IN THE SUPREME COURT OF TEXAS
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No. 05-0986
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Harris County Hospital District, Petitioner,
v.
Tomball Regional Hospital, Respondent
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On Petition for Review from the
Court of Appeals for the Fourteenth District of Texas
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Argued December 4, 2007
Justice Johnson delivered the opinion of the Court, in which Justice Hecht, Justice Wainwright, Justice Medina, and Justice Green joined.
Chief Justice Jefferson filed a dissenting opinion, in which Justice O=Neill, Justice Brister, and Justice Willett joined.
In this case we consider whether Harris County Hospital District is immune from suit by the Tomball Hospital Authority to recover medical expenses for hospital care the Hospital Authority rendered to indigent patients. We hold that the Legislature has not waived the district=s immunity from suit either by specific statutory language or by implication from a constitutional and statutory framework.
I. Background
Tomball Hospital Authority (THA) was created and organized pursuant to chapter 262 of the Texas Health and Safety Code. Tex. Health & Safety Code ch. 262.[1] It owns and operates Tomball Regional Hospital (the hospital) in Harris County. From 2001 to 2002, the hospital provided medical care to certain indigent patients who were residents of the Harris County Hospital District (HCHD). THA sought payment from HCHD for the care it provided, but HCHD refused to pay. THA sued HCHD in district court, basing its claim on the Indigent Health Care and Treatment Act (IHCTA) and the Texas Constitution. In a plea to the jurisdiction and motion for dismissal and alternatively for summary judgment, HCHD asserted that (1) it had governmental immunity from suit; (2) county courts had exclusive jurisdiction over the matters; and (3) the Texas Department of Health had exclusive, original jurisdiction over the claim. THA responded by alleging that jurisdiction was proper in the district court and that Article IX, Section 4 of the Texas Constitution and Health and Safety Code sections 61.002(6), 61.0045, 61.060, and 281.056(a), which require a hospital district to provide and pay for indigent care, waived HCHD=s governmental immunity.
The trial
court granted HCHD=s
plea to the jurisdiction and motion to dismiss. In an opinion predating this
Court=s decision in
Tooke v. City of Mexia,
In this Court, HCHD challenges the court of appeals= holding that the “sue and be sued” language in section 281.056(a) waives its governmental immunity. THA argues the court of appeals is correct, but also contends that even if section 281.056(a) does not explicitly waive HCHD=s immunity to suit, its immunity is waived by a framework of law that includes the Texas Constitution and the Health and Safety Code. Additionally, THA argues that upholding HCHD=s claim that it retains immunity will lead to: (1) cities withholding taxes collected for hospital districts in order to offset debts owed by districts to the cities for indigent care resulting in suits against the cities to recover the withheld taxes; (2) bankruptcies of cities and municipal hospital authorities; and (3) violations of Texas Constitution Article III, Section 52(a) by cities in that a public benefit does not result from expenditures of public funds benefitting indigent parties not entitled to care by the cities. Disagreeing with THA=s positions, we reverse the judgment of the court of appeals and dismiss the case.
II. Standard of Review
A party
asserting governmental immunity to suit challenges the trial court=s jurisdiction.
See
State v. Holland,
III. Analysis
A. Construction
In construing
the Constitution, as in construing statutes, the fundamental guiding rule is to
give effect to the intent of the makers and adopters of the provision in
question. Cox v. Robison,
In construing
a statute, our objective is to determine and give effect to the Legislature=s intent. State v.
Gonzalez,
B. Governmental Immunity
Governmental
immunity protects political subdivisions of the State from lawsuits for damages.
See Reata Constr. Corp. v. City of Dallas,
C. “Sue and be sued”
The board of
managers of a hospital district “shall manage, control and administer the
hospital or hospital system of the district.” Tex. Health & Safety
Code § 281.047. Section
281.056 is entitled “Authority to Sue and be Sued; Legal Representation” and
provides that “[t]he board may sue and be sued.” The court of appeals held that
this language waived immunity from suit. 178 S.W.3d
252-53. In its brief predating this Court=s decision in Tooke, THA cites Missouri Pacific Railroad Co. v.
