OFPICE OF 

THE ATTORNEY GENERAL 

AUSTIN.TEXAS 

18 ,i~,PRICE DANIEL 

*noIINJm OENERAL February 14, 1947 

r 

Hon. William N. Hensley 

Criminal District Attorney 

Bexar County 

San Antonio, Texas Opinion No. V-19 

,Re: City-County Tuberculosis Board, authority of 

to aid indigent tubercular patients who are 

aliens, Article 4437a, 

Section 6A, V.A.C.S., 

and related questions. 

Dear Sir: -~ 

We refer to your letter of January 27, 1947, 

and excellent brief wherein you request the opinion of 

this Department on three specific questions concerning 

the .following submitted facts and statutory matters 

which are, in substance as follows: 

Pursuant to Article 4437a, Section 6A, 

V.A.C.S., Acts 1945, 49th Legislature, Chapter 295, Page 466, Bexar County, in August, 

1945, established a City-County joint program of tuberculosis control having for its 

object the protection of public health by 

the alleviation, suppression and prevention 

of the spread of tuberculosis. A special 

tax authorised'under Section 6A (b) of not 

to exceed 5# per $100.00 valuation was 

voted. Under provisions of-Section 6A (c) 

and (d) of said 'Act, a City-County Tuberculosis Control Board has been appointed to 

exercise the duties and powers set out in 

Subsection (e) of Section 6A, Article 4437a. 

Said Board submits the following questions: 

1. Under provisions of Article 4437a, 

Section 6A, V.A.C.S., and any other applicable law, may the City-County Tuberculosis 

-Control Board extend economic aid to an indigent person who is an alien and to members 
Hon. William N. Hensley - Page 2~ 

of his family? 

2. Occasionally, it appears desirable to 

said Board in carrying out the purposes of Section 6A, Article'4437a, to cause to be placed 

in a County Hospital (such as the County Tuberculosis Hospital at Southpon, Texas) an indigent tubercular who is an alien who qualifies 

for aid under Section 6A. May the County Hos- 

'pita1 receive such an.indigent alien patient as 

a free service patient upon request of the CityCounty Tuberculosis 'Control Board, upon its 

statement that he is a client of and entitled 

to aid from said Board? 

3. Is the. City-County Tuberculosis Control Board authorized to pay, out of its funds, 

the County Hospital, for the care of an indigent tuberculosis patient who has been certified to it by the Board? 

We will quote herein only those,portions of 

Art&e 4437a which we believe are pertinent to this opinion. Section 68 (a) provides as follows: 

"The governing bodies of the~county and 

of the city or cities within said county adopting the provisions hereof as herein provided, 

dare hereby authorized to conduct a joint program of tuberculosis control within said city 

or cities and county, having for its object the 

protection of public health by the alleviation, 

suppression and prevention of the spread of tuberculosis. Such program may include cooperation with all public 'or private agencies, Federal; State or local, having the same objective, 

and shall include providing economic aid'in the 

discretion of the Board hepeinafter created, 

under medical certification as hereinafter provided, to indigents suffering from tuberculosis and to dependent members of their immediate 

.family as a part of the total treatment of and 

as an aid in the prevention of the spread of 

the disease, for the protection of the public 

health." 

Subsection (b) of. Section 6A provides, in part, 

as follows: 
Hon. William N. Hensley - Page 3 

"The Countv Commissioners' Court is herebv 

authorized to levy a direct annual tax .of not 1 

to exceed lO# on the $100.00 valuation, which 

shall be in addition to the tax authori,zed by 

Section 3 herein, and the funds produced thereby shall be kept separate from other ,funds and 

shall be used solely for the purposes set forth 

in this Section (Section 6A);. . . . The governing body of the city or cities acting here- 

,unde'r shall .likewise be authorized to levy a 

direct'tax of not to exceed 5# on the $100.00 

valuation to provide funds to be used for the 

same purpose,, and 1~ such joint program of tuberculosis control,. . . .Such fund shall be 

kept separate from other city funds and shall 

be used only for the purpose herein stated. 

