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Tulalip Tribes of Washington Codes and Regulations

Amended: 2004

Ordinance 112 - Healthcare Quality Assurance


Formation
Objectives
Establishment of Health Commission
Authority and Operations
Clinic Management

Section 1.1 Purpose

This ordinance establishes the Tulalip Indian Health Clinic (“TIHC”) as an arm of the Tulalip Tribes of Washington (hereinafter “The Tribes”), to provide health-related services in a clinic setting to members of the Tribes, to other Indians who are eligible for health services from the Indian Health Service, and to members of the Tulalip and surrounding communities.

The primary objective of the TIHC is to provide for the health care needs of Tulalip tribal members. It is intended that revenue generated by the TIHC shall be utilized for the essential governmental purpose of meeting the unmet health care needs of Tulalip Tribal members.


Section 1.2 Jurisdiction And Applicable Law

The TIHC and this Ordinance are created pursuant to the inherent sovereign authority of the Tulalip Tribes over the Tribes internal affairs, as expressed through tribal law and regulations. The TIHC through this Ordinance is created as an integral branch of the Tulalip tribal government to serve the health care needs of Tulalip tribal members and such other persons as the Tulalip Board of Directors authorizes, or as required by applicable Federal Law.

The laws of the Tulalip Tribes and this Ordinance shall control the resolution of all matters arising out of the operation of the TIHC, unless otherwise controlled by Federal law.

Nothing in this section or Ordinance shall be construed as consent to the payment of any fees, taxes of levies not otherwise payable, or as consent to the imposition of any State or Federal regulations not otherwise applicable, or as consent to the waiver of the sovereign immunity of the Tulalip Tribes or the TIHC except as specifically set forth herein.


FORMATION


Section 1.3 Name

The official name of the health clinic established by this Ordinance shall be the "Tulalip Indian Health Clinic" and is referred to in this Ordinance as the "TIHC".


Section 1.4 Location

The TIHC is located in the community of Tulalip, Washington, on land owned by the Tulalip Tribes or by another Tribal entity.


Section 1.2 Definitions

Unless otherwise indicated, the following terms shall have the meanings indicated:

(a) “Tribes” means the Tulalip Tribes of Indians of Washington.

(b) “Board” means the Tulalip Tribes Board of Directors.

(c) “Commission” means the Health Commission created by this Ordinance to govern the operations of the TIHC.

(d) “Reservation” means the Tulalip Indian Reservation, provided that for purposes of health services to individual Tulalip tribal members, reservation refers to the service area of the Tribes.

(e) “Service Area” means the county in which Tulalip tribal members are entitled to federal benefits and services regardless of whether they are within the boundaries of the Indian reservation. This county is Snohomish County excluding the townships of Arlington and Darington.

(f) “Administrative Officer” means the person responsible for administrative operation of the TIHC.

(g) “Clinical Director" means the physician or physicians responsible for health care delivery at the TIHC.

(h) “Contracting Entity” means an organization comprised of physicians or a group of physicians with whom the Tulalip Tribes or TIHC contracts to provide physician services at the TIHC and to provide the position of Clinical Director of the TIHC.


OBJECTIVES


Section 1.6 General

The objectives of the TIHC include as follows:

(a) To provide direct health care services to Tulalip tribal members and other IHS-eligible clients who present themselves at the TIHC for treatment;

(b) To provide gatekeeper referral services to the Tulalip tribal members being served by IHS contract care;

(c) To provide fee-based health care services to the people of the community of the Tulalip Tribes and the surrounding area;

(d) To generate revenue for the tribe's Health Department for supplemental health care services for Tulalip Tribal members;

(e) To house health-related programs and services of the Tribe as space is available;

(f) To provide other services as directed by the Health Commission and approved by the Tulalip Tribes.


Section 1.7 Treatment by Indian Doctors or Spiritual Means

None of the laws of this Reservation regulating the practice of medicine or healing shall be construed to interfere with treatment by prayer, or with any person who administers to or treats the sick or suffering by mental or spiritual means, nor shall any person who selects such treatment for the cure of disease be compelled to submit to any form of medical treatment, except in the case of a dangerous communicable disease, nor any person be removed to any isolation hospital without their consent, except in the case of a dangerous communicable disease.

The Healer must report all cases coming to him for treatment to the Board of Health, and instruct the patient to submit to examination only that the nature of the disease may be ascertained and if quarantine or isolation is necessary, that it may be carried out in accordance with the Public Health laws.


