Missouri Statute | Act | Code |Public Health And Welfare| US Code - US Statute

1. A hospital district may be created, incorporated and managed
as provided in this chapter and may exercise the powers herein granted or
necessarily implied. A hospital district may include municipalities or
territory not in municipalities or both or territory in one or more
counties; provided, that the provisions of this chapter are not effective
in counties having a population of more than four hundred thousand
inhabitants. The territory contained within the corporate limits of an
existing hospital district shall not be incorporated in another hospital
district.

2. When a hospital district is organized it shall be a body corporate and
political subdivision of the state and shall be known as "..............
Hospital District", and in that name may sue and be sued, levy and
collect taxes within the limitations of this chapter and the constitution
and issue bonds as herein provided. (L. 1961 p. 524 § 2)

(1985) Statute provision that the hospital district "may sue and be sued"
in its own name does not waive sovereign immunity for negligence actions.
State ex rel. New Liberty Hospital District v. Pratt (Mo. banc), 687
S.W.2d 184.

Whenever the creation of a hospital district is desired, a
number of voters residing in the proposed district equal to ten percent
of the vote cast in the proposed district in the next preceding general
election may file with the county clerk in which the territory or the
greater part thereof is situated a petition requesting the creation
thereof. In case the proposed district which shall be contiguous is
situated in two or more counties, the petition shall be filed in the
office of the county clerk of the county in which the greater part of the
area is situated, and the commissioners of the county commission of said
county shall set the petition for public hearing. The petition shall set
forth:

(1) A description of the territory to be embraced in the proposed
district;

(2) The names of the municipalities located within the area;

(3) The name of the proposed district;

(4) The population of the district which shall not be less than two
thousand inhabitants;

(5) The assessed valuation of the area, which shall not be less than two
million five hundred thousand dollars; and

(6) A request that the question be submitted to the voters residing
within the limits of the proposed hospital district whether they will
establish a hospital district under this chapter to be known as ".....
Hospital District" for the purpose of constructing and maintaining a
public hospital. (L. 1961 p. 524 § 3, A.L. 1978 H.B. 971)

1. Upon the filing of the petition with the county clerk, he
shall present it to the commissioners of the county commission who shall
thereupon set the petition for hearing within not less than thirty nor
more than forty days after the filing thereof.

2. Notice shall be given by the commissioner of the county commission of
the time and place where the hearing will be held, by publication on
three separate days in one or more newspapers having a general
circulation within the territory proposed to be incorporated as a
hospital district, the first of which publications shall be not less than
twenty days prior to the date set for the hearing and if there is no such
newspaper, then notice shall be posted in ten of the most public places
in the territory, not less than twenty days prior to the date set for the
hearing. This notice shall include a description of the territory as set
out in the petition, names of municipalities located therein and the name
of the proposed district and the question of creating a hospital district.

3. The cost of printing and publication or posting of notices of public
hearing thereon shall be paid in advance by the petitioners, and, if a
district be organized under this chapter, they shall be reimbursed out of
the funds received by the district from taxation or other sources. (L.
1961 p. 524 § 4)

If two or more petitions covering in part the same territory are
filed prior to the public hearing upon the petition which is first filed,
the petitions shall be consolidated for public hearing, and hearing
thereon may be continued to permit the giving of notice of any subsequent
petition or petitions. At the public hearing upon the petitions, the
petitioners in the petition first filed may move to amend the petition to
include any part of the territory described in the subsequent petition or
petitions, either as originally filed or as amended. Any such motion
shall be allowed by the commissioners of the county commission. The
public hearing shall proceed upon the first petition as originally filed
or as so amended, and further proceedings upon any other petitions
subsequently filed shall be stayed and held in abeyance until the
termination of all proceedings upon the first petition, or any petition
may be dismissed or withdrawn upon motion of the petitioners therein by
their representatives. (L. 1961 p. 524 § 5)

If the territory, petition and proceedings meet the requirements
of this chapter, the commissioners of the county commission shall in and
by the order finding and determining the sufficiency of the petition and
that the territory meets the requirements of the chapter * order the
question to be submitted to the voters of the proposed district. (L. 1961
p. 524 § 6, A.L. 1978 H.B. 971)

*Word "shall" appears here in original rolls.

