Drafter
Clerk 09/24/2024
Title
AN ORDINANCE establishing a workgroup to develop recommendations on modernizing public health - Seattle & King County clinic services and operations supporting the county hospital.
Body
STATEMENT OF FACTS:
1. As part of the county hospital, formed under Chapter 174, Laws of Washington 1925 ex.s., Harborview Medical Center ("Harborview") is now the region's a comprehensive health care facility, owned by King County and under the general supervision of the county hospital board of trustees. Since 1967, in accordance with the hospital services agreement between King County, by and through its executive and county hospital board, and the Regents of the University of Washington, Harborview has been operated by UW Medicine.
2. Harborview is the only Level 1 Trauma Center for adults and children serving a four-state region that includes Alaska, Idaho, Montana, and Washington. It provides specialized care for a broad spectrum of patients. Harborview is maintained by King County to improve the health and well-being of the entire community and to provide quality healthcare to the most vulnerable.
3. Public health - Seattle & King County clinics ("public health clinics") provide direct services to an estimated 78,000 people annually at public health clinics and through mobile engagement sites, home visits, outreach events, and service points that are co-located within community-based organizations.
4. Like Harborview's mission population which is defined in the hospital services agreement, public health clinics provide accessible services to meet the needs of people historically underserved by the medical system including Black, indigenous, and people of color, those who speak a primary language other than English, those experiencing homelessness, and those who are uninsured.
5. Ordinance 19117 placed a $1.74 billion twenty-year bond on the November 3, 2020, ballot to fund facility and infrastructure improvements at Harborview. The ballot measure was approved by more than seventy-five percent of King County voters.
6. In 2023, the facility improvement program at Harborview funded by the voter approved bond levy was required to be revised due to unprecedented cost growth following the COVID-19 global pandemic. The council adopted a rescoped facility improvement program plan for the county hospital in Motion 16435, which prioritized voter approved bond funding for construction of a new multi-story medical tower; renovation of essential services currently located in older hospital spaces; and expansion of county spaces located in older hospital facilities. The updated program plan was determined after considering the operational needs of Harborview and the shared priorities of King County, the county hospital board of trustees, and UW Medicine.
7. In the lead-up to and during the 2024 Washington state legislative session, UW Medicine and King County partnered to ask the Legislature to grant King County additional revenue authority to allow the county to support capital and operating expenses, in addition to maintenance, for the county hospital.
8. Due to collaboration between UW Medicine and the county, the legislature voted to amend RCW 36.62.090, authorizing the councilmanic county hospital property tax for the operation, maintenance, and capital expenses of the county hospital and any outpatient clinics operated by the county hospital, and for the payment of principal and interest on bonds issued for such purposes.
9. During the 2024 legislative session, King County also advocated for revenue authority needed to continue operating its public health clinics. The Legislature saw an opportunity to address the public health clinic need by expanding the use of the county hospital revenue authority to include funding for clinics operated by a county hospital. Public health clinics fall within the mission of the county hospital by improving the health of those persons with the least access to health resources and preventative care.
10. Public health clinics serve an important need for those who experience barriers to accessing healthcare. It is necessary to evaluate the way that public health clinic services are delivered to ensure efficacy and efficiency in the provision of healthcare services.
11. Given the depth and breadth of analysis necessary to evaluate how to provide services most effectively to the shared mission population; the need to engage multiple labor partner organizations; and the timing of the transmittal of the executive's 2025 proposed budget to the council, more time is needed to identify a comprehensive plan with UW Medicine on how public health clinics could best operate within the county hospital structure.
12. With the adoption of Proposed Ordinance 2024-0321 (Ordinance XXXXX), the county's public health clinics shall become county hospital outpatient clinics to be operated by public health - Seattle & King County. Additionally, the Harborview board of trustees has been renamed as the "county hospital board of trustees" ("the board").
13. The county is committed to continued collaboration and engagement with the board, labor partners, public health experts, and UW Medicine around developing the recommendations called for in this ordinance, which will inform further implementation of the authority granted under RCW 36.62.090.
BE IT ORDAINED BY THE COUNCIL OF KING COUNTY:
SECTION 1. A. The executive, in collaboration with the King County council, the county hospital board of trustees ("the board"), labor groups, public health experts and UW Medicine shall convene a workgroup as described in subsection F. of this section. The workgroup shall develop recommendations regarding modernizing the public health clinics of the county hospital. The executive shall transmit the recommendations in the form of a report to the council, and a proposed motion acknowledging receipt of the report concurrently with the executive's 2026 proposed budget.
B. The recommendations shall at minimum address the following elements:
1. Ensuring patients continue to receive accessible high-quality healthcare services;
2. Allocating operating funds to support the mission population across Harborview Medical Center and outpatient clinics, including public health clinics;
3. Increasing revenues, including maximizing federally qualified health center and outpatient direct payment program opportunities;
4. Achieving operational efficiencies, including a potential joint model for serving patients in integrated facilities such as Harborview Pioneer Square Clinic, Medical Respite, and the public health downtown clinic or other yet to be determined space opportunities;
5. Leveraging core competencies of UW Medicine and public health providers;
6. Ensuring patients continue to receive accessible high-quality healthcare services;
7. Avoiding unfunded mandates and operational deficits;
8. Identifying and leveraging existing or new partnerships for the provision of clinic services, including primary care, dental, parent-child health services, services at existing public health clinic facilities, and services operated at Harborview Medical Center, such as the tuberculosis clinic, the sexual health clinic, and the public health clinical laboratory; and
9. Recognizing the role of organized labor in the provision of healthcare services at Harborview Medical Center, public health clinics, and other community healthcare clinics.
C. The workgroup shall develop analytical criteria to guide development of its recommendations, including criteria that considers the potential equity and social justice impacts of the recommendations.
D. Consulting resources are necessary to support the executive in gathering and analyzing information and assisting with recommendation development, as well as facilitating the workgroup processes and development of workgroup materials. The executive shall issue the contract for the consultant with development of the request for proposal undertaken jointly with the county, the board, and UW Medicine.
E. The workgroup shall be facilitated by a neutral party and produce the documentation necessary for the recommendations as described in subsection B.1. through 8. of this section.
F. The workgroup shall consist of the following members:
1. Two representatives selected by the King County executive;
2. Two representatives representing the King County council;
3. Two representatives selected by UW medicine; and
4. Two representatives selected by the board.
G. Workgroup members representing the council shall be appointed by the council chair.
H. Staff to members of the workgroup may attend meetings of the workgroup and provide support to the workgroup.
I. The consultant and workgroup shall provide meaningful opportunities for input into the development of the recommendations called for in subsection B. of this section from:
1. Labor organizations that represent public health clinic employees and University of Washington employees who work at the Harborview Medical Center;
2. Public health clinic employees;
3. Patients and clients served by public health clinics; and
4. Community-based organizations.
J. The executive shall electronically transmit the workgroup’s recommendations and a proposed motion acknowledging receipt of the report concurrently with the executive’s 2026 proposed budget, to the clerk of the council, who shall retain an electronic copy and provide an electronic copy to all councilmembers, the council chief of staff, and the lead staff for the committee of the whole or its successor.
K. The workgroup established in subsection F. of this section shall disband upon
passage of the motion acknowledging receipt of a report called for in subsection J. of this section.