The Doctor is out

by SUZANNE SCHREINER & r & & r & & lt;span class= & quot;dropcap & quot; & F & lt;/span & or the second time in little more than a year, politics appears to be trumping objectivity as elected leaders intend to fire Dr. Kim Thorburn, director of the Spokane Regional Health District.





Thorburn is widely praised by health professionals and has been appointed by Gov. Christine Gregoire to direct the state health board. But she is seen as abrasive and uncooperative by her bosses on the local Board of Health, largely comprised of elected city and county officials who have gone so far as to criticize the kind of clothing she wears.





Like Thorburn, Eric Skelton, former director of the Spokane County Air Pollution Control Authority (SCAPCA), was widely praised for his work and had even won federal recognition for making Spokane County's air healthy and breathable enough to be removed from a dirty air list. Yet Skelton drew heat from elected officials on the SCAPCA Board for not being compliant enough for local business interests. He resigned last September ahead of a firing that seemed inevitable.





Thorburn has been locked in a two-year battle with the Health Board (some of whom were also on the SCAPCA Board), after she expressed resistance at "using discretion" when it came to compliance with state health standards regarding local espresso huts.





On Nov. 15, the board gave notice they are going to fire Thorburn. She is on administrative leave until a meeting Nov. 27 to finalize her fate. That Monday meeting had widely - and erroneously - been expected to be a public hearing where residents can voice their opinions. Thorburn will address the board, but no public testimony will be taken, says health board chairman Todd Mielke, a Spokane County Commissioner. The board will decide Thorburn's fate before Christmas, he says.





Thorburn looks back at her tenure with some regret: "I should have been more thick-skinned. I am thicker-skinned now," she says.





The Black Cloud


Thorburn's troubles began two years ago in a blistering -- and, Thorburn says, accidental -- e-mail exchange with former County Commissioner Kate McCaslin about regulating espresso huts. The health board hit Thorburn with a vote of no confidence in December 2004. Some 18 months later, she had her first of supposedly annual performance reviews and was criticized by board members for "California casual attire" and other failings, even as health professionals and staffers praised Thorburn as a capable boss and public health advocate.





"I wish I hadn't pushed 'Send,'" Thorburn says. She explains that she sometimes finds it helpful to "write for therapy." She began such a therapeutic e-mail to Kate McCaslin, who had instructed her to "exercise discretion" with regard to espresso hut hookups. When state regulations changed, with espresso huts no longer regarded as mobile food units, and thus were required to be hooked up to sewer and water, Thorburn says there were about 20 holdouts not in compliance. She raised the issue "to give the board a heads-up," at which point, she says, "McCaslin lit into me." Then McCaslin asked for a list of the holdouts with the intent, Thorburn believed, of organizing them to appear before the board. Worn down by "seven years of Kate McCaslin," she got sarcastic, responding, "I've decided how to apply rules with discretion. I will go to each coffee stand.... If I like the coffee, they won't have to hook up. If I don't like it, they will." A few lines on, the e-mail broke off in mid-sentence. Thorburn had hit "Send." A month later, the board passed its vote of no confidence.





Thorburn says discretion can be exercised when a business seeks a waiver through the appeals process. Then she can work with the operator "to meet the public health intent of the rule." Inspectors in the field, though, should interpret the rules in pretty black-and-white terms. "Fairness is very important to me," says Thorburn. "My responsibility is protecting the health of the public," by using the best science available. "I'm willing to work with somebody," she says, "but I won't lower standards. I'm not going to allow things that create that risk."





"A Superb Advocate"


"I am disappointed," says Dr. Deb Harper, a pediatrician and local coordinator of UW regional medical education. "But I predicted this back in the spring."


Harper sees Thorburn's firing as fallout from the clash of politics and science. "It puts people who don't know science and have to get elected in conflict with someone who is talking about science." She adds, "I find it strange that public officials would want to be involved in making public health decisions because it's going to anger people on both sides." Even with something as simple as hand-washing regulations, she points out, "People can feel the government is coming down on them."





At health district meetings, says Harper, "I personally criticized [Thorburn] when I disagreed with her. But I never found her to be arrogant. She was respectful and she listened. She always looked to the scientific evidence."





In a political environment, however, that isn't enough. Take the so-called fluoride debate. For doctors, the science is in: Fluoridated water reduces dental decay with no harmful side effects. Rehashing that is like revisiting the question about the Earth being round or flat, Harper says. It would be wrong and absurd. Because Dr. Thorburn would only discuss the science, Harper says the board silenced her on the subject altogether.





