JIM MAlTOX Attorney General

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An Equal Opportunity/ Affirmative Action Employer 

# The Attorney General of Texas

October 6, 1986

Honorable CarlM. Anderson Nolan CountyAttorney P. 0. Box 1201 Sweetwater,Texas 79556 OpinionNo. JM-552

Ret Whether the city of Sweetwater is required to share the expense of health care for indigent residents of Nolan~County

Dear Mr. Anderson:

You inquirewhether, under the IndigentHealth Care and Treatment Act, the city of Sweetwater is required to share the expense of health
care services for indigents who are residents of Nolan County. We conclude that such expense is a joint responsibilityof the county and the city. We are asked the following specificquestions:

1. Within the provisions of article 4438f. V.T.C.S., is an eligibleresident,ofNolan County, Texas a personwho does not resideuithin the area that a Iublic hospital or hospital district has a legal obligation to serve?

2. If the answer to the foregoing is in the negative then, under the provisions of section 12.03of article 4438f, Is the city of Sweetwater, Texas, a governmental entity that created or authorized the creation of a 'hospitalauthority'
as that term isused in section 12.03?

The only hospital in Nolan County is operatedby a joint countycity hospital board created under article 44941-l. V.T.C.S. Such a board is a separa'x!entity which acts independentlybut operates the hospital as a joint agent of the county and the city. V.T.C.S. art. 44941-l. 62. The board may not encumber, sell, lease, or convey real
or personalpropertywithoutprior approval of the commissioners**court** and the governingbody of the city. Art. 4494i-1, ,65. The board may issue revenuebonds, but itmay not deliver bonds unless the issuance is approved by the comissioners court and the governing body of the city. Art. 4494i-1, 506. 8. Section 5 also expressly authorizes the county and the city to contract with the board for the care of indigentpersonswith both the county and the city making payments to the board pursuant to such a contract **from** any of their funds or resources.

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Prior to the enactment of the IndigentHealth Care and Treatment Act, which is codified as article 4438f. V.T.C.S., Attorney General Opinion MW-33 (1979) detenained that **the** commissioners court of each county was required by sta:ute to provide necessarymedical care for its indigentsand that a countywas liable **for** expensesof an indigent resident incurred at a joint county-city hospital unless the county contracted with the city J:CI share such expenses under section 5 of article 44941-l. The Indigent Health Care and Treatment Act changes the law expressed in that opinion.

Under the Indigent Health Care Act, each county shall provide health care assistance to i.tseligible residentswho do not reside in the area that a public hospital or hospital~district has a legal obligation to serve. V.T.C.S. art. 4438f, 92.02(a). Each public hoapital shall provide health care assistance to the eligible residents of the area that the hospital has a legal obligation to serve, and each governmentxl entity that owns, operates, or leases a public hospital shallprovid,e sufficientfunding to allow thehospital to provide that health ca:reassistance. Art. 4438f, 110.02(a). A public hospital is liable for health care services provided by any provider, including another public hospital, to an eligible resident of the area that the hospital has a legal obligation to serve. Art. 4438f. 512.01(a). Sectior.12.03 of the Indigent Health Care Act provides that

[elach governmental entity that ,owns,operates, or leases a public hospital shall provide sufficient funding to thenho:spitalto provide the health care assistance require'dby this Act. If a public hospital is owned, operated,or leasedby a hospital authority, the governmental entity that created or authorized the creation of the authority shall provide sufficient funding to thepublic hospital or hospital authority toprovide thehealth care assistance requiredby thisAct.

You first ask whether an eligible resident of Nolan County is a person who resideswithin the area that a public hospital or hospital districthas a legal obligationto serve. Health care assistance to a person who does not reside in such an area is providedby the county. It is our opinion, however, that an eligible resident of Nolan County resides in anarea that a public hospital has a legal obligation to
serve.
The hospital in Nolan County operated by the joint county-city hospital board is a public hospital as that term is used in the Indigent Health Care Act. The act defines a public hospital as "a hospital owned. operated, or leased by a governmental entity" and a governmentalentity includesa county, city, town,hospital authority,
or other political subdivis,lon of the state, but does not include a hospital district. Art. 4438f. 01.02(6)(10). The hospital in quest-ion

has a legal obligation to serve the area of the county and

p. 2451Honorable CarlM. Anderson '-Page 3 (JM-552)

the city. Under the IndigentHealth Care Act, thepublic hospital in Nolan County provideshealth care assistance to indigent residents of Nolan County.

