Douglas County Commissioners discuss their decision to leave Tri-County Health Department

Douglas County, Colorado — named the second healthiest county in the country — recently split from the Tri-County Health Department (TCHD) and formed their own, following months of disagreement between Douglas County leaders and those of TCHD over public health measures.

While the formation of the new department is a heavy lift, the Douglas County Commissioners told State of Reform their decision is in the best interest of county residents and they will continue to have a cooperative relationship with TCHD moving forward.

 

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Lora Thomas, commissioner for District III of Douglas County, explained the split had been a long time coming. Public health leadership disputes between Douglas and the other two counties began forming even before COVID-19, she said.

“It’s inaccurate if people think this is all just over a mask mandate.”

Thomas referenced inter-county disputes over a “controversial” 2019 sex education bill as one example. Dr. John M. Douglas, Jr., executive director of TCHD, testified in support of the bill and said he was representing the views of Adams, Arapahoe, and Douglas Counties. But Thomas said he hadn’t consulted with Douglas County on the bill and didn’t represent the county’s perspective.

“So this had been a long time coming, and it’s not just over masks. It is about a very different demographic in the populations of the counties …”

The needs arising from Douglas County’s “unique public health profile” over the last several years created a “groundswell of dissatisfaction” in the region, culminating in the Board announcing their intent to form their own health department on July 10, 2020, said George Teal, commissioner for District II.

As District I Commissioner Abe Laydon put it:

“We were getting inconsistent, top-down, overbroad orders from both the state and from Tri-County Health over the course of the pandemic that didn’t reflect unique characteristics of Douglas County. And for us, that was really problematic from a public policy standpoint, which is where our lane intersects with public health.”

Differing land use needs, for instance, made the case for an independent department, Teal explained. While Adams and Arapahoe counties both have abundant high-density urban land areas, Douglas County has none. Douglas’s most populous areas are suburban rather than urban, he said.

Teal is concerned that, due to Douglas County’s lack of urban, populous regions like the Denver-Metro area, TCHD hasn’t provided certain services to Douglas County and its entirely suburban and rural population because they don’t see it as a high priority. Douglas County residents, however, still paid for these services as part of TCHD. He also doesn’t believe Douglas county is getting its “fair share” of state and federal funds on a per capita basis.

“Our population is being used to anchor the revenue for services that we don’t have delivered here …”

Teal — who became a county commissioner in January of this year — was formerly on the Castle Rock Town Council. Frustrated with TCHD’s leadership, he and the other council members moved to form their own municipal health department in early 2020. This city-led push instead resulted in the Douglas County Commissioners announcing their intent to leave TCHD in July 2020.

“Had they not done that, it is my belief that I and my colleagues on the Castle Rock Town Council would have followed through and left Tri-County on their own, forming an independent municipal board of health as allowed by Colorado state law.”

However, following TCHD’s decision to allow member counties to opt out of public health orders in Nov. 2020, Douglas County rescinded their announcement. Teal remained skeptical when he was sworn in as a commissioner in January, saying he was concerned there was no way to hold TCHD accountable and ensure it kept its word.

The major shift happened when TCHD instituted a mask mandate for schools and child care facilities in Aug. 2021. Disagreeing with this order, the Douglas County Commissioners chose to opt out, per TCHD’s new policy, but TCHD countered by rescinding the opt-out policy. This prompted the Douglas County Commissioners to pick up where they left off and resume their maneuver to establish their own agency, adopting a resolution to do so on Sept. 7.

Under Colorado law, the county is required to give at least a one-year notice to TCHD before splitting off, but the Douglas County Commissioners said their notice of intent to leave from the previous summer remained intact.

Thomas said the “final straw” for her was when Julie Mullica, vice president of TCHD, made the motion to include Douglas County in TCHD’s mask mandate, which initially was only going to apply to Adams and Arapahoe Counties, as recommended by Dr. Douglas.

“That’s when it became very clear to me that Tri-County Health no longer served Douglas County and that we needed to have our own public health department. In fact, the next day, I made the motion that we leave Tri-County Health.”

Laydon pointed out that 49 of Colorado’s 64 counties have their own health department, emphasizing that the decision to have an autonomous Board of Health isn’t abnormal. 

“Instituting this is not unique, it’s not an unusual animal … I often say government is best [when it is] closest to the people, and that really speaks to that unique character of our county component.”

On Sept. 14, the Douglas County Commissioners appointed the new Board of Health’s members. Thomas and Teal will sit on the board, as well as Doug Benevento, Dr. Linda Fielding, and Kim Muramoto, the latter two having previously represented Douglas County in the TCHD.

The Douglas County Commissioners and TCHD signed an intergovernmental agreement (IGA) on Sept. 28. The board held their first meeting on Sept. 30, which officially established the new health department and during which the board voted to remove the mask mandate.

The IGA provides for the continuity of services between Douglas County and TCHD. Teal said it defined the terms of the obligation TCHD will have to provide public health services to Douglas County for the rest of 2021 but also through 2022. The two entities are still hashing out the details of the agreement, and Teal believes TCHD might continue to provide certain public health services to his county in 2023.

“It provides the framework for us to do the analysis [and] determine what … the public health services [are] that we’re going to want to handle in-house.”

Teal explained there are services TCHD provides that Douglas County doesn’t need, and vice versa. For example, TCHD has a needle exchange program, but Douglas County has no need for such a program, he said. 

Specifically, he believes his county will likely focus on transitioning the provision of environmental services — which represent 80% of all the services it provides to Douglas County — away from TCHD and into Douglas County. This includes restaurant inspections, the certification of health care facilities, and land use review. 

Until the county determines the specifics of providing these services individually, however, it will continue receiving public health services from TCHD while maintaining its ability to make its own decisions regarding health policy.