Brownsville Navigation District,
When an
entity=s organic
statute provides that the entity may “sue and be sued,” the phrase in and of
itself does not mean that immunity to suit is waived. Tooke,
Likewise, the other sections of chapter 281 do not, in context, reflect legislative intent to waive immunity. For example, section 281.050 authorizes a district, in broad terms and subject to approval of the commissioners court, to construct, acquire, and maintain property and hospital facilities to provide services. Section 281.051 grants authority, again subject to approval of the commissioners court, to contract or cooperate with various governmental and private entities to fulfill a district=s duties and to enter contracts to provide for medical care of certain classes of needy individuals. Section 281.055 authorizes districts to accept gifts and endowments to be held in trust and to administer them.
The context in which section 281.056(a) is found shows that the Legislature intended to invest districts with powers and authority necessary to conduct their business, subject in large part to approval of the county commissioners court. There is, however, no indication that by use of the “sue and be sued” language the Legislature clearly intended to waive districts= immunity from suit. We conclude that section 281.056(a) does not, either by itself or in context, clearly and unambiguously waive HCHD=s immunity to suit.
Next, we turn to THA=s claim that HCHD=s immunity is waived by the framework of law created by the Texas Constitution and certain sections of the Health and Safety Code.
D. Constitutional Provisions
Article IX,
Section 4 of the Texas Constitution was proposed and adopted as an amendment in
1954. It provides that if a hospital district is legislatively authorized and
created, “such Hospital District shall assume full responsibility for providing
medical and hospital care to needy inhabitants of the county and thereafter such
county and cities therein shall not levy any other tax for hospital purposes.”
Id. At
the time the amendment was proposed, city-county hospitals were supported by
both city and county taxes. The amendment was meant to address the issue of city
residents being taxed by both cities and counties to support the hospitals,
while non-city residents paid only county taxes. Dallas= Stake Big in Hospital
Vote, Dallas Morning News, Oct. 24, 1954, at pt.
VII, p. 6. At that time, the common-law doctrine of sovereign immunity that
Ano state can be sued
in her own courts without her consent, and then only in the manner indicated by
that consent” had been established in Texas for over one hundred years. See Tooke,
E. Statutory Provisions
Looking next
to the statutes involved, we note that it is more difficult to determine
legislative consent to suit against an entity when language specifying that
“immunity is waived” is absent from the provisions in question. Taylor,
Pursuant to the authority granted by Texas Constitution Article IX, Section 4, section 281.002 of the Health and Safety Code statutorily authorizes creation of hospital districts in counties with populations over 190,000. Section 281.046 provides that if such a district is created, then “[b]eginning on the date on which taxes are collected for the district, the district assumes full responsibility for furnishing medical and hospital care for indigent and needy persons residing in the district.” Section 281.046=s language parallels that of the Constitution insofar as mandating that once a district begins collecting taxes for purposes of providing health care to indigents, then it has the responsibility to provide such care. Our analysis of the similar constitutional language applies to section 281.046 which is, for purposes of the issue before us, the same as the language in article IX, section 4. The statutory language might impact or even foreclose the question of whether a hospital district is liable for allowable expenses, an issue not before us, but the statute is silent as to waiver of a district=s immunity from suits such as the one THA has brought. And section 281.046 neither requires the district to be joined in some type of suit nor does it set an objective limitation on the district=s potential liability. See Taylor, 106 S.W.3d at 697-98. In sum, section 281.046 does not waive HCHD=s immunity from suit.
We next consider THA=s argument that HCHD=s immunity is waived by Section 61.002(6) of the IHCTA. Section 61.002 contains definitions applicable to that chapter:
(6) “Governmental entity” includes a county, municipality, or other political subdivision of the state, but does not include a hospital district or hospital authority.
(7) “Hospital district” means a hospital district created under the authority of Article IX, Sections 4-11, of the Texas Constitution.
THA claims
that because a hospital district is excluded from the definition of
“governmental entity,” immunity does not apply to hospital districts for claims
under the IHCTA because only “governmental entities” are protected by the
doctrine of governmental immunity. A fair and reasonable reading of the statute
yields the conclusion that where the term “governmental entity” is used
in the chapter, a hospital district is not included. If the chapter said that
notwithstanding any provision of the chapter that might be interpreted
otherwise, immunity is retained for governmental entities, then THA’s argument would carry greater weight. But the chapter
nowhere addresses immunity of “governmental entities.” Applying the
interpretation aids of Taylor, we conclude that section
61.002(6)’s definition of “governmental entity” which excludes HCHD, does not
waive HCHD’s immunity. See Taylor,
Section 61.0045 is entitled “Information Necessary to Determine Eligibility.” Section 61.0045(a) allows medical service providers to require patients to furnish and authorize the release of information necessary for determination that the patient is an eligible resident of the service area so the provider may submit a claim to the Acounty, hospital district, or public hospital that is liable for payment for the service.” Section 61.0045(b) provides:
A county, hospital district, or public hospital that receives information obtained under Subsection (a) shall use the information to determine whether the patient to whom services were provided is an eligible resident of the service area of the county, hospital district or public hospital and, if so, shall pay the claim made by the provider in accordance with this chapter.
