The activities of organizations, including hospitals and hospital districts, are generally directed by a group of individuals who serve to represent the membership of the controlling entity as a whole. For not-for-profit hospitals, these groups are generally described as boards of directors or trustees. For public hospital districts, these are referred to as boards of commissioners, keying into the fact that the individuals serving in these representative positions are elected officials who have been chosen by the voters to be the commissioners who will govern the hospital district. This section identifies some of the key issues relating to commissioners, including the number of commissioners, terms of office, qualifications, and methods of filling vacancies. Several topics affecting commissioners are also found in other sections within this chapter, such as, commissioner compensation liability and forms of action.

Because a hospital district is a local government, its governing body consists of publicly elected officials. These commissioners must run for office, and the qualifications for office, campaigns, and elections are regulated by Washington law. Private boards generally have much greater latitude in requirements for holding office and the process for confirming their selection and placement on a board.

The hospital district board is legally responsible for establishing hospital district policy with respect to the powers of a public hospital district spelled out in RCW 70.44.060 .

Generally speaking, the board and individual commissioners are responsible for overseeing the hospital district's general policies and organization with respect to the operation of the district, including the delivery of quality patient care. In fulfilling this responsibility, the board role is to adopt the necessary general policies to achieve these ends and to delegate the day-to-day operations to the district administrator.

Commissioners are required to take action by motion or resolution. In the case of certain types of action, the commissioners are required by statute to take action by resolution. Among the types of actions requiring a resolution are the following:

• Abolition of commissioner districts [RCW 70.44.042];

• Approval of commissioner's compensation [RCW 70.44.050];

• Approval of the rules governing transaction of the commissioner’s business (district bylaws) [RCW 70.44.050];

• Proposal to increase the number of commissioners and specifying the terms of office of the new commissioners [RCW 70.44.053];

• Exercise of eminent domain and condemnation [RCW 70.44.060 (2)];

• Issuance of bonds or other type of obligations [RCW 70.44.060 (5)];

• Approval of the District's annual budget [RCW 70.44.060 (6)];

• Appointment of the district superintendent and fixing his or her compensation [RCW 70.44.070];

• Approval of a plan for additions or betterments to the district's facilities, estimated costs thereof and the amount of indebtedness to be approved therefor [RCW 70.44.110];

• Appointment of the district's treasurer and the specification of the amount of his or her surety bond [RCW 70.44.171];

• Creation of special funds in addition to the district's general fund [RCW 70.44.171];

• Approval of banks into which the district's funds may be deposited [RCW 70.44.171];

• Consolidation of two or more districts [RCW 70.44.190];

• Annexation of additional territory [RCW 70.44.200 -230];

• Withdrawal or reannexation of district territory [RCW 70.44.235];

• Declaring real property surplus [RCW 70.44.300 -310];

• Declaring personal property surplus [RCW 70.44.320]; and

• Division of a district [RCW 70.44.350].

Hospital districts have the option of having three, five, or seven commissioners on the board of commissioners. [RCW 70.44.040]

If a hospital district wishes to increase its number of commissioners, the board may elect to submit such a proposal to the voters at either a general or special election. The board is required to submit such a proposal if it receives a petition signed by ten percent or more of the district's voters. [RCW 70.44.053]

The statutes spell out a number of requirements relating to the process for increasing the number of commissioners, including redistricting (if commissioners are elected from individual commissioner districts) and the need to stagger commissioner terms. Initially, however, the additional commissioner positions shall be deemed vacant, and the board must appoint qualified people to serve in the positions until the next general election. [RCW 70.44.056; 42.12.070]

Hospital district commissioners serve six year terms of office. The only exceptions are those commissioners elected upon the creation of the district, those taking office as a result in the increase in number of commissioners, and those appointed or elected to serve the remainder of vacant terms. Upon creation of a district, Washington statutes spell out a number of requirements limiting the original commissioners' terms to between one and six years. These are designed to ensure that the expiration of commissioner terms will be staggered as evenly as possible.

The basic qualification for a public hospital district commissioner is that he or she be a citizen of the United States and the state of Washington and be an "elector" within the district boundaries. The State Constitution defines an "elector" as persons at least 18 years of age who are citizens of the United States and who have lived in the precinct 30 days preceding the election.

Further Legal Background

The requirement of actual physical residence has been strictly applied by Washington courts in issues of qualifications for candidacy. [Freund v. Hastie, 13 Wn. App. 731 (1975)]

Article VI, Section 3 of the Constitution also disqualifies "all idiots, insane persons, and persons convicted of infamous crime unless restored to their civil rights". Convicted felons are normally considered to have committed infamous crimes.

If the public hospital district has commissioner districts, and a commissioner is filling a slot reserved for a particular geographic area within the district, he or she must also reside within this geographic area. Also, a candidate should not hold an incompatible office as described in section K of this chapter or otherwise be incapable of holding office for the reasons stated in the laws relating to removal of public hospital district commissioners. [RCWs 70.44.045 , 42.04.020 and The Washington State Constitution Article VI, 1]

In general, elections of public hospital district commissioners are governed by the general Washington election laws found in Title 29 of the Revised Code of Washington. [RCW 70.44.040]

Topics covered by Title 29 of the code include registration of voters, times for holding elections, ballots, voting machines, absentee voting, polling place regulations, voters' pamphlets, and crimes and penalties. Rather than provide an overview of all election law, this section merely identifies some of the major issues affecting candidates for public hospital district commissioner posts.

Candidates for public hospital district commissioner must file financial disclosure forms with the Public Disclosure Commission within two weeks of announcing candidacy. The period covered is the previous 12 months.