Harper acknowledges that Thorburn's approach didn't always square with political reality: "Maybe the message could be delivered in a softer way that didn't make officials feel defensive." Facts and science won't necessarily carry the day, she adds. "What's worse, even if it is proven that something works, it doesn't mean it's going to get funded."





Noting that Thorburn is a nervous public speaker and not gregarious by nature, Harper observes that shyness and reserve can come across as arrogance, possibly contributing to Thorburn's political problems. Harper says Thorburn saw it as her job to protect the health of this region and she took it very seriously. "I'm going to use the word 'chivalrous,'" Harper says. "She's like a Knight of the Round Table."





"We think it's a big loss," says Spokane County Medical Society President Dr. Nick Fairchild. "She's been so right on in terms of her advocacy and public health skills. She has complete mastery of the issues. She brings a lot of things to the table we don't have mastery of but need to advise our patients. She has been a superb advocate for the public health of this community." Fairchild says Thorburn's appointment to lead the State Board of Health was an endorsement of her public health skills.





"If I fault her for anything, I fault Kim for wanting to win every battle," says Fairchild. Though he adds that Thorburn always wanted what's best for patients and the community, "politicians have got to be seen as important and have to be given their due." Sometimes, however, "it can appear they want to compromise public health for economic or political reasons."





When it comes time to recruit the next Health Officer, Fairchild thinks the board may face a few awkward questions from prospective hires: "Look what happened to your last health officer. What's going to happen when I butt heads with you? Will the business community or some other group's interests take priority over public health?" Fairchild says, "We don't seem to have forward-looking leadership that can embrace different points of view."





"It's a Personnel Issue"


Mielke says Thorburn's termination isn't about tension between science and politics. "This is a personnel issue between an employer and an employee," he says.





At his very first Board of Health meeting, Mielke says he walked in and was presented with the packet of e-mail exchanges between Thorburn and McCaslin. Because he had worked with Thorburn previously on the fluoridation issue, Mielke says, "I walked in the door as a proponent of her." Then, he says, "I looked at the communication that took place between employee and employer. I felt it was inappropriate, less than professional, and cast a negative light on the professionalism of the health district." After the vote, Mielke says he told Thorburn, "It was just flat-out over the top."





Board member Dave Crump, the lone holdout in the no-confidence vote, says he was responding to the question, "Do you have confidence in Dr. Thorburn as health officer?" and not to the e-mails, which he agrees were inappropriate.





Mielke says board members have reached out to Thorburn, attempting to correct the situation, but didn't make any headway. Spokane City Councilman Brad Stark says he tried, too: "I sought out a relationship with her and a lot of those attempts at opening lines of communication were rebuffed."





Mielke says matters were complicated by Thorburn's employment contract, which he deems poorly written and vague on the subject of disciplinary options: "Basically, everything's hunky-dory or you stop the contract."





From an employer's perspective, he says, "an employee is hired to advance the interest of the employer," and though she was not terminated for cause or criticized for her public health performance, Thorburn was just "not a good fit."





Incoming County Commissioner Bonnie Mager, however, says, "We ought to require more openness in the process," adding that Thorburn is "an important figure in our community. I think she is extremely professional, and what I really care about is that she is protecting our public health. The public has a right to know why she was dismissed -- it undermines public confidence when they don't know."





The Future


Thorburn says she has absolutely no plans to sue the board or take other legal action. Reflecting on the "new direction" the board has talked about, Thorburn says, "It makes me very fearful." She recalls county commissioner Phil Harris' talk of dismantling the health district and making it into a health department firmly under the control of the county. Mielke denies this, sort of: "It is not a majority opinion of the board," he says.





Thorburn argues that Washington state's health boards are out of step with modern practice. She says more than 80 percent of boards of health across the country are made up of constituents or officials directly elected to the health board, not city or county politicians whose first loyalties lie elsewhere. And larger cities are going away from boards of health entirely. If the responsibilities of the public health officer assume independence, but working under the "direction of the board" sets public health on a collision course with politics, Thorburn now thinks it's time for a change. n





The Spokane Regional Health District board will meet on Monday, Nov. 27, at noon in the Commissioners Hearing Room of the Public Works Building, 1026 W. Broadway Ave. Call 324-1500.