Health district may split chief’s job

With the firing of former Health Officer Dr. Kim Thorburn barely behind them, members of the Spokane Regional Health District Board will soon consider an even more drastic change: dismantling the position she held.

In January, the board will begin discussing whether to follow Thorburn’s controversial dismissal last month with a wholesale overhaul of the district’s leadership.

At issue is whether a medical doctor who’s also an administrator is the best manager of the agency’s $23 million budget, 250 employees and nearly four dozen programs and services – or whether splitting those duties into two jobs will better serve public health.

“Do we want to go that way? I’m not sure,” said Todd Mielke, former board chairman. “Is it too much to ask of one person?”

It’s a change that would leave Spokane as one of the state’s largest population centers without a full-time, combined health officer and administrator.

And it’s a move that is hotly opposed by Thorburn, the former head of the state board of health, who said she believes the restructuring plan is a political move aimed at weakening the power of the region’s chief health official.

“I just think it’s a really bad idea. I worry that it’s divide and conquer,” Thorburn said last week, adding: “I feel that I was the public health face for the community.”

But health district board members said the end of Thorburn’s nine-year tenure marks a good time to reconsider structure and operation of the agency.

“I think we sit down in January and go through that whole review of pros and cons and go back to that question: Is there a compelling reason to change?” Mielke said.

He detailed few specific criticisms of the current structure. Problems with Thorburn, who was fired without cause, were mired in personality clashes and long-simmering communication stalemates, not misconduct. The former health officer had worked under a vote of no-confidence for nearly two years before her contract was terminated.

Instead, Mielke said board members are simply interested in exploring other options.

“I’m not trying to find justification for a decision that I’ve already made,” he said.

It’s not clear whether the move would be supported by staff members at the agency. Torney Smith, the administrator who worked as Thorburn’s deputy, said professionals would flourish under either arrangement. More important, he said, is that staffers are included in any discussions of change.

Twenty-nine of the state’s 35 county health districts or departments now operate with part-time health officers and separate administrators, according to Vicki Kirkpatrick, the state’s policy director for public health. But the four largest agencies – serving Tacoma-Pierce, Kitsap, Snohomish and Benton-Franklin counties – all have full-time health officers who are also administrators, she noted.

In King County, which includes the city of Seattle, a local statute allows the chief administrator to function as health officer, even without a medical degree, Kirkpatrick noted.

State law grants local boards of health wide latitude in choosing executives, so long as they hire or contract with a health officer who holds a medical degree and a master’s degree in public health.

Both systems have advantages, said Kirkpatrick, who couldn’t recommend one structure over the other. On one hand, separating the duties frees the health officer from administrative duties, she noted. On the other hand, the administrator would lack specific medical training.

“The potential downside would be possibly not recognizing the importance of the health officer’s responsibilities,” Kirkpatrick added.

She cited the Thurston County Public Health and Social Services Department as an example of a successful split arrangement. Administrator Sherri McDonald and Health Officer Dr. Diana Yu monitor public health of some 250,000 residents.

The arrangement works well, McDonald and Yu said, partly because the women’s personalities and skills are well-matched, but also because everyone knows what to expect.

“People need to understand their roles and understand their relationship with the board,” McDonald said.

The health officer’s relationship with the board can be a tricky one, said Ned Baker, an ex-officio member of the National Association of Local Board of Public Health based in Ohio. There are some 3,200 local health boards in the United States, with leadership arrangements that vary widely.

In Spokane and elsewhere, the board is responsible for hiring and supervising the health official and administrator. Finding someone who is a talented medical director, a sharp manager and a skilled politician can be a challenge.

“We often find that MDs don’t make the best administrators,” Baker said. “They’re interested more in the healing arts.”

Thorburn said she was equally competent handling fiscal, staffing and administrative tasks as well as the medical demands of public health.

“I really felt I was a defender of the programs often. I could make those hard decisions because of my professional training and experience,” she said.

But Mielke hinted that the board would look for better balance in a future leader.

“I wonder about that notion of the health officer also trying to do all of the administrative work,” he said. “Given the choice, do they focus on the administrative piece or the health officer piece?”

Mielke said legal limits on discussion of personnel issues prevented him from detailing any administrative problems with Thorburn.

For many of the state’s small health departments and districts, cost is the primary obstacle to hiring a full-time health officer, Kirkpatrick said. In Spokane, taxpayers provided salaries of about $125,000 a year for Thorburn and $90,000 annually for Smith. It’s not clear whether splitting the health officer’s post would require two similarly paid positions, Mielke said.

The last time anyone considered revamping the Spokane health district was in 1996, just before Thorburn was hired, when county commissioners proposed dissolving the agency into a county-run health department.

That plan was nixed by a health advisory board, which voted to retain the multi-agency health district.

The move to restructure the health district on the heels of Thorburn’s firing worries citizens concerned that the agency will move to weaken her strong stance on public health issues such as immunization, injury prevention and HIV/AIDS education.

At a hearing before Thorburn’s dismissal, several citizens expressed concern about parallels between that action and the forced resignation of Eric Skelton, former director of the Spokane County Air Pollution Control Authority. “Another Skelton in the county commissioner’s closet?” read one hand-lettered sign.

Skelton, who now works in Boston as a senior policy analyst with a nonprofit air quality agency, said the two situations invite comparison. Both he and Thorburn took seriously the regulatory duties of the agencies they led, no matter who it affected, he said.

“Taking such a stance in Spokane can carry with it political risks and is especially problematic for executive directors who serve at the pleasure of local officials,” Skelton said.

Mary Verner, the health board’s new chairwoman, said she was dismayed at Skelton’s treatment, but added that she didn’t believe Thorburn’s situation was similar. Public sentiment, however, will require the board to act carefully in choosing Thorburn’s replacement, she acknowledged.

The future structure of the health district, and the selection of a new leader – or leaders – will be made through an “open, transparent process.”

“Folks are just distrustful of the decisions their public officials are making,” Verner said. “I understand the community concern, but I don’t think they need to worry about that.”