This spring, the Washington Legislature passed a law changing how local governments structure their public health boards.
Gov. Jay Inslee praised the bill as he signed it, saying it would “take politics out of public health.”
On Monday, the Spokane County commissioners voted to change the Board of Health in order to comply with the new law, and the legislator who played a major role in getting the bill passed is frustrated how they did it.
“It’s really disappointing to see politics being put over public health,” Spokane Democratic Rep. Marcus Riccelli said.
The Spokane County commissioners voted to cut down the county Board of Health from 12 to eight members and eliminate the five seats representing the cities of Spokane and Spokane Valley. The current Board of Health will cease to exist on Dec. 31.
Riccelli said the commissioners completely violated the spirit of the law by making the health board so small. The commissioners will now have three of eight seats, and they’ll personally appoint four of the remaining five members.
“This is a move really to control power,” Riccelli said. “It seems like the end goal is just absolute power, not good public policy decisions.”
The new law, which goes into effect July 1, states that health boards must have an equal number of elected and unelected representatives. Riccelli said the law’s intent was to ensure people with public health and medical knowledge have more influence over public health decisions.
During the COVID-19 pandemic, elected officials without public health expertise have far outnumbered medical experts on health boards – for instance, Spokane County’s health board currently has nine elected officials and two unelected appointees with health backgrounds.
Riccelli said the purpose of the legislation was to increase the number of voices and amount of expert opinion on health boards. An eight-member board reduces input and limits the number of medical professionals who can serve, he said.
“This was a direct attempt to cut particularly the city of Spokane out of the decision-making process,” Riccelli said. “We need to act in the best interest of our community and not have turf wars where people are just trying to protect power.”
When the Board of Health voted 8-4 last fall to fire the district’s health officer, Dr. Bob Lutz, the city of Spokane’s three health board representatives cast three of the dissenting votes.
Spokane County Commissioner Josh Kerns said the county chose to have a smaller board for two main reasons: First, the county alone funds the Spokane Regional Health District, Kerns said. And second, the commissioners represent all county residents.
“We are everybody’s voice on the board,” he said.
Kerns also emphasized that the commissioners followed the letter of the law. He said if Riccelli wanted more public health professionals and more elected city officials on the board, he should have written that into the bill.
“It’s his law,” Kerns said. “I would say Rep. Riccelli’s rhetoric doesn’t match the bills that he drafts.”
What the law says
The current Board of Health, which will meet one more time, is supposed to have 12 members. Each member serves a four-year term.
Three of the 12 seats are for at-large citizen representatives, appointed by the county commissioners. Jason Kinley, a registered naturopathic physician who voted against firing Dr. Bob Lutz, and credentialed dental hygienist Andrea Frostad, fill two of those seats. The third citizen seat has been vacant for months.
Elected officials make up the rest of the nine seats: three county commissioners, three Spokane City Council members, two Spokane Valley City Council members and one official chosen by the county’s smaller cities.
The new eight-member board will look different.
It will include four elected officials and four unelected representatives, each of whom will serve a two-year term. No one The Spokesman-Review talked to for this story knew for certain how the even-numbered board might resolve tie votes, but based on Robert’s Rules of Order there won’t be any tiebreaker. If the board can’t muster a majority for a given motion, the motion will simply die.
Per state law, each of the three county commissioners automatically gets a seat.
The commissioners also decided to add one elected official from Spokane County’s cities and towns. They get to pick that official and have tapped Millwood Mayor Kevin Freeman.
Freeman, who currently serves as the board’s vice chair and is slated to take over as chair in 2022, said the commissioners never told him they were selecting him for the fourth elected seat. He said Tuesday he was first learning of the new board structure from The Spokesman-Review.
The commissioners will pick three of the four unelected representatives, and there are rules outlining who they can pick. Anyone interested in applying for these positions is asked to reach out to the county commissioners.
One of the three unelected board members has to represent public health, health care and medical providers.
State law gives the commissioners a lot of leeway in picking that representative. Some of the options include: a licensed or retired pharmacist, nurse or dentist, an osteopath, an epidemiologist and anyone with a master’s degree in public health.
One representative must have lived experience with public health-related programs or personal experience with health care inequities.
The commissioners could pick someone with first-hand knowledge of home visits, for instance, or someone who has gone through a supplemental nutrition program. The law strongly encourages the commissioners to pick someone from a historically marginalized or underrepresented community.
Then there’s a “community stakeholders” category, which doesn’t have much of an affiliation with health care or public health.
For instance, the commissioners could choose a retired armed services member, a businessman or someone who works for a nonprofit. They can also pick someone from the “environmental public health regulated community.”
The American Indian Health Commission will select the fourth unelected board member.
Why the structure matters
The commissioners could have made the board as large as they wanted.
They could have kept much of the current structure , setting aside dedicated seats for Spokane and Spokane Valley.
Spokane City Council President Breean Beggs said the commissioners never consulted with him about the new board structure.
He said he thinks it’s a mistake to remove Spokane representatives from the board, even if the commissioners represent all county residents.
“We represent 40% of the population,” Beggs said, “(and) we have a lot of programs that overlap with the health district.”
Beggs said he had concerns about Riccelli’s bill even before the Legislature passed it.
“The idea of simply making some requirements for health care people to be on the board was not going to solve the issue,” he said, noting that commissioners could appoint alternative health care professionals to those roles.
He pointed out that, while Kinley and Frostad work hard, “they come from an alternative perspective, medically.” Kinley and Frostad would still be allowed to serve under the new law’s guidelines.
A better way to depoliticize health boards would have been to change how they’re funded, Beggs said, explaining that if they got more money from the state, they wouldn’t be as reliant on local elected officials for financial support.
The health district is asking the county for $2 million to balance its 2022 budget.
“The health administrator (Amelia Clark) is quite cognizant of that and I think has been totally transparent and intentional about making sure she first satisfies her funders in terms of the decisions she makes, and that’s just predictable,” Beggs said.
Spokane Mayor Nadine Woodward said her administration has a good relationship with the health district, particularly under Lutz’ replacement, Dr. Francisco Velázquez.
Freeman said he couldn’t comment much on the newly arranged board because he only just learned about it. But he, like Kerns, said that if Riccelli wanted a larger board, the new law should have required it. He also said he expects Spokane and Spokane Valley will have concerns about losing their seats.
Spokane Valley Mayor Ben Wick, who serves on the health board, did not respond to a request for comment.
Riccelli said he didn’t think the law needed language requiring a larger board.
“I guess we thought we didn’t have to legislate things that are common sense,” he said.
To some extent, Riccelli’s concerns will be addressed automatically in 2023.
Spokane County is moving from three to five commissioners. When that transition happens in a little more than 13 months, all five commissioners will sit on the board.
That, in turn, will force the commissioners to add more unelected representatives from the three categories to maintain an equal number of elected and unelected board members. Starting in 2023, the board will have a minimum of 10 members.
Riccelli said that based on the commissioners’ decision this week, the Legislature will have to consider amending the law.
“I think we may need to give it a look if folks are trying to game the system,” he said. “It shows clearly that politics is infecting public health at the local level here in Spokane in a way that could be really concerning for our community.”
S-R reporter Adam Shanks contributed to this story.