For the purposes of this chapter and unless the context thereof clearly indicates to the contrary:
"Comprehensive public health district" means all territory consisting of one or more counties organized under this chapter serving a combined population of over 250,000 people in which a district health department has capacity and resources to provide foundational public health services as defined in RCW 43.70.515 to all people within the territory.
"Department" means the department of health.
"District board of health" means the board of health that oversees the comprehensive public health district.
"District health departments" means the county or district which provides comprehensive public health services to persons within the area.
"District health officer" means the legally qualified physician who has been appointed as the health officer for the district health department.
"Secretary" means the secretary of health.
In counties with a home rule charter, the county legislative authority shall establish a local board of health and may prescribe the membership and selection process for the board. The county legislative authority may appoint to the board of health elected officials from cities and towns and persons other than elected officials as members so long as persons other than elected officials do not constitute a majority. The county legislative authority shall specify the appointment, term, and compensation or reimbursement of expenses. The jurisdiction of the local board of health shall be coextensive with the boundaries of the county. The local health officer, as described in RCW 70.05.050, shall be appointed by the official designated under the provisions of the county charter. The same official designated under the provisions of the county charter may appoint an administrative officer, as described in RCW 70.05.045.
[ 1995 c 43 § 7; 1993 c 492 § 237; ]
The district board of health shall elect a chair and appoint an administrative officer. A district health officer shall be appointed pursuant to RCW 70.05.050. Vacancies on the district board of health shall be filled by appointment within thirty days and made in the same manner as was the original appointment. At the first meeting of the district board of health, the members shall elect a chair to serve for a period of one year.
The administrative officer shall act as executive secretary and administrative officer for the district board of health, and shall be responsible for administering the operations of the board including such other administrative duties required by the district board of health , except for duties assigned to the health officer as enumerated in RCW 70.05.070 and other applicable state law.
The administrative officer must hold the degree of master or doctor of public health, master or doctor of public administration, master of public policy, master of business administration, or an equivalent degree.
The district health officer shall be an experienced physician licensed to practice medicine and surgery or osteopathic medicine and surgery in this state and who is qualified or provisionally qualified in accordance with the standards prescribed in RCW 70.05.051 through 70.05.055 to hold the office of district health officer.
The district board of health must submit its district health officer candidate to the secretary.
After determining whether the district health officer candidate is qualified and committed to the public health of the community in the region, the secretary may appoint the district health officer whose salary is to be paid by the department.
The district board of health may petition the secretary for termination of the district health officer for cause. The secretary may terminate the district health officer for cause.
The following persons holding licenses as required by RCW 70.05.050 shall be deemed qualified to hold the position of district health officer:
2.
Persons qualified by virtue of completing three years of service as a provisionally qualified officer pursuant to RCW 70.05.053 through 70.05.055.
A person holding a license required by RCW 70.05.050 but not meeting any of the requirements for qualification prescribed by RCW 70.05.051 may be appointed by the secretary for a maximum period of three years upon the following conditions and in accordance with the following procedures:
He or she shall participate in an in-service orientation to the field of public health as provided in RCW 70.05.054, and
He or she shall satisfy the secretary pursuant to the periodic interviews prescribed by RCW 70.05.055 that he or she has successfully completed such in-service orientation and is conducting such program of good health practices as may be required by the jurisdictional area concerned.
The secretary shall provide an in-service public health orientation program for the benefit of provisionally qualified district health officers.
Such program shall consist of
A three months course in public health training conducted by the secretary either in the state department of health, in a county and/or city health department, in a local health district, or in an institution of higher education; or
An on-the-job, self-training program pursuant to a standardized syllabus setting forth the major duties of a district health officer including the techniques and practices of public health principles expected of qualified district health officers: PROVIDED, That each provisionally qualified district health officer may choose which type of training he or she shall pursue.
Each year, on a date which shall be as near as possible to the anniversary date of appointment as provisional district health officer, the secretary or the secretary's designee shall personally visit such provisional officer's office for a personal review and discussion of the activity, plans, and study being carried on relative to the provisional officer's jurisdictional area: PROVIDED, That the third such interview shall occur three months prior to the end of the three year provisional term. A standardized checklist shall be used for all such interviews, but such checklist shall not constitute a grading sheet or evaluation form for use in the ultimate decision of qualification of the provisional appointee as a public health officer.
