Once a public hospital district has been created through the process described earlier in Chapter One, a series of actions must be taken in order to comply with the legal requirements for operating a hospital district in Washington. The most important of these is to adopt rules which will govern the conduct of business by the Board of Commissioners, which is usually done in the form of corporate by-laws. This section provides the basic actions which must be taken as well as a model PHD By-Laws for reference purposes.

There are a number of legal steps that must be taken once a public hospital district has been created. Many of these steps are detailed in RCW 70.44.050, the portion of the statute that describes some of the duties of district commissioners. Upon formation, a public hospital district (more specifically, the board of commissioners) is required to adopt by resolution rules governing the transaction of its business. [RCW 70.44.050] While there is no legal requirement that this be done through the adoption of by-laws, it is usually done in this manner. Corporate bylaws typically address the procedure for electing and establishing the terms of office of the president and secretary of the board of commissioners, the schedule for regular meetings of the board, and the procedure for calling special meetings, the authority and duties of the district officers including the superintendent, the treasurer and the auditor, and approval of the corporate seal.

RCW 70.44.050 requires that, upon formation, a public hospital district must organize by election of its own members a president and secretary of the board of commissioners. The procedure for electing and establishing the terms of office of the president and secretary of the board is best addressed in the corporate bylaws which the district must also adopt.

A public hospital district may have three (3), five (5), or seven (7) commissioners. It is possible to begin operation as a district with any of these three alternatives. The district can change the number of commissioners after its formation, or decide to have commissioner districts. The district can also chose to abolish any commissioner districts. See Chapter 1, Section 1.

RCW 70.44.050 requires that, upon formation, a public hospital district must adopt an official seal. The approval of an official seal is best addressed in the corporate bylaws which the district must also adopt.

Compensation shall be set for commissioners at a rate of $70 for each day or portion of each day devoted to the business of the district. In no event may the total compensation paid in any calendar year exceed $6,720.

The commissioners must survey the district and determine the health care needs of the residents.

Based upon the survey, the commissioners must adopt a plan to meet those health care needs.

Depending upon the time of creation of the district, the commissioners may need to adopt a budget for the following calendar year, as must normally be done on November 15 of each year.

The commissioners must appoint a superintendent and set his or her salary by resolution. The resolution must be introduced at one regular meeting and then cannot be adopted until the next regular meeting.

The commissioners must designate one of the employees as the district auditor.