[Rev. 11/21/2013 11:47:11 AM--2013]

CHAPTER 450 - COUNTY HOSPITALS AND HOSPITAL DISTRICTS

GENERAL PROVISIONS

NRS 450.005           Definitions.

NRS 450.006           “Allied health profession” defined.

NRS 450.008           “Purchasing group” defined.

COUNTY HOSPITALS

Definitions

NRS 450.010           “Taxpayers” defined.

 

Establishment

NRS 450.020           Procedure.

NRS 450.030           Petition signed by at least 30 percent of taxpayers; submission of question at next general election.

NRS 450.040           Petition signed by at least 50 percent of taxpayers; submission of question at next primary or general election.

NRS 450.043           Motion of board of county commissioners; submission of question at special election or next primary or general election.

NRS 450.045           Approval of bond issue; appointment of board of hospital trustees; issuance and sale of bonds.

NRS 450.050           Administration, control and government of county hospitals acquired by purchase or construction under provisions of certain legislative acts.

NRS 450.060           Acquisition of additional building or site when board of hospital trustees assumes control of existing hospital.

 

Board of Hospital Trustees

NRS 450.070           Number; election; terms of office.

NRS 450.080           Office of hospital trustee nonpartisan.

NRS 450.090           Selection of county commissioners for membership on board.

NRS 450.100           Oath and bond.

NRS 450.110           Vacancies.

NRS 450.120           Officers of board.

NRS 450.130           Compensation and expenses of trustees.

NRS 450.135           Interest in purchase of supplies prohibited; exception.

NRS 450.140           Meetings of board; quorum.

NRS 450.150           General powers and duties of board.

NRS 450.160           Rules and regulations.

NRS 450.165           Board authorized to acquire building or other facility for provision of health care in county adjacent to county where hospital is established; board authorized to issue special obligations to finance facility.

NRS 450.170           Visits and examinations of hospital; report to board of county commissioners.

NRS 450.175           Hospital advisory board in certain counties: Appointment; powers and duties; compensation of members.

NRS 450.180           Employment or removal of employees or appointed persons; contract for medical services.

NRS 450.191           Contract for management of hospital.

NRS 450.200           Condemnation of property for use by hospital.

NRS 450.210           Approval of plans and specifications for construction of hospital; advertisement of bids.

NRS 450.220           Gifts and bequests to hospital: Title vested in county; control by board of hospital trustees.

 

Finances

NRS 450.230           Budget.

NRS 450.240           Management of county hospital by board; levy of tax for maintenance and operation.

NRS 450.250           Control of expenditures by board; lease of buildings; deposit of money in hospital fund or separate account.

NRS 450.255           Mortgage or pledge of personal property of hospital; acquisition of real property for expansion.

NRS 450.260           Collection or settlement of claims.

 

Bonds

NRS 450.270           Maximum amount.

NRS 450.280           Purposes and procedure for issuance of general obligation bonds at request of board of hospital trustees.

NRS 450.290           Issuance of general and special obligation bonds by board of county commissioners.

NRS 450.300           Applicability of Local Government Securities Law.

NRS 450.310           Schedules of fees, rates and charges for services, facilities and commodities.

 

Administration

NRS 450.390           Hospital for benefit of county; payment of charges; exclusion of persons from use of hospital.

NRS 450.400           Extension of privileges and use of hospital to certain nonresidents: Notice; removal of person to resident county; payment for temporary care; action for recovery of charges.

NRS 450.410           Admission of paying patients; charges.

NRS 450.420           Board of county commissioners to determine status of patient; charges fixed by board of hospital trustees; costs chargeable to county; exceptions.

NRS 450.425           Board of county commissioners may levy ad valorem tax to pay cost of services rendered at hospital to certain persons admitted for emergency treatment.

NRS 450.430           Equal privileges of practitioners; exception; rights of patients; loss of hospital privileges not adverse action against physician in certain circumstances.

NRS 450.440           Staff of physicians: Organization; affiliation with university; rotation of service; assistance.

NRS 450.450           General administration of hospital subject to regulations of trustees.

NRS 450.455           Program for training resident physicians.

NRS 450.460           School for training nurses.

NRS 450.470           Room for examination of persons alleged to have mental illness; room for custodial supervision of persons with mental illness and dangerous persons.

NRS 450.480           Use of advanced emergency medical technicians for emergency care authorized. [Effective through December 31, 2013.]

NRS 450.480           Use of paramedics for emergency care authorized. [Effective January 1, 2014.]

NRS 450.485           Contract for use of facility for intermediate care or facility for skilled nursing.

 

Transfer

NRS 450.490           Conveyance or lease of hospital to corporation.

NRS 450.500           Conveyance or lease of hospital to nonprofit corporation.

NRS 450.510           County whose population is less than 100,000 may contract with community nonprofit hospital for care of indigent patients; enlargement or alteration of hospital.

 

Miscellaneous Provisions

NRS 450.520           Determination that emergency exists before submission of certain questions at special election.

NRS 450.525           Membership of hospital in purchasing group.

NRS 450.530           Purchase of supplies, materials and equipment without complying with certain requirements for competitive bidding.

COUNTY HOSPITAL DISTRICTS

NRS 450.550           Definitions.

NRS 450.560           Establishment of district on motion of board of county commissioners.

NRS 450.570           Notice of intent to establish district: Contents; publication.

NRS 450.580           Objections to formation of district; hearing.

NRS 450.590           Establishment of district: Petition of owners of property; adoption, contents and publication of resolution of intention to establish district; exception.

NRS 450.600           Hearing on petition.

NRS 450.610           Resolution creating district.

NRS 450.620           Enactment of ordinance regarding number, terms and election of trustees; service of board of county commissioners ex officio as board of trustees.

NRS 450.625           Trustees of district that includes territory within more than one county.

NRS 450.630           General powers and duties of board of trustees; rules and regulations.

NRS 450.640           Employees and staff of hospital: Appointment to board of chief of staff of physicians for district hospital; appointment by board of chief executive officer and necessary assistants for hospital; compensation; removal; admission.

NRS 450.650           Budgets.

NRS 450.660           Tax levies; disposition of proceeds. [Effective until November 24, 2014, and after that date unless the provisions of Senate Joint Resolution No. 15 (2011) are approved and ratified by the voters at the 2014 General Election.]

NRS 450.660           Tax levies; disposition of proceeds. [Effective November 25, 2014, if the provisions of Senate Joint Resolution No. 15 (2011) are approved and ratified by the voters at the 2014 General Election.]

NRS 450.665           Powers of board of trustees: Borrowing of money and incurrence or assumption of indebtedness; limitations and conditions.

NRS 450.670           Powers of board of trustees: Issuance and sale of bonds for certain purposes.

NRS 450.675           Powers of board of trustees: Mortgage or pledge of personal property and acquisition of real property.

NRS 450.680           Election concerning issuance of bonds; applicability of Local Government Securities Law.

NRS 450.690           Donations.

NRS 450.700           Board of trustees to determine status of patient and fix charges.

NRS 450.710           Creation of district for sole purpose of contracting for services of hospital.

NRS 450.715           Authority of board of trustees to contract for services of hospital.

NRS 450.720           Contract for management of district hospital.

NRS 450.725           Membership of district hospital in purchasing group.

NRS 450.730           Purchase of supplies, materials and equipment without complying with certain requirements for competitive bidding.

NRS 450.750           Board of county commissioners in certain districts deemed local government responsible for transferring certain payments of money.

NRS 450.751           Dissolution of hospital district in county whose population is less than 700,000: Determination that dissolution is in best interest required; ordinance of board of county commissioners; considerations; duties of county clerk.

NRS 450.753           Dissolution of hospital district: Right of qualified electors to protest; dissolution prohibited if majority of qualified electors protest; dissolution by final ordinance; recital of protests.

NRS 450.755           Dissolution of hospital district: Hearing; full consideration of all protests required; adoption of final ordinance of dissolution or ordinance of nondissolution by board of county commissioners.

NRS 450.757           Dissolution of hospital district: County clerk must file final ordinance of dissolution; locations.

NRS 450.759           Dissolution of hospital district in county whose population is less than 700,000: Unpaid taxes, levies and assessments are lien on property; power of board of county commissioners to collect.

NRS 450.760           Dissolution of hospital district in county whose population is less than 700,000: Retirement of outstanding debt and other obligations; levy of property tax; disposition of property.

MISCELLANEOUS PROVISIONS

NRS 450.800           County or district hospital may contract for services.

NRS 450.810           Lease of naming rights relating to public hospital; ordinance establishing procedures for lease; enterprise fund for proceeds of lease, fees or charges and other money received for public hospital.

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GENERAL PROVISIONS

      NRS 450.005  Definitions.  As used in this chapter, unless the context otherwise requires, the words and terms defined in NRS 450.006 and 450.008 have the meanings ascribed to them in those sections.

      (Added to NRS by 1975, 641; A 1977, 961; 1979, 150; 1991, 1133; 1999, 191)

      NRS 450.006  “Allied health profession” defined.  “Allied health profession” means:

      1.  Psychology as defined in chapter 641 of NRS; or

      2.  Oriental medicine or acupuncture as defined in chapter 634A of NRS.

      (Added to NRS by 1999, 190; A 2001, 1830)

      NRS 450.008  “Purchasing group” defined.  “Purchasing group” means a cooperative organization of hospitals and other health care organizations that affiliate for the purpose of combining their purchasing power to secure a lower cost for their purchases of supplies, materials and equipment than would be available to the members of the purchasing group individually.

      (Added to NRS by 1999, 191)

COUNTY HOSPITALS

Definitions

      NRS 450.010  “Taxpayers” defined.  For the purposes of NRS 450.010 to 450.510, inclusive, “taxpayers” include only citizens of the United States of the age of 18 years and upward who, at the time of filing their petition, are registered electors of the county in which an election is proposed to be held and whose names appear on the latest assessment roll of the county as owners of real or personal property.

      [Part 1:169:1929; A 1931, 231; 1943, 213; 1953, 365]—(NRS A 1975, 79; 1987, 295; 1995, 332)

Establishment

      NRS 450.020  Procedure.  Any county or group of counties may establish a public hospital in the manner prescribed in NRS 450.030 and 450.040.

      [Part 1:169:1929; A 1931, 231; 1943, 213; 1953, 365]

      NRS 450.030  Petition signed by at least 30 percent of taxpayers; submission of question at next general election.  Whenever the board of county commissioners of any county is presented with a petition signed by at least 30 percent of the taxpayers in such county or in each of a group of counties asking that an annual tax be levied for the establishing and maintenance of a public hospital, at a place in the county or counties named therein, and specifying the maximum amount of money proposed to be expended in purchasing or building the hospital, including the acquisition of a site, the board of county commissioners shall, after a compliance with and subject to the provisions of NRS 350.011 to 350.0165, inclusive, submit the question of issuing bonds therefor to the qualified electors of the county at the next general election to be held in the county, as provided in NRS 350.020 to 350.070, inclusive.

      [Part 1:169:1929; A 1931, 231; 1943, 213; 1953, 365] + [Part 2:169:1929; A 1937, 194; 1949, 83; 1955, 165]—(NRS A 1965, 632; 1969, 1603; 1981, 962)

      NRS 450.040  Petition signed by at least 50 percent of taxpayers; submission of question at next primary or general election.

      1.  Whenever the board of county commissioners of any county is presented with a petition signed by at least 50 percent of the taxpayers in the county or in each of a group of counties asking that an annual tax be levied for the establishment and maintenance of a public hospital, at a place in the county or counties named therein, and specifying the maximum amount of money proposed to be expended in purchasing or building the hospital, including the acquisition of a site, the board of county commissioners shall forthwith comply with the provisions of NRS 350.011 to 350.0165, inclusive, and shall submit the proposal to issue bonds for the project to the county debt management commission for each of the counties.

      2.  Upon the receipt of the approval thereof of each such commission, each board of county commissioners shall submit the question of issuing bonds for the hospital project designated in the petition to the qualified electors of the county at the next primary or general election, as provided in NRS 350.020 to 350.070, inclusive.

