Kern County Municipal Code Ch. 2.170 Kern County Hospital Authority

The board of supervisors of the county of Kern finds and declares as follows:

A. The Kern Medical Center is currently an acute care hospital operated as a constituent department of the county of Kern.

B. The board of supervisors has the authority to create a hospital authority ("hospital authority") to operate and control the Kern Medical Center, as set forth in Chapter 5.5 (commencing with Section 101852) of Part 4 of Division 101 of the Health and Safety Code.

C. The Kern Medical Center is a designated public hospital, as defined in Section 14166.1 of the Welfare and Institutions Code, and a critical component of the state and county health care safety net.

D. The ongoing evolution of the healthcare environment requires public health care entities to pursue innovative health care delivery models that improve the quality of patient care services and patient experience, efficiently and effectively increase access to needed health care services across the care continuum, provide services in a patient-centered manner, and moderate the rate of growth of health care expenditures.

E. In order to provide access to affordable, high-quality health care services and to ensure the full engagement and viability of the health care safety net in the county to improve the health status of the people of the county of Kern, the Kern Medical Center and related health-care resources shall be operated under a new hospital authority that provides an organizational and operational structure that facilitates and improves the Kern Medical Center's ability to function with flexibility, responsiveness, and innovation.

F. The creation of an independent hospital authority to provide maintenance, operation, management, and control of the Kern Medical Center and related health care resources, in a manner consistent with the county's obligations under Section 17000 of the Welfare and Institutions Code, is the best way to achieve these objectives in a manner that ensures continued viability of the Kern Medical Center and constitutes an ongoing material benefit to the county and its residents.

G. The county medical facilities currently known as the Kern Medical Center and related health care resources shall be transferred to the hospital authority under such terms to be set forth in various agreements and other documents, consistent with this chapter as may be amended from time to time, between the County of Kern and the hospital authority.

H. The Hospital Authority shall operate pursuant to the provisions of Chapter 5.5 (commencing with Section 101852) of Part 4 of Division 101 of the Health and Safety Code, other provisions of law, and in accordance with the provisions of this chapter, bylaws adopted by the board of supervisors, and any formal written agreements between the hospital authority and the county of Kern.

I. Transfer of the Kern Medical Center and related health care resources to the hospital authority, and any additional or further support or benefit that the county provides to the hospital authority in furtherance of its purposes as described in Section 101853 of the Health and Safety Code, shall be in furtherance of the county's public purposes, including, but not limited to, promotion of the health and welfare of the residents of the county of Kern.

(Ord. No. A-356, § 2, 10-6-15, eff. 11-6-15)

A. The board of supervisors hereby creates and establishes a hospital authority pursuant to Section 101853 of the Health and Safety Code, as provided by and subject to the terms and conditions of this chapter.

B. The hospital authority created pursuant to this chapter shall be known as the "Kern County Hospital Authority" and may do business as the "Kern Medical Center." Upon the board of supervisors' transfer of the medical center to the hospital authority pursuant to the terms of this chapter and implementing bylaws and agreements, the hospital authority shall own and operate the Kern Medical Center, which shall continue as a designated public hospital and safety net provider and which shall include, but shall not be limited to, all outpatient clinics, pharmacies, ambulatory surgery centers, and other health care resources specified in various agreements and other documents between the county of Kern and the hospital authority.

C. As specified in various agreements and related documents approved by legal counsel for the county:

1. Substantially all of the assets of the Kern Medical Center and related health care resources, specified therein, shall be transferred to the hospital authority;

2. The hospital authority, in consideration for transfer of the ownership of the Kern Medical Center, shall assume and accept responsibility for paying: (a) substantially all of the current known and unknown obligations of the county of Kern associated with its operation of the Kern Medical Center (including, without limitation, any amounts advanced from the county general fund but not repaid to cover cash flow deficits of the Kern Medical Center); (b) any payments due for personnel transition benefits as provided in Section 2.170.100(B); and (c) such other consideration as may be specified in one or more agreements between the county of Kern and the hospital authority, including, but not limited to, the extent to which and manner in which the hospital authority shall provide indigent care services;

3. The county shall guarantee the obligations of the hospital authority for payment of required pension contributions necessary to fund all benefits administered by the Kern County Employees' Retirement Association as provided in Section 101583.1(g)(7) of the Health and Safety Code and in Section 2.170.100(B);

4. The county shall guarantee the payment by the hospital authority of liabilities the hospital authority assumes for obligations incurred by the county during its ownership and operation of the Kern Medical Center;

5. The hospital authority shall grant a first deed of trust to the county of Kern securing its obligations to the county;

6. The hospital authority shall provide or arrange for the provision of health care services to indigent residents of the county of Kern to satisfy some or all of the county's obligation to provide aid in receiving needed medical services pursuant to Section 17000 of the Welfare and Institutions Code. Nothing herein shall preclude the county from entering into agreements with other providers for the provision of indigent care services;

7. The county of Kern shall consent to the hospital authority participating in and receiving allocations of local revenue fund amounts provided pursuant to Chapter 6 (commencing with Section 17600) of Part 5 of Division 9 of the Welfare and Institutions Code in such amount as identified or earmarked by the county in support of indigent health care services of the type and amount provided by the Kern Medical Center and its related health care resources to Medi-Cal beneficiaries, uninsured and other low-income individuals, and consistent with maintaining the status of the Kern Medical Center as a designated public hospital;

8. The agreements and related documents shall provide for the indemnification of the county by the hospital authority for liabilities as set forth in the agreement(s), except that the agreement(s) shall specify that the county shall remain liable for its own negligent acts; and

9. The hospital authority shall agree to follow the notice and hearing procedures set forth in Section 1442.5(a) of the Health and Safety Code that are otherwise applicable to county facilities, in addition to any other applicable notice requirements set forth in state law.

