Make these 3 changes to fix Idaho’s antiquated public health district law
In the early days of the coronavirus pandemic, Idaho House Speaker Scott Bedke wrote a letter to Gov. Brad Little, offering his support, encouragement and a suggestion.
“A statewide, one-size-fits-all approach, in my judgment, is ill-advised,” Bedke wrote in the letter dated April 12. “Rather, allowing public health districts the discretion to modify response policies regionally and locally would best begin the transition back to our pre-COVID-19 economy.”
At the time, the suggestion seemed preposterous, as new cases began to spike all over the state, and so much was still unknown about the virus, how it was going to spread and whether it was going to overwhelm our health care system.
As time has passed, however, that localized approach has begun to take hold, and the strategy begins to make more sense.
Idaho has had a wide disparity in how coronavirus has affected different parts of the state. While Ada and Canyon counties combined have had more than 12,000 cases of COVID-19 and nearly 90 deaths, for example, Lewis and Butte counties have yet to have a confirmed case. Other regions, such as the Magic Valley and Sun Valley, have been hot spots, while other parts of the state have managed to escape a widespread outbreak. Treating individual regions with a little more surgical precision makes sense.
However, there are serious flaws in Idaho’s public health district law, written in 1970, that we have seen painfully played out as some public health boards struggle to respond to the pandemic.
For example, disregarding recommendations from hospital officials and health experts, Southwest District Health board members last month failed to issue a mask mandate in Canyon County, where new cases, hospitalizations and deaths were spiking.
“I mean that is just, from my perspective, a complete failure of public health duty, and a complete abdication of their duty,” Dr. David Pate, retired physician and former CEO of St. Luke’s, told me in a phone interview Monday morning. “And I think irresponsible.”
The good news is that the fixes are relatively simple and would make a district-by-district approach not only more palatable, but eminently more effective.
Here are three main areas that should be fixed:
Health district boundaries
I can’t speak firsthand for the boundaries all of the health districts, and at first blush, most of them seem to make sense. District 1 covers the Panhandle; District 2 covers North Central and includes Latah, Clearwater, Nez Perce, Lewis and Idaho counties; District 5 covers South Central and is centered around Twin Falls and the Magic Valley, and includes Sun Valley; District 6 is centered around Pocatello; and District 7 is centered around Idaho Falls.
Districts 3 and 4, though, are problematic.
Ada County is in one district, Central District Health, which also includes Elmore, Boise and Valley counties. Canyon County is in another district, Southwest District Health, that includes Owyhee, Payette, Adams, Washington and Gem.
Splitting Canyon and Ada counties into two separate districts is a mistake. The two counties are so interconnected, it is vital to make unified public health decisions for both counties.
“Perhaps it makes sense back in 1970, when the legislature passed the law, to have a Southwest District Health (in Canyon County) and a Central District Health in Ada County — Idaho looked a lot different back then,” Pate said. “But when you look at it today and you look at how infectious organisms work, it makes no sense to take a large metropolitan area and divide it in two and make completely separate and different decisions about how to mitigate a health threat.”
I suggest creating a “Treasure Valley Health District” that includes Ada, Canyon and Owhyee counties.
Elmore County would join the South Central district in Twin Falls.
That would leave Adams, Washington, Payette, Gem, Boise and Valley counties to make up what could be called the Western Idaho Public Health District.
This also would eliminate someone from rural Adams County, population 4,250, making public health decisions for Canyon County, population 230,000. In 1970, when the public health district law was written and the boundaries were established, Canyon County’s population was 61,000. Nampa was about the size Kuna is today, at 20,000 people.
Also, who is making those decisions is the next change that should be made.
Public health district governance
Each district has a health board, whose members are appointed by county commissioners, which keeps that line of accountability to the voters. As it turns out, most health board members are county commissioners. Only one board member is required to be a licensed physician.
Other than that, the only requirement for being a board member is, “All members shall be chosen with due regard to their knowledge and interest in public health and in promoting the health of the citizens of the state and the public health district.”