      3.  If the petition designated in subsection 1 indicates the hospital is to serve more than one county, each county designated shall submit to the commission and to the qualified electors of the county a bond question authorizing the issuance of the county’s bonds for the project in a maximum principal amount at least sufficient to defray the county’s proportional share of the maximum amount designated in the petition to be expended for the project based upon the last assessed valuation of the taxable property in the county and the valuation of that property in all the counties designated in the petition.

      [Part 1:169:1929; A 1931, 231; 1943, 213; 1953, 365] + [Part 2:169:1929; A 1937, 194; 1949, 83; 1955, 165]—(NRS A 1965, 633; 1969, 1603; 1981, 962; 1993, 1078; 1995, 773)

      NRS 450.043  Motion of board of county commissioners; submission of question at special election or next primary or general election.  Whenever the board of county commissioners of any county on its own motion desires to establish a county hospital, the board shall:

      1.  Specify the maximum amount of money proposed to be expended in purchasing or building the hospital, including the acquisition of a site;

      2.  Comply with the provisions of NRS 350.011 to 350.0165, inclusive; and

      3.  Upon the receipt of the approval of the county debt management commission of the proposal to issue the county hospital bonds, submit the question of issuing bonds for the project to the qualified electors of the county at a special election or the next primary or general election, as provided in NRS 350.020 to 350.070, inclusive.

      (Added to NRS by 1965, 633; A 1969, 1604; 1981, 963; 1993, 1078; 1995, 773)

      NRS 450.045  Approval of bond issue; appointment of board of hospital trustees; issuance and sale of bonds.  Whenever a question of issuing bonds submitted to the qualified electors of any county pursuant to NRS 450.030, 450.040 or 450.043 has been approved as provided in NRS 350.070, the board or boards of county commissioners shall immediately proceed to appoint the board of hospital trustees and shall proceed to issue and sell the bonds as provided in NRS 450.010 to 450.510, inclusive, subject to the provisions of the Local Government Securities Law.

      (Added to NRS by 1965, 633; A 1969, 1604; 1985, 293)

      NRS 450.050  Administration, control and government of county hospitals acquired by purchase or construction under provisions of certain legislative acts.  In all cases where any county hospital has been acquired by purchase, construction or otherwise, in any of the several counties of this State under or by virtue of any act of the Legislature other than NRS 450.010 to 450.510, inclusive, and has been governed and administered thereunder by the board of county commissioners, or otherwise, the board of county commissioners is authorized and empowered forthwith to appoint a board of hospital trustees for such county hospital. Thereafter, all the provisions of NRS 450.010 to 450.510, inclusive, relative to the maintenance of hospitals, election of hospital trustees, maintenance of a training school for nurses, provision for suitable care for such hospitals and persons with disabilities, and the administration and government of county hospital and patients therein shall be immediately applicable and controlling with respect to the future administration, control and government of such hospital in like manner and with the same force and effect as if an election had been duly held in accordance with the provisions of NRS 450.010 to 450.510, inclusive, and a majority of all the votes cast had been in favor of establishing such hospital.

      [1.1:169:1929; added 1953, 126]—(NRS A 1965, 633)

      NRS 450.060  Acquisition of additional building or site when board of hospital trustees assumes control of existing hospital.  In all counties where existing hospitals are taken over by a board of hospital trustees, as provided in NRS 450.010 to 450.510, inclusive, additional necessary buildings and sites may be acquired only if a bond issue is approved by the voters at a primary, general or special election according to the terms of NRS 450.010 to 450.510, inclusive, as if no hospital then existed. In a county whose population is 100,000 or more, in cases where buildings or parts thereof have been constructed but remain unfinished and unequipped, the board of hospital trustees may complete the building or buildings or part or parts thereof and furnish and equip them from the board’s current receipts, without a bond issue.

      [16:169:1929; A 1937, 194; 1941, 14; 1931 NCL § 2240]—(NRS A 1969, 1543; 1979, 548; 1993, 1079)

Board of Hospital Trustees

      NRS 450.070  Number; election; terms of office.

      1.  Except in counties where the board of county commissioners is the board of hospital trustees, the board of hospital trustees for the public hospital consists of five trustees, who must:

      (a) Be residents of the county or counties concerned.

      (b) Be elected as provided in subsection 2.

      2.  In any county:

      (a) Whose population is less than 100,000, hospital trustees must be elected for terms of 4 years in the same manner as other county officers are elected.

      (b) Whose population is 100,000 or more but less than 700,000, hospital trustees must be elected from the county at large for terms of 4 years.

      [Part 2:169:1929; A 1937, 194; 1949, 83; 1955, 165]—(NRS A 1959, 556; 1965, 634; 1967, 1255; 1969, 338, 1390, 1543; 1971, 1537; 1973, 127; 1975, 1101; 1979, 548; 1989, 1927; 2011, 1265)

      NRS 450.080  Office of hospital trustee nonpartisan.  Except in counties where the board of county commissioners is the board of hospital trustees:

      1.  The offices of hospital trustees are hereby declared to be nonpartisan, and the names of candidates for such offices shall appear alike upon the ballots of all parties at all primary elections.

      2.  At the general election only the names of those candidates, not to exceed twice the number of hospital trustees to be elected, who received the highest numbers of votes at the primary election shall appear on the ballot.

      [Part 2:169:1929; A 1937, 194; 1949, 83; 1955, 165]—(NRS A 1973, 274; 1975, 1102)

      NRS 450.090  Selection of county commissioners for membership on board.

      1.  In any county whose population is 700,000 or more, the board of county commissioners is, ex officio, the board of hospital trustees, and the county commissioners shall serve as hospital trustees during their terms of office as county commissioners.

      2.  In any county whose population is less than 700,000, the board of county commissioners may enact an ordinance providing that the board of county commissioners is, ex officio, the board of hospital trustees. If such an ordinance is enacted in a county:

      (a) The county commissioners shall serve as hospital trustees during their terms of office as county commissioners; and

      (b) If hospital trustees have been elected pursuant to NRS 450.070 and 450.080, the term of office of each hospital trustee who is serving in that capacity on the effective date of the ordinance is terminated as of the effective date of the ordinance.

      3.  A board of county commissioners shall not enact an ordinance pursuant to subsection 2 unless it determines that:

      (a) The county has fully funded its indigent care account created pursuant to NRS 428.010;

      (b) The county has fulfilled its duty to reimburse the hospital for indigent care provided to qualified indigent patients; and

      (c) During the previous calendar year:

             (1) At least one of the hospital’s accounts payable was more than 90 days in arrears;

             (2) The hospital failed to fulfill its statutory financial obligations, such as the payment of taxes, premiums for industrial insurance or contributions to the Public Employees’ Retirement System;

             (3) One or more of the conditions relating to financial emergencies set forth in subsection 1 of NRS 354.685 existed at the hospital; or

             (4) The hospital received notice from the Federal Government or the State of Nevada that the certification or licensure of the hospital was in imminent jeopardy of being revoked because the hospital had not carried out a previously established plan of action to correct previously noted deficiencies found by the regulatory body.

      4.  Except in counties where the board of county commissioners is the board of hospital trustees, in any county whose population is 100,000 or more but less than 700,000, the board of hospital trustees for the public hospital must be composed of the five regularly elected or appointed members, and, in addition, three county commissioners selected by the chair of the board of county commissioners shall serve as voting members of the board of hospital trustees during their terms of office as county commissioners.

      5.  Except in counties where the board of county commissioners is the board of hospital trustees, in any county whose population is less than 100,000, the board of hospital trustees for the public hospital must be composed of the five regularly elected or appointed members, and, in addition, the board of county commissioners may, by resolution, provide that:

      (a) One county commissioner selected by the chair of the board of county commissioners shall serve as a voting member of the board of hospital trustees during his or her term of office as county commissioner;

      (b) A physician who is the chief of the staff of physicians for the public hospital shall serve as a voting member of the board of hospital trustees; or

      (c) Both a county commissioner appointed pursuant to the provisions of paragraph (a) and a physician appointed pursuant to the provisions of paragraph (b) shall serve as voting members of the board of hospital trustees.

Ê The term of office of a member appointed pursuant to the provisions of paragraph (b) is 2 years and begins on the date the board of county commissioners appoints the member.

      [Part 2:169:1929; A 1937, 194; 1949, 83; 1955, 165]—(NRS A 1960, 407; 1967, 1255; 1969, 1544; 1975, 1102; 1979, 549; 1989, 1928; 1995, 791; 1997, 571; 2001, 467; 2011, 1265)

      NRS 450.100  Oath and bond.  Within 10 days after their appointment or election, trustees shall qualify by taking the oath of office. No bond shall be required of them.

      [Part 3:169:1929; A 1955, 244]

      NRS 450.110  Vacancies.  Except in counties where the board of county commissioners is the board of hospital trustees, a vacancy in the board of hospital trustees occasioned by a resignation, removal or otherwise must be reported to the board or boards of county commissioners and must be filled in the same manner as the original appointment. An appointee shall hold office:

      1.  Until the next following general election in the usual manner; or

      2.  If the appointee is a physician appointed to fill the vacancy of a member appointed pursuant to the provisions of paragraph (b) of subsection 5 of NRS 450.090, for the unexpired term of that member.

      [5:169:1929; NCL § 2229]—(NRS A 1975, 1103; 2001, 468)

      NRS 450.120  Officers of board.  Except as provided in subsection 3:

      1.  Within 10 days after their appointment or election, the trustees shall organize as a board of hospital trustees by the election of one of their number as chair, one as secretary, and by the election of such other officers as they may deem necessary.

      2.  The county treasurer of the county in which the hospital is located shall be the treasurer of the board of hospital trustees. The treasurer shall receive and pay out all the moneys under the control of the board, as ordered by it, but shall receive no compensation from the board of hospital trustees.

      3.  In counties where the board of county commissioners is the board of hospital trustees, the chair of the board of county commissioners may be the chair of the board of hospital trustees or the board of county commissioners may, at its first meeting in January of each year, designate another of its members to serve as chair of the board of hospital trustees for a term of 1 year. The vice chair of the board of county commissioners may be the vice chair of the board of hospital trustees, or the board of county commissioners may, at its first meeting in January of each year, designate another of its members to serve as vice chair of the board of hospital trustees for a term of 1 year. The county clerk shall be the secretary of the board of hospital trustees. The county clerk shall receive no compensation from the board of hospital trustees.

      [Part 3:169:1929; A 1955, 244]—(NRS A 1975, 1103; 1977, 931)

      NRS 450.130  Compensation and expenses of trustees.

      1.  Except in counties where the board of county commissioners is the board of hospital trustees, in any county whose population is less than 100,000:

      (a) A hospital trustee is entitled to receive a salary as follows:

             (1) The chair and secretary of the board of hospital trustees are entitled to receive $85 for each meeting of the board or a committee appointed by the board that they attend, not to exceed $510 per month.

             (2) The other trustees are entitled to receive $80 for each meeting of the board or a committee appointed by the board that they attend, not to exceed $480 per month.

      (b) In addition to the salary required by paragraph (a), the board of hospital trustees may provide to each member of the board the same health insurance coverage as the board provides to its employees.

      2.  Except in counties where the board of county commissioners is the board of hospital trustees, in any county whose population is 100,000 or more, a hospital trustee, subject to the provisions of subsection 3, is entitled to receive a salary of $100 per month and the chair of the board of hospital trustees is entitled to receive a salary of $200 per month.

      3.  Before any hospital trustee is entitled to any compensation as provided in subsection 2, he or she must first have devoted a minimum of 1 day during the month exclusively to the business and affairs of the hospital, exclusive of regular meetings of the board of hospital trustees.

      4.  Any trustee of any county hospital is entitled to receive reimbursement for any cash expenditures actually made for personal expenses incurred as a trustee. An itemized statement of all those expenses and money paid out must be made under oath by each of the trustees and filed with the secretary. An itemized statement may be allowed only by an affirmative vote of all trustees present at a meeting of the board.

      5.  In counties where the county commissioners are the board of hospital trustees, they shall serve without compensation, but are allowed the per diem allowance and traveling expenses fixed by law.