D. The hospital authority shall comply with the provisions of Section 53051 of the Government Code and register with the Secretary of State as a public agency.

E. The creation and establishment of the hospital authority shall not constitute a transfer of, or a commitment to transfer, the maintenance, operation, management, control, ownership, or personnel of the Kern Medical Center to the hospital authority without the satisfactory completion of specific tasks, and the execution and delivery of documents and/or agreements as set forth in the board of supervisors-approved hospital authority implementation plan.

(Ord. No. A-356, § 2, 10-6-15, eff. 11-6-15)

A. The hospital authority shall be a local unit of government separate and apart from the county and any other public entity, as provided by Chapter 5.5 (commencing with Section 101852) of Part 4 of Division 101 of the Health and Safety Code. The hospital authority shall not be an agency, division, or department of the county or any other public entity, but shall be considered to be an instrumentality of the county for purposes of participation in the Kern County Employees' Retirement Association and other government employee benefit plans. Any determination with respect to the manner in which the hospital authority qualifies as a governmental plan sponsor shall not change or otherwise modify the hospital authority's status as a public agency that is a unit of local government and subdivision of the state for other purposes set forth in Chapter 5.5 (commencing with Section 101852) of Part 4 of Division 101 of the Health and Safety Code.

B. The hospital authority shall not be governed by or subject to the county of Kern Rules of the Civil Service Commission and the hospital authority shall not be governed by, or subject to, other policies or operational rules of the county, including, but not limited to, those relating to personnel and procurement.

C. Unless otherwise provided herein or agreed to by the hospital authority and the board of supervisors or as otherwise required by law, future obligations or liabilities incurred by the hospital authority shall be the obligations or liabilities solely of the hospital authority and shall not be the obligations or liabilities of the county.

D. The hospital authority is hereby deemed a public agency for purposes consistent with Chapter 5.5 (commencing with Section 101852) of Part 4 of Division 101 of the Health and Safety Code, including, but not limited to, eligibility with respect to grants and other funding and loan guarantee programs, Medi-Cal financing mechanisms such as transferring funds to the state and incurring certified public expenditures, and receipt of other local, state and federal funding.

E. With respect to its maintenance, operation, management, control, ownership, or lease of the Kern Medical Center, the hospital authority shall comply with any applicable requirements of Section 1442.5 of the Health and Safety Code. In accordance with Section 1442.5(b)(3) of the Health and Safety Code, the hospital authority shall serve as the designated agency to provide a twenty-four-hour information service that can provide immediate information on available services and access to them, and to receive and respond to complaints as required under the statute.

F. The provisions of Section 101855 of the Health and Safety Code pertaining to the Myers-Milias-Brown Act, the Public Records Act and the Brown Act shall apply to the hospital authority and shall immediately take effect.

G. The medical facilities owned by the county of Kern to be transferred to the hospital authority and governed, maintained, operated and administered by the hospital authority shall consist of substantially all of the facilities, equipment, supplies, personnel, and operations comprising the Kern Medical Center and other facilities, clinics, and programs which deliver medical services, as shall be further defined in one (1) or more agreements between the county and the hospital authority.

H. The hospital authority may establish its own treasury subject to the prior approval of the board of supervisors or it may participate in the county treasury pool subject to approval of the county treasurer. If the hospital authority participates in the county treasury pool, the hospital authority may not elect to leave the treasury pool if the hospital authority has any temporary transfer amounts outstanding from the treasury pool pursuant to Article XVI of the California Constitution. The county treasurer, at his or her sole discretion, shall determine "anticipated revenues" for the purposes of establishing a temporary transfer of funds pursuant to Article XVI of the California Constitution. In the event the hospital authority is granted a temporary transfer from the treasury pool pursuant to Article XVI, Section 6, of the California Constitution, the county treasurer shall have the right and duty to forcibly impose repayment prior to the end of each fiscal year before any other obligation is met from such revenue. The county shall charge the hospital authority an appropriate fee.

(Ord. No. A-356, § 2, 10-6-15, eff. 11-6-15)

A. Upon transfer by the county to the hospital authority, the Kern Medical Center shall continue its status as a designated public hospital and safety net provider, with a mission of maintaining and improving the health of all county residents.

B. Upon transfer by the county to the hospital authority, the Kern Medical Center shall provide comprehensive, high quality medical treatment, health promotion and health maintenance through an integrated system of hospital, clinic, and other health services staffed by individuals who are responsive to the diverse cultural needs of the community.

C. Upon transfer by the county to the hospital authority, the Kern Medical Center, as a training institution, shall be committed to maintaining an environment that is supportive of a wide range of educational programs and activities.

D. Education, including continuing education of medical students, residents, nursing, and other staff, along with clinical research, shall continue to be essential components of the Kern Medical Center's environment upon transfer by the county to the hospital authority.

E. The hospital authority shall manage, administer, and control the Kern Medical Center, including, but not limited to, the general acute care hospital and outpatient clinics and other health services, in a manner that assures accessible, cost effective, quality medical care.

F. The hospital authority may explore innovative health care delivery models to help ensure its viability and its ability to provide an ongoing material benefit to Kern County residents.

(Ord. No. A-356, § 2, 10-6-15, eff. 11-6-15)

A. Upon the effective date of the ordinance codified in this chapter, a transitional governing board for the hospital authority shall be formed composed of the chief executive officer of the Kern Medical Center and one (1) person engaged in the administration of the Kern Medical Center designated by the chief executive officer of the Kern Medical Center; the county administrative officer and one (1) person employed as a senior executive of the county of Kern designated by the county administrative officer. The county administrative officer shall be the chair of the transitional governing board.

