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

It's 5:20 p.m. and there is still enough light outside to see the pedestrians dodging rush hour traffic. It is light, now, when I drive to work in the morning--we have turned the corner and are headed toward spring!

And it cannot come soon enough to those who are laboring on your behalf in Olympia, especially Lisa Thatcher and Len McComb, AWPHD's lobbyists. Patience is wearing thin and frustration rising as we hit the halfway mark. It is a very close-quarters experience, this law-making adventure-the legislators and lobbyists are together all day, every day, and the desire to make great things happen collides with the challenges of real life over and over. It is no wonder people lose their tempers!

It seems clear that the unions are acting on their belief that they are responsible for the Democratic majorities in both the House and the Senate. They are behaving like they are "owed." And there is some evidence, at least, that their message is being heard.

What's harder to see is what, if anything, is being done to bridge the practical crevasse between legislators that represent the Puget Sound region (where coping with population growth, economic development, and the traffic both bring is really the only priority) and those that represent the rest of the state (still struggling with declining population, double-digit unemployment, and stagnant economies). Both parties talk about reaching out to build their "statewide base," but both chose King County residents with strong records on local issues when it came time to pick new leadership last weekend.

There is a lot happening in and around AWPHD at present, and we are stretched to keep meeting our obligations. I want to thank my staff here--Dick Goldsmith, Wendy Ray and Beionka Moore--and our leadership for their skill and support as they work to build an organization that meets your expectations and challenges you to dream bigger!

SNAPSHOTS

The Puget Sound presentation of AWPHD's "Creating a Peer Mediation Program for Your Public Hospital District" is set for Friday, March 17th at the Red Lion Seattle Airport Hotel in SeaTac. The program was a big hit in Kennewick on January 6th: everyone who turned in an evaluation (19 out of 21 participants) rated it as "Excellent" and many of the districts at that presentation will be sending more staff on March 17th. The program flyer will be going out next week and attendance is limited-so don't delay sending in your registrations.

AWPHD's legislative staff already has reviewed and tracked over 50 policy bills this session that could potentially affect PHDs as local governmental entities. But so far, few have had either positive or negative impacts on districts' operations.

Senators Joyce Mulliken (R-13th District, parts of Kittitas, Grant and Yakima counties ) and Jean Berkey (D-38th District, Everett and Marysville) introduced Senate Bill (SB) 6504--AWPHD's bill to prevent a district employee from concurrently holding office as a commissioner in that district. Last week, Dick Goldsmith, AWPHD's Director of Legal Services and Public Policy, testified before the Senate Government Operations and Elections Committee in support of this bill; no one testified in opposition. The committee unanimously approved the bill, which is now awaiting action by the Senate Rules Committee

AWPHD also has been working hard behind the scenes for the passage of two "companion" bills that would enable hospitals in the state to participate in a national heart surgery study being conducted by Johns Hopkins University. The study is to determine whether certain non-emergency angioplasty procedures can be performed safely and effectively at hospitals without open heart surgery programs. Fifteen hospitals, including five PHD hospitals, are supporting SB 6632 and HB 2888. The bills' prime sponsors are Senator Jim Kastama and Representative Dawn Morrell, both Democrats from the 25th District (Puyallup and other areas of Pierce County around Tacoma).

Thanks to responses from district CEOs and Administrators to an AWPHD e-mail requesting information on district activities relating to the provision of services to jails and prisons, as well as the purchase of goods and the hiring of inmate labor from those facilities, AWPHD was better able to assess the impacts of HB 2737. This bill, if enacted, would specifically prohibit PHDs from contracting with "any prison or correctional industry program." What we learned was that many districts provide health care for inmates, a few hire inmates to perform yard work and similar services, one prepares meals for the local jail, and at least one has purchased prison-made furniture. A hearing has yet to be held on this bill.

About three weeks ago, we were told that the State Attorney General had issued Attorney General Opinion (AGO) 2006 No. 1 with unfavorable results for PHDs and other special purpose districts. This AGO opined that a collective stance by district governing boards on ballot measures was not part of their "normal and regular conduct" and thus prohibited by RCW 42.17.130.