ESTABLISHMENT OF HEALTH COMMISSION


Section 1.8 General

The TIHC shall be operated and managed by the Health Commission, subject to any restrictions contained in Federal or Tribal law, the Health Commission shall have the authority to do whatever is necessary, expedient or advisable to carry out the objectives of the TIHC and the provisions of this Ordinance. The TIHC may utilize its resources to negotiate and execute Contract, enter into formal agreements with the Tribes, the Federal Government or other entities and businesses, and exercise such other authority not inconsistent with this Ordinance or applicable law necessary to conduct the affairs of the TIHC.


Section 1.9 Health Commission

(a) Members. There is established a Health Commission composed of seven (7) members to operate and manage the TIHC. Members of the Health Commission shall be appointed by the Chairman of the Board, subject to the approval of the Board of Directors, for a term of three (3) years. The Health Commission shall consist of the following seven positions:

(1) the CEO of the Tulalip Tribes;

(2) a representative of the Board of Directors of the Tulalip Tribes;

(3) two community members who are TIHC clients and are members of the Tulalip Tribes;

(4) a health care administrator;

(5) a physician;

(6) a person with experience in financial affairs, such as a banker or a CPA.

The Director of the Health Quality Assurance Department of the Tribes shall be an ex officio member of the Health Commission without a vote. Position numbers two and three above shall be restricted to enrolled members of the Tribes. No member of the Commission shall be an employee of the TIHC or the Health Quality Assurance Department with the exception of the Director to the capacity as stated above.

(b) Appointment. When the Health Commission is first appointed, two (2) members shall appointed for a term of one (1) year, two (2) members shall be appointed for a term of two years, and three (3) members shall be appointed for a term of three (3) years, except the CEO shall be a permanent member of the Commission, and the Board representative's position shall be for the period of his or her term.

Appointments to fill a vacancy caused by other than expiration of a member's regular shall be only for the unexpired part of the term.

Health Commission members shall be eligible for reappointment. Any person interested in being a Health Commission member shall submit a written application to the Health Commission or the Board.

(c) Election of Officer. The Health Commission shall each year elect a chairperson, a vicechair and a secretary from its membership.

(d) Number of Health Commission members. The number of Commission members may increased or decreased from time to time by amendment to the Ordinance. No decrease in the number of Commission members shall shorten the term of office of any incumbent member.

(e) Resignation. With the exception of the CEO, who may resign his or her position as Commission member only by resigning as CEO of the Tulalip Tribes, a Commission member may resign at any time, either by oral tender of resignation at any meeting of the Commission, or by giving written notice of resignation to the Commission Chairperson or to the Chairman of the Board. Resignation shall be ineffective at the time specified and unless otherwise indicated, acceptance by the Commission or Board shall not be necessary to make it effective.

(f) Removal. The Commission, by affirmative vote of five (5) of the seven (7) Board members, may suspend or expel any member of the Commission for cause after proper notice and hearing at any regularly constituted meeting of the commission, except for the CEO. The CEO is removed from the Commission only if terminated from his or her position as the CEO of the Tribes by the Board. Failure of a Commission member to attend three (3) consecutive regularly scheduled meetings of the Commission without notice to the Commission and approval by the Commission chair, shall constitute cause for removal

(g) Vacancy. Any vacancy occurring in the Commission, and/or any increase in membership of the Commission seats made by the Commission shall be filled by the Board with recommendations from the Commission.. A Commission member appointed to fill a vacancy shall serve the unexpired term of his or her predecessor. Vacancies shall be filled within sixty (60) days. An increase in Commission membership shall provide that a majority of Commission members shall be Tulalip Tribal members.

(h) Conflicts. No member of the Board or the Commission shall be employed by the TIHC in any capacity, nor shall they enter into any contracts or agreement to provide goods or services to the TIHC or have an interest in any business enterprise or profit agreement. This section may be waived by resolution of the Board authorizing a specific person to serve on the Commission. Any member of the Commission who has a financial interest, either direct or indirect, in any decision, vote, or other action taken by the Commission shall recuse him or herself from the Commission’s discussion of such action, and shall not vote or participate in any decision on such action.


AUTHORITY AND OPERATIONS


Section 1.10 Operations of The Health Commission

(a) Management Responsibility. The Commission through the establishment of policies and guidelines shall manage the affairs of the TIHC. The Commission shall answer directly to the Board.