Copies of the results of each interview shall be supplied to the provisional officer within two weeks following each such interview.
Following the third such interview, the secretary shall evaluate the provisional district health officer's in-service performance and shall notify such officer by certified mail of the secretary's decision whether or not to qualify such officer as a district health officer. Such notice shall be mailed at least sixty days prior to the third anniversary date of provisional appointment. Failure to so mail such notice shall constitute a decision that such provisional officer is qualified.
Each district board of health shall have supervision over all matters pertaining to the preservation of the life and health of the people within its jurisdiction and shall:
Enforce**,** through the district health officer or the administrative officer appointed under RCW 70.05.040, the public health statutes of the state and rules adopted by the state board of health and the secretary ;
Supervise the maintenance of all health and sanitary measures for the protection of the public health within its jurisdiction;
Enact district rules and regulations necessary to preserve, promote**,** and improve the public health and provide for the enforcement thereof;
Provide for the control and prevention of any dangerous, contagious**,** or infectious disease within the jurisdiction of the district health department;
Provide for the prevention, control**,** and abatement of nuisances detrimental to the public health;
Make such reports to the state board of health and department through the district health officer or the administrative officer as the state board of health or department may require;
Establish fee schedules for issuing or renewing licenses or permits or for such other services as are authorized by the law and the rules of the state board of health: PROVIDED, That such fees for services shall not exceed the actual cost of providing any such services**; and**
Maintain open communication and close coordination with the department to ensure consistent implementation of public health interventions.
The district health officer must:
Enforce the public health statutes of the state, rules of the state board of health and the secretary , and all local health rules, regulations and ordinances within his or her jurisdiction including imposition of penalties authorized under RCW 70A.125.030 and 70A.105.120, the confidentiality provisions in RCW 70.02.220 and rules adopted to implement those provisions, and filing of actions authorized by RCW 43.70.190;
Take such action as is necessary to maintain health and sanitation supervision over the territory within his or her jurisdiction;
Control and prevent the spread of any dangerous, contagious or infectious diseases that may occur within his or her jurisdiction;
Inform the public as to the causes, nature, and prevention of disease and disability and the preservation, promotion and improvement of health within his or her jurisdiction;
Prevent, control or abate nuisances which are detrimental to the public health;
Attend all conferences called by the secretary or his or her authorized representative;
Collect such fees as are established by the state board of health or the district board of health for the issuance or renewal of licenses or permits or such other fees as may be authorized by law or by the rules of the state board of health;
Inspect, as necessary, expansion or modification of existing public water systems, and the construction of new public water systems, to assure that the expansion, modification, or construction conforms to system design and plans;
Take such measures as he or she deems necessary in order to promote the public health, to participate in the establishment of health educational or training activities, and to authorize the attendance of employees of the district health department or individuals engaged in community health programs related to or part of the programs of the district health department.
The district health officer may grant a waiver from specific requirements adopted by the state board of health for on-site sewage systems if:
The on-site sewage system for which a waiver is requested is for sewage flows under three thousand five hundred gallons per day;
The waiver request is evaluated by the district health officer on an individual, site-by-site basis;
The district health officer determines that the waiver is consistent with the standards in, and the intent of, the state board of health rules; and
The district health officer submits quarterly reports to the department regarding any waivers approved or denied.
Based on review of the quarterly reports, if the department finds that the waivers previously granted have not been consistent with the standards in, and intent of, the state board of health rules, the department shall provide technical assistance to the district health officer to correct the inconsistency, and may notify the local and state boards of health of the department's concerns.
If upon further review of the quarterly reports, the department finds that the inconsistency between the waivers granted and the state board of health standards has not been corrected, the department may suspend the authority of the district health officer to grant waivers under this section until such inconsistencies have been corrected.
The district health officer must respond to the applicant for an on-site sewage system permit within thirty days after receiving a fully completed application. The district health officer must respond that the application is either approved, denied, or pending.