1. Each notice shall state briefly the purpose of the election,
setting forth the question to be voted upon, form of ballot to be used
and a description of the territory. The notice shall further state that
any district upon its establishment shall have the powers, objects and
purposes provided by this chapter, and shall have the power to levy a
property tax not to exceed one dollar on the one hundred dollars
valuation.

2. For any ballot proposal in which the maximum levy exceeds fifty cents
per one hundred dollars of assessed valuation, the board of directors
shall publish in a newspaper or newspapers of general circulation and
otherwise make available upon request a summary description of the
board's plans for using the money for ongoing hospital operations. (L.
1961 p. 524 § 7, A.L. 1978 H.B. 971, A.L. 1984 S.B. 576, A.L. 1999 S.B.
348)

The question shall be submitted in substantially the following
form:

Shall there be organized in the counties of ......, state of Missouri, a
hospital district for the establishment and operation of a hospital to be
located at* ....... in ....... County, Missouri, and having the power to
impose a property tax not to exceed the annual rate of fifty cents on the
hundred dollars assessed valuation without voter approval, and such
additional tax as may be approved hereafter by vote thereon to be known
as "....... Hospital District", as prayed for by petition filed with the
county clerk of ....... County, Missouri, on the .... day of ......,
20......? (L. 1961 p. 524 § 8, A.L. 1978 H.B. 971, A.L. 1984 S.B. 576)

*Word "at" does not appear in original rolls.

The county commissioners shall cause the order determining and
declaring results of the election to be entered upon the records of the
commission and a certified copy thereof shall be filed with the county
clerk of each other county in which the proposed district lies who shall
cause the same to be spread upon the records of the county commission. If
the order shows that the majority of the votes cast on the question are
in favor thereof, the order shall declare the district organized. (L.
1961 p. 524 § 9, A.L. 1978 H.B. 971)

1. After the hospital district has been declared organized, the
declaring county commission shall divide the district into six election
districts as equal in population as possible, and shall by lot number the
districts from one to six inclusive. The county commission shall cause an
election to be held in the hospital district within ninety days after the
order establishing the hospital district to elect hospital district
directors. Each voter shall vote for six directors, one from each
district. Directors shall serve a term of six years or a lesser term of
years as may be established by the county commission. If directors are to
serve a term of six years, the initial term of the director elected from
district number one shall serve a term of one year, the director elected
from district number two shall serve a term of two years, the director
elected from district number three shall serve a term of three years, the
director elected from district number four shall serve a term of four
years, the director elected from district number five shall serve a term
of five years, and the director elected from district number six shall
serve a term of six years; thereafter, the terms of all directors shall
be six years. If the county commission chooses to establish a term of
office of less than six years, the initial election of directors shall be
done in a manner established by the county commission. All directors
shall serve until their successors are elected and qualified. Any vacancy
shall be filled by the remaining members of the board of directors who
shall appoint a person to serve as director until the next municipal
election.

2. Candidates for director of the hospital district shall be citizens of
the United States, voters of the hospital district who have resided
within the state for one year next preceding the election and who are at
least thirty years of age. All candidates shall file their declaration of
candidacy with the county commission calling the election for the
organizational election, and for subsequent elections, with the secretary
of the board of directors of the district.

3. Notwithstanding any other provisions of law, if the number of
candidates for office of director is no greater than the number of
directors to be elected, no election shall be held, and the candidates
shall assume the responsibilities of their offices at the same time and
in the same manner as if they had been elected.

