Public Health- Seattle/King County (PHSKC) is responsible for overseeing population-based health concerns in the City and County. By preventing the high costs to society that come from epidemics, polluted water systems, and other health risks, the public health system saves resources every year in health care and social costs. PHSKC’s key priorities for the next five years will involve addressing the following:

Another technology improvement is in development for the Emergency Services Division (EMS). EMS and local emergency medical services providers have joined to develop a regional data collection system which will improve access to information on the quality of patient care, efficiency of resource utilization and effectiveness of prevention programs. The goal of the project is to electronically collect and consolidate data to provide increased reporting and analysis capabilities of all emergency medical incidents within King County. The project will also support special studies, quality assurance and continuous quality improvement efforts within King County, EMS and other agencies.

CX Target Reductions - ($170,226/1.21 FTEs). These reductions were made to CX funded programs. Minimal, if any, service impacts have resulted. The reductions include a half-time Epidemiologist (26,879), a .25 reduction for a Dental Hygienist (17,294), a .5 Administrative Specialist (15,625), and contracted services for physician time (86,918) that was never used. It also includes savings from a reduction in motor pool rates (23,510). PH was also able to replace 377,680 in CX with other revenues in the family planning and parent child health programs.

AIDS/STD Programs - ($583,299/.85 FTE). Most of these reductions reflect completed grant funded projects or a necessary decrease in program expenditures because the grant awards have not kept up with inflation. Most of the reductions were taken in supply lines. One study for 152,000 is being reduced because the research is done and the project is almost complete. Another proposal reduces expenditures by 70,000 and 1.00 contract FTE at the STD clinic, made possible by of the 1998 consolidation of the Broadway and Harborview clinics.

Family Planning/Women and Child Health - ($283,939/5.45 FTEs). This reduction includes a maternity liaison contract with the UW (13,000) as PH is merging maternity services into family health and closing operation of one maternity clinic. PH is also reducing a .5 Health Services Assistant, a .5 Nurse Practitioner in East Region and a .05 Nurse practitioner in South Region in Family Planning. Client volumes will be maintained and service delivery will not be impacted by this cut. The largest reduction of 183,986 and 4.25 FTEs is occurring in the Women, Infants, and Children Program (WIC). The proposal reduces the hours of seven Administrative Specialists II & IIIs. Some will continue to work half time. This reduction does not reduce client services. A new automated system that allows scheduling, client eligibility determination, and reduced filing and paperwork has made this reduction possible. The reductions are based on changes experienced in other counties that have implemented this computer system.

Cedar Hills Medical Clinic Restructure - ($340,373/6.25 FTEs). The Department of Community and Human Services (DCHS) will be assuming responsibility for limited on-site medical services at Cedar Hills; 275,000 of this decrease represents a transfer to DCHS.

Alcohol, Tobacco, and Other Drugs - ($176,486/2.00 FTEs). This reduction will reduce a Program Analyst IV position that is currently vacant (65,236/1.00FTE). It also reduces 1.00 Health Educator in the tobacco prevention program due to a reduction in federal funding. Four less training spots will be available per month to the 19 school districts as a result. The federal grant targeted these specific services for a reduction.

City of Seattle Program Reductions - ($695,962/9.00 FTEs). PH has made some reductions to programs within the City of Seattle. They include reductions in the Refugee Health Access Program (76,023/3.00 FTEs) and (36,992/.5 FTE) in the Childcare Health Program. The largest reduction is in Dental Services (394,048/3.5 FTEs). This reduction has no service impacts since the reduction in FTEs are vacant positions that were initially intended for a new service model that will not be implemented at this time.

Environmental Health Target Reduction – ($174,721/6.80 FTEs). This reduction eliminates one routine inspection per year for approximately 6,000 of the 8,900 food establishments. Lower risk establishments will be targeted for this reduction.

Environmental Health Other Reductions – ($235,078). This reduction is in response to an increase in operating expenditures exceeding the agency’s ability to generate additional revenues. The reduction is a part of the elimination of the routine inspections for food establishments mentioned above.

