The unique legal nature of public hospital districts is reflected by the manner in which the districts are created. Private organizations are formed essentially by filing some documents with the appropriate state official and paying a filing fee. For hospital districts, on the other hand, an extensive process is laid out in the state statute, chapter 70.44 RCW, with the laws covering a wide variety of different procedural possibilities. Furthermore, after the district is formed there are a number of legal steps that must be taken by the board of commissioners to initiate operations of the district.

A public hospital district can be categorized in one of three ways based upon the positioning of its boundaries: (1) as a county-wide district, where the boundaries are identical to that of a county within which the district operates, (2) as an intra-county district, where the boundaries are smaller than that of the county and where more than one public hospital district can reside within that county, or (3) as an inter-county district, where boundaries extend beyond the boundaries of one county into another county or counties. Public hospital districts are one of the exceptions among Washington’s local special purpose governments to the extent that they do not follow county boundaries. This distinction among the three types of districts is not trivial as it relates to the creation of a district -- RCW 70.44 lays out different procedural steps for setting up each of the district types and provides for safeguards to allow public expression of disagreement with the boundaries.

The procedures for setting up a county-wide district are found in RCW 70.44.020. A county-wide district is one whose boundaries are identical to the boundaries of the county wherein the district will operate. Such a district may be portrayed graphically as the following:

The graphic shows a hypothetical Wheat County and a hospital district which covers exactly the same territory.

A proposal for setting up a public hospital district may come from the citizens of a community or communities or it may come from the legislative authority of the county (like the board of county commissioners). In either case, the proposal must ultimately go before the community for a vote to determine whether the community as a whole supports the creation of a public hospital district . From a procedural standpoint, creating a county-wide public hospital district involves fewer steps then creating an intra- or inter-county district.

If the board of county commissioners, or other legislative authority of the county, determines that the creation of a public hospital district is desirable, it may, by resolution, submit to the voters of the county a proposition for creating a public hospital district coextensive with the boundaries of the county. The standard for “desirability” is not spelled out in the public hospital district statute. Presumably, the determination of desirability cannot be made in an arbitrary or capricious manner. This, at least, is the standard by which any court of law in the state of Washington would use in reviewing the decision-making actions by a legislative authority of the county.

If the citizens initiate the idea for setting up a district, they must memorialize their commitment to this proposal by drafting a petition for the formation of a district and having the petition signed by at least ten (10) percent of the eligible electors of the county based upon the total vote cast in the last general county election. A valid (or “sufficient”) petition guarantees that the county legislative authority will, by resolution, submit to the voters a proposition for setting up a district. RCW 70.44.020 obligates county authorities to submit the proposition to the voters if a sufficient petition has been filed with the county auditor. The petition may call for the proposal to be submitted to the electorate at either a general or special election.

The sufficiency of a citizen-initiated petition is determined by the county auditor. The citizens file the petition with this official. Within fifteen (15) days of the filing, the county auditor must examine the signatures thereon and certify to the sufficiency of these signatures. To carry out this certification process, the county auditor shall have access to all registration books in the possession of the election officers of the county.

As is the case with all petition processes, no person signing a petition may later withdraw his or her name therefrom after the petition has been filed.

If the petition is found to be insufficient, it must be returned to the persons who filed it. These persons then have ten (10) days to amend or add names to the petition and return it to the auditor. The auditor then has up to fifteen (15) days to examine the amended petition and either certify it as sufficient or reject it as insufficient.

When the county auditor has certified that a petition is sufficient, the auditor must then transmit the petition, together with his/her certificate of sufficiency, to the county legislative authority.

As stated earlier, if the county legislative authority has received from the county auditor a certified (sufficient) petition of the citizens calling for the creation of a hospital district, the authority must pass a resolution which submits the proposal to the entire electorate of the county. It must do this immediately upon receiving the valid petition from the auditor.