      [Part 3:169:1929; A 1955, 244]—(NRS A 1973, 319; 1975, 1103; 1979, 549; 1993, 921; 1995, 792; 2001, 364)

      NRS 450.135  Interest in purchase of supplies prohibited; exception.  A trustee shall not have a personal pecuniary interest, either directly or indirectly, in the purchase of any supplies for the hospital unless the supplies are purchased by competitive bidding.

      (Added to NRS by 1977, 1114)

      NRS 450.140  Meetings of board; quorum.

      1.  The board of hospital trustees shall hold meetings at least once each month, and shall keep a complete record of all its transactions.

      2.  Except as otherwise provided in NRS 241.0355:

      (a) In counties where three county commissioners are not members of the board, three members of the board constitute a quorum for the transaction of business.

      (b) And except as otherwise provided in paragraph (c), in counties where three county commissioners are members of the board, any five of the members constitute a quorum for the transaction of business.

      (c) In counties where the board of county commissioners is the board of hospital trustees, a majority of the board constitutes a quorum for the transaction of business.

      [Part 2:169:1929; A 1937, 194; 1949, 83; 1955, 165] + [Part 4:169:1929; A 1937, 194; 1943, 17; 1955, 194]—(NRS A 1960, 93, 407; 1991, 288; 2001, 1129)

      NRS 450.150  General powers and duties of board.  The board of hospital trustees, in general, shall carry out the spirit and intent of NRS 450.010 to 450.510, inclusive, in establishing and maintaining a county public hospital.

      [Part 4:169:1929; A 1937, 194; 1943, 17; 1955, 194]

      NRS 450.160  Rules and regulations.  The board of hospital trustees shall make and adopt such bylaws, rules and regulations for its own guidance and for the government of the hospital, and such rules and regulations governing the admission of physicians to the staff, as may be deemed expedient for the economic and equitable conduct thereof, not inconsistent with NRS 450.010 to 450.510, inclusive, or the ordinances of the city or town wherein such hospital is located.

      [Part 4:169:1929; A 1937, 194; 1943, 17; 1955, 194]—(NRS A 1963, 346)

      NRS 450.165  Board authorized to acquire building or other facility for provision of health care in county adjacent to county where hospital is established; board authorized to issue special obligations to finance facility.

      1.  A board of hospital trustees may acquire a building or other facility for the provision of health care in a county adjacent to the county or one of the counties where the county hospital is established, may operate such a facility, and may, but need not, enter into a contract with a private hospital or other person to operate such a facility, but only if no tax is levied or appropriation made from the county general fund in the county or counties where the county hospital is established for the maintenance and operation of the county hospital. The board of hospital trustees may use money in the hospital fund or in any separate account established by the board for this purpose.

      2.  To finance the acquisition of the additional facility, the board of hospital trustees may issue, without any election, special obligations payable only from revenues of the additional facility or from those revenues and the revenues of the county hospital and any related facilities. These obligations are not an indebtedness of the county or counties where the county hospital is established or of the county in which the additional facility is located.

      3.  As used in this section, “acquire” and “acquisition” have the meaning attributed to them in NRS 350.506.

      (Added to NRS by 1995, 332)

      NRS 450.170  Visits and examinations of hospital; report to board of county commissioners.

      1.  One of the hospital trustees shall visit and examine the hospital twice each month.

      2.  During the first week in February of each year, the board shall file with the board of county commissioners a report of the proceedings of the board of hospital trustees with reference to the hospital.

      [Part 4:169:1929; A 1937, 194; 1943, 17; 1955, 194]

      NRS 450.175  Hospital advisory board in certain counties: Appointment; powers and duties; compensation of members.

      1.  In counties where the board of county commissioners is the board of hospital trustees, the board of hospital trustees may appoint a hospital advisory board which shall exercise powers and duties delegated to the advisory board by the board of hospital trustees.

      2.  Members of a hospital advisory board must be appointed by a majority vote of the board of hospital trustees and shall serve at the pleasure of the board.

      3.  Members of the hospital advisory board may receive compensation for their services in an amount not to exceed $500 per month.

      (Added to NRS by 1975, 1101; A 1995, 793; 2011, 917)

      NRS 450.180  Employment or removal of employees or appointed persons; contract for medical services.  The board of hospital trustees may:

      1.  Appoint a chief executive officer and necessary assistants, and fix their compensations.

      2.  Employ physicians and interns, either full-time or part-time, as the board determines necessary, and fix their compensations.

      3.  Remove those appointees and employees.

      4.  Control the admission of physicians and interns to the staff by promulgating appropriate rules, regulations and standards governing those appointments.

      5.  Contract with individual physicians or private medical associations for the provision of certain medical services as may be required by the hospital.

      [Part 4:169:1929; A 1937, 194; 1943, 17; 1955, 194]—(NRS A 1963, 346; 1979, 444; 1987, 387; 2005, 2557)

      NRS 450.191  Contract for management of hospital.

      1.  The governing body of a county hospital may contract with a company which manages hospitals for the rendering of management services in a county hospital under the ultimate authority of the governing body.

      2.  The agreement may provide:

      (a) That the administrator of the hospital must be an employee of the company which manages the hospital; and

      (b) That the hospital may, in accordance with the requirements of NRS 450.530, purchase supplies, materials and equipment through the purchasing contracts of the company which manages the hospital, or through a purchasing group, without complying with the requirements for competitive bidding set forth in chapter 332 of NRS.

      (Added to NRS by 1975, 1101; A 1979, 444; 1987, 295; 1999, 191)

      NRS 450.200  Condemnation of property for use by hospital.  If the board of hospital trustees and the owners of any property desired by the board of hospital trustees for hospital purposes in the county or counties where the county hospital is established cannot agree as to the price to be paid therefor, the board of hospital trustees shall report the facts to the board or boards of county commissioners. Condemnation proceedings shall be instituted by the board or boards of county commissioners and prosecuted in the name of the county or counties by the district attorney for such county as may be concerned.

      [7:169:1929; NCL § 2231]—(NRS A 1995, 333)

      NRS 450.210  Approval of plans and specifications for construction of hospital; advertisement of bids.  No hospital buildings shall be erected or constructed until the plans and specifications have been made therefor and adopted by the board of hospital trustees, and bids advertised for according to law for other county public buildings.

      [8:169:1929; NCL § 2232]

      NRS 450.220  Gifts and bequests to hospital: Title vested in county; control by board of hospital trustees.  Any person, firm, organization, corporation or society desiring to make donations of money, personal property or real property for the benefit of a county public hospital shall have the right to vest title of the money, personal property or real property so donated in the county or counties where the county hospital is established to be controlled, when accepted, by the board of hospital trustees according to the terms of the deed, gift, devise or bequest of such property.

      [15:169:1929; NCL § 2239]—(NRS A 1995, 333)

Finances

      NRS 450.230  Budget.  The board of hospital trustees shall file with the board of county commissioners a budget as required of all governmental agencies of this state by chapter 354 of NRS, and in the fiscal management of the affairs of the public hospital and all other institutions under the supervision, government and control of the board of hospital trustees, the board of hospital trustees are governed by the provisions of chapter 354 of NRS.

      [Part 4:169:1929; A 1937, 194; 1943, 17; 1955, 194]—(NRS A 1963, 455; 1965, 747; 1975, 13; 1987, 296)

      NRS 450.240  Management of county hospital by board; levy of tax for maintenance and operation.

      1.  In all counties where a tax for the establishment and maintenance of a public hospital has been authorized by a majority of the voters voting for a bond issue in accordance with law, the supervision, management, government and control of the county hospital vests in and must be exercised by the board of hospital trustees for the county public hospital, and the institution must thereafter be operated by the board of hospital trustees.

      2.  Annually, upon the request of the board of hospital trustees, the board of county commissioners may levy a tax for the maintenance and operation of the county public hospital, excluding the establishment, maintenance or operation of any facility located outside the county or counties where the county hospital is established.

      3.  The resolution adopted by the board of county commissioners imposing a tax levy for a county public hospital must state:

      (a) The portion of the levy which is necessary to retire hospital bonds and any other outstanding hospital securities, and to pay interest thereon;

      (b) The portion of the levy which is necessary to pay for the care of indigent patients; and

      (c) The portion of the levy which is necessary to pay for the cost of new equipment, replacement of old equipment and other improvements to the hospital not covered by specific bond issues or other securities and not included in the cost of care of indigent patients as provided in paragraph (b). The cost must be prorated to the county in accordance with the number of patient days of care of county patients.

      4.  The board of county commissioners may not levy a tax for the care of indigents in the county public hospital as a hospital expense unless the levy and its justification are included in the budget for the hospital fund submitted to the Department of Taxation as provided by law.

      [1:67:1931; 1931 NCL § 2243] + [2:67:1931; A 1937, 167; 1941, 15; 1943, 39; 1943 NCL § 2243.01]—(NRS A 1957, 239; 1965, 945; 1969, 1605; 1975, 1745; 1987, 387; 1995, 333)

      NRS 450.250  Control of expenditures by board; lease of buildings; deposit of money in hospital fund or separate account.

      1.  The board of hospital trustees has the exclusive control of:

      (a) The expenditures of all money collected to the credit of the hospital fund.

      (b) The purchase of the site or sites.

      (c) The purchase or construction of any hospital building or buildings.

      (d) The supervision, care and custody of the grounds, rooms or buildings purchased, constructed, leased or set apart for that purpose.

      2.  With the approval of the board of county commissioners of the county or counties where the county hospital is established, the board of hospital trustees may lease buildings in that county or those counties for medical purposes or for purposes of related health care activities.

      3.  All money received for the hospital must be deposited in the county treasury of the county in which the hospital is situated to the credit of the hospital fund, and paid out only upon warrants drawn by the board of hospital trustees of the county or counties upon properly authenticated vouchers of the board of hospital trustees, after their approval by the county auditor, except that all money received for a hospital may be deposited in a separate account established and administered by the board of hospital trustees under the provisions of NRS 354.603.

      [Part 4:169:1929; A 1937, 194; 1943, 17; 1955, 194]—(NRS A 1971, 1349; 1975, 1811; 1979, 550, 1407, 1408; 1981, 686, 1771; 1993, 1974; 1995, 333)

      NRS 450.255  Mortgage or pledge of personal property of hospital; acquisition of real property for expansion.  The board of trustees of a county hospital, with the approval of the board of county commissioners, if the board of county commissioners is not the board of hospital trustees, may, by resolution:

      1.  Mortgage or pledge the personal property of the hospital, including accounts receivable, and enter into agreements for the sale and leasing back to the hospital of its personal property to provide security for acquiring money for the operation of the hospital; and

      2.  Acquire real property for the expansion of the hospital by entering into a contract for purchase of a type and duration and on such terms as the governing body determines, including a contract secured by a mortgage or other security interest in the real property.

      (Added to NRS by 1987, 295; A 1997, 3100)

      NRS 450.260  Collection or settlement of claims.  The board of hospital trustees may:

      1.  By proper legal action, collect claims due to the public hospital.

      2.  Accept as settlement of a claim due an amount less than that of the claim.

      3.  Pay from the hospital fund all fees and expenses necessarily incurred by the board in connection with the collection of claims.

      [Part 4:169:1929; A 1937, 194; 1943, 17; 1955, 194]—(NRS A 1987, 296)

Bonds

      NRS 450.270  Maximum amount.  Whenever any county or counties in this state shall have provided for the appointment and election of hospital trustees, and have voted for the issuance of bonds for hospital purposes, as authorized by law, each such county shall issue bonds in such sums and amounts as the board of hospital trustees shall certify to the board of county commissioners to be necessary for the purpose stated in the bond question approved at the election, but such bonds in the aggregate shall not exceed the maximum amount authorized by the bond question.

      [Part 6:169:1929; NCL § 2230]—(NRS A 1965, 634)

      NRS 450.280  Purposes and procedure for issuance of general obligation bonds at request of board of hospital trustees.