Water/Wastewater Supervision Consolidation – ($72,780/1.00 FTE). The reduction is the result of a consolidation of two environmental health programs. The consolidation eliminates one supervisor position and places responsibility for both programs with one position.

North Rehabilitation Facility Target Reductions – (203,969/4.00 FTEs). The reduction eliminates the Drug/Alcohol Treatment Program at the Regional Justice Center. The program provided recovery readiness assessment, counseling and case management services to approximately 64 male and 25 female inmates.

Jail Health Target Reductions – ($444,503/4.50 FTEs). This reduction will convert Registered Nurse positions into License Practical Nurse positions. The reduction also includes the elimination of a Program Analyst I, a Program Analyst II, two Registered Nurse positions and a .50 FTE Staff Physician. Due to operational efficiencies, these changes will not result in a reduction in service.

North Rehabilitation Facility – Other Reduction – ($54,703). This reduction corrects an error in the Motor Pool account.

Other Miscellaneous Changes - ($61,664). This proposal includes a reduction in a .5 coordinator for 36,998 in the Childcare Health program. This change was possible because the City and County moved to one location and reduced the need for a full-time coordinator. This proposal also contains a reduction in a completed project in the Evaluation Unit and a .5 FTE program planner at the Youth Health Centers. The net FTE count for these changes is 0. No direct service impacts will result.

Communicable Disease Supplemental Request - $172,975/3.00 FTEs. This request would add a Public Health Nurse, a Disease Intervention Specialist, and an Administrative Specialist to the Communicable Disease Section. Population increases, increases in cases of reportable disease, upcoming unfunded mandates that expand reporting requirements, and the need to be more proactive in analyzing disease trends have made additional resources necessary. This request is funded by CX.

Lab Supplemental Request for Outbreak Situations - $51,349/.5 FTE. Public Health is requesting a .5 FTE and additional supplies for the Public Health Lab. This proposal would increase a .5 Microbiologist to full-time. The addition is needed to address increased workload during outbreaks, increased screening for STDs, new studies (HIVIS study) and unscheduled absences. This request is funded by CX.

Medical Examiner Additions - 107,786/.5 FTE. This request, funded by CX, will be used to hire a part-time Pathologist needed to maintain the Medical Examiner's accreditation and other salary needs.

Add FTEs To Maintain Immunization Services - $118,765/ 2.22 FTEs. This proposal requests additional FTEs to accommodate growth and grant responsibilities related to the vaccine distribution program and related quality assurance and education activities for health care providers. The FTEs are supported by increased revenue from Medicaid Administrative Match and federal immunization program funds.

SKIL Project - $1,173,219/2.00 FTEs. This add is the third and final installment of a new information system for PH. The Environmental Health components are to be implemented 1999. The two FTEs associated with this request are information systems specialists needed to run the Pharmacy and EH components. The Pharmacy component will be added late 1999 or early 2000. The final piece consists of a billing and scheduling system that will assist PH in its primary care practices and other clinic services as well as assure proper reimbursement.

Centralized Accountability for Primary Care - $675,099/ 8.45 FTEs. This request is one of the bigger changes occurring in Public Health budget for the year 2000. With this restructuring, PH anticipates that it will be able to cover the costs of uncompensated care at three Seattle Clinics and the KC clinic at Eastgate. 43% of visits at these clinics are uncompensated. This program is intended to provide centralized oversight for the financial and operational aspects of primary care service delivery. This restructuring creates a central operations unit with expertise in financial management, managed care and clinical practice. This program change also combines Pediatrics and Family Health at three of the four sites.

Administrative Services Restructuring - $113,416 /4.00FTEs. The Health Department is restructuring its financial management division with the intention of improving its revenue forecasting abilities and the quality of its financial information. This change is also intended to make it easier for PH to respond to information requests from the City of Seattle and King County. Two TLTs will be replaced with FTEs and two additional FTEs will also be added for a total of four FTEs. One of the additional FTEs is a certified coding specialist in the Accounts Receivable Section. This position is intended to generate increased revenues and is revenue backed which will support the costs of the position. The other additional FTE is an accountant position who will be responsible for monitoring and reconciling capitation revenue for Public Health managed care plans and capitated FQHC payments. This FTE was transferred from the COPC division.

