§ 32121

Each local health care district shall have and may exercise all of the following powers:

(a) To have and use a corporate seal and alter it at its pleasure.

(b) To sue and be sued in all courts and places and in all actions and proceedings whatever.

(c) To purchase, receive, have, take, hold, lease, use, and enjoy property of every kind and description within and without the limits of the district, and to control, dispose of, convey, and encumber the same and create a leasehold interest in the same for the benefit of the district.

(d) To exercise the right of eminent domain for the purpose of acquiring real or personal property of every kind necessary to the exercise of any of the powers of the district.

(e) To establish one or more trusts for the benefit of the district, to administer any trust declared or created for the benefit of the district, to designate one or more trustees for trusts created by the district, to receive by gift, devise, or bequest, and hold in trust or otherwise, property, including corporate securities of all kinds, situated in this state or elsewhere, and where not otherwise provided, dispose of the same for the benefit of the district.

(f) To employ legal counsel to advise the board of directors in all matters pertaining to the business of the district, to perform the functions in respect to the legal affairs of the district as the board may direct, and to call upon the district attorney of the county in which the greater part of the land in the district is situated for legal advice and assistance in all matters concerning the district, except that if that county has a county counsel, the directors may call upon the county counsel for legal advice and assistance.

(g) To employ any officers and employees, including architects and consultants, the board of directors deems necessary to carry on properly the business of the district.

(h) To prescribe the duties and powers of the health care facility administrator, secretary, and other officers and employees of any health care facilities of the district, to establish offices as may be appropriate and to appoint board members or employees to those offices, and to determine the number of, and appoint, all officers and employees and to fix their compensation. The officers and employees shall hold their offices or positions at the pleasure of the boards of directors.

(i) To do any and all things that an individual might do that are necessary for, and to the advantage of, a health care facility and a nurses’ training school, or a child care facility for the benefit of employees of the health care facility or residents of the district.

(j) (1) To establish, maintain, and operate, or provide assistance in the operation of, one or more health facilities or health services, including, but not limited to, outpatient programs, services, and facilities; retirement programs, services, and facilities; chemical dependency programs, services, and facilities; or other health care programs, services, and facilities and activities at any location within or without the district for the benefit of the district and the people served by the district.

(2) “Health care facilities,” as used in this subdivision, means those facilities defined in subdivision (b) of Section 32000.1 and specifically includes freestanding chemical dependency recovery units. “Health facilities,” as used in this subdivision, may also include those facilities defined in subdivision (d) of Section 15432 of the Government Code.

(k) To do any and all other acts and things necessary to carry out this division.

(l) To acquire, maintain, and operate ambulances or ambulance services within and without the district.

(m) To establish, maintain, and operate, or provide assistance in the operation of, free clinics, diagnostic and testing centers, health education programs, wellness and prevention programs, rehabilitation, aftercare, and any other health care services provider, groups, and organizations that are necessary for the maintenance of good physical and mental health in the communities served by the district.

(n) To establish and operate in cooperation with its medical staff a coinsurance plan between the health care district and the members of its attending medical staff.

(o) To establish, maintain, and carry on its activities through one or more corporations, joint ventures, or partnerships for the benefit of the health care district.

(p) (1) To transfer, at fair market value, any part of its assets to one or more corporations to operate and maintain the assets. A transfer pursuant to this paragraph shall be deemed to be at fair market value if an independent consultant, with expertise in methods of appraisal and valuation and in accordance with applicable governmental and industry standards for appraisal and valuation, determines that fair and reasonable consideration is to be received by the district for the transferred district assets. Before the district transfers, pursuant to this paragraph, 50 percent or more of the district’s assets to one or more corporations, in sum or by increment, the elected board shall, by resolution, submit to the voters of the district a measure proposing the transfer. The measure shall be placed on the ballot of a special election held upon the request of the district or the ballot of the next regularly scheduled election occurring at least 88 days after the resolution of the board. If a majority of the voters voting on the measure vote in its favor, the transfer shall be approved. The campaign disclosure requirements applicable to local measures provided under Chapter 4 (commencing with Section 84100) of Title 9 of the Government Code shall apply to this election.

(2) To transfer, for the benefit of the communities served by the district, in the absence of adequate consideration, any part of the assets of the district, including, without limitation, real property, equipment, and other fixed assets, current assets, and cash, relating to the operation of the district’s health care facilities to one or more nonprofit corporations to operate and maintain the assets.

