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HomeMy WebLinkAbout970946.tiffRESOLUTION RE: APPROVE AMENDMENTS TO BY-LAWS OF WELD COUNTY LONG-TERM CARE BIO-ETHICS COMMITTEE WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS, by Resolution dated March 25, 1996, the Board of County Commissioners did approve the Weld County Long -Term Care Bio-Ethics Committee By -Laws, and WHEREAS, proposed amendments to said by-laws have been written and submitted to the Board of County Commissioners for its review and approval, a copy of said by-laws being attached hereto and referred to herein, and WHEREAS, after study and review, the Board deems it advisable to approve said proposed amendments. NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado, that the Amendments to the Weld County Long -Term Care Bio-Ethics Committee By -Laws be, and hereby are, approved. The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 14th day of May, A.D., 1997. Deputy Clerk t;' the Board BOARD OF COUNTY COMMISSIONERS WEL)UNTY, C7RADO eorge'E. Baxter, Chair EXCUSED tance L. Harbert, • ro- IF / IIin Dale K. Hall OFORM: !/ /71 arbara J. Kirkmeye ounty Attor ey 970946 : ,AolL;c /ASS LD" ww/!EE H R0002 WELD COUNTY LONG-TERM CARE BIO-ETHICS COMMITTEE BY-LAWS Purpose and Functions of the Committee The purpose of the Weld County Long -Term Care Bio-Ethics Committee is to create a community -based, interdisciplinary, volunteer advisory committee to assist health care decision makers and providers in clarifying and resolving bio-ethical dilemmas. The Committee will assist surrogate medical decision makers in promoting and protecting "the best interests" of those persons who cannot make decisions for themselves. The Committee will also assist health care patients, professionals, family members and Weld County organizations in health care decisions that involve ethical dilemmas. The functions of the Committee include education, consultation and case review, and the development of guidelines related to medical decision making in long-term care facilities and with patients receiving home health care. The Committee's educational function includes informing committee members, family members and community members about ethical principles in health care decision making and their relation to current issues, cases, and options. The Committee is consultation and case review function involves two activities: (1) on -call review of current cases and dilemmas; and (2) retrospective case reviews in the regularly scheduled monthly meetings. The Committee's guideline development function includes promoting advance medical directives, designing appropriate surrogate decision making protocols, and reviewing established procedures for meeting the needs of long-term care recipients. THE COMMITTEE DOES NOT MAKE DECISIONS IN BIO-ETHICAL DILEMMAS, BUT ACTS AS A RESOURCE AND FORUM FOR INFORMED DISCUSSION. Composition, Selection, Training, and Responsibilities Committee Composition. The Committee will consist of at least twelve members and up to thirty members. It will be interdisciplinary and may include social workers, physicians, nurses, nursing home administration representatives, attorneys, clergy, ethicists, long-term care recipients, advocates of the elderly and disabled, home health care representatives, mental health professionals, certified nurses aides, nursing home staff members, children with parents receiving long-term care, and any other persons interested in the work of the Committee. In addition to the Committee members described above, there will be three standing or permanent members of the Committee: The Weld Page 1 of 5 Pages County Long -Term Care Ombudsman, a Case Manager from the Weld County Area Agency on Aging, and an Adult Protection Services Case Worker from the Weld County Department of Social Services. Committee Member Selection. Prospective Committee members can be nominated by any active committee member or they can apply directly to the Committee. Individuals interested in becoming active members must submit an application upon the form approved by the Committee for Weld County Advisory Board Applications to be submitted to the Weld County Commissioners. Applicants will be interviewed and approved by the Committee as a whole. The final approval and appointment of the person as a member of the Committee shall be made by the Weld County Board of County Commissioners. Committee selection will encourage diversity in gender, age, ethnicity, education, socioeconomic status, and values orientation. Terms of Membership. Each member of the Committee will be nominated to serve a term of three years, with the possibility of one additional renewal term. The terms of Committee members shall commence on January 1 of the first year of the membership. Members, terms shall be staggered so that no more than one-third of the Committee membership will be scheduled for appointment by the Weld County Board of County Commissioners in any one year. By staggering the terms of memberships of the Committee members, this will help provide for continuity of the Committee membership and functions. This provision does not apply to the standing members of the Committee. Committee Member Training. The Committee members are committed to educating themselves in bio-ethical theory, issues and decision making related to the purpose and functions of the