AIDS/STD Programs - $326,546/(.67 FTE). PH has several program additions to its AIDS/STD programs. One new initiative is a pilot project that will provide "client-centered counseling" to Men who have Sex with Men (MSM) as a way to reduce STD transmissions among this population. The project will be modeled after a Center for Disease Control study. The 155,000 in CX funding will be used for contract work at Harborview. Other additions are primarily grant-funded projects.

Family Planning/Women and Child Health - $2,894,802/6.80 FTE. This addition includes two large grant increases. PH has been chosen to be a prime contractor to provide Breast and Cervical Health Program services for King and Snohomish counties. The additional service area will support the Women’s Health Unit infrastructure and provide increased screening services. The increase is for 1,331,015 and 2.00 FTEs. The other grant increase will support an extension of the Infant Mortality and Medicaid Outreach program for 1,282,324 and .5 FTE. There are two parts to this project. The first part involves efforts to prevent infant mortality in African American and Native American communities by linking them to prenatal and pediatric care and family planning services. The second part of the program involves Medicaid outreach, with the goal of increasing the number of families with insurance coverage. A large part of this funding is contracted out to community organizations. PH is also adding 110,546 and 1.8 FTE to its Maternity Support Services, which provide education and counseling visits to pregnant and postpartum women. Finally, 170,917and 2.50 FTEs will be added at DCHS Community Service Offices. PH provides family planning services on-site to interested individuals, including counseling and referral to family planning services, pregnancy testing, general health information and referral.

Clinic Improvements - $183,619/1.25 FTEs. This add includes an increase in pharmaceuticals which is related to South County’s newly formed partnership with Community Health Care Clinics of King County (CHCKC) and specifically to the jointly provided services at the Roxbury Family Healthcare Clinic in White Center. Prescriptions are provided at low or no cost because most of the patients are at-risk or uninsured. There is also an increase in Medical Records support and management totaling $92,318 and 2.00 FTEs. The Travel Clinic will also increase by $36,301 based on an increase in immunization fees to most closely reflect fees of other community providers.

Alcohol, Tobacco, and Other Drugs - $99,735/1.00 FTE. This addition includes a Program Analyst II position for $66,379. The person in this position will conduct community needs assessment and act as a liaison with substance abuse treatment providers serving women, parents, and children. There is also an increase in the tobacco prevention program that will make it possible to conduct tobacco compliance checks on Sunday.

Computer/Technology Upgrades - $77,934/.67 FTE. This addition includes funding for the PC replacement program, a position adjustment for the PH information system, and an EDP hardware reduction. The total nets to $77,934.

Community Health Center Contracts/King County - $125,283/.04 FTE. PH is increasing Community Health Center Contracts to reflect increases in HCFA matching funds. These programs provide, via contracts, safety net funding for community health centers.

Grants - $925,306/3.00 FTEs. PH has received several grants for the year 2000 that will fund a variety of programs. Some of the larger grants include $194,000 for the Healthcare for the Homeless program, $127,736 for substance abusing women, and $259,049 for Healthy Kids 2001.

Labor - $480,242. PH needs to increase its budget to pay for the cost of several labor settlements that have been or will be approved. This add also includes a 138,879 technical adjustment for the retirement rate that increased after the status quo budget had been completed.

City of Seattle Adds - $1,024,481/6.97 FTEs. PH made several increases to programs within the City of Seattle. Included in this proposal is $233,205 for the Families and Education Levy programs, Dental Clinic Expenditures for 55,000, adjustments to the Northwest Family Center Subcontract for 327,504 and an increase in HCFA matching funds of 174,145 for Community Health Center Contracts.

Value of Vaccines - $811,886. PHSKC has received additional vaccine funding from the Washington State Department of Health for childhood immunizations

Food Handlers Cards - $118,152/(2.12 FTEs). Effective January 1, 2000, local health departments are required to provide a minimum of thirty minutes of interactive training prior to giving the food worker’s test and issuing the card. The add reflects an increase in the number of cards that will be issued in the year 2000. Due to the increase in costs associated with the new requirement and the maximum charge of $8 per card set by the State, the increase in revenue would not be sufficient to cover those costs. Environmental Health will reduce staff and provide classes and issue testing at one site instead of nine sites.

