Case Information
*1 OFPICE OF
THE ATTORNEY GENERAL
AUSTIN.TEXAS ,i~,PRICE DANIEL *noIINJm OENERAL February 14, 1947
r
Hon. William N. Hensley
Criminal District Attorney
Bexar County San Antonio, Texas
Opinion No. V-19 ,Re: City-County Tuberculo- sis Board, authority of to aid indigent tuber- cular patients who 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 excellent brief wherein you request the opinion of this Department on three specific questions concerning the .following submitted facts and statutory matters
which are, in substance as follows:
Pursuant to Article 4437a, Section 6A,
V.A.C.S., Acts 1945, 49th Legislature, Chap-
ter 295, Page 466, Bexar County, in August,
1945, established a City-County joint pro- gram of tuberculosis control having for its
object the protection of public health by
the alleviation, suppression and prevention
of the spread of tuberculosis. A special
tax authorised'under Section 6A (b) of not
to exceed 5# per $100.00 valuation was
voted. Under provisions of-Section 6A (c)
and (d) of said 'Act, a City-County Tubercu-
losis 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 provisions of Article 4437a,
Section 6A, V.A.C.S., and any other applica-
ble law, may the City-County Tuberculosis
-Control Board extend economic aid to an in-
digent person who is an alien and to members
Hon. William N. Hensley - Page 2~
of his family?
2. Occasionally, it appears desirable to said Board in carrying out the purposes of Sec- tion 6A, Article'4437a, to cause to be placed in a County Hospital (such as the County Tuber- culosis Hospital at Southpon, Texas) an indi- gent tubercular who is an alien who qualifies for aid under Section 6A. May the County Hos- 'pita1 receive such an.indigent alien patient as
a free service patient upon request of the City- County Tuberculosis 'Control Board, upon its statement that he is a client of and entitled to aid from said Board?
3. Is the. City-County Tuberculosis Con- trol Board authorized to pay, out of its funds, the County Hospital, for the care of an indi- gent tuberculosis patient who has been certi- fied to it by the Board?
We will quote herein only those,portions of Art&e 4437a which we believe are pertinent to this o- pinion. Section 68 (a) provides as follows:
"The governing bodies of the~county and of the city or cities within said county adopt- ing the provisions hereof as herein provided, dare hereby authorized to conduct a joint pro- gram of tuberculosis control within said city or cities and county, having for its object the protection of public health by the alleviation, suppression and prevention of the spread of tu- berculosis. Such program may include coopera- tion with all public 'or private agencies, Fed- eral; State or local, having the same objective, and shall include providing economic aid'in the discretion of the Board hepeinafter created, under medical certification as hereinafter pro- vided, to indigents suffering from tuberculo- sis and to dependent members of their immediate .family as a part of the total treatment of and as an aid in the prevention of the spread of the disease, for the protection of 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 authorized to 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 there- by shall be kept separate from other ,funds and shall be used solely for the purposes set forth in this Section (Section 6A);. . . . The gov- erning body of the city or cities acting here- ,unde'r shall .likewise be authorized to levy a
direct'tax of 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 tu-
berculosis 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 val- uation of $lOO.OO'may be authorized and levied by the Commissioners' Court"of,such county for the purpose.-of erecting buildings or other im- provements and for operating and maintaining
such hospital;. . . .n
Subsection (,e) of Section 6~ provides as fol- lows:
"The Board shall have power to carry out the terms of this Section in order to allevi- ate, suppress and prevent the spread of tuber- culosis within the county, as a public health function, subject to the provisions hereof.
The funds derived from the special taxes here- in 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 depen- dentmembers of their immediate family, upon
certification in each case to the Board by
the city or county health officer to the ef-
fect that the persons receiving such aid'are
Hon. William N. Hensley - Page 4
,,
indigent, and that they are bona fide resi- dents of the county and have been 'for more than six months; and, such funds shall also be expended.to provide for administration ex- penses hereunder, including case inve’stiga- tions 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 requirement that an ,indigent person suffering from tuberculosis or the dependent members of his immediate family must be citi- zens of the United States before he or they may be en- titled, at the discretion of the City-County Tuberculosis Control Board, to the necessary economic aid provided un- . der Article 4437a; Section 6A. The Act requires only that tubercular persons to qualify for necessary economic aid thereunder must 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 betobserved that this law, Section 6A, is a public health.measure and was designed to prevent disease in the community and is not designed primarily to'-aid an individual as a matter of I charity.'
