Whatcom County Council as the Health Board (Joint Meeting with Public Health Advisory Board)

Whatcom County's Health Board and Public Health Advisory Board held their final joint meeting of 2025, focusing primarily on health department operations, disease surveillance, and the ongoing debate over restructuring the health board's composition. The meeting featured comprehensive presentations on tuberculosis control, respiratory disease trends including avian flu, and updates on department activities ranging from severe weather shelter operations to environmental health modernization. The tuberculosis presentation proved particularly impactful, highlighting both the county's strong public health performance and emerging concerns about capacity. Dr. Amy Harley and retiring TB nurse Ann Lund detailed how Whatcom County has maintained TB rates consistently below state and national averages through dedicated nursing care, but warned that recent budget cuts and staffing reductions threaten this success. The revelation that Ann Lund's position will not be filled due to budget constraints sparked discussion about the county's ability to maintain essential public health functions. The health board restructuring debate continued with Council Member John Scanlon presenting a draft ordinance that would expand the board from 7 elected county council members to 10 members including tribal representatives, city officials, and community health experts. However, the proposal faces opposition from six small city mayors who sent a letter opposing the change, citing concerns about accountability and democratic representation. Multiple public commenters echoed these concerns during the meeting. Health Director Champ Thomaskutty reported successful implementation of the severe weather shelter using a new staffing model, progress on environmental health service improvements through an FDA grant partnership with Nevada, and ongoing work to modernize data systems. Co-Health Officer Dr. Meg Lelonek warned about a new flu variant (H3N2) that may reduce vaccine effectiveness and provided updates on avian influenza monitoring after Washington state's first human death from the disease. The meeting underscored tensions between maintaining essential public health services amid budget constraints and ambitious plans for structural reform. While PHAB members generally supported health board expansion as a way to bring diverse expertise to decision-making, several council members and public commenters questioned whether the county should pursue major restructuring when basic services like TB control face funding pressures.

No formal votes were taken at this meeting. All agenda items were either presentations or discussions: - **AB2025-840 (PHAB Chair Update):** PRESENTED - Dr. Christine Espina reported on PHAB's 2025 accomplishments including community health assessment work and budget input - **AB2025-841 (Health Director Update):** PRESENTED - Champ Thomaskutty provided operational updates including severe weather shelter launch and new staff hires - **AB2025-842 (Health Officers Update):** PRESENTED - Dr. Meg Lelonek briefed on respiratory disease surveillance and Dr. Amy Harley/Ann Lund presented on tuberculosis control - **AB2025-541 (Health Board Restructuring):** DISCUSSED - Council Member Scanlon presented draft ordinance for restructuring but noted no vote would occur today The most significant development was the presentation of a draft ordinance for health board restructuring, though this remains under discussion with new council members taking office in January.

**Ann Lund, TB nurse on retirement and TB vaccine hopes:** "All these past 18 years, I have said by the time I retire, My wish is that the world would have a effective TB vaccine. And here we are. There is no vaccine yet, but I'm not giving up hope." **Dr. Amy Harley, honoring Ann Lund's service:** "Her motto, as I've quoted her here on this slide, is really to partner with her patients in their healing journey, coming alongside them to do what she sees as the true work of a TB nurse." **Rachel McGarrity (PHAB), on accountability in restructuring:** "I would argue directly to the contrary, I would say that if a Board of Health were made up of some elected officials who have clear party affiliations or position affiliations, that would be well counter balanced by people who have public health expertise." **Marvin Mickley, public commenter on representation:** "Greater Bellingham has about 104,000 residents, compared to about 137,000 outside of Bellingham, leaves the county underrepresented in the proposed board only one representative out of 10." **Christine Espina (PHAB), on nursing investment:** "I often see or hear that nurses are expensive, but the long term expense is so much more. And so I just want to elevate and be protective of nurses, because we can do a lot." **Council Member Todd Donovan, on health board powers:** "There's a fairly narrow lane for a Board of Health. The council still retains all of the supervision, financial powers that we've had as council members slash health board members." **Champ Thomaskutty, on pandemic preparedness:** "TB control is a direct reflection of the strength of the public health system, and TB often can be considered the canary in the coal mine, where public health systems are weak, you expect to see TB case rates are are higher."

