Saw an interesting opinion Greg Abbott, Attorney General of Texas, in 2007 regarding whether a county may own or operate a medical clinic in an adjacent county without the adjacent county's consent. This was from Yoakum County in Plains, TX. From reading this, it seems that Yoakum County wanted to put a clinic in Gaines County, that even though Gaines County had a hospital district, apparently the area that Yoakum wanted to open one up was in an area that neither Gaines County hospital district nor any other governmental health care entity covered.