(Emphasis added). THA argues that the use of “shall” mandates payment by HCHD, and if the language is not interpreted as waiving HCHD’s immunity from suit, then the statute’s use of mandatory language is of no effect. THA urges that failing to interpret section 61.0045 as waiving immunity would violate our principles of statutory construction and the Legislature’s mandate that in interpreting statutes it is presumed the entire statute is intended to be effective and that a just and reasonable result is intended. See Tex. Gov’t Code § 311.021(2),(3). We disagree with THA. Like our discussion of sections 281.046 and 61.002(6), the analysis for legislative consent to suit applies here as well: (1) the statutory provisions do not waive the district’s immunity from suit without doubt; (2) to the extent the statute creates some ambiguity as to waiver of immunity from suit, we resolve the doubt in favor of retaining immunity; (3) neither section 61.0045 nor chapter 61 requires a hospital district to be joined as a party to some type of lawsuit; and (4) neither section 61.0045 nor chapter 61 places an objective limitation on any potential liability. See Taylor, 106 S.W.3d at 697-98.
Section 61.0045 requires a hospital district to pay claims by a provider for services rendered to an eligible resident of the district. But as with Article IX, Section 4 of the Constitution and section 281.046, section 61.0045 is directed toward the question of whether a hospital district is liable for allowable expenses; but the statute is silent as to waiver of a district’s immunity from suit asserting a right to reimbursement by parties such as THA. Thus, section 61.0045 does not waive HCHD’s immunity from suit.
Section 61.060 is entitled “Payment for Services.” Section 61.060(b) provides that “[a] hospital district is liable for health care services as provided by the Texas Constitution and the statute creating the district.” Section 61.060 also addresses a hospital district’s liability for payment and not its immunity from suit. THA’s urging that section 61.060 waives HCHD’s immunity from suit is misplaced for the reasons we have expressed above as to sections 281.046, 61.002(6), and 61.0045.
F. Additional Considerations
Next we
consider THA’s assertion that the IHCTA is part of a
framework of law that waives HCHD’s immunity from
suit. THA contends that the provisions of the IHCTA, when considered with the
previously discussed language of Article IX, Section 4 of the Constitution and
section 281.046(a) (specifying that a hospital district “assumes full
responsibility for furnishing medical and hospital care for indigent and needy
persons residing in the district”), yield the inescapable conclusion that the
Legislature intended for hospital districts’ immunity from suit to be waived.
Districts could then be required to pay claims for which they are statutorily
liable and for which they have received tax money. THA posits that if the law
were otherwise, hospital districts could collect taxes to pay for indigent care,
yet deny a treating entity’s requests for payment with impunity, thereby
transferring the cost of the care to entities such as THA that do not have
taxing authority. See Tex. Health & Safety Code §§
262.003(e), 281.045(a) (providing that a hospital authority does not have taxing
power). THA warns that if we hold the Legislature has not
waived HCHD’s immunity from suit, then (1) cities will
begin withholding taxes collected for hospital districts and offset those
collections against alleged Adebts” owed by
districts to the cities for indigent care, resulting in numerous suits by
districts to recover the taxes withheld; (2) cities and municipal hospital
authorities will be bankrupted by paying for indigent medical care; and (3)
cities and municipal hospital districts, by expending funds for care of
ineligible indigents will be in violation of Texas Constitution Article III,
Section 52(a). Despite THA’s construct and warnings of
dire results if HCHD prevails here, we disagree with THA that the statutory
framework or predicted negative effects of sustaining HCHD’s claim of immunity to suit justifies our reading clear
and unambiguous waiver language into the statutes. See Seay v. Hall,
Even though a
hospital district assumes responsibility for providing medical and hospital care
as a condition of collecting a tax, none of the statutes referenced by THA
clearly waive a hospital district’s governmental immunity so it can be sued over
how and when the tax receipts are spent. And policy
determinations involving who actually collects taxes, whether collecting
entities are subject to suit if taxes are withheld by the collecting authority,
whether laws will result in bankruptcy of municipal entities, and conforming
statutory mandates for indigent care to constitutional mandates are the very
type of policy decisions the Legislature is expected to make. The
judiciary’s task is not to refine legislative choices about how to most
effectively provide for indigent care and collect and distribute taxes to pay
for it. The judiciary’s task is to interpret legislation as it is written. See McIntyre v. Ramirez,
THA also argues
that in light of the constitutional provision, the Legislature must have
intended to waive immunity to suit by so thoroughly addressing hospital
districts’ liability and procedures for determination of eligibility of
indigents for care.[3] THA refers to two statutes that have been
interpreted as waiving sovereign or governmental immunity by language that the
governmental entity “is liable for” certain damages, similar to the statutes
under consideration here. The first is the Tort Claims Act’s provision that “[a]
governmental unit in the state is liable for . . . property damage, personal injury,
and death” under certain circumstances. See Tex. Civ. Prac. & Rem.