(b) Powers and Duties.

(1) The Commission shall establish or modify job descriptions for the positions of Clinical Director and Administrative Officer of the TIHC.

(2) The Commission shall approve the establishment of assistant clinical director or administrative officer positions by either the Clinical Director of the Administrative Officer.

(3) The Commission shall have the power to enact administrative rules and regulations pursuant to ordinances and resolutions of the Tulalip Tribes.

(4) The Commission shall review and send all contracts related to operation of the TIHC to the Tulalip Tribes legal department for approval, prior to their submission to the Board, and shall oversee the administration of such contracts.

(5) The Commission shall administer any contract between the Tribes and an outside entity to provide physician services and the position of Clinical Director to the TIHC. The Commission shall have authority to modify, reauthorize and renegotiate any such contract, or a new contract, with review and approval by the Tulalip Tribes legal department and then the Board. The Commission shall have authority to remove or terminate the services of the Clinical Director pursuant to the terms of any such contract and this Ordinance. The Commission shall have authority to initiate termination of any such contract for cause, with the final decision on termination to be approved by the Board.

(6) The Commission shall review all procurements and subcontracts in excess of $10,000.00.

(7) The Commission shall develop and make health policy recommendations concerning the TIHC. The Health Quality Assurance Director is responsible for developing and implementing health policy for the Tribes and its members, and any recommendations developed by the Commission relating to the TIHC shall be reviewed by the Tulalip Tribes legal department and the Health Quality Assurance Director, and incorporated into the Director's overall policy recommendations.

(8) The Commission shall review administrative systems for the TIHC.

(9) The Commission shall review and any changes or modifications to the organizational structure of the TIHC, and shall make and recommend changes in the operations of the TIHC.

(c) Meetings.

(1) Regular Meetings. Regular meetings of the Commission shall be held at such times and as often as necessary; provided that the Commission shall meet on at least a quarterly basis. Notice of regular meetings of the Commission shall be received by Commission members at least forty-eight (48) hours in advance of the meeting date, shall be made orally or in writing, and shall state the time, date, place and agenda of the meeting.

Any Commission member actually present at a regular meeting shall be deemed to have waived any defects in satisfying the notice requirements of this section, unless the presence of such Health Board member is only for the purpose of objecting to the transaction of any business because the regular meeting has not been properly raised or convened.

The Commission may discuss, but not decide, any item raised at a regular meeting for which proper notice has not been given to members. This provision may be waived only unanimous consent of all seven (7) members at any regular meeting of the Board.

(2) Special Meetings. Special meetings of the Commission may be called by, or at the request of the Chairperson of the Commission or any two (2) Commission members, and shall be held at the TIHC or at such other location as the Board may decide.

Notice of any special meeting of the Commission shall be given at least forty-eight (48) hours previous to the proposed special meeting time by written notice delivered personally or sent by mail or facsimile to each member at his or her address of record. A Commission member may waive notice of any such meeting. Attendance at a special meeting shall constitute waiver of notice for such meeting, except if a Commission member attends such meeting only for the purpose of objecting to transaction of any business on the grounds that the meeting was not properly called or convened.

Only agenda items specified in the special meeting notice may be decided at a special meeting. Other items may be discussed but not decided unless all members are present and waive the notice requirement.

(3) Quorum. A quorum for the transaction of business at any meeting shall be a majority of the members established by this Ordinance. In the absence of any Commissioner, a quorum may select another Commission member to preside over a regular or special the Commission by majority vote of the members present.

(4) Health Commission Decisions. The act(s) of a majority of the members present at any which a quorum is present shall be the act(s) of the Commission unless a greater number is required by this Ordinance or applicable laws or regulations. Each member of the Commission, including the Chairperson, shall be entitled to one (1) vote.

(5) Compensation. Health Commission members shall receive a stipend for each regularly scheduled meeting of the Commission that the Commissioner attends. Said stipend shall not exceed one and a quarter times the combined monthly base rates for mileage, per diem, or other costs, Commission shall establish prevailing government rates for mileage, per diem, or other costs, incurred while on approved Commission business which are consistent with the policy of the Tribes, and subject to the availability of funds within the TIHC.

(6) Accountability. The Commission shall be responsible to the members of the Tulalip Tribes and shall provide such reports of its activities as are required by the Board of Directors.

(d) Officers.

