District lacked healthy communications

Seldom has a board of directors and a chief executive officer suffered a breakdown of communication as complete as that between the Spokane Regional Health District and its medical officer. And almost surely none were allowed to persist so long.

The dismissal last month of Dr. Kim Thorburn was either too long coming, or should not have happened at all. Despite a board vote of no confidence two years ago, she continued to perform her duties — admirably by most accounts — but never healed a rupture opened by an intemperate e-mail to former health board member and county commissioner Kate McCaslin.

In several reported instances since then, Thorburn squared off publicly with the board. Yet when the end came, Thorburn was genuinely surprised.

That alone, say management experts at Whitworth College and Washington State University, indicates how badly each side misunderstood the imperatives of the other. Where science and politics intersected, neither side saw the yield sign.

What might be an objective, scientific call at the low end of a bureaucracy becomes ever more political as the level of decision-making increases, says Whitworth’s Craig Hinnenkamp. Thorburn was bound to make rulings that would irk some business or political constituency. What she saw as black or white from a public health perspective, the board saw as one shade of political gray or another.

In the end, he says, the dispute was all about political power. The board won.

Thorburn’s firing will not be the end of the problem, predicts Hinnenkamp, who has worked with a number of boards in the past.

“The damage that was done through this will filter through the organization,” he says. There are almost certainly structural deficiencies behind the personality disputes.

Tom Tripp, an expert in conflict resolution who teaches on WSU’s Vancouver campus, says private companies might try mediation when neither side in a dispute will yield, but the costs of separation are high. That can be tricky in a relationship as asymmetrical as that between a board clearly vested with supervisory powers, and an individual, he adds.

If the simple answer is to fire the individual, that’s what usually happens, Tripp says.

At one point, some health board members approached the Spokane County Medical Society about becoming a mediator in the dispute with Thorburn.

“They wanted a compromise,” says society President Dr. Nick Fairchild.

He praises Thorburn’s “spectacular command of the issues,” but adds that where science meets politics, sometimes the practical must prevail.

Thorburn rejected the overture, and was upset the society was even consulted. “I don’t think an outsider should be involved,” she says.

Too bad, because the insiders were certainly not getting the job done.

“They claimed they were giving me direction,” says Thorburn. “By telepathy, maybe.”

Board Chairman and County Commissioner Todd Mielke attributes some of the problem to the contract with Thorburn, which did not provide for discipline, nor reopeners that might have let the two sides better define their relationship.

For example, he says, he wants to explore a contract that splits the duties of health officer and district administrator.

Fairchild says the medical society would want assurances the medical professional, not a lay administrator, whould have the last say in matters of public health.

“The tough choices in public health are professional, not administrative,” Fairchild says.

Although recruitment could be a problem given Thorburn’s fate, Fairchild says he would tell a potential replacement there’s much that’s good in the Spokane public health arena, and that the opportunity to succeed is there.

By most measures, Thorburn was a success, so much so her management of the health district earned her the appointment to head the Washington state Board of Health. She had the admiration of her peers.

Her relationship with her boss was another matter. If the issue was just communication, that’s a shame. If compliance with political agendas was ultimately the cause, that’s a concern.

Sooner or later, bird flu, e.coli or some other major medical emergency will put public health front and center. There should be no question who is in charge, and no risk of miscommunication.