      1.  Whenever the board of hospital trustees of any county deems it advisable that bonds be issued for the enlargement, maintenance, repair, improvement or reconstruction of a public hospital, including, without limitation, the construction, installation and other acquisition of additional fixtures, structures, and buildings for the public hospital, equipment and furnishings therefor, and additional sites therefor, or any combination thereof, the board shall, by resolution, request the board of county commissioners of the county to issue general obligation bonds therefor and shall specify in the resolution the maximum amount of money proposed to be expended for any of those purposes.

      2.  Thereupon the board of county commissioners shall:

      (a) Comply with the provisions of NRS 350.011 to 350.0165, inclusive; and

      (b) Upon the receipt of the approval of the county debt management commission of the proposal to issue the county hospital bonds, submit the question of issuing the bonds to the qualified electors of the county at a special election or the next primary or general election, as provided in NRS 350.020 to 350.070, inclusive.

      [Part 1:169:1929; A 1931, 231; 1943, 213; 1953, 365]—(NRS A 1965, 634; 1969, 1605; 1981, 963; 1993, 1079; 1995, 773)

      NRS 450.290  Issuance of general and special obligation bonds by board of county commissioners.

      1.  Subject to the provisions of NRS 450.010 to 450.510, inclusive, for any hospital project stated in a bond question approved as provided in NRS 350.070, the board of county commissioners, at any time, in the name and on the behalf of the county, may issue:

      (a) General obligation bonds, payable from taxes; and

      (b) General obligation bonds, payable from taxes, which payment is additionally secured by a pledge of gross or net revenues derived from the operation of the hospital facilities, and, if so determined by the board of county commissioners, further secured by a pledge of gross or net revenues derived from any other income-producing project of the county or from any license or other excise taxes levied by the county for revenue, as may be legally made available for their payment.

      2.  The board of county commissioners of any county, in the name and on behalf of the county, may issue, for any hospital project, without the securities being authorized at any election, special obligation municipal securities payable solely from net revenues or gross revenues derived from the operation of hospital facilities.

      [Part 1:169:1929; A 1931, 231; 1943, 213; 1953, 365]—(NRS A 1965, 635; 1969, 1606; 1975, 1158; 1977, 777; 1979, 550; 1981, 510; 1983, 1670)

      NRS 450.300  Applicability of Local Government Securities Law.  Subject to the provisions of NRS 450.290, for any hospital facilities authorized by NRS 450.010 to 450.510, inclusive, the board of county commissioners may, on the behalf and in the name of the county, borrow money, otherwise become obligated, and evidence obligations by the issuance of bonds and other county securities, and in connection with the undertaking or facilities, the board may otherwise proceed as provided in the Local Government Securities Law.

      [Part 1:169:1929; A 1931, 231; 1943, 213; 1953, 365]—(NRS A 1965, 635; 1969, 1606; 1985, 293)

      NRS 450.310  Schedules of fees, rates and charges for services, facilities and commodities.  In order to insure the payment of the general obligation bonds of the county, the payment of which is additionally secured by a pledge of revenues of such hospital facilities, of any such other income-producing project and of any such excise taxes, as provided in NRS 450.290, or other such additionally secured general obligation securities of the county, there may be established and maintained, and from time to time revised, a schedule or schedules of fees, rates and charges for services, facilities and commodities rendered by or through such facilities and any such other income-producing project and a schedule or schedules of any such excise taxes, as the case may be, by the board of hospital trustees for such hospital facilities and otherwise by the board of county commissioners, in an amount sufficient for that purpose and also sufficient to discharge any covenant in the proceedings authorizing the issuance of any of the bonds or other securities, including any covenant for the establishment of reasonable reserve funds.

      [Part 1:169:1929; A 1931, 231; 1943, 213; 1953, 365]—(NRS A 1965, 636; 1969, 1607)

Administration

      NRS 450.390  Hospital for benefit of county; payment of charges; exclusion of persons from use of hospital.

      1.  Every county hospital in this State being supported by public money, and every hospital established under NRS 450.010 to 450.510, inclusive, must be for the benefit of that county or counties and of any person falling sick or being injured or maimed within its limits, but the governing body of the hospital may extend the privileges and use of the hospital to persons residing outside of the county or counties upon such terms and conditions as the governing body may by its rules and regulations prescribe.

      2.  Every inhabitant or person who is not a pauper and every relative required by the laws of this State to support an inhabitant or person who is a pauper shall pay to the governing body, or an officer it designates, a reasonable compensation for occupancy, nursing, care, medicine and attendance, other than medical or surgical attendance, according to the rules and regulations prescribed by the governing body. If after demand by the governing body, or its designated officer, the inhabitant, person or relative fails, refuses or neglects to pay the compensation, it may be recovered in a suit at law brought by the governing body.

      3.  The hospital is subject to such reasonable rules and regulations as the governing body may adopt in order to render the use of the hospital of the greatest benefit to the greatest number of people.

      4.  The governing body may exclude from the use of the hospital any and all inhabitants and persons who willfully violate those rules and regulations.

      5.  The provisions of this section do not prohibit the hospital from exercising other powers granted to it by the provisions of this chapter.

      [9:169:1929; NCL § 2233] + [1:132:1941; 1931 NCL § 2245]—(NRS A 1987, 388)

      NRS 450.400  Extension of privileges and use of hospital to certain nonresidents: Notice; removal of person to resident county; payment for temporary care; action for recovery of charges.

      1.  When the privileges and use of the hospital are extended to a resident of another county who is reasonably believed to be indigent, as defined in NRS 439B.310, and who is:

      (a) Entitled under the laws of this state to relief, support, care, nursing, medicine or medical or surgical aid from the other county; or

      (b) Injured, maimed or falls sick in the other county,

Ê the governing head shall notify the board of county commissioners of that county within 3 working days after the person is admitted to that hospital.

      2.  The notice must be in writing and addressed to the board of county commissioners of that county.

      3.  Except in the case of an injury suffered in a motor vehicle accident, the board of county commissioners receiving the notice shall cause the person to be removed immediately to that county, and shall pay a reasonable sum to the hospital for the temporary occupancy, care, nursing, medicine, and attendance, other than medical or surgical attendance, furnished to the person.

      4.  If the board of county commissioners neglects or refuses to remove the person, or if in the opinion of the attending physician it is not advisable to remove the person, the governing head has a legal claim against the county for all charges for occupancy, nursing, care, medicine, and attendance, other than medical or surgical attendance, necessarily furnished, and may recover those charges in a suit at law.

      [2:132:1941; A 1949, 588; 1943 NCL § 2245.01]—(NRS A 1983, 1943; 1991, 1000; 1993, 1974)

      NRS 450.410  Admission of paying patients; charges.

      1.  Supervising boards of county hospitals may:

      (a) Provide for treatment to sick or injured persons and require the payment of reasonable charges therefor.

      (b) Contract for the provision of such treatment on a periodic prepaid basis with any person authorized by the Commissioner of Insurance pursuant to title 57 of NRS to arrange for or provide health care services on a periodic prepaid basis.

Ê The treatment of such persons must not be permitted to interfere with the treatment of purely charitable cases.

      2.  Every person treated by a county hospital and required to pay charges for hospitalization, shall pay the charges fixed by the supervising board therefor, which charges, when paid, must be paid forthwith into the county treasury and deposited to the credit of the hospital fund.

      3.  Every person treated by a county hospital and required to pay charges to the hospital has the right to the services of a physician or surgeon of the person’s own choice, and has the right to employ such special nurses as may be necessary, but the cost of the physician, surgeon or nurses must not become a claim against the county.

      4.  Supervising boards shall fix and determine reasonable charges to be paid by sick and injured persons treated by county hospitals, which charges must include the board and lodging of the person and the customary use of hospital facilities by the person admitted.

      [1:124:1941; 1931 NCL § 2244] + [2:124:1941; 1931 NCL § 2244.01] + [3:124:1941; 1931 NCL § 2244.02] + [4:124:1941; 1931 NCL § 2244.03]—(NRS A 1987, 389; 1997, 907)

      NRS 450.420  Board of county commissioners to determine status of patient; charges fixed by board of hospital trustees; costs chargeable to county; exceptions.

      1.  The board of county commissioners of the county in which a public hospital is located may determine whether patients presented to the public hospital for treatment are subjects of charity. Except as otherwise provided in NRS 439B.330, the board of county commissioners shall establish by ordinance criteria and procedures to be used in the determination of eligibility for medical care as medical indigents or subjects of charity.

      2.  The board of hospital trustees shall fix the charges for treatment of those persons able to pay for the charges, as the board deems just and proper. The board of hospital trustees may impose an interest charge of not more than 12 percent per annum on unpaid accounts. The receipts must be paid to the county treasurer and credited to the hospital fund. In fixing charges pursuant to this subsection the board of hospital trustees shall not include, or seek to recover from paying patients, any portion of the expense of the hospital which is properly attributable to the care of indigent patients.

      3.  Except as provided in subsection 4 of this section and subsection 3 of NRS 439B.320, the county is chargeable with the entire cost of services rendered by the hospital and any salaried staff physician or employee to any person admitted for emergency treatment, including all reasonably necessary recovery, convalescent and follow-up inpatient care required for any such person as determined by the board of trustees of the hospital, but the hospital shall use reasonable diligence to collect the charges from the emergency patient or any other person responsible for the support of the patient. Any amount collected must be reimbursed or credited to the county.

      4.  The county is not chargeable with the cost of services rendered by the hospital or any attending staff physician or surgeon to the extent the hospital is reimbursed for those services pursuant to NRS 428.115 to 428.255, inclusive.

      [14:169:1929; NCL § 2238]—(NRS A 1969, 875; 1975, 1305; 1977, 480; 1983, 1943; 1985, 1463; 1987, 389, 878; 1993, 1975)

      NRS 450.425  Board of county commissioners may levy ad valorem tax to pay cost of services rendered at hospital to certain persons admitted for emergency treatment.

      1.  The board of county commissioners of a county in which a county hospital is established may, upon approval by a majority of the voters voting on the question in an election held throughout the county, levy an ad valorem tax of not more than 2.5 cents on each $100 of assessed valuation upon all taxable property in the county, to pay the cost of services rendered in the county by the hospital pursuant to subsection 3 of NRS 450.420. The approval required by this subsection may be requested at any primary or general election.

      2.  Any tax imposed pursuant to this section is in addition to the taxes imposed pursuant to NRS 428.050, 428.185 and 428.285. The proceeds of any tax levied pursuant to this section are exempt from the limitations imposed by NRS 354.59811, 428.050 and 428.285 and must be excluded in determining the maximum rate of tax authorized by those sections.

      (Added to NRS by 1987, 878; A 1989, 2086; 1991, 482; 1993, 1079; 1995, 334)

      NRS 450.430  Equal privileges of practitioners; exception; rights of patients; loss of hospital privileges not adverse action against physician in certain circumstances.

      1.  Except as otherwise provided in NRS 450.440, in the management of the public hospital, no discrimination may be made against physicians, podiatric physicians or dentists licensed under the laws of this state or licensed practitioners of the allied health professions, and all such physicians, dentists, podiatric physicians and practitioners have privileges in treating patients in the hospital in accordance with their training and ability, except that practitioners of the allied health professions may not be members of the staff of physicians described in NRS 450.440. Practitioners of the allied health professions are subject to the bylaws and regulations established by the board of hospital trustees.

      2.  The patient has the right to employ, at the patient’s own expense, his or her own physician, if that physician is a member of the hospital staff, or the patient’s own nurse, and when acting for any patient in the hospital, the physician employed by the patient has charge of the care and treatment of the patient, and the nurses in the hospital shall comply with the directions of the physician concerning that patient, subject to the regulations established by the board of hospital trustees.

      3.  If a physician loses privileges at a hospital because the physician no longer holds a faculty or clinical appointment with the University of Nevada School of Medicine or the University of Nevada, Las Vegas, School of Dental Medicine, as required pursuant to NRS 450.440, that action shall not be deemed to be an adverse action by the hospital against the physician.

      [Part 11:169:1929; A 1955, 194]—(NRS A 1957, 780; 1975, 641; 1979, 150; 2001, 1830; 2011, 917)

      NRS 450.440  Staff of physicians: Organization; affiliation with university; rotation of service; assistance.