Code § 101.021. THA
cites University of Texas Medical Branch v. York,
101.025 Waiver of Governmental Immunity; Permission to Sue
(a) Sovereign immunity to suit is waived and abolished to the extent of liability created by this chapter.
(b) A person having a claim under this chapter may sue a governmental unit for damages allowed by this chapter.
Tex. Civ. Prac. & Rem.
Code § 101.025. And in
York, the question was not whether immunity to suit had been waived by
the Tort Claims Act; the issue was whether the use, misuse, or non-use of
information recorded in a patient’s medical records constituted use of tangible
personal property for which governmental immunity is waived. York,
THA also points
to Code of Criminal Procedure article 104.002(a) which states “[e]xcept as otherwise provided by this article, a county is
liable for all expenses incurred in the safekeeping of prisoners . . . kept
under guard by the county.” THA refers us to Harris County v. Hermann
Hospital,
Furthermore, as
we have noted, “[T]he >heavy presumption in
favor of immunity’ derives not just from principles related to separation of
powers but from practical concerns: >In a world with
increasingly complex webs of governmental units, the Legislature is better
suited to make the distinctions, exceptions, and limitations that different
situations require.’” Nueces County v. San Patricio County, 246 S.W.3d
651, 653 (Tex. 2008) (quoting City of
Galveston v. State,
IV. Response to the Dissent
The dissent
argues that the case should be remanded based on City of Beaumont v. Bouillion,
V. Conclusion
HCHD’s immunity from suit for damages has not been waived and the trial court did not have jurisdiction over TRH=s suit. The judgment of the court of appeals is reversed and the cause is dismissed.
________________________________________
Phil Johnson
Justice
OPINION DELIVERED: May 1, 2009
Notes
[1] Further references to provisions of the Health and Safety Code will generally be by section numbers.
[2] Even if we were to go behind the plain language of the Constitution, the available legislative history and records of public discussions about the proposed amendment do not show that any consideration was given to the subject of immunity from suit.
[3] This argument is similar to an argument that the statutes at issue would have no purpose absent waiver of HCHD’s immunity from suit. See Tex. Dep’t of Transp., 146 S.W.3d at 643. THA does not claim that the statutes have no purpose in the absence of waiver. To the contrary, at oral argument THA candidly professed that the statutory construct is well designed in regard to allocation of responsibility for indigent care.
[4] See Act of May 15, 1987, 70th Leg., R.S., ch. 149, § 1, 1987 Tex. Gen. Laws 707, 793.
[5] THA also references several Attorney General opinions responding to questions about county hospital districts’ liability for costs of indigent care. The opinions address liability of the districts, but not immunity from suit. The referenced Attorney General opinions do not persuade us that districts’ immunity from suit has been waived for the reasons we have expressed as to statutory provisions addressing districts’ liability for indigent health care costs.
[6] In City of El Paso v. Heinrich, ___ S.W.3d ___ (Tex. 2009), also issued today, the Court holds that a claim for prospective declaratory and injunctive relief against government actors in their official capacities but acting ultra vires is not barred by immunity even if the requested relief compels the governmental entity to make monetary payments. However, the Court reaffirms the principle that immunity bars suits against governmental entities for retrospective monetary relief. Id. at ___.