B. The transitional governing board shall function for the exclusive purpose of facilitating the transfer of the Kern Medical Center and its operations to the hospital authority in advance of the appointment of the governing board of the hospital authority. It shall have no authority to operate the Kern Medical Center or any other services, and its sole function shall be to take such actions as may be needed to effectuate the transfer of the Kern Medical Center to the hospital authority.

These actions may include, but are not limited to, such items as initiating change of ownership procedures for Medicare and Medi-Cal; assignment of contracts currently in place for the operation of the Kern Medical Center; transfer or establishment of licenses needed to operate the Kern Medical Center; authorizing the establishment of a medical staff; adopting policies and procedures needed for applications to regulatory agencies for purposes of licensure, accreditation, and/or Medi-Cal and Medicare enrollment; facilitating the transfer of existing staff; filing legal notices; and other administrative matters necessary for the hospital authority to assume ownership and operation of the Kern Medical Center. It shall have no authority to spend funds, hire staff, or enter into any agreements on behalf of the hospital authority. Any action taken by the transitional governing board may be taken only after a unanimous vote in favor of the action.

C. The transitional governing board shall be subject to the Brown Act, the Public Records Act, and all laws applicable to the hospital authority as a California public entity.

D. The transitional governing board shall cease upon its dissolution by the board of supervisors, or shall automatically be dissolved upon the assumption of office of sufficient members of the governing board to constitute a quorum allowing the hospital authority to conduct business. In the event members of the governing board are appointed constituting less than a quorum, members of the transitional governing board may not be counted for purposes of a quorum of the governing board.

(Ord. No. A-356, § 2, 10-6-15, eff. 11-6-15)

A. Definition. The governing body of the hospital authority shall be known as the "Kern County Hospital Authority Board of Governors" (board of governors).

B. Qualifications.

1. Desired Qualifications. The board of governors shall be composed, to the extent feasible, of individuals with the expertise necessary to enable the Kern Medical Center to achieve the highest quality of care and appropriate scope of services in a manner that is both fiscally responsible and sensitive to the needs of the community. Desirable skills include, but are not limited to, business management, strategic planning, finance, public health policy, health care administration, personnel management, medical services, and consensus building.

2. Specific Qualifications. Members of the board of governors (members) must be full-time residents of the county of Kern, at least eighteen (18) years of age, and should, to the extent feasible, collectively have the following types of knowledge, skills, and experience:

(a) Knowledge of health care delivery systems;

(b) Knowledge of health care policy and regulatory issues and with current and projected health care trends;

(c) Knowledge of human resources in large organizations;

(d) An understanding of budgeting process, revenue cycle, financial reports, and basic accounting principles;

(e) Experience with managing hospital services and understanding of the health care needs of the hospital authority's patient populations; and

(f) Experience in advocating for safety net populations including, but not limited to, the pursuit of public funding for the delivery of health care services.

3. Disqualified Persons. The following types of persons may not serve as members:

(a) Persons who are or may be, in the view of the board of supervisors, in competition with, or otherwise have a conflict of interest with, the hospital authority.

(b) Any person who has been excluded from participation in a federal or state medical care benefits program, or is currently suspended from participation in any such program.

(c) Any person who has been convicted of a felony, or has been convicted or subject to discipline for any crime involving moral turpitude.

(d) Any person who holds an incompatible office, other than employment or affiliation with the county of Kern.

(e) Any person whose service as a member would constitute having an interest in a contract as provided by Article 4 (commencing with Section 1090) of Chapter 1 of Division 4 of Title 1 of the Government code, except as otherwise provided by Health and Safety Code Section 101854(d).

C. Composition. The board of governors shall consist of seven (7) voting members, as follows:

1. The county administrative officer (ex-officio) or his or her designee which shall be appointed by the board of supervisors (any designation shall be for no less than one (1) year);

2. A member of the Kern Medical Center medical staff appointed by the board of supervisors; and

3. Five (5) members of the community at large appointed by the board of supervisors, none of whom shall be a physician.

D. Manner of Appointment.

1. Recruitment. Announcement of community member at large (CML) and the Kern Medical Center medical staff (medical staff) vacancies on the board of governors shall be posted on county and hospital authority websites and at the Kern Medical Center. The announcement shall include the minimum qualifications and submission deadline.

2. Applications.

(a) The chief executive officer of the Kern County Hospital Authority shall develop a form of application, known as the Kern County Hospital Authority Board of Governors application for appointment (application), and a security clearance consent form to be completed by all applicants to serve on the board of governors. All applicants must complete the application process by submitting a complete application and a security clearance consent form by the submission deadline. The application and the security consent form may be modified by the board of governors from time to time.

(b) The Kern County Hospital Authority chief executive officer shall post the required notice under Section 2.170.060(D)(1) that applications are being accepted.

(c) Applications shall be accepted from all eligible persons.

(d) Applications to serve on the board of governors may be made by submitting a completed application to: Kern County Hospital Authority, Chief Executive Officer, 1700 Mount Vernon Avenue, Bakersfield, California, 93306.

(e) A member whose term is expiring and who is eligible for reappointment need not submit a new application for reappointment if such member notifies the chairman of the board of governors who will notify the chairman of the board of supervisors in writing of the member's intent to seek reappointment.

(f) A qualifications review committee (QRC), composed of the county counsel (or his or her designee), the county administrative officer (or his or her designee), and the chief executive officer of the Kern Medical Center (or his or her designee), shall review all accepted applications for the initial board of governors to confirm that the applicants meet the required qualifications set forth in this Section 2.170.060(B)(2) and are not disqualified pursuant to this Section 2.170.060(B)(3). The board of supervisors may appoint additional members to the QRC at its discretion.

