Law and Justice / Human Services Committee - Regular Meeting

Good morning. Snohomish County Council Health and Community Services Committee will be called to order. Today is Tuesday, June 9th. It's 11 a.m. We're meeting in the Jackson Boardroom and also remotely. Before we get into the agenda, I'm going to read a brief public comment script. We'll be taking public comment beginning with in person and then remotely. In Zoom, you'll click the hand icon to raise your hand. Calling by phone, press star 9 to raise your hand. When called upon, press star 6 to unmute. Each speaker will have three minutes to speak and please start your comment with your name and your city of residence. And now our clerk will please call roll.

Committee Chair Mead.

Here.

Vice Chair Lowe. Committee Member Nearing.

Here.

Committee Member Dunn. Here. Committee Member Peterson.

Here.

Chair, there are four members present.

Great. Thank you. So with that, we will now move on in the agenda to public comment. And I will first invite anyone who's in person to provide public comment to go ahead and step up to the podium. Do you have anybody in person to provide comment this morning? Welcome. Welcome. You just want to start with your name and your city residence.

My name is Mr. Brown, Colton Brown. I'm a public affairs specialist with United States Small Business Administration Office of Disaster Recovery. Originally from Seattle, but my family used to have a homestead in Briar, so I'm here on assignment. The reason why I'm here is to make sure that it is well known that the Small Business Administration is still here and we will be here. There was a cutoff date for, this has to do with the presidential declaration from the floods and the economic injuries that are occurring within the Snohomish County area and surrounding areas from December. So we're still here. We want to make sure that although FEMA and the state are shutting down some of their sites beginning on the 10th, that there is still assistance available to homeowners, renters, small businesses, non-profits, and also faith-based organizations on two different levels, meaning there's physical damage, but then also economic injury disaster loans. The bigger part of it is the economic injury disaster loans. There's zero interest, zero payments, and no prepayment penalty for the first year. Knowing that 20 East is still having some difficulties and understanding just how much the Cascade Loop adds to the value of this beautiful area. and knowing some of the other issues that have occurred with Stevens Pass before that even occurred, we want to make sure that the word gets out that there is assistance. We do have a disaster assistance center, a mobile unit, going up into Darrington on the 11th, and we'll be there all day to be able to assist those that are challenged in that area. In addition to that, you can definitely go to our website, which is sba.gov slash disaster to check and see some of the other opportunities that we have available. For those that are affected as far as physical damage, the compensation or what is available to them as far as homeowners and renters as well is up to $500,000. And for those businesses that have been impacted, it's up to $2 million. And this is really because what's going on is it's, I've been moving around the county, Sultan, Monroe, everywhere, and everybody is impacted. They're not really thinking about it until, you know, you're already 60 days late on some of your inventory. So the economic injury disaster loans also assist with all operating costs and restocking to allow for these businesses to last through the next decade. through the next cycle. So with that, I will be sending emails to you. I'm pretty sure you guys have been inundated already, but I will still send more after today just to let you guys know where we are. And we've been able to help. We've already been able, as far as our portion of the SBA, been able to help the county with somewhere close to about $3 to $4 million thus far.

Thank you very much for your comment. Thanks for joining us, Mr. Brown. You're very welcome. have any other commenters in person who'd like to provide public comment all right seeing none i'll verify we have no hands raised online no hands are raised great thank you so we'll close public comment and we will move on in our agenda to our action items first up is motion 26-216 for the record cynthia foley council staff

The Snohomish County Health Department is seeking to contract with Ascendant Advisors Incorporated for financial consulting. The contract will create an action plan that addresses the health department's structural deficit and build a resilient and financially sustainable organization positioned to meet current and future strategic operational needs. The contract is funded by a public health infrastructure grant. Motion 26-216 authorizes the executive to sign the agreement. and between Ascendian Healthcare Advisors in Snohomish County for Consulting Services. The request is to move motion 26-216 to the GLS agenda for council consideration.

Thank you, Cynthia. Do you have any questions or comments from council members? Do you have any objections to consent? Seeing none, we'll go ahead and move this motion to June 17th's GLS agenda on consent. Next is motion 26-225.

Thank you. A data sharing agreement with the Washington State Department of Health will grant Snohomish County Health Department access to information related to decedents. The information will include the decedent's name, date of birth, date of death, and residence. This is restricted confidential information. Section 2B of the contract describes data security policies. Motion 26-225 authorizes the executive to sign the contract. The request is to move motion 26-225 to the JLS agenda for council consideration.

Great. Thank you, Cynthia. Questions or comments from council members or objections to consent? Seeing none, we'll move this motion to June 17th's GLS agenda on consent. Those are our two action items. Finally, we do have a discussion item today. We have a presentation on the state of health care. So I'll invite up the team that's here today. Sorry I didn't write down all of your names, but I see you got Lisa, Megan, and Ann. It's just the three of you? It is. Thank you so much for your time today. Thank you for joining us. Thanks for being here.