If the district health officer denies an application to install an on-site sewage system, the denial must be for cause and based upon public health and environmental protection concerns, including concerns regarding the ability to operate and maintain the system, or conflicts with other existing laws, regulations, or ordinances. The district health officer must provide the applicant with a written justification for the denial, along with an explanation of the procedure for appeal.
If the district health officer identifies the application as pending and subject to review beyond thirty days, the district health officer must provide the applicant with a written justification that the site-specific conditions or circumstances necessitate a longer time period for a decision on the application. The district health officer must include any specific information necessary to make a decision and the estimated time required for a decision to be made.
A district health officer may not limit the number of alternative sewage systems within his or her jurisdiction without cause. Any such limitation must be based upon public health and environmental protection concerns, including concerns regarding the ability to operate and maintain the system, or conflicts with other existing laws, regulations, or ordinances. If such a limitation is established, the district health officer must justify the limitation in writing, with specific reasons, and must provide an explanation of the procedure for appealing the limitation.
The department , in consultation and cooperation with district environmental health officers, shall develop a one-day course to train district environmental health officers, health officers, and environmental health specialists and technicians to address the application of the waiver authority granted under RCW 70.05.072 as well as other existing statutory or regulatory flexibility for siting on-site sewage systems.
The training course shall include the following topics:
The statutory authority to grant waivers from the state on-site sewage system rules;
The regulatory framework for the application of on-site sewage treatment and disposal technologies, with an emphasis on the differences between rules, standards, and guidance. The course shall include instruction on interpreting the intent of a rule rather than the strict reading of the language of a rule, and also discuss the liability assumed by a unit of local government when local rules, policies, or practices deviate from the state administrative code;
The application of site evaluation and assessment methods to match the particular site and development plans with the on-site sewage treatment and disposal technology suitable to protect public health to at least the level provided by state rule; and
Instruction in the concept and application of mitigation waivers.
The training course shall be made available to all district health departments and districts in various locations in the state without fee. Updated guidance documents and materials shall be provided to all participants, including examples of the types of waivers and processes that other jurisdictions in the region have granted and used.
If the local board of health or other official responsible for appointing a local health officer under RCW 70.05.050 refuses or neglects to appoint a local health officer after a vacancy exists, the secretary of health may appoint a local health officer and fix the compensation. The local health officer so appointed shall have the same duties, powers and authority as though appointed under RCW 70.05.050. Such local health officer shall serve until a qualified individual is appointed according to the procedures set forth in RCW 70.05.050. The board or official responsible for appointing the local health officer under RCW 70.05.050 shall also be authorized to appoint an acting health officer to serve whenever the health officer is absent or incapacitated and unable to fulfill his or her responsibilities under the provisions of chapters 70.05 and 70.46 RCW.
[ 1993 c 492 § 240; 1991 c 3 § 310; 1983 1st ex.s. c 39 § 4; 1979 c 141 § 81; 1967 ex.s. c 51 § 13; ]
Whenever any physician shall attend any person sick with any dangerous contagious or infectious disease, or with any diseases required by the state board of health to be reported, he or she shall, within twenty-four hours, give notice thereof to the district health officer within whose jurisdiction such sick person may then be or to the state department of health in Olympia.
In case of the question arising as to whether or not any person is affected or is sick with a dangerous, contagious or infectious disease, the opinion of the district health officer shall prevail until the department can be notified, and then the opinion of the executive officer of the department , or any physician he or she may appoint to examine such case, shall be final.
It shall be the duty of the district board of health, health authorities or officials, and of physicians in localities where there are no local health authorities or officials, to report to the state board of health, promptly upon discovery thereof, the existence of any one of the following diseases which may come under their observation, to wit: Asiatic cholera, yellow fever, smallpox, scarlet fever, diphtheria, typhus, typhoid fever, bubonic plague or leprosy, and of such other contagious or infectious diseases as the state board may from time to time specify.
1.
Any member of a district board of health who violates any of the provisions of this chapter or chapter 70.24 RCW or refuses or neglects to obey or enforce any of the rules, regulations or orders of the state board of health made for the prevention, suppression**,** or control of any dangerous contagious or infectious disease or for the protection of the health of the people of this state, is guilty of a misdemeanor, and upon conviction shall be fined not less than $10 nor more than $200.
