Olympic Regional Tribal-Public Health Collaboration
Develop an operation plan for tribes and LHJs in close proximity on the Olympic Peninsula. Explore government-to-government agreements, facilitated by Dr. Lindquist and Dr. Locke, to enhance public health response coordination.
Download Presentation
Please find below an Image/Link to download the presentation.
The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author.If you encounter any issues during the download, it is possible that the publisher has removed the file from their server.
You are allowed to download the files provided on this website for personal or commercial use, subject to the condition that they are used lawfully. All files are the property of their respective owners.
The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author.
E N D
Presentation Transcript
Who I am: Susan Ferguson Facilitator for the Olympic Regional Tribal-Public Health Collaboration and MAA and Operation Plan Contact Information: Phone: 206-909-0613 Email: sferguson222@msn.com
THE OLYMPIC REGIONAL MAA AND OPERATION PLAN: HISTORY OF THE TRIBAL- LHJ MAA DEVELOPMENT PROCESS STATUS OF AGREEMENT TODAY OPERATION PLAN DEVELOPMENT AND IMPLEMENTATION
Seven tribes and three LHJs located in close proximity on the Olympic Peninsula: Hoh Tribe Jamestown S Klallam Tribe Lower Elwha KlallamTribe Makah Tribe Port Gamble S Klallam Tribe Quileute Tribe Suquamish Tribe Kitsap County Health District Clallam County Health Department Jefferson County Health Department
Kitsap LHO Dr. Scott Lindquist and Jefferson/Clallam LHO Dr. Tom Locke proposed and supported project Tribes expressed desire to explore MAA, support and interest DOH agreed to support work, both for facilitation and some tribal and public health support. Neutral facilitator does not represent any party or DOH and DOH not a party to the agreement Preexisting conditions: Interdependent region of state Strong existing relationship between LHJs and Tribes Recognized need for coordinated public health response
Initial meeting of Scott Lindquist, Tom Locke, Jessica Guidry (Region 2 PHEPR Coordinator) and facilitator to discuss project Identify appropriate tribal chairpersons and medical directors to contact; Consult with American Indian Health Commission Initial letter of invitation to chairpersons explaining idea: Government to government proposed agreement Work group cannot bind governments May or may not come to agreement
Important to start the process understanding government to government principles Letter of introduction and invitation was sent from Drs. Lindquist and Locke to the tribal chairpersons with a cc to the medical directors Letter asked the chairpersons to appoint a representative to the meetings Tribes selected medical directors, executive directors, public safety/emergency response coordinators, and a community health nurse
To get to know one another To establish parameters of agreement: decision to have agreement be for these seven tribes and three LHJs, not open statewide but perhaps useful as model for others To decide scope of proposed agreement: decision to cover emergency mutual aid, some day to day public health operations, communicable disease control and isolation and quarantine To select three model MAAs to create Starting Points for Discussion document To schedule all meeting dates and locations
CDC Menu of Suggested Provisions LHJ Inter-Jurisdictional Mutual Aid Agreement Lummi Nation/Whatcom County Health Department draft MAA, deals with isolation and quarantine issues Portions of 1996 draft MAA prepared by Dr. Locke related to day to day public health operations
Recognition that public health related issues arise everywhere, including on tribal lands; example, substantial exposure Most tribes have not adopted comprehensive public health codes. Most don t have persons functioning as local health officers, with related legal authority Providers in health clinics are not public health practitioners and have a different perspective
In all MAAs, definitions are extremely important! Work group defined: Tribal Lands to include land within tribal reservation boundary, tribal and member trust lands, settlement agreements lands and lands under control of the tribal government, or its agents. People on Tribal Lands to include members of the Tribe, members of other tribes that live on tribal lands, and all other people on Tribal Lands (employees, residents, etc). Mutual Aid to mean assistance requested or provided during a public health emergency or disaster, or related to day to day public health services, communicable disease outbreak, isolation and quarantine, or other public health service.
IMPLEMENTATION PARTICIPATION Agreement effective upon signing by any one LHJ and any one tribe Remains in effect until such time a party gives written notice of withdrawal Termination by one party does not affect continued agreement operation so long as one LHJ and one tribe remain parties Expressed desire to help one another but no legal duty to provide mutual aid All actions voluntary and in each party s sole discretion A party must take into consideration whether giving aid will unreasonably diminish its capacity to provide basic public health services to its own jurisdiction
Each party agreed to take all actions necessary to qualify and maintain qualification of its own personnel, employees or volunteers as emergency workers under RCW 38.52 and WAC 118-04 Parties may condition their willingness to respond and continuance of their response on issuance of a mission number and compliance with RCW 38.52 and WAC 118-04 To extent local, state or federal governments do not provide complete waiver, immunity, indemnification, reimbursement, or other payment related to liability, each party legally responsible for own liability. Party requesting aid responsible to seek issuance of mission number from state EMD
This provision recognizes need for qualified and experienced person to function in LHO role and the need for laws to govern the response The issue: how do sovereign governments that function alongside one another want to address their responsibilities related to disease that crosses the borders? Without tribal public health codes, persons on staff with public health expertise, or the need (or budgets) to create full time public health departments, some tribes have authority and responsibility to deal with issues that affect public health, but not the public health infrastructure
OPTION ONE OPTION TWO Party tribal government will exercise own public health authority Parties understand that ability or willingness of Party HD to respond within the tribal jurisdiction may be limited Party TG may still seek technical assistance from the Party HD Party TG may grant Party HD in its closest geographical proximity permission to exercise public health authority Either Party HD or Party TG may refuse, decline, withdraw or rescind the grant of authority at any time
Issue: Without a tribal public health code that addresses the specific event, how does a responding LHJ public health nurse or doctor know what public health laws apply on tribal lands or to people on tribal lands during the response? Tribe may choose to adopt federal, state or local law as tribal code temporarily to address the specific public health threat. Specific details implementing this provision were developed by the work group for inclusion in the Operation Plan
TUBERCULOSIS CONTROL SEXUALLY TRANSMITTED DISEASE CONTROL SUBSTANTIAL EXPOSURE TO BODILY FLUIDS COMMUNICABLE DISEASE CONTROL ISOLATION AND QUARANTINE BIOMEDICAL WASTES EMERGENCY RESPONSE
If a Party TG has adopted a public health code that addresses the specific public health response, then the Party HD exercises the grant of authority in conformance with tribal, as well as the adopted or applicable federal, state or local public health laws. If there is a conflict between or among the legal requirements, the Party HD may decline to accept, or withdraw its acceptance of, the authority
Issue: How do the parties resolve disputes between them, and what effect does tribal sovereign immunity have on the process? The attorney representing the Suquamish Tribe proposed dispute resolution through direct discussions, mediation, and binding arbitration. Arbitration award enforceable by Tribal Court or Federal or State Court Tribal limited waiver of sovereign immunity granted solely for purpose of dispute resolution and as limited by process set forth in agreement. This proposal was accepted by the work group.