As you likely remember, AGO 2005 No. 4 interpreted the term "elected legislative body" as not applying to the governing boards of special purpose districts. This interpretation deprived district commissioners of the ability to support or oppose ballot measures under RCW 42.17.130(1). After the Public Disclosure Commission adopted this interpretation, AWPHD and other special purpose districts--through Representative Geoff Simpson (D-47th District, SE King County)--asked for an AGO as to whether taking a collective stance on ballot measures could be considered as "normal and regular conduct" of a district board, which was allowed by RCW 42.17.130(3).

AGO 2006 No. 1 forecloses any opportunities--short of legislation or a court battle--for the governing boards of special purpose districts to take a collective stance on ballot measures "related to the district's operations" or that "directly affect the interests of the district's taxpayers...." But Representative Simpson has again championed the cause of special purpose districts on this matter by introducing HB 2713. If enacted, this bill will expressly state that the governing boards of special purpose districts--including PHDs--can take a collective stance on ballot measures affecting their districts if the procedures outlined in RCW 42.17.130(1) are followed. Representative Geoff Simpson introduced HB 2713 at the request of the Washington Public Ports Association and we, of course, are supporting it. The bill passed out of the State Government Operations and Accountability Committee and has gone to the Rules Committee. Lisa Thatcher and other lobbyists already are working to get it out to a vote of the full House.

Some unexpected benefits for all PHDs may have come out of a recent meeting with State Treasurer Michael Murphy to discuss his concerns over HB 1341, which would enable the larger PHDs to invest in corporate equities and bonds. Mike Glenn, CEO at Olympic Medical Center in Port Angeles (Clallam County PHD No. 2); Chrissy Yamada, CFO at Evergreen Healthcare in Kirkland (King County PHD No. 2); Lisa Thatcher and Dick Goldsmith were the AWPHD "delegation" that wanted to learn more about the Treasurer's objections to this bill. During the discussion, they learned that the Local Government Investment Pool (LGIP), authorized by the Legislature in 1986 and run by the Treasurer's Office, may be obtaining higher returns on investments than other options that local governments have been using--and PHDs are eligible to participate in the pool. The Treasurer also mentioned a program in his office that provides tax-exempt, lease-purchase financing for local governments, including PHDs. The program--LOCAL (Local Option Capital Asset)--provides access to capital markets for equipment and real estate (including construction, acquisition of buildings and land, and refinancing). Information about the LGIP and LOCAL is available on-line at http://tre.wa.gov/LGIP/lgip.htm. And AWPHD will be polling district CEOs and Administrators shortly to determine whether there's enough interest in having staff from the Treasurer's Office put on a web cast about these opportunities.

If you're looking for new ideas for running levy campaigns for elections by mail, Greg Reed, CEO at United General Hospital in Sedro-Woolley (Skagit County PHD No. 304), has a suggestion: talk with local school districts after the February elections to find out the strategies they used, and what worked…or didn't work. Greg noted that many school districts around the state are facing bond elections by mail for the first time.

District facilities where podiatric surgery is performed should be aware of the State Podiatric Medical Board's Interpretative Statement on Anesthesia Administration for Podiatric Surgical Patients, issued on January 12th. Although podiatrists are generally prohibited from administering spinal or general anesthetics, WAC 246-922-001 (5) allows podiatrists to treat foot ailments requiring the use of a general or spinal anesthetic "provided that administration…is by or under the supervision of a physician authorized under chapter 18.71 or 18.57 RCW." This interpretative statement allows Certified Registered Nurse Anesthetists, acting within their scope of practice, to administer the anesthetic when under the supervision of a licensed physician, as well as defines "supervision." However, be aware that this Interpretive Statement "is intended to be an interim measure until the [Podiatric] Board has had an opportunity to receive and consider input on revision of WAC 246-922-01." For a copy of this interpretative statement, please e-mail Beionka Moore at beionkam@wsha.org.

