Section 27B. Two or more municipalities may, in a city having a Plan E charter by the affirmative vote of a majority of all members of the city council, in other cities by vote of the city council and approval of the mayor, and by vote of a town at a regular annual town meeting, form a regional health district which shall consist of a regional board of health, a director of health and his staff. The regional health district shall have all the powers and shall perform all the duties conferred upon, or exercised by, the boards of health and health departments of the constituent municipalities under any law or ordinance pertaining thereto, except in so far as the regional health district may by majority vote delegate certain powers and duties to the constituent municipalities.

The regional health district, hereinafter referred to as the district, shall be administered by a full-time director of health, who shall be either (a) a physician, graduated from an approved school of medicine and registered or eligible for registration to practice medicine in the commonwealth, with one year of full-time graduate public health academic training or two years of full-time experience, and not engaged in private practice while serving as director of health; or (b) a lay person with professional academic training equivalent to a bachelor’s degree and with five years of satisfactory full-time experience in generalized public health programs, or a lay person with ten years of full-time satisfactory administrative experience and supervision of generalized public health programs. When a lay health officer is employed, there shall be employed a registered physician to perform such medical functions as are required.

The regional board of health, hereinafter referred to as the board, shall be comprised of at least one representative from each constituent municipality. Each constituent municipality having a population greater than ten thousand shall have one additional representative to the board for every population unit of ten thousand or major fraction thereof beyond the first ten thousand. In no instance shall there be more than five representatives from a single municipality on a board. Towns shall at a town meeting select, or change the method of selecting, their representative or representatives by any of the following methods:— (a) by appointment of the board of health, (b) by appointment of the selectmen, (c) by vote at the annual town meeting, or (d) by any other method decided at the annual town meeting. In cities such representatives shall be appointed by the mayor with the approval of the city council, or in cities having Plan E charters by the city manager, unless a definite mode of appointment is otherwise provided by the city charter. When the district includes one or more entire counties, the county commissioners of each entire county shall appoint an additional representative to the board. Each representative shall serve for a period of three years, excepting that at its initial organization the board shall decide the term of years for the first representatives who shall be elected or appointed to the board, so that thereafter approximately one third of the representatives will be elected or appointed each year. Said representatives shall serve without compensation, but shall receive their necessary traveling expenses from the board while in the performance of their official duties. Representatives to the board may be re-elected or reappointed for a maximum of two terms. The board shall meet annually and at such other times as it shall determine by its rules or when requested by the chairman of the board or the director of health.

Any constituent municipality may, by vote passed prior to July first in any year, withdraw from the district, such withdrawal becoming effective January first following; provided, that the municipality shall have been a member of the district for at least five years.

The board shall select a treasurer, who may be the treasurer of one of the constituent municipalities, to act as treasurer for the district. For the faithful performance of his duties, said treasurer shall give bond, with a surety company authorized to transact business in the commonwealth, in such sums and upon such conditions as the board may require. Said board, annually in the month of December, shall (a) estimate the amount of money required to pay the cost and expense of the district for the following year, (b) fix and determine by a majority vote the proportion of such costs and expenses to be paid by the individual municipalities thereof during such year, and (c) certify the amount so determined for each municipality to the assessors thereof, who shall include same in the tax levies of each year, and each municipality shall appropriate such sum for the district. In apportioning the costs, the board by a majority vote may use any of the following formulae as a basis for their apportionment:—(a) valuation according to the latest state valuation, establishing the basis of apportionment of state and county taxes, (b) population as determined by the most recent estimate by the secretary of the commonwealth, exclusive of universities and federal, state and county institutions, (c) a combined formula of valuation according to the latest state valuation and population as determined by the most recent estimate by the secretary of the commonwealth, exclusive of universities and federal, state and county institutions, or (d) any other method decided by majority vote of the board. Upon order of the board, the treasurer of each constituent municipality thereof shall from time to time, subject to the provisions of section fifty-two of chapter forty-one, pay to the treasurer of the district the amount certified by the board as the municipality’s share of the cost and expenses of the district. The treasurer of the district shall disburse the money so received upon warrant approved by the director of health and signed by the chairman or vice-chairman of the board. The accounts of each district shall be audited annually by the bureau of accounts of the department of corporations and taxation, under the provisions of sections thirty-five, forty and forty-one of chapter forty-four.

The board shall appoint, and may reappoint, for a term of five years, a director of health, hereinafter referred to as the director, as provided in this section. The board may remove the director for cause after proper notice and a public hearing. The director shall serve as secretary of the board, but shall have no vote. He shall be the executive and administrative head of the district, and may, with the approval of the board, designate one or more deputies and may appoint and employ, with like approval, such assistants as may be provided for in the budget. The director shall prepare and present annually to the board a report and a budget for its approval, together with such recommendations as he may deem proper. The board shall make and promulgate reasonable rules and regulations, for which notice and public hearing shall be given in the same manner and extent as required by the provisions of section thirty-seven of chapter thirty and section two of chapter thirty A. The board shall also (a) take evidence in appeals, (b) consider plans and appointments required by law, (c) hold hearings, and (d) discharge other duties required by law; but it shall have no administrative or executive functions. The board may delegate the holding of hearings to the director or his deputies. The board may elect an executive committee consisting of its chairman, vice-chairman, secretary and such other members as its rules may determine. Said executive committee shall have the authority to act for the board when the board is not in session.

All full-time incumbents of any office or position brought under the district at the time of its formation shall be transferred thereto without loss of civil service, retirement or other rights. All positions and offices of the district, including the director, but excluding representatives to the board, shall be subject to the provisions of chapter thirty-two, and all such included offices and positions shall be placed in the county retirement system of the county which has the majority of the population of the area served by the district at the time of its organization. Ninety days after the organizational meeting of the board, all district positions and offices, except the director and the representatives to the board, not under the provisions of chapter thirty-one at the time of the formation of the regional board of health, shall be placed within the civil service in the manner provided by chapter thirty-one and the rules and regulations promulgated thereunder, and all positions and offices subsequently established by the board shall be subject to the provisions of said chapter thirty-one and the rules and regulations thereof, unless the board by a majority vote within ninety days after its organizational meeting votes not to extend the provisions of said chapter to any or all of such eligible positions and offices. At any time after such a vote to exclude, however, the board by a majority vote may bring within the provisions of chapter thirty-one, in the manner set forth therein, any or all positions and offices, except the director and the representatives to the board, which were excluded but which are still subject to the jurisdiction of the board. The wages and salaries of all offices and positions, including those subject to chapter thirty-one, shall be determined by the board.