PORT ANGELES — County public health departments would survive, their health officers intact, under legislation that amends a regional district proposal that health and elected officials feared would have eliminated local health agencies as well.
The new version, which would retain the new health-district structure, has the officials breathing a little easier even as they marshal their forces as signatories to a letter written by Jefferson County Commissioner Kate Dean warning lawmakers not to wrest away local control.
“I think the current version of the legislation, from my perspective, is a significant improvement,” Clallam County commissioners Chair Mark Ozias said Friday.
“I am worried about the extra level of bureaucracy and how that’s going to work, and is that going to affect the system here, what the lines of authority will be, and the cost of the bureaucracy.”
The legislation is contained in HB 1152 and SB 5149, the text and analysis of which is at leg.wa.gov.
“Each county department or health district has a local board of health, which is responsible for the supervision over all matters pertaining to the preservation of the life and health of the people within its jurisdiction,” according to the House bill analysis.
“Each local health jurisdiction must appoint a local health officer.”
Six regional health officers appointed by the state secretary of health would oversee districts with regional health boards largely appointed by the governor that would each include a tribal representative. Elected officials cannot constitute a majority of the boards.
Dean’s letter is being signed by governments and hospitals from across the North Olympic Peninsula and could be forwarded to lawmakers this week.
“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,” it says.
“We oppose the concept, introduced in [the original version of] HB 1152, of reassigning them as employees of the state.”
Under the legislation, shared services that could include health officer positions are presented as an option.
“Local health departments and health districts can take various forms and include a single county health department or district, a combined city and county health department, or several counties can join a health district,” according to the bill analysis at leg.wa.gov.
“It’s never been a matter of replacing” local health departments, 24th District state Rep. Steve Tharinger of Port Townsend insisted Friday, adding the bill faces much fine-tuning.
“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 Tharinger, a member of the House Health Care and Wellness Committee.
Clallam County Health Officer Dr. Allison Berry is “not a big fan” of the original bill, she said last week at a county board of health meeting.
The updated version “is something we could work with,” she said.
But more work needs to be done on the regional district structure, Berry said.
“I don’t see a delineation over what we would share and what we would retain local control over,” she said.
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 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,” Dean said in the letter.
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.
Ozias deferred on supporting the new legislation. He said Friday said Clallam County should be “at the table” and take part in revising it as it is refined.
A work group appointed by Gov. Jay Inslee will recommend “a public health system to provide foundational public health services through comprehensive public health districts and the Department of Health,” according to the bill analysis.
It will be comprised of two representatives from the Senate, two representatives from the House, three from local public health, two from state public health, three from counties, two from cities, one tribal representative and one representative with expertise in government finance.
Dean said a lot could happen to the bill by the time it’s voted on toward the end of the legislative session.
“Local authority could still go away,” Dean feared.
“Everything is still very much in play.”
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.”
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Senior Staff Writer Paul Gottlieb can be reached at 360-452-2345, ext. 55650, or at pgottlieb@peninsuladailynews.com.
