### OFPICE OF



# THE ATTORNEY 

# GENERAL

AUSTIN.TEXAS 

## 18 ,i~,PRICE DANIEL *noIINJm OENERAL February 14, 1947

r
Hon. William N. Hensley CriminalDistrict Attorney Bexar County San Antonio, Texas Opinion No. V-19

,Re: City-CountyTuberculosis Board, authority of to aid indigent tubercular patientswho 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 excellentbrief wherein you request the opinion of this Department on three specificquestions concerning the .following

submitted facts and statutorymatters which are, in substanceas follows:

Pursuant to Article 4437a, Section 6A, V.A.C.S., Acts 1945, 49th Legislature,Chapter 295, Page 466, Bexar County, in August, 1945, establisheda City-County joint program of tuberculosiscontrol having for its object the protection of public health by the alleviation,suppressionand prevention of the spread of tuberculosis. A special tax authorised'under Section 6A (b) of not to exceed 5# per $100.00 valuationwas voted. Under provisions of-Section6A (c) and (d) of said 'Act, a City-CountyTuberculosis 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 provisionsof Article 4437a, Section 6A, V.A.C.S., and any other applicable law, may the City-CountyTuberculosis -ControlBoard extend economic aid to an indigent person who is an alien and to membersHon. William N. Hensley - Page 2~

of his family?

2. Occasionally,it appears desirable to said Board in carryingout the purposes of Section 6A, Article'4437a, to cause to be placed in a County Hospital (such as the County TuberculosisHospital at Southpon,Texas) an indigent tubercularwho is an alien who qualifies for aid under Section 6A. May the County Hos- 'pita1 receive such an.indigentalien patient as a free service patient upon request of the CityCounty Tuberculosis'Control Board, upon its statementthat he is a client of and entitled to aid from said Board?

3. Is the.

City-CountyTuberculosisControl Board authorizedto pay, out of its funds, the County Hospital, for the care of an indigent tuberculosispatientwho has been certified to it by the Board?

We will quote herein only those,portions of Art&e 4437a which we believe are pertinentto this opinion. Section 68 (a) providesas follows:

"The governing bodies of the~countyand of the city or cities within said county adopting the provisionshereof as herein provided, dare hereby authorizedto conduct a joint program of tuberculosiscontrolwithin said city
or cities and county,having for its object the protectionof public health by the alleviation, suppressionand preventionof the spread of tuberculosis. Such programmay include cooperation with all public 'or private agencies, Federal; State or local, having the same objective, and shall include providingeconomic aid'in the discretion of the Board hepeinaftercreated, under medical certification as hereinafterprovided, to indigents sufferingfrom tuberculosis and to dependentmembers of their immediate .family as a part of the total treatment of and

as an aid in the preventionof the spread of the disease, for the protectionof 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 authorizedto 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 authorizedto levy a direct'taxof 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'maybe authorizedand levied by the Commissioners' Court"of,such

county for the purpose.-of

erectingbuildings or other improvementsand for operatingand 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 provisionshereof. 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 certificationin each case to the Board by the city or county health officer to the effect that the persons receiving such aid'areHon. 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.toprovide for administrationexpenses hereunder, includingcase 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 requirementthat
an ,indigent

person suffering from tuberculosisor the dependentmembers of his immediatefamily must be citizens of the United States before he or they may be entitled, at the discretion of the City-CountyTuberculosis Control Board, to the necessary economicaid providedunder Article 4437a; Section 6A. The Act requires only . that tubercularpersons to qualify for necessary economic aid thereundermust 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 betobservedthat this law, Section 6A, is a public health.measure and was designed to prevent disease in the communityand is not designed primarilyto'-aid an individualas a matter of charity.' I

Therefore, in answer to your first question, you are advised that in our opinion the City-CountyTubercular Control Board may extend economic:aidto 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 requirementsof the statutehaving been met.

Article 443g, V.A.C.S., Acts 1876, Page 51, provides that if there is a regular establishedpublic 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 limitationas to citizenshipor 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 tuberculosisIs sojourning in any other county than his residenceand makes applicationfor financialrelief to any county health officer or Commissioners' Court or to the Mayor or health officer of anyHon. 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,thereis no requirementor limitation as.to citizenshipor.residence ,ofsuch indigent.

1927, Section 5 of Article 4437a, V.A.C.S.,Acts 40th Legislature,Chapter 219; provides that in certain counties,among which is includedBexar 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 cumulativeof 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 necessarypro~gram for the public health of the people ,residing

inthe c0unt.y.

By the express ,provisions of Article 4438, the Commissioners' Court in those countieswhere there is one or more established.county hospitals, shall provide .for.thesending of, the indigent sick of the c.ounty to such 'ahospital. Article 4l+l+O.provides likewise for resident indigentpersons sufferingfrom tuberculosis who are so'journing in other counties. But by provisions of.

Article 4437a, Section 6A, tuberculosiscontrol in those countiesadopting the City-CountyCooperative.Planhas been delegated to a special Board provided therein, and all tubercular cases would now very likely and properly be channeledby 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 governingboard of county hospitals,by virtue of the over-all interest,purposes' and cooperativenature of the plan to control tuberculosis in Bexar County under the provisionsof Sec. 6A, Art. 4437a, to accept as a patient for treatment of tuberculosisany resident indigentrecommend.ed by the City-CountyTuberculosisControl Board, the Board iiThe City-CountyTuberculosisControl Board of~Bexar County created under provisionsof Article 4437a, Section 6A,, V.A.C.S.,may extend economic aid to an indigent tubercularwho 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 tubercularwho is an alien, but under the provisionsof Subsection (e) .Section 6A of said Hon. William N. Hensley - Page 

### 6

Paying for his hospital service out of its economicaid funds.

It.is observedthat 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 erectingbuildings or other improvements and for operating and maintaining such a hospital or hospitals jointly owned and operatedb the other hand, Subsectionsr any city and county. On d) and (e), Section 6A, Article 4437a,.authoriaing the levy of an additional tax for tuberculosiscontrol,providesthat such tax shall be used and expended to provide necessary economic aid to indigentpersons sufferingfrom tuberculosis and dependentmembers of their.family who qualify thereunder. We construe Subsection (e) as authorisingthe * City-CountyTuberculosisControl Board to use Its funds to supply necessary economic aid to its cli~ents, and if the tubercularneed service in a county hospital, the Board is authorizedthereunderto expend its funds in payment of the necessaryhospital service renderedby the county hospital. The Act, in our opinion,does not authorizethe expenditureby the Board of;its funds for the constructionor maintenanceof additioiial county hospit$s for the care of county indigenttuberculosis patients. Clearly, the statutesconstruedtogether, as they.shouldbe, contemplatesfull cooperationbetween the authoritiesof the City-County joint hospitalsand the City-CountyTuberculosisControl 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.

SUMMARYHon. '@lliam N. Hensley - Page 7

Act, may ,paysuch expenses to the said county hospital out of.the fund to be administered by the City-CountyTuberculosisControl Board.

Very truly yours

ATTORNEY-GENERAL

OF TEXAS 

# By?A=--=-d

Chester E. Ollison Assistant

APPROVED FEB 14, 

### 1947

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CEO:dm:bb .

APPROVED OPINION COMMITTEE

BY F.D. CHAIRMAN