House File 260 - Enrolled




                                             HOUSE FILE 260

                             AN ACT
 RELATING TO THE OPERATION OF COUNTY, CITY, AND MEMORIAL
    HOSPITALS AND THE DUTIES AND POWERS OF HOSPITAL TRUSTEES
    AND COMMISSIONERS.

 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  Section 21.5, subsection 1, paragraph l, Code
 2009, is amended to read as follows:
    l.  To discuss patient care quality and process improvement
 initiatives in a meeting of a public hospital or to discuss
 marketing and pricing strategies or similar proprietary
 information in a meeting of a public hospital, where public
 disclosure of such information would harm such a hospital's
 competitive position when no public purpose would be served by
 public disclosure.  The minutes and the audio recording of a
 closed session under this paragraph shall be available for
 public inspection when the public disclosure would no longer
 harm the hospital's competitive position.  For purposes of
 this paragraph, "public hospital" means the same as defined in
 section 249J.3.  This paragraph does not apply to the
 information required to be disclosed pursuant to section
 347.13, subsection 14 11, or to any discussions relating to
 terms or conditions of employment, including but not limited
 to compensation of an officer or employee or group of officers
 or employees.
    Sec. 2.  Section 37.9, subsection 5, Code 2009, is amended
 to read as follows:
    5.  The commissioners having the management and control of
 a memorial hospital shall, within ten days after their
 appointment, qualify by taking the usual oath of office, but
 no bonds shall be required of them except as hereinafter
 provided.  The commissioners shall organize by electing a
 chairperson, secretary, and treasurer.  The secretary and
 treasurer shall each file with the chairperson of the
 commission a surety bond in such sum as the commission may
 require, with sureties approved by the commission, for the use
 and benefit of the memorial hospital.  The reasonable costs of
 such bonds shall be paid from operating funds of the hospital.
 The secretary shall immediately report to the county auditor
 and county treasurer the names of the chairperson, secretary,
 and treasurer of the commission.  The commission shall meet at
 least once each month as necessary to adequately oversee the
 operation of the hospital.  A majority of the commission
 members shall constitute a quorum for the transaction of
 business.  The secretary shall keep a complete record of its
 proceedings.  The commissioners of a memorial hospital shall
 have all of the powers and duties necessary to manage,
 control, and govern the memorial hospital including but not
 limited to any applicable powers and duties granted boards of
 trustees under other provisions of the Code relating to
 hospitals, nursing homes, assisted or independent living
 services, and other ancillary services irrespective of the
 chapter of the Code under which such institutions are
 established, organized, operated, or maintained, unless such
 provisions conflict with this chapter.
    Sec. 3.  Section 249J.24, subsection 6, paragraph b, Code
 2009, is amended to read as follows:
    b.  The board of trustees of the acute care teaching
 hospital identified in this subsection and the department
 shall execute an agreement under chapter 28E by July 1, 2005,
 and annually by July 1, thereafter, to specify the
 requirements relative to distribution of the proceeds and the
 distribution of moneys to the hospital from the IowaCare
 account.  The agreement shall include provisions relating to
 exceptions to the deadline for submission of clean claims as
 required pursuant to section 249J.7 and provisions relating to
 data reporting requirements regarding the expansion
 population.  The agreement may also include a provision
 allowing such hospital to limit access to such hospital by
 expansion population members based on residency of the member,
 if such provision reflects the policy of such hospital
 regarding indigent patients existing on April 1, 2005, as
 adopted by its board of hospital trustees pursuant to section
 347.14, subsection 4.
    Sec. 4.  Section 331.321, subsection l, paragraph p, Code
 2009, is amended to read as follows:
    p.  A temporary board of hospital trustees in accordance
 with sections 347.9, 347.9A, and 347.10 if a proposition to
 establish a county hospital has been approved by the voters.
    Sec. 5.  Section 347.7, Code 2009, is amended to read as
 follows:
    347.7  TAX LEVIES.
    1.  a.  If a county hospital is established, the board of
 supervisors, at the time of levying ordinary taxes, shall levy
 a tax at the rate voted not to exceed fifty=four cents per
 thousand dollars of assessed value in any one year for the
 erection and equipment of the hospital, and also a tax not to
 exceed twenty=seven cents per thousand dollars of value for
 the improvement, maintenance, and replacements of the
 hospital, as certified by the board of hospital trustees.
