The Honorable Anna Beth Merten Opinion No. H-777 

County Auditor 

Wailer County lie: Operation of a 

Hempetead, Texas 71445 medical clinic in 

Waller County. 

Dear Us. Mertenr 

You have requested our opinion regarding the operation 

of a medical clinic in Waller County. You state that Waller 

.County has received a federal grant from the United States 

Department of Health, Education (r Welfare for the purpose oft 

operating such a facility. Specifically, you askr 

1. Whether Wailer County may build 

and maintain a medical clinic without 

submitting the decision to a vote of 

the people. 

2. Whether funds budgeted under 

‘Major Repairs to %uflQings’ may 

be expended for construction of 

such a clinic. 

3. Whether Waller County may lease 

office space in such a clinic to 

physicians engaged in the private 

practice of medicine, and, if so, 

for what purposes any rental paymntm 

resulting therefrom may be expended. 

4. Whether funds received under the 

federal grant are subject to audit 

by the County Auditor. 

Article 4470, V.T.C.S., provides: 

p. 3279 
The Honorable Anna Beth Merten - page 2 (H-777) 

The commissioners court of any 

county shall have power to establish a 

county hospital and any medical or other 

health facilities and to enlarge any 

existing hospitals or facilities for the 

care and treatment of persons suffering 

from any illness, disease or injury, 

subject to the provisions of this 

chapter. At intervals of not less than 

twelve months, ten per cent of the 

qualified property tax paying voters of 

a county may petition such court to 

provide for the establishing or enlarging 

of a county hospital, or any medical or 

other health facilities, in which event 

said court within the time.designated in 

such petition shall submit to such 

voters at a special or regular election 

the proposition of issuing bondsin such 

aggregate amount as may be designated-in 

said petition for the establishing or 

enlarging of such hospital or facilities. 

Whenever any such proposition shall 

receive a majority of the votes of the 

qualified property tax payers voting at 

such election, said commissioners court 

shall establish and maintain such hospital 

or facilities and shall have the following 

powers: 

1. To purchase and lease real 

property therefor,, ,or acquire such real 

property, and easements therein, by 

condemnation proceedings. 

2. To purchase or erect all necessary 

buildings, make all necessary improvements 

and repairs and alter any'existing~ 

buildings, for the use of said hospital 

or facilities. The plans for such 

erection, alteration, or repair shall 

first be approved by the State Health 

Officer, if his approval is requested by 

the said commissioners court. 

p. 3280 
The Honorable Anna Beth Merten - page 3 (H-777) 

3. To cause to be assessed, levied 

and collected, such taxes upon the real 

and personal property owned in the 

county as it shall deem necessary to 

provide the funds for the maintenance 

thereof, and for all other necessary 

expenditures therefor. 

4. To issue county bonds to provide 

funds for the establishing, enlarging 

and ,equipping of said hospital or facilities 

and for all other necessary permanent 

improvements in connection .therewithr to 

do all other things that may be required 

by law in order to render said bonds 

valid. 

5. To appoint,a board of managers 

for said hospital or facilities., or 

both. 

6. To accept and hold in trust for 

the county, any grant or devise of land, 

or any gift or bequest of money or other 

personal property or any donation to be 

applied, principal or income or both, 

for the benefit of said hospital or 

facilities, and apply the same in accordance 

with the terms of the gift. 

7. The Commissioners Court may 

lease all or part of any'medical facility 

so constructed, purchased or acquired 

under this Act. 

Although it might be argued that the statute's grant of 

authority to the commissioners court "subject to the provisions of this chapter" requires an affirmative vote in a 

bond election as a prerequisite to the establishment of any 

hospital or other medical facility, it is our view that the 

statute confers broad authority upon a county to "establish" 

such facilities. As long ago as 1942, this Office reached 

this conclusion. Attorney General Opinion O-4569 (1942) 

declared that the language of article 4479 "is plain and 

unambiguous, and confers unqualified general power upon the 

Commissioners Court to establish and to enlarge hospitals 

for county purposes.n 

p. 3281 
The Honorable Anna Beth Merten - page 4 (H-777) 

A recent judicial decision supports such a readina of 

article 4470. -In Sullivan v. And&s Count 

+I 

517 S.W.-2d 

410 (Tex. Civ. App. -- El Pzomwr t ref'd n.r.e.), the 

court held that 

[alrticle 4478 gives the Commissioners 

Court power to establish a county 

hospital and other medical or health 

facilities, includin the ri ht to 

call a bond dtEs&sror 

The clear implication is that a county’s authority to establish these facilities is independent of the bond election 

provisions of article 4475. 