      1.  Except as otherwise provided in subsection 2, the board of hospital trustees shall organize a staff of physicians composed of each regular practicing physician, podiatric physician and dentist in the county in which the hospital is located who requests staff membership and meets the standards set forth in the regulations prescribed by the board of hospital trustees.

      2.  The board of hospital trustees may, after consulting with the chief of staff of the hospital and the deans of the University of Nevada School of Medicine and the University of Nevada, Las Vegas, School of Dental Medicine, organize a staff of physicians composed of physicians, podiatric physicians and dentists who are affiliated with the University of Nevada School of Medicine or the University of Nevada, Las Vegas, School of Dental Medicine who request staff membership and meet the requirements set forth in subsection 3. If the board of hospital trustees organizes a staff of physicians in accordance with this subsection, the board of hospital trustees may require:

      (a) Not more than 60 percent of the staff of physicians to be so affiliated before January 1, 2013.

      (b) Not more than 85 percent of the staff of physicians to be so affiliated on or after January 1, 2013, and before January 1, 2018.

      (c) The staff of physicians to have such an affiliation in such a percentage as the board of hospital trustees deems appropriate on or after January 1, 2018.

      3.  Except as otherwise provided in subsection 4, if the board of hospital trustees decides to organize the staff of physicians in accordance with subsection 2, a physician, podiatric physician or dentist who requests staff membership must:

      (a) Meet the standards set forth in the regulations prescribed by the board of hospital trustees; and

      (b) Hold a faculty or clinical appointment with the University of Nevada School of Medicine or the University of Nevada, Las Vegas, School of Dental Medicine and maintain that appointment while he or she is on the staff of physicians.

      4.  If the board of hospital trustees decides to organize the staff of physicians in accordance with subsection 2, the board of hospital trustees may enter into a contract with a physician or group of physicians who do not meet the requirements of subsection 3 if the physician or group of physicians will be the exclusive provider of certain services for the hospital. Such services may include, without limitation, radiology, pathology, emergency medicine and neonatology services.

      5.  The provisions of subsections 2 and 3 shall not be deemed to prohibit a physician, podiatric physician or dentist who is on the staff of physicians from being affiliated with another institution of higher education.

      6.  The staff shall organize in a manner prescribed by the board so that there is a rotation of service among the members of the staff to give proper medical and surgical attention and service to the indigent sick, injured or maimed who may be admitted to the hospital for treatment.

      7.  The board of hospital trustees or the board of county commissioners may offer the following assistance to members of the staff to attract and retain them:

      (a) Establishment of clinic or group practice;

      (b) Malpractice insurance coverage under the hospital’s policy of professional liability insurance;

      (c) Professional fee billing; and

      (d) The opportunity to rent office space in facilities owned or operated by the hospital, as the space is available, if this opportunity is offered to all members of the staff on the same terms and conditions.

      [Part 11:169:1929; A 1955, 194]—(NRS A 1963, 346; 1967, 996; 1979, 150, 1408, 1409; 2001, 1830; 2005, 2557; 2011, 917)

      NRS 450.450  General administration of hospital subject to regulations of trustees.  When a county hospital is established, the physicians, nurses, attendants, the persons sick therein, and all persons approaching or coming within the limits of the same, and all furniture and other articles used or brought there shall be subject to such rules and regulations as the board of hospital trustees may prescribe.

      [10:169:1929; NCL § 2234]

      NRS 450.455  Program for training resident physicians.  A board of hospital trustees may institute and maintain training programs in the county hospital for resident physicians, including interns and postgraduates. Such programs must meet the standards for recognition by the American Medical Association and for accreditation by the Liaison Committee on Graduate Medical Education.

      (Added to NRS by 1963, 455; A 1979, 676)

      NRS 450.460  School for training nurses.  The board of hospital trustees may establish and maintain in connection with a county hospital and as a part thereof a training school for nurses. Upon completion of the prescribed course of training the board of hospital trustees shall give diplomas to such nurses as complete the course satisfactorily.

      [12:169:1929; NCL § 2236]

      NRS 450.470  Room for examination of persons alleged to have mental illness; room for custodial supervision of persons with mental illness and dangerous persons.

      1.  If the county hospital is located at the county seat, the board of hospital trustees shall, at all times, provide a suitable room that may be used for the examination of persons who are alleged to have mental illness and who are to be brought before the judge of the district court for proceedings to determine the issue of involuntary court-ordered admission as provided in chapter 433A of NRS. This section does not prohibit or limit the examination of persons alleged to have mental illness at a private hospital as provided in chapter 433A of NRS.

      2.  The board of trustees of such a county hospital, in cooperation with the local law enforcement agencies, may provide a suitable room that may be used for the custodial supervision of persons who are alleged to:

      (a) Have mental illness; or

      (b) Be dangerous to themselves or others.

      [13:169:1929; NCL § 2237]—(NRS A 1967, 1679; 1975, 1634; 1993, 834)

      NRS 450.480  Use of advanced emergency medical technicians for emergency care authorized. [Effective through December 31, 2013.]  A hospital or rescue unit which meets minimum requirements established by the State Board of Health, or an ambulance service which meets minimum requirements established by the State Board of Health in a county whose population is less than 100,000, or a county or district board of health in a county whose population is 100,000 or more, may use advanced emergency medical technicians, as defined in NRS 450B.025, for the rendering of emergency medical care to the sick or injured:

      1.  At the scene of an emergency and during transport to a hospital;

      2.  While in a hospital emergency department; and

      3.  Until responsibility for care is assumed by the regular staff of the hospital.

      (Added to NRS by 1973, 610; A 1975, 37; 1987, 2206; 1993, 2827)

      NRS 450.480  Use of paramedics for emergency care authorized. [Effective January 1, 2014.]  A hospital or rescue unit which meets minimum requirements established by the State Board of Health, or an ambulance service which meets minimum requirements established by the State Board of Health in a county whose population is less than 100,000, or a county or district board of health in a county whose population is 100,000 or more, may use paramedics, as defined in NRS 450B.095, for the rendering of emergency medical care to the sick or injured:

      1.  At the scene of an emergency and during transport to a hospital;

      2.  While in a hospital emergency department; and

      3.  Until responsibility for care is assumed by the regular staff of the hospital.

      (Added to NRS by 1973, 610; A 1975, 37; 1987, 2206; 1993, 2827; 2013, 937, effective January 1, 2014)

      NRS 450.485  Contract for use of facility for intermediate care or facility for skilled nursing.  The board of hospital trustees may contract for the use of a facility for intermediate care or a facility for skilled nursing for the treatment of patients who may safely be discharged to such a facility.

      (Added to NRS by 1987, 295)

Transfer

      NRS 450.490  Conveyance or lease of hospital to corporation.

      1.  The board of county commissioners of any county for which a public hospital has been established or is administered pursuant to NRS 450.010 to 450.510, inclusive, and whose public hospital is the only hospital in the county, may convey the hospital for an amount not less than its appraised value or lease it for a term of not more than 50 years to any corporation if all of the following conditions are met:

      (a) The corporation must provide in its articles of incorporation for an advisory board for the hospital. The advisory board must consist of persons who represent a broad section of the people to be served by the hospital.

      (b) The corporation must contract to:

             (1) Care for indigent patients at a charge to the county which does not exceed the actual cost of providing that care, or in accordance with NRS 439B.300 to 439B.340, inclusive, if applicable; and

             (2) Receive any person falling sick or maimed within the county.

      (c) The corporation must agree to accept all the current assets, including accounts receivable, to assume all the current liabilities, and to take over and maintain the records of the existing public hospital.

      (d) The agreement must provide for the transfer of patients, staff and employees, and for the continuing administration of any trusts or bequests pertaining to the existing public hospital.

      (e) The agreement must provide for the assumption by the corporation of all indebtedness of the county which is attributable to the hospital, and:

             (1) If the hospital is conveyed, for payment to the county of an amount which is not less than the appraised value of the hospital, after deducting any indebtedness so assumed, immediately or by deferred installments over a period of not more than 30 years.

             (2) If the hospital is leased, for a rental which will, over the term of the lease, reimburse the county for its actual capital investment in the hospital, after deducting depreciation and any indebtedness so assumed. The lease may provide a credit against the rental so required for the value of any capital improvements made by the corporation.

      2.  If any hospital which has been conveyed pursuant to this section ceases to be used as a hospital, unless the premises so conveyed are sold and the proceeds used to erect or enlarge another hospital for the county, the hospital so conveyed reverts to the ownership of the county. If any hospital which has been leased pursuant to this section ceases to be used as a hospital, the lease is terminated.

      (Added to NRS by 1981, 1186; A 1987, 879)

      NRS 450.500  Conveyance or lease of hospital to nonprofit corporation.

      1.  Except as otherwise provided in NRS 450.490, the board of county commissioners of any county for which a public hospital has been established pursuant to NRS 450.010 to 450.510, inclusive, or established otherwise but administered pursuant to NRS 450.010 to 450.510, inclusive, may convey the hospital, or lease it for a term of not more than 50 years, to a nonprofit corporation if all of the following conditions are met:

      (a) The governing body of the nonprofit corporation must be composed initially of the incumbent members of the board of hospital trustees, as individuals. The articles of incorporation must provide for:

             (1) A membership of the corporation which is broadly representative of the public and includes residents of each incorporated city in the county and of the unincorporated area of the county or a single member which is a nonprofit corporation whose articles of incorporation provide for a membership which is broadly representative of the public and includes residents of each incorporated city in the county and of the unincorporated area of the county;

             (2) The selection of the governing body by the membership of the corporation or, if the corporation has a single member, by the single member;

             (3) The governing body to select its members only to fill a vacancy for an unexpired term; and

             (4) The terms of office of members of the governing body, not to exceed 6 years.

      (b) The nonprofit corporation must contract to:

             (1) Care for indigent patients at a charge to the county which does not exceed the actual cost of providing such care, or in accordance with NRS 439B.300 to 439B.340, inclusive, if applicable; and

             (2) Receive any person falling sick or maimed within the county.

      (c) The nonprofit corporation must agree to accept all the current assets, including accounts receivable, to assume all the current liabilities, and to take over and maintain the records of the existing public hospital.

      (d) The agreement must provide for the transfer of patients, staff and employees, and for the continuing administration of any trusts or bequests pertaining to the existing public hospital.

      (e) The agreement must provide for the assumption by the corporation of all indebtedness of the county which is attributable to the hospital, and:

             (1) If the hospital is conveyed, for payment to the county of its actual capital investment in the hospital, after deducting depreciation and any indebtedness so assumed, immediately or by deferred installments over a period of not more than 30 years.

             (2) If the hospital is leased, for a rental which will over the term of the lease reimburse the county for its actual capital investment in the hospital, after deducting depreciation and any indebtedness so assumed. The lease may provide a credit against the rental so required for the value of any capital improvements made by the corporation.

      2.  Boards of county commissioners which have joint responsibility for a public hospital may jointly exercise the power conferred by subsection 1, and are subject jointly to the related duties.

      3.  If any hospital which has been conveyed pursuant to this section ceases to be used as a nonprofit hospital, unless the premises so conveyed are sold and the proceeds used to erect or enlarge another nonprofit hospital for the county, the hospital so conveyed reverts to the ownership of the county. If any hospital which has been leased pursuant to this section ceases to be used as a nonprofit hospital, the lease is terminated.

      (Added to NRS by 1969, 215; A 1975, 575; 1981, 1186; 1985, 597; 1987, 880)

      NRS 450.510  County whose population is less than 100,000 may contract with community nonprofit hospital for care of indigent patients; enlargement or alteration of hospital.

      1.  The board of county commissioners of any county whose population is less than 100,000 may contract with any nonprofit corporation to which a public hospital has been conveyed or leased, for the care of indigent patients from the contracting county and the receiving of other persons falling sick or being maimed or injured within the contracting county. The contract must be consistent with the provisions of NRS 439B.300 to 439B.340, inclusive, if applicable.