Committee. Training and education are continual and include awareness of current ethical thought, biomedical advances, and relevant legal applications. Committee members agree to familiarize themselves with the basic textbook and material studied by the Committee members, collect relevant literature and case studies, share pertinent information with other Committee members, and attend, when possible, ethics seminars, workshops and lectures. Committee Responsibilities. Committee members agree to do the following: a. Serve for a minimum of one term; b. Respect the diversity and range of ethical outlooks expressed by other Committee members; c. Contribute regularly to the Committee process (education, case review and guideline formation); d. Acknowledge the dignity and rights of privacy and confidentiality of individuals involved in case consultations and reviews; and e. Obtain prior Committee approval of any speeches, articles, or statements Page 2 of 5 Pages of opinion made by a Committee member, in which the Committee member identifies `mcnx2cives himself as a member of this Committee. And If If such approval is granted and the Commttee member is- making it elcar in any such speech, article, or statement of opinion cnt lrts,o t=behalf, then the tiieax ber shall; make it cleat that such does not nreflect the position of the Committee. Removal of Committee Members. If a Committee member has more than three unexcused absences in a given calendar year, she/he will be removed from the membership roster. A member may be excused by notifying the chairperson in advance of the meeting of their inability to attend. Upon motion of any Committee member, the Committee may consider the removal of one of its members for good cause. After a motion for removal is made, notice shall be given to all Committee members for the next meeting of the Committee that a vote will be taken upon the motion to remove a Committee member. Upon the vote of a majority of the members of the Committee present at the time of the vote upon the motion, a recommendation for removal of the Committee member may be approved. The recommendation for the removal of the Committee member will then be forwarded to the Weld County Board of Commissioners for final approval. Committee Member Liability The Weld County Long Term Care Bio-Ethics Committee is not a decision maker. This obligation falls to the legal guardian, family member, health care proxy, or agent of the incapacitated individual. Since the Committee is advisory only, there should be little basis to which any liability can attach. The Committee is a separate and distinct advisory committee under the supervision and approval of the Weld County Area Agency on Aging. Committee members shall be appointed and subject to removal by the Weld County Board of County Commissioners. The Committee therefore is a volunteer organization organized pursuant to the Weld County Home Rule Charter and subject to the control and direction of the Weld County Board of County Commissioners. Committee Operations Officers. The Committee will annually elect a chairperson who will be responsible for coordinating meeting agendas and other committee activities. Meetings. Regularly scheduled meetings will be held monthly for approximately one and one-half to two hours at a date and time set by the chairperson. The agenda for the meetings will be distributed by the chairperson prior to the meeting. No voting in the meetings shall be permitted except on matters of policy and procedure, or upon a motion for removal of a Committee member. Any action to be taken by the Committee shall be approved by a majority vote of those Committee members present at the meeting. The meetings of the Committee are not open to the public, and no person shall be allowed to attend except members of the Committee and those persons invited in Page 3 of 5 Pages accordance with the policies contained herein. Review of a Specific Case. The request for a meeting of the Committee for consideration of a bio-ethical situation requiring the review of a specific case shall be made in writing on the form prescribed by the chairperson. The request will be reviewed by the chairperson, or a designated representative, to determine whether the issues presented in the request are issues which are within the purpose and function of the Committee. If a meeting is set by the chairperson for the review of a specific case, all members of the Committee will be invited to attend by adequate prior notice. No quorum shall be necessary for conducting a meeting. In no event will a meeting be held concerning a specific case unless and until the treating physician, the responsible patient care staff, and the patient/surrogate medical decision maker for the patient have been invited to attend. Scheduling of the meeting will be made to accommodate the attendance of the physician, responsible nursing staff, patient and family. On -Call Subcommittee. A subcommittee of four committee members will meet as needed to provide consultation on active cases in which circumstances require urgent action. Subcommittee members shall serve one month during each rotation. Organization Subcommittee. The organizational subcommittee shall be responsible for preparation of agendas for meetings, distribution of agendas and notices to members, and all other matters regarding the organization