Untitled Texas Attorney General Opinion ( 1973 )

Honorable Tim Curry Opinion No. H- 31
Criminal District Attorney
Tarrant County Re: Whether Hospital District
Fort Worth, Texas 76102 may assume duties and
functions of city and county
health departments and
related questions concerning
Dear Mr. Curry: taxation and funding.
The Tarrant County Hospital District was created by authority of
5 4 of Article 9 of the Texas Constitution and Article 4494n, Vernon’s
Texas Civil Statutes. By virtue of the authority contained in Article 3,
s 64 of the Texas Constitution and Article 4413 (32c),(Vernon’s Texas
Civil Statutes), the Interlocal Cooperation Act, Tarrant County has
contracted to pay the City of Fort Worth $5.000.00 annually to com-
pensate the City, for authorizing the City Health Officer to assume all
duties and responsibilities of the County Health Officer.
Among the services performed by the health departments of Fort
Worth and Tarrant County are restaurant, meat, milk, sewage, water
and other “regulatory” inspections. “Non-regulatory” services per-
formed include the operation and maintenance of a venereal disease
clinic, vaccinations for communicable diseases, etc. Officials of the
City and the County are considering the possibility that the Hospital
District may assume the health duties and services, thus prompting
your questions, the first of which is:
“Is Article 4494n, Vernon’s Ann. Civ. St. sufficiently
broad to authorize the Tarrant County Hospital District
to absorb the regulatory and non-regulatory health
services currently being executed and enforced by the
health departments of Fort Worth and Tarrant County? ‘I
Your question cannot be given a categoric answer. Section 4 of
Article 9 of the Constitution of Texas provides that the Legislature
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The Honorable Tim Curry, page 2 (H-31)
may authorize the creation of county-wide hospital districts in counties
having a population in excess of 190, 000 and in Galveston County with
power to issue bonds for the establishment of “hospitals or hospital
facilities”. Such a district must be authorized by an election and it
must assume full responsibility for “providing medical and hospital
care to needy inhabitants of the County”.
The enabling law enacted pursuant to this constitutional provision
is Article 4494n, Vernon’s Texas Civil Statutes. It too calls for
creation of a hospital district to provide “for the establishment of a
hospital or hospital system to furnish medical aid and hospital care
to the indigent and needy persons residing in said hospital district”.
Neither the Constitution nor Article 4494n defines what is a hospital
or what constitutes providing “medical aid”, “medical care” or “hospital
care”.
The Texas Hospital Licensing Law (Article 4437f. Vernon’s Texas
Civil Statutes) defines a general hospital as one offering services and
facilities requiring “diagnosis, treatment or care for illness, injury,
deformity, abnormality, or pregnancy” and maintaining various types
of facilitie8. A special hospital is defined as one offering services,
facilities, and beds for individuals who require services more intensive
than room, board, personal services and general nursing care
and which also has certain laboratory facilities, etc.
It is our opinion that the Tarrant County Hospital District is limited
to the furnishing of hospital services and the maintenance of hospital
facilities and that, ecren if it could be so construed, Article 4494n cannot
confer any greater authorization than that contained in the provisions of
§ 4 of Article 9 of the Constitution. City of Wichita Falls v. Cooper,
170 S.W.2d 777 (Tex. Civ. App. , 1943, err. ref. ); Dickison v. Woodmen
of the World Life Insurance Society, 280 S.W.2d 315 (Tex. Civ. App. ,
1955, err. ref. ); 12 Tex. Jur. 2d, Constitutional Law, 5 13, pp. 361-362.
The regulatory services which you describe in your letter, including
restaurant, meat, milk, sewage and water inspections, would not appear
to fall within any definition of hospital care or facilities and, in our
opinion, are services which legitimately could not be performed by a
hospital district organized under the provisions of § 4 of Article 9 of the
Constitution and Article 4494n of the Civil Statutes.
p. 131
The Honorable Tim Curry, page 3 (H-31)
The non-regulatory services which you specify, i. e., operation and
maintenance of venereal disease clinic, vaccinations for communicable
diseases, etc., may well be functions falling within the meaning of
“hospital care” and might properly be performed by the hospital.
Certainly 5 64 of Article 3 of the Constitution would authorize the
Hospital District to contract with the county government or other
political subdivisions for the performance of governmental functions
which the Hospital District would otherwise be authorized by the
Constitution to perform. Article 4413( 32c), the Interlocal Cooperation
Act and the enabling act adopted under 5 64 of Article 3 of the Constitution,
specifically includes “public health and welfare” in the definition of
“governmental functions and services”.
However, 0 64 of Article 3 is a general authorization while 5 4
of Article 9 is a specific authorization of the creation of hospital dist-
ricts. To the extent there is any conflict between the provisions, the
special provision will prevail. 12 Tex. Jur. 2d, Constitutional Law,
5 28, pp. 372-373 and cases cited.
Our answer to your first question asking whether Article 4494n is
sufficiently broad to authorize the District to absorb both regulatory
and non-regulatory health services currently being executed and
enforced by the health departments of Fort Worth and Tarrant County,
is “No”, although it is broad enough to authorize absorption of those
which are hospital functions, as indicated above.
Your second question is whether the revenues of the Hospital Dist-
rict from taxes levied pursuant to Article 4494n may be spent by the
District in rendering regulatory and non-regulatory health services.
It is our opinion the taxes levied pursuant to Article 4494n must be
limited in their expenditure to purposes within the scope of that
Article and g 4 of Article 9, i. e. , providing of hospitals and hospital
facilities, medical or hospital care, etc. , and to the extent, that any
of the regulatory or non-regulatory health services do not fit within
that definition, the taxes may not be used to provide them.See, for
instance, Baylor County Hospital District v. Crosby, 327 S. W. td 445
(Tex. 1959).
.
p. 132
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The Honorable Tim Curry, page 4 (H-31)
Your third question asks whether revenues of the District from
non-tax sources might be spent in the execution of regulatory and
non-regulatory health services. In view of our answer to your first
question, that we do not believe the District to be authorized to
engage in activities other than those specified in the Constitution,
our answer to question three is “NO”,
Your fourth question asks whether Tarrant County and the City
of Fort Worth (and other cities or political subdivisions) could
spend taxes from their general funds to contract with the District
under § 64 of Article 3 of the Constitution and Article 4413(32c)of the
statutes to pay contractual sums to the Hospital District in exchange
for its assumption of various health services.
Again, in view of our answer to the first question, limiting as it
does the scope of functions which can properly be performed by the
Hospital District, our answer to the fourth question must be similarly
limited. Furthermore, § 4 of Article 9 of the Constitution specifically
provides that a hospital district created thereunder “Fhall assume
full responsibility for providing medical and hospital care to needy
inhabitants of the county, and thereafter such counties and cities
shall not levy any other tax for hospital purposes . . . “. (Emphasis
added). This, in our opinion, precludes the expenditure of any other
tax revenues for purposes falling within the allowable scope of
functions to be performed by a hospital district.
SUMMARY
A hospital district organized under the authority of
5 4 of Article 9 of the Constitution may engage only in
those activities specifically authorized by the Constitution
and may not, by contract or otherwise, assume to render
services which are not among those ordinarily rendered
by a hospital such as the regulatory inspection of restaurants,
meat, milk, sewage, and water.
Very truly yours,
HN L. HILL
ttorney General of Texas
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The Honorable Tim Curry, page 5 (H-31)
DAVID M. KENDALL, Chairman
Opinion Committee
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