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 forhospital andmedical 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-extensivewith the boundaries of Cochran County, Texas. You further state in your letter that amedical doctorpracticing in the Cochran County Memorial Hospital has recommended that an indigentpatient be sent to the John Sealy Hospital for care and treatmentwhich cannot be supplied at the localhospital. Article IX, Section 9, of the Texas Constitutionprovides 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 anypart of one or more countieswith power to issue bonds for the purchase, construction,acquisition, repair or renovation of buildings and improvementsand equipping same, for hospital. purposes; providing for the transfer to the hospital district of the title to any land,buildings, improvementsand equipment locatedwholly within the districtwhich mav be lointlv or seoaratelvowned bv anv citv, town or-county,providing-that any district so created shall assume full responsibility forproviding rn9 nh rtants and assume the outstanding indebtedness incurred by cities, towns and counties forhospitalpurposes prior to the creation of the district, if same are locatedwholly within its boundaries,

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and a pro rataportion of such indebtednessbased 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.passedHouse Bill 1233, Acts 60th Legislature, Regular Session 1967, Chapter 494, page 1113 (Art.4494q,V.C.S.), known as the CochranMemorial HospitalDistrict Bill,pursuant to Article IX, Section 9, and its pertinentprovisions 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-extensivewith the boundaries of Cochran County, Texas, and possess such rights, powers, and duties as are hereinafterprescribed. "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 anywisepertaining to the hospitals or hospital systems owned by Cochran County and anycity or townwithin such county, and thereafter the district shall provide for the establishment of a hospital systemby thepurchase, construction,acquisition, repair or renovation of buildings and equipment, and equipping the same and the admindebtednesswhich shall have been incurredby any city or town or by Cochran County forhospital purposes prior to the creation of said district. II

. . . "Sec. 9. Purchases and expenditures. The board of directors of such district shallharthe. :1

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

power to prescribe themethod andmanner of making purchases and expenditures,by and for such hospital district, and also shall be authorized to prescribe all accounting and controlprocedures and tomake such rules and regulations asmay be required to carry out the provisions of thisAct.

II

. . . "Sec. 17. District alone to incur indebtedII

. . . ' (Emphasisadded.) 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 accordancewith general law for the building of any facilitiesnecessary to carry out its purposes; statesmanner of engaging a depositorybank for the district: exempts thebonds from taxation: gives power of eminent domain; and creates a framework for screeningpatients as indigents.

The responsibilitiesof the commissioners court in Article 2351,Vernon's Civil Statutes, and Article 4438,Vernon's Civil Statutes, are now the duties of Cochran Memorial HospitalDistrict. AttorneyGeneral's Opinion No. C-334:(1964). The question thereforenecessarily 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 formedical treatment of an indigent out-

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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:

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. . . "Under the provisions of article 4438, the countywas under no duty to send Barbosa to any hospital, therebeing no public hospital in the county, and under the implied restriction of this provision it is doubtful if the county couldbe bound by the commissioners'court, certainlynot otherwise, to send him to a hospital without the county, at public expense. II

. . . But the liabilitiesof counties are fixedby law and cannotbe extended by the courts beyond theplain authority of the statutes. I, I,

. . . The Court's opinion above noted is controllingas to the interpretationof 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 Constitutionhas enhanced the powers and duties of thehospital 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 assumesfull responsibility forprovidingmedical and hospital care for its needy inhabitants
. . .' (Emphasisadded.) Similar language is containea in Section 2 of H.B. 1233 providingpurposes of the district, as follows: ". Such district shall assume full responsibility forproviding'medical andhospital c~arefor its needy inhabitants
. . .* (Emphasisadded.)

Specifically, it is our opinion thatwhen a hospital district is created, it is no longerbound by the distinctions betweena pauper, an indigent and other restrictionswhich continue to be valid for countypurposes. The Willacy County case, althoughbinding on commissioners courts in countieswhere countywidehospital districtshave not been created, is not applicable to a hospital district. Limitations on the au-

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thority of a hospital district are determinedby the constitutionalprovision and statutewhereunder itwas formed and not by the statutorypowers and limitations thereof of commissioners courts. i.t. kgsearglfrom yaw letter, that there is no public hospital in COchran C'ounty which can "care" for the needy inhabitant,eithermedically or as a hospital. The district's responsibility forproviding such care can be exercised in sending such needy inhabitant to a public hospital outside of the district and under such circumstanceswould 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.ofTexas, and Section 2 of House Bill 1233, 60th Legislature, R.S. 1967, (Art. 4494q,V.C.S.) has the full responsibility forprovidingmedical and hospital care for the needy inhabitants of suchhospital district. Where the hospital district cannot discharge its full responsibility to such needy inhabitantwithin the hospital districtbe,causeof a lack of sufficientmedical 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 AssistantAttorney General APPROVED: OPINION COMMITTEE Hawthorne Phillips, Chairman Kerns Taylor, Co-Chairman W. V. Geppert

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Pat Bailey Brock Jones Bill Allen A. J. CARUBBI, JR. Staff Legal Assistant I..

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