This case study examines who participated in a state rulemaking process, when and how they were engaged, and what difference their involvement made. This case—the Washington State Ergonomics Rule—is the only rule in state history that was overturned by citizen initiative. Its development became a classic struggle between labor, seeking a safer workplace, and management, which called it a "job-killing" rule. The two sides were unable to resolve their difference during a 1999-2000 public participation process. The Building Industry Association of Washington (BIAW), a disgruntled but well-financed party, left the deliberative forum and went directly to voters through the initiative process. In a media vacuum, the BIAW filled the airwaves with ads that scared potential voters and may have swayed a majority. The Ergonomics Rule was the first time this happened in Washington State, but it may not be the last. The outcome of 2003's Initiative 841 can be viewed through several lenses: truth in initiative gathering and campaigning, the role of news coverage in campaigns, the role of money in elections, the role of misinformation in the outcome of a tight election, and ideas for reform of the rulemaking and initiative processes. Despite a long-held preference for rulemaking, situation-specific deliberations may work better for "wicked" public health problems, those with complex social and scientific roots. This case study uses both quantitative and qualitative methods, and fills a gap in the literature by linking rulemaking and citizen initiatives.