(g) Not sooner than thirty (30) days, nor longer than sixty (60) days, after the notice is posted that applications are being accepted, the QRC shall forward all applications from qualified applicants to the board of supervisors.

(h) The completed applications of all qualified applicants for the board of governors for CML and medical staff positions shall be submitted to the board of supervisors at least thirty (30) days prior to the scheduled meeting of the board of supervisors to consider appointment of an individual to fill any vacancy of the hospital authority board of governors.

3. Selection.

(a) Selection of the initial CML members and medical staff member and vacancies caused by term expiration.

(i) The board of supervisors, in its discretion, shall appoint to the initial board of governors five (5) CML members and one (1) member of the medical staff.

(ii) The board of governors shall forward to the board of supervisors all applications received by all qualified applicants to fill any vacancy. The board of supervisors may consider any such application to fill a vacancy created by the expiration of the term of a CML member or medical staff member.

(iii) The board of supervisors shall consider qualified applicants for appointment, but shall not be bound to appoint any such individual. The board of supervisors may only appoint qualified individuals who have formally applied for membership on the board of governors and have passed security clearance. The board of supervisors shall act by either making an appointment from the pool of qualified applicants, or requesting the submission of additional candidates to fill the vacancy, within thirty (30) days of receiving the list of qualified applicants.

(b) Selection of Members for Midterm Vacancies.

(i) In the event of a vacancy occurring before the expiration of a member's term, the board of governors shall forward all applications from qualified applicants to the board of supervisors. The list of qualified candidates and copies of their applications shall be submitted to the board of supervisors within sixty (60) days after the vacancy occurs.

(ii) Within thirty (30) days of receiving the names of qualified candidates to fill a midterm vacancy, or at its next regularly scheduled meeting, if such meeting occurs later than thirty (30) days after receiving candidates' names, the board of supervisors shall act to either: (a) appoint an individual to serve the remaining term of a member; or (b) ask for additional qualified applicants from the board of governors.

E. Term of Office.

1. The term of office for appointed members shall conform to the following:

(a) Each member, other than a member holding office ex-officio, shall hold office for a term of three (3) years, except the members initially appointed shall have staggered terms of one (1), two (2), and three (3) years. The board of supervisors shall determine which members shall be appointed to terms of one (1), two (2), and three (3) years by drawing lots. The lots shall be drawn on behalf of the board of supervisors by the clerk of the board of supervisors.

(b) The first term for the initial appointed members of the board of governors shall commence on the date of the initial board of governors meeting, and shall end at midnight on June 30 of the year in which the member has served his or her initial term of office of one (1), two (2), and three (3) years, as the case may be.

(c) Terms for members other than the initial members shall commence on July 1, or the date of the first scheduled board of governors meeting subsequent to his or her appointment if the member is appointed to fill a vacancy.

(d) An individual who is appointed to fill a vacancy mid-term shall have the balance of that term as his or her initial term.

2. Reappointment.

(a) Members may serve an unlimited number of terms if reappointed by the board of supervisors.

(b) Each member, whether serving an initial term or reappointed to a subsequent term, shall serve continuously until the expiration of his or her then-current term, or until a replacement is appointed, whichever occurs last.

F. Vacancies; Removal.

1. Attendance.

(a) A member shall automatically be removed from office, and said office shall become vacant, if within a one-year period of time, he or she fails to attend any combination of three (3) properly noticed regular and/or special meetings of the board of governors without having secured, either in advance of or promptly after the missed meeting, approval from a majority of the other members of the board of governors, or from the chairman of the board of governors, to miss the meeting.

(b) The board of governors shall advise in writing both the member and the board of supervisors of the pending removal of the member under this section and shall recite facts forming the basis for such removal. The removal shall become effective forty-five (45) days after the board of supervisors has been notified, without further action, unless the board of supervisors acts to reinstate the member for the balance of his or her term within the forty-five-day period.

2. Removal. A member may be removed by the board of supervisors during his or her term with or without cause, on its own initiative.

3. Resignation. A member may resign by submitting a letter of resignation to the chairman of the board of governors, who will notify the chairman of the board of supervisors in writing of the member's resignation.

4. Vacancies. Vacancies shall be filled by appointment by the board of supervisors, pursuant to Section 2.170.060(D)(3).

G. Procedures of the Board of Supervisors. All actions by the board of supervisors in connection with the board of governors of the hospital authority shall be subject to the following procedures:

1. Appointment or removal of members, and all other actions, other than actions that are advisory only, shall be by majority vote. The term "majority vote" in reference to a vote by the board of supervisors shall mean, throughout this chapter, a vote of at least three (3) of the total authorized members of the board of supervisors, notwithstanding any vacancies or absences then occurring.

2. Appointment of the initial members of the governing board shall be conducted as follows:

(a) CML Nominees. From the pool of qualified applicants provided by the QRC, each individual board of supervisors' member shall select up to two (2) candidates in order to generate a final roster of up to ten (10) candidates. A final roster shall be generated not longer than sixty (60) days from the applicable submission deadline. At its next regularly scheduled meeting, the board of supervisors shall vote by ballot to select the new appointees, with appointment to follow during the meeting.

(b) Medical Staff Nominees. The QRC shall recommend up to three (3) candidates chosen from the pool of medical staff applicants to the board of supervisors. Board of supervisors' members shall consider, but need not accept, the recommendations of the QRC. Applications from all qualified applicants shall be provided to the board of supervisors. The board of supervisors shall decide which candidates it wishes to interview, and conduct an interview of the candidates at its next regularly scheduled meeting. At this same meeting, the board of supervisors shall vote by ballot to select the appointee from among those candidates interviewed, with the appointment to follow during the meeting.