4. Notwithstanding the provisions of subsections 1 to 3 of this section,
after the formation of the hospital district, the hospital board of
directors, by a majority vote of the directors with the consent of a
majority of the county commission on an order of record, may abolish the
six hospital districts' election districts and cause the hospital
district directors to be elected from the hospital district at large.
Upon opting to elect the hospital district directors at large, the then
serving hospital district directors shall continue to serve the remainder
of their terms and any vacancies on the board, after the date of such
option, shall be filled by an election conducted at large in the
district. (L. 1961 p. 524 § 10, A.L. 1967 p. 319, A.L. 1978 H.B. 971,
A.L. 1982 H.B. 1086, A.L. 1988 H.B. 1635, A.L. 1996 S.B. 484)

1. The board of directors of a district shall possess and
exercise all of its legislative and executive powers. Within thirty days
after the election of the initial directors, the board shall meet. The
time and place of the first meeting of the board shall be designated by
the county commission. At its first meeting the board shall elect a
chairman from its members and select a secretary, treasurer and such
officers or employees as it deems expedient or necessary for the
accomplishment of its corporate objects. The secretary and treasurer need
not be members of the board. At the meeting the board by ordinance shall
define the first and subsequent fiscal years of the district, and shall
adopt a corporate seal and bylaws, which shall determine the times for
the annual election of officers and of other regular and special meetings
of the board and shall contain the rules for the transaction of other
business of the district and for amending the bylaws.

2. Each director of any district shall devote such time to the duties of
the office as the faithful discharge thereof may require and shall serve
without compensation. (L. 1961 p. 524 § 11)

1. The board of hospital trustees shall include in its bylaws
that every physician, a podiatrist and dentist requesting permission to
practice in its hospital shall submit an application for staff membership
in writing to it upon forms approved by the board. In his application
each applicant shall give specifically his training and qualifications,
his willingness to accept the board as the supreme governing authority of
the hospital, his willingness to abide by the bylaws of the board and the
staff in all respects, and his determination to practice his profession
in a manner which is legal, moral, and ethical. A written copy of all
such bylaws, with any amendments, shall be kept on file in the office of
the hospital administrator and shall be available to all staff members
and applicants during normal business hours.

2. The professional staff of the hospital shall be an organized group
which shall initiate and, with the approval of the board, adopt bylaws,
rules, regulations, and policies governing professional activities in the
hospital. General practitioners may practice in the hospital in
accordance with their competence as recommended by the professional staff
and as authorized by the board. (L. 1971 H.B. 301)

1. A hospital district, both within and outside such district,
except in counties of the third or fourth classification (other than
within the district boundaries) where there already exists a hospital
organized pursuant to chapters 96, 205, RSMo, or this chapter; provided,
however, that this exception shall not prohibit the continuation or
expansion of existing activities otherwise allowed by law, shall have and
exercise the following governmental powers, and all other powers
incidental, necessary, convenient or desirable to carry out and
effectuate the express powers:

(1) To establish and maintain a hospital or hospitals and hospital
facilities, and to construct, acquire, develop, expand, extend and
improve any such hospital or hospital facility including medical office
buildings to provide offices for rental to physicians and dentists on the
district hospital's medical or dental staff, and the providing of sites
therefor, including offstreet parking space for motor vehicles;

(2) To acquire land in fee simple, rights in land and easements upon,
over or across land and leasehold interest in land and tangible and
intangible personal property used or useful for the location,
establishment, maintenance, development, expansion, extension or
improvement of any hospital or hospital facility. The acquisition may be
by dedication, purchase, gift, agreement, lease, use or adverse
possession or by condemnation;

(3) To operate, maintain and manage a hospital and hospital facilities,
and to make and enter into contracts, for the use, operation or
management of a hospital or hospital facilities; to engage in health care
activities; and to make and enter into leases of equipment and real
property, a hospital or hospital facilities, as lessor or lessee,
regardless of the duration of such lease; and to provide rules and
regulations for the operation, management or use of a hospital or
hospital facilities. Any agreement entered into pursuant to this
subsection pertaining to the lease of the hospital shall have a definite
termination date as negotiated by the parties, but this shall not
preclude the trustees from entering into a renewal of the agreement with
the same or other parties pertaining to the same or other subjects upon
such terms and conditions as the parties may agree;