(1) Officers. The officers shall consist of a Chairperson, a Vice-Chairperson, and a treasurer, each of whom shall be elected by the Commission. The Commission may elect other officers and assistant officers as may be deemed necessary. Any two (2) or more offices may be held by the same person, except those of Chairperson and Secretary / Treasurer.

(2) Election and Term of Office. The officers shall be elected annually by the Board. Each officer shall hold office until his or her successor has been duly elected and has accepted office, until his or her death, or until he or she shall resign or has been removed in a manner set forth herein.

(3) Removal. Any officer elected or appointed by the Commission may be removed by the Commission or the Board when ever in its judgment, the best interest of Tribes would thereby be served. No officer removed under this provision shall have the right to appeal to any forum.

(4) Vacancies. A vacancy in any office because of death, resignation, removal, disqualification or otherwise, may be filled by the Commission for the unexpired portion of the term.

(5) Chairperson of the Commission. If present, the Chairperson shall preside at the meetings of the Commission. He or she shall sign, with the Secretary or any other officer authorized by the Commission, any contract or other instrument which the Commission has authorized to be executed. The Chairperson shall perform such other duties as from time to time may be prescribed by the Commission.

(6) Vice-Chairperson. In the absence of the Chairperson or in the event of his or her death, inability, or refusal to act, the Vice-Chairperson shall perform the duties of the Chairperson, and when so acting the Vice-Chairperson shall perform such other duties as from time to time may be prescribed by the Chairperson or the Commission.

(7) Secretary / Treasurer. The Secretary / Treasurer shall perform or cause to be performed the following duties.

(A) Keeping minutes in one or more books provided for that purpose; (B) Insuring all notices are duly given;

(B) Maintaining all Commission records.

(C) Attesting to authorized signatures;

(D) Maintaining and accounting for all funds and securities;

(E) Receiving and giving receipts for monies due and payable;

(F) Depositing all such monies in the name of the Tulalip Indian Health Commission in such depositories as may be selected;

(G) And in general performing all duties as may be prescribed.

(8) Compensation. Officers of the Commission shall receive per diem and expenses while employed in their official duties at amounts set by the Board. Such expenses shall be expenses of the TIHC. Tribal employees who are on the Health Commission shall not be compensated except as provided for in Tribal compensation policies. The CEO and Health Quality Assurance Department Director shall serve on the Health Commission as part of their official job responsibilities.


CLINIC MANAGEMENT


Section 1.11 Role of the Health Quality Assurance Department Director

(a) The Director of the Tulalip Health Quality Assurance Department shall be an ex officio member of the Health Commission for the purpose of advising the Commission on matters of Tribal health policy.

(b) The Director oversees any and all Tulalip Tribes' healthcare and mental healthcare provider's licensing including but not limited to ensuring active licenses and the required continuing education.

(c) The Director deals with consumer/patient complaints about the TIHC and/or other health related agency's such as Family Services and the Youth Hope House and/or those agency employees. The Director will submit all TIHC complaints to the Commission who will then submit recommendation for resolution of the issue to the Director. The Director will either follow the Commission's recommendations or submit a determination of his own with reasons explaining why the Commission's recommendations were not followed in full.

(d) The Administrative Officer of the TIHC shall be a Tribal employee, and the Health Quality Assurance Department Director is the Administrative Officer's immediate supervisor in the Tribal personnel structure. The Health Quality Assurance Department Director shall be responsible for supervising the Administrative Officer. The Health Quality Assurance Department Director shall report to the Health Commission as requested on administrative operations of the Commission.

(e) The Health Quality Assurance Department Director is a Tribal employee and is not subject to direct control by or accountability to the Health Commission. Any complaints about the performance of the Director or with regard to the TIHC shall be processed according to the Tulalip Human Resource Ordinance 84.


Section 1.12 Administrative Officer

(a) The Administrative Officer shall be a Tulalip Tribal employee, and shall be subject to the hiring, firing, and personnel procedures of the Tulalip Human Resource Ordinance. The Administrative Officer shall not be subject to hiring, firing or disciplinary action by the Health Commission.

(b) The Administrative Officer shall be responsible for the administrative operation of the TIHC, and for supervision of non-medical Tribal employees and contract employees at the TIHC, The Administrative Officer shall report directly to the Health Commission on administrative operations of the TIHC. The Administrative Officer shall also report on the operation of the TIHC to the Tulalip Health Compliance Department Director.