(c) Ballot Process:

(i) The clerk of the board of supervisors shall prepare and distribute written ballots containing the names of all candidates, by category (CML or medical staff).

(ii) Board of supervisors' members shall mark their ballots, voting for five (5) CML candidates and one (1) medical staff candidate, and return the ballot to the clerk of the board of supervisors. There is no cumulative voting.

(iii) The five (5) CML candidates and the one (1) CML medical staff candidate receiving a majority of votes in their respective categories shall be appointed.

(A) If, after the votes are tallied, one (1) or more vacancies remain because no candidate received a majority, the board of supervisors shall continue voting from among those who received votes, until each vacancy is filled by a candidate receiving a majority of votes. Each member of the board of supervisors may cast ballots for the number of vacancies remaining in each category, if any. For example, if two (2) CML vacancies remain, each member of the board of supervisors may cast two (2) ballots. There shall be no cumulative voting.

(B) If, after the voting, more than five (5) CML candidates or more than one (1) medical staff candidate receive a majority of votes, the board of supervisors shall proceed as follows: The top vote-getters shall be elected unless there is a tie among candidates whose election would cause the total number of CML members to exceed five (5), or the number of medical staff members to exceed one (1). The candidates receiving votes sufficient for election who cannot be seated due to a tie vote for the remaining seat(s) shall have their names placed upon a ballot by the clerk of the board of supervisors, and each member of the board of supervisors shall vote between or among such candidates for as many seats on the board of governors as remain open. The top vote-getter shall be elected. In the event of a tie, the process shall be repeated.

(C) At the conclusion of voting, the ballots shall be available for public inspection.

(D) At the conclusion of voting, the clerk of the board of supervisors shall certify the results and all successful candidates shall be eligible to assume office as members of the board of governors of the hospital authority.

3. The process for filling any vacancy occurring on the board of governors of the hospital authority shall be as follows:

Vacancy created by an expiring term or a midterm vacancy.

(a) The board of governors shall forward to the board of supervisors all applications of qualified applicants for a CML or medical staff vacancy, which may include a recommendation of the board of governors of a qualified applicant to fill the vacancy. The board of supervisors, in its discretion, may decide whether to request additional candidates and/or whether to interview any or all of the qualified candidates.

(b) The clerk of the board of supervisors shall prepare and distribute a ballot of all qualified candidates for the vacant position(s).

(c) Each member of the board of supervisors shall cast a ballot with one (1) vote for each vacancy. There is no cumulative voting. A candidate receiving a majority of all votes shall be appointed to the board of governors of the hospital authority. In the event a vacancy remains because no individual received a majority of all votes, the board of supervisors shall continue voting by ballot among all those receiving votes until each vacancy is filled by a candidate receiving a majority of all votes. In the event of a tie vote, or if more candidates receive a majority of votes than the number of vacant positions available, the board of supervisors shall proceed as described in Section 2.170.060(G)(2)(c). The clerk of the board of supervisors shall certify the voting results and the successful candidate(s) shall be eligible to assume office.

(d) At the conclusion of the voting, the ballots shall be available for public inspection.

(Ord. No. A-356, § 2, 10-6-15, eff. 11-6-15; Ord. No. A-359, § 2, 12-13-16; Ord. No. G-8814, § 2, 3-19-19)

Upon the creation of the hospital authority, prior to and subsequent to the transfer of the Kern Medical Center and other health-related resources, the hospital authority shall have the powers as set forth in Chapter 5.5 (commencing with Section 101852) of Part 4 of Division 101 of the Health and Safety Code, subject to written agreements with the county of Kern, the hospital authority bylaws adopted by the board of supervisors, and this chapter, including, but not limited to, the following:

A. The hospital authority may explore innovative health care delivery models to help ensure its viability and its ability to provide an ongoing material benefit to Kern County residents.

B. The hospital authority shall have the ability to retain surplus revenues for uses consistent with its purposes, as set forth in the various agreements and other documents between the county of Kern and the hospital authority. If the hospital authority participates in the county treasury pool pursuant to Section 2.170.030(H), the hospital authority shall deposit all revenues when received in the county treasury, and the treasurer shall immediately credit and apply on its books any and all revenues so deposited by the hospital authority to the repayment of any temporary transfers previously made to the hospital authority pursuant to Article XVI, Section 6 of the California Constitution (each, an "outstanding treasury transfer"). Thereafter, the hospital authority shall reserve and set aside on its books collected revenues or, with the agreement of the county, anticipated revenues sufficient to pay and satisfy any and all obligations of the hospital authority that are due and payable or shall be so due and payable in the then current fiscal year (each, a "current obligation"), including amounts due and payable to the county of Kern in such fiscal year (including, without limitation, amounts owing on advances to cover prior year hospital cash flow deficits and retirement payment obligations). All revenues received by the hospital authority in a fiscal year shall be deemed encumbered to the extent of any and all outstanding treasury transfers and current obligations in such fiscal year, and only the excess, if any, of such revenues over such outstanding treasury transfers and other obligations in a fiscal year shall be deemed "surplus revenues." Nothing herein shall preclude the hospital authority from the use of surplus revenues for the repayment of its debts or other liabilities, either in advance of, or when they come due, using funds that are not otherwise encumbered.

C. The hospital authority shall have the power to appoint and employ or otherwise engage a chief executive officer and other necessary officers and employees.

D. The hospital authority shall have the power to incur indebtedness and to borrow money and issue bonds, subject to the approval of the board of supervisors.

E. The hospital authority shall have the ability to transfer funds to the state and incur certified public expenditures in support of the Medi-Cal program and other programs for which federal financial participation is available.

