Entities oppose regionalization

Letter suggests change to bills before Legislature

Kate Dean

Kate Dean

PORT TOWNSEND — Several government and health-focused agencies across the North Olympic Peninsula have joined the Jefferson County commissioners in signing a letter regarding proposed legislation to create regional public health districts.

The two bills that the draft letter addresses are House Bill 1152 and Senate Bill 5149.

Initially, the companion bills requested by Gov. Jay Inslee, would have centralized public health officers, creating regional districts overseeing multiple counties instead of relying on local health officers.

That has been amended to keep local jurisdictions but create a regional system, saying it would increase accountability.

The bill now includes a district comprised of Clallam, Jefferson and Kitsap counties. Kitsap has 271,500 residents to Clallam and Jefferson’s combined 108,600 residents, far less than half of Kitsap’s.

“In a regional health district, our smaller counties would have less say in policy and funding decisions, therefore less ability to act swiftly to respond to local crises,” says the draft letter written by Kate Dean, chair of the Jefferson County commissioners and county Board of Health.

The House substitute bill has been referred to the Appropriations Committee. Discussions are expected to last through the legislative session, so the bills might change again, Dean said.

“Local authority could still go away,” Dean feared. “Everything is still very much in play.”

Rep. Steve Tharinger of Port Townsend said that “it’s never been a matter of replacing” local health departments.

The bills face much fine-tuning, said Tharinger, a member of the House Health Care and Wellness Committee, which made the changes in the original House bill.

“A lot of work will be done by the stakeholder group during interim talks about what the regions are, what their roles will be,” said the legislator who represents the 24th District, which covers Jefferson and Clallam counties and part of Grays Harbor County.

Tharinger said the legislation was spurred by elected officials playing health politics during the pandemic.

In some counties, health officials who stuck fast to protocols of social distancing and masking butted heads with elected officials — without health backgrounds — who challenged their directives and, in some cases, fired them.

With regional health districts, elected officials would feel financial pressure if they inject politics into health decisions, Tharinger said.

“If there is another pandemic, they will say, ‘you get this money to deal with it, but you’ve got to follow these protocols,’” he said.

The revised bill will go to the House floor by the end of this week, Tharinger predicted, then go to the Senate.

As of Friday, Dean’s letter had been approved by boards of health of Clallam and Jefferson counties, the Port Angeles and Port Townsend city councils, Jefferson Healthcare hospital and the Jefferson County Board of Commissioners.

Clallam County Commissioners, who serve as board of health members, could give a second stamp of approval Tuesday.

The chairman of the Olympic Medical Center board of commissioners, John Nutter, said Saturday he will sign Dean’s letter on behalf of the board.

“The regionalization plan is a solution for a problem we don’t have,” he said Saturday in a text message.

The Forks City Council has not voted on the letter but has expressed support for Berry and the work she’s done, City Attorney-Planner Rod Fleck said Friday.

Forks Community Hospital also supports Dean’s letter, CEO Heidi Anderson said Friday.

And the Sequim City Council will discuss its own version of a letter opposing the idea when it meets at 6 p.m. Monday.

The letter supports one aspect of SB 5149 — to increase funding for the public health system.

“We are thrilled to see Senate Bill 5149 address the chronic need for funding and urge your support., it says.

The letter says that 2021 is a “terrible” time to restructure the public health system.

“The past year has been, arguably, one of the most challenging for public health in a century,” the letter says. “And yet now, while desperately trying to vaccinate our entire population, we are asking these same public health folks to strategize on inventing and building a new public health system.

“And this reinvention is supposed to occur before we have even begun the process of evaluating the short-and long-term effects of the most wide-spread pandemic in modern history,” it continues.

“At the very least, the work group created in HB 1152 should spend 2021 doing analysis to inform regionalization bills in 2022.”

The letter supports a separate piece of legislation, HB 1110, that addresses boards of health being expanded, saying that the language in HB 1110 either be adopted independently or added to HB 1152.

If legislators decide to restructure public health in some way, the letter urges them to keep policy- and priority-setting at the local level.

“The regionalization of public health is problematic if it strips away local relationships and authority and replaces them with a regional framework, which may not reflect the communities therein,” the letter says.

“As an example, Clallam County has one of the highest rates of overdose deaths from opiates. In response, they expanded their naloxone program, used their local authority to make overdose events a notifiable condition, and intensified efforts to expand treatment access,” the letter continues.

“Similarly, Jefferson County had a high teen pregnancy and suicide ideation rate in the past. Their public health department sought funding to secure family planning and mental health clinics in high schools leading to the launch of three school-based clinics.”

The letter supports local jurisdictions working together on common issues, pointing out that Clallam and Jefferson public health departments have a long history of assisting each other, such as with behavioral health administration, and that the Jamestown S’Klallam Tribe has been an asset in its work to provide vaccinations.

Tharinger compared the regional health district structure to state-to-local lines of authority for schools.

That chain leads from the Office of the Superintendent of Public Instruction to education service districts to local school districts. Under the health district legislation, it will lead from the Department of Health to a regional district that has some control over purse strings for local health departments.

“We understand the need for consistency and for accountability, and I think that is an apt comparison,” Dean said.

“The important thing is we retain the ability to set local priorities and keep policymaking at a local board of health [level], not a regional board of health.”

But it’s clear regional health districts will have the power to make funding decisions that will affect local health jurisdictions.

“It’s always been about state funding regionally directed and locally implemented,” Tharinger said.

“I think there will be local boards of health and there will be local departments of health, and they will have quite a bit of autonomy.

“I don’t think the actual decisions they make now at the local level will be impacted.”

The two bills can be read and their current status found at https://tinyurl.com/PDN-HB1152 for HB 1152 and https://tinyurl.com/PDN-SB5173 for SB 5173.

________

Jefferson County reporter Zach Jablonski can be reached at 360-385-2335, ext. 5, or at [email protected]

Senior Staff Writer Paul Gottlieb can be reached at 360-452-2345, ext. 55650, or at [email protected]

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