New health board composition hits snag over different understandings of tribal component of the law

Legislation passed last session requiring local health boards in Washington to add new members or at least mix up membership by July. One part of the legislation that calls for tribal representation on health boards has led to differing interpretations of the new state law.

While many believe that the law intends to have a single tribal representative on each county health board, the American Indian Health Commission argues that it is more broad, and that each tribe with lands within a county’s boundaries would have a representative.

In Spokane County, that would mean the Spokane, Kalispel and Colville tribes, along with the NATIVE Project, would be eligible to seat members on the board.

The legislation directs the American Indian Health Commission to appoint tribal representation to boards of health statewide. The commission is made up of representatives from each tribe, Urban Indian Health Organization and American Indian Community Center in the state.

The commission is having tribes and organizations use resolutions to appoint members to boards of health, said Vicki Lowe, the commission’s executive director.

The legislation states that, “if a federally recognized Indian tribe holds reservation, trust lands, or has usual and accustomed areas within the county, or if a 501(c)(3) organization registered in Washington that serves American Indian and Alaska Native people and provides services within the county, the board of health must include a tribal representative selected by the American Indian health commission.”

Lowe said the commission understands this to mean that each tribe with reservation and trust lands in a county as well as each nonprofit that serves American Indian and Alaska Native people get a seat on the local board of health, should they want to be represented. Lowe said this is appropriate representation.

“Tribes are asked to represent each other all the time, and we know it’s inappropriate but because of the systems that have been put in place it’s either inappropriate representation or none,” Lowe said.

The commission has asked tribes to indicate whether they want a seat on respective boards of health by April, although Lowe said she’s unsure if all tribes will elect to send representation.

So far, only the NATIVE Project has delegated their board member, clinic director Dylan Dressler. The American Indian Health Commission sent the Spokane County Commissioners the resolution from the NATIVE Project with their nominee.

Earlier this month, county commissioners met to discuss this resolution. The county and the Washington State Association of Counties interpret the bill differently than the commission.

They believe it means that there is a single Board of Health seat for a tribal representative, said Eric Johnson, executive director of the association.

“I understand the way this statute was crafted puts the American Indian Health Commission in the position of choosing between tribes and that’s not something we did, but we’re working to make sure there’s a tribal representative on each board of local health,” Johnson said.

Several counties have started the process or will soon begin the process of seating new board members, and Spokane County is working ahead of the curve. The law does not go into effect until July, and rulemaking is not expected to be finished until later this spring.

The State Board of Health is conducting the rulemaking around the new law, but that process does not include addressing tribal representation.

Rep. Marcus Riccelli, D-Spokane, who authored the legislation, said he modeled the language from another bill he previously worked on that established tribal representation on regional transportation planning organizations, which called for a single board seat.

However, he said he sees no issue with including all of the tribes in a county on the board, adding that the conversation is important.

“The whole point is to be more inclusive and get better health outcomes, and I think it’s important to respect tribal sovereignty,” he said.

The Spokane County commissioners sent a letter to Lowe on Feb. 7 explaining their interpretation of the bill. The commissioners wrote that they believe the legislation indicates a single board representative to be appointed by the commission directly.

The commissioners have already selected the three community members to fill the additional seats on the Spokane Board of Health, which is scheduled to meet in a week.

Riccelli said there might be a need for additional fixes to the legislation in 2023 after looking at how implementation goes. He said he could ask for a formal or informal opinion from the Attorney General’s office as well.

Johnson said an opinion is just that, however, and ultimately, a challenge to how a county interprets the law could be worked out in the judicial system. Alternatively, legislative clarity, he added, is another option.