SENATE BILL REPORT
SB 5454
BYSenators Wojahn, West, Metcalf, Niemi, Stratton, Bailey, Rasmussen, Newhouse, Johnson, Sellar, Barr, Matson, Benitz, Conner, Hansen, Bauer, McDonald, Warnke, Vognild, DeJarnatt, Williams, Murray, Sutherland, Fleming, Gaspard, Smith, Saling, Bender and Anderson; by request of Governor
Creating a department of health.
Senate Committee on Health Care & Corrections
Senate Hearing Date(s):February 7, 1989; March 1, 1989
Majority Report: That Substitute Senate Bill No. 5454 be substituted therefor, and the substitute bill do pass.
Signed by Senators West, Chairman; Smith, Vice Chairman; Amondson, Johnson, Kreidler, Niemi, Wojahn.
Senate Staff:Don Sloma (786-7414)
March 3, 1989
Senate Committee on Ways & Means
Senate Hearing Date(s):March 6, 1989
Majority Report: That Second Substitute Senate Bill No. 5454 be substituted therefor, and the second substitute bill do pass.
Signed by Senators McDonald, Chairman; Craswell, Vice Chairman; Amondson, Bailey, Bauer, Bluechel, Cantu, Fleming, Gaspard, Hayner, Johnson, Lee, Matson, Moore, Newhouse, Niemi, Owen, Saling, Smith, Talmadge, Warnke, Williams, Wojahn.
Senate Staff:W. Featherstone Reid (786-7715)
March 8, 1989
AS REPORTED BY COMMITTEE ON WAYS & MEANS, MARCH 6, 1989
BACKGROUND:
A Department of Health was first created in Washington in 1921 by transferring the administrative responsibilities of the state Board of Health. The Department of Health continued until 1970 when it was merged into the Department of Social and Health Services (DSHS). The new umbrella agency was formed to integrate and decentralize services. Repeated efforts to realize the goals for DSHS met with only limited success. Many now claim that services are not adequately integrated, that programs are not adequately decentralized, and accountability is hampered by an unnecessarily complex organization. Advocates for the traditional purposes of public health (i.e. disease and illness prevention, control of epidemics, etc.) state that DSHS places a low priority on public health purposes within the umbrella agency.
In 1986, the Legislature considered a proposal by the Joint Select Committee on Public Health to create a separate state department of public health and environment, by removing traditional public health functions from DSHS and merging them with health related functions housed in the Department of Ecology. Enabling legislation passed the Senate, but has failed in the House for several years.
SUMMARY:
A Department of Health is created to provide leadership in assuring the quality of health care, protect the general population's health, contain the cost of personal health care services, and develop state health policies.
The Governor must appoint a director with the consent of the Senate. A state health officer must be employed by the department, as the director or as an advisor to the director. The state health officer must be a physician and have a masters degree in public health or its equivalent.
The director may organize the department as he or she sees fit for efficient operations. He or she shall appoint a deputy director, assistant directors as required to operate the divisions, and an additional 25 persons, all of whom shall be exempt from civil service protections.
A systematic data evaluation program is established to analyze health care practices, outcomes, the need for changes in health care delivery, and bioethical issues, and to provide data to consumers, providers and purchasers of health care.
An office of health consumer assistance is created.
The director must enter into written operating agreements with each professional licensing and disciplinary board to provide a process for consultation on administrative matters.
The new department merges the Board of Pharmacy, the duties of the State Hospital Commission, the health professional licensure functions of the Department of Licensing, and the traditional public health functions, the mandated health benefit review, new health professional credentialing review, health planning and certificate of need functions of the Department of Social and Health Services.
Traditional public health functions transferred from DSHS include:
Environmental health protection programs including radiation, drinking water, toxic substances, on-site sewage, recreational water contact facilities, food service sanitation, and shellfish;
Personal health protection programs including immunizations, tuberculosis, sexually transmitted diseases, AIDS, diabetes control, primary health care, hypertension, kidney disease, regional genetic services, newborn metabolic screening, sentinel birth defects, communicable disease epidemiology, and chronic disease epidemiology;
The public health laboratory;
Public health support services, including vital records, health data, and health education and information;
Selected health facilities licensure authority including hospitals, maternity homes, boarding homes, abortion facility approval, emergency medical services, transient accommodations, home health and hospice care, and private establishments.