(4) To fix, charge and collect reasonable fees and compensation for the
use or occupancy of the hospital or any part thereof, or any hospital
facility, and for nursing care, medicine, attendance, or other services
furnished by the hospital or hospital facilities, according to the rules
and regulations prescribed by the board from time to time;

(5) To borrow money and to issue bonds, notes, certificates, or other
evidences of indebtedness for the purpose of accomplishing any of its
corporate purposes, subject to compliance with any condition or
limitation set forth in this chapter or otherwise provided by the
Constitution of the state of Missouri;

(6) To employ or enter into contracts for the employment of any person,
firm, or corporation, and for professional services, necessary or
desirable for the accomplishment of the corporate objects of the district
or the proper administration, management, protection or control of its
property;

(7) To maintain the hospital for the benefit of the inhabitants of the
area comprising the district who are sick, injured, or maimed regardless
of race, creed or color, and to adopt such reasonable rules and
regulations as may be necessary to render the use of the hospital of the
greatest benefit to the greatest number; to exclude from the use of the
hospital all persons who willfully disregard any of the rules and
regulations so established; to extend the privileges and use of the
hospital to persons residing outside the area of the district upon such
terms and conditions as the board of directors prescribes by its rules
and regulations;

(8) To police its property and to exercise police powers in respect
thereto or in respect to the enforcement of any rule or regulation
provided by the ordinances of the district and to employ and commission
police officers and other qualified persons to enforce the same.

2. The use of any hospital or hospital facility of a district shall be
subject to the reasonable regulation and control of the district and upon
such reasonable terms and conditions as shall be established by its board
of directors.

3. A regulatory ordinance of a district adopted under any provision of
this section may provide for a suspension or revocation of any rights or
privileges within the control of the district for a violation of any such
regulatory ordinance.

4. Nothing in this section or in other provisions of this chapter shall
be construed to authorize the district or board to establish or enforce
any regulation or rule in respect to hospitalization or the operation or
maintenance of such hospital or any hospital facilities within its
jurisdiction which is in conflict with any federal or state law or
regulation applicable to the same subject matter. (L. 1961 p. 524 § 12,
A.L. 1981 H.B. 258, A.L. 1987 H.B. 810, A.L. 1996 S.B. 676, A.L. 1997
S.B. 104)

1. For the purpose of purchasing hospital sites, erecting
hospitals and related facilities and furnishing the same, building
additions to and repairing old buildings, the board of directors may
borrow money and issue bonds for the payment thereof in the manner
provided herein. The question of the loan shall be submitted to the
voters by an order of the board of directors of the district.

2. The question shall be submitted in substantially the following form:

Shall the ...... hospital district borrow money in the amount of .......
dollars for the purpose of ........ and issue bonds in payment thereof?

3. If the then constitutionally required majority of the votes cast are
for the loan, the board shall, subject to the restrictions of subsection
5, be vested with the power to borrow money in the name of the district,
to the amount and for the purposes specified on the ballot, and issue the
bonds of the district for the payment thereof.

4. If less than the required majority of the votes cast are for the first
loan submitted to the voters following the organization of the district,
a second question for authority to borrow money may be submitted and if
unsuccessful a third question may be submitted. If each of the first
three questions submitted to the voters for authority to borrow money for
the purposes of this section is defeated, or if no successful submission
for such purpose is conducted within five years after the establishment
of the district, then the district shall be immediately dissolved by
order of the county commission establishing it, and any funds remaining
on hand and belonging to the district shall forthwith be paid pro rata to
those taxpayers from whom they were collected; provided that in any
district wherein a hospital is in operation without having voted bonds,
the provisions of this section as relating to dissolution shall not apply.