(c) Any complaints by the Health Commission about the performance of the Administrative Officer shall be processed according to the Tulalip Human Resource Ordinance. The Health Commission shall be responsible for operations of the TIHC, and shall have authority to give the Administrative Officer direction on TIHC operation issues.


Section 1.13 Clinical Director

(a) The Clinical Director shall be a Board-certified or Board-eligible physician(s), and shall work under contract to the TIHC. The Clinical Director shall be subject to supervision of the Health Commission, and the Commission shall have hiring and ruing authority over the position of Clinical Director.

(b) The initial Clinical Director(s) shall be appointed by the Tulalip Board of Directors. Thereafter, the Clinical Director shall be appointed by majority vote of the Health Board.

The Clinical Director shall serve until termination, resignation, or until termination of any contract with an entity contracting with the Tulalip Tribes to provide Clinical Director services to the TIHC.

The position of Clinical Director shall be provided by contract with an entity comprised of or controlled by Board certified or Board-eligible physicians. The Clinical Director position is an independent contractor and shall not be considered an employee of the Tulalip Tribes. The Clinical Director shall have none of the rights and responsibilities of Tulalip Tribal employee, and shall not be entitled to any of the benefits of Tulalip Tribal employees. The Clinical Director shall only have those rights and benefits specifically agreed to in any contract between the Tulalip Tribes and any entity providing a Clinical Director to the TIHC. The Health Commission shall have authority to modify or change any such contract upon negotiation and agreement with the contracting entity, and to provide other benefits to the Clinical Director.

(c) The Clinical Director may be removed for cause by a vote of five (5) members of the Commission, after proper notice and a hearing conducted a regularly scheduled meeting of the Commission. Removal of the Clinical Director may be subject to limitations contained within any contract between the Tulalip Tribes and any entity to provide a Clinical Director to the TIHC. In the event of a conflict between specifications of any such contract and this Ordinance, the contract shall prevail.

The Clinical Director may resign upon oral or written notice to the Health Commission at a regularly scheduled meeting of the Health Commission, or upon written notice to the Commission Chairperson. Such resignation shall be effective as indicated, and approval of the Commissions or Commission Chairperson is not necessary to effectuate such resignation. Resignation of the Clinical Director shall be effective only upon termination of employment of the physician(s) serving as Clinical Director from the entity providing Clinical Director services to the TIHC, except as otherwise mutually agreed upon by the Health Commission and such entity.

It shall be the responsibility of the Health Commission, in conjunction with any entity contracting with Tulalip Tribes to provide Clinical Director services to the TIHC, to recruit and fill any vacancy in the position of Clinical Director. The term of employment of a replacement Clinical Director shall be the remaining length of any contract between the Tulalip Tribes and such entity. Hiring of a replacement Clinical Director shall be subject to the approval of the Health Commission, which shall not be unreasonably withheld.

(d) The Clinical Director shall report directly to the Health Commission on health care delivery matters. The Clinical Director shall be responsible for supervising medical employees of the TIHC on health care delivery issues. The Clinical Director shall report to the Tulalip Compliance Department Director on health care delivery issues involving the TIHC, but shall not be subject to supervision by the Compliance Department Director.

In the event of conflict between the Administrative Officer and the Clinical Director with regard to supervision of a TIHC employee, such conflict shall be resolved by the Health Commission.

(e) Personnel issues involving TIHC employees shall be the responsibility of the Administrative Officer. The Clinical Director shall refer personnel issues involving TIHC employees to the Administrative Officer for resolution.


Section 1.14 Budgets; Contracts; Records; Miscellaneous

(a) Contracts. The Health Commission may authorize the Administrative Officer to enter into contracts in the name of the TIHC or to execute and deliver any instrument in the name of the TIHC to accomplish the goals set out in this Ordinance.

(b) Budgets. The Administrative Officer of the TIHC shall prepare an annual budget covering anticipated operations of the TIHC in conjunction with the Clinical Director and the Tulalip Health Compliance Department Director. The budget shall be approved and adopted by the Health Commission. The initial budget of the TIHC shall cover the period remaining in the calendar year.

(c) Bank Accounts. The TIHC shall maintain separate bank accounts as designated by the Commission.

(d) Cheques, Drafts or Orders. All cheques, drafts or orders for payment of money, notes, other evidence of indebtedness issued in the name of the TIHC shall be signed by the Administrative Officer and / or duly authorized agent or officer of the Health Commission in such manner as may be determined from time to time by the Health Commission.

