FROM WHERE I'M SITTING...By jeff mero, executive director

It's been cloudless and warm with brilliant sunshine for five days in a row, now. There was a time, when I lived in New York, when that wouldn't faze me, but having spent 25 years in Western Washington, some sort of chemical imbalance kicks in after three days, making me even dizzier than usual. I used to worry about it, but watching the driving around me as I go back and forth to work tells me I'm not the only one!

Very busy around here, with lots of focus on quality and safety. There is also a healthy dose of concern about how the state is moving forward with the new Certified Public Expenditure (CPE) program, instituted to address federal complaints about some of our state's Disproportionate Share programs.

Safety first (hmmmm, seems like a slogan!). We have spent quite a bit of time since the Rural Hospital Workshop in Chelan talking about how we can reduce (or, if that can't be done, at least better coordinate) the demands being made on your quality assurance/risk management/medical records staff. Even as we do that here, other organizations are bringing their plans forward. Qualis, the state Health Care Authority, Labor and Industries, and the state Department of Health are all preparing to launch new initiatives (or are in the early stages of collecting information). We are looking for opportunities to promote both the WSHA Patient Safety Initiative and the work of the Rural Healthcare Quality Network (RHQN) in regulatory environments to demonstrate what voluntary efforts can do, but this is an uphill battle. We are committed to better coordination among the organizations here at 300 Elliott Avenue West. This will be on the front burner of most RHQN, AWPHD and WSHA member gatherings over the next few months.

On the CPE front, we are hearing loud and clear that the new approach is off to a shaky start. Jeff Uyyek and Claudia Sanders are in regular contact with program managers at the Health Recovery Services Administration (which we used to know as the state Medicaid Assistance Administration) to raise questions and discuss solutions. This has been a troubling proposal from the first day it surfaced (about a year ago), and beyond very good work done with state officials to gain protections in the state budget act, I'm not sure we can expect things to settle down anytime soon. At least some of the districts affected (the new program applies to public hospitals that are NOT Critical Access Hospitals) believe finding a new way to solve this problem should be AWPHD's and WSHA's top budget priority for 2006.

Finally, a few words about the Image Campaign. We sent you material recently that included the results of a statewide public opinion poll. That poll found lots of public support for your institutions. We did hear that the public would like to know more about what, specifically, hospitals are doing to promote safety for patients and improve quality in clinical outcomes. The Image Campaign Steering Committee will soon review a plan to use some of the funding you provided to respond to that public interest.

September will be here soon! I hope all of you have found (or soon will be finding) some time to enjoy this beautiful time of year.

SNAPSHOTS

Before the election season goes into full swing, be sure that you and your district's commissioners know what actions public officials and public agencies can and can't take during campaigns. Here's the link to the Public Disclosure Commission (PDC)'s April 26, 2005 revisions to its Guidelines for Local Public Agencies in Election Campaigns: http://awphd.org/news/PDC_interpretation.pdf

As you know from reading earlier editions of In Focus, AWPHD and other special purpose district organizations are jointly addressing the Guidelines revision that ignores a quarter-century of legal interpretation and practice by banning the governing boards of these districts from taking collective stances on ballot measures. (This revision was based on 2005 Attorney General Opinion No. 4, which opines that these boards do not qualify for the "legislative body" exemption under Section 42.17.130(1) of the Revised Code of Washington (RCW) and are consequently prohibited from collectively opposing or supporting ballot propositions. It should be noted that courts are not required to follow Attorney General Opinions.)

Our efforts have been partially successful. In an August 2nd letter to AWPHD, the executive director of the PDC wrote,

Given the history surrounding this matter and the urgency expressed in your July 19th letter, at its July 26 meeting, the Commission unanimously adopted a motion directing staff not to take enforcement action against special purpose districts that engage in activities authorized for "legislative" bodies consistent with RCW 42.17.130(1) pending clarification by the Legislature during the 2006 session of the application of RCW 42.17.130(1).

In the meantime AWPHD and these other organizations are still considering a number of possibilities for a return to the status quo. One avenue: requesting an Attorney General Opinion on whether a collective stance is an activity that is part of the governing board's "normal and regular conduct" and thus allowed by RCW 42.17.130(3). Another approach: changing the wording of RCW 42.17.130(1) so that its exemption applies to "governing bodies." And still another: going to court for a declaratory judgment that the term "legislative body" includes the governing boards of special purpose districts. There are, however, downsides to all these courses of action.

Even with the PDC's promise of non-enforcement, the commissioners of each PHD need to be made aware that taking a collective stance on an upcoming ballot measure is not risk-free. State law allows the Attorney General, prosecuting attorneys of political subdivisions of the state, and-under certain circumstances-citizens to enforce public disclosure laws. It is suggested that each board weigh those risks before taking-or not taking-a collective stance on a ballot measure. And before taking a collective stance a board should scrupulously follow the requirements of RCW 42.17.130(1): the meeting must be open; any required notice of the meeting must include the title and number of the ballot proposition; and members of the board or the public "are afforded an approximately equal opportunity for the expression of an opposing view."

