April 12, 1951 

Hon. Geo. W. Cox, M.D. 

State Health Officer 

State Department of Health 

Austin, Texas opinion No. V-1168 

Re: Anthority o? the State 

Department of Iiealth 

550 defray the cost of 

diagnostic procedures 

to~determIne eliglbllity of children for 

crippled 'ch.lldren?a 

Dear Dr. Cox: care and trea@ent. 

Your request for an opiniofi relates to the authority of the Crippled Children's Division of tile State 

Department of Health to finance diagnostic procedures to 

determIne if a child comes within the proviqions and intent of House Bill 754, Acts 49th Leg., 1945, ch.216, p. 

298 (Art. 4419c, V.C.S.), without first having prodqred 

a certificate of the county judge to the effect that the 

child’s parents are financially unable to provide the 

care and treatment embraced in the act. 

The Federal Government has provided a grant to 

States for the purpose of enabling each State to extend 

and improve services for locating crippled children and 

for providing medical, surgical, correatlve, and other 

services and care, and facilities fork diagnosis, hospitalization, and aftercare for cNldren who are crippled 

or who are suffering from conditl ns,whlch 

pllng. (42 U.S.C.A. 811 711-714.9 

lead to crlpPursuant to the crippled children’s program 

above referred to, the Federal Security Agency has promulgated certain rules and regulationti, the pertinent 

regulation or the purpose of this discussion being Section 200.9, f which Is as follows: 

1. 42 Code Fed. Regs. Sec. 200.9 (~ig,&g C&.Pocket. Supp.) 
Hon. Geo. W. Cox, page 2 (V-1168) 

“State Plans for Crippled Children’s 

Services shall provide that the diagnostic 

services under the plan will be made available within the area served b 

noetic center to any child (a 3 

each dlagwithout charge, 

(b) without restriction or requirement as to 

the economic status of such child’s family or 

relatives or their legal residence, and (c) 

without any requirement for the referral of 

such child by 8ny Individual or 8gency.’ 

In the furtherance of this program, an act was 

passed by the Texas Legislature creating a physical restoratlon service for Crippled ohildren In the State Department of Health. Art. 4419c, supra. This act makes 

provisi.ons for locating, examining, and physically restoring arippled children of the State. section 3 of 

Article 4419c empowers the Crippled Children’s Mvlsion 

to “take census, make surveys and establish permanent 

records of crippled children . . . and to take such other 

steps as may be necessary In order to accomplish the’purposes of this Act.” As to care 8nd treatment of crippled 

children, Section 4 of the act places a llmltatlon thereon 

by requiring the county judge of the county in which the 

child resides to certify to the State Department of Health, 

upon sworn petition of the parents, that the parents are 

financially unable to provide such care and treatment. It 

Is further provided that the county judge must also certify that one or more physicians regularly practicing under 

the laws of the State of Texas have examined the child and 

have recommended such child as coming within the PPOQiSiOnS 

and intent of this act. Section 8 of the act empowers and 

directs the State Department of Health to take all ,actlon 

neaessary to accomplish the purposes provided or implied 

by the act and to cooperate with public agencies, Federal, 

State, county, and local, and with private agencies and individuals interested In the welfare of crippled children. 

In addition to authorization contained in Article 44190, su ra State participation in this program is 

authorized K+ y ection 2, Subdivision 10, of the General 

Appropriation Act (H.B. 322, Acts 51st Leg., R.S. 1949, 

ch.615, at p. 1345), which states that the proper officer 

op officers of any State departments, bureaus, divislons, 

or State agencies are authorized to make application for, 

accept any gifts, grants, allotments, or funds from the 

United States Government or educational or health projects 

and programs to be used on State cooperative and other 

projects and programs in Texas. The statute further provides that all of such funds shall be deposited in the 
Hon. Geo. W. Cox, page 3, (V-1168) E: :.,:. 

State, Treasury and ar,e< appropriated to,, the specific perease QP purposes, authorized by, the>‘grantor; and shall 

be withdrawn from theState Treasury sub~ject to llmitations placed on this Act except if contrtry to, the purposes for which the funds were received. 

As noted above, in order for a child to be accepted for treatment, the county judge must certify that 

the child’s parents are financially. Unable to provide the 

necessary care and treatment, and must further certify 

that one or more physicians have examined the child and 

have recosnnended him as coming within the provisions and 

intent of the act. Art. 4419c, Sec. 4. You state that 

in numerous cases a physician cannot make a definite 

diagnosis for determlnlng whether the child comes wlthin the provislons and intent of the tact,; nor can’he determlne the extent of crippling, without various types 

of laboratory tests and X-rays. Your lnqniry Is *whether 

the State Department of Health may pay for these,prellminary diagnostic examinations without securing the certlficate of the county judge. 

It is our opinion that a necessary diagnosfs 

by laboratory tests or otherwise may be paid for by, the 

State Department of Health without the necessity of obtaining a certificate of the ,parents’ financial inabllity from the county judge. The limitation contained In 

Section 4 of Article 44190 is a reqnirement that a certificate of financial lnabillty be obtained only 8s a prerequisite to accepting the child for care and treatment 

and does not relate to the preliminary diagnosis. This 

conclusion is borne out by the p~ovlslons of Sections 

and 8 of Article 44190, 8s well as by the specific re3 

quirements of the Federal regulation qUQted above. Woreover, the county judge could not certify that a parent 

was financially Unable to provide care and treatment in 

the absence of an adequate diagnosis as to the nature of 

the crippling condition. 

smRY 

The Crippled Children’s ‘Division of the 

Texas State Department of Health is authorized by House Bill 754, Acts 49th Leg., 1945, 

ch.216, p.298 (Art. 4419c, V.C.S.), to finance 

diagnostic procedures ordered by practicing 

physicians to determine if a child ccanes Under 
-- . 

Hon. Geo W. Cox, page 4 (V-1168) 

the provisions of the act without securing 

8 certificate of the county judge that the 

child's parents are financially unable to 

provide the needed care and treatment. This 

limitation contained In House Bill 754 Is 

only applicable to care and treatment of 

crippled children and Is not a limitation 

relating to diagnostic procedure. 

APPROVEDI Yours very truly, 

J. C. Davis, Jr. PRICE DMIEL 

County Affairs Mvislon Attorney General 

Jesse P. Lotion, Jr. 

Reviewing Assistant 

Charles D, Mathews 

First Assistant 

?iii** 

Assistant