      2.  The contracting county may participate in the enlargement or alteration of the hospital.

      (Added to NRS by 1969, 216; A 1969, 1545; 1979, 551; 1987, 881; 1993, 2661)

Miscellaneous Provisions

      NRS 450.520  Determination that emergency exists before submission of certain questions at special election.

      1.  For the purposes of NRS 450.043, 450.060 and 450.280, a special election may be held only if the board of county commissioners determines, by a unanimous vote, that an emergency exists.

      2.  The determination made by the board is conclusive unless it is shown that the board acted with fraud or a gross abuse of discretion. An action to challenge the determination made by the board must be commenced within 15 days after the board’s determination is final.

      3.  As used in this section, “emergency” means any unexpected occurrence or combination of occurrences which requires immediate action by the board to prevent or mitigate a substantial financial loss to the county or to enable the board to provide an essential service to the residents of the county.

      (Added to NRS by 1993, 1078; A 1995, 334)

      NRS 450.525  Membership of hospital in purchasing group.

      1.  A county hospital may, with the approval of the governing body of the hospital, become a member of a purchasing group for the purpose of purchasing supplies, materials and equipment used by the county hospital.

      2.  A county hospital that becomes a member of a purchasing group may, in accordance with the requirements of NRS 450.530, purchase supplies, materials and equipment through the purchasing group without complying with the requirements for competitive bidding set forth in chapter 332 of NRS.

      (Added to NRS by 1999, 190)

      NRS 450.530  Purchase of supplies, materials and equipment without complying with certain requirements for competitive bidding.  A county hospital that is authorized pursuant to NRS 450.191 or 450.525 to purchase supplies, materials and equipment in accordance with this section through the purchasing contracts of the company that manages the hospital or through a purchasing group may purchase the supplies, materials and equipment without complying with the requirements for competitive bidding set forth in chapter 332 of NRS if:

      1.  The documents pertaining to the proposed purchase, including, without limitation, the prices available to the company or purchasing group, are summarized in writing and, together with a sworn statement by an officer or agent of the company or purchasing group that the prices were obtained by the company or purchasing group through a process of competitive bidding, are presented to the governing body of the county hospital at its next regularly scheduled meeting; and

      2.  The governing body, after reviewing the summary and statement, finds that the proposed purchase will be made at a lower price than the lowest price reasonably obtainable by the hospital through competitive bidding pursuant to chapter 332 of NRS or available to the hospital pursuant to NRS 333.470 and approves the proposed purchase.

      (Added to NRS by 1999, 190)

COUNTY HOSPITAL DISTRICTS

      NRS 450.550  Definitions.  As used in NRS 450.550 to 450.760, inclusive, unless the context otherwise requires:

      1.  “Board of trustees” means:

      (a) A board of hospital trustees:

             (1) Elected pursuant to NRS 450.620 and a physician who is appointed pursuant to subsection 1 of NRS 450.640, if applicable; or

             (2) Appointed pursuant to NRS 450.625 and a physician who is appointed pursuant to subsection 1 of NRS 450.640, if applicable; or

      (b) A board of county commissioners, if that board enacts an ordinance which provides that the board of county commissioners is, ex officio, the board of hospital trustees, and a physician who is appointed pursuant to subsection 1 of NRS 450.640, if applicable.

      2.  “District hospital” means a hospital constructed, maintained and governed pursuant to NRS 450.550 to 450.760, inclusive.

      (Added to NRS by 1969, 1387; A 1989, 1011; 1993, 1975; 1995, 793; 1997, 3100, 3135; 1999, 639, 2076; 2001, 468; 2005, 1448)

      NRS 450.560  Establishment of district on motion of board of county commissioners.

      1.  The board of county commissioners of any county may of its own motion establish a hospital district in the manner prescribed in NRS 450.550 to 450.750, inclusive. The establishment of a hospital district is in addition to any other powers granted to a board of county commissioners pursuant to NRS 450.010 to 450.510, inclusive.

      2.  Except as otherwise provided in this subsection, a hospital district specified in subsection 1 may include territory within more than one county. If the establishment of such a district is proposed by a board of county commissioners, the district may be established only if the board of county commissioners of each county included within the district, other than the county of the board of county commissioners that proposes to establish the district, adopts a resolution approving the establishment of the district.

      (Added to NRS by 1969, 1387; A 1997, 3100, 3135; 1999, 639)

      NRS 450.570  Notice of intent to establish district: Contents; publication.  The notice of intent to establish a hospital district must:

      1.  State the name of the proposed district and the name of the county or counties in which the proposed district is located.

      2.  State the time and place fixed by the board of county commissioners for a hearing on the proposed establishment of the district.

      3.  Describe the territory or specify the exterior boundaries of the territory proposed to be included within the district, which boundaries, so far as practicable, must be the centerlines of highways.

      4.  Be published once a week for 2 successive weeks before the time fixed for the hearing in a newspaper designated by the board of county commissioners.

      (Added to NRS by 1969, 1387; A 1997, 3101, 3136; 1999, 639)

      NRS 450.580  Objections to formation of district; hearing.

      1.  At or before the time fixed for the hearing of the proposed establishment of a hospital district, any person interested may file written objections to the establishment of the district with the clerk of the board of county commissioners that proposes to establish the district.

      2.  At the hearing, the board of county commissioners shall hear and consider any objections filed pursuant to subsection 1.

      3.  The board may:

      (a) Sustain any objections filed pursuant to subsection 1;

      (b) Change or alter the boundaries of the proposed district to conform to the requirements of the district; and

      (c) Exclude from the district any land that will not be benefited by the establishment of the district.

      (Added to NRS by 1969, 1387; A 1997, 3101, 3136; 1999, 639)

      NRS 450.590  Establishment of district: Petition of owners of property; adoption, contents and publication of resolution of intention to establish district; exception.

      1.  Except as otherwise provided in subsection 3, if 25 percent or more of the holders of title or evidence of title to lands lying within the proposed district, whose names appear as such upon the last county assessment roll, present a petition to the board of county commissioners of the county in which the land lies, setting forth the exterior boundaries of the proposed district and asking that the district so described be established within a county hospital district pursuant to the provisions of NRS 450.550 to 450.750, inclusive, the board of county commissioners shall adopt a resolution declaring the intention of the board to include the territory within a county hospital district, naming the district and describing its exterior boundaries.

      2.  The resolution must:

      (a) Fix a time and place for the hearing of the proposed establishment of the district not less than 30 days after its adoption.

      (b) Direct the clerk of the board of county commissioners to publish:

             (1) The notice of intention of the board of county commissioners to establish the county hospital district; and

             (2) The time and place fixed for the hearing.

      (c) Designate that the notice must be published in a newspaper of general circulation published in the county and circulated in the proposed county hospital district, or if there is no newspaper so published and circulated, then in a newspaper of general circulation circulated in the proposed district.

      3.  The provisions of this section do not apply to a proposed hospital district if it includes territory within more than one county.

      (Added to NRS by 1969, 1388; A 1997, 3101, 3136; 1999, 639)

      NRS 450.600  Hearing on petition.  Upon the hearing of the petition, the board of county commissioners shall determine whether or not the petition complies with the requirements and purposes of NRS 450.550 to 450.750, inclusive, and must hear all competent and relevant testimony offered in support or in objection thereto.

      (Added to NRS by 1969, 1388)

      NRS 450.610  Resolution creating district.  If after a hearing, the board of county commissioners determines that the creation of the proposed hospital district is desirable, the board shall by resolution provide for the creation of such district, designating the name of the district and establishing the boundaries of the district.

      (Added to NRS by 1969, 1388)

      NRS 450.620  Enactment of ordinance regarding number, terms and election of trustees; service of board of county commissioners ex officio as board of trustees.

      1.  Except as otherwise provided in subsection 2 and NRS 450.625, if a hospital district is created pursuant to NRS 450.550 to 450.750, inclusive, the board of county commissioners shall provide by ordinance for:

      (a) The number of members of the board of trustees;

      (b) The term of office of the trustees, which must not exceed 4 years; and

      (c) The times and manner of the election of the trustees, which must be nonpartisan.

      2.  If a hospital district specified in subsection 1 does not include territory within more than one county, the board of county commissioners may enact an ordinance providing that the board of county commissioners is, ex officio, the board of hospital trustees of the district hospital. If such an ordinance is enacted in a county:

      (a) The county commissioners shall serve as the hospital trustees of the district hospital during their terms of office as county commissioners; and

      (b) If hospital trustees have been elected pursuant to subsection 1, the term of office of each hospital trustee of the district hospital who is serving in that capacity on the effective date of the ordinance is terminated as of the effective date of the ordinance.

      3.  Except as otherwise provided in NRS 450.710, a board of county commissioners shall not enact an ordinance pursuant to subsection 2 unless it determines that:

      (a) The county has fully funded its indigent care account created pursuant to NRS 428.010;

      (b) The county has fulfilled its duty to reimburse the hospital for indigent care provided to qualified indigent patients; and

      (c) During the previous calendar year:

             (1) At least one of the hospital’s accounts payable was more than 90 days in arrears;

             (2) The hospital failed to fulfill its statutory financial obligations, including the payment of taxes, premiums for industrial insurance or contributions to the Public Employees’ Retirement System;

             (3) One or more of the conditions relating to financial emergencies set forth in subsection 1 of NRS 354.685 existed at the hospital; or

             (4) The hospital received notice from the Federal Government or the State of Nevada that the certification or license of the hospital was in imminent jeopardy of being revoked because the hospital had not carried out a previously established plan of action to correct previously noted deficiencies found by the regulatory body.

      (Added to NRS by 1969, 1388; A 1995, 793; 1997, 572, 3102, 3137; 1999, 639, 2077)

      NRS 450.625  Trustees of district that includes territory within more than one county.

      1.  If a hospital district created pursuant to NRS 450.550 to 450.750, inclusive, includes territory within more than one county, the board of trustees of the hospital district must consist of three members of the board of county commissioners that created the district and:

      (a) Three members of the board of county commissioners of each county other than the county of the board of county commissioners that created the district, if the portion of the county included in the district is two-thirds or more of the total area of the county;

      (b) Two members of the board of county commissioners of each county other than the county of the board of county commissioners that created the district, if the portion of the county included in the district is more than one-third of the total area of the county but less than two-thirds of the total area of the county; or

      (c) One member of the board of county commissioners of each county other than the county of the board of county commissioners that created the district, if the portion of the county included in the district is one-third or less of the total amount of the area of the county.

      2.  Each member of the board of trustees appointed pursuant to this section must be appointed by the board of county commissioners of which he or she is a member.

      3.  The term of office of the members of the board of trustees is 3 years.

      4.  A member who ceases to be a member of the board of county commissioners that appointed him or her ceases to be a member of the board of trustees.

      5.  Any vacancy must be filled for the unexpired term by the board of county commissioners that appointed the member who created the vacancy.

      (Added to NRS by 1997, 3099; A 1997, 3134; 1999, 639)

      NRS 450.630  General powers and duties of board of trustees; rules and regulations.  The board of trustees shall:

      1.  Carry out the spirit and intent of NRS 450.550 to 450.750, inclusive, in establishing and maintaining a hospital in each district created pursuant to NRS 450.550 to 450.750, inclusive.

      2.  Make and adopt bylaws, rules and regulations:

      (a) For its own guidance and the government of any such hospital; and

      (b) Fixing the charges for treatment of patients.

      (Added to NRS by 1969, 1388; A 1987, 390)

      NRS 450.640  Employees and staff of hospital: Appointment to board of chief of staff of physicians for district hospital; appointment by board of chief executive officer and necessary assistants for hospital; compensation; removal; admission.  The board of trustees may:

      1.  After the board is formed pursuant to the provisions of NRS 450.620 or 450.625, increase the number of members who serve on the board by appointing, as a voting member of the board, one physician who is the chief of staff of physicians for a district hospital. The term of office of a member who is appointed pursuant to this subsection is 2 years, commencing on the date of appointment by the board of trustees. A vacancy in the term of a member appointed pursuant to this subsection must be filled in the same manner as the original appointment for the remainder of the unexpired term.