In general, public hospital districts, like other local governments, are prohibited from using public resources to assist in any election campaign. These public resources include publicly owned buildings, equipment, and mailing lists as well as employees of public entities. Based on this prohibition, a public hospital district should not act to support or oppose any candidate for commissioner in any way. See also “Special Issues”, Chapter Six, Topic II. [RCW 42.17.130]

It is permissible for the district to make its facilities available on a non-discriminatory basis for purposes of making an objective and fair presentation of facts relevant to a ballot proposition or candidates for public office, if this is part of the normal and regular conduct of the public hospital district. Thus, it may be possible for the hospital district to hold an open candidate session for those running for post of public hospital district commissioner.

Campaigns for office are the responsibility of the candidate for PHD commissioner. Candidates must be aware of their duties in this regard, including filing a statement of financial affairs with the Public Disclosure Commission for the previous twelve months within two weeks of becoming a candidate. [RCW 42.17.241]

Washington law requires that local election costs be prorated among the various districts with ballot propositions or candidates on the ballot at any election. Thus, in a general election a public hospital district must pay its share of costs. If a special election is held solely for a public hospital district issue, the hospital district must pay all of the election costs. [RCW 29A.04.410]

Occasionally, the unfortunate happens and a candidate for office dies. A Washington State Attorney General Opinion addresses how situations involving the death of a candidate should be handled. [See AGO 1999 No. 5.] The office of public hospital district commissioner is non-partisan. Under the analysis provided in AGO 1999 No. 5, if a candidate for judicial or other non-partisan office dies before the primary or general election, the candidate's name should remain on the ballot. If the deceased candidate gains the most votes, the result is a vacancy in the office, to be filled as provided by law for the office in question; the person with the second highest vote total is not entitled to a certificate of election. Please see the section below for information on Vacancies and Replacements of Commissioners.

Vacancies may occur as a result of resignation, death, removal, conviction of a felony, unexcused nonattendance at meetings, statutory disqualification (e.g., a commissioner moves out of a district or is determined to hold an incompatible office as described in below), or permanent disability preventing the proper discharge of the commissioner's duty. [RCWs 70.44.045 , 42.12.010 and 70.44.056]

Commissioners may be removed by a "recall" process which is spelled out in Article I, Section 33 of the State Constitution. Basically, a petition must be filed noting the inappropriate acts, be supported by a certain number of electors, and be voted on at a special election. RCW 29A.56.110-270 sets out the specific requirements of the “recall” process.

Vacancies are filled on a temporary basis by the naming of a replacement by the remaining commissioners [RCW 42.12.070, 70.44.056] This appointment is effective only until the next regular election for public hospital district commissioners at which time a commissioner must be elected to fill the balance of the vacant term. A contingency process addresses situations where there is only one or no commissioners left on the board to make appointments or the remaining commissioners fail to fill the vacancy within 90 days.

Prospective commissioners must take an oath of office before commencing their term. This oath should be administered and certified by an officer or notary public authorized to administer oaths and should state that he or she will faithfully and impartially discharge the duties of office to the best of his or her ability. A commissioner is not technically qualified to hold office until the oath is administered.

Hospital district commissioners, like all elected and appointed public officials in Washington, must file a statement of financial affairs with the Public Disclosure Commission each year. The filing must be completed between January 1 and April 15 for the preceding calendar year. The forms include information on personal and business financial relationships and property holding for the previous year, including specific information on occupation, investments, creditors, business directorships compensation, and real estate holdings. [RCW 42.17.240]

Any Commissioner who fails to file a report is subject to a $10 per day fine. Also, the Attorney General or private party can initiate enforcement proceeding. Finally, if the violation affected the outcome of an election, the election may be held void. [RCWs 42.17.390 and 42.17.400]

Hospital district commissioners are authorized to receive compensation for service on the board at a rate of $104 for each full or partial day devoted to the business of the district up to an annual limit of $9,984. See section I of this chapter for a broader discussion of issues relating to this compensation and expense reimbursement. [RCW 70.40.050]

There is no specific requirement that hospital district commissioners pursue educational activities that support their service as commissioners. However, prudence suggest that each district support these educational activities and perhaps adopt a general board action recommending participation by each commissioner.

The board may meet in regular or special meetings. Most districts establish a monthly meeting schedule by resolution or bylaw. Special meetings may be called at any time by the President of the Board or by a majority of the board. If called, notice must be provided at least 24 hours before the meeting. (See also "Meetings and Records", Chapter Five)

The order of business at regular board meetings is normally as follows:

• Call to Order

• Approval of minutes of the last regular meeting and any intervening special meeting.

• Reports

• Consideration of items on the agenda or other matters properly before the board and action thereon

• Adjournment

The board may act as a committee of the whole or appoint other committees to assist in its deliberations. The activities of any of these committees must be conducted in accordance with applicable law and be recorded in written minutes.

Most public hospital district commissioner duties and liabilities are created by the same common law principles that create duties and responsibilities for private hospital trustees. These are generally referred to as "fiduciary" duties. For example, the duty of due diligence and care requires commissioners to use reasonable skill and diligence in the performance of their official duties.

Specific liabilities and penalties are also created by the conflict of interest laws discussed in Section K of this chapter.

Public officials are immune from civil liability for damages for any discretionary decision or failure to make a discretionary decision within his or her official capacity. At the same time, the liability does apply to the public agency. [RCW 4.24.470]

Further Legal Background

Actions are brought against public hospital districts under RCW 4.96. The commissioner board must appoint an agent to receive claims for damages. The agent's identity and location during regular business hours must be recorded with the county auditor. [RCW 4.96.020]