(A) A transfer of 50 percent or more of the district’s assets, in sum or by increment, pursuant to this paragraph shall be deemed to be for the benefit of the communities served by the district only if all of the following occur:

(i) The transfer agreement and all arrangements necessary thereto are fully discussed in advance of the district board decision to transfer the assets of the district in at least five properly noticed open and public meetings in compliance with Section 32106 and the Ralph M. Brown Act (Chapter 9 (commencing with Section 54950) of Part 1 of Division 2 of Title 5 of the Government Code).

(ii) The transfer agreement provides that the health care district shall approve all initial board members of the nonprofit corporation and any subsequent board members as may be specified in the transfer agreement.

(iii) The transfer agreement provides that all assets transferred to the nonprofit corporation, and all assets accumulated by the corporation during the term of the transfer agreement arising out of, or from, the operation of the transferred assets, are to be transferred back to the district upon termination of the transfer agreement, including any extension of the transfer agreement.

(iv) The transfer agreement commits the nonprofit corporation to operate and maintain the district’s health care facilities and its assets for the benefit of the communities served by the district.

(v) The transfer agreement requires that any funds received from the district at the outset of the agreement or any time thereafter during the term of the agreement be used only to reduce district indebtedness, to acquire needed equipment for the district health care facilities, to operate, maintain, and make needed capital improvements to the district’s health care facilities, to provide supplemental health care services or facilities for the communities served by the district, or to conduct other activities that would further a valid public purpose if undertaken directly by the district.

(vi) The transfer agreement includes the appraised fair market value, from an independent consultant with expertise in methods of appraisal and valuation and in accordance with applicable governmental and industry standards for appraisal and valuation, of any asset transferred pursuant to this paragraph.

(vii) The appraisal that is used to determine the fair market value that is included within the transfer agreement is performed within the six months preceding the date on which the district approves the transfer agreement.

(B) A transfer of 10 percent or more but less than 50 percent of the district’s assets, in sum or by increment, pursuant to this paragraph shall be deemed to be for the benefit of the communities served by the district only if both of the following occur:

(i) The transfer agreement and all arrangements necessary thereto are fully discussed in advance of the district board decision to transfer the assets of the district in at least two properly noticed open and public meetings in compliance with Section 32106 and the Ralph M. Brown Act (Chapter 9 (commencing with Section 54950) of Part 1 of Division 2 of Title 5 of the Government Code).

(ii) The transfer agreement meets all of the requirements of clauses (iii) to (v), inclusive, of subparagraph (A).

(C) Before the district transfers, pursuant to this paragraph, 50 percent or more of the district’s assets to one or more nonprofit corporations, in sum or by increment, the elected board shall, by resolution, submit to the voters of the district a measure proposing the transfer. The resolution shall identify the asset proposed to be transferred, its appraised fair market value, and the full consideration that the district is to receive in exchange for the transfer. The appraisal shall be performed by an independent consultant with expertise in methods of appraisal and valuation and in accordance with applicable governmental and industry standards for appraisal and valuation within the six months preceding the date on which the district approves the resolution. The measure shall be placed on the ballot of a special election held upon the request of the district or the ballot of the next regularly scheduled election occurring at least 88 days after the resolution of the board. If a majority of the voters voting on the measure vote in its favor, the transfer shall be approved. The campaign disclosure requirements applicable to local measures provided under Chapter 4 (commencing with Section 84100) of Title 9 of the Government Code shall apply to this election.

(D) Notwithstanding the other provisions of this paragraph, a health care district shall not transfer any portion of its assets to a private nonprofit organization that is owned or controlled by a religious creed, church, or sectarian denomination in the absence of adequate consideration.

(3) If the district board has previously transferred less than 50 percent of the district’s assets pursuant to this subdivision, before any additional assets are transferred, the board shall hold a public hearing and shall make a public determination that the additional assets to be transferred will not, in combination with any assets previously transferred, equal 50 percent or more of the total assets of the district.

(4) The amendments to this subdivision made during the 1991–92 Regular Session, the amendments made to this subdivision and to Section 32126 made during the 1993–94 Regular Session, and the amendments made to this subdivision during the 2011–12 Regular Session, shall only apply to transfers made on or after the effective dates of the acts amending this subdivision. The amendments to this subdivision made during those sessions shall not apply to either of the following:

(A) A district that has discussed and adopted a board resolution prior to September 1, 1992, that authorizes the development of a business plan for an integrated delivery system.

