Case Information

*1 Criminal District Attorney

Bexar County Courthouse Re: Authority of the Bexar County San Antonio, Texas 78204 Hospital District, pursuant

to Section S(b) of Article 4494n, Vernon’s Civil Statutes, to fund the operation of a clinic for the poor and in- digent without assuming re- sponsibility for control and supervision of such clinic.

Dear Mr. Butler:

Your recent letter requesting the opinion of this office concerning the referenced matter states, as follows:

“This office requests your opinion con- May the Bexar cerning following question:

County Hospital District fund the operation

a clinic for the poor and indigent at Villa

Coronado in south Bexar County without taking

over the operation and supervision of the clinic?

“The Villa Coronado Clinic was originally set up and funded by a Government Grant (OEO)

during the past year with the understanding it (OEO) would only fund the clinic for

one year. The Clinic is now operated by a

non-profit organization, “Southside Neighbor- The Clinic’s

hood Association Corporation”.

first year funds were expended on February 1,

1972. At this time the Bexar County Hospital decided to fund the operation since

the persons attended by the Clinic would or-

dinarily be cared for by the Bexar County except for a

transportation problem of about 25 miles. It

is the Bexar County Hospital District’s con-

tention since the transportation problem

so acute for these residences, that by the

time the patients from Villa Coronado finally

came to the Bexar County Hospital District they would be so advanced in their illnesses that they would become in-patients of the hospital instead of clinical out-patients.

The Bexar County Hospital District funding this clinic through the non-profit corporation (SSNAC) on a month to month basis without assuming any operation or supervision of the clinic and without a contract with the South- side Neighborhood Association Corporation.” Pursuant to the authority of Section 4 of Article IX of the Bexar County Hospital District was the Constitution of Texas, established by Article 4494n, Vernon’s Civil Statutes. Section 1 of that Article provides, that:

“Any county having a population 190,000 or more . . . may be constituted a Hospital District as hereinafter set out and . . . may provide for the establishment of a hospital or hospital system to furnish medical aid and hospital care to the indigent and needy persons in said Hospital District. . . .I’ (b) of Section 5b of that Article provides,

in pertinent part, as follows:

,1 . .(T)he (hospital district) Board of . Managers, with the approval of the Commissioners Court, may cooperate and contract with . . . any privately owned or operated hospitilircz;E;;;;; or otherwise, which privately owne

hos ital is situated in the hospital district; p& . in the opinion of the Board of Managers and of tie Commissioners Court, such a contract is deemed expedient and advantageous to the hospital district under existing circumstances, and be for such fair and reasonable compensation and on such other terms and for such length of time as may be deemed to further and assist hospital in performing its duty to provide medical and hospital care to needy in- (Emphasis added). habitants of the county.” *3 ‘M-l 154)

Hon. Ted Butler, page 3

Section 2 of Article 4437f. Vernon’s Civil Statutes,

(the Texas Hospital Licensing Law) 9 defines the term “hospital.” That Act’s definition of the term “hospital” is expressly made applicable to the Bexar County HosPltal District by virtue Subsection (b) (1) of Section 2 of Article 4437f, which provides, in part, as follows :

II . The definition of ‘hospital’ does, include those maintained however ’ or operited by lgovernmental’ or ‘governmental unit 1 as those terms are defined in Section 2, (d) of this Act.” Subsection (d) , referred to in the foregoing statutory

provision, provides,

“The term ‘governmental ’ Or 'governmental unit ) means any hospital . . .” (Emphasis added).

your letter has also advised US that the Villa Coronado the funding of which is at issue in your request, does Clinic, not fall within the definition set forth in Article applicable to Article 4494n. For purposes 4437f, and, therefore, of this opinion, we assume that your statement concerning the Clinic’s falling without the purview of the definition of “hospital** is correct

we are aware that prior to the enactment of Article 4494n, the board of managers of a hospital district, pursuant to Articles 4478 and 4481, Vernon’s Civil had authority to establish Statutes, clinics similar to the nature of the Villa Coronado Clinic. If the Villa Coronado Clinic had been extant at the time of the enactment i of Article 4494n (1953), which it.was not, it would have become the

property of the Bexar County Hospital District, by virtue of the pro- visions of Section 4 of Article 4494n.