After the county authority has passed the resolution calling for an election, it must immediately transmit a proposition to the supervisor of elections in the county or to any other election officer of the county. The proposition must be expressed on the ballot substantially in the following terms:

"For public hospital district No. _____ Against public hospital district No. _____ ."

The elections official must then submit the proposition to the voters at the next general election. If, however, the petition has requested that the proposition be submitted to the voters in a special election, the elections official must follow this directive and call a special election no earlier than thirty (30) days after the date of the auditor’s certificate of sufficiency and no later than ninety (90) days after this date.

The notice of the election must in all respects conform to the requirements of law governing the time and manner of holding elections in the State of Washington. (See Chapter Two, “Washington Election Laws, Generally.”) Furthermore, the notice must state the boundaries of the proposed district and the object of the election.

The will of the community is then reflected in the results of the general or special election. A simple majority (greater than 50 percent) is needed to create a county-wide public hospital district. If the “no” votes prevail, there can be no public hospital district.

From the perspective of procedural requirements, the formation of a county-wide hospital district is the simplest scenario when compared to creating an intra-county or inter-county district. Creating either one of these districts requires an additional step: the holding of a public hearing to allow those persons affected by boundary decisions to air their opinions about, and challenge, the proposal. (See “Forming An Intra-County Public Hospital District” and “Forming An Inter-County Public Hospital District” below.)

Keep in mind that the boundaries of a public hospital district may be altered at a later time and there are a number of ways in which the boundaries may be altered.

An intra-county public hospital district is one whose boundaries are smaller than the boundaries of the county in which the district operates and is fully contained within the boundaries of one county. Thus, there may be more than one district operating within the boundaries of a county. A graphic representation of an intra-county district is the following:

In this graphic, the public hospital district is smaller than, and completely contained within, the hypothetical Wheat County.

The procedural requirements for setting up an intra-county public hospital district are spelled out in RCW 70.44.030. The requirements are more involved than the requirements for forming a county-wide district, primarily because a hearing process is required to create an intra-county district. The laws governing the process of elections is contained in other sections of the RCW and the state constitution. See Chapter Two, “Washington Elections Laws, Generally.”

The public hospital district statute states that any petition for the formation of a public hospital district may describe an area which is less than the entire county in which the petition is filed (i.e., an intra-county district.) Yet, the area described must conform to one critical requirement: its boundaries must, as proposed, follow the then existing precinct boundaries and not divide any voting district. Later, it is possible for the hospital district to not follow precinct boundaries through deletion of property (For example, see Farm Boundaries in Section F of this Chapter). Thus, an intra-county district may be viewed as a bundle of voting districts within the boundaries of a county. Presumably, it is the county legislative authority who, in its review of the citizens district proposal, must guarantee that this requirement is met.

Unlike the formation of a county-wide public hospital district, the creation of an intra-county district may only be initiated by the public through the petition process. Thus, the initiation of a proposal for formation may not come from the county board of commissioners. From a practical standpoint, it would be highly unlikely that the county board of commissioners would initiate the idea for a non-county-wide district since their interest would naturally extend to meeting the needs of the entire county.

Further Legal Background

This issue may cause some confusion since the wording of RCW 70.44.030 does not explicitly prohibit county commissioners from proposing the creation of an intra-county district by resolution. Neither does it expressly authorize the county board to take such action. This apparent gap highlights an important message of this manual: if actions regarding municipal corporations, such as public hospital districts, are not expressly authorized by statute, or necessarily implied, they should not be undertaken. Thus, the omission of any procedure by which a board of county commissioners could create an intra-county public hospital district must be interpreted as not conferring this authority to the county board.

Proposals for the formation of an intra-county district must come from the citizens as initiated by the petition process.

As is the case with county-wide public hospital districts, if the citizens initiate the idea for setting up a district, they must memorialize their commitment to the proposal by a petition signed by at least ten (10) percent of the eligible electors of the county based upon the total vote cast in the last general county election. A valid petition guarantees that the county board will, by resolution, submit to the voters a proposition for setting up a district. The petition may call for the proposal to be submitted to the electorate at either a general or special election. Below is a sample petition, showing the general content and format that would be expected.