Any physician who refuses or neglects to report to the proper health officer or administrative officer within twelve hours after first attending any case of contagious or infectious disease or any diseases required by the state board of health to be reported or any case suspicious of being one of such diseases, is guilty of a misdemeanor, and upon conviction shall be fined not less than $10 nor more than $200 for each case that is not reported.
Any person violating any of the provisions of this chapter or chapter 70.24 RCW or violating or refusing or neglecting to obey any of the rules, regulations or orders made for the prevention, suppression and control of dangerous contagious and infectious diseases by the district board of health or district health officer or administrative officer or state board of health, or who shall leave any isolation hospital or quarantined house or place without the consent of the proper health officer or who evades or breaks quarantine or conceals a case of contagious or infectious disease or assists in evading or breaking any quarantine or concealing any case of contagious or infectious disease, is guilty of a misdemeanor, and upon conviction thereof shall be subject to a fine of not less than $25 nor more than $100 or to imprisonment in the county jail not to exceed 90 days or to both fine and imprisonment.
All expenses incurred by the state, health district, or county in carrying out the provisions of this chapter or any other public health law, the rules of the department of health enacted under such laws, or enforcing proclamations of the governor during a public health emergency, shall be paid by the county and such expenses shall constitute a claim against the general fund as provided in this section.
In addition to powers already granted them, any countyor district health department may contract for either the sale or purchase of any or all health services from any district health department.
A district board of health that adopts a moratorium affecting water hookups, sewer hookups, or septic systems without holding a public hearing on the proposed moratorium, shall hold a public hearing on the adopted moratorium within at least sixty days of its adoption. If the board does not adopt findings of fact justifying its action before this hearing, then the board shall do so immediately after this public hearing. A moratorium adopted under this section may be effective for not longer than six months, but may be effective for up to one year if a work plan is developed for related studies providing for such a longer period. A moratorium may be renewed for one or more six-month periods if a subsequent public hearing is held and findings of fact are made prior to each renewal.
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The legislature finds that the mortality rate in Washington state among infants and children less than eighteen years of age is unacceptably high, and that such mortality may be preventable. The legislature further finds that, through the performance of child mortality reviews, preventable causes of child mortality can be identified and addressed, thereby reducing the infant and child mortality in Washington state.
It is the intent of the legislature to encourage the performance of child death reviews by district health departments by providing necessary legal protections to the families of children whose deaths are studied, district health department officials and employees, and health care professionals participating in child mortality review committee activities.
As used in this section, "child mortality review" means a process authorized by a district health department as such department is defined in RCW 70.05.010 for examining factors that contribute to deaths of children less than eighteen years of age. The process may include a systematic review of medical, clinical, and hospital records; home interviews of parents and caretakers of children who have died; analysis of individual case information; and review of this information by a team of professionals in order to identify modifiable medical, socioeconomic, public health, behavioral, administrative, educational, and environmental factors associated with each death.
District health departments are authorized to conduct child mortality reviews. In conducting such reviews, the following provisions shall apply:
All health care information collected as part of a child mortality review is confidential, subject to the restrictions on disclosure provided for in chapter 70.02 RCW. When documents are collected as part of a child mortality review, the records may be used solely by district health departments for the purposes of the review.
No identifying information related to the deceased child, the child's guardians, or anyone interviewed as part of the child mortality review may be disclosed. Any such information shall be redacted from any records produced as part of the review.
Any witness statements or documents collected from witnesses, or summaries or analyses of those statements or records prepared exclusively for purposes of a child mortality review, are not subject to public disclosure, discovery, subpoena, or introduction into evidence in any administrative, civil, or criminal proceeding related to the death of a child reviewed. This provision does not restrict or limit the discovery or subpoena from a health care provider of records or documents maintained by such health care provider in the ordinary course of business, whether or not such records or documents may have been supplied to a district health department pursuant to this section. This provision shall not restrict or limit the discovery or subpoena of documents from such witnesses simply because a copy of a document was collected as part of a child mortality review.
No district health department official or employee, and no members of technical committees established to perform case reviews of selected child deaths may be examined in any administrative, civil, or criminal proceeding as to the existence or contents of documents assembled, prepared, or maintained for purposes of a child mortality review.