(B) A lease agreement, transfer agreement, or both between a district and a nonprofit corporation that were in full force and effect as of September 1, 1992, for as long as that lease agreement, transfer agreement, or both remain in full force and effect.

(5) Notwithstanding paragraph (4), if substantial amendments are proposed to be made to a transfer agreement described in subparagraph (A) or (B) of paragraph (4), the amendments shall be fully discussed in advance of the district board’s decision to adopt the amendments in at least two properly noticed open and public meetings in compliance with Section 32106 and the Ralph M. Brown Act (Chapter 9 (commencing with Section 54950) of Part 1 of Division 2 of Title 5 of the Government Code).

(6) Notwithstanding paragraphs (4) and (5), a transfer agreement described in subparagraph (A) or (B) of paragraph (4) that provided for the transfer of less than 50 percent of a district’s assets shall be subject to the requirements of this subdivision when subsequent amendments to that transfer agreement would result in the transfer, in sum or by increment, of 50 percent or more of a district’s assets to the nonprofit corporation.

(7) For purposes of this subdivision, a “transfer” means the transfer of ownership of the assets of a district. A lease of the real property or the tangible personal property of a district shall not be subject to this subdivision, except as specified in Section 32121.4 and as required under Section 32126.

(8) Districts that request a special election pursuant to paragraph (1) or (2) shall reimburse counties for the costs of that special election as prescribed pursuant to Section 10520 of the Elections Code.

(9) (A) Nothing in this section, including subdivision (j), shall be construed to permit a local district to obtain or be issued a single consolidated license to operate a separate physical plant as a skilled nursing facility or an intermediate care facility that is not located within the boundaries of the district.

(B) Notwithstanding subparagraph (A), Eastern Plumas Health Care District may obtain and be issued a single consolidated license to operate a separate physical plant as a skilled nursing facility or an intermediate care facility that is located on the campus of the Sierra Valley District Hospital. This subparagraph shall have no application to any other district and is intended only to address the urgent need to preserve skilled nursing or intermediate care services within the rural County of Sierra.

(C) Subparagraph (B) shall only remain operative until the Sierra Valley District Hospital is annexed by the Eastern Plumas Health Care District. In no event shall the Eastern Plumas Health Care District increase the number of licensed beds at the Sierra Valley District Hospital during the operative period of subparagraph (B).

(10) A transfer of any of the assets of a district to one or more nonprofit corporations to operate and maintain the assets shall not be required to meet paragraphs (1) to (9), inclusive, of this subdivision if all of the following conditions apply at the time of the transfer:

(A) The district has entered into a loan that is insured by the State of California under Chapter 1 (commencing with Section 129000) of Part 6 of Division 107.

(B) The district is in default of its loan obligations, as determined by the Department of Health Care Access and Information.

(C) The Department of Health Care Access and Information and the district, in their best judgment, agree that the transfer of some or all of the assets of the district to a nonprofit corporation or corporations is necessary to cure the default, and will obviate the need for foreclosure. This cure of default provision shall be applicable prior to the office foreclosing on district hospital assets. After the office has foreclosed on district hospital assets, or otherwise taken possession in accordance with law, the office may exercise all of its powers to deal with and dispose of hospital property.

(D) The transfer and all arrangements necessary thereto are discussed in advance of the transfer in at least one properly noticed open and public meeting in compliance with Section 32106 and the Ralph M. Brown Act (Chapter 9 (commencing with Section 54950) of Part 1 of Division 2 of Title 5 of the Government Code). The meeting referred to in this paragraph shall be noticed and held within 90 days of notice in writing to the district by the office of an event of default. If the meeting is not held within this 90-day period, the district shall be deemed to have waived this requirement to have a meeting.

(11) If a transfer under paragraph (10) is a lease, the lease shall provide that the assets shall revert to the district at the conclusion of the leasehold interest. If the transfer is a sale, the proceeds shall be used first to retire the obligation insured by the office, then to retire any other debts of the district. After providing for debts, any remaining funds shall revert to the district.

(12) A health care district shall report to the Attorney General, within 30 days of any transfer of district assets to one or more nonprofit or for-profit corporations, the type of transaction and the entity to whom the assets were transferred or leased.