 However, in counties having a population of two hundred
 twenty=five thousand or over, the levy for taxes payable in
 the fiscal year beginning July 1, 2001, and for subsequent
 fiscal years, for improvements and maintenance of the hospital
 shall not exceed two dollars and five cents per thousand
 dollars of assessed value in any one year.
    b.  The proceeds of the taxes constitute the county public
 hospital fund and the.  The fund is subject to review by the
 board of supervisors in counties having a population of two
 hundred twenty=five thousand or over.  However, the board of
 trustees of a county hospital, where funds are available in
 the county public hospital fund of the county which are
 unappropriated, may use the unappropriated funds for erecting
 and equipping hospital buildings and additions to the hospital
 buildings without authority from the voters of the county.
    2.  No A levy shall not be made for the improvement,
 maintenance, or replacements of the hospital until the
 hospital has been constructed, staffed, and receiving
 patients.  If revenue bonds are issued and outstanding under
 section 331.461, subsection 2, paragraph "d", the board may
 levy a tax to pay operating and maintenance expenses in lieu
 of the authority otherwise contained in this section not to
 exceed twenty=seven cents per thousand dollars of assessed
 value or not to exceed one dollar and twenty=one and one=half
 cents per thousand dollars of assessed value for improvements
 and maintenance of the hospital in counties having a
 population of two hundred twenty=five thousand or over.
    3.  In addition to levies otherwise authorized by this
 section, the board of supervisors hospital trustees may
 certify for levy a tax at the rate, not to exceed twenty=seven
 cents per thousand dollars of assessed value, necessary to
 raise the amount budgeted by the board of hospital trustees
 for support of ambulance service as authorized in section
 347.14, subsection 14 8.
    4.  a.  The tax levy authorized by this section for
 operation and maintenance of the hospital may be available in
 whole or in part to any county with or without a county
 hospital organized under this chapter, to be used to enhance
 rural health services in the county.  However, the tax levied
 may be expended for enhancement of rural health care services
 only following a local planning process.  The Iowa department
 of public health shall establish guidelines to be followed by
 counties in implementing the local planning process which
 shall require legal notice, public hearings, and a referendum
 in accordance with this section and section 347.30 subsection
 prior to the authorization of any new levy or a change in the
 use of a levy.  The notice shall describe the new levy or the
 change in the use of the levy, indicate the date and location
 of the hearing, and shall be published as least once each week
 for two consecutive weeks in a newspaper having general
 circulation in the county.  The hearing shall not take place
 prior to two weeks after the second publication.
    b.  Enhancement of rural health services for which the tax
 levy pursuant to this section may be used includes but is not
 limited to emergency medical services, health care services
 shared with other hospitals, rural health clinics, and support
 for rural health care practitioners and public health
 services.
    c.  When alternative use of funds from the tax levy
 authorized by this section is proposed in a county with a
 county hospital organized under this chapter, use of the funds
 shall be agreed upon by the elected board of trustees of the
 county hospital.  When alternative use of funds from the tax
 levy authorized by this section is proposed in a county
 without a county hospital organized under this chapter, use of
 the funds shall be agreed upon by the board of supervisors and
 any publicly elected hospital board of trustees within the
 county prior to submission of the question to the voters.
    d.  Moneys raised from a tax levied in accordance with this
 paragraph subsection for the purpose of enhancing rural health
 services in a county without a county hospital shall be
 designated and administered by the board of supervisors in a
 manner consistent with the purposes of the levy.
    Sec. 6.  Section 347.9, Code 2009, is amended to read as
 follows:
    347.9  TRUSTEES == APPOINTMENT == TERMS OF OFFICE.
    When it has been determined by the voters of a county to
 establish a county public hospital, the board shall appoint
 seven trustees chosen from among the resident citizens of the
 county with reference to their fitness for office, and not
 more than four of the trustees shall be residents of the city
 at which the hospital is located.  The trustees shall hold
 office until the following general election, at which time
 their successors shall be elected, two for a term of two
 years, two for four years, and three for six years, and they
 shall determine by lot their respective terms, and thereafter
 their successors shall be elected for regular terms of six
 years each.  A person or spouse of a person with medical or
 special staff privileges in the county public hospital or who
 receives direct or indirect compensation in an amount greater
 than one thousand five hundred dollars in a calendar year from
 the county public hospital or direct or indirect compensation
 in an amount greater than one thousand five hundred dollars in
 a calendar year from a person contracting for services with
 the hospital shall not be eligible to serve as a trustee for
 that county public hospital.  However, this section does not
 prohibit a licensed health care practitioner from serving as a
 hospital trustee if the practitioner's sole use of the county
 hospital is to provide health care service to an individual
 with mental retardation as defined in section 222.2.