Your second question ::I; whether, by creating the joint hospital board with the county, the city is a governmentalentity that created
or authorized the creation of a hospital authority as that term is used In section 12.03of th,zIndigentHealth CareAct.

The IndigentHealth CarsAct does not define "hospitalauthority" for purposes of the act. .ijoint county-cityhospital board created under article 44941-l and hospital authorities created by a city under article 4437e. V.T.C.S., and by a county under article 4494r, V.T.C.S..have both similarand dissimilar characteristics. Neither a hospital authority nor a joint county-city hospital board has taxing power. Both a hospital authority and a joint county-city hospital board are entities separate from the governmentalentity that created them andmay construct, enlarge, furnish, equip, operate, andmaintain their respective hospitals. V.T.C.S. art. 4437e. 56(a); art. 4494r, 56(a);art. 44941-l. 54. A hospital authoritymay Issue revenuebonds after an election to approvsz thebonds if tenpercent of the qualified voters request such an election and without an election if thevoters do not request it. A jo,Lntcounty-city hospital board **may** issue
revenue bonds, but all such bonds must be approvedby both the county and the city that created the joint board. Art.'44941-l. 58. By statute, hospital authorities are a "body politic and corporate" and, in the case of a county hos:pitalauthority, a "political subdivision of the State," as distinguished from a joint county-city hospital board which constitutes a '"publicagency and body politic." Art. 4437e. 53; art. 4494r. $3; <art. 44941-1, 01. Although a joint countycity hospital board is a separate entity in the performance of the functions authorized by article 4494i-1, section 2 of that article expressly provides that such a board is a joint agent of **the** county and the city for hospitalpurposes.

As a practicalmatter.whether a joint county-cityhospitalboard constitutes a hospital autllority within the meaning of the Indigent Health Care Act is immaterial to a determinationof the obligation to fund the health care assistance required of a hospital operated by a jointhospitalboard. It is our opinion that forpurposes of the Indigent Health Care Act, while nominal title is in a jointboard, actual ownershipof a hospital opezatedby a joint county-cityhospitalboard is in the county and the cj.ty. Such ownership is consistentwith the statutoryagency relationsh:Lp of the jointboard to the county and the city and with the joint board's authority pertaining to hospital property that is subject to prior approval of both the county and city. Art. 44941-1. 104, 5. In either capacity, sections 10.02(a) and 12.03of article 4438f provide that the governmentalentities that
own a public hospital or create a hospital authority that owns or operates a public hospital shall provide sufficient funding to allow the hospital to provide tt.ehealth care assistance required by the IndigentHealth CareAct. 'Cheact is the legislature'simplementation

p. 2452HonorableCarlM. Anderson -Page 4 (JM-552)

of reconnnendations made b5,the Task Force on Indigent Health Care jointly appointedby the governor, lieutenantgovernor,and speaker of thehouse in September, 1983,and chargedwith presentinga package of findings and recommendaticlnsto the Sixty-ninth Legislature. The intention of the Task Fore<?recommendations.among other things, was to allocate responsibility for the administration and financing of indigent care among various levels of government and types of providers in an attempt t,owork within the existing **system** while proposingmeasures to,reduc,ethe inequities in that **system.** See Task Force on Indigent Eealth Care. Final Report, December 1984, at 21. The provisions of the act ,:hat relate to your questions reflect that intention.
Since the legislature expressly provided in article 4438f. sections 10.02(a) and 12.03 that each governmental entity shall provide funding to the hospital frhealth care assistance, we conclude that the legislature Intends that the share of expense to be provided by each entity is a joint responsibility and an internal matter tobe determinedby the county and the city.

SUMMARY

Under the IndigentHealth Care and TreatmentAct,
an eligibleresident of Nolan County is a personwho resides in an arl?athat a public hospital has a legal obligation 

### to serve. A governmental entity that either owns, operates, or leases a public hospital or that #:reateda hospital authority that owns, operates, or leases a public hospital shall provide funding fcr health care assistance required by the act. Hence, funding for indigenthealth care expense of a hospital operated by a joint countycityhospitalboard is a joint responsibilityof the county and the city.

AttorneyGeneral of Texas

JACK HIGHTOWER First AssistantAttorneyGeneral

NARY KELLER ExecutiveAssistantAttorneyGeneral

RICK GILPIN Chairman,Opinion Committee
Preparedby Nancy Sutton AssistantAttorneyGeneral

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