To the Board of County Commissioners,

____________________ County, Washington

The petition of the undersigned shows:

1. The undersigned petitioners are all duly qualified electors of the County of _________________, State of Washington, and constitute not less than ____________ [ten] percent of the voters of the proposed district who voted in the last general election.

[Signatures]

The sufficiency of a citizen-initiated petition must be determined by the county auditor of the county for which the district is proposed. The citizens file the petition with this county official. Within fifteen (15) days of the filing, the county auditor must examine the signatures thereon and certify to the sufficiency of these signatures. To carry out this certification process, the county auditor shall have access to all registration books in the possession of the election officers of the county.

As is the case with all petition processes, no person signing a petition may later withdraw his or her name therefrom after the petition has been filed.

If the petition is found to be insufficient by the county auditor, it must be returned to the persons who filed it. These persons then have ten (10) days to amend or add names to the petition and return it to the auditor. The auditor then has up to fifteen (15) days to examine the amended petition and either certify it as sufficient or reject it as insufficient.

When the county auditor has certified that a petition is sufficient, the auditor must then transmit the petition, together with his/her certificate of sufficiency, to the board of county commissioners.

After the board of county commissioners has received a certified petition from the county auditor, they must hold a public hearing before they can place the proposal on a ballot.

A valid petition obligates the county commissioners to fix a date for this hearing and publish the petition, without the signatures, together with a notice announcing the date and time of the hearing The publication of the petition and notice must precede the hearing by at least two (2) weeks. Publication must be in a newspaper that is routinely published in the area of the proposed public hospital district, or, if there is no such newspaper, then in a newspaper published in the county in which the district is to be established. The paper must be of general circulation.

The purpose of holding a hearing is to allow those persons whose property would be included in the district to air their opinions about the proposal and challenge the proposal if they wish. Any interested persons may attend the hearing and address the county commissioner.

70.44.030 RCW permits adjournments of the hearing by the county commissioners, but the total elapsed time of the adjournments may not exceed four (4) weeks.

If, upon the final hearing, the board of county commissioners makes a finding that the borders of the proposed district are unreasonable or unjust or not conducive to the welfare and convenience of the citizens, they may change and fix the boundary lines of the proposed district in order to make them reasonable, just and conducive to the welfare and convenience of the citizens.

RCW 70.44.030 gives the county commissioners this authority to change and fix the district boundaries. It is clear that the county commissioners must make specific findings relating to the unreasonableness, injustice, or non-convenience of the proposed boundaries. What is not clear are the precise standards by which the commissioners are to make such determinations. Presumably, such determinations cannot be made in an arbitrary or capricious manner. This, at least, is the standard by which any court of law in the state of Washington would use in reviewing the decision-making actions by a board of county commissioners.

Upon making such a finding, the board of county commissioners must then enter an order establishing and defining the final boundary lines of the proposed public hospital district. One critical proviso to this procedure is that no lands lying outside of the boundaries of the district as originally described in the petition may be included in the final version of the district proposal as fixed by the county commissioners unless the owners of those lands have requested inclusion in the district by writing. Thus, clearly the county commissioners are prohibited from adding territory to the district that was not originally proposed in the citizens’ petition unless owners of this territory have formally requested such inclusion.

Upon the completion of the hearing process, at which the boundaries of the proposed intra-county district are fixed (finalized) by order of the county commissioners, the commissioners must pass a resolution which submits the proposal to the entire electorate residing within, and only within, the boundaries of the proposed district. After the county commissioners have passed the resolution calling for an election, they must immediately transmit a proposition to the supervisor of elections in the county or to any other election officer of the county. The proposition must be expressed on the ballot substantially in the following terms:

"For public hospital district No. _____ Against public hospital district No. _____ ."