of meetings and consultations of the committee. Members Subcommittee. This subcommittee will be responsible for actively seeking additional members, and screening applicants for possible membership on the Committee. Educational Subcommittee. The members of this Committee will be responsible for organizing materials, speakers and other, education opportunities for presentation at the committee meetings. Access to the Committee. Upon request and advance notification, any interested party to a case can appear before the Committee or to seek information and clarification of issues and options. Documentation. A brief record of Committee activities will be kept. The record will include issues discussed, actions taken, and cases reviewed. All Committee members shall maintain strict confidentiality of patient information, patient identity, and care giver identities. States of Operation. Any expenses or costs for the operations of the Committee must be agreed upon by representatives of the five nursing home facilities in Weld County. The nursing home facilities (Bonell Good Samaritan Center, Kenton Manor Living Center, Centennial Health Care Center, Fairacres Manor, Inc., and Windsor Health Care Center) shall share equally all mutually agreed upon costs and expenditures for operations of the Committee. The Weld County Board of County Commissioners shall not be obligated to pay any of the costs of operation of the Committee. Page 4 of 5 Pages Effective Date of By Laws. These by laws shall become effective after approval by a vote of the committee members, subsequent approval by the Weld County Area Agency on Aging, and final approval by the Weld County Board of County Commissioners. Amendments. These by laws may be amended or repealed by a vote of the majority of the members present at a regularly scheduled meeting of the Committee. Recommendations for amendments must then be submitted to the Weld County Area Agency on Aging for its approval of the amendments, and final approval of any amendments to the by laws must be made by a vote of the Weld County Board of County Commissioners. CERTIFICATE I hereby certify that the foregoing by laws have been approved by the Weld County Long Term Care Bio-Ethics Committee. M:\ WPFILES\BYLAWS \BI•BYL.BTB Page 5 of 5 Pages WUDe. COLORADO TO: Board of Weld County Commissioners FROM: Bruce T. Barker, Weld County Attorney DATE: May 5, 1997 RE: Revised Proposed Amendments to Weld County Long Term Care Bioethics Committee Bylaws As you may recall, on April 9, 1997, I submitted to the Board of County Commissioners a Memorandum regarding the proposed amendments to the Weld County Long Term Care Bioethics Committee Bylaws. A copy of that Memorandum is attached. I received the Memorandum back with the comments which are shown. I then spoke with Linda Piper by E - Mail and with Chuck Connell, Attorney at Law, by telephone regarding the comments. Attached are the Bylaws with the proposed amendments and with my revisions to the proposed amendments in accordance with the comments which you all provided. Those revisions are shown in the strike outs and highlighted language. Please review the revisions and let me know if they are ok. If they are, I will see that the Bylaws are put on the agenda for the Board's formal approval. Say OK to the Proposed Amendments and Place Schedule on Agenda Work Session George Baxter Dale Hall Connie Harbert Barb Kirkmeyer Bill Webster BTB/db:Memo/BOCC/Biobylaw Attachments pc: Linda Piper Chuck Connell Vicky Sprague e T. Barre Weld County Attorney Other 970946 TO: Board of County Commissioners f to 1st FROM: Bruce T. Barker, Weld County Attorney DATE: April 9, 1997 RE: COLORADO Proposed Amendments to Weld County Long Term Care Bioethics By Laws Attached are copies of a resolution and explanatory letter which I received from Chuck Connell regarding some proposed changes to the Weld County Long Term Care of Bioethics Committee Bylaws. Linda Piper reports that the proposed changes are because one of the Committee members has been speaking to the Greeley Tribune about a confidential matter. The majority of the Committee's members desire to oust the talkative member. Additionally, the Committee wants to create a rule whereby no member may speak or write in a manner in which he identifies himself as a Committee member. ,1 5PLrl.K&&E aite'Act- or Crsin vi7" /uni5Z,LF �A>ts The proposed changes have been incorporated into the current version of the Bylaws. Those changes are highlighted in gray on the attached copy. Linda and I recommend that the Board consider and approve the proposed changes. I note that the removal section states the Committee's role is merely to recommend removal to the Board of County Commissioners. The Board then has ultimate authority with respect to the removal. Regarding the proposed rule on speaking or writing, that rule seems to be one which is definitely important and should be included in the Bylaws. Say OK and Place on Agenda George Baxter Dale Hall Connie Harbert Barb Kirkmeyer i�..,. Bill Webster BTB/db: Memo/BOCC/B ioethics Attachments pc: Linda Piper 2„,40-,71 Schedule Work Session Bruce T. Bar r Weld County • ttorney Iw6 qFs qal'" rent", a1/ise s vita k1 Cam; c, MEMO To: George Baxter, Chair Board of County Commissioners From: Linda E. Piper, Director Weld County Area Agency on Agi Subject: Revision to Bio-Ethics Committee By -Laws Date: March 14, 1997 Attached please find By -Law revisions for the Weld County Area Agency on Aging Bio-Ethics Committee. The revisions were drafted in accordance with stated procedures and address the following: ► procedure for removal of any committee member ► procedure to obtain prior Committee approval of any speeches, articles, or statements of opinion when the Committee member identifies himself as a member of the Committee. Please call Linda Piper at 353-3800, extension 3320 if you have questions. CHARLES J. CONNELL ATTORNEY AT LAW The Law Building 1011 11th Avenue Greeley, CO 80631 February 20, 1997 Ms. Linda E. Piper, Director Weld County Area Agency on Aging P.O. Box 1805 Greeley, CO 80632 (97d) 353-2507 Fax (970) 356-1111 RE: Weld County Long -Term Care Bio-Ethics Committee Dear Linda: The Committee has recommended that there be amendments to the original By -Laws of the Committee. The original By -Laws provide that any recommended amendments would first be approved by the Area Agency on Aging. Please find enclosed the original of the Resolution that has been signed by Dan W. Gauger, the Chairperson of the Committee. If the proposed amendments meet with your approval, we would request that you date and sign it where indicated on page two. Then please return the original to my office so I can forward it on to Ms. Vicky Sprague at the Office of the Clerk of the Board of County Commissioners for her to send it through their approval process. If you have any questions regarding the amendments please let me know. Thank you for your attention to this matter. Very truly you rtes -J. Connell ttorney at Law CJC/lsb /Enclosure RESOLUTION WHEREAS, the members of the Weld County Long -Term Care Bio- Ethics Committee have considered certain amendments to the By -Laws of the Committee, and WHEREAS, notice to all members of the Committee having been sent prior to the January meeting of the Committee for consideration of amendments to the By -Laws of the Committee, and WHEREAS, a majority of those individuals present at the regularly scheduled January meeting of the Committee on January 27, 1997 have approved the amendments to the By -Laws of the Committee as provided herein. NOW, THEREFORE, BE IT RESOLVED by the Weld County Long -Term Bio-Ethics Committee that the following amendments be recommended to the Weld County Board of County Commissioners for their approval to modify the original By -Laws of the Committee: 1. The By -Laws of the Committee shall be amended by adding to the paragraph "Removal of Committee Members" the following provisions: Upon motion of any Committee member, the Committee may consider the removal of one of its members. After a motion for removal is made, notice shall be given to all Committee members for the next meeting of the Committee that a vote will be taken upon the motion to remove a Committee member. Upon the vote of a majority of the members of the Committee present at the time of the vote upon the motion, a recommendation for removal of the Committee member may be approved. The recommendation for the removal of the Committee member will then be forwarded to the Weld County Board of Commissioners for final approval. 2. Amendment to the By -Laws provision regarding "Committee Operations" under the paragraph "Meetings" would be as follows: The third sentence of the paragraph would be amended to read as follows: No voting in the meeting shall be permitted except on matters of policy and procedure, or upon a motion for removal of a Committee member. 3. The paragraph of the By -Laws entitled "Committee Responsibilities" shall be amended by adding the following subparagraph "e". e. Obtain prior Committee approval of any speeches, articles, or statements of opinion made by a Committee member, in which the Committee member identifies themselves as a member of this Committee. And if such approval is granted, making it clear in any such speech, article, or statement of opinion, that such do not reflect the position of the Committee. The above and foregoing Resolution was, on motion duly made and seconded, adopted by the Weld County Long -Term Care Bio-Ethics Committee by a majority of those persons present at the meeting held on January 27, 1997. Weld County Long -Term Care Bio-Ethics Committee Date BY: BY: Date Linda Piper, Director Dan W. Gauger, CijAirperson APPROVED: WELD COUNTY AREA AGENCY ON AGING 2 WELD COUNTY LONG-TERM CARE BIO-ETHICS COMMITTEE BY-LAWS Purpose and Functions of the Committee The purpose of the Weld County Long -Term Care Bio-Ethics Committee is to create a community -based, interdisciplinary, volunteer advisory committee to assist health care decision makers and providers in clarifying and resolving bio-ethical dilemmas. The Committee will assist surrogate medical decision makers in promoting and protecting "the best interests" of those persons who cannot make decisions for themselves. The Committee will also assist health care patients, professionals, family members and Weld County organizations in health care decisions that involve ethical dilemmas. The functions of the Committee include education, consultation and case review, and the development of guidelines related to medical decision making in long-term care facilities and with patients receiving home health care. The Committee's educational function includes informing committee members, family