    Sec. 7.  NEW SECTION.  347.9A  TRUSTEE ELIGIBILITY ==
 CONFLICT OF INTEREST.
    1.  The following persons shall not be eligible to serve as
 a trustee for a county public hospital:
    a.  A person or spouse of a person with medical or special
 staff privileges in the county public hospital.
    b.  A person or spouse of a person who receives direct
 compensation in an amount greater than one thousand five
 hundred dollars in a calendar year from the county public
 hospital.
    2.  The transactions of a hospital trustee or a hospital
 trustee's spouse shall be limited as follows:
    a.  A conflict of interest transaction is a transaction
 with the hospital in which a hospital trustee or a hospital
 trustee's spouse has a direct interest of less than or equal
 to one thousand five hundred dollars or indirect interest in
 any amount.  A conflict of interest transaction is not
 voidable on the basis of the conflict of interest if all of
 the following are true:
    (1)  The material facts of the transaction and the interest
 of the trustee or the trustee's spouse were disclosed or known
 to the board of hospital trustees.
    (2)  The board of hospital trustees authorized, approved,
 or ratified the transaction.  A conflict of interest
 transaction is authorized, approved, or ratified if it
 receives the affirmative vote of a majority of the
 disinterested trustees at a meeting where a quorum is present
 and where three or more trustees are disinterested in the
 conflict of interest transaction.
    (3)  The transaction was fair to the hospital at the time
 of the transaction.
    b.  For the purposes of this section, a trustee has an
 indirect interest in a transaction if either of the following
 is true:
    (1)  Another entity in which the trustee or the trustee's
 spouse has a material interest or in which the trustee or the
 trustee's spouse is a general partner is party to the
 transaction.
    (2)  Another entity of which the trustee or the trustee's
 spouse is a director, officer, or trustee is a party to the
 transaction.
    3.  This section does not prohibit a licensed health care
 practitioner from serving as a hospital trustee if the
 practitioner's sole use of the county hospital is to provide
 health care service to an individual with mental retardation
 as defined in section 222.2.
    Sec. 8.  Section 347.10, Code 2009, is amended to read as
 follows:
    347.10  VACANCIES.
    Vacancies in on the board of trustees may, until the next
 general election, be filled by appointment by the remaining
 members of the board of trustees or, if fewer than four
 trustees remain on the board, by the board of supervisors for
 the period until the vacancies are filled by election.  An
 appointment made under this section shall be for the unexpired
 balance of the term of the preceding trustee.  If any a board
 member is absent for four consecutive regular board meetings,
 without prior excuse, the member's position shall be declared
 vacant and filled as set out in this section.
    Sec. 9.  Section 347.11, Code 2009, is amended by striking
 the section and inserting in lieu thereof the following:
    347.11  ORGANIZATION == MEETINGS == QUORUM.
    Hospital trustees shall qualify by taking the usual oath of
 office as provided in chapter 63 and organize by the election
 of a chairperson, a secretary, and a treasurer.  The secretary
 shall report to the county auditor and county treasurer the
 names of the chairperson, secretary, and treasurer of the
 board of hospital trustees as soon as practicable after the
 qualification of each.  A board of hospital trustees shall
 meet as necessary to adequately oversee the operation of the
 hospital.  Four trustees shall constitute a quorum necessary
 for actions by the board of hospital trustees.  The secretary
 shall maintain a complete record of board meetings,
 proceedings, and actions.
    Sec. 10.  Section 347.12, Code 2009, is amended to read as
 follows:
    347.12  OFFICERS' DUTIES == PURCHASING REGULATIONS REVENUE
 COLLECTED == ACCOUNTING PRACTICES.