The Board of Health is transferred to the Department of Health, designated as the primary entity for state health policy development and required to produce a biennial state health report which sets forth the state's health priorities. Mechanisms for public involvement are authorized through local health departments and ad hoc advisory groups.
All administrative duties and the duty to enforce drug laws are transferred from the Board of Pharmacy to the new department.
EFFECT OF PROPOSED SUBSTITUTE:
References to health care cost containment duties are removed from the mission statement and powers of the Department of Health (DOH).
Organizational principles for DOH are articulated in greater detail.
The Deputy Secretary of Health must be the State Health Officer. The State Health Officer must have a masters degree in public health or equivalent experience.
The Secretary of Health must structure the department in a manner consistent with the organizational principles established in the act.
All assistant secretaries, deputy secretaries, division directors, bureau directors, offices chiefs and five additional personnel are exempt from civil service protections.
Biennial reviews and determinations regarding continuation of all advisory structures within the department are made by the secretary.
The Legislature intends that DOH promote, assess and assure quality in health care. The department is designated as the primary agency to collect data related to illness and injury prevention, health promotion, and the quality of health care. Safeguards against improper use of data are established. The department must develop a state research agenda as part of the biennial state health report. Research and other studies may be undertaken only in accordance with the research agenda and procedures established for study approval and funding. The secretary must use study results as appropriate to improve health quality.
A hotline is added to the Office of Health Consumer Assistance established by the act.
A study of present statutes and programs to assure quality in health care professional practices must be completed by the department.
The Secretary of Health and each professional licensure board must develop agreements regarding their respective responsibilities which must be set in rule.
Parent and Child Health Services programs are transferred from DSHS to DOH effective July 1, 1991.
The duty to designate nursing shortage areas under the nursing scholarship program is transferred from the State Health Coordinating Council (SHCC) to the Secretary of Health.
Two staff in addition to an executive director and a secretary must be employed by the Board of Health.
The Board of Health is authorized to recommend means for obtaining citizen and professional involvement in all health policy formulation and other matters regarding the Department of Health's duties.
The Governor must approve, disapprove, or modify the state health report by September 1 of each even numbered year.
The Board of Health must establish ad hoc advisory groups in developing the state health report as necessary.
The Board of Health is removed from making recommendations regarding new proposals for mandated benefit offerings in insurance laws.
Funeral directors and embalmers regulation is retained within the Department of Licensing (DOL), and DOL must recommend legislation by 1990 to eliminate any statutory barriers to this retention.
The Board of Pharmacy administrative duties are not transferred to the Department of Health. The Board of Pharmacy must review its duties and delegate those it feels can be most efficiently performed by DOH. The LBC must complete a similar review as part of its sunset review of the board due in June, 1989.
All mention of the Hospital Commission and the Certificate of Need program is deleted from the act.
Funds and employees for regional health planning are transferred from DSHS to the Department of Health.
The LBC must study health related functions in DSHS, Department of Fisheries, Department of Ecology, and Department of Agriculture and recommend transfers by December 1989.
Regional health planning councils as authorized under Chapter 70.38 RCW are abolished.
EFFECT OF PROPOSED SECOND SUBSTITUTE:
A standard null and void provision is included which requires that a funding level for the new department be established in the operating budget for the next biennium.
Appropriation: none
Revenue: none
Fiscal Note: available
Effective Date:October 1, 1989
Senate Committee - Testified: HEALTH CARE & CORRECTIONS: Bud Nicola, Bobbie Evans, Washington State Association Local Public Health (pro); John Thayer, Washington State Env. Health Directors (pro); Mary Selecky; Bob Ellis, State Board of Health (pro); George Schneider, Washington State Medical Association (pro); Bob Atwood, Yakima Health District (pro); Eldon Jacobsen, SHCC (pro); Margaret Shepherd, Puget Sound Health Systems Agency (pro); Patty Joynes, WSNA (pro); Yvonne Spies, Planned Parenthood Affiliates of Washington (pro); Lars Hennum
Senate Committee - Testified: WAYS & MEANS: Len Eddinger, Washington State Medical Association; Gary Goldbaum, M.D., on behalf of county health departments and Washington State Association of Local Public Health Officials; Lars Hennum, Pharmacists of Washington; Yvonne Spies, Planned Parenthood Affiliates of Washington