September 8, 1970

Dr. J. E. Peavy Commissioner of Health State Department of Health Austin, Texas 78756

Dear Dr. Peavy: Opinion No. M-683
Re:Whether the City ofAnthony, which isnot amember of the El Paso City-County Health Unit, entitled topublic health service from the El Paso City-County Health Unit, and related questions.

Inmaking your request for an opinion from this office, you have supplied the following information:

"TheCity and County of El Pasohave presented this Agency with several questions as to the scope of authority of their City-County Board of Health formed by authority ofArticle 4436a-1, V.C.S. "TheCity and County of El Pasohave an existing City-County,Health Unit organized under authority of the abovementioned statute. In the County of El Paso there is the City ofAnthony which isa general lawCity properly incorporated under the laws of this State. This Agency support$ the City-County Health Unit in the form of assigned personnel, loan of equipment, etc. While the City ofAnthony isnot amember of'the health unit and does not contribute to its financial support other than as county tax payers, the City has requested of the El Paso County Commissioner's Court toprovide allpublic health services entitled itunder State law.

-3262-Dr. J. E. Peavy, page 2 (M-683)
"Subsequently, the Commissioner's Court of El Paso County met andpassed aResolution requiring the El Paso City-County Health Board and the El Paso City-County Health Director to furnish these health services to the town ofAnthony, Texas. The City of Anthony has itsown appointed health officer.
"Wewould appreciate your opinion regarding the following questions: 1.

2.

3.

4. Is the City ofAnthony, which isnot amember of the El Paso City-County Health Unit, entitled topublic health service from the El Paso CityCounty Health Unit?
Does the El Paso County Commissioner's Court without concurrence of the City Council of El Paso or the Board of Health, duly appointed under Article 4436a-1, V.C.S., have authority to direct the Director of the City-County Health Unit to furnish public health services to the City ofAnthony? With concurrence of El Paso County and the City of El Paso, doesArticle 4436a-1, V.C.S., enable the City ofAnthony tobecome aparticipating member of the El Paso City-County Health Unit? Section 4 ofArticle 4436a-1, V.C.S., forbids the appointment of a City Health Officer or County Health Officer in any health unit. The town of Anthony, not amember of the El Paso City-County Health Unit, has appointed its own City Health Officer. If the City-County Health Unit is required to furnish public health services to the town ofAnthony, what would be the authority, ifany, of the Director of the City-County Health Unit inthe City ofAnthony?"

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Dr. J. E. Peavy, page 3 (M-683)

Article 4436a-1, Vernon's Civil Statutes, which authorizes the creation of City-County Health Units, authorizes a county and participating incorporated cities to combine theirhealth functions into one operating unit. Such unit remains, however, subject to the supervision andbu~dgetarycontrol of thegovernmental entities which have contracted tobring it into existence. The City-County Health Unit is thus a convenient vehicle through which the individual governmental units may discharge their responsibilities inthe furtherance ofpublic health. In serving its citizens and taxpayers, a county government has certain duties inthe area ofpublic health which are imposedby law, and these duties may be discharged directly or indirectly. The same is true of an incorporated city. With these general statements inmind, your specific questions will be answered.
In reply toyour first question, you are advised that it is the opinion of this office that El Paso County has the duty toprovide certain health services toall the residents of the county, andmay not abrogate that duty by delegating public health functions to a subordinate entity which services less than thepopulation of the entire county. Article 4436a-1 does not limit a City-County Health Unit to service simply within a city, but contemplates that itwill provide authorized health services throughout thegeographical area of the governmental units which comprise thehealth unit.
In response toyour second question, we note thatArticle 4436a-1 provides that the City-County Health Unit shallbe under the direction and supervision of the City-County Board of Health, which isappointed by the joint action of'the Commissioner's Court and the City Council. All matters ofpublic health involving the expenditure ofpublic fundsmust be submitted to the Board of Health for study and recommendation before final action is taken by the City Council and Commissioner's Court. However, the director of the City-County Health Unit is appointed jointly by the City Council and Commissioner's Court, subject to the approval of the City-County Board of Health, and such director maybe removed atwill by the appointing authorities. Such an organizational structure clearly requires ahigh degree of cooperation between the various governmental entities involved, and

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Dr. J. E. Peavy, page 4 (M-683)

we are unwilling tomake a categorical statement as to the extent of the supervisory authority of any one participant under this statute. However, theparticular instruction issued in this particular case by the Commissioner's Court constitutes only a request that the Health Unit carry out the duties which are required of itby law, and itwould serve nopurpose for this office to attempt adefinition of the rights of control under Article 4436a-1.
Inreplying toyour third question, we first note that a City-County Health Unit isa creature of agreement between cooperating units ofgovernment. Although Article 4436a-1 speaks exclusively interms of a county cooperating with one citywithin the county, we quote the following fromArticle 10,Vernon's Civil Statutes:

"The following rules shall govern in the construction of all civil statutory enactments: .... 4. The singular andplural number shall each include the other, unless otherwise expressly provided...."
You are accordingly advised that the City ofAnthony may join the County and City ofEl Paso inthe operation of the City-County Health Unit upon the agreement of thegovernmental units concerned. With regard toyour fourth question, it is the opinion of this office that the Director of the City-County Health Unit, in furnishing health services to residents of the City ofAnthony, would have the duty and authority toperform only those services which the county government is required by State law to furnish within such city. Of course, in the event the City ofAnthony becomes aparticipant in the City-County Health Unit, thehealth unitwould assume the functions of the City Health Officer and that office in the citywould be abolished.
SUMMARY City-County Health Units created pursuant to theprovisions ofArticle 4436a-1, Vernon's Civil Statutes, are subject to the supervision

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Dr. J. E. Peavy, page 5 (M-683)

andbudgetary control of thegovernmental entities which have contracted tobring them into existence. Services of suchhealth units are not limited to the corporate limits ofparticipating cities, but apply throughout the geographical area of the county, including areas of a city in the county which isnotparticipating in the contract. Such services, however, are limited to services which otherwise areperformed by the county andwould not include those services required to be furnished by a city unless such citybecomes aparticipant in the City-County Health Unit.

General of Texas Prepared by Malcolm L. Quick Assistant Attorney General
APPROVED: OPINION COMMITTEE
Kerns Taylor, Chairman W. E.Allen, Co-Chairman Melvin Corley Robert Davis Allen Hill Dyer Moore, Jr.
MEADE F. GRIFFIN Staff Legal Assistant
ALFRED WALKER Executive Assistant
NOLA WHITE First Assistant -3266-