      2.  Appoint a chief executive officer and necessary assistants for each hospital, and fix the compensations of such persons.

      3.  Employ physicians, surgeons and interns, as the board determines necessary, and fix their compensation.

      4.  Remove such appointees and employees.

      5.  Remove persons who are appointed or employed pursuant to this section.

      6.  Control the admission of physicians, surgeons and interns to the staff by promulgating rules, regulations and standards governing such appointments.

      (Added to NRS by 1969, 1389; A 1987, 390; 2001, 469)

      NRS 450.650  Budgets.  The board of trustees of each county hospital district shall prepare annual budgets in accordance with NRS 354.470 to 354.626, inclusive.

      (Added to NRS by 1969, 1389; A 2011, 2731)

      NRS 450.660  Tax levies; disposition of proceeds. [Effective until November 24, 2014, and after that date unless the provisions of Senate Joint Resolution No. 15 (2011) are approved and ratified by the voters at the 2014 General Election.]

      1.  At the time of making the levy of county taxes for that year, each board of trustees shall levy a tax sufficient, together with the revenue which will result from application of the rate to the net proceeds of minerals, to raise the amount so budgeted upon any real and personal property that is subject to taxation within the boundaries of the district. Any tax levied on interstate or intercounty telephone lines, power lines and other public utility lines pursuant to this section must be based upon valuations as established by the Nevada Tax Commission pursuant to the provisions of NRS 361.315 to 361.330, inclusive.

      2.  When levied, the tax must be:

      (a) Entered upon the assessment rolls of each county that is included within the district; and

      (b) Collected in the same manner as state and county taxes.

      3.  When the tax is collected it must be:

      (a) Placed in the treasury of the county in which the district hospital is located;

      (b) Credited to the current expense fund of the district; and

      (c) Used only for the purpose for which it was raised.

      (Added to NRS by 1969, 1389; A 1989, 49; 1993, 1976; 1997, 3103, 3138; 1999, 639)

      NRS 450.660  Tax levies; disposition of proceeds. [Effective November 25, 2014, if the provisions of Senate Joint Resolution No. 15 (2011) are approved and ratified by the voters at the 2014 General Election.]

      1.  At the time of making the levy of county taxes for that year, each board of trustees shall levy a tax that is sufficient, together with the revenue which will result from application of the rate to the net proceeds from mineral extraction and royalties subject to the excise tax pursuant to the provisions of NRS 362.100 to 362.240, inclusive, to raise the amount so budgeted upon any real and personal property that is subject to taxation within the boundaries of the district. Any tax levied on interstate or intercounty telephone lines, power lines and other public utility lines pursuant to this section must be based upon valuations as established by the Nevada Tax Commission pursuant to the provisions of NRS 361.315 to 361.330, inclusive.

      2.  When levied, the tax must be:

      (a) Entered upon the assessment rolls of each county that is included within the district; and

      (b) Collected in the same manner as state and county taxes.

      3.  When the tax is collected it must be:

      (a) Placed in the treasury of the county in which the district hospital is located;

      (b) Credited to the current expense fund of the district; and

      (c) Used only for the purpose for which it was raised.

      (Added to NRS by 1969, 1389; A 1989, 49; 1993, 1976; 1997, 3103, 3138; 1999, 639; 2013, 3139, effective November 25, 2014, if the provisions of Senate Joint Resolution No. 15 (2011) are approved and ratified by the voters at the 2014 General Election)

      NRS 450.665  Powers of board of trustees: Borrowing of money and incurrence or assumption of indebtedness; limitations and conditions.

      1.  The board of trustees may borrow money and incur or assume indebtedness on behalf of the county hospital district if the total amount of the indebtedness, excluding revenue bonds and other securities constituting special obligations which are not debts, does not exceed an amount equal to 10 percent of the total of the last assessed valuation of taxable property, excluding motor vehicles, located within the district.

      2.  The board of trustees shall not borrow money or issue securities to evidence such borrowing until the board has obtained the approval of the:

      (a) Debt management commission; and

      (b) Board of county commissioners,

Ê of each county in which the hospital district is located.

      (Added to NRS by 1989, 1011; A 1995, 774; 1997, 3103, 3138; 1999, 639)

      NRS 450.670  Powers of board of trustees: Issuance and sale of bonds for certain purposes.  The board of trustees may issue and sell, for each district in its jurisdiction:

      1.  General obligation bonds, payable from taxes;

      2.  General obligation bonds, payment of which is additionally secured by a pledge of gross or net revenues derived from the operation of hospital facilities; and

      3.  Special obligation bonds, payable solely from gross or net revenues derived from the operation of hospital facilities,

Ê for the purpose of providing funds for the purchase of hospital equipment, the acquisition of property, the construction of buildings and improvement of property owned by the district for use in any one county hospital district.

      (Added to NRS by 1969, 1389; A 1989, 1011)

      NRS 450.675  Powers of board of trustees: Mortgage or pledge of personal property and acquisition of real property.  The board of trustees, with the approval of the board of county commissioners, if the board of county commissioners is not the board of hospital trustees, or, if the district in which the hospital is located includes territory within more than one county, with the approval of the board of county commissioners of each of those counties, may, by resolution:

      1.  Mortgage or pledge the personal property of the hospital, including accounts receivable, and enter into agreements for the sale and leasing back to the hospital of its personal property to provide security for acquiring money for the operation of the hospital; and

      2.  Acquire real property for the expansion of the hospital by entering into a contract for purchase of a type and duration and on such terms as the governing body determines, including a contract secured by a mortgage or other security interest in the real property.

      (Added to NRS by 1997, 3100)

      NRS 450.680  Election concerning issuance of bonds; applicability of Local Government Securities Law.

      1.  If a board of trustees desires to avail itself of the power conferred by NRS 450.670 and submission to the voters is required by the provisions of NRS 350.020 to 350.070, inclusive, the board shall submit the question of issuing the bonds to the registered voters of the district in accordance with those provisions.

      2.  The provisions of the Local Government Securities Law apply to any bonds authorized to be issued pursuant to NRS 450.670, except to the extent those provisions are inconsistent with the provisions of NRS 450.550 to 450.750, inclusive.

      (Added to NRS by 1969, 1389; A 1981, 964; 1989, 1012)

      NRS 450.690  Donations.  Any person, firm, organization, corporation or society desiring to make donations of money, personal property or real property for the benefit of any district hospital may make such donations to the district. Any such donation is effective when accepted by the board of trustees according to the terms of the deed, gift, devise or bequest of such property.

      (Added to NRS by 1969, 1389)

      NRS 450.700  Board of trustees to determine status of patient and fix charges.

      1.  The board of trustees may determine whether patients presented to the district hospital for treatment are subjects of charity. Except as otherwise provided in NRS 439B.330, the board of trustees shall establish the criteria and procedures to be used in the determination of eligibility for medical care as medical indigents or subjects of charity.

      2.  The board of trustees shall fix the charges for treatment of those persons who are able to pay for the treatment. The receipts for those charges must be paid to the county treasurer of the county in which the district hospital is located and credited to the fund for the district.

      (Added to NRS by 1969, 1389; A 1987, 390, 881; 1997, 3104, 3138; 1999, 639)

      NRS 450.710  Creation of district for sole purpose of contracting for services of hospital.

      1.  A board of county commissioners may create a hospital district in an area where no hospital district exists for the sole purpose of contracting with a public agency or a privately owned hospital to provide the services of a hospital to the residents of the district. If such a contract is executed, the board of trustees:

      (a) Shall prepare a budget pursuant to NRS 450.650;

      (b) Shall levy a tax pursuant to NRS 450.660;

      (c) May accept donations pursuant to NRS 450.690;

      (d) May determine medical indigency pursuant to NRS 450.700; and

      (e) May borrow money and incur or assume indebtedness pursuant to NRS 450.665.

      2.  A board of county commissioners shall not create a hospital district pursuant to this section unless it determines that:

      (a) The proposed hospital district constitutes a geographic area of the county that is not served by adequate medical services;

      (b) There is no county hospital or the county hospital is not capable of providing the necessary services; and

      (c) The proposal is approved by a majority of the votes cast on the issue by persons in the proposed hospital district.

      3.  If a hospital district is created pursuant to this section, the board of county commissioners may be designated by ordinance as, ex officio, the board of trustees of the hospital district, notwithstanding the provisions of subsection 3 of NRS 450.620.

      (Added to NRS by 1999, 2075)

      NRS 450.715  Authority of board of trustees to contract for services of hospital.  The board of trustees may contract with a public agency or a privately owned hospital to provide the services of a hospital to the residents of the hospital district if it determines that:

      1.  There is a need to provide medical services to the residents of the district which are not being provided by the district; or

      2.  It is less costly or more efficient to provide the services of a hospital to the residents of the district by contracting with a public agency or a privately owned hospital.

      (Added to NRS by 1999, 2075)

      NRS 450.720  Contract for management of district hospital.

      1.  The board of trustees may contract with a company which manages hospitals for the rendering of management services in a district hospital.

      2.  The agreement may provide:

      (a) That the chief executive officer of the hospital must be an employee of the company which manages the hospital; and

      (b) That the hospital may, in accordance with the requirements of NRS 450.730, purchase supplies, materials and equipment through the purchasing contracts of the company which manages the hospital, or through a purchasing group, without complying with the requirements for competitive bidding set forth in chapter 332 of NRS.

      (Added to NRS by 1999, 2076)

      NRS 450.725  Membership of district hospital in purchasing group.

      1.  A district hospital may, with the approval of the board of trustees, become a member of a purchasing group for the purpose of purchasing supplies, materials and equipment used by the district hospital.

      2.  A district hospital that becomes a member of a purchasing group may, in accordance with the requirements of NRS 450.730, purchase supplies, materials and equipment through the purchasing group without complying with the requirements for competitive bidding set forth in chapter 332 of NRS.

      (Added to NRS by 1999, 2076)

      NRS 450.730  Purchase of supplies, materials and equipment without complying with certain requirements for competitive bidding.  A district hospital that is authorized pursuant to NRS 450.720 or 450.725 to purchase supplies, materials and equipment in accordance with this section through the purchasing contracts of the company that manages the hospital or through a purchasing group may purchase the supplies, materials and equipment without complying with the requirements for competitive bidding set forth in chapter 332 of NRS if:

      1.  The documents pertaining to the proposed purchase, including, without limitation, the prices available to the company or purchasing group, are summarized in writing and, together with a sworn statement by an officer or agent of the company or purchasing group that the prices were obtained by the company or purchasing group through a process of competitive bidding, are presented to the board of trustees at its next regularly scheduled meeting; and

      2.  The board of trustees, after reviewing the summary and statement, finds that the proposed purchase will be made at a lower price than the lowest price reasonably obtainable by the hospital through competitive bidding pursuant to chapter 332 of NRS or available to the hospital pursuant to NRS 333.470 and approves the proposed purchase.

      (Added to NRS by 1999, 2076)

      NRS 450.750  Board of county commissioners in certain districts deemed local government responsible for transferring certain payments of money.  For the purposes of NRS 422.380 to 422.390, inclusive, if a hospital district created pursuant to NRS 450.550 to 450.750, inclusive, includes territory within more than one county, the board of county commissioners of the county in which the hospital is located shall be deemed to be the local government responsible for transferring payments of money to the Department for treatment of patients pursuant to the provisions of NRS 422.380 to 422.390, inclusive.

      (Added to NRS by 1997, 3099; A 2009, 2299)

      NRS 450.751  Dissolution of hospital district in county whose population is less than 700,000: Determination that dissolution is in best interest required; ordinance of board of county commissioners; considerations; duties of county clerk.  In a county whose population is less than 700,000:

      1.  Except as otherwise provided in subsection 2, if a majority of the members of the board of county commissioners determine that it is in the best interests of the county and of the hospital district that the hospital district be dissolved, the board of county commissioners shall so determine by ordinance, after there is first found, determined and recited in the ordinance that:

      (a) All outstanding indebtedness and bonds of all kinds of the hospital district have been paid; and

      (b) The services of the hospital district are no longer needed or can be more effectively performed by an existing unit of government.

