Transcript Slide 1

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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: [email protected]
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THE OLYMPIC REGIONAL
MAA AND OPERATION
PLAN:
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HISTORY OF THE TRIBALLHJ MAA DEVELOPMENT
PROCESS
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STATUS OF AGREEMENT
TODAY
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OPERATION PLAN
DEVELOPMENT AND
IMPLEMENTATION
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Seven tribes and three LHJs located in close proximity
on the Olympic Peninsula:
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Hoh Tribe
Jamestown S’Klallam Tribe
Lower Elwha Klallam Tribe
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:
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 Interdependent region of state
 Strong existing relationship between LHJs and Tribes
 Recognized need for coordinated public health response
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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
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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
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CDC Menu of Suggested Provisions
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LHJ Inter-Jurisdictional Mutual Aid Agreement
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Lummi Nation/Whatcom County Health
Department draft MAA, deals with isolation and
quarantine issues
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Portions of 1996 draft MAA prepared by Dr.
Locke related to day to day public health
operations
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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
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In all MAAs, definitions are
extremely important!
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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
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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
PARTICIPATION
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
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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
Party requesting aid
responsible to seek issuance
of mission number from state
EMD
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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
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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.
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
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OPTION ONE
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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
OPTION TWO
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
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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
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TUBERCULOSIS CONTROL
SEXUALLY TRANSMITTED DISEASE
CONTROL
SUBSTANTIAL EXPOSURE TO BODILY
FLUIDS
COMMUNICABLE DISEASE CONTROL
ISOLATION AND QUARANTINE
BIOMEDICAL WASTES
EMERGENCY RESPONSE
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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.
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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
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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
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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
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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
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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.
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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.
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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.
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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
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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)
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Disaster impacts
multiple jurisdictions or
causes significant
impacts that
overwhelm response
structure of a Party HD
or TG
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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
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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)
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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
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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
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Staging and
deployment
Deployment briefing
contents
Worker registration
Demobilization
License/Credential
Requirements
Reimbursement
Recordkeeping
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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
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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.
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Susan Ferguson
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Phone: 206-909-0613
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Email: [email protected]