Not long after Douglas County commissioners announced that the county would withdraw from the Tri-County Health Department amid the COVID-19 pandemic — a decision that sparked an outpouring of comments from county residents — commissioners began discussions with the department about the possibility of staying with the agency, according to Tri-County’s top official and a county commissioner.
Now, Tri-County and all three of the counties it serves — including Adams and Arapahoe — are working to find a way they could all remain together, officials told Colorado Community Media.
“We’re all in discussions. We’re trying to figure out what are the best interests of all three counties and Tri-County Health,” Commissioner Lora Thomas said in an interview last week.
In an Aug. 13 meeting, Tri-County’s board of health created a committee to explore whether its bylaws could be changed to appease Douglas County, said agency Executive Director Dr. John Douglas, who also confirmed that talks with county officials are underway.
“It’s not clear whether or not what would make Douglas County comfortable will work for the other counties,” Douglas said in an interview. “The other counties have to be convinced that whatever change might be proposed would work for them.”
Douglas County announced July 9 that it would be splitting from Tri-County Health Department, a day after the agency’s board voted to approve an order requiring the wearing of masks in public in Douglas, Arapahoe and Adams counties.
MORE: The child and the barking dog — Inside Douglas County's split with Tri-County
At the time, commissioners cited objections to the mask order being imposed by a non-elected health board. At a July 14 county meeting, Commissioner Abe Laydon complained about "a mandate which could fine or criminalize” people not wearing masks, although he also said he supported the voluntary use of masks.
But in last week's interview, Thomas said the county's move "has nothing to do with masks. The decision for the county to withdraw from Tri-County Health was based on our need for governance and policy making autonomy.”
Commissioners voted to leave Tri-County at a work session, not a regularly scheduled board meeting. The meeting was posted 24 hours in advance and, like all work sessions, was not recorded. No minutes or summary were taken and no members of the media were present, according to a spokesperson.
Thomas said that the commissioners decided to split from Tri-County because the agency's board of health went against recommendations from Douglas, the TCHD chief, about the need for a mask order in the county. But in an interview, Douglas responded that the board did not go against his advice.
“I’ve tried to explain to Douglas County the inaccuracy of that,” he said. “The accurate version of events is that I thought a (mask) mandate would be useful in all three of our counties ... but that the mandate could be differently framed based on the incidence rate in each of our three counties.”
Thomas said that Douglas did not believe the county needed a mask order, but Douglas clarified that while he thought the order would be helpful, he thought it should be carried out differently so that elected county officials felt more in control of the decision.
“I didn’t think that (Douglas County didn’t need a mask order.) I didn’t mean to communicate that. I don’t think I did communicate that,” Douglas said. “I do believe when the governor issued his mandate, everybody benefited, including Douglas County.”
After Tri-County Health announced its mask order, Gov. Jared Polis imposed a 30-day statewide mask-wearing requirement applying to indoor settings. Last week he extended that order another 30 days.
While the county negotiates with Tri-County, the health department will still provide its citizens with health services, Thomas and Douglas said. Those services will be available from Tri-County until at least July 11, 2021, based on the county’s withdrawal letter.
No timeline has been outlined for when a decision will be made regarding Douglas County’s future public health services.
“I don’t think the timeline is as critical as getting a good outcome,” Thomas said when asked about specific timing.
When the county attorney’s withdrawal letter was first submitted to Tri-County, Douglas said he believes that most people took it “at face value." Based on the state statute cited in the letter, the county was required to give a full year’s notice and then either form their own health department or join a different department.
“The assumption (was) that they would have been planning to create their own health department because they’re required to have a health department by statute,” Douglas said.
But before long, he said, county officials reached out to discuss a possible compromise, which would allow them to stay within the health department.
“Within a week or two after that, there began to be discussions of what the future could look like,” Douglas said.
But in last week's interview, Thomas implied that the letter informing Tri-County of the county’s plan to leave did not necessarily mean the commissioners actually intended to do so.
“That was part of a statutory requirement that we needed to make. So we followed the law,” she said. “But what’s important is the outcome. And we are working to make sure that outcome works well for (the health department and its three member counties)."
When asked if the intention of the letter was to gain leverage in negotiations, Thomas did not answer the question directly but said: "Everybody has opportunities to win through this discussion.”
Soon after the separation decision was announced, the county held an open meeting to allow citizens to comment on the decision. All who spoke voiced opposition to the decision.
“I do not support the Douglas County commissioner's clearly partisan, political decision to sever ties with the Tri-County Health Department” and the decision to opt out of the mask order, said one speaker, Brian Clarke of Highlands Ranch.
Two Democratic candidates for county commissioner in November's election have also criticized aspects of the Republican incumbents' Tri-County pullout plan, saying that forming a new health department during a pandemic and within the time frame of a year could be challenging.
While no official steps appear to have been taken to form a new health department, commissioners won’t officially rule out that possibility. When asked if that option is still on the table, Thomas said: "Right now we’re really focusing our efforts on these discussions with the counties and Tri-County to see if we can find a resolution now that works well for everybody."
If the county does decide to move forward with a new health department, there are multiple steps that will need to be taken before the relationship with Tri-County is severed in 11 months, said Glen Mays, a professor and chair of the Department of Health Systems, Management and Policy in Colorado School of Public Health at the University of Colorado Anschutz Medical Campus.
“There’s a lot of work that needs to occur,” he said. “A year strikes me as an aggressive, ambitious timeline. But not impossible.”
The county would need to decide how the health department would operate, what services it will offer, how its data analytics infrastructure would be set up, define a funding mechanism and hire a full staff, all in the midst of an ongoing pandemic, Mays said.
“The thing about standing up a new health department in a surge capacity, it’s got to pose some unique challenges,” he said. “We’re also in an economic recession where state and local revenues have really tanked and are not projected to recover very quickly.”
If the county wasn’t able to complete all these tasks in the next 11 months, the risk is that the county could be without essential services during the pandemic, Mays said.
The most recently formed health department in the state is Silver Thread Public Health District, which serves Hinsdale and Mineral counties in the southwest part of the state. It was created in 2016.
That district took two full years to get off the ground, said Tara Hardy, the district’s public health director. “We ran into some glitches,” she said about the process.
Many of these speed bumps were around how the health department would operate and be funded and required months of discussions and negotiations, she said.
Douglas County also considered creating its own health department in 2004, when then-commissioners created a committee to study the feasibility of the option.
That study recommended that the county not leave Tri-County, according to the document acquired by Colorado Community Media through a public records request.
“There are economies of scale associated with belonging to a multi-county health department,” according to the study. “We would not be able to keep the per-capita cost as low if we had our own health department.”
The study also found that a Douglas County-only health department likely wouldn’t respond as quickly or as well as Tri-County to a large-scale public health emergency or infectious disease outbreak, according to the document.
While the study recommended that the county conduct similar studies periodically, no future studies exist, according to a county spokesperson.
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