Don't forget to participate in Public Records and Public Hospital Districts, AWPHD's August 15th web cast, which begins at noon. Angela Belbeck and Don Black, attorneys with the Seattle firm of Ogden Murphy Wallace P.L.L.C., will be discussing the newest changes to the state's Public Disclosure Act (PDA), as well as what districts need to do to ensure that their policies and practices are in compliance with the PDA.

For more about the web cast and connecting to it, go to http://awphd.org/events/AdvanceNotice_PublicRecordsWebcast.doc.

Make sure that your district is represented at Opportunities and Challenges, the September 15th-16th conference in Yakima for Washington State PHD foundations. This first-ever conference, which has been planned by PHD foundation staff, is an exceptional educational and networking event for foundation board members and staff, as well as district CEOs/administrators.

Fundraising, staffing, and legal issues are the major topics and there's even a special conference "extension" session for those districts who want to establish a foundation. Among the featured speakers are John Anderson (HealthCare Fund Development Consultants, Westmont, Illinois), Dixie Coggins (Strategies 360, Seattle), and Brad Berg (Foster, Pepper & Shefelman, Seattle).

The conference brochure and registration form are available on-line at http://awphd.org/events/OPBrochure.pdf. If you have questions, call Beionka Moore at (206) 216-2530.

End-of-life issues will be the focus of two free events in October. Lessons from Terry Schiavo-Are Advance Directives the Solution or Part of the Problem? is an October 1st program in Tacoma for health care professionals. Through interactive lectures and discussions, as well as breakout sessions with mentored role-playing and case-simulation, participants will obtain the tools for turning discussions with patients who have life-limiting illnesses into end-of-life documents such as the Physician Orders for Life Sustaining Treatment (POLST). The program, which is a joint effort of the Washington State Medical Association (WSMA) and the Washington End of Life Consensus Coalition (WEOLCC), will take place during WSMA's Annual Meeting; physicians and physician assistants can obtain CME credits for participating.

WEOLCC's 2005 Fall Conference will be held on October 28th at the Marriott SeaTac Airport Hotel.

For more information and registration materials on both events, contact Graham Short at WSMA (800-552-0612, gfs@wsma.org).

Mark your calendars for a Construction Management workshop scheduled for November 3rd and 4th in Ellensburg. Contact Wendy Ray (wendyr@awphd.org or 206-216-2516) for more information.

PEOPLE AND PLACES

Chelan County PHD No. 1 (Cascade Medical Center in Leavenworth) and Grays Harbor PHD No. 1 (Mark Reed Hospital in McCleary) will be going to the voters on September 20th for levy approval. Cascade's commissioners voted to put an $8.8 million bond measure on the ballot for facility renovations, including $3.5 million in infrastructure modernization. The commissioners at Mark Reed want voters to approve a $16.5 million bond measure to build a new hospital.

UPCOMING EVENTS

Rural Hospital Committee Retreat
August 11-13 • Davenport Hotel, Spokane
Contact: Melissa Waddell (206)216-2510

RHQN Regional Meeting
August 13 - 2:00 • Davenport Hotel, Spokane
Contact: Brad Vollegraaf (206)216-2550

AWPHD Public Records and Public Hospital Districts Web Conference
August 15 - 12:00 • Web Conference
Contact: Wendy Ray (206)216-2516

AWPHD Board Meeting
August 17 - 10:00 • Conference Call
Contact: Beionka Moore (206)216-2530

Workers' Compensation Regional Claims Meeting
August 19 - 9:00 • Radisson Hotel Gateway, Seattle
Contact: Anita Badri (206)216-2553

Workers' Compensation Regional Claims Meeting
August 20- 9:00 • Hallmark Hotel, Moses Lake
Contact: Anita Badri (206)216-2553

WWRHCC Board Retreat
August 25-26 • La Push
Contact: Elizabeth Floersheim (206)577-1851

RHQN Regional Meeting
August 30 - 1:00 • Samaritan Healthcare, Moses Lake
Contact: Brad Vollegraaf (206)216-2550

RHQN Board Meeting
September 13 - 10:00 • Conference Call
Contact: Brad Vollegraaf (206)216-2550

AWPHD/WSHA Rural Advocacy Days
September 13-14 • Washington, DC
Contact: Wendy Ray (206)216-2516

AWPHD Public Hospital District Foundation Conference
September 15-16 • Red Lion, Yakima
Contact: Beionka Moore (206)216-2530

WSHA Executive Committee & Finance Committee
September 16 - 8:00 • WSHA Offices
Contact: Lisa Rusk (206)577-1852

WHF Board Retreat
September 22-23 • Alderbrook Resort, Union
Contact: Heather Pitre (206)577-1848

WWRHCC Board Meeting
September 23 • Morton
Contact: Elizabeth Floersheim (206)577-1851

WSHA Patient Safety Task Force
September 28 - 5:00 p.m. • WSHA Offices
Contact: Angela Segarra (206)216-2539

The deadline for the next In Focus is: Friday, August 26th. Send articles or information to Dick Goldsmith (richardg@awphd.org, Fax: 206-577-1897, 300 Elliott Avenue West, Suite 300, Seattle, WA 98119-4118).

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