members and community members about ethical principles in health care decision making and their relation to current issues, cases, and options. The Committee is consultation and case review function involves two activities: (1) on -call review of current cases and dilemmas; and (2) retrospective case reviews in the regularly scheduled monthly meetings. The Committee's guideline development function includes promoting advance medical directives, designing appropriate surrogate decision making protocols, and reviewing established procedures for meeting the needs of long-term care recipients. THE comm 11 LE DOES NOT MAKE DECISIONS IN BIO-ETHICAL DILEMMAS, BUT ACTS AS A RESOURCE AND FORUM FOR INFORMED DISCUSSION. Composition, Selection, Training, and Responsibilities Committee Composition. The Committee will consist of at least twelve members and up to thirty members. It will be interdisciplinary and may include social workers, physicians, nurses, nursing home administration representatives, attorneys, clergy, ethicists, long-term care recipients, advocates of the elderly and disabled, home health care representatives, mental health professionals, certified nurses aides, nursing home staff members, children with parents receiving long-term care, and any other persons interested in the work of the Committee. In addition to the Committee members described above, there will be three standing or permanent members of the Committee: The Weld Page 1 of 5 Pages County Long -Term Care Ombudsman, a Case Manager from the Weld County Area Agency on Aging, and an Adult Protection Services Case Worker from the Weld County Department of Social Services. Committee Member Selection. Prospective Committee members can be nominated by any active committee member or they can apply directly to the Committee. Individuals interested in becoming active members must submit an application upon the form approved by the Committee for Weld County Advisory Board Applications to be submitted to the Weld County Commissioners. Applicants will be interviewed and approved by the Committee as a whole. The final approval and appointment of the person as a member of the Committee shall be made by the Weld County Board of County Commissioners. Committee selection will encourage diversity in gender, age, ethnicity, education, socioeconomic status, and values orientation. Terms of Membership. Each member of the Committee will be nominated to serve a term of three years, with the possibility of one additional renewal term. The terms of Committee members shall commence on January 1 of the first year of the membership. Members, terms shall be staggered so that no more than one-third of the Committee membership will be scheduled for appointment by the Weld County Board of County Commissioners in any one year. By staggering the terms of memberships of the Committee members, this will help provide for continuity of the Committee membership and functions. This provision does not apply to the standing members of the Committee. Committee Member Training. The Committee, members are committed to educating themselves in bio-ethical theory, issues and decision making related to the purpose and functions of the Committee. Training and education are continual and include awareness of current ethical thought, biomedical advances, and relevant legal applications. Committee members agree to familiarize themselves with the basic textbook and material studied by the Committee members, collect relevant literature and case studies, share pertinent information with other Committee members, and attend, when possible, ethics seminars, workshops and lectures. Committee Responsibilities. Committee members agree to do the following: a. Serve for a minimum of one term; b. Respect the diversity and range of ethical outlooks expressed by other Committee members; C. Contribute regularly to the Committee process (education, case review and guideline formation); d. Acknowledge the dignity and rights of privacy and confidentiality of individuals involved in case consultations and reviews; and e. Obtain prior Committee approval of any speeches, articles, or statements Page 2 of 5 Pages of opinion made by a Committee member, in which the Committee member identifies themselves as a member of this Committee. And if such approval is granted, making it clear in any such speech, article, or statement of opinion, that such do not reflect the position of the Committee. Removal of Committee Members. If a Committee member has more than three unexcused absences in a given calendar year, she/he will be removed from the membership roster. A member may be excused by notifying the chairperson in advance of the meeting of their inability to attend. Upon motion of any Committee member, the Committee may consider the removal of one of its members. After a motion for removal is made, notice shall be given to all Committee members for the next meeting of the Committee that a vote will be taken upon the motion to remove a Committee member. Upon the vote of a majority of the members of the Committee present at the time of the vote upon the motion, a recommendation for removal of the Committee member may be approved. The recommendation for the removal of the Committee member will then be forwarded to the Weld County Board of Commissioners for final approval. Committee Member Liability The Weld County