Inasmuch as the Villa Coronado Clinic is not the property the only way whereby the Hospital District of the Hospital District? connection with such Clinic is through rhe provisions may have a legal of Section 4494n, quoted supra.

pursuant (a) of Section Sb, the “ospital could elect to purchase the Clinic to effectuat? its duty for “the establishment of a hospital or hosFita1 system of providing to furnish medical aid and hospital care to the indigent and need?

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persons” in the District.

However, the District cannot , pursuant (b) of Section Sb, contract with the Clinic, inasmuch as it is not a “hospital” as that term is used in Subsection (b), by virtue of the provisions of Subsection (b)(l) of Section 2 of Article 443?f, quoted supra. Furthermore? no authority found in Section 5b of Article 4494n whereby the District could contract with any clinic, as opposed to a hospital, in the District. Cf. Attorney -1’s Opinion No. M-85 (1967), and authorities cxed therein, whereby the right of a hospital to pay private hos itals for medical care rendered to needy and indigent persons o -7T-hixty was upheld, where it was not practical to treat such persons in the hospital district’s own facilities.

Even if, arguendo , clinics fell within the purview of (b) of Section Sb of Article 4494n, it is manifest from import, and specific terms,of that Subsection that the only the way the District could have a relationship with the Clinic would be by contract.

Your letter clearly states that the Hospital District is presently funding the Clinic, on a month-to-month basis, through a non-profit corporation, and that the District neither assumes any operation or supervision of the Clinic, nor does it have any con- tract with the parent non-profit corporation.

We are unable to find any legal authority sanctioning the fact situation at issue in your request. You are advised Bexar County Hospital District may contract only with those entities set forth in Subsection (b) of Section 4494n. If the Villa Coronado Clinic meets the definition (as that term is used in Article 4437f, quoted supra), you are further ad- vised that the Hospital District may contract with the Clinic to render such medical services to the needy and indigent of the District as the Board of Managers deems necessary.

No funding of the operations of the Clinic, or of its parent non-profit corporation, may be granted from funds of the until a contract is executed between the Dis- whereby the District will assume trict and the parent corporation, appropriate responsibility for the operation and control of the Clinic.

We are mindful of the fact that the Bexar County Hospital has the constitutional and statutory duty to furnish medical *5 aid and hospital care to the indigent and needy persons residing in said District. Accordingly, you are further advised that the Hospital District may acquire the of the Villa Coronado Clinic if it deems such acquisition necessary to the proper perfor- mance of its constitutional and statutory duties in this regard.

In view of the foregoing, your question is answered in the negative.

SUMMARY (1) Pursuant to Subsection (b) of Section 5b of Article 4494n, Vernon’s Civil Statutes,

the Bexar County Hospital District has no au-

thority to fund the operations of a clinic, or

its parent non-profit corporation, unless: (a)

the clinic meets the definition a contract is executed between the

and (b) and the parent corporation

whereby the District will have an appropriate

degree of supervision and control over

operations of the funded facility.

(2) The Hospital District has the consti- tutional and statutory duty to furnish medical

and hospital care to the indigent and needy

persons in its District.

(3) Pursuant (a) of Section 4494n, Vernon’s Civil Statutes, the Hospital District may acquire the Villa

Coronado Clinic, and operate the Clinic as a

part of the Hospital District, if the Board of

Managers of the District deems such acquisition

necessary and proper to the effectuation its

duties.

truly yours, ey General of Texas Prepared by Austin C. Bray, Jr.

Assistant Attorney General *6 page i

APPROVED:

OPINION COMMITTEE

Kerns Taylor, Chairmaz

W. E. Allen, Co-Chaizz

John Banks

Charles Lind

John Reeves

Scott Garrison

SAMUEL D. MCDANIEL

Staff Legal Assistant

ALFRED WALKER

Executive Assistant

NOLA WHITE

First Assistant