**Meeting ID:** WHA-CON-HLT-2025-12-02 # The Health Board Restructuring Debate — A Meeting Narrative ## Meeting Overview The Whatcom County Council, serving as the Board of Health, convened at 10:03 a.m. on December 2, 2025, for a joint meeting with the Public Health Advisory Board (PHAB). Council Chair Jon Scanlon called the meeting to order in council chambers with hybrid participation available online. Six of seven council members were present, with Tyler Byrd absent. More than a dozen PHAB members participated, including newly appointed member Dr. Alan Lipson. What distinguished this nearly two-hour meeting was the convergence of three significant themes: the county's strong performance in tuberculosis prevention, budget pressures threatening public health capacity, and an ongoing debate over restructuring the Board of Health itself. Public commenters voiced sharp opposition to proposed changes, while health officials painted a concerning picture of rising disease rates and shrinking resources. ## Public Opposition to Health Board Changes The meeting opened with pointed public criticism of the proposed health board restructuring. Three remote speakers and one in-person commenter expressed deep skepticism about expanding the board beyond elected officials. Marvin Mickley led the opposition, arguing the proposed structure would undermine democratic accountability: "Our representative form of government should have elected officials having this kind of responsibility and power. What recourse would voters have when the board makes decisions with which they disagree?" Mickley criticized the representation imbalance, noting that tribal representatives would comprise 20% of the board despite being 3.3% of the population, while rural areas outside Bellingham would have just one representative despite being the majority. Lance Callaway echoed these concerns, emphasizing the importance of accountability: "The current structure ensures decisions are made by people who carry a clear mandate from the voters. That's what keeps transparency and public trust strong." He noted that all six mayors from smaller cities oppose the change, preferring health policy decisions be made by officials accountable to their communities. Natalie Chavez delivered perhaps the sharpest critique, calling the restructuring effort "one council member's pet project" that has consumed "so much time, many months and numerous hours." She questioned the validity of a community survey with only 161 respondents — less than 0.1% of the county's population — and raised concerns about coordinated email campaigns with identical wording supporting the changes. ## Public Health Advisory Board Accomplishments Dr. Christine Espina, PHAB chair, presented the board's 2025 accomplishments, highlighting their work on community health assessment and planning. The board recommended using the Mobilizing for Action through Planning and Partnerships 2.0 framework for the county's next community health improvement cycle and has been in continuous dialogue with department leadership about capacity for this work. PHAB Vice Chair Rachel McGarrity emphasized the board's role in understanding new state laws expanding health board membership, noting that both statutes "aim to ensure responsive health boards by either composition of experts, people with lived experiences, particularly from underrepresented groups such as rural communities and elected lawmakers, or by ensuring a robust advisory board with strong voice in the decisions at hand." The board has also engaged with budget discussions, though McGarrity noted they would like "to weigh in sooner on the department's budgetary decisions in line with the board's statutory duty." They're requesting a meeting with the new finance director in 2026. ## Health Department Updates Amid Resource Constraints Director Champ Thomaskutty provided updates on department operations, highlighting successful launches of the severe weather shelter under a new staffing model and the onboarding of key personnel including emergency planner Joyous Van Mater and accounting supervisor Amy Bikin. The department is managing infectious disease clusters in congregate settings while building capacity for potential avian flu responses. Environmental health is implementing a new enterprise system to modernize permitting and complaint response, partnering with Nevada's Washoe County on an FDA grant examining customer service procedures. Thomaskutty emphasized workforce development, noting six interns supporting crisis response and mental health court programs, plus ongoing staff training in violence prevention, suicide prevention, and motivational interviewing as part of behavioral health agency certification requirements. When PHAB member Leah Wainman asked about billing for behavioral health services, Thomaskutty revealed the complexity: "Sometimes the idea of billing seems really attractive, but it actually may not be cost effective, and so we're trying to determine what's the best path forward." ## Respiratory Health Challenges and Preparedness Health Officer Meg Lelonek provided updates on the current flu season, warning of a new H3N2 variant that emerged after vaccine formulation was complete. This means "not only will this virus be better at slipping past flu vaccines, but it will also be better at slipping past prior immunity," potentially increasing hospitalization risks. Vaccine rates are concerning, with most estimates showing they're "about eight percentage points less, which ends up being about 30% less than in previous years for flu vaccine in particular." The county has already seen its first flu death and first facility outbreak with over 20 cases in a facility with only 40% vaccination rates. On avian influenza, Lelonek noted positive flocks in Whatcom County and the first human death in Washington state from H5N5 in Grays Harbor County. The department has launched media campaigns with information about backyard flock safety and protective measures. PHAB member Alan Lipson raised pandemic preparedness concerns: "If we get greater mammalian adaptation, and we get human to human transmission, we could be faced with the epidemic on the scale of what we saw for covid." Lelonek emphasized the importance of the newly onboarded emergency preparedness specialist and the need for adequate resources to handle pandemic responses. ## Tuberculosis: A Model Public Health Success Under Threat The meeting's most substantive presentation came from Dr. Amy Harley and retiring TB nurse Ann Lund, who detailed the county's tuberculosis program — a story of public health success now threatened by budget constraints. Lund opened with sobering global statistics: "Every day, 4000 people die of TB in the world." While TB is completely preventable and treatable, it persists due to "gaps and inequities in healthcare and social and economic systems." In Washington state, counties must organize, fund, and operate comprehensive TB prevention and management programs. This includes covering medical care costs for active TB cases when no third-party reimbursement is available — a significant financial obligation. Harley explained TB's unique characteristics: it spreads through airborne droplets