So, I am Lisa LaPlante. I am the Superintendent of Snohomish County Public Hospital District Number 1 and the Chief Administrator of Evergreen Health Monroe. I have with me Ann Peterson. She's our VP of Finance and Megan Wershing. She's our Chief Nursing Officer. So, we're going to give you an update on access and capacity at the hospital and also talk about we have a UTGO on the ballot for August 4th for a replacement hospital. So, we're going to present a lot in a very short period. So, if you have questions, let us know. All right, and I control the slides, or nope, nope. All right, so Evergreen Health Monroe, we are the local community hospital, and in a minute I'll show you what our district looks like. We have, as the public hospital district, we have local control. So we have a board of commissioners. We have five elected commissioners. They serve six-year terms. We have some of our commissioners have been on our board for over 30 years, so we have a lot of support and commitment there. They live within our district. That's a requirement, and so they represent the community, and we are here to serve the community. All of our tax dollars, we are like any civic organization, schools, fire. We collect property taxes. That all goes back into the organization, whether it be renovations, new services, staff salaries, those things. Here we go. So here is our district. You can see we go from Almost cutting into Mill Creek, we dance just below the Lake Stevens boundary there, all the way past Index. We are one of the biggest districts, public hospital districts in the state. We are the first full-access hospital from Monroe to Wenatchee. So if you think of all the things coming off the pass, we see a lot of trauma. You can see in the green there, that is the King County Public Hospital District. We're two public hospitals that work closely together, but we have to remain separate. Finances, all of those things. I'm going to hand it over to Megan Wershing.

All right. So I want to just talk a little bit about the demographics within our hospital district, what we're seeing with growth. And this slide really shows what we've seen in the last four years of growth within our hospital district. So 50% more unique patients that are coming to utilize our services than what we had seen previously. So That is indicative of our hospital services as well as clinic services and really just quite a jump, again, in what we're seeing for community members needing to access our healthcare services. Breaking that down a little bit more, this is showing four different service lines where we've seen quite a bit of growth in the last four to six years. So upper left is our emergency department. Starting from 2020 through 2025 of last year, we've seen significant increase We only have a 14-bed ED, and last year we saw just under 21,000 patients in that ED, seeing on average 60 to 80 patients a day. So very, very busy. Bottom left is our inpatient days, also kind of following that same trajectory as the emergency department growth. Top right, surgical services. We've really seen some increases there as we've expanded on orthopedic general surgery, brought out new service lines such as urology, ENT, as well as continuing to really partner closely with our Evergreen Health Medical Group and really focusing on specialty services close to home. And then that bottom right graph is our urgent care, which we opened in April of 22 and has seen quite significant growth. We knew that we really needed that service. We felt like we needed it. And then what we have seen with the data shows us that Our community needs same-day care, right? It's very difficult to get into PCP's offices in the same way that it used to be, so that care has shifted quite a bit. So when we think about how we got to this point and we look at our hospital services today and our facility, we have an increased emergency department demand. As I mentioned, it's only 14 beds. We have some interim plans to increase by four beds, but that's not going to quite get to what we need with our growing community and families that are moving out this way. Our inpatient capacity, we only have 26 inpatient beds as of today. We are looking to bring four more on this fall. But I'm sitting here today and our inpatient unit is full. We don't have the ability to keep taking patients even right now because there's a growing need. Excuse me. We have an aging infrastructure. Our hospital, the oldest parts of the building were built in 1925. So we've got a building that's over 100 years old and has been expanded upon about eight different times. as we've tried to grow with the needs of the community. And so we get challenges there. The more you lose efficiencies when you've had to build on multiple times, which creates patient flow challenges. Again, we can't be as efficient today as we'd like. We don't get as much patient experience that we'd like. And most staff experience struggles when things are chopped up and not laid out in the way we would like them to be. Limited room for growth. We are a little bit landlocked in places. Our ED, again, we don't have ways to expand out. similar, same as our inpatient areas, so we're challenged there. And then care spaces that are outdated and aren't fit for modern technologies for today and into the future.

Sorry about that. What we've done with these challenges, our board came to us in 2023 and asked us to look at a long-range master facility plan. And we have been good stewards of our finances and We're fortunate because we've been able to continue to increase access. And so you can see what we've done is we broke it into three phases. Phase one is continue to grow in place. We're investing $7.2 million there. We are expanding our emergency department by four beds. That's all we can fit, but we are doing that. Reopening our ICU, as Megan mentioned. Increasing specialty services, trying to keep patients local and not having to travel for care. And then equipment upgrades. Phase two is expand access in the district. So, we're well on our way there. So, $63 million investment of the district. And so, we bought a medical office building that is in our, on our campus that we have never owned. But it allows us the ability to grow our clinics there, have control of that space and access. So, we purchased that in August. And also, I'm hoping everyone has heard, we are opening a clinic in Snohomish on Avenue D. So where the former Bartels was next to Safeway, we are putting in an urgent care, primary care. So 30 exam rooms. Unfortunately, it takes about 12 months of construction to do that. But we're bringing, like I said, urgent care, primary care, mammography, x-ray, and lab services to Snohomish. And then phase three is our future new replacement hospital. So as you can see, the investment is $382 billion, which Ann, the finance person, will talk about. But we have done a lot of work to really figure out, can we build a hospital on the campus that we're at now? Can we continue to exist in place while we build that new hospital? So we've gone through. We've done a needs assessment. evaluation, pre-design, and selected an architect. So we're well on our way. And our board has put us on the ballot, like I said, August 4th for UTGO. I think I'd turn it back over to Megan.