(13) (A) Notwithstanding paragraphs (1) and (3), and subparagraph (C) of paragraph (2), Palomar Health may transfer all or any part of its assets to the Palomar UCSD Health Authority, provided that all the following conditions are satisfied:

(i) The Palomar Health Board adopts or adopted a resolution approved by a majority of the members of the Palomar Health Board authorizing the execution, delivery, and performance of the operative agreements necessary for the transfer of Palomar Health District assets to the authority, including, but not limited to, the transfer of all or substantially all of Palomar Health District’s remaining assets once authorized to do so by applicable law.

(ii) The authority is formed in furtherance of the provision or support of community hospital and other health care services within, or for the benefit of, the communities served by Palomar Health District, or organized for the purpose of the provision or support.

(iii) The joint exercise of powers agreement governing the authority, the agreements providing for the transfer of the assets to the authority, or one or more other written agreements legally binding upon the authority, contains enforceable covenants requiring that the authority operate and maintain the transferred assets for the provision of health care services for not less than 10 years from the effective date of the transfer of the assets, specifically including commitments to do all of the following:

(I) Ensure that the Palomar hospitals continue to be operated as acute care hospitals.

(II) Ensure that the Palomar hospitals remain certified to participate in the Medicare and Medicaid programs and provide services to Medicare and Medicaid beneficiaries in a nondiscriminatory manner.

(III) Ensure that the Palomar hospitals provide medical care and treatment without regard to insurance status, income, or ability to pay, in a manner consistent with the patient financial assistance policies and procedures adopted by the authority.

(IV) Use commercially reasonable efforts to maintain the services that were provided by the Palomar hospitals immediately prior to the effective date of the transfer.

(B) A transfer pursuant to subparagraph (A) shall be at fair market value as determined by an independent consultant with expertise in methods of appraisal and valuation and in accordance with applicable governmental and industry standards for appraisal and valuation. The appraisal shall be performed within the 12 months of the date on which Palomar Health District executes the transfer agreement.

(C) Palomar Health District shall continue to comply with the obligations of Section 32121.9.

(D) (i) At least 30 days prior to the transfer of all or substantially all of its assets pursuant to this paragraph, the authority shall hold at least two public hearings, noticed in accordance with the Ralph M. Brown Act (Chapter 9 (commencing with Section 54950) of Part 1 of Division 2 of Title 5 of the Government Code).

(ii) Palomar Health District shall be invited to participate at the public hearings described in clause (i).

(iii) Members of the public shall be entitled to provide at the public hearings described in clause (i) public comment regarding the proposed transfer, the terms of the transfer agreement, and the anticipated effects of the transfer on health care services, employees, and the communities served by Palomar Health District.

(E) Transfers pursuant to this paragraph may be made in one transaction or in successive transactions.

(F) Within 30 days of any transfer of Palomar Health District assets pursuant to this paragraph, Palomar Health District shall report to the Attorney General, in writing, all of the following:

(i) Identity of the authority as the transferee.

(ii) Description of the assets transferred.

(iii) The type of transaction and the date of closing.

(iv) Summary of the consideration received.

(v) Summary of the health care service commitments and employee protections contained in the transfer agreement or related agreements.

(G) This paragraph does not authorize the practice of medicine in violation of Section 2400 of the Business and Professions Code, provided, however, that the transfer of assets to the authority pursuant to this paragraph shall not, standing alone, be deemed to constitute the practice of medicine. A transfer of Palomar Health District assets to the authority, as a public agency, pursuant to this paragraph shall not be construed as a contribution of facilities to a joint venture within the meaning of subdivision (r).

(H) (i) This paragraph shall apply retroactively to any transfer of Palomar Health District assets to the authority that was approved by the Palomar Health Board on or after January 1, 2025, and that, at the time of the board’s approval, would have satisfied the conditions set forth in clauses (i) and (ii) of subparagraph (A).

(ii) With respect to any transfer described in clause (i) that was consummated prior to the effective date of this paragraph, the appraisal requirement set forth in subparagraph (B) shall be deemed satisfied if an independent appraisal of the fair market value of the transferred assets was obtained within 12 months of the date on which the Palomar Health Board approved the operative transfer agreement, notwithstanding the appraisal window otherwise required by this paragraph.

(iii) The retroactive application provided for in this subparagraph shall not affect any final judgment entered prior to the effective date of this paragraph. With respect to any judicial or administrative proceeding that is pending as of the effective date of this paragraph, this paragraph shall be applied to the extent permitted by law.