(e) Financial Commitments. Financial commitments in excess of $10,000.00 shall not be effective until approved by resolution of the Health Commission. In no event shall any security agreement, contract or other financial agreement obligate the Tulalip Tribes to pay any financial commitments of the TIHC.

(f) Records and Accounts. Separate accounting records for the TIHC shall be maintained in accordance with a system, and in a manner satisfactory to the Health Commission. A monthly trial balance shall be prepared from the general ledger and copies shall be furnished to the Health Commission.

(g) Audits and Reports. The accounts of the TIHC shall be audited annually at the close of the fiscal year at the expense of the TIHC. Annual reports will be submitted to the Tulalip Board of Directors. The audit will be performed by a Certified Public Accountant selected by the Health Commission, and conducted according to all applicable federal requirements.

(h) Insurance. Insurance on property owned or used by the TIHC, or on property in which the TIHC has any financial interest, shall be in amounts and types of coverage specified by the Tribe.

(i) Fiscal Year. The fiscal year of the TIHC shall be the calendar year, unless otherwise directed by the Tribe.

(j) Petty Cash Fund. A petty cash fund is authorized to be established for the TIHC in the amount of $1,000.00. This amount may be increased subject to approval of the Health Commission. This fund may be used to pay small expenses and obligations of the TIHC when it is not feasible to pay by cheque drawn on the official depository of the TIHC in the amount of submitted receipts, vouchers, or statements signed by the payee or by proof of expenditure. Petty cash reimbursement vouchers shall be certified by the Administrative Officer.

(k) Indemnification. The Tulalip Board of Directors shall indemnify and hold harmless each of the members of the Health Commission (whether or not then a current member) and his or her executor, administrator and heirs against any judgment or expenses actually and reasonably incurred in connection with any action, suit or proceeding in which he or she is made a party by reason of being or having been a Commission member. A Health Commission member shall have no right to reimbursement or indemnification in relation to matters in which he or she has been adjudged by such action, suit or proceeding to be liable for willful misconduct or fraud in the performance of duties as a Health Commission member. The right to indemnification for liability and expense also shall apply to actions, suits or proceedings which are compromised or settled if the court having jurisdiction of the matter shall approve such settlement.


Section 1.15 Distribution of Revenue

It is anticipated that operational expenses of the TIHC shall be covered on an annual basis through contract with the Indian Health Service. One of the objectives of the TIHC is to provide fee-for-service health related services to the non-Indian population of the community of Tulalip and the surrounding area who are not eligible for services under Indian Health Service regulations. All revenues generated by the TIHC in excess of operational costs and expenses shall be budgeted on an annual basis pursuant to Budget Procedures Ordinance ____ and shall be designated for use for unmet health care needs of Tulalip Tribal members. The Health Department Director shall submit a proposed budget to use such funds, using project revenues, on an annual basis pursuant to the time lines established in the Budget Procedures Ordinance.


Section 1.16 Ownership of Assets

All assets acquired by the TIHC shall belong to the TIHC as a governmental arm of the Tulalip Tribes, and shall ultimately reside in the Tulalip Tribes. Title to assets shall be taken in the name of the Tulalip Tribes. In the event of dissolution, title to all assets of the TIHC shall revert directly to the Tribes.


Section 1.17 Severability

If any part or parts, or the application of any part, of this Chapter is held invalid, such holding shall not affect the remaining parts of this Chapter. The Tribal Council hereby declares that it would have passed this Chapter even if it had known that such part or parts of application of any part thereof would be declared invalid.


Section 1.18 Sovereign Immunity

Nothing in this Charter shall be deemed a waiver of the sovereign immunity of the Tulalip Tribes for any purpose whatsoever.


Section 1.19 Amendments

This Ordinance may be recommended for amendment by a majority of the Health Commission present at any regular or special meeting, provided that at least ten (10) days written notice is give of the intention to consider amendment to this Ordinance. If passed, a recommendation for amendment shall be forwarded to the Board of Directors for approval and adoption as set forth below.

This Ordinance may be amended by the Board of Directors only upon a vote of two-thirds (2/3) of the entire Board.

This Ordinance became effective pursuant to Resolution No. 01 -164, passed by the Tulalip Tribes Board of Directors at a meeting held in Tulalip, WA on May 5, 2001.


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Legislative History

Adopted by Reso. 01 -164, Laws of May 5, 2001.

Approved, May 24, 2001, Superintendent, Puget Sound Agency


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