As we saw during the debate over whether to mandate masks in Canyon County, which has the state’s highest rate of new cases, one board member for Southwest District Health, Viki Purdy, a county commissioner from Adams County, regularly posted anti-mask and conspiracy theories about the pandemic on social media.
Purdy, a dairy farmer and rancher, won her last election in 2018, with 1,206 votes.
In Purdy’s defense, Adams County has had only 18 confirmed cases of COVID-19. So whatever Purdy wants to think about mask use and the coronavirus “hoax,” that might be fine fine for Adams County. But that’s not fine for Canyon County, which has a quarter-million people and two large city centers. As of Monday, Canyon County had 37 deaths and 4,869 total cases.
Changing the geographic boundaries of the districts will help, but changing the requirements also would help.
Rather than a vague mention of having “knowledge and interest in public health,” board members making decisions should have some sort of medical or health care expertise. Board members still could be appointed by county commissioners, thus maintaining that line of voter accountability. But the decisions must be made on the basis of some sort of medical expertise and knowledge.
“If we’re going to trust the health and welfare of people in health districts to these boards, then the board members need to be qualified, and qualified means that you must have an acceptance of the basic public health principles,” Pate said. “And you must be open to listening to health care experts and public health experts and make decisions, to the best of your ability of what you think will help protect the public health, it seems to me. It’s that simple.”
Pate noted there are people who don’t believe in going to the hospital or relying on medical treatment, “and that’s fine, and they’re entitled to those beliefs. Those people don’t need to be on the St. Luke’s health system board, though.” People who don’t believe in public education shouldn’t be on the local school board. Those who don’t believe in banking principles need not serve on a banking board. Similarly, he said, those who do not accept basic public health principles should not serve on a public health board.
As we saw in the Southwest District Health board’s recent decision to merely “recommend” face coverings, board members took no public testimony from public health officials, such as hospital CEOs and medical directors who had been making the rounds urging public officials to issue mask mandates. Board members, who themselves were not wearing masks or practicing social distancing, also apparently ignored submitted written testimony from St. Luke’s officials who documented their alarm in the rapidly increasing number of new cases, hospitalizations, ICU admissions and deaths. An angry gallery of public attendees heard none of that testimony, missing out on an opportunity to become educated in the local situation.
One can’t help but think that if medical experts and people with good medical and scientific knowledge were on the board, the decision would have been different and less politicized. At the very least, medical experts would have used data and science to explain their reasoning.
Rather than have the bulk of boards governed by elected officials, with just one medical expert as a member, flip it around.
Health district order penalties
According to the public health district statute, “It shall be unlawful for any person, association, or corporation, and the officers thereof to willfully violate, disobey, or disregard the provisions of the public health laws or the terms of any lawful notice, order, standard, rule, regulation, or ordinance issued pursuant thereto.” In short, it’s illegal to violate a health district’s order, such as a mask mandate.
Unfortunately, the only penalty listed in the statute is a misdemeanor. As we saw with the mask debate, it is unreasonable to charge someone with a misdemeanor for violating the mask order. Health districts should have an option of issuing a citation, like a parking ticket, for those who violate any health order.
Removing board members
One more change that Pate suggested is making it easier to remove someone from the board, an issue that people, including myself, started asking about when Purdy’s views were discovered. According to the law, a majority of all the county commissioners in the district would need to vote to remove the board member. As I pointed out before, given the rural nature of some of these districts, it’s more than likely other commissioners would have the same views as Purdy, meaning that removing her from the health board would be a tall order. The law could be changed to require a majority of the health board itself voting to remove a fellow board member.
The pandemic has shined a spotlight on the public health districts and elevated their importance, which is a good thing. But if Bedke and other legislators want them to play a bigger role in responding to health emergencies like the current coronavirus pandemic, they need to make some changes to the state law that’s now going on 50 years old and is woefully out of date and inadequate.
When legislators reconvene in January and discuss changes they need to make because of the pandemic, fixing the public health district law should be near the top of the list.