The final Model Rules for the Public Records Act were just issued by the State Attorney General. These model rules provide information to public agencies and requestors on "best practices" for complying with the requirements of this act. The model rules were adopted after the Attorney General's Office held 13 public hearings around the state and reviewed written comments from state and local agencies, and the public (including AWPHD).

What should be especially helpful to PHDs--and their public records coordinators--is the commentary provided with the model rules. Although the model rules are advisory only, they offer guidance to public agencies on how to respond to records requests. The final Model Rules are available on-line at www.atg.wa.gov/records/modelrules/index.shtml.

Eastern Washington legislators came out in force to listen to the concerns of Columbia Basin Hospital Council members on January 18th in Olympia. It's an annual Council event that has been effective in keeping members' concerns in front of legislators at the start of the legislative session. Insufficient reimbursement for nursing home care, rising medical liability premiums, shortages of nurses, and the need to expand the Basic Health Plan were among the topics raised this year.

In attendance were Senators Joyce Mulliken, Bob Morton (R-7th District, Ferry, Pend Oreille, Stevens, and parts of Lincoln, Okanogan and Spokane counties), and Mark Schoesler (R-9th District, Asotin, Whitman and parts of Adams, Franklin, and Garfield counties). They were joined by Representatives Bill Hinkle (R-13th District, parts of Grant, Kittitas, and Yakima counties), Don Cox (R-9th District), Mike Armstrong (R-12th District, parts of Chelan, Douglas, Grant and Okanogan counties), and Joel Kretz (R-7th District). Because these legislators sit on committees of importance to AWPHD members--Health Care, Appropriations and Rules in the House; Appropriations, and Government Operations and Elections in the Senate--these dinners take on added significance.

AWPHD's State Auditor's Office (SAO) Committee recently reviewed a draft of the "2005 Financial Reporting Package for Public Hospitals" for the SAO. Special thanks go to committee members Harold Brockman (Administrator, Kittitas County PHD No. 2, Cle Elum, and CFO, Kittitas County PHD No. 1, Ellensburg); Tom Dingus (Thomas D. Dingus and Associates PLLC, Spokane), Don Hansen (Moss Adams LLP, Everett) and Dave Sherwood (LeMaster and Daniels, Spokane PLLC).

March 15th is the deadline for applying for a Rural Health Leadership grant from the Washington Health Foundation (WHF). WHF will be awarding one-year grants up to $50,000 in three "Healthy Living" action areas: (1) Protecting Against Injury and Disease; (2) Avoiding Addictions; and (3) Engaging in Healthy Habits." WHF just mailed out grant brochures with application forms and an on-line application form is available at www.whf.org. If you're thinking about applying for a Rural Health Leadership grant, contact Katharine Sanders to discuss grant eligibility and guidelines, and to get answers to your questions. Her phone number is (206) 216-2509.

WHF's Healthy System Challenge Grants are another potential source of funding for activities in your district. Information on these grants will be out in March.

PEOPLE AND PLACES

The commissioners at Quincy Valley Medical Center (Grant County PHD No. 2) have appointed Mehdi Merred as the new Administrator. His previous position was CEO of Gordon Memorial Hospital in Gordon, Nebraska.

Aimée Brice is the new in-house counsel at Evergreen Healthcare. She comes to Evergreen from a three-year stint with the Kirkland law firm of Livengood, Fitzgerald & Alskog where her practice focused on business transactions.

Klickitat Valley Health Services (Klickitat County PHD No.1) has begun construction on a $5.2 million hospital addition, scheduled to be completed by December 2006. The new 22,000 square-foot building will house the emergency department, urgent care and diagnostic imaging services, as well as be the central entrance for admissions. The facility was designed to be expanded in six to eight years for patient rooms, lab and surgery.

Pend Oreille PHD No. 1 has unveiled a new name for Newport Community Hospital--Newport Hospital and Health Services.