Section 3 of Article 4437a as amended by Acts 

1945, 49th Legislature, Chapter 295, which amendment 

also added Section 6A quoted herein, provides in part as 

follows: 

. . 

"A direct tax of not over 204 on the valuation of $lOO.OO'may be authorized and levied 

by the Commissioners' Court"of,such county for 

the purpose.-of erecting buildings or other improvements and for operating and maintaining 

such hospital;. . . .n 

lows: 

Subsection (,e) of Section 6~ provides as fol- 

"The Board shall have power to carry out 

the terms of this Section in order to alleviate, suppress and prevent the spread of tuberculosis within the county, as a public health 

function, subject to the provisions hereof. 

The funds derived from the special taxes herein authorized shall be combined together by 

'joint action of the county and city or cities 

and be expended by or under the direction of 

such Board subject to the limitations herein; 

provided that such funds shall be expended to 

provide necessary economic aid to indigent 

persons suffering from tuberculosis and dependentmembers of their immediate family, upon 

certification in each case to the Board by 

the city or county health officer to the effect that the persons receiving such aid'are 
Hon. William N. Hensley - Page 4 

,, 

indigent, and that they are bona fide residents of the county and have been 'for more 

than six months; and, such funds shall also be 

expended.to provide for administration expenses hereunder, including case inve’stigations and necessary,equipment and.services, 

but for no other purposes." 

In none of these above quoted.statutes or in 

any other applicable law do we find any requirement that 

an ,indigent person suffering from tuberculosis or the 

dependent members of his immediate family must be citizens of the United States before he or they may be entitled, at the discretion of the City-County Tuberculosis 

Control Board, to the necessary economic aid provided under Article 4437a; Section 6A. The Act requires only . 

that tubercular persons to qualify for necessary economic 

aid thereunder must be medically certified in each case 

to the Board by the city or county health officer to the 

effect that they are: first, suffering from.tuberculosis;, 

second, indigent; and third, bona fide residents of the 

county,.and have been for more than six months. As 

stated so ably in your brief', it should betobserved that 

this law, Section 6A, is a public health.measure and was 

designed to prevent disease in the community and is not 

designed primarily to'-aid an individual as a matter of 

charity.' I 

Therefore, in answer to your first question, 

you are advised that in our opinion the City-County Tubercular Control Board may extend economic:aid to an indigent,tubercular who is an alien and to members of his 

immediate famiiy under Article 4437a, Section 6A, V. A. 

c. s., the other requirements of the statute having been 

met. 

Article 443g, V.A.C.S., Acts 1876, Page 51, 

provides that if there is a regular established public 

hospital in the county, the Commissioners' Court shall 

provide for sending the indigent siak of the county to 

said hospital. There is no requirement, or limitation as 

to citizenship or residence of such an indigent. 

Article 4440, V.A.C.S., Acts.1909, First Called 

Session, Page 337, provides that whenever any indigent 

person suffering from tuberculosis Is sojourning in any 

other county than his residence and makes application for 

financial relief to any county health officer or Commissioners' Court or to the Mayor or health officer of any 
Hon. William N. Hensley - Page 5 

city; before relief is granted, he shall make an affidavit that he is indigent and unable to provide for himself.. Here again,there is no requirement or limitation 

as.to citizenship or.residence ,of such indigent. 

1927, 

Section 5 of Article 4437a, V.A.C.S., Acts 

40th Legislature, Chapter 219; provides that in 

certain counties, among which is included Bexar County, 

the said Count;c Hospital or hospitals shall give free 

service to.al~l sick and injured indigent citizens of 

the entire county. 