(iv) The Legislature finds and declares that this subparagraph is intended to provide statutory authorization for, and to remove any procedural impediment or infirmity with respect to, any such previously approved transfer, and that it is in the public interest to apply this paragraph retroactively to ensure the continuity and improvement of health care services within the communities served by Palomar Health District. It is the intent of the Legislature that this paragraph be given the fullest retroactive effect to the extent permitted by law.

(I) Palomar Health District and the authority may enter into ancillary agreements, amendments, and implementation actions that are reasonably necessary to consummate, implement, and administer any transfer authorized by this paragraph, including, but not limited to, transition services agreements, shared services agreements, license agreements, and corrective instruments. Any material amendment to the principal transfer agreement shall be subject to approval by the Palomar Health Board at a public meeting.

(J) (i) The authority shall not transfer, sell, lease, or otherwise convey all or substantially all of the assets transferred to it by Palomar Health District pursuant to this paragraph without the prior approval of the Palomar Health Board and compliance with all applicable provisions of this subdivision.

(ii) Notwithstanding clause (i), transfers or other conveyances expressly permitted by the joint exercise of powers agreement governing the authority, any agreements referenced therein, and the ancillary agreements thereto shall not require any further Palomar Health Board approval or other compliance with this subdivision.

(K) The authorization provided by this paragraph to enter into a transfer agreement shall expire on December 31, 2028, if Palomar Health District does not execute a transfer agreement with the authority on or before December 31, 2028. The expiration of the authorization shall not affect the validity or enforceability of any transfer agreement executed, or any transfer consummated prior to December 31, 2028, and all obligations, commitments, and protections set forth in this paragraph and in any such transfer agreement shall survive the expiration provided by this paragraph and remain in full force and effect in accordance with their respective terms.

(L) For purposes of this paragraph, the following definitions apply:

(i) “Assets” means hospital, health care, and related assets, including, without limitation, real property, personal property, equipment, licenses, permits, contracts, accounts receivable, and other tangible and intangible assets.

(ii) “Palomar Health Board” means the board of directors of Palomar Health District.

(iii) “Palomar Health District” means Palomar Health, the California local health care district organized pursuant to this division that operated the Palomar hospitals.

(iv) “Palomar hospitals” means Palomar Medical Center Escondido and Palomar Medical Center Poway.

(v) “Palomar UCSD Health Authority” or “authority” means Palomar UC San Diego Health Authority, the joint powers authority formed pursuant to Chapter 5 (commencing with Section 6500) of Division 7 of Title 1 of the Government Code by and between Palomar Health District and the Regents of the University of California, a California constitutional corporation organized and existing under Section 9 of Article IX of the Constitution of the State of California, on behalf of the University of California, San Diego Health.

(q) To contract for bond insurance, letters of credit, remarketing services, and other forms of credit enhancement and liquidity support for its bonds, notes, and other indebtedness and to enter into reimbursement agreements, monitoring agreements, remarketing agreements, and similar ancillary contracts in connection therewith.

(r) (1) To establish, maintain, operate, participate in, or manage capitated health care service plans, health maintenance organizations, preferred provider organizations, and other managed health care systems and programs properly licensed by the Department of Insurance or the Department of Managed Care, at any location within or without the district for the benefit of residents of communities served by the district. However, that activity shall not be deemed to result in, or constitute, the giving or lending of the district’s credit, assets, surpluses, cash, or tangible goods to, or in aid of, any person, association, or corporation in violation of Section 6 of Article XVI of the California Constitution.

(2) This section does not authorize activities that corporations and other artificial legal entities are prohibited from conducting by Section 2400 of the Business and Professions Code.

(3) Any agreement to provide health care coverage that is a health care service plan, as defined in subdivision (f) of Section 1345, shall be subject to Chapter 2.2 (commencing with Section 1340) of Division 2, unless exempted pursuant to Section 1343 or 1349.2.

(4) A district shall not provide health care coverage for any employee of an employer operating within the communities served by the district, unless the Legislature specifically authorizes, or has authorized in this section or elsewhere, the coverage.

(5) This section does not authorize any district to contribute its facilities to any joint venture that could result in transfer of the facilities from district ownership.

(s) To provide health care coverage to members of the district’s medical staff, employees of the medical staff members, and the dependents of both groups, on a self-pay basis.

(Amended by Stats. 2026, Ch. 252, Sec. 8. (AB 173) Effective September 18, 2026.)