F. The hospital authority shall have the power to purchase supplies, equipment, materials, property, and services and the power to enter into contracts, pursuant to Chapter 5.5 (commencing with Section 101852) of Part 4 of Division 101 of the Health and Safety Code. Any contract executed by and between the county of Kern and the hospital authority, or any other entity and the hospital authority, shall contain a provision that liabilities or obligations of the hospital authority with respect to its activities pursuant to the contract shall be the liabilities or obligations of the hospital authority and shall not be nor become the liabilities or obligations of the county.

G. The hospital authority shall have the power to establish its own policies and procedures, such as (without limitation) human resources and procurement policies.

H. The hospital authority shall have the power to participate as an employer district in the Kern County Employees' Retirement Association.

I. The hospital authority shall have the power to retain legal counsel and the power to pay retained legal counsel for representation and services.

(Ord. No. A-356, § 2, 10-6-15, eff. 11-6-15; Ord. No. A-360, § 2, 12-20-16)

The following items are intended to help ensure the transfer of the Kern Medical Center constitutes an ongoing material benefit to the county of Kern and its residents.

A. The board of supervisors shall approve the hospital authority's annual budget after the budget is approved by the hospital authority's board of governors. The board of supervisors shall either approve or reject the hospital authority's annual budget in its entirety; the board of supervisors shall not approve or reject individual line items in the budget. The hospital authority shall provide its budget to the board of supervisors in accordance with the processes set forth in a formal written agreement between the hospital authority and the county of Kern. If the hospital authority does not provide its budget in accordance with such processes, the board of supervisors shall adopt an annual budget for the hospital authority.

B. The hospital authority shall conduct and fund an independent annual audit by an audit firm selected by the board of governors and approved by the board of supervisors and shall provide copies of all final audits of the hospital authority to the board of supervisors. The hospital authority shall provide the board of supervisors upon request with a plan to address audit findings requiring corrective action, and a report of corrective action taken.

C. The board of supervisors shall approve the chief executive officer of the hospital authority prior to his or her appointment by the hospital authority. The board of supervisors may participate in the evaluation of the chief executive officer of the hospital authority.

D. The hospital authority shall obtain the approval of the board of supervisors prior to entering into or incurring any debt other than the following: (1) debt that has a repayment term of less than one (1) year; and (2) debt secured only by personal property.

E. The hospital authority may request that the board of supervisors levy a tax on behalf of the hospital authority. If the board of supervisors approves the proposal to levy the tax, it shall call the election to seek voter approval and place the appropriate measure on the ballot for that election.

F. The board of supervisors may contract with the hospital authority to provide services or items pursuant to Chapter 5.5 (commencing with Section 101852) of Part 4 of Division 101 of the Health and Safety Code.

G. The board of supervisors may, at the request and on behalf of the hospital authority, contract for services or purchase items as it deems necessary, appropriate, or convenient for the conduct of the hospital authority's activities consistent with its purposes.

H. The county of Kern shall continue to retain the ultimate responsibility for indigent medical care pursuant to Section 17000 of the Welfare and Institutions Code.

I. The hospital authority shall not offer its employees, whether new or legacy, who are members of Kern County Employees' Retirement Association retirement benefits that are greater than those available to the Kern Medical Center employees at the time of the transfer of the Kern Medical Center to the hospital authority and that increase the unfunded pension obligations of the county of Kern without the express prior approval of the board of supervisors.

J. The board of supervisors shall have the right to approve certain actions by the hospital authority, which shall include (without limiting any other rights of the board of supervisors set forth in this chapter or any agreement between the county of Kern and the hospital authority):

1. The use of any name or names by the hospital authority for "doing business as" in addition to the name "Kern Medical Center" with respect to the licensed acute care hospital;

2. Transfer of substantially all of the assets, operations, or control of the Kern Medical Center from the hospital authority to any other person or entity;

3. Relocation or replacement of the acute care hospital;

4. Establishment or acquisition of any new acute care hospital;

5. Establishment or acquisition of new health care programs or facilities that have an annual operating budget that exceeds fifteen percent (15%) of the hospital authority's total annual operating budget;

6. Any joint venture or joint powers agreement that creates new health programs or facilities that have an annual operating budget that exceeds fifteen percent (15%) of the hospital authority's total annual operation, or any joint venture with a private nongovernmental entity(s) or individual(s) regardless of the size of such joint venture's operating budget;

7. Complete elimination of graduate medical education, trauma services, obstetrical services, or inpatient psychiatric services;

8. Establishment or operation of a health plan as defined by the Knox-Keene Act of 1975; and

9. Operation or ownership of any health facility or clinic located outside of the county of Kern.

(Ord. No. A-356, § 2, 10-6-15, eff. 11-6-15; Ord. No. A-357, § 3, 3-8-16; Ord. No. A-360, § 3, 12-20-16; Ord. No. G-8814, § 3, 3-19-19)

A. The transfer of the governance, administration, operations, maintenance, and ownership of the Kern Medical Center shall occur in an incremental manner through three (3) coordinated phases. The intent of this phased-in implementation is to coordinate the transfer and to minimize the effects on patients, employees, staff, and to the county.

B. The individual phases shall be implemented as set forth in the hospital authority implementation plan approved by the board of supervisors. The three (3) phases include:

1. Creation of the hospital authority;

2. Transfer of the ownership and governance of the Kern Medical Center and transfer of its employees and operations; and

3. Transfer of remaining county services, as necessary.

C. The effective date of transfer of governance and assets and liabilities of the Kern Medical Center shall be an agreed-upon closing date following the execution and delivery of:

1. One (1) or more agreements and such other documents deemed necessary by legal counsel for the county to complete the transfer of the Kern Medical Center, its operations, and personnel to the hospital authority consistent with this chapter; and

2. Approval of the general acute care hospital license(s) and all other regulatory requirements, along with satisfaction of all closing conditions set forth in the various agreements and other documents between the county of Kern and the hospital authority, and all other actions deemed necessary by legal counsel for the county to complete the transfer.