It should be noted also that Subsection (g) 

of Section 6A provides that Section 6A of Article J+&37a 

shall be cumulative of other laws and shall not operate 

to repeal any other part of Title 71, V.A.C.S. All-of 

said statute, thoreforo, 

we believe, 

should be construed liberally, 

where possible to enable the county.in coonere.tion with the cities or other public agencies designated in Section 6h, to.carry out a constructive and 

necessary pro~gram for the public health of the people 

,residing inthe c0unt.y. 

By the express ,provisions of Article 4438, 

the Commissioners' Court in those counties where there 

is one or more established.county hospitals, shall provide .for .the sending of, the indigent sick of the c.ounty 

to such 'a hospital. Article 4l+l+O.provides likewise for 

resident indigent persons suffering from tuberculosis 

who are so'journing in other counties. But by provisions of. Article 4437a, Section 6A, tuberculosis control in those counties adopting the City-County Cooperative.Plan has been delegated to a special Board provided therein, and all tubercular cases would now very 

likely and properly be channeled by the county through 

this Board for its assistance .or recommendation. 

True, Section 5 of Article J+l+37a, limits the!! 

authority of the Board of Managers of Bexar County HOST 

pital, to the giving of free service to the.sick and ! 

injured indigent citizens of the county, but we think 

that authority lies in the governing board of county 

hospitals, by virtue of the over-all interest, purposes' 

and cooperative nature of the plan to control tuberculosis in Bexar County under the provisions of Sec. 

6A, Art. 4437a, to accept as a patient for treatment 

of tuberculosis any resident indigent recommend.ed by 

the City-County Tuberculosis Control Board, the Board 

ii 
The City-County Tuberculosis Control Board 

of~Bexar County created under provisions of Article 4437a, Section 6A,, V.A.C.S., may extend economic aid to an indigent tubercular who is an alien and to members of his immediate family qualifying under the statute. Said Board may not require the Bexar City-County Hospital Board or 

Managers to give free hospital service to an indigent tubercular who is an alien, but under the 

provisions of Subsection (e) .Section 6A of said 

Hon. William N. Hensley - Page 6 

Paying for his hospital service out of its economic aid 

funds. 

It.is observed that Article 4437a, authorizing the levy of a tax to support county hospitals, provides that such tax levy shall b,e used for the purpose 

of erecting buildings or other improvements and for operating and maintaining such a hospital or hospitals 

jointly owned and operated b 

the other hand, Subsections r 

any city and county. On 

d) and (e), Section 6A, 

Article 4437a,.authoriaing the levy of an additional 

tax for tuberculosis control, provides that such tax 

shall be used and expended to provide necessary economic aid to indigent persons suffering from tuberculosis 

and dependent members of their.family who qualify thereunder. We construe Subsection (e) as authorising the * 

City-County Tuberculosis Control Board to use Its funds 

to supply necessary economic aid to its cli~ents, and if 

the tubercular need service in a county hospital, the 

Board is authorized thereunder to expend its funds in 

payment of the necessary hospital service rendered by 

the county hospital. The Act, in our opinion, does not 

authorize the expenditure by the Board of;its funds for 

the construction or maintenance of additioiial county 

hospit$s for the care of county indigent tuberculosis 

patients. Clearly, the statutes construed together, as 

they.should be, contemplates full cooperation between 

the authorities of the City-County joint hospitals and 

the City-County Tuberculosis Control Board, to the end 

that the public health of'the county be protected from 

the spread of tuberculosis. 

Accordingly, our answer to your second question is in the negative; and our answer to your third 

question is in the affirmative. 

SUMMARY 
Hon. '@lliam N. Hensley - Page 7 

Act, may ,pay such expenses to the said county 

hospital out of.the fund to be administered 

by the City-County Tuberculosis Control Board. 

Very truly yours 

ATTORNEY-GENERAL OF TEXAS 

By?A=--=-d 

Chester E. Ollison 

Assistant 

APPROVED FEB 14, 1947 

Z%& 

CEO:dm:bb . 

APPROVED 

OPINION COMMITTEE 

BY F.D. 

CHAIRMAN