Volume/Time Factor Adjustments - $343,328/6.11 FTEs. This add reflects volume and activity time adjustments. Volume estimates are based on analyses of current and historical trends, population forecasts, regulatory changes, economic factors, and changes in industry

practices. Increases are predicted in Solid Waste, Plumbing/Gas Piping, Vector/Nuisance Control, Food Protection, and Local Hazardous Waste.

Cross Connections - $150,432/2.28 FTEs. This add is a component of the Plumbing/Gas Piping that will provide inspections of plumbing systems within buildings to assure that no cross connections of safe and unsafe water supplies exist. This program was continued until 1991 as a joint program with the Seattle Water Department. From 1991 until 1999, cross connection control has been the responsibility of the water purveyor. Effective April 1999, the State Board of Health amended 246-290 WAC to place the responsibility on the Plumbing Jurisdiction in each county. The Environmental Health Division is responsible for plumbing in the City of Seattle, unincorporated King County and twelve suburban cities.

Central Environmental Health Rent - $90,481. The add supports the increase in rental cost of office space for the Central Environmental Health Staff. The agency received notice from the City of Seattle that the current facility would not be available in the year 2000.

DUI Revenue Backed Add - $79,547/2.00 FTEs. The request provides for the addition of one Office Technician and one Chemical Dependency Counselor position. These additions are in response to the County Auditor’s recommendation regarding the DUI Offender Program. The Auditor recommended an increase in hours and an increase in direct services. Starting in 1998 the program was allowed to charge DUI offenders on a sliding scale basis. NRF collected approximately $77,000 in 1998 and projects a collection of approximately $90,000 for the year 1999 and a similar amount for 2000.

Jail Industries Revenue Backed Add - $100,096/2.00 FTEs. This request provides for the addition of two Special Detention positions. The agency has contracts with the cities of Shoreline and Mercer Island to provide supervised inmate work crews to perform outdoor landscaping and maintenance functions. A qualified Special Detention Attendant must supervise each crew. These crews have been supervised in the past from regular security staff, thus creating gaps in coverage in the six dorms on campus. The positions are assigned responsibility for crews of four to six inmates that includes the safe and timely completion of customer work, while attending to the necessary health, safety and security requirements of the inmates.

NRF Security Coverage - $125,847/3.00 FTES. This funding will add three Special Detention Attendant positions. The addition of these positions is intended to fill the gaps that exist in security coverage. The gaps in coverage have been covered in the past by using salary savings and extra help.

NRF Resident Supplies - $7,332. This request provides for the replacement of approximately 30 beds that are badly deteriorated with rust, broken springs and worn and torn mattresses. It would also replace approximately 180 inmate uniforms that are in disrepair.

Program Analyst IV - $34,481/.50 FTE. The addition, when added to the current half-time Program Analyst IV position, will provide full time analytical and financial support to the Jail

Health Administrator for both the King County Correctional Facility and the Regional Justice Center.

Position Clean Ups and Adjustments - ($461,292/2.51 FTEs). This decrease is the total of several technical adjustments and other miscellaneous changes that net to a negative number. Included in this item is an increase in hours for an Information Systems Professional from part-time to full-time, a decrease in one-time dental expenses, and infrastructure and overhead reduction in the regions.

Central Rates - $693,117. Central rates include charges for financial services, telecommunications, prosecutor services, rent, and general government overhead.

Technical Adjustment - ($93,430/.38 FTE). This change provides for the correction of errors made during the budget process.

Program Analyst IV (TLT) - $60,701/1.0 TLT. Due to the failure of the Emergency Medical Services (EMS) levy in November of 1997, the King County Council called for the creation of Financial Planning Task Force to make recommendations regarding future funding and the operational aspects of the regional EMS system. This Term Limited Position will serve as project manager for the EMS Strategic Plan update for the next EMS levy period and coordinate the development with the EMS Advisory Committee and the Financial Staff Team. The Strategic Plan update will include a status report on the implementation and impact(s) of the various strategic initiatives, projections of future needs and make financing recommendations for the next levy period.