This section shall not be construed to prohibit or restrict any person from reporting suspected child abuse or neglect under chapter 26.44 RCW nor to limit access to or use of any records, documents, information, or testimony in any civil or criminal action arising out of any report made pursuant to chapter 26.44 RCW.
The department shall assist district health departments to collect the reports of any child mortality reviews conducted by district health departments and assist with entering the reports into a database to the extent that the data is not protected under subsection (3) of this section. Notwithstanding subsection (3) of this section, the department shall respond to any requests for data from the database to the extent permitted for health care information under chapter 70.02 RCW. In addition, the department shall provide technical assistance to district health departments and child death review coordinators conducting child mortality reviews and encourage communication among child death review teams. The department shall conduct these activities using only federal and private funding.
This section does not prevent a district health department from publishing statistical compilations and reports related to the child mortality review. Any portions of such compilations and reports that identify individual cases and sources of information must be redacted.
A person rendering emergency care or transportation, commonly known as a "Good Samaritan," as described in RCW 4.24.300 and 4.24.310, may request and receive appropriate infectious disease testing free of charge from the district health department of the county of her or his residence, if: (1) While rendering emergency care she or he came into contact with bodily fluids; and (2) she or he does not have health insurance that covers the testing. Nothing in this section requires a district health department to provide health care services beyond testing. The department shall adopt rules implementing this section.
The information obtained from infectious disease testing is subject to statutory confidentiality provisions, including those of chapters 70.24 and 70.05 RCW.
A district board of health in the twelve counties bordering Puget Sound implementing an on-site sewage program management plan may:
Impose and collect reasonable rates or charges in an amount sufficient to pay for the actual costs of administration and operation of the on-site sewage program management plan; and
Contract with the county treasurer to collect the rates or charges imposed under this section in accordance with RCW 84.56.035.
In executing the provisions in subsection (1) of this section, a district board of health does not have the authority to impose a lien on real property for failure to pay rates and charges imposed by this section.
Nothing in this section provides a district board of health with the ability to impose and collect rates and charges related to the implementation of an on-site sewage program management plan beyond those powers currently designated under RCW 70.05.060(7).
Nothing in this chapter prohibits a county from relying on self-inspection of on-site sewage systems consistent with RCW 36.70A.690 or eliminates the requirement that counties protect water quality consistent with RCW 36.70A.070 (1) and (5).
[ 2017 c 105 § 3; ]
**
By January 1, 2023, counties must form comprehensive public health districts. The structure of the comprehensive public health districts is determined by the work group under section 2 of this act and the rules adopted by the department under section 3 of this act. The department must certify a comprehensive public health district.
Counties with populations over 1,000,000 may be considered a comprehensive public health district without joining with other counties when the county legislative authority of the county passes a resolution or ordinance to organize such a comprehensive public health district under this chapter. Any city with a population of 100,000 or more and the county in which it is located, are authorized, as agreed upon between the respective governing bodies of such city and county, to establish and operate the comprehensive public health district. The respective governing bodies must pass resolutions or ordinances to organize the comprehensive public health district.
Comprehensive public health districts consisting of two or more counties may be created when two or more boards of county commissioners pass a resolution establishing a district for such purpose. In counties with a home rule charter, the county legislative authority must establish a district board of health. The boards of county commissioners or county legislative authority must specify the appointment, term, and compensation or reimbursement of expenses. The comprehensive public health district shall consist of all the area of the combined counties.
The district board of health shall constitute the local board of health for all the territory included in the comprehensive public health district, and shall supersede and exercise all the powers and perform all the duties by law vested in the county board of health of any county included in the comprehensive public health district.
Members of the district board of health are as follows:
One commissioner from each county represented on the comprehensive public health district chosen by nomination from each county commission board;
One elected city official from a larger populous city in the comprehensive public health district chosen by nomination from the city;
One elected city official from a smaller populous city in the comprehensive public health districts chosen by nomination from the city;
One tribal representative of a tribe or urban Indian health organization from within the comprehensive public health district;
An equal number of seats as the total represented by county commissioners and city officials under (a) through (c) of this subsection filled by:
Hospital representatives from the hospitals in the comprehensive public health district;
Licensed, practicing physician representatives practicing in the comprehensive public health district;
Licensed, practicing nurse representatives practicing in the comprehensive public health district; and
Consumer representatives residing in the comprehensive public health district who also act as representatives of the comprehensive public health district advisory committee; and
The district health officer for the comprehensive public health district.
