HOUSE BILL REPORT
HB 1324
BYRepresentatives Brooks, Valle, Pruitt, Braddock, Hankins, Betrozoff, Kremen, Beck, Wood, Dellwo, Bowman, Haugen, Winsley, Brekke, Walker, Horn, Nelson, Moyer, Fraser, D. Sommers, Van Luven, Cooper, R. Meyers, Jesernig, Miller, May, Rust, Sprenkle, Brumsickle, Grant, Cole, Chandler, Prince, Holland, Doty, Silver, Belcher, Scott, Rasmussen, Hine, Baugher, Dorn, Walk, Rayburn, Gallagher, Schoon, Sayan, Heavey, Vekich, Patrick, Fuhrman, Leonard, Bristow, Schmidt, Morris, Jones, Basich, R. Fisher, Wineberry, Todd, Prentice, Nealey, Ferguson, McLean, R. King, P. King, Wolfe, Nutley, K. Wilson, Cantwell, Brough, Anderson, Smith, Hargrove, Day, Crane, Rector, G. Fisher, Appelwick, H. Myers, Ebersole, Inslee, Spanel and Tate; by request of Governor Gardner
Creating a department of health.
House Committe on Health Care
Majority Report: The substitute bill be substituted therefor and the substitute bill do pass. (9)
Signed by Representatives Braddock, Chair; Day, Vice Chair; Brooks, Ranking Republican Member; Cantwell, Chandler, Morris, Prentice, Sprenkle and Vekich.
House Staff:Bill Hagens (786-7131)
Rereferred House Committee on Appropriations
Majority Report: The substitute bill by Committee on Health Care as amended by Committee on Appropriations be substituted therefor and the substitute bill as amended do pass. (25)
Signed by Locke, Chair; Grant, Vice Chair; H. Sommers, Vice Chair; Silver, Ranking Republican Member; Belcher, Bowman, Brekke, Brough, Dorn, Ebersole, Ferguson, Hine, Holland, May, McLean, Nealey, Padden, Peery, Rust, Sayan, Spanel, Sprenkle, Valle, Wang and Wineberry.
House Staff: Dave Knutson (786-7146)
AS REPORTED BY COMMITTEE ON APPROPRIATIONS MARCH 5, 1989
BACKGROUND:
Like many states at the time of creation, Washington placed its health administration responsibilities in a Board of Health. This body, with a part time membership of five physicians, was the only state agency officially responsible for the health of the citizens. The original purpose of the board was to respond to emergent short term problems, e.g., epidemics, with specific remedies. As the board evolved along with a greater need for public health oversight, new on-going responsibilities emerged, e.g., inspection of ships for communicable diseases; safety of milk; food sanitation; oyster bed inspections; and the collection of vital statistics. Along with this growth, came the need for local cooperation to enforce the state health regulations. To meet this need, the Legislature provided for the establishment of local boards of health, which eventually created local health departments.
The progressive expansion of the state's population and the public health sector required a more continuous supervision and management at the state level. Because of its part time nature, the Board of Health was no longer an effective means for administrating the increasingly complex public health system. To meet these new needs, a Department of Health was created in 1921. The board maintained certain rule making authority, while the new department assumed general administrative authority.
The Department of Health continued its independent existence until 1970, when it was enveloped, along with several other state departments, into the Department of Social and Health Services (DSHS)--the state's umbrella human services agency. DSHS was part of a national phenomenon meant to create a "comprehensive" and "integrated" human service system. Between 1969 and 1974, 26 states established umbrella agencies. However, since then, most of those state umbrella agencies, like Washington's, have been in an almost perpetual state of reorganization in the areas of: administration, service delivery, decentralization, scope of services, etc. Perennial complaints are that umbrella agencies are too big to be responsive to client needs, and that individual programs have lacked visibility and accountability because they are "buried" within the bureaucracy.
The first proposal to reconstitute a Department of Health came in 1986 in the report of the Joint Select Committee on Public Health. The committee identified several areas where the duplication of functions with the Department of Ecology (DOE) had prevented efficient administration, especially in the areas of drinking water quality, on-site sewage control, radiation control, and shellfish protection. The committee also concluded that modern day public health problems, e.g., AIDS and environmental protection, are of such magnitude as to require the elevation of related programs to the departmental level. The committee's recommendations mainly focused on consolidating the Division of Health of DSHS with DOE into an independent agency. During the 1986 sessions, bills were introduced in both the Senate and House to accomplish this goal by the creation of a Department of Public Health and Environment. The measure was passed by Senate, but failed to receive House approval. Similar bills were introduced in the 1987 and 1988 sessions--neither passed the Legislature.
On December 1, 1988, Governor Gardner announced his intention to create a Department of Health to improve leadership and management in the area of health. House Bill 1324 is the enabling act for the new department.
SUMMARY:
SUBSTITUTE BILL: The Department of Health (DOH) is created as an independent state agency. Its primary focus is: public health, quality of care, and health policy development.
For the most part, DOH organizational content is made up of existing functions that will be transferred from the following agencies: The Department of Social and Health Services (DSHS), the Department of Licensing (DOL), and the State Health Coordinating Council (SHCC).
Regarding the public health focus, the following functions are transferred from DSHS: Office on AIDS; sexually transmitted disease control and prevention; epidemiology; environmental health services; public laboratories; communicable disease control and prevention; vital statistics and other health data collection; and, effective July 1, 1990, the parent and child health services.