Criteria Based Dispatch Licensing – $23,000. This request provides the expansion of the EMS Division Criteria Based Dispatch (CBD) and training material in the King County Emergency Medical Dispatch Program. This program generates revenues through:

1) The sale of CBD software by the EMS division

2) Licensing fees for use of copyrighted program materials

3) Contractual services for CBD Basic and Instructor training

Regional Data System Enhancement Project - $275,000. This funding will provide for the continuance of the development of a regional EMS electronic data transmittal and reporting capability. It will permit better transmittal of EMS information, more accurate and complete information, and would allow fire departments and paramedic providers to access information electronically on their own departments. The project will eventually allow all 35 fire departments and fire districts to transmit standardized data electronically and rapidly access reports for their agency.

Paramedic Vehicle Replacement - $665,273. The requested funding would provide for the replacement of six paramedic vehicles. The replacement includes two units for Bellevue Medic One and four units for King County Medic I. The replacements are a part of a regular replacement program.

EMS Technical Adjustments – ($357,546/.18FTE). The technical adjustment provides for the correction of errors and makes other technical changes to the agency budget. It includes the costs ($258,257) of two Medic One units that were erroneously included in the initial budget building stage of the agency’s budget development. It also reflects the net of reductions and increases in various accounts including but not limited to Miscellaneous Operating Supplies ($54,837) and Other Minor Equipment and Small Tools ($40,263).

EMS Central Rates – ($61,525). The Central Rates for EMS decreased by $61,525. The rates include charges for telecommunications, data processing, flex benefit and finance rates.

Interest-Short Term Adjustment – ($6,000,000). The EMS levy passage in February of 1998 provided funding for the second half of 1998 expenditures and the following three years. However, because the tax revenues were not collected until 1999 and the timing of when the revenues were actually received, the Council adopted an ordinance, authorizing the sale of Tax Anticipation Notes to cover both the funding gap and subsequent cash flow needs in 1998 and beyond. In 1999, the agency borrowed approximately $15 million and will borrow approximately $9 million in the year 2000, which reflects the reduction of $6 million.

Local Hazardous Waste Initiatives - $1,506,435. In 1998, the Local Hazardous Waste Management Plan Management Coordinating Committee asked division staff to develop hazardous waste initiatives to target unmet service needs and fund these initiatives from the Local Hazardous Waste Fund balance in the year 2000. The initiatives include:

· the addition of a program administrator

· additional suburban city grant support for implementing hazardous waste collection and education activities

· increased funding for disposal of banned pesticides in households and Small Quantity Generators (SQG - small businesses that generate approximately 220 pounds, or one half of a 55 gallon drum, of hazardous waste monthly)

· funding for stock piled hazardous waste in school chemistry labs

· additional educational outreach services to K-12 schools

· funding for SQG voucher program for hazardous waste disposal incentives

I-695 Reductions ($6,471,204 / 21.18 FTEs). The reduction reflects actions taken due to the Department’s loss of Motor Vehicle Excise Tax revenue (approximately $10.5 million) due to the passage of I-695. The changes include initial reductions in both administration and program services. It also includes an additional service reduction of $4,157,112 that will be implemented on April 1, 2000, depending on the extent that the loss of revenue is mitigated by the State.

The Council, through a budget proviso, has requested that the Department submit a plan for their review and approval, which identifies in priority order a staged reduction of up to $4,157,109 to be taken, if necessary, beginning April 1, 2000. The plan is to include a staged addition listing, which identifies in priority order additions which the department would propose at three separate thresholds of funding, up to $10,526,193. The three thresholds represent the reasonable break points at which different adds scenarios would be appropriate. Priorities will be identified based on core public health functions and services and current public health needs.

Food Inspections - $410,000 / 6.80 FTEs. The council restored this reduction, which will continue food inspections at their previous levels.

Updated: June 28, 2000