For the initial appointments, members of the district board of health appointed under subsection (5)(e) of this section must be nominated by county and city officials and selected by the secretary. For subsequent appointments, the district board of health shall solicit nominations and select members listed under subsection (5)(e) of this section.
[ 2021 c XXX § 6; ]**
**
A district advisory committee is established to bring various community perspectives to the district health board, with members as provided in this subsection.
Comprehensive public health districts must accept nominations and select representatives to the advisory committee from communities within the comprehensive public health district experiencing health inequities as determined by the district board of health, and other members of the community that interact with public health. No more than 15 members may be appointed to the advisory committee and members must include at least one small business representative, one teacher representative, one consumer representative, and two consumer representatives from communities experiencing health inequities within the region.
The advisory committee must reflect diversity in race, ethnicity, persons living with a disability, gender identity, age, LGBTQ+ populations, urban and rural communities, and socioeconomic status of the comprehensive public health district.
The advisory committee may choose a chair from among its membership and the comprehensive public health district must convene meetings of the advisory committee.
Members of the advisory committee shall serve two to four-year terms. Of the initial members, at least five must be appointed to two-year terms.
The advisory committee shall promote and facilitate communication, coordination, and collaboration among relevant local agencies and Black, indigenous, and people of color communities, persons living with a disability, and the private sector and public sector, to address health inequities. The advisory committee may conduct public hearings or other forms of information gathering to understand how the actions of the comprehensive public health district can ameliorate or contribute to health inequities.
The advisory committee is a class one group under RCW 43.03.220. The public members shall be paid per diem and travel expenses in accordance with RCW 43.03.050 and 43.03.060.
[ 2021 c XXX § 7; ]**
**
Each comprehensive public health district shall establish a district health fund in the custody of the county treasurer. In a district composed of more than one county, the county treasurer of the county having the largest population shall serve as custodian of the fund. All receipts received by the district must be deposited into the fund. Expenditures by the district must be authorized by the district board of health and must be disbursed through the fund. The county auditor of the county shall keep the record of the receipts and disbursements.
Each county and city included in the comprehensive public health district must contribute towards maintenance and operating fees and the expense of providing public health services for the comprehensive public health district.
[ 2021 c XXX § 8; ]**
** A comprehensive public health district may own, construct, purchase, lease, add to, and maintain any real and personal property or property rights necessary to conduct the affairs of the district. A comprehensive public health district may sell, lease, convey, or otherwise dispose of any district real or personal property no longer necessary to conduct district affairs. A comprehensive public health district may enter into contracts to carry out this section.
[ 2021 c XXX § 9; ]**
** Notwithstanding any provisions to the contrary contained in any city or county charter, and to the extent provided by the city and the county under appropriate legislative enactment, employees of the district health department may be included in the personnel system or civil service and retirement plans of the city or the county or a personnel system for the district health department that is separate from the personnel system or civil service of either county or city if residential requirements for these positions are coextensive with the county boundaries. The city or county may pay parts of the expense of operating and maintaining the personnel system or civil service and retirement system and contribute to the retirement fund on behalf of employees sums as may be agreed upon between the legislative authorities of the city and county.
[ 2021 c XXX § 10; ]**
** Any county or city may withdraw from membership in a comprehensive public health district any time after it has been within the district for a period of two years, but no withdrawal is effective until the county or city receives approval from the secretary. To approve the request, the secretary must determine that termination or withdrawal will not negatively affect the public's health. The secretary must provide a final determination to the requester within 14 days of receiving the request. No withdrawal entitles any member to a refund of any money paid to the district nor relieve it of any obligations to pay to the district all sums for which it obligated itself due and owing by it to the district for the year at the end of which the withdrawal is to be effective. Any county or city that withdraws from membership in a comprehensive public health district must immediately seek admission to another comprehensive public health district under this chapter.
[ 2021 c XXX § 11; ]**