Dr. Anthony Chen was heading to the mountains for a hike with his wife on a rare day off from work when he learned the Pierce County Council was moving to dissolve the health department he leads.
Sitting in the passenger seat of the car, he read an email from Councilmember Derek Young about an ordinance that would end the agreement between the city of Tacoma and Pierce County that created the Tacoma-Pierce County Health Department, and replace it with a new county department.
“I was like, ‘What?’ And you know, that’s when I first heard about it,” said Chen, the department’s director of health.
The move by the council to take control of the nonpolitical department isn’t an isolated incident amid a pandemic that’s amplified fissures between politicians, policymakers and health professionals. While such debates have been writ large on a national scale, they’re occurring more regionally as well.
Spokane’s health officer was fired last month, an action many in the medical community attributed to criticism from the business community over the health district’s coronavirus response. Public health professionals across the country are dealing with political pressure as well as a plague of misinformation amid some of the deadliest days of the coronavirus.
In Idaho, a virtual health board meeting was canceled not long after it began Tuesday as protesters opposed to proposed public health orders to mitigate the spread of coronavirus gathered outside the health department’s building and the homes of some board members.
As the pandemic tore through the United States, prompting stay-at-home and mask orders, public health and elected officials felt the wrath of many businesspeople and those who view disease mitigation measures as an affront to their rights.
“There’s this great policy conflict of liberty versus security, and when those two intersect, there tends to be some rubbing,” said Jefferson Ketchel, executive director of the Washington State Public Health Association.
In Tacoma, Republican Councilmember Pam Roach signed on to sponsor the Pierce County ordinance, though it’s not clear who is behind it. The proposal was a surprise to the council’s three Democrats and the health department’s leadership.
Young, who is a Democrat, believes the ordinance came from Republican county executive Bruce Dammeier, who is pressing for the change before the council flips control next year from Republicans to Democrats.
Dammeier declined an interview request and asked county spokesperson Libby Catalinich to respond. In an email, she wrote, “he is following the actions by the council regarding the Tacoma-Pierce County Health Department but withholds comment until the legislative body has finished considering the proposed ordinance.”
“It appears to be a power grab by the executive,” Young said. “This would essentially make it a county department like any other. So rather than the health director reporting to the Board of Health, they would report to the executive.”
Chen is miffed by the proposed change, contending the work of public health isn’t political. “We don’t deal with politics the same way as county departments do,” Chen said. “We are able to respond when there’s a need.”
The ordinance has swiftly moved from introduction at the council’s Dec. 1 meeting, to the council’s Rules Committee meeting Monday, when it received a “do-pass” recommendation that broke along party lines. A full council vote is expected Tuesday. If passed, the change would occur a year later.
The structure of health boards varies across the state. King and Spokane counties’ health boards are similar to Pierce County’s, while others have county councils doubling as the health board, such in Whitman and Clark counties.
Health boards have significant influence over a health district as they set policy and approve budgets. Much of public health’s actions, like septic permitting, restaurant inspections and quarantine requirement, are authorized under the medical license of the health officer.
The fight over the power of health professionals is playing out across the country. Armed, maskless demonstrators showed up at the Michigan Capitol, voicing their displeasure with Gov. Gretchen Whitmer’s stay-home orders in the spring. Months later, 14 men were arrested and charged, accused of planning to kidnap Whitmer.
In California, Orange County’s chief health officer left her job after she was threatened and protesters showed up at her home because of her order requiring masks in businesses.
Since April, more than 100 local or state public health leaders in dozens of states have retired, resigned or been fired, according to an investigation by The Associated Press and Kaiser Health News.
Experts told the two news outlets that the departures are the largest exodus of public health leadership in American history.
Washington hasn’t been immune to top public health officials leaving on their own or being forced out.
Health districts in Spokane, Yakima, Lewis, Okanogan, Whatcom, Walla Walla and Mason counties had health officers who were fired or stepped away from their jobs and administrators in Whitman, Walla Walla, Grays Harbor and Chelan-Douglas have left.
The turnover atop public health departments is remarkable, Ketchel, with the state public health association, said.
“What is compelling is the sheer volume. I have never seen this many vacancies over a short period of time,” he wrote in an email.
Some of those departures, including John Wiesman, the state’s secretary of health, were planned before the pandemic. Dr. Kathy Lofy, the state’s health officer, will be departing in by year’s end, saying, “it’s the right time for me personally.”
Others departures appear to be casualties of pandemic politics.
The most visible public health department meltdown happened in Spokane.
During a hastily called and chaotic news conference in late October, the Spokane Regional Health District’s administrator fired the district’s health officer, Dr. Bob Lutz. Amelia Clark, the administrator, said she terminated Lutz because of “performance issues.” Lutz was officially fired by the health board the following week.
Other public health and medical professionals believe politics is the real reason Lutz was forced out. Seven members of the Spokane Regional Health District’s Health Advisory Council resigned this week in response to Lutz’s firing.
Lutz declined to comment. However, after the meeting in which he was fired, Lutz’s attorney, Bryce Wilcox, issued a statement saying the “termination was without reasonable cause and was politically motivated in retaliation for unpopular COVID-19 decisions he made this year.”
Dr. John McCarthy, the health officer for the Okanogan Health District, said Lutz’s support for Black Lives Matter and pandemic-related decisions that didn’t mesh with the desires of the business community drove the firing.
“This is a conversation that medicine owns,” McCarthy said. “It is not a conversation that business owns.”
Public health being caught in political currents isn’t unusual. Harm reduction measures like needle exchanges, championed by public health agencies, and vaccination programs have drawn heated political backlash.
“This intersection of politics and public health is not new. It’s just that the pandemic has definitely elevated and exacerbated the issue quite a bit,” said Ketchel, who has been an administrator with the Snohomish Health District and the Grant County Health District.
The politically charged environment public health workers find themselves in has hurt morale and made it difficult to keep staff at all levels, said Betty Bekemeier, director of the Northwest Center for Public Health Practice at the University of Washington.
“What we’ve got is already a horribly underfunded public health system that is now being trampled to the bone,” she said.
During the 12 years Chen has been with the Tacoma-Pierce County Health Department, the idea of the county taking control has been brought up twice. Both times the idea was vetted and dropped.
That doesn’t mean it shouldn’t be explored once the pandemic has ended, Young said.
“If this is a good idea now it’ll be a good idea later,” he said. “But what this does is throw into turmoil an organization that is already exhausted, overworked and I think in some ways underappreciated while managing a global pandemic.”
If the public-comment portion of the virtual council committee meeting is any indicator, the proposed ordinance doesn’t have broad community support. At the Rules Committee meeting Monday, nearly 30 people made passionate pleas that the proposal be dropped.
Doug Richardson, the Rule Committee chair, ended the public comments after an hour with at least 60 more people queued up to speak. Young, the lone Democrat on the committee, asked the three-member committee to hear more people.
“The reason I asked to not limit the public comments is because there is very little time for folks to speak up on this, and it only adds to the perception that there is something improper going on here,” he said.
Young’s request was rejected by Richardson and Dave Morell, the other Republican on the committee.