The elections official must then submit the proposition to the voters at the next general election. If, however, the petition has requested that the proposition be submitted to the voters in a special election, the elections official must follow this directive and call a special election no earlier than thirty (30) days after the date of the auditor’s certificate of sufficiency and no later than ninety (90) days after this date. Special elections may be held only on the dates specified in RCW 29.13.010 and 29.13.020 and requests must be filed with the county auditor no less than forty-five (45) days before the election.

The notice of the election must in all respects conform to the requirements of law governing the time and manner of holding elections in the State of Washington. [See Chapter Two, “Washington Election Laws, Generally.”] Furthermore, the notice must state the boundaries of the proposed district and the object of the election.

The will of the community is then reflected in the results of the general or special election. A simple majority (greater than 50 percent) of those voting is needed to create an intra-county public hospital district. If the “no” votes prevail, there can be no district.

Keep in mind that the boundaries of a public hospital district may be altered by a later time and there are a number of ways in which the boundaries may be altered.

An inter-county public hospital district is one whose boundaries extend beyond the boundaries of one county into one or more other counties. An inter-county district may also be comprised of contiguous lands in various counties, none of which completely contain a county. Finally, inter-county districts may contain more than one whole county. Thus, graphic representations of inter-county districts may be numerous. Three examples are:

In Scenario A, the public hospital district encompasses part of the hypothetical Wheat County and a portion of the lands contained in the hypothetical Apple County.

In Scenario B, the public hospital district encompasses contiguous lands contained in four counties.

In Scenario C, the public hospital district encompasses part of three counties: Wheat, Apple, and Forest Counties.

The procedural requirements for setting up an inter-county public hospital district are spelled out in RCW 70.44.035. (The laws governing the process of elections is contained in other sections of the RCW and the state constitution. See Chapter Three, “Elections Laws, Generally.”)

Further Legal Background

As would be expected, the creation of an inter-county public hospital district is not a simple matter as it involves multiple county jurisdictions and a degree of coordination among these jurisdictions. Unfortunately, RCW 70.44.035 does not offer clear guidance on all of the procedural steps. As a result, parties assisting in the formation of an inter-county public hospital district should proceed cautiously. To demonstrate how the procedural steps of district creation can be complicated when an inter-county district is proposed, imagine that citizens from four (4) contiguous counties propose to set up a public hospital district whose boundaries extend into each of the four counties. This necessarily implies that there must be four (4) petitions (one for each county represented in the district proposal), four (4) sets of public hearings before each county board, and one election in each of the four (4) counties. These procedural steps are all held in a parallel time frame, of course, to maintain the integrity and continuity of the formation process. It should be clear from this example that coordination among the parties from the different counties is essential to successfully form an inter-county public hospital district. Unfortunately, RCW 70.44.035 does not build into the process any guidance for how this coordination can be achieved efficiently and within the confines of the law.

The public hospital district statute states that any petition for the formation of a public hospital district may describe an area which is less than the entire county in which the petition is filed (i.e., an intra-county district.) Yet, the area described must conform to one critical requirement: its boundaries must, as proposed, follow the then existing precinct boundaries and not divide any voting district. Later, it is possible for the hospital district to not follow precinct boundaries through deletion of property (For example, see Farm Boundaries in Section F of this Chapter). Thus, an intra-county district may be viewed as a bundle of voting districts within the boundaries of a county. Presumably, it is the county legislative authority who, in its review of the citizens district proposal, must guarantee that this requirement is met.

Unlike the formation of a county-wide public hospital district, the creation of an inter-county district may only be initiated by the public through the petition process. Thus, the initiation of a proposal for formation may not come from the county board of commissioners of any of the counties wherein a portion of the proposed district is to lie.