D. The effective date of the transfer of employees shall be upon execution and delivery of all agreements, documents, approvals, and actions needed to accomplish the closing as set forth in the various agreements and other documents between the county of Kern and the hospital authority, including, without limitation, approval by the board of supervisors of the personnel transition plan as set forth in Section 101853.1(a) of the Health and Safety Code.

E. Prior to the transfer of the Kern Medical Center to the hospital authority, the hospital authority and the county shall file all state and federal documents necessary to: transfer the Kern Medical Center and employees to the hospital authority, transfer or obtain new licenses and provider numbers, assign or transfer such agreements, leases, accounts and other business or regulatory approvals as may be necessary to transfer the operations of the Kern Medical Center to the hospital authority, establish the status of the hospital authority as a local government entity for federal tax purposes, and participate in the financing of and receive funding as a designated public hospital.

F. Prior to the initial appointment of the board of governors pursuant to Section 2.170.060, the county of Kern shall have the power to meet and confer with employee representatives on such subjects as have been identified in Section 101853.1(a) of the Health and Safety Code, and any agreements or memoranda of understanding that have been reached by the county and such employee representatives shall be binding on the hospital authority.

After the initial appointment of the board of governors pursuant to Section 2.170.060 and prior to the transfer of the Kern Medical Center to the hospital authority, the hospital authority shall have the power to meet and confer with employee representatives regarding the transfer of county employees to the hospital authority on such subjects as have been identified in Section 101853.1(a) of the Health and Safety Code and to the extent such powers have been delegated to the hospital authority by the county of Kern.

G. The hospital authority may borrow funds from the county, and the county may lend funds to the hospital authority in a manner consistent with applicable law and county policy. Any loans or other funds provided by the county in support of the hospital authority shall be consistent with the public purposes of the county and shall be at the discretion of the county. Prior to lending funds to the authority, the county shall determine that such loan does not have a negative impact upon any obligation or responsibility, whether existing or contemplated in the future, which the county may have.

H. The hospital authority may engage in marketing, advertising, and promotion of the medical and health care services to be made available to the community by the Kern Medical Center.

I. The hospital authority shall accept the assignment and delegation of any contract assigned to it by the county in which the county is a party on behalf of the Kern Medical Center. Once assigned, the hospital authority shall possess those rights and perform the duties previously attributed to the county, pursuant to the contract terms, subject to any applicable terms of assignment.

(Ord. No. A-356, § 2, 10-6-15, eff. 11-6-15)

A. The board of supervisors shall adopt a personnel transition plan as set forth in Section 101853.1(a) of the Health and Safety Code prior to the transfer of employees from the county to the hospital authority. The personnel transition plan shall address personnel policy, compensation and benefit issues for county employees transferred to the hospital authority, consistent with Section 101853.1(a) of the Health and Safety Code. As provided in Section 101853.1(b) of the Health and Safety Code, employees of the Kern Medical Center or county on the date of transfer, who become hospital authority employees shall retain their existing or equivalent classifications and job descriptions upon transfer to the hospital authority, receive comparable pension benefits (if permissible pursuant to relevant plan terms), and their existing salaries and other benefits that include but are not limited to vacation (including accrued unused vacation), sick leave, personal leave, health care, retiree health benefits and deferred compensation plans. In accordance with Section 101853.1(d) of the Health and Safety Code, the hospital authority shall provide the same level of employee benefits for a period of twenty-four (24) months after the effective date of the transfer of the Kern Medical Center to the hospital authority, to the extent required by applicable memoranda of understanding, other agreements, or law. Should any memoranda of understanding be expired on the date of the transfer of the Kern Medical Center, then the hospital authority shall continue to be bound by the terms and conditions of the most recent memoranda of understanding, unless modified by a mutual agreement with each of the exclusive employee representatives.

B. In accordance with Section 101853.1(g)(7) of the Health and Safety Code, the board of supervisors shall direct the preparation of a plan for participation of specified categories of hospital authority employees in the Kern County Employees' Retirement Association, which plan shall (i) provide that county employees who retired from the Kern Medical Center prior to the effective date of the transfer of the Kern Medical Center to the hospital authority, county employees who are initially transferred to the hospital authority on the date of the transfer of the Kern Medical Center to the hospital authority, and those employees hired directly by or retired from the hospital authority during the first twenty-four (24) months following the effective date of the transfer of the Kern Medical Center to the hospital authority ("legacy employees"), shall continue to be deemed to be employees of the county for purposes of participation in the Kern County Employees' Retirement Association, but only for such purpose, and shall not be employees of the county for any other purpose, and, upon the transfer of control of the Kern Medical Center and thereafter, the county shall include legacy employees in a special county employee group for which the county shall continue to be primarily responsible to fund all employer contributions that, together with contributions by employees and earnings thereon, are necessary to fund all benefits for legacy employees administered by the Kern County Employees' Retirement Association; (ii) provide that the hospital authority shall be primarily responsible for any required pension contributions attributable to new employees hired by the hospital authority after the twenty-four-month transition period described in item (i) above ("new employees"); (iii) that the hospital authority shall make all periodic employer pension contributions that together with contributions by employees and earnings thereon are necessary to fund all benefits administered by the Kern County Employees' Retirement Association for both new and legacy employees; (iv) provide that in the event the hospital authority fails to make required periodic employer contributions for legacy employees when due and after demand from the Kern County Employees' Retirement Association, the county shall be obligated to make such contributions after receipt of notice and demand from the Kern County Employees' Retirement Association; (v) provide that in the event the hospital authority fails to make required contributions for any new employees when due and after demand from the Kern County Employees' Retirement Association, the county shall be obligated to make such required contributions after receipt of notice and demand from the Kern County Employees' Retirement Association, and that this obligation shall continue until such time as the hospital authority demonstrates, and the Kern County Employees' Retirement Association Board of Retirement determines, that the hospital authority is sufficiently capable financially to fully assume the obligation to make all such employer contributions for the new employees, based upon the standard of financial capability approved by the Kern County Employees' Retirement Association and the county in the plan of participation and incorporated within a written agreement between the county and the hospital authority; and (vi) once the county obligation under subpart (v) ends, provide that in the event the hospital authority fails to make required periodic employer contributions due to the hospital authority's dissolution or bankruptcy, the county shall be obligated to make such contributions after receipt of notice and demand from the Kern County Employees' Retirement Association. This plan of participation must be approved by the Kern County Employees' Retirement Association's governing board; following such approval, the final plan of participation shall be considered by the board of supervisors and, if consistent with the foregoing, said plan of participation shall be adopted by the board of supervisors. The terms of this plan of participation shall be included in a written agreement between the county of Kern and the hospital authority.

