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Plan would put more doctors on health board

Tue., Feb. 10, 2009

Marr legislation leaves fewer politicians at helm

Even as the Spokane Regional Health District board contemplates changing its management structure to take the top job away from a medical professional, state Sen. Chris Marr is going a different direction.

He has proposed legislation that would pull politics out of health districts by removing most of the politicians who dominate the board positions.

In their place should be at least two physicians, other health professionals, two members from the business community and a couple of at-large appointments, Marr said.

Only two county commissioners would remain on the board as elected representatives.

The changes are proposed against the backdrop of a nearly 26-month vacancy in Spokane’s top health job.

Marr worries that the controversial firing of Dr. Kim Thorburn in November 2006, and the subsequent struggle to find a replacement, is harming Spokane. Specifically, he spoke of a belief held by many in the medical community that the board wants to employ a physician who will carry out the board’s wishes even if they go against his or her judgment about what’s in the public’s best interests.

“My concern is that at the end of the day we as a community … aren’t as prepared as we should be to deal with a health epidemic,” Marr said. “That’s a concern held by many people I speak with.”

Board members bristle at suggestions that they are seeking a public health officer who will rubber-stamp their decisions.

Bill Gothmann, a Spokane Valley councilman and health board member, warned such changes in board makeup would surrender independent oversight of an agency with policing powers.

“The system we have now works very well,” he said.

Gothmann said he believes a balance can be struck among public health, politics and the need for financial restraint.

He compared the health district, with its ability to enforce laws pertaining to food safety, environmental health and other public measures, to a police department.

“Would we want the police union in charge of the City Council?” he asked.

He expects other health boards across the state will have serious reservations about the proposed changes.

Marr, who is sponsoring the bill with state Senate Majority Leader Lisa Brown, said that under the new bill the majority of the board would still be composed of commissioners and their direct appointments.

The board would consist of:

•Two county commissioners.

•Two physicians nominated by the Spokane Medical Society.

•A local health care professional chosen by commissioners.

•Two business people nominated by the local chamber of commerce, one from the restaurant industry and one from the building industry.

•Two members of the public chosen by commissioners.

Currently, the Spokane district’s board is made up of all three Spokane County commissioners, three elected representatives from the city of Spokane, two from Spokane Valley, one from an outlying Spokane County community, and three appointments made by commissioners.

“I’m anticipating that county and city elected officials won’t be supportive,” Marr said. “But I think it’s in the best interest of public health.

“And if we have to agree to disagree on this, so be it.”

Marr said the legislation was sought by the Spokane Medical Society and the Washington Medical Association.

The local medical society is worried the health district’s mission will fade if a business administrator is given charge of day-to-day operations instead of a physician.

“If the key goal was to expand the board to include more medical representation, I’m in favor of that concept,” said Spokane Mayor Mary Verner. She would lose her seat on the board under Marr’s proposal.

She said, however, that elected officials, as representatives of government, add clout to health boards – especially when it comes to seeking funding for public health measures or advocating necessary policy changes.

Limiting elected representation to the county would be a step backward, Verner said, adding that she doesn’t want to return to a system of county health boards rather than what has become a system of broad-based public health districts.

Verner advocates re-examining health district management. She would like to see a management structure that would dilute the authority of a public health officer by splitting the top job. Instead of a physician running the health district, Verner would rather see the duties shared between a public health physician and an administrator.

Torney Smith, the Spokane health district’s administrator, said the local board now benefits from medical expertise of several members, including new appointee Dr. Bob Lutz, who has a master’s degree in public health; David Crump, a Liberty Lake councilman and child psychologist; and Michael Fisk, a chiropractor. There is an open seat from Commissioner Todd Mielke’s district, and several applicants under consideration have health care backgrounds.

In the absence of a health officer, the district has consulting contracts with two public health officers from other counties.

Dr. Larry Jecha, of the Franklin-Benton Health District, has a draft contract that calls for $3,000 a month. And Dr. Scott Lindquist, of the Kitsap County Health District, has a contract that is not to exceed $26,503 a year.

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