What's the Prognosis for the Tri-County Health Department?

While Douglas, Arapahoe and Adams counties have been partners in the Tri-County Health Department for over a half-century, the COVID-19 pandemic has unraveled the ties between the three entities.

After Tri-County issued a mask mandate in early July, Douglas County gave a year's notice that it would be withdrawing from Tri-County, with the intention of forming its own health department. If it does, that move would throw the future of Tri-County, which currently serves over one and a half-million people, into uncertainty.

Here's what could result:

A full breakup, with each county getting its own health department:

The July 10 letter sent by the Douglas County attorney to Tri-County at the behest of the three Douglas County commissioners got straight to the point: "Douglas County intends to withdraw from the Tri-County Health Department."

But establishing a new county health department is a daunting proposition at any time, let alone during a pandemic. Tri-County offers a sweeping array of programs and services, from immunizations to restaurant inspections, and matching its level of service would be difficult. Even the Douglas County commissioners express their overwhelming appreciation for the staff at Tri-County. However, they were upset that the Board of Health that oversees Tri-County had voted to include Douglas County in its mask mandate (which was soon superseded by Governor Jared Polis's statewide order for mandatory face coverings).

In particular, the Douglas County commissioners felt that they hadn't been adequately represented by the Board of Health, since the provisions of that mandate went against not only their own preference, but also the advice of John Douglas, the department's executive director, who'd recommended that Arapahoe and Adams counties be included, while Douglas County could be given the choice of opting in.

But while Douglas County has been most vehement about its dissatisfaction with Tri-County, some officials in Adams County also want out.

"I’ve been wanting our own health department for about five years," says Eva Henry, an Adams County commissioner. Unlike Douglas County, whose three commissioners are all Republicans, all five of Adams County's commissioners are Democrats. (Arapahoe County is split between Democratic and Republican commissioners.)

According to Henry, the lack of political alignment between the three counties has created tension over certain issues, such as family planning and mental health funding.

"The values in Adams County were totally different than in the other two counties," Henry says, who adds that she "totally understands where Douglas County is coming from, but during a pandemic is not a time to be leaving your health department."

The counties aren't just divided by politics. The average median income in Adams County hovers around $70,000, while Douglas County's is closer to $120,000.

"That means that we just have higher populations of need," says Emma Pinter, another Adams County commissioner. "We have needs such as access to medical care, making sure that the medical care that our residents receive is high quality, and that they're receiving medical care in their native language. If you have a county where the average median income is $120,000 a year, one could speculate that access to medical care isn’t as much of a concern."

A full breakup with some new partnerships:

While the counties comprised by Tri-County may end up going their own way, that doesn't mean that partnerships have to end. After all, health departments in southwestern, southeastern and northeastern Colorado all comprise a number of counties.

"In the rumor mill, some people have said, 'Hey, maybe Broomfield, maybe Jefferson County,'" Henry says of potential partnerships for Adams County.