Therefore, in answer to your first question, you are advised that in our opinion the City-County Tu- bercular Control Board may extend economic:aid to an in- digent,tubercular who is an alien and to members of his immediate famiiy under Article 4437a, Section 6A, V. A. c. s., the other requirements of the statute having been met.
Article 443g, V.A.C.S., Acts 1876, Page 51,
provides that if there is a regular established public 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 limitation as to citizenship or 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 tuberculosis Is sojourning in any other county than his residence and makes application for financial relief to any county health officer or Commis- sioners' Court or to the Mayor or health officer of any *5 Hon. William N. Hensley - Page
ii city; before relief is granted, he shall make an affida- vit that he is indigent and unable to provide for him- self.. Here again,there is no requirement or limitation as.to citizenship or.residence ,of such indigent.
Section 5 of Article 4437a, V.A.C.S., Acts 1927, 40th Legislature, Chapter 219; provides that in certain counties, among which is included Bexar 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 cumulative of other laws and shall not operate to repeal any other part of Title 71, V.A.C.S. All-of said statute, thoreforo, should be construed liberally, we believe, where possible to enable the county.in co- onere.tion with the cities or other public agencies des- ignated in Section 6h, to.carry out a constructive and necessary pro~gram for the public health of the people ,residing inthe c0unt.y.
By the express ,provisions of Article 4438, the Commissioners' Court in those counties where there is one or more established.county hospitals, shall pro- vide .for .the sending of, the indigent sick of the c.ounty to such 'a hospital. Article 4l+l+O.provides likewise for resident indigent persons suffering from tuberculosis who are so'journing in other counties. But by provi- sions of. Article 4437a, Section 6A, tuberculosis con- trol in those counties adopting the City-County Cooper- ative.Plan has been delegated to a special Board pro- vided therein, and all tubercular cases would now very likely and properly be channeled by 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 governing board of county hospitals, by virtue of the over-all interest, purposes' and cooperative nature of the plan to control tuber- culosis in Bexar County under the provisions of Sec.
6A, Art. 4437a, to accept as a patient for treatment of tuberculosis any resident indigent recommend.ed by the City-County Tuberculosis Control Board, the Board
Hon. William N. Hensley - Page
Paying for his hospital service out of its economic aid funds.
It.is observed that Article 4437a, authoriz- ing the levy of a tax to support county hospitals, pro- vides that such tax levy shall b,e used for the purpose of erecting buildings or other improvements and for op- erating and maintaining such a hospital or hospitals jointly owned and operated b any city and county. On the other hand, Subsections r d) and (e), Section 6A, Article 4437a,.authoriaing the levy of an additional tax for tuberculosis control, provides that such tax shall be used and expended to provide necessary econom- ic aid to indigent persons suffering from tuberculosis and dependent members of their.family who qualify there- under. We construe Subsection (e) as authorising the * City-County Tuberculosis Control Board to use Its funds to supply necessary economic aid to its cli~ents, and if the tubercular need service in a county hospital, the Board is authorized thereunder to expend its funds in payment of the necessary hospital service rendered by the county hospital. The Act, in our opinion, does not authorize the expenditure by the Board of;its funds for the construction or maintenance of additioiial county hospit$s for the care of county indigent tuberculosis patients. Clearly, the statutes construed together, as they.should be, contemplates full cooperation between the authorities of the City-County joint hospitals and the City-County Tuberculosis Control Board, to the end that the public health of'the county be protected from the spread of tuberculosis.
Accordingly, our answer to your second ques- tion is in the negative; and our answer to your third question is in the affirmative.
SUMMARY
The City-County Tuberculosis Control Board of~Bexar County created under provisions of Ar- ticle 4437a, Section 6A,, V.A.C.S., may extend ec- onomic aid to an indigent tubercular who is an al- ien and to members of his immediate family quali- fying under the statute. Said Board may not re- quire the Bexar City-County Hospital Board or Managers to give free hospital service to an in- digent tubercular who is an alien, but under the provisions of Subsection (e) .Section 6A of said *7 Hon. '@lliam N. Hensley - Page 7
Act, may ,pay such expenses to the said county hospital out of.the fund to be administered by the City-County Tuberculosis Control Board.
Very truly yours ATTORNEY-GENERAL OF TEXAS By?A=--=-d
Chester E. Ollison Assistant
APPROVED FEB 14, Z%& .
CEO:dm:bb
APPROVED OPINION COMMITTEE
BY F.D.
CHAIRMAN