C. Consistent with Section 101853.1(a) of the Health and Safety Code, upon transfer of the Kern Medical Center to the hospital authority, the memoranda of understanding in effect on the date of the transfer, or, in the absence of any such existing memoranda of understanding, the most recent memoranda of understanding, shall remain in effect for a period of twenty-four (24) months, or through the term of such memoranda of understanding, whichever shall be longer, unless modified by mutual agreement with the applicable exclusive employee representative.

(Ord. No. A-356, § 2, 10-6-15, eff. 11-6-15)

A. The board of supervisors shall adopt the initial governing bylaws for the hospital authority, which it may amend from time to time. The bylaws shall become operative upon approval by a majority vote of the board of supervisors. Any changes or amendments to the bylaws shall be by majority vote of the board of supervisors. The board of governors shall implement the bylaws adopted by the board of supervisors. The hospital authority bylaws shall provide, in detail, for the operation of the hospital authority and shall contain articles pertaining to, at minimum, the following:

1. Mission and purposes of the hospital authority;

2. Qualifications for membership on the hospital authority board of governors;

3. Composition and term of office;

4. Manner of appointment;

5. Vacancies and removal;

6. Compensation;

7. Conflict of interest;

8. Duties and responsibilities of board of governors;

9. Meetings;

10. Committees;

11. Officers;

12. Indemnification;

13. Adoption and amendment of bylaws;

14. Administration; and

15. Medical staff.

B. The board of governors shall adopt medical staff bylaws and take other such actions as may be necessary to establish the medical staff of the Kern Medical Center.

(Ord. No. A-356, § 2, 10-6-15, eff. 11-6-15)

The hospital authority and its officers and directors shall conduct activities in a manner that is in conformity with the laws of the state of California as they pertain to conflicts of interest, including, but not limited to, the following:

A. Political Reform Act. The hospital authority shall adopt and promulgate a conflict of interest code pursuant to the provisions of the Political Reform Act of 1974 (commencing with Section 81000 of the Government Code), which shall be submitted to the board of supervisors or other appropriate code reviewing body within six (6) months of the date the hospital authority came into existence pursuant to the effective date of the ordinance codified in this chapter. Each member of the board of governors of the hospital authority is subject to the provisions of the Political Reform Act, and shall be required to execute a "statement of economic interests" in a manner consistent with the Act and the hospital authority's conflict of interest code.

B. Financial Interests Involving Contracts. A member of the hospital authority board of governors shall not be deemed interested in a contract entered into by the hospital authority within the meaning of Sections 1090 et seq. of the Government Code if the conditions set forth in Section 101854(d) of the Health and Safety Code are met.

C. Common Law Conflicts of Interest. Each member of the hospital authority board of governors and officer shall discharge his or her duties with integrity and fidelity and may not let private interests influence public decisions.

D. Incompatible Activities. In accordance with Section 101855(o) of the Health and Safety Code, a member of the hospital authority's administrative staff shall not be considered to hold an incompatible office or to be engaged in activities inconsistent and incompatible with his or her duties as a result of his or her employment or affiliation with the county of Kern or an agency of the county.

(Ord. No. A-356, § 2, 10-6-15, eff. 11-6-15)

The hospital authority shall have the power to adopt reasonable rules and regulations consistent with Section 3507 of the Government Code.

(Ord. No. A-356, § 2, 10-6-15, eff. 11-6-15)

A. The board of supervisors, in its discretion, may find and declare by adoption of a resolution that the hospital authority shall cease to exist and cause the hospital authority to be dissolved. In that event, the board of supervisors shall on its own or taking into account a plan of dissolution developed by the board of governors at the board of supervisors' direction, provide for the disposition of the hospital authority's assets, obligations, and liabilities to the county or another California state or public entity for a public purpose, through ordinance, resolution, or other action.

B. Upon dissolution of the liabilities of the hospital authority and distribution of any remaining assets, the board of supervisors shall rescind this chapter establishing the hospital authority, and the hospital authority shall cease to exist.

(Ord. No. A-356, § 2, 10-6-15, eff. 11-6-15; Ord. No. A-357, § 2, 3-8-16)

If any section, subsection, phrase, or clause of this chapter is for any reason held to be unlawful, such decision shall not affect the validity of the remaining portions of this chapter.

(Ord. No. A-356, § 2, 10-6-15, eff. 11-6-15)