5. The loans authorized by this section shall not be contracted for a
period longer than twenty years, and the entire amount of the loan shall
at no time exceed, including the existing indebtedness of the district,
in the aggregate, ten percent of the value of taxable tangible property
therein, as shown by the last completed assessment for state and county
purposes, the rate of interest to be agreed upon by the parties, but in
no case to exceed the highest legal rate allowed by contract. When
effected, it shall be the duty of the directors to provide for the
collection of an annual tax sufficient to pay the interest on the
indebtedness as it falls due, and also to constitute a sinking fund for
the payment of the principal thereof within the time the principal
becomes due. (L. 1961 p. 524 § 13, A.L. 1967 p. 319, A.L. 1969 S.B. 38,
A.L. 1978 H.B. 971)

As an alternative to the authorization for an indebtedness
provided by section 206.120, for the purpose of providing funds for the
acquisition, construction, erection, equipment and furnishing of
hospitals and related facilities, including medical office buildings to
provide offices for rental to physicians and dentists on the district
hospital's medical or dental staff, and for providing sites therefor,
including offstreet parking space, and making from time to time
enlargements or extensions thereof, the board of directors may issue and
sell revenue bonds. The revenue bonds are payable, both as to principal
and interest, solely and only out of the net income and revenues arising
from the operation of the facility, after providing for the costs of
operation and maintenance thereof, or from other funds made available to
the facility from sources other than from proceeds of taxation. (L. 1971
S.B. 142, A.L. 1981 H.B. 258)

Any bonds issued under and pursuant to sections 206.122 to
206.128 shall not be deemed to be an indebtedness of the state of
Missouri, or of any city or of the board of directors, or of the
individual members of the board of directors and shall not be deemed to
be an indebtedness within the meaning of any constitutional or statutory
limitation upon the incurring of indebtedness. (L. 1971 S.B. 142)

1. Revenue bonds issued pursuant to the provisions of section
206.122 shall be of such denomination, shall bear such rate of interest
not to exceed the highest rate permitted by law, and shall mature at such
times as determined by the board of directors. The bonds may be either
serial bonds or term bonds and may be issued with or without reservation
of the right to call them for payment or redemption in advance of their
maturity, upon the giving of notice and with or without the covenant
requiring the payment of a premium in the event of the call and
redemption prior to maturity as the board determines.

2. The bonds when issued and sold shall be negotiable instruments within
the meaning of the law merchant and the negotiable instruments law and
the interest thereon is exempt from income taxes under the laws of the
state of Missouri. (L. 1971 S.B. 142)

1. The board of directors, issuing bonds under the provisions of
section 206.122, shall prescribe the form, details and incidents of the
bonds and the board of directors shall make such covenants as in their
judgment are advisable or necessary properly to secure the payment
thereof; but the form, details, incidents and covenants shall not be
inconsistent with any of the provisions of sections 206.122 to 206.128.

2. The holder of any bonds issued hereunder or of any coupons
representing interest accrued thereon may, by civil action either at law
or in equity, compel the board of directors issuing such bonds to perform
all duties imposed upon them by the provisions of sections 206.122 to
206.128, and also to enforce the performance of any and all other
covenants made by such board of directors in the issuance of the bonds.

3. The provisions of sections 206.122 to 206.128 shall not be exclusive
of other legal methods of financing the facilities therein described, but
shall furnish an alternative method of finance. (L. 1971 S.B. 142)

1. A petition for annexation of land to a hospital district
shall be signed by not less than ten percent or fifty voters, whichever
is fewer, residing within the territory therein described proposed for
annexation and shall be filed with the county clerk of the county in
which the district or the greater portion thereof is situated, and shall
be addressed to the commissioners of the county commission. A hearing
shall be held thereon as nearly as possible as in the case of a formation
petition. If upon the hearing, the commissioners of the county commission
find that the petition is in compliance with this chapter, they shall
order the question to be submitted. The question shall be submitted
within the territory by the county commission as is provided in section
206.060.

2. The question shall be submitted in substantially the following form:

Shall ........ (description of territory) be annexed to the .......
hospital district?

3. If a majority of the votes cast on the question in the district and in
the territory described in the petition, respectively, are in favor of
annexation, the commissioners of the county commission shall by order
declare the territory annexed and shall describe the altered boundaries
of the district. (L. 1961 p. 524 § 14, A.L. 1978 H.B. 971)

1. The board shall provide for the proper and safekeeping of its
permanent records and for the recording of the corporate action of the
district. It shall keep a true and accurate account of its receipts and
an annual audit shall be made of its books, records and accounts.