All governments considered the MAA over summer 2009 Attorney reviews, as well as reviews by insurance providers, admin committees, tribal councils, BOH and BOCC LHOs were asked to make presentations to some Tribal Councils in fall 2009 All governments signed the agreement as of January 2010 First agreement of its kind: Groundbreaking work Dedicated, diligent work group
Work group formed including representatives from all MAA participating governments Meetings March through August 2010, and an additional teleconference in September 2010 Five attorneys representing tribes and LHJs attended several meetings, reviewed the Plan and participated in preparation of BOH and Tribal Council Resolutions
At the same time that the parties are determining the scope of the emergency, that is, whether it is low, moderate or high level of severity, they must also think about what laws will apply and whether the tribal government wants to exercise its own tribal public health authority or offer to grant authority to the health department or district.
BOARDS OF HEALTH TRIBAL COUNCILS Boards of Health are considering resolutions now that authorize health officers to make the initial decision to accept or deny a tribal offer of grant of authority. These resolutions will be attached to the Plan as appendices. Tribal Councils decide at the time of the emergency whether they want to grant public health authority to the health department or district. A model tribal council resolution is attached as an appendix to the Plan for use at the time of the emergency.
Party HDs and TGs consult re: whether tribal code has been adopted and what specific laws the Tribal Council may choose to adopt temporarily to respond to the emergency. The parties also consult regarding the appropriate duration of law adoption given nature of emergency.
If Tribal Council adopts the resolution, a certified copy is given to health department/district. Health Officer decides whether to accept the tribal grant of public health authority. If accepted, tribe informs enrolled members and other People on Tribal Lands of the adoption of the resolution, its scope and duration. Health Officer seeks affirmation by BOH at next meeting, but previous actions taken valid regardless of whether affirm. Health Officer and Tribal Governments may rescind or withdraw the tribal grant of authority at any time. If needed, tribe may extend duration of resolution.
The Plan provides that Authorized representatives, those people who are authorized to make or agree to requests for assistance (or know how to contact the decision-maker in the emergency) are listed on the Washington SECURES website.
Low level, moderate level or severe level Parties consult to determine level Example of low level is training or technical assistance For low level, parties can decide whether to seek a mission number
Example: an event that impacts a single health department or tribe The parties emergency operation plans must be activated The parties must operate under the incident command system The parties must seek and obtain a mission number from the state EMD (health departments or districts seek them through their county departments of emergency management; tribes can seek them directly)
Disaster impacts multiple jurisdictions or causes significant impacts that overwhelm response structure of a Party HD or TG
In events of low or moderate severity, the parties can request assistance directly from one another, take the necessary steps set forth in the Plan, and then complete the resource request form In events of high severity, a single coordination and receiving point for all mutual aid requests may be established, called the Local Mutual Aid Team (LMAT)
LMAT activated following conference call with Party HD and TG representatives and DOH to assess incident and need LMAT staffed by one or two Party HD or TG personnel LMAT activated under mission number LMAT receives requests for aid and matches resources to needs May use form in Appendix 5
Contacts made by ARs or designees Form is in Appendix 4 Part 1: Filled out by Requesting Party HD or TG (The Request) Part 2: Filled out by Assisting Party HD or TG (The Response) Part 3: Filled out by Requesting Party HD or TG(The Acceptance) Must complete form fully before departure of Assistance, if possible, or unless electronically or logistically impossible to do so
Staging and deployment Deployment briefing contents Worker registration Demobilization License/Credential Requirements Reimbursement Recordkeeping
Appendices 1A and B: Definitions; Acronyms Appendices 1C,D and E: BOH Resolutions Appendix 1F: Partial List of Laws Appendix 1G: Model Tribal Resolution Appendix 2A: LMAT Responsibilities
Appendix 2B: Requesting Party HD Mobilization Process Checklist Appendix 2C: Assisting Party HD Mobilization Process Checklist Appendix 2D: Assisting Party HD s Demobilization Process Checklist Appendix 3: Authorized Representatives (now on SECURES) Appendix 4: Resource Request Form Appendix 5: Mutual Aid Resource Tracking Form
The health departments and tribes are now scheduling training sessions in anticipation of participation in a statewide exercise in 2011.
Susan Ferguson Phone: 206-909-0613 Email: sferguson222@msn.com