Further Legal Background

This issue may cause some confusion since the wording of RCW 70.44.035 does not explicitly prohibit a board of county commissioners from proposing the creation of an inter-county district by resolution. Neither does it expressly authorize the county commissioners to take such action. This apparent gap highlights an important message of this manual: if actions regarding municipal corporations, such as public hospital districts, are not expressly authorized by statute, or necessarily implied, they are void. Thus, the omission of any procedure by which respective boards of county commissioners could create an inter-county public hospital district must be interpreted as not conferring this authority to the respective county boards.

Proposals for inter-county public hospital districts must come from the citizens through the petition process. Citizens residing in different (but contiguous) counties may come together with a proposal for the creation of a district.

As is the case with county-wide and intra-county public hospital districts, if the citizens initiate the idea for setting up a district, they must memorialize their commitment to the proposal by a petition. For example, if a group of citizens from four different counties propose to form a district whose boundaries extend over a portion of each of the four counties, there will be four petitions: one for each of the portions of the counties represented in the proposal. The petition must be filed with each of the county auditors of the respective counties in which a portion of the proposed district is located. The petition must contain valid signatures from no less than ten (10) percent of the voters of each area of each county of the proposed district who voted in the last general election. A valid (certified) petition guarantees that the respective boards of county commissioners will, by resolution, submit to the voters a proposition for setting up a district. The petition may call for the proposal to be submitted to the electorate at either a general or special election.

The sufficiency of a citizen-initiated petition must be determined by a county auditor. Although RCW 70.44.035 is vague on this point, it appears that each county auditor is responsible for reviewing the petition flowing from the citizens of that auditor’s jurisdiction. Thus, if the citizen proposal for a public hospital district comprises territory from four (4) counties, there must be four (4) petitions and review by each of four (4) county auditors. The citizens file the petitions with the respective auditors. Within fifteen (15) days of the filing, each county auditor must examine the signatures thereon and certify to the sufficiency of these signatures. To carry out this certification process, the county auditor shall have access to all registration books in the possession of the election officers of the county.

As is the case with all petition processes, no person signing a petition may later withdraw his or her name therefrom after the petition has been filed.

If the petition is found to be insufficient, it must be returned to the persons who filed it. These persons then have ten (10) days to amend or add names to the petition and return it to the auditor. The auditor then has up to fifteen (15) days to examine the amended petition and either certify it as sufficient or reject it as insufficient.

When each county auditor has certified that a petition is sufficient, each auditor must then transmit the petition, together with his/her certificate of sufficiency, to the county commissioners of each of the counties affected by the district proposal.

Further Legal Background

The above description of the multiple certification process demonstrates the practical complexity of forming an inter-county public hospital district. RCW 70.44.035 seems to ignore this complexity and offers no guidance as to how this process is to be played out. Consequently, an interpreter of the statute must assume that parallel processes must occur in each of the counties wherein a portion of the district is to lie. Perhaps there is an opportunity for a greater degree of coordination to be achieved. For example, perhaps one auditor from one of the respective counties can be selected as the reviewer of the petition. Such a step would be desirable. Whether or not it is allowed by the statute is not clear. For this reason, it is suggested that parallel review by all affected auditors is the prudent course to take.

Upon receiving a county auditor-certified petition for the formation of an inter-county public hospital district , the board of county commissioners of each of the counties in which a portion of the proposed district is located must hold a public hearing before they can place the proposal on a ballot.

A valid petition obligates the respective county commissioners to fix a date for this hearing and publish the petition, without the signatures, together with a notice announcing the date and time of the hearing. The publication of the petition and notice must precede the hearing by at least two (2) weeks. The publication required by statute must be In a newspaper published in the portion of each county lying within the proposed district, or, if there is no such newspaper published in any such portion of a county, then in a newspaper published in the county wherein such portion of the proposed district is located. The papers must be of general circulation.

The purpose of holding a hearing is to allow those persons whose property would be included in the district to air their opinions about the proposal and challenge the proposal if they wish. Any interested persons may attend the hearing and address the county commissioners, however.