NETWORK NEWS

· Rural Healthcare Quality Network (RHQN)

University of Minnesota's Rural Emergency Department Research Study: Half of the RHQN's membership has elected to take part in this important study and the RHQN staff is now scheduling training sessions for participating hospitals.

Training sessions for hospitals in central and eastern Washington will take place on February 9th and 10th at Deaconess Medical Center in Spokane. For hospital staff unable to attend in-person, the RHQN is making arrangements with INHS for participation through Telehealth. After hospitals have been formally notified by the RHQN of these sessions, they should contact Brad Vollegraaf to confirm: (1) the session they will attend; and (2) participation in-person or via Telehealth. (Brad's e-mail address is bradv@awphd.org.)

Participating hospitals that are also members of the Western Washington Rural Health Care Collaborative should contact Elizabeth Floersheim (elizabethf@awphd.org) about their training dates.

For specific questions about this study, please contact Jackie Huck at jackieh@awphd.org

Plan-Do-Study-Act (PDSA) Workshops: The RHQN just completed another successful PDSA workshop and member hospitals have requested more. So planning for at least two more workshops over the next year--one on the east side of the state and the other on the west side--will begin shortly. As soon as the schedule is set, the RHQN will notify members.

These workshops specifically address planning, implementing, measuring and sustaining change. They enable participants to work and learn together in groups on how to implement successful system changes.

For more information on Quality Improvement methodology and PDSA workshops, contact Jackie Huck. Jackie also is available to provide individual consultation to members who need more time to focus on making successful system changes that incorporate quality as part of daily work.

New RHQN Website: The RHQN's web site---www.rhqn.org-has a new look and RHQN staff would like to hear from members and others about it. Send or phone comments on appearance, suggested improvements, and "glitches" to Brad Vollegraaf at bradv@awphd.org; (206) 216-2550.

UPCOMING EVENTS

WRHA Rural Health Policy Day
February 7 - 7:00 am • General Administration Building, Olympia
Contact: Marlene O'Dea (509)358-7653

WSHA Rural Hospital Committee
February 7 - 10:00 am • WSHA Offices, Seattle
Contact: Melissa Waddell (206)216-2510

WSHA Executive Committee
February 9 - 1:00 pm • WSHA Offices, Seattle
Contact: Lisa Rusk (206)577-1852

WSHA Medicaid Hospital Advisory Committee
February 13 - 11:00 am • WSHA Offices, Seattle
Contact: Melissa Waddell (206)216-2510

WSHA Medicaid Reconciliation: Best Practices & Understanding Regulations Webcast
February 17 - 12:00 noon • Webcast
Contact: Angela Segerra (206)216-2539

WSHA Strategic Planning Committee
February 24 - 10:00 am • WSHA Offices, Seattle
Contact: Lisa Rusk (206)577-1852

WSHA Nominating Committee
February 24 - 2:00 pm • WSHA Offices, Seattle
Contact: Lisa Rusk (206)577-1852

WSHA Winter Board Retreat
March 16-17 • Fairmont Olympic Hotel, Seattle
Contact: Lisa Rusk (206)577-1852

AWPHD Creating a Peer Mediation Program for Your Public Hospital District
March 17 - 9:30 am • Red Lion Seattle Aiport Hotel, SeaTac
Contact: Beionka Moore (206)216-2530

AWPHD Board
March 21 - 10:00 am • WSHA Offices, Seattle
Contact: Beionka Moore (206)216-2530

NW Regional Critical Access Hospital Conference: Invest in the Future
March 22 • Red Lion Hotel at the Park, Spokane
Contact: Kaarin Appel (509)358-7640

NW Regional Health Conference: Dare to Prepare
March 23-24 • Red Lion Hotel at the Park, Spokane
Contact: Kaarin Appel (509)358-7640

WSHA Patient Safety Task Force
March 27 - 5:00 pm • Washington Athletic Club, Seattle
Contact: Angela Segerra (206)216-2539

The deadline for the next In Focus is Friday, February 17th. 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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