Yeah, so what will a new hospital do for us if Prop 1 passes? Lisa mentioned pre-design. We really looked at what is our community health needs data telling us, our demographics, the growth within our hospital district, as well as Snohomish County and surrounding areas. And really tried to take all of those assumptions forward as part of this pre-design work. So I won't go through all of these bullets. There's a lot of information on this slide. But really, again, what we're focused on is keeping care close to home, expanding services. We know we need to grow with our growing community. We know we need to improve emergency access and care. That's a big focus, as I've mentioned already several times. It's a growing ED. And we need to be able to grow with that. So we're looking to have a minimum of 24 rooms with some behavioral health convertible spaces. We don't have those today. You may be aware, right, behavioral health needs are on the rise, and we end up seeing quite a bit of those in our emergency department. So really wanting to make sure we can meet the needs of that population. Improving inpatient and surgical access. We're looking to double our current room capacity that we have today and, again, really provide more inpatient services as well as OR suites. We have three right now. We want to expand that to six and improve more procedural suites as well. We know that the hospital in our pre-design will be just under 200,000 square feet. So we're looking at a big building. What we really want to focus on is putting acute care hospital needs in there and then building our clinics around as part of all that master's facility planning we've been doing. I'll turn it over to Ann.

Great. So this chart shows a levy rates per 1000 of assessed home value by hospital districts. So in the state of Washington, there's 57 public hospital districts, 38 of which actually have a hospital. And the chart shows the blue bars are the maintenance and operation levies. So you can see Monroe is a second from the left. So the second lowest in the state at 15.6 cents per thousand of assessed value. All right, so this chart shows a typical breakdown for a home in the city of Snohomish. So that little red circle shows a dollar of tax assessment. The hospital receives about 1.64 cents of that dollar. And then the lower chart shows the history of the Evergreen Health Monroe levy. So you can see way back in 2002, we actually had a bond component to our levy And then that was retired in 2008. And so since then we did, and then we did a levy lid lift in 2014. And you can see since then with assessed values increasing at very rapid rate and our ability to increase our, our levy by just 1% per year, that rate per thousand dollars has decreased over time. All right. So, so this is our UTGO scenario. So I think one thing we want to clarify is that we are able to, fit a new hospital on our current campus. So what is this 382 million that Lisa mentioned, what do we get for that? So that includes construction of a new facility, fully equipping that new facility, and Megan kind of talked through the size, et cetera. We would demolish the majority of the existing facility, so we would be able to maintain operations, not have any disruption in services for our community, and be able to sort of transition to the new hospital in one day. And then we would be, creating some more flat lot parking where the current hospital resides. So that's really what the 382 million is getting us. And the estimated bond rate is 43.7 cents per 1,000 of assessed values. So we looked at what is the impact kind of on an average home with an assessed value of 745,000. For the duration of the bonds, it averages $489 per year, or just under $41 per month, or $1.31 per day. I mean, it's not insignificant, but those are the numbers. So year one would be about $323 in taxes for that home of $745,000 in value, and then growing to $695 by the final year, which is assumed to be 2058. And the reason why we've selected the UTGO approach to funding the new hospital is it's really the most cost effective for the taxpayers, the lowest cost option. It's backed by government taxes, and so it is very safe for investors, which means that it translates into a lower interest rate. We're ready for any questions.

Yeah, for any questions you may have.

Well, thank you for being here. Thanks for the information. It's super helpful to see you break all of that down, especially like the maps and kind of understanding the jurisdiction. So thank you for being here. Do you have any questions for them from our council members? That's where we're done?

So the current levy rate is 0.156 for every thousand, and then this will be Will that levy expire and there's a bond or?

So the levy continues. We do not envision doing a levy lift request. So that value would continue to decrease as assessed values increase. So this would be the 43.7 cents would be on top of our maintenance and operations, but it would expire at the end of the bond term, about 30 years.

Okay. Okay. So the .156 will go lower, will decrease, and then will expire after 30 years.

Because we can increase our levy by 1% per year, and the assessed value, for example, from 25 to 26 in our district went up by 6.5%. So it definitely brings down that. Okay.

Thank you.

Other questions from council members or anyone online?

Okay.

Okay.

not hearing any questions thank you all for being here appreciate all the information thanks thank you that brings us to the conclusion of our agenda for today and this is the last meeting that we have as counsel for today so we will be adjourned thank you all