but can remain dormant for years before causing illness. Treatment is complex, requiring multiple antibiotics for six to twelve months, with directly observed therapy to prevent resistance. "The fatality rate of even treated cases is roughly 12%," Harley noted. Lund presented concerning epidemiological trends. After reaching historic lows in 2020, TB rates have increased dramatically. The most recent national case count of 10,300 cases was 8% above 2023 rates and the highest since 2011. Washington state has followed this trend. However, Whatcom County has performed exceptionally well. "Over the last five years, we've been consistently below both the Washington State rate and the US rate, which is really attributable to our strong public health efforts," Lund explained. The county has averaged two to six cases per year over the past five years. Lund quantified the nursing workload required for TB care, estimating 53 hours per week for complex cases during initial treatment phases — far exceeding a standard 40-hour work week. The program includes not only direct patient care but contact investigation, facility coordination, surveillance, reporting, and screening of newly arrived permanent residents flagged by the CDC. The discussion revealed a critical budget situation. Assistant Director Charlene Ramont announced that due to budget constraints, they decided not to fill Lund's position upon her retirement. "That workload and that tremendous amount of prevention activities that are happening there will be distributed among other nursing staff for the short term at least." ## Budget Crisis in Public Health The budget discussion exposed deeper structural problems. Ramont explained that TB work is "severely underfunded from the state. We receive a very, very, very minimal amount of dollars specifically for this work and for all of our communicable disease work. It's an underfunded mandate." Scanlon learned that the health department took a million-dollar general fund cut, "bringing the department's general fund take back to sort of pre-pandemic levels." Additionally, the department faces ongoing cuts to foundational public health services funding, with $230,000 cut this year and similar cuts anticipated next year. When Scanlon asked about pandemic surge capacity, Ramont was candid: "We are very mindful of surge capacity within the department, and we are kind of on the cusp right now. We're in a space where we're okay if we have to surge, and if we were to lose any additional medical professional positions, licensed positions, we would be in a challenging place as a community for surging." Thomaskutty emphasized the local nature of TB control: "We won't be able to respond or benefit from federal response unless it's possible. So we're dependent on us being sound. Have our foundation shored up as well as our neighboring jurisdictions." PHAB Chair Christine Espina made an impassioned plea: "This is clearly empirical evidence of the investment of public health nurses, and I often see or hear that nurses are expensive, but the long term expense is so much more." ## The Restructuring Debate Continues The meeting's final hour focused on the ongoing health board restructuring discussion. Scanlon presented a comprehensive draft ordinance developed by a working group that has met with tribes, mayors, and community members over the past year. The proposed structure would create a 10-member board with five elected officials (three county council members, one small city representative, one Bellingham representative) and five non-elected members (two tribal representatives and three community members with health expertise or lived experience). Scanlon emphasized accountability measures built into the proposal: staggered terms with limits, alternate members for each position, defined vacancy procedures, and removal processes requiring a super-majority of the county council. "All appointments to a new Board of Health would be in the hands of the county council," he noted, maintaining electoral accountability. However, the small cities' opposition presents a challenge. Given the mayors' letter opposing participation, Scanlon acknowledged the working group could modify the proposal to include five county council members as the elected representatives rather than city officials. PHAB member Rachel McGarrity addressed trust concerns raised by commenters: "If a Board of Health were made up of some elected officials who have clear party affiliations or position affiliations, that would be well counter balanced by people who have public health expertise or lived experiences that may not have those direct affiliations." PHAB member Shu-Ling Zhao supported the restructuring, seeing "an amazing opportunity" for multi-sector collaboration at the decision-making table. Council member Todd Donovan, who has partnered with Scanlon on this work, noted the state law requirements that led to the current unwieldy 21-member PHAB structure, suggesting a restructured board could enable "something more focused with PHAB" that wouldn't be bound by current statutory mandates. But Council member Mark Stremler expressed reservations: "I reached out to stakeholders regarding this issue and said he opposes moving forward without the cities on board." Council member Kaylee Galloway requested further clarification about the health board's legal authorities compared to the county council's powers, with Prosecuting Attorney Kimberly Thulin agreeing to provide a detailed memo. ## Looking Ahead Amid Uncertainty As the meeting concluded at 12:02 p.m., several threads remained unresolved. The health board restructuring faces continued opposition from small cities and some community members who question the democratic accountability of appointed positions. The tuberculosis program exemplifies both the success of strong public health infrastructure and the vulnerability created by budget cuts. Scanlon emphasized that the working group has followed other counties' advice to "take your time" and thoroughly study the pros and cons. With new council members joining in January and responses still pending from both tribal nations, the restructuring discussion will continue into 2026. The meeting highlighted a fundamental tension in public health governance: balancing democratic accountability with expert knowledge, managing competing demands for resources while maintaining essential services, and adapting traditional structures to meet evolving public health challenges. As PHAB member Leah Wainman noted when discussing the survey responses, there's "the clear lack of trust in government that we saw in some of those responses." Whether through restructuring or other means, rebuilding that trust while maintaining effective public health protection remains the central challenge facing Whatcom County's health governance. The December 2nd meeting captured a moment of transition — celebrating successes in TB control while confronting budget realities, debating governance structures while managing immediate health threats, and navigating political tensions while seeking to protect community health. The path forward remains uncertain, but the stakes for public health infrastructure have never been clearer.