Finally, article 4419f would seem to provide additional 

authority for a county's right to build and maintain a 

medical clinic without submitting the decision to a vote of 

the electorate: 

The Commissioners Court of any County 

shall have the authority to appropriate 

and expend money from the general revenues 

of its County for and inbehalf of public 

health and sanitation within its County. 

Thus, we answer your first question in the affirmative. 

You also ask whether funds budgeted for “Major Repairs 

to Buildings" in the 1975 budget may be expended for construction of a medical clinic. As we have noted, article 

4410f authorizes the expenditure of general revenue funds 

"for and in behalf of public health and sanitation." If the 

county has not consolidated its four constitutional funds 

pursuant to article S, section 9 of the Texas Constitution, 

however, we believe that expenditures for construction are 

to be made from the county's permanent,improvement fund. 

Attorney General Opinion V-567 (1948)t Attorney General 

Opinion O-6441 (1945). In order to expend for these 

purposes in the 1975 budget, the commissioners court must 

certify an emergency and amend its budget, pursuant to 

p. 3282 
The Honorable Anna Beth Merten - page 5 (H-777) 

article 689a-11, V.T.C.S. The existence of an emergency is 

;o:;Fstion of fact to be determined by the cemmissioners 

(1940;. 

Attorney General Opinions O-2499 (1949), O-2315 

It is therefore our opinion that the county may 

construct a medical clinic from funds budgeted in 1975 for 

"Major Repairs to %uilaings," provided the commissioners 

court certifies an emergency and amends its budget. Such 

expenditures are to be made from the county's permanent 

improvement fund, or, if the county has, consolidated its 

constitutional funds, from its general revenue fund. 

Your third question is whether Waller County may lease 

office space in its medical clinic to physicians engaged in 

the private practice of medicine. We answered this question 

in the negative in Attorney General Opinion H-16 (1973). 

Subsequent thereto, the Legislature amended article 4478 by 

adding the following: 

The Commissioner Court,may lease all or 

part of any medical facility so constructed, 

purchased or acquired under this Act. 

In Sullivan VA Andrew8 County, su ra, the court noted that 

article 4470 nom the comm fr 8s oners court authority to 

"lease all or partn of a medical facility. .517.s.w.za at 

412. Since we indicated in our anwer to your.Piret question 

that the county may establish a medical facility pursuant to 

article 4478, our opinion that it may lease "all or part" of 

the facility "so constructed, purchased or acquired under 

this Act." We note, however, that in order to avoid the 

objection that such leasing of a county-owned facility is: 

violative of article 3, section 52 of the Texas Constitution, 

it must be done for a valid public purpose and the county 

must receive 'substantial value in return" for its grant of 

the leasing privilege. See Sullivan & Andrew8 County, 

supra at 413. 

- 

Rsntal payments received for the lease of the medical 

facility are appropriated by article 1629, V.T.C.S., to the 

"third class" of county funds, which comprises: 

p. 3283 
The Honorable Anna Beth Merten - page 6 (H-777) 

All money received, not otherwise 

appropriated herein or by,the 

commissioners court. 

Moneys paid into this account are to be utilized to pay 

[a]11 the general indebtedness of 

the county, including feeding and 

guarding prisoners, and paupers 

claims. V.T.C.S. art. 1626. 

In our opinion, therefore, rental payments received for the 

lease of the medical facility should be paid into the county's 

general revenue fund, to be expended for the general inaebtedness of the county. 

your last question is whether funds received under the 

federal grant are subject to audit by the County Auditor. 

The County Auditor is charged by article 1651, V.T.C.S., 

with the 

general oversight of all the books 

and records of all the officers of 

the county, district or state, who 

may be authorized or required by 

law to receive or collect any money, 

funds, fees, or other property for 

the use of, or belonging to, the 

county . . . 

This statute is extremely broad, and we believe that it 

empowers the County Auditor to audit all county funds, 

including those received under a federal,grant. An exception 

would, of course, obtain if the terms of the grant specified 

that the funds received did not become county monies or were 

not otherwise subject to county audit. See Attorney General 

Opinion M-007 (1971). But, subject to tm exception, it is 

our opinion that funds received under a federal grant are 

subject to audit by the County Auditor. 

p. 3284 
The Honorable Anna Beth Merten - page 7 (H-777) 

SUMMARY 

Waller County may build and maintain a medical clinic without submitting 

the decision to a vote of the people. 

The county may utilize for such purpose 

funds budgeted under “Major Repairs to 

Building" in the 1975 budget, provided 

the commissioners court certifies an 

emergency and amends its budget. 

Very truly yours, 

Attorney General of Texas 

APPROVED: 

Opinion Committee 

jwb 

p. 3285