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 of Anthony, 

which is not a member of the 

El Paso City-County Health Unit, 

entitled to public health service from the El Paso City-County 

Health Unit, and related 

questions. 

In making your request for an opinion from this office, you 

have supplied the following information: 

"The City and County of El Paso have presented 

this Agency with several questions as to the scope 

of authority of their City-County Board of Health 

formed by authority of Article 4436a-1, V.C.S. 

"The City and County of El Paso have an existing 

City-County,Health Unit organized under authority 

of the above mentioned statute. In the County of 

El Paso there is the City of Anthony which is a 

general law City 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 of Anthony is not 

a member 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 to provide all public health 

services entitled it under State law. 

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Dr. J. E. Peavy, page 2 (M-683) 

"Subsequently, the Commissioner's Court of El 

Paso County met and passed a Resolution requiring the 

El Paso City-County Health Board and the El Paso 

City-County Health Director to furnish these health 

services to the town of Anthony, Texas. The City of 

Anthony has its own appointed health officer. 

"We would appreciate your opinion regarding the 

following questions: 

1. 

2. 

3. 

4. 

Is the City of Anthony, which is not a member 

of the El Paso City-County Health Unit, entitled 

to public 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 of Anthony? 

With concurrence of El Paso County and the City 

of El Paso, does Article 4436a-1, V.C.S., enable 

the City of Anthony to become a participating 

member of the El Paso City-County Health Unit? 

Section 4 of Article 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 a member 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 of Anthony, what would be the authority, 

if any, of the Director of the City-County Health 

Unit in the City of Anthony?" 

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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 their health functions 

into one operating unit. Such unit remains, however, subject to 

the supervision and bu~dgetary control of the governmental entities 

which have contracted to bring it into existence. The City-County 

Health Unit is thus a convenient vehicle through which the 

individual governmental units may discharge their responsibilities 

in the furtherance of public health. In serving its citizens 

and taxpayers, a county government has certain duties in the area 

of public health which are imposed by law, and these duties may 

be discharged directly or indirectly. The same is true of an 

incorporated city. With these general statements in mind, your 

specific questions will be answered. 

In reply to your first question, you are advised that it 

is the opinion of this office that El Paso County has the duty 

to provide certain health services to all the residents of the 

county, and may not abrogate that duty by delegating public 

health functions to a subordinate entity which services less 

than the population of the entire county. Article 4436a-1 does not 

limit a City-County Health Unit to service simply within a city, 

but contemplates that it will provide authorized health services 

throughout the geographical area of the governmental units which 

comprise the health unit. 

In response to your second question, we note that Article 

4436a-1 provides that the City-County Health Unit shall be 

under the direction and supervision of the City-County Board 

of Health, which is appointed by the joint action of'the Commissioner's Court and the City Council. All matters of public 

health involving the expenditure of public funds must 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 may be removed at will by the appointing authorities. 

Such an organizational structure clearly requires a high degree 

of cooperation between the various governmental entities involved, and 

-3264- 
. . 

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

we are unwilling to make a categorical statement as to the extent 

of the supervisory authority of any one participant under this 

statute. However, the particular 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 it by law, and it would serve no purpose for this office 

to attempt a definition of the rights of control under Article 

4436a-1. 

In replying to your third question, we first note that a 

City-County Health Unit is a creature of agreement between 

cooperating units of government. Although Article 4436a-1 speaks 

exclusively in terms of a county cooperating with one city within 

the county, we quote the following from Article 10, Vernon's 

Civil Statutes: 

"The following rules shall govern in the construction of all civil statutory enactments: . . . . 

4. The singular and plural number shall each include 

the other, unless otherwise expressly provided...." 

You are accordingly advised that the City of Anthony may 

join the County and City of El Paso in the operation of the 

City-County Health Unit upon the agreement of the governmental 

units concerned. 

With regard to your 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 of Anthony, 

would have the duty and authority to perform only those services 

which the county government is required by State law to furnish 

within such city. Of course, in the event the City of Anthony 

becomes a participant in the City-County Health Unit, the health 

unit would assume the functions of the City Health Officer and 

that office in the city would be abolished. 

SUMMARY 

City-County Health Units created pursuant 

to the provisions of Article 4436a-1, Vernon's 

Civil Statutes, are subject to the supervision 

-3265- 
. . 

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

and budgetary control of the governmental 

entities which have contracted to bring them 

into existence. 

Services of such health units are not 

limited to the corporate limits of participating cities, but apply throughout the geographical 

area of the county, including areas of a city in 

the county which is not participating in the contract. Such services, however, are limited to services 

which otherwise are performed by the county and would 

not include those services required to be furnished 

by a city unless such city becomes a participant 

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 

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