    The treasurer of the county hospital shall receive and
 disburse all funds.  Warrants shall be drawn by the secretary
 and countersigned by the chairperson of the board after the
 claim has been certified by the board.  However, the board may
 adopt purchasing regulations to govern the purchase of
 specified goods and services without the prior certification
 by the board.  The purchasing regulations shall conform to
 generally accepted practices followed by public purchasing
 officers.
    The treasurer of the county hospital shall keep an accurate
 account of all receipts and disbursements and shall register
 all orders drawn and reported to the treasurer by the
 secretary, showing the number, date, to whom drawn, the fund
 upon which drawn, the purpose and amount.
    The secretary of the hospital board of trustees shall file
 monthly on or before the thirtieth day of each month with such
 board a complete statement of all receipts and disbursements
 from all funds during the preceding month, and also the
 balance remaining on hand in such funds at the close of the
 period covered by said statement.
    1.  Before the fifteenth day of each month, the county
 treasurer shall give notice to the chairperson of the board of
 hospital trustees or the chairperson's designee of the amount
 of revenue collected for each fund of the hospital to the
 first day of that month and the county treasurer shall pay the
 taxes to the treasurer of the hospital as provided in section
 331.552, subsection 29.
    2.  a.  The hospital administrator, or the administrator's
 designee, shall ensure that all accounts, funds, reports, and
 financial statements of the county hospital conform to
 generally accepted accounting principles as established by the
 governmental accounting standards board.
    b.  The hospital administrator, or the administrator's
 designee, shall file a financial report with the board of
 hospital trustees on or before the date of each regularly
 scheduled board meeting for the period of time since the
 board's previous regularly scheduled meeting.
    Sec. 11.  Section 347.13, Code 2009, is amended by striking
 the section and inserting in lieu thereof the following:
    347.13  BOARD OF TRUSTEES == DUTIES.
    A board of hospital trustees' duties shall include all of
 the following:
    1.  Engage in all activities necessary to manage, control,
 and govern the hospital unless otherwise prohibited under this
 chapter.
    2.  Exercise all the rights and duties of hospital trustees
 including but not limited to authorizing the delivery of any
 health care service, assisted or independent living service,
 or other ancillary service.
    3.  Adopt bylaws and rules for its own guidance and for the
 government of the hospital.
    4.  Exercise fiduciary duties in accordance with section
 504.831, subsections 1 through 5.
    5.  Employ or contract for an administrator and fix the
 administrator's compensation.  The administrator shall have
 authority to oversee the day=to=day operations of the hospital
 and its employees.
    6.  Approve the appointment of a qualified medical staff
 and oversee the quality of medical care and services provided
 by the hospital.
    7.  Manage and control the hospital's funds in accordance
 with chapter 540A.  In addition to investments permitted under
 section 12B.10, county hospital investments may include common
 stocks.
    8.  Establish charity care policies for free treatment or
 financial assistance for care provided by the hospital, and
 fix the price to be charged to other patients admitted to the
 hospital for care and treatment.
    9.  Procure and pay premiums on any and all insurance
 policies required for the prudent management of the hospital
 including but not limited to public liability, professional
 malpractice liability, workers' compensation, and vehicle
 liability.  Said insurance may include as additional insureds
 members of the board of trustees and employees of the
 hospital.  This subsection applies to all county hospitals
 whether organized under this chapter, chapter 347A, chapter
 37, or otherwise established by law.
    10.  Certify levies for a tax in excess of any tax levy
 limit to meet its obligations to pay the premium costs on tort
 liability insurance, property insurance, workers' compensation
 insurance, and any other insurance that may be necessary for
 the prudent management and operation of the county public
 hospital, the costs of a self=insurance program, the costs of
 a local government risk pool, and amounts payable under any
 insurance agreements to provide or procure such insurance,
 self=insurance program, or local government risk pool.
    11.  Publish quarterly in each of the official newspapers
 of the county as selected by the board of supervisors pursuant
 to section 349.1 the schedule of bills allowed, and publish
 annually in such newspapers the schedule of salaries paid by
 job classification and category, but not by listing names of
 individual employees.  The names, business addresses,
 salaries, and job classification of employees paid in whole or
 in part from a tax levy shall be a public record and open to
 inspection at reasonable times as designated by the board of
 trustees.
