospital District Bill, pursuant to Article IX, Section 9, 

and its pertinent provisions read as follows: 

"Section 1. Authority to create. Pursuant to 

authority granted by the provisions of Section 9, 

Article IX, Constitution of the State of Texas, 

Cochran Memorial Hospital District is hereby authorized to be created and as created shall have 

boundaries co-extensive with the boundaries of 

Cochran County, Texas, and possess such rights, 

powers, and duties as are hereinafter prescribed. 

"Sec. 2. Purposes of district. The district 

herein authorized to be created shall take over 

and there shall be transferred to it title to all 

lands, buildings, improvements, and equipment in 

anywise pertaining to the hospitals or hospital 

systems owned by Cochran County and any city or 

town within such county, and thereafter the district shall provide for the establishment of a 

hospital system by the purchase, construction, acquisition, repair or renovation of buildings and 

equipment, and equipping the same and the admindebtedness which shall have been incurred by any 

city or town or by Cochran County for hospital 

purposes prior to the creation of said district. 

II . . . 

"Sec. 9. Purchases and expenditures. The 

board of directors of such district shall harthe 
. :1 . . -1 

. 

Hon. James X. Walker, page 3, (W-171) 

power to prescribe the method and manner of making 

purchases and expenditures, by and for such hospital district, and also shall be authorized to prescribe all accounting and control procedures and 

to make such rules and regulations as may be required to carry out the provisions of this Act. 

II 

. . . 

"Sec. 17. District alone to incur indebtedII 

. . . ' (Emphasis added.) 

In addition to the above quoted provisions, the Act 

provides for the levying of taxes not to exceed seventy-five 

cents ($.75) on the One Hundred Dollar valuation; authorizes 

bonds to be issued in accordance with general law for the 

building of any facilities necessary to carry out its purposes; states manner of engaging a depository bank for the 

district: exempts the bonds from taxation: gives power of 

eminent domain; and creates a framework for screening patients 

as indigents. 

The responsibilities of the commissioners court in 

Article 2351, Vernon's Civil Statutes, and Article 4438, Vernon's Civil Statutes, are now the duties of Cochran Memorial 

Hospital District. Attorney General's Opinion No. C-334:(1964). 

The question therefore necessarily arises as to the authority 

of the hospital district to pay for indigent care in a public 

institution outside of its boundaries, either under its assumed 

powers of the commissioners court or powers given to it under 

the Constitution and statute creating it. 

The leading case prohibiting the payment by commissioners courts for medical treatment of an indigent out- 

-820. 
.I . . _. 

. 

Hon. James X. Walker, page 4, (d-171) 

side of the county in a private hospital is Willacy County v. 

Valley Baptist Hospital, 29 S.W.2d 456 (Tex.Civ.App. 1930, no 

writ history). The Court stated on page 458: 

11 

. . . 

"Under the provisions of article 4438, the 

county was under no duty to send Barbosa to any 

hospital, there being no public hospital in the 

county, and under the implied restriction of this 

provision it is doubtful if the county could be 

bound by the commissioners' court, certainly not 

otherwise, to send him to a hospital without the 

county, at public expense. 

II . . . But the liabilities of counties are 

fixed by law and cannot be extended by the courts 

beyond the plain authority of the statutes. 

I, I, . . . 

The Court's opinion above noted is controlling as 

to the interpretation of the law, on the facts and law that 

were presented to the court at the time of the decision. 

It is our opinion, however, that Article IX, Section 9, of the Constitution has enhanced the powers and duties 

of the hospital district, as opposed to the commissioners 

courts, and this is carried forward in the enabling legislation. The oertinent orovision of Article IX. Section 9. is: 

"that any district so-created shall assumes full responsibility 

for providing medical and hospital care for its needy inhabitants . . .' (Emphasis added.) Similar language is containea in Section 2 of H.B. 1233 providing purposes of the 

district, as follows: ". Such district shall assume full 

responsibility for providing'medical and hospital c~are for its 

needy inhabitants . . .* (Emphasis added.) 

Specifically, it is our opinion that when a hospital 

district is created, it is no longer bound by the distinctions 

betweena pauper, an indigent and other restrictions which continue to be valid for county purposes. The Willacy County case, 

although binding on commissioners courts in counties where 

countywide hospital districts have not been created, is not 

applicable to a hospital district. Limitations on the au- 

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_ . 

Hon. James K. Walker, page 5, (M-171) 

thority of a hospital district are determined by the constitutional provision and statute whereunder it was formed and not 

by the statutory powers and limitations thereof of commissioners 

courts. 

i.t. kgseargl from yaw letter, that there is no public 

hospital in COchran C'ounty which can "care" for the needy 

inhabitant, either medically or as a hospital. The district's 

responsibility for providing such care can be exercised in 

sending such needy inhabitant to a public hospital outside 

of the district and under such circumstances would have the 

authority to'pay for the same. 

SUMMARY' 

The Cochran Memorial Hospital District, by 

virtue of the provisions of Article IX, Section 

9 of the Constitution.of Texas, and Section 2 of 

House Bill 1233, 60th Legislature, R.S. 1967, (Art. 

4494q, V.C.S.) has the full responsibility for providing medical and hospital care for the needy inhabitants of such hospital district. Where the hospital district cannot discharge its full responsibility to such needy inhabitant within the hospital 

district be,cause of a lack of sufficient medical or 

hospital facilities, it may send the inhabitant to 

a hospital facility outside the district and legally 

pay for such expense. 

6 very truly, 

ai== 

. MARTIN 

enerai of Texas 

Prepared by Pat Cain 

Assistant Attorney General 

APPROVED: 

OPINION COMMITTEE 

Hawthorne Phillips, Chairman 

Kerns Taylor, Co-Chairman 

W. V. Geppert 

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Hon. James X. Walker, page 6, (M-171) 

Pat Bailey 

Brock Jones 

Bill Allen 

A. J. CARUBBI, JR. 

Staff Legal Assistant 

I.. . 

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