Long Term Care Bio-Ethics Committee is not a decision maker. This obligation falls to the legal guardian, family member, health care proxy, or agent of the incapacitated individual. Since the Committee is advisory only, there should be little basis to which any liability can attach. The Committee is a separate and distinct advisory committee under the supervision and approval of the Weld County Area Agency on Aging. Committee members shall be appointed and subject to removal by the Weld County Board of County Commissioners. The Committee therefore is a volunteer organization organized pursuant to the Weld County Home Rule Charter and subject to the control and direction of the Weld County Board of County Commissioners. Committee Operations Officers. The Committee will annually elect a chairperson who will be responsible for coordinating meeting agendas and other committee activities. Meetings. Regularly scheduled meetings will be held monthly for approximately one and one-half to two hours at a date and time set by the chairperson. The agenda for the meetings will be distributed by the chairperson prior to the meeting. No voting in the meetings shall be permitted except on matters of policy and procedure, or upon a motion for removal of a Committee member. Any action to be taken by the Committee shall be approved by a majority vote of those Committee members present at the meeting. The meetings of the Committee are not open to the public, and no person shall be allowed to attend except members of the Committee and those persons invited in accordance with the policies contained herein. Page 3 of 5 Pages Review of a Specific Case. The request for a meeting of the Committee for consideration of a bio-ethical situation requiring the review of a specific case shall be made in writing on the form prescribed by the chairperson. The request will be reviewed by the chairperson, or a designated representative, to determine whether the issues presented in the request are issues which are within the purpose and function of the Committee. If a meeting is set by the chairperson for the review of a specific case, all members of the Committee will be invited to attend by adequate prior notice. No quorum shall be necessary for conducting a meeting. In no event will a meeting be held concerning a specific case unless and until the treating physician, the responsible patient care staff, and the patient/surrogate medical decision maker for the patient have been invited to attend. Scheduling of the meeting will be made to accommodate the attendance of the physician, responsible nursing staff, patient and family. On -Call Subcommittee. A subcommittee of four committee members will meet as needed to provide consultation on active eases in which circumstances require urgent action. Subcommittee members shall serve one month during each rotation. Organization Subcommittee. The organizational subcommittee shall be responsible for preparation of agendas for meetings, distribution of agendas and notices to members, and all other matters regarding the organization of meetings and consultations of the committee. Members Subcommittee. This subcommittee will be responsible for actively seeking additional members, and screening applicants for possible membership on the Committee. Educational Subcommittee. The members of this Committee will be responsible for organizing materials, speakers and other, education opportunities for presentation at the committee meetings. (Bruce, I don't know what goes here.) Upon request and advance notification, any interested party to a case can appear before the Committee or to seek information and clarification of issues and options. Documentation. A brief record of Committee activities will be kept. The record will include issues discussed, actions taken, and cases reviewed. All Committee members shall maintain strict confidentiality of patient information, patient identity, and care giver identities. States of Operation. Any expenses or costs for the operations of the Committee must be agreed upon by representatives of the five nursing home facilities in Weld County. The nursing home facilities (Bonell Good Samaritan Center, Kenton Manor Living Center, Centennial Health Care Center, Fairacres Manor, Inc., and Windsor Health Care Center) shall share equally all mutually agreed upon costs and expenditures for operations of the Committee. The Weld County Board of County Commissioners shall not be obligated to pay any of the costs of operation of the Committee. Page 4 of 5 Pages Effective Date of By Laws. These by laws shall become effective after approval by a,vote of the committee members, subsequent approval by the Weld County Area Agency on Aging, and final approval by the Weld County Board of County Commissioners. Amendments. These by laws may be amended or repealed by a vote of the majority of the members present at a regularly scheduled meeting of the Committee. Recommendations for amendments must then be submitted to the Weld County Area Agency on Aging for its approval of the amendments, and final approval of any amendments to the by laws must be made by a vote of the Weld County Board of County Commissioners. CERTIFICATE I hereby certify that the foregoing by laws have been approved by the Weld County Long Term Care Bio-Ethics Committee. M:\WPFILESTYLAWSkBIOBYLBTB Page 5 of 5 Pages Hello