Would a health department run by Pierce County decrease costs and speed permitting?
Republican members of the Pierce County Council contend dissolving the Tacoma-Pierce County Health Department and creating a department under county rule would lead to cost savings and a streamlined permitting process.
No comprehensive study has been completed to examine the possible outcomes, but The News Tribune has found that health department employee salaries might rise under the proposal.
A comparison of permitting turnarounds between the Tacoma-Pierce County Health Department and those of a neighboring county with a county-run health department show quicker time lines in some cases in the neighboring county.
The Republican majority on the Pierce County Council has fast-tracked a proposal that would end an interlocal agreement between the county and the city of Tacoma for an independent health department.
The County Council is expected to vote on the proposal Dec. 15.
Council member Pam Roach, R-Puyallup, said the move would lead to more direct representation when it comes to public health. Some of her Republican colleagues argue there would be efficiencies if the county ran the health department.
Since the inception of the bill in a Dec. 1 study session, Chairman Doug Richardson, the Lakewood Republican who introduced the bill, said he wants to streamline permitting processes and cut down on administrative costs.
Vice Chairmain Dave Morell, R-Lake Tapps, tweeted a statement Friday saying he believes some of the health department’s responsibilities would be better overseen by Pierce County.
The city of Tacoma, Tacoma-Pierce County Health Department leaders and others have called for a more thorough review of the impacts before the County Council votes.
Jeff Ketchel, executive director of Washington State Public Health Association, said while it isn’t wrong to consider the move, he thinks the county should wait until the coronavirus pandemic is over.
“This is a substantial, monumental change,” Ketchel said. “This isn’t necessarily wrong to move the health department, but it needs to be entered into with great thought and planning.”
He wants a study done before the vote.
“This is not something you enter into lightly,” he said. “What if they are wrong, and after analysis realize it’s revenue-neutral or worse, what then? Will they revert back?”
On Thursday, Richardson and Morell told The News Tribune the Dec. 15 vote is to formally notify the City of Tacoma of the county’s intent to dissolve the interlocal agreement. The health department would not be absorbed into county government until after a year or more of transition discussions.
“I see it as we’re providing the notification to our partners, that we are intending to go to a different form of health department,” Richardson said.
Morell said the details would be worked out over the year’s time and expects County Executive Bruce Dammeier “to take a very thoughtful approach to the transition plan before moving forward.”
When asked if a future County Council could repeal the decision if studies show the transition to be too costly or ineffective, Morell said, “All I can say is we would not be making this decision if we thought it was going to go off the rails.”
Richardson and Morell emphasized the health department would not disappear Jan. 1, and public health services would continue to exist under county rule, just with a different form of governance.
They said the fact that Republicans will lose majority in the Pierce County Council in three weeks is not a factor in the timeline. Richardson saw how effective the health department worked with Pierce County’s Emergency Management to provide mobile COVID-19 testing sites and wanted that to continue after the coronavirus pandemic.
“I’ve watched the health department beside the operation center, working side by side,” the chairman said. “I would see that the health department continue as a county department, and we can even help to improve that synergy.”
Bill Riley, co-chair of Pierce County’s Red Tape Reduction Oversight Committee and developer and Realtor, agreed with Wilson, but said he was surprised by the news of Pierce County’s proposed takeover of the health department.
“I was shocked. Then I saw the rationale,” he told The News Tribune. “Trying to streamline permitting is what we need to do to create affordable housing.”
Health department salaries
Six years ago, the Tacoma-Pierce County Health Department’s financial staff conducted a salary review when the department and county government were considering sharing a general services building.
That review found about 200 of the department’s 300 employees could see a salary increase of up to 9.3 percent, according to the health department. That was based on 27 county positions that were parallel to jobs done by health department workers, including assistants and analysts, the health department said.
Richardson told The News Tribune those numbers aren’t concrete.
“That’s kind of speculative at this point, because we haven’t done the transition planning,” he said.
Morell said he believes there will be more teamwork between social services and programs the county and health department both provide.
“The other thing that we look at is there’s often a duplication of services within human services, and that duplication can be eliminated because they’re a team now, and they can tap off each other’s resources,” he said.
The cost of providing insurance to health department employees also could be a financial hit if Pierce County takes over the department.
In 2016, Snohomish County considered a proposal to dissolve its independent health district and set up the department under county rule after the Snohomish Health District saw revenues drop by over 18 percent in less than 10 years while inflation increased expenses.
A 2016 study found that the cost of providing insurance to health district employees would have increased by $607,000 annually due to more expensive monthly rates under Snohomish County’s plan at time, the study found.
In 2018, Snohomish County commissioned a study to weigh the pros and cons of a county health department merger. Consultant and former Snohomish County council member, Dave Gossett, published a 63-page report.
Gossett found advantages of the county taking over included:
Snohomish’s Board of Health does not create “clear lines of accountability,” and a county health department would leave the county responsible for public health decisions.
As a county health department, public health staff could influence policy more easily.
It could be more effective to overlap similar positions like Human Resources, Finance, Accounts Payable, Payroll and “synergy” between permitting and drug and alcohol programs.
Gossett found disadvantages included:
Snohomish County was “more bureaucratic,” and issues like negotiating contracts could take a year or longer, while the Health District was seen as nimble and quick to respond.
There were concerns about a loss of potential funding from cities. The report said, “In taking over the Health District, Snohomish County would be accepting new responsibilities and liabilities with no revenues beyond what the Health District already possesses.”
There was concern that public health would get “lost” or “swallowed up” as part of the much larger County.
There was a potential that public health issues become politicized. The report said, “Campaigns might focus on efforts to change septic rules, loosen food safety requirements, prohibit needle exchanges, or other health policy.”
The proposal to have Snohomish County take over the health district did not happen.
Permitting
Richardson and Morell said as elected officials they have heard of long waiting periods for health department permits over the years.
Morell’s tweets mentioned septic, well-water permits and food service permits would be streamlined if the health department was under county rule.
The News Tribune compared Thurston County permitting turnaround times to those of Tacoma-Pierce County Health Department. The Thurston County Public Health and Social Services Department is a branch of the county government.
Septic repair permits for Pierce County take an estimated nine days to be reviewed while it takes about seven days in Thurston County.
Well-water site inspection and construction permits are turned around in about 43 days in Pierce County while it takes at least 31 days to complete in Thurston.
In both Pierce and Thurston counties, a food plan review has an average response time of 15 days from completed application to first review by staff.
The Master Builders Association of Pierce County, an advocacy group for developers in the county, said it was not a party to the proposal for Pierce County to take over the health department and declined to comment on the potential impact to permitting processes.
Some developers believe the consolidation would be helpful for them.
Kurt Wilson, the chief operations officer of SoundBuilt Homes, one of Pierce County’s leading developers, said it would be easier if all permitting was under the county umbrella.
He said the current system requires developers to submit permits with both the county and the health department, meaning there are duplicate entries for the same project.
“We have a fragmented management structure with the health department,” Wilson told The News Tribune. “I think there is a lot to be gained with the cost savings and folks who do business with the county.”
Masako Cochran with Fox Custom Homes Inc. said the move makes sense.
”The County has its own turnaround issues with building permits, but having all the ‘decision makers’ under one roof (for septic, storm water, environmental reviews) should mean easier time conducting feasibility research, better coordination between specialists and less need for revisions and re-submittals down the road,” Cochran said in an email.
This story was originally published December 13, 2020 at 7:00 AM.