Regarding the quality of care focus, the following functions are transferred from DSHS: licensure of emergency medical personnel and services, hospitals, boarding homes, and maternity homes.
Transferred from the SHCC is review of health professional licensure and mandated from DOL, the following health professional licensure functions are transferred (RCW reference provided):
18.06 Acupuncture
18.19 Counselors
18.22 Podiatry
18.25 Chiropractic
18.26 Chiropractic Disciplinary Board
18.29 Dental Hygienist
18.32 Dentistry
18.34 Dispensing Opticians
18.35 Hearing Aids
18.36A Naturopathy
18.50 Midwifery
18.52 Nursing Home Administrators
18.52A Nursing Assistants - Training Program
18.52B Nursing Assistants
18.52C Nursing Pools
18.53 Optometry
18.54 Optometry Board
18.55 Ocularists
18.57 Osteopathy
18.57A Osteopathic Physicians' Assistants
18.59 Occupational Therapy
18.71 Physicians
18.71A Physicians' Assistants
18.72 Medical Disciplinary Board
18.74 Physical Therapy
18.78 Practical Nurses
18.83 Psychologists
18.84 Radiologic Technologists
18.88 Registered Nurses
18.89 Respiratory Care Practitioners
18.92 Veterinary Medicine, Surgery & Dentistry
18.108 Massage Practitioners
18.135 Health Care Assistants
18.138 Dietitians and Nutritionists
The State Board of Pharmacy, which is under sunset review during 1989, shall in the future discharge its responsibility in consultation with the Secretary of Health.
As part of its sunset review, the Legislative Budget Committee shall consider full integration with the DOH. Regarding the health policy development focus, the SHCC is terminated and the health planning function, in a modified form, is transferred to the State Board of Health. The new process requires the boards to develop a state health report biennially. The report shall: consider citizen input gathered through public forums; be developed with the assistance and input of local health departments and state health agency administrators; be used by these administrators in the development of their respective agency's budgets and be submitted to the Governor for approval.
To support these functions, DOH is designated as the primary collection agency for existing health data collection. State agencies are required to provide appropriate data to DOH. The Department of Health and the board are required to develop a health care research agenda.
The head of the agency shall be the Secretary of Health who shall be appointed by the Governor. The secretary shall appoint a State Health Officer; both shall be approved by the Senate.
The secretary and each of the health professional and disciplinary boards are required to promulgate jointly through rules, working agreements. The rules shall address administrative support activities, budgets, and personnel.
The Legislative Budget Committee is required to study for possible inclusion in the new department, a variety of state health agency functions that were not transferred to DOH, including: the environmental health programs within the Department of Ecology: food inspection programs within the Department of Agriculture; the shellfish protection program within the Department of Fisheries. The committee will submit its recommendation to the Legislature by December 1. 1989.
SUBSTITUTE BILL COMPARED TO ORIGINAL: The Hospital Commission and certificate of need provisions are deleted from the bill.
Legislative intent and principles of organization are clarified.
The requirement that there be a deputy secretary is deleted.
The administrative head's title is changed from "Deputy" to "Secretary."
The office of consumer assistance is deleted.
The governor is required to approve, disapprove, or modify the state health report by September 1 of each even-numbered year.
Funeral director and embalmer licensure is deleted from the transfer.
The full transfer of the the Board of Pharmacy is deleted, pending the sunset revision.
The effective date is changed from October 1, 1989 to July 1, 1989.
CHANGES PROPOSED BY COMMITTEE ON APPROPRIATIONS: The requirement that the Legislative Budget Committee study health-related functions of various state agencies is deleted.
Fiscal Note: Available.
Effective Date:The bill contains an emergency clause and takes effect July 1, 1989.
House Committee ‑ Testified For: (Health Care) Kathleen Clark, Washington State Dietetic Association, Food and Nutrition Council; Robb Menaul, Washington State Hospital Association; George Schneider, Washington State Medical Association; Nancy Selecky, Northwest Tri County Health; Lars Hennum, Pharmacists of Washington; John Thayer, Washington State Environmental Health Directors; Gary Goldbaum, Washington State Public Health Association; Tom Mane, Southwest Washington Health District; Jeff Larsen, Care Unit Hospital of Kirkland (with amendments), Yvonne Spies, Planned Parenthood Affiliates of Washington; John Pinette, Washington State Catholic Conference; Bobbie Evans, Seattle King County Department of Health; Bud Nicole, Seattle King County Department of Health; Leona Dater; Chair, State Health Coordinating Council (with concerns) and Jackie McFayden, Association of Counties.
(Appropriations) Representative Peter Brooks, Bill Prime Sponsor; Bud Nicola, King County Department of Health, Seattle, Washington; Dr. Bob Crittendon, Office of Governor Booth Gardner; Mary Selecky, Public Health Officers of Washington; Pat Levy, Thurston County Health Department, Olympia, Washington; and Len Eddinger and Dewey Dessler, State Health Coordinating Council, Department of Social and Health Services, Olympia, Washington.
House Committee - Testified Against: (Health Care) None Presented.
(Appropriations) None Presented.
House Committee - Testimony For: (Health Care) Creating a new Department of Health will serve to focus state health programming, planning, and policy. The department will mobilize and coordinate state efforts to preserve, protect, and promote the health of the people of the state; ensure quality and cost-effective health care delivery; provide leadership and regulatory control.
(Appropriations) Public health programs will become a higher priority with the creation of a Department of Health.
House Committee - Testimony Against: (Health Care) None Presented.
(Appropriations) None Presented.