2. All officers and employees authorized to receive or retain the custody
of money or to sign vouchers, checks, warrants or evidences of
indebtedness binding upon the district shall furnish surety bond for the
faithful performance of their duties and the faithful accounting for all
moneys that may come into their hands in an amount to be fixed and in a
form to be approved by the board. (L. 1961 p. 524 § 15)

Any person desiring to donate property for the benefit of a
hospital, constructed or to be constructed under this chapter, may vest
title to the property so donated in the board of directors created under
this chapter, and the board of directors shall hold and control the
property so received and accepted according to the terms of the deed,
gift, devise or bequest of the property, and shall be a trustee of the
property and shall take title to all property it may acquire in the name
of the district and shall control the property for the purposes provided
in this chapter. (L. 1961 p. 524 § 16)

1. A hospital district may sell and convey property of the
district, both real and personal, in the manner provided in subsection 2
of this section for real property and in the manner provided in
subsection 3 of this section for personal property, which is no longer
needed by the district to carry out the purposes for which the district
was organized, including hospital buildings and grounds which have been
adequately replaced by other hospital buildings and grounds, provided
that all bonds of the district, whether general obligation bonds
constituting a lien on the property no longer needed, or revenue bonds
constituting a lien on the revenue arising from the operation of such
property, have been paid in full; or a sum sufficient to pay all of such
bonds, together with interest accrued or to accrue thereon, together with
any other items of expense provided in such bonds, is deposited with the
fiscal agent named in the bonds for the purpose of full payment; or
consent in writing is obtained from all of the holders of the bonds.

2. Upon receipt of a request for sale of excess real property, the board
of directors of the hospital district shall review the reasons why the
specified real property is no longer needed by the hospital district and
the manner in which the conditions of the provisions of subsection 1 of
this section have been satisfied. If the board of directors is satisfied
that the statements and the reasons are true and valid, it shall adopt a
resolution approving the sale or other disposition of the specified real
property. A certified copy of the board of director's adopted resolution
to sell or otherwise dispose of specified real property of the district
shall be filed with the county clerk of the county in which the original
petition to organize the district was filed. If the county commission is
satisfied that the statements in the resolution are true and valid, it
shall by order approve the resolution. The board of directors of the
hospital district shall then proceed to sell, convey or otherwise dispose
of the specified real property pursuant to the terms of the resolution
adopted by the board of directors. The deed shall be executed under the
hand and seal of the secretary of the board of directors of the hospital
district for and on behalf of the hospital district and shall be
sufficient to convey to purchaser or other recipient all the right,
title, interest and estate which the hospital district has in the
specified real property.

3. Upon receipt of a request for sale of excess personal property, the
board of directors of the hospital district shall review the reasons why
the specified personal property is no longer needed by the hospital
district and the manner in which the conditions of the provisions of
subsection 1 of this section have been satisfied. If the board of
directors is satisfied that the statements and the reasons are true and
valid, it shall adopt a resolution approving the sale or other
disposition of the specified personal property. The board of directors of
the hospital district shall then proceed to sell, convey or otherwise
dispose of the specified personal property pursuant to the terms of the
resolution adopted by the board of directors. Any bill of sale required
shall be executed under the hand and seal of the secretary of the board
of directors of the hospital district for and on behalf of the hospital
district and shall be sufficient to convey to purchaser or other
recipient all the right, title, interest and estate which the hospital
district has in the specified personal property.

4. The proceeds from the sale of the real or personal property remaining
after the expenses of the property have been paid shall be placed in the
treasury of the district and used to carry out the purposes for which the
district was organized. (L. 1976 S.B. 648, A.L. 1996 S.B. 676)

The chapter shall be known and may be referred to as "The
Hospital District Law". (L. 1961 p. 524 § 1)

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