    12.  Fix the amount necessary for the improvement and
 maintenance of the hospital and for support of ambulance
 service during the ensuing fiscal year, and certify the amount
 to the county auditor before March 15 of each year, subject to
 any limitation in section 347.7.
    Sec. 12.  Section 347.14, Code 2009, is amended by striking
 the section and inserting in lieu thereof the following:
    347.14  BOARD OF TRUSTEES == POWERS.
    The board of trustees may:
    1.  Purchase, condemn, or lease a site for such public
 hospital and provide and equip suitable hospital buildings.
    2.  Cause plans and specifications to be made and adopted
 for all hospital buildings, and advertise for bids, as
 required by law for other county buildings, before making a
 contract for the construction of a building.
    3.  Accept property by gift, devise, bequest, or otherwise.
 If the board deems it advisable, the board may sell, lease,
 exchange, or otherwise dispose of any hospital property upon a
 concurring vote of a majority of all members of the board of
 hospital trustees.  The proceeds of such sale, lease,
 exchange, or other disposition may be applied to any lawful
 purpose, subject to approval of the board.
    4.  Borrow moneys to be secured solely by hospital revenues
 for the purposes of improvement, maintenance, or replacement
 of the hospital or for hospital equipment.
    5.  Establish and maintain in connection with the hospital
 a training school for nurses or other health professions.
    6.  Establish a fund for depreciation as a separate fund.
 Moneys deposited in the fund shall remain in the fund until
 such time as in the judgment of the board of trustees it is
 deemed advisable to use the funds for hospital purposes.
 Interest earned on moneys in the fund shall be deposited in
 the fund.
    7.  Operate a health care facility as defined in section
 135C.1 in conjunction with the hospital.
    8.  Purchase, lease, equip, maintain, and operate an
 ambulance or ambulances to provide necessary and sufficient
 ambulance service or to contract for such vehicles, equipment,
 maintenance, or service when such ambulance service is not
 otherwise available.
    9.  a.  Submit to the voters at an election held on a date
 specified in section 39.2, subsection 4, paragraph "a", a
 proposition to sell or lease a county public hospital for use
 as a private hospital or as a merged area hospital under
 chapter 145A or to sell or lease a county hospital in
 conjunction with the establishment of a merged area hospital.
 The authorization of the board of hospital trustees submitting
 the proposition may, but is not required to, contain
 conditions which provide for maintaining hospital care within
 the county, for the retention of county public hospital
 employees and staff, and for the continuation of the board of
 trustees for the purpose of carrying out provisions of
 contracts.  Proceeds from the sale or lease of the county
 hospital or other assets of the board of trustees shall not be
 used for the prepayment of health care services for residents
 of the county with the purchaser or lessee of the county
 hospital or to underwrite the sale or lease of the county
 hospital.
    b.  The proposition submitted to the voters of the county
 shall not be set forth at length, but it shall be in
 substantially the following form:
    "Shall the board of hospital trustees of ..........
 county, state of Iowa, be authorized to .............. (state
 authorization which may exclude the conditions) in accordance
 with the terms of authorization approved at the meeting of
 ..... (cite date) of the board of hospital trustees?"
    c.  If the proposition is approved by a majority of the
 total votes cast for and against the proposition at the
 election, the board of hospital trustees shall proceed to
 carry out the authorization granted.
    10.  If the board authorizes delivery of additional health
 care services, assisted or independent living services, or
 other ancillary services under section 347.13, subsection 2,
 the board is granted all of the powers and duties necessary
 for the management, control, and government of the
 institutions including but not limited to any applicable
 powers and duties granted boards of trustees under other
 provisions of the Code relating to hospitals, nursing homes,
 assisted or independent living services, and other ancillary
 services irrespective of the chapter of the Code under which
 such an entity is established, organized, operated, or
 maintained, unless such provisions are in conflict with this
 section and section 347.13.
    Sec. 13.  Section 347.16, subsection 4, Code 2009, is
 amended by striking the subsection.