70.44.035 RCW permits adjournments of the hearing by the county commissioners, but the total of the adjournments may not exceed four (4) weeks.

If, upon the final hearing, the respective boards of county commissioners find that any land has been unjustly or improperly included within the proposed district, they may change and fix the boundary lines of the portion of the district located within their respective counties in such a manner as they deem reasonable and just and conducive to the welfare and convenience of the citizens residing in this portion.

RCW 70.44.035 gives the county commissioners this authority to change and fix the district boundaries. It is clear that the county commissioners must make specific findings relating to the unreasonableness, injustice, or non-convenience of the proposed boundaries. What is not clear are the precise standards by which the commissioners are to make such determinations. Presumably, such determinations cannot be made in an arbitrary or capricious manner. This, at least, is the standard by which any court of law in the state of Washington would use in reviewing the decision-making actions by a board of county commissioners.

Each county board must then enter an order establishing and defining the final boundary lines of the proposed public hospital district. One critical proviso to this procedure is that no lands lying outside of the boundaries of the district as originally described in the petition may be included in the final version of the district proposal as fixed by the county commissioners unless the owners of those lands have requested inclusion in the district by writing. Thus, clearly the county commissioners are prohibited from adding territory to the district that was not originally proposed in the citizens’ petition unless owners of this territory have formally requested such inclusion.

Further Legal Background

This process of changing and fixing boundaries of the proposed public hospital district highlights yet another complexity related to the formation of an inter-county public hospital district. How do the county commissioners of the respective counties coordinate this change to the boundaries? How are the respective boards to agree on what is reasonable, just, convenient? The statute is simply silent on these points.

Upon the completion of the hearing process, at which the boundaries of the proposed inter-county district are fixed by order of the respective county commissioners, the respective boards must pass a resolution which submits the proposal to the entire electorate residing within the boundaries of the proposed district. After the county commissioners have passed the resolution calling for an election, they must immediately transmit a proposition to the supervisor of elections or to any other election officer of the respective counties. The proposition must be expressed on the ballot substantially in the following terms:

"For public hospital district No. _____ Against public hospital district No. _____ ."

The elections official must then submit the proposition to the voters at the next general election. The election is confined solely to the portions of each county lying within the proposed district. The electorate, however, is to vote on the proposal as a whole.

If, however, the petition has requested that the proposition be submitted to the voters in a special election, the elections official must follow this directive and call a special election no earlier than thirty (30) days after the date of the auditor’s certificate of sufficiency and no later than ninety (90) days after this date.

The notice of the election must in all respects conform to the requirements of law governing the time and manner of holding elections in the State of Washington. [See Chapter Two, “Washington Election Laws, Generally.”] Furthermore, the notice must state the boundaries of the proposed district and the object of the election.

The will of the community is then reflected in the results of the general or special election. A simple majority (greater than 50 percent), within each of the portions of the county voting, is needed to create an inter-county public hospital district. If the “no” votes prevail, there can be no district.

Keep in mind that the boundaries of a public hospital district may be altered by a later time and there are a number of ways in which the boundaries may be altered.

Practical Considerations

As stated earlier, only in the case of forming a county-wide public hospital district may the board of county commissioners initiate the idea by resolution, bypassing the citizen petition process (citizens may also initiate the formation of a county-wide district). By contrast, setting up an intra- or inter-county district requires citizen initiative. Another distinguishing feature of forming non-county-wide public hospital districts is that public hearings are a required procedural step. It should be clear that citizen input is critical to the formation of non-county-wide districts.

Why is this citizen involvement safeguarded in the public hospital statute? Clearly, the legislature intended to give citizens the power to determine the desirability of creating a public hospital district. Perhaps more importantly, the legislature wanted to ensure that the citizens have an opportunity to air their thoughts about a proposal which will impact their pocketbooks through property taxes. Inclusion in the boundaries of a public hospital district normally carries some financial obligations on the part of taxpayers.