As a leader, I was responsible for navigating change -- but never change for change's sake. It was important to understand trends and try to stay in the forefront; to make adjustments when programs and services didn't meet performance standards; and to change course in response to emerging community health issues.
When I hear Health Board chair and commissioner Todd Mielke say, "It's time for a different direction," I feel a chill. Based on recent history, I surmise that this statement translates to: sell the public health building, dismantle the health district, and put a bureaucrat in charge. I will elaborate.
Mr. Mielke has acknowledged that the county has discussed selling the public health building to Kendall Yards developer Marshall Chesrown, although he has denied any further discussions since this issue became public. The sale would be no big deal, Mr. Mielke argued. The building would be replaced.
Oh, really. Replacing the building, with all its special features, unique to its public health functions, would run somewhere between $25 million to $30 million. The real estate value of the current building and land is about $7 million. The sale wouldn't pay for a new building. And why would Spokane voters want to float tens of millions in bonds when they have already paid for a perfectly functional building? Selling the building would take public health in Spokane back to the old days when programs and services were scattered about the city in various dilapidated offices, challenging integration, cross-fertilization and collaboration.
Which brings me to dismantling the health district. By Washington state law, county commissioners can do this. Throughout my tenure and before, Health Board member and outgoing commissioner Phil Harris has been vocal about his desire to take apart the health district.
In fact, before I became health officer, in 1996, Mr. Harris along with then-commissioner Steve Hassan voted to dissolve the health district and absorb public health functions into county departments. The law requires that a year must pass before a resolution to change a health district can be put in effect. During that period, throughout 1996, a citizens' advisory panel studied the matter and recommended against it. At year's end, the resolution was withdrawn. There was, however, a dissenting minority report, favoring the dissolution, from panel member Dr. Charles Wolfe, now an appointed citizen member of the Health Board.
Besides power and control, why would the commissioners want to get rid of the health district? It's a misunderstanding of health regulatory functions. Instead of recognizing the community protective role of environmental health, many misconstrue health regulation as business licensing. One of the plans in 1996 was to move the health district's environmental health division to the county Building Department permit center, potentially jeopardizing objectivity.
One of the stated possibilities for this "different direction" for the health district is to eliminate the health officer and put an administrator in charge. This would be a step backward for a health district that has always been directed by a physician, in a community that is a medical center.
In government entities, there is always a tension between administration and programs. The strain is exacerbated in times of scant resources, necessitating a balance between having enough business capacity to maximize revenue and provide efficient program support, and keeping up with community needs for programs and services.
I believe that, as a health office director, I was able to provide a good balance between administration and programs at the health district. There is an old adage that doctors make bad administrators, but we public health physicians receive training in administration. I provided skilled oversight of our business practices at the health district, but my heart was in the programs like TB control, restaurant safety and public health nursing. I fought hard to protect our programs and services, even as resources shrank.
Beware, Spokane, of a "different direction" for the Spokane Regional Health District. Public health is a vital governmental public safety function. Any of these changes could weaken our currently vigorous and strong health district.
Dr. Kim Marie Thorburn is the former
Spokane County Health Officer.