    Sec. 14.  Section 347.19, Code 2009, is amended to read as
 follows:
    347.19  COMPENSATION == EXPENSES.
    No A trustee shall not receive any compensation for
 services performed under this chapter, but a trustee shall be
 reimbursed for any cash expenditures actually made for
 personal actual and necessary expenses incurred in the
 performance of the trustee's duties.  An itemized statement of
 such expenses, verified by the oath of each such trustee,
 shall be filed with the secretary, and the same shall only be
 allowed by an affirmative vote of all trustees present at the
 meeting of the board.
    Sec. 15.  Section 347A.1, Code 2009, is amended to read as
 follows:
    347A.1  REVENUE BONDS == TRUSTEES == ADMINISTRATION.
    1.  A county having a population less than one hundred
 fifty thousand may issue revenue bonds for a county hospital
 as provided in section 331.461, subsection 2, paragraph "e".
    2.  a.  The administration and management of the hospital
 shall be vested in a board of hospital trustees consisting of
 five or seven members.  Appointments for a five=member board
 shall be made by the board of supervisors from among the
 resident citizens of the county with reference to their
 fitness for office, and not more than two of the trustees
 shall be residents of the same township.  Expansion from a
 five=member to a seven=member board of trustees shall occur
 only on approval of a majority of the five=member board of
 trustees.  The five=member board of trustees shall appoint
 members to the additional vacancies; one appointee shall serve
 until the succeeding general election and the other appointee
 shall serve until the second succeeding general election at
 which times successors shall be elected.
    b.  The trustees shall hold office until the next
 succeeding election, at which time their successors shall be
 elected, two for a term of two years, two for a term of four
 years and one for a term of six years, and thereafter their
 successors shall be elected for regular terms of six years
 each.  Vacancies in on the board of trustees may be filled in
 the same manner as original appointments, to hold office until
 the vacancies are filled pursuant to section 69.12.
    c.  The trustees shall qualify by taking the usual oath of
 office as provided in chapter 63, but no bond shall be
 required of them.  The trustees shall receive no compensation
 but shall be reimbursed for all expenses incurred by them with
 the approval of the board of trustees in the performance of
 their duties.
    d.  The board first appointed shall organize promptly
 following its appointment, and shall serve until successors
 are elected and qualified; thereafter.  Thereafter, and no
 later than December 1 of each year, the board shall reorganize
 by the appointment of a chairperson, secretary, and treasurer.
 The secretary and treasurer shall each file with the
 chairperson of the board a surety bond in the amount the board
 of trustees requires, with sureties to be approved by the
 board of trustees, for the use and benefit of the county
 hospital.  The reasonable cost of the bonds shall be paid from
 the operating funds of the hospital.  The secretary shall
 report to the county auditor and the county treasurer the
 names of the chairperson, secretary, and treasurer of the
 board as soon as practicable after the appointment of each.
    The treasurer of the county hospital shall receive and
 disburse all funds.  Warrants shall be drawn by the secretary
 and countersigned by the chairperson of the board after the
 claim has been certified by the board.  However, the board may
 adopt purchasing regulations to govern the purchase of
 specified goods and services without the prior certification
 of the board.  The purchasing regulations shall conform to
 generally accepted practices followed by purchasing officers.
 The treasurer of the county hospital shall keep an accurate
 account of all receipts and disbursements and shall register
 all orders drawn and reported by the secretary, showing the
 number, date, to whom drawn, the fund upon which drawn, the
 purpose, and amount.  The secretary of the board of trustees
 shall file with the board on or before the tenth day of each
 month, a complete statement of all receipts and disbursements
 from all funds during the preceding month, and also the
 balance remaining on hand in all funds at the close of the
 period covered by the statement.
    e.  Expansion from a five=member to a seven=member board of
 trustees shall occur only on approval of a majority of the
 five=member board of trustees.  The five=member board of
 trustees shall appoint members to the additional vacancies;
 one appointee shall serve until the succeeding general
 election, and the other appointee shall serve until the second
 succeeding general election at which times successors shall be
 elected.
    3.  a.  Before the fifteenth day of each month, the county
 treasurer shall give notice to the chairperson of the board of
 trustees, or the chairperson's designee, of the amount of
 revenue collected for each fund of the hospital to the first
 day of that month and the county treasurer shall pay the taxes
 to the treasurer of the hospital as provided in section
 331.552, subsection 29.
    b.  The hospital administrator, or the administrator's
 designee, shall ensure that all accounts, funds, reports, and
 financial statements of the county hospital conform to
 generally accepted accounting principles as established by the
 governmental accounting standards board.
    c.  The hospital administrator, or the administrator's
 designee, shall file a financial report with the board of
 hospital trustees on or before the date of each regularly
 scheduled board meeting for the period of time since the
 board's previous regularly scheduled meeting.
    4.  a.  The board of hospital trustees may employ, fix the
 compensation of, and remove at pleasure professional,
 technical, and other employees as it deems necessary for the
 operation and maintenance of the hospital, and disbursement of
 funds for operation and maintenance shall be made upon order
 and approval of the board of hospital trustees.  A county
 hospital may include a nurses home and nurses training school.
 The board of trustees shall make all rules and regulations
 governing its meetings and the management, government, and
 operation of the county hospital and shall fix charges for the
 services furnished so that the revenues will be at all times
 sufficient in the aggregate to provide for the payment of the
 interest on and principal of all revenue bonds issued and
 outstanding for the hospital, and for the payment of all
 operating and maintenance expenses of the hospital.
    The board of hospital trustees may establish a fund for
 depreciation as a separate fund.  Depreciation fund moneys may
 be invested in United States government bonds and the
 accumulation of interest on the bonds shall be used for the
 purposes of the depreciation fund.  The moneys shall remain
 invested in the bonds until the board of hospital trustees
 determines the moneys shall be used for hospital purposes.
    b.  The board of trustees shall have all of the powers and
 duties necessary to manage, control, and govern the county
 hospital including but not limited to any applicable powers
 and duties granted boards of trustees under other provisions
 of the Code relating to hospitals, nursing homes, assisted or
 independent living services, and other ancillary services
 irrespective of the chapter of the Code under which such
 institutions are established, organized, operated, or
 maintained, unless such provisions are in conflict with this
 section.
    Sec. 16.  Section 392.6, Code 2009, is amended to read as
 follows:
    392.6  HOSPITAL OR HEALTH CARE FACILITY TRUSTEES.
    1.  If a hospital or health care facility is established by
 a city, the city shall by ordinance provide for the election,
 at a general, city, or special election held pursuant to
 section 39.2, subsection 4, paragraph "b", of three trustees,
 whose terms of office shall be four years.  However, at the
 first election, three shall be elected and hold their office,
 one for four years and two for two years, and they shall by
 lot determine their respective terms.  A candidate for
 hospital or health care facility trustee must be a resident of
 the hospital or health care facility service area within the
 boundaries of the state at the time of the election at which
 the person's name appears on the ballot.  A board of trustees
 elected pursuant to this section shall serve as the sole and
 only board of trustees for any and all institutions
 established by a city as provided for in this section.
    2.  Cities maintaining an institution as provided for in
 this section which have a board of trustees consisting of
 three or five members may by ordinance increase the number of
 members to five or seven.  The ordinance shall provide for the
 immediate appointment of the additional members necessary to
 establish a five=member or seven=member board and shall
 provide that, of the additional members added to the board by
 appointment, one=half of the additional members added The
 administration and management of an institution as provided
 for in this section is vested in a board of trustees
 consisting of three, five, or seven members.  A three=member
 board may be expanded to a five=member board, and a
 five=member board may be expanded to a seven=member board.
 Expansion of the membership of the board shall occur only on
 approval of a majority of the current board of trustees.  The
 additional members shall be appointed by the current board of
 trustees.  One appointee shall serve until the next succeeding
 general or regular city election, at which time a successor
 shall be elected, and the remaining additional members other
 appointee shall serve until the second succeeding general or
 regular city election, at which time a successor shall be
 elected.  The ordinance shall also provide that the
 determination of which election an appointed additional member
 shall be required to seek election shall be determined by lot.
 Thereafter, the terms of office of such additional members
 shall be four years.  However, if a city has adopted an
 ordinance which increases the number of members of the board
 of trustees to five or seven members and the terms of office
 of four of the five members or six of the seven members end in
 the same year, the date of expiration of the term of one of
 the four members or two of the six members, to be determined
 by lot, shall be extended by an additional two years.
    3.  a.  Terms of office of trustees elected pursuant to
 general or regular city elections shall begin at noon on the
 first day in January which is not a Sunday or legal holiday.