      2.  If the hospital district includes territory within more than one county, the hospital district may be dissolved only if a majority of the members of the board of county commissioners of each county included within the district take the actions described in subsection 1.

      3.  In determining pursuant to subsection 1 whether the dissolution of a hospital district is in the best interests of the county and of the hospital district, a board of county commissioners must consider, without limitation, whether:

      (a) The hospital district is capable of providing sufficient health care services to the residents of the county or counties within the territory of the hospital district in an economical manner;

      (b) The basic health care needs of the residents of the county or counties within the territory of the hospital district will be met if the hospital district is dissolved;

      (c) There have been substantial changes in the financial status of the hospital district during the immediately preceding 2 years; and

      (d) There has been an increased tax burden on the residents of the county or counties within the territory of the hospital district during the immediately preceding 2 years.

      4.  The county clerk of each county within which any territory of the hospital district is located shall thereupon certify a copy of the ordinance to the board of trustees of the hospital district and shall mail written notice to all qualified electors who reside within the hospital district in his or her county, containing:

      (a) The adoption of the ordinance;

      (b) The determination of the board of county commissioners of that county that the district should be dissolved; and

      (c) The time and place for the hearing on the dissolution.

      (Added to NRS by 2005, 1446; A 2011, 1266)

      NRS 450.753  Dissolution of hospital district: Right of qualified electors to protest; dissolution prohibited if majority of qualified electors protest; dissolution by final ordinance; recital of protests.

      1.  On or before the date fixed for the hearing on the dissolution of a hospital district, any qualified elector who resides within the hospital district may protest against the dissolution of the hospital district by filing a written protest with the county clerk of the county in which the elector resides.

      2.  If, at or before the time fixed by the ordinance and notice, written protest is filed pursuant to subsection 1 by a majority of the qualified electors who reside within the hospital district, the hospital district must not be dissolved. If any written protests are filed and:

      (a) If the hospital district does not include territory within more than one county, the board of county commissioners determines that the protests so filed represent less than a majority of the qualified electors who reside within the hospital district, the board may complete the dissolution by the adoption of a final ordinance of dissolution, which ordinance must contain a recital of the protests, and the recital is binding and conclusive for all purposes; or

      (b) If the hospital district includes territory within more than one county, the board of county commissioners of each county included within the hospital district determines that the protests so filed represent less than a majority of the qualified electors who reside within the hospital district, the dissolution may be completed by the adoption of a final ordinance of dissolution by the board of county commissioners of each county included within the hospital district, which ordinance must contain a recital of the protests, and the recital is binding and conclusive for all purposes.

      (Added to NRS by 2005, 1446)

      NRS 450.755  Dissolution of hospital district: Hearing; full consideration of all protests required; adoption of final ordinance of dissolution or ordinance of nondissolution by board of county commissioners.  Except as otherwise provided in subsection 2 of NRS 450.753, at the place, date and hour specified for the hearing on the dissolution of a hospital district in the notice mailed pursuant to NRS 450.751 or at any subsequent time to which the hearing may be adjourned, the board of county commissioners of each county within which any territory of the hospital district is located shall give full consideration to all protests which have been filed pursuant to NRS 450.753 and shall hear all persons desiring to be heard and shall thereafter adopt either the final ordinance of dissolution or an ordinance determining that the hospital district must not be dissolved. The dissolution may be completed by the adoption of a final ordinance of dissolution by the board of county commissioners of each county included within the hospital district.

      (Added to NRS by 2005, 1447)

      NRS 450.757  Dissolution of hospital district: County clerk must file final ordinance of dissolution; locations.  Within 30 days after the effective date of each ordinance which is required for the dissolution of a hospital district pursuant to NRS 450.753 or 450.755, each county clerk shall file a copy of the ordinance in his or her office and shall cause to be filed an additional copy of the ordinance in the Office of the Secretary of State, which filings must be without fee and must otherwise be filed in the same manner as articles of incorporation are required to be filed under chapter 78 of NRS.

      (Added to NRS by 2005, 1447)

      NRS 450.759  Dissolution of hospital district in county whose population is less than 700,000: Unpaid taxes, levies and assessments are lien on property; power of board of county commissioners to collect.  In a county whose population is less than 700,000:

      1.  All outstanding and unpaid tax sales and levies and all special assessment liens of a dissolved hospital district are valid and remain a lien against the property against which they are assessed or levied until paid, subject to the limitations of liens provided by general law. Taxes and special assessments paid after the dissolution of a hospital district must be placed in the general fund of the county in which the district hospital was located.

      2.  The board of county commissioners of the county in which the district hospital was located has the same power to enforce the collection of all special assessments and outstanding tax sales of the hospital district as the hospital district had if it had not been dissolved.

      (Added to NRS by 2005, 1447; A 2011, 1267)

      NRS 450.760  Dissolution of hospital district in county whose population is less than 700,000: Retirement of outstanding debt and other obligations; levy of property tax; disposition of property.  In a county whose population is less than 700,000:

      1.  Before dissolving a hospital district pursuant to NRS 450.751 to 450.760, inclusive, the board of county commissioners of the county in which the district hospital is located shall determine whether the proceeds from the taxes currently being levied in the hospital district, if any, for the operation of the hospital and the repayment of debt are sufficient to repay any outstanding obligations of the hospital district within a reasonable period after the dissolution of the hospital district. If there are no taxes currently being levied for the hospital district or the taxes being levied are not sufficient to repay the outstanding obligations of the hospital district within a reasonable period after the dissolution of the hospital district, before dissolving the hospital district pursuant to NRS 450.751 to 450.760, inclusive:

      (a) If the hospital district does not include territory within more than one county, the board of county commissioners may levy a property tax on all of the taxable property in the hospital district that is sufficient, when combined with any revenue from taxes currently being levied in the hospital district, to repay the outstanding obligations of the hospital district within a reasonable period after the dissolution of the hospital district; or

      (b) If the hospital district includes territory within more than one county, the board of county commissioners of each county within which any territory of the hospital district is located may levy a property tax on all of the taxable property in the county that is within the hospital district that is sufficient, when combined with any revenue from taxes currently being levied in the hospital district, to repay the outstanding obligations of the hospital district within a reasonable period after the dissolution of the hospital district.

      2.  The allowed revenue from taxes ad valorem determined pursuant to NRS 354.59811 does not apply to any additional property tax levied pursuant to subsection 1. If the hospital district is being managed by the Department of Taxation pursuant to NRS 354.685 to 354.725, inclusive, at the time of dissolution, the rate levied pursuant to subsection 1 must not be included in the total ad valorem tax levy for the purposes of the application of the limitation in NRS 361.453, but the rate levied when combined with all other overlapping rates levied in the State must not exceed $4.50 on each $100 of assessed valuation. A board of county commissioners shall discontinue any rate levied pursuant to subsection 1 on a date that will ensure that no taxes are collected for this purpose after the outstanding obligations of the hospital district have been paid in full.

      3.  If, at the time of the dissolution of the hospital district pursuant to NRS 450.751 to 450.760, inclusive, there are any outstanding loans, bonded indebtedness or other obligations of the hospital district, including, without limitation, unpaid obligations to organizations such as the Public Employees’ Retirement System, unpaid salaries or unpaid loans made to the hospital district by the county, the taxes being levied in the hospital district at the time of dissolution must continue to be levied and collected in the same manner as if the hospital district had not been dissolved until all outstanding obligations of the hospital district have been paid in full, but for all other purposes, the hospital district shall be considered dissolved from the date on which each board of county commissioners of each county included within the hospital district has adopted a final ordinance of dissolution pursuant to NRS 450.753 or 450.755.

      4.  If the hospital district is being managed by the Department of Taxation pursuant to NRS 354.685 to 354.725, inclusive, at the time of dissolution, the management ceases upon dissolution, but the board of county commissioners of the county in which the district hospital was located shall continue to make such financial reports to the Department of Taxation as the Department deems necessary until all outstanding obligations of the hospital district have been paid in full.

      5.  The property of the dissolved hospital district may be retained by the board of county commissioners of the county in which the district hospital was located for use as a hospital or disposed of in any manner the board deems appropriate.

      6.  Any proceeds of the sale or other transfer of the property of the dissolved hospital district and any proceeds from taxes which had been levied and received by the hospital district before dissolution, whether levied for operating purposes or for the repayment of debt, must be used by the board of county commissioners of the county in which the district hospital was located to repay any indebtedness of the hospital district.

      (Added to NRS by 1999, 86; A 2005, 1448; 2011, 1267)

MISCELLANEOUS PROVISIONS

      NRS 450.800  County or district hospital may contract for services.

      1.  In addition to having the powers conferred under chapter 277 of NRS, a county or district hospital may contract with a private hospital or other organization for emergency medical services, including the transportation of patients, or any other services performed in connection with or related to the operation of a hospital. The services may be performed by the parties to the contract or the parties may establish a separate organization for that purpose.

      2.  A county or district hospital may enter into a contract to provide services:

      (a) For persons, whether or not admitted to the hospital, if those services are performed in connection with or related to the operation of the hospital.

      (b) Necessary for the health and welfare of the general public.

      (Added to NRS by 1981, 511; A 1987, 391)

      NRS 450.810  Lease of naming rights relating to public hospital; ordinance establishing procedures for lease; enterprise fund for proceeds of lease, fees or charges and other money received for public hospital.

      1.  The board of county commissioners of a county in which a public hospital is located may adopt, by ordinance, procedures for the lease of naming rights relating to the public hospital, including, without limitation, the lease of naming rights to:

      (a) Buildings, improvements, facilities, rooms, features, fixtures and sites located within the boundaries of the public hospital; and

      (b) Activities, events, programs, chairs, fellowships and memorials held or established at the public hospital.

      2.  If a board of county commissioners leases naming rights in accordance with the procedures adopted pursuant to this section, the board shall create an enterprise fund exclusively for the proceeds of the lease of all such naming rights, for fees or charges for use of the hospital and for any gifts, grants, donations, bequests, devises or money from any other source received for the public hospital. Any interest or other income earned on the money in the fund, after deducting any applicable charges, must be credited to the fund. Money that remains in the fund at the end of a fiscal year does not revert to the county general fund and the balance in the fund must be carried forward to the next fiscal year. The money in the fund may only be used to pay for expenses directly related to the costs of the public hospital for construction, improvement, operation, maintenance or programs.

      3.  The procedures adopted pursuant to subsection 1 must, without limitation:

      (a) Prohibit the lease of naming rights for a public hospital to that public hospital;

      (b) Provide that the board of county commissioners may reject any name proposed pursuant to a lease of naming rights;

      (c) Provide for the development of selection criteria for awarding a lease of naming rights, including procedures for circumstances in which more than one request for the lease of naming rights is submitted to the board of county commissioners;

      (d) Provide that the name must be consistent with the mission of the public hospital;

      (e) Prohibit the use of a name that:

             (1) Is false, misleading or deceptive;

             (2) Promotes unlawful or illegal goods, service or activities;

             (3) Promotes or encourages hate, violence or antisocial behavior;

             (4) Implies an endorsement by the county or a public official of any good, service or activity;

             (5) Is libelous or defamatory;

             (6) Contains text or an image that is likely to be confused with safety, traffic or emergency signage; or

             (7) Is associated with a person who has been convicted of a felony;

      (f) Provide that the term of a lease does not exceed 20 years; and

      (g) Provide that the board of county commissioners:

             (1) Shall require the change of a name authorized pursuant to a lease or revoke a lease before the expiration of its term if a change of circumstances results in a violation of the provisions of paragraph (d) or (e); and

             (2) May require the change of a name authorized pursuant to a lease or revoke a lease before the expiration of its term for any other purpose in accordance with the procedures adopted pursuant to subsection 1.

      4.  The terms of a lease granted pursuant to this section may be renegotiated and renewed. Each such renewal must provide that the term of the lease does not exceed 20 years.

      5.  A lease of naming rights pursuant to this section and the procedures adopted pursuant thereto are not subject to the requirements for competitive bidding set forth in chapter 332 of NRS.

      (Added to NRS by 2009, 2653)