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Commissioners May Take Over Health Decisions Cities Would Lose Say Over Tough Issues

State health care reform may doom the board that started Spokane’s needle exchange program and banned certain types of laundry detergents.

Decisions on issues as diverse as cigarette advertising, sewer regulations and beer bans at public facilities could be affected.

The state Legislature, as part of the 1993 health care package, told counties to replace health districts with departments by July 1, 1995.

That wouldn’t change the way the district does restaurant inspections, provides inoculations, warns the public about epidemics or conducts other day-to-day operations. But the mandate, which the Legislature is reconsidering this session, changes who makes decisions over controversial public health issues.

The health district is governed by the Spokane County Health Board, which includes all three county commissioners, three Spokane City Council members and two representatives from small towns.

The health department that would replace the district would be a county agency, governed by the commissioners. City governments would not have a vote on health issues, even those affecting policies within their boundaries.

The intent, said Gary Lowe, director of the Association of Washington Counties, is to give counties more control over regional issues and end the turf wars common in Western Washington.

All three Spokane County commissioners say they favor the change, as long as the state makes up for money the counties would lose in the process. The Legislature this session is considering earmarking more money for health departments.

The change to a health department “would be a real step backward,” said Bev Numbers, a City Council representative on the health board.

“Our health board has always worked so well with the small cities as well as the county,” she said.

But commissioners have not always agreed with the board’s decisions.

Commissioner Steve Hasson is especially critical of the board. A plan to restrict billboard advertising of cigarettes was “stupid,” Hasson said at the time. Restricting development where sewers aren’t available was an erosion of property rights, he said.

Commissioner Phil Harris recently told members of the county’s water quality advisory committee that he’s “looking forward to the county health district coming under us.”

Commissioner Skip Chilberg, who normally agrees with health board decisions, nevertheless thinks the county should take control. He’d like a new health board on which cities are represented but commissioners are the majority. The Legislature is considering such arrangements.

“I think the county of the future will be the provider of regional services, and certainly health care is part of that regional service,” Chilberg said.

Commissioners, who formed the health district in 1970, always had the option of dissolving it, although not without losing the city’s money. Spokane pays about $1.9 million each year to the health district, and smaller towns contribute more than $200,000.

The 1993 law attempted to make up for that loss by giving county health departments a portion of the motor vehicle excise tax that went to cities. That money fell short by about $10 million statewide and $850,000 in Spokane County.

The Washington Association of Counties this year is suggesting the Legislature make up the loss from other sources.

The Legislature’s mandate to remove health districts doesn’t apply to those that cover more than one county, such as the Tri-County Health District based in Colville. Officials in Ferry, Stevens and Pend Oreille counties have said they don’t want to split up.

xxxx Commission and health issues A 1993 state law allows Spokane County commissioners to start making decisions now made by the eight-member health board. Here are some of the issues in recent years that put one or more commissioners at odds with the health board. (Newly elected Commissioner Phil Harris has not yet voted on any controversial public health issues.) Beer ban. Former Commissioner Pat Mummey wanted beer banned at the coliseum, fairgrounds and other public facilities. Commissioner Steve Hasson opposed any restrictions, while Commissioner Skip Chilberg wanted less severe restrictions, such as those the health board approved in 1994. Detergents. Commissioners in 1990 rejected a ban on laundry detergents containing phosphorus, which fuel algae blooms in Lake Spokane. The health board overturned that decision. Sewers. A 1990 health board decision requires homeowners to install $10,000 pressurized septic systems if their neighborhood refuses a public sewer project. That situation has not yet come up. Mummey supported the rule; Hasson opposed it; Former Commissioner John McBride wasn’t present for the vote. Hasson also opposed a 1993 ban on new lots smaller than five acres in areas where public sewers are not available. And he opposed the board’s endorsement of a 1991 plan to consolidate Spokane city and county sewer systems. Cigarette ads. The health board in 1991 requested that the Spokane City Council limit billboard advertising of cigarettes. Hasson called the move “stupid.” Transmission lines. Hasson wanted stiffer restrictions on transmission towers and electric power lines, which some scientists consider a health risk. The health board voted to wait for more studies on the issue. - Dan Hansen