 Terms of office of trustees appointed to fill a vacancy or
 elected pursuant to special elections shall begin at noon on
 the tenth day after appointment or the special election which
 is not a Sunday or legal holiday.  The trustees shall begin
 their terms of office by taking the oath of office, and
 organize as a board by the election of one of their number
 trustee as chairperson, one trustee as treasurer, and one
 trustee as secretary, but no bond shall be required of them.
 Terms of office of trustees shall extend to noon on the first
 day in January which is not a Sunday or legal holiday or until
 their successors are elected and qualified.
    b.  Vacancies on the board of trustees may, until the next
 general or regular city election, be filled by appointment by
 the remaining members of the board of trustees, unless within
 fourteen days after the appointment is made, there is filed
 with the city clerk a petition which requests a special
 election to fill the vacancy in the same manner as provided in
 section 347.10.  Trustees who are appointed to fill a vacancy
 or who are elected at special elections shall serve the
 unexpired terms of office or until their successors are
 elected and qualified.  An appointment made under this
 paragraph shall be for the unexpired balance of the term of
 the preceding trustee.  If a board member is absent for four
 consecutive regular board meetings, without prior excuse, the
 member's position shall be declared vacant and filled as set
 out in this paragraph.
    The treasurer of the board of trustees shall receive and
 disburse all funds under the control of the board as ordered
 by it.  The treasurer shall give bond in a form and amount as
 determined by the board in its discretion.
    4.  No A trustee shall not receive any compensation for
 services performed under this chapter, but a trustee may
 receive reimbursement shall be reimbursed for any cash
 expenses actually made for personal expenses incurred as
 trustee, but an itemized statement of all expenses and moneys
 paid out shall be made under oath by each of the trustees and
 filed with the secretary and allowed only by the affirmative
 vote of the full board actual and necessary expenses incurred
 in performance of the trustee's duties.
    5.  The board of trustees shall be vested with authority to
 provide for the management, control, and government of the
 city hospital or health care facility established as permitted
 by this section, and shall provide all needed rules for the
 economic conduct thereof and shall annually prepare a
 condensed statement of the total receipts and expenditures for
 the hospital or health care facility and cause the same to be
 published in a newspaper of general circulation in the city in
 which the hospital or health care facility is located.  In the
 management of the hospital or health care facility no
 discrimination shall be made against practitioners of any
 school of medicine recognized by the laws of the state.
    As a part of the board's authority it may accept property
 by gift, devise, bequest or otherwise; and, if the board deems
 it advisable, may, at public sale, sell or exchange any
 property so accepted upon a concurring vote of a majority of
 all members of the board of trustees, and apply the proceeds
 thereof, or property received in exchange therefor, to any
 legitimate hospital or health care facility purpose.
    The trustees may in their discretion establish a fund for
 depreciation as a separate fund.  Said funds may be invested
 in United States government bonds and when so invested the
 accumulation of interest on the bonds so purchased shall be
 used for the purposes of the depreciation fund; an investment
 when so made shall remain in United States government bonds
 until such time as in the judgment of the board of trustees it
 is deemed advisable to use the funds for hospital or health
 care facility purposes.
    6.  Boards of trustees of institutions provided for in this
 section are granted all of the powers and duties necessary for
 the management, control, and government of the institutions,
 specifically including but not limited to any applicable
 powers and duties granted boards of trustees under other
 provisions of the Code relating to hospitals, nursing homes,
 assisted or independent living services, and custodial homes
 other ancillary services irrespective of the chapter of the
 Code under which such institutions are established, organized,
 operated, or maintained, unless such provisions are in
 conflict with this section.
    Sec. 17.  Sections 347.18, 347.28, 347.29, 347.30, and
 347A.5, Code 2009, are repealed.


                                                             
                               PATRICK J. MURPHY
                               Speaker of the House


                                                             
                               JOHN P. KIBBIE
                               President of the Senate

    I hereby certify that this bill originated in the House and
 is known as House File 260, Eighty=third General Assembly.


                                                             
                               MARK BRANDSGARD
                               Chief Clerk of the House
 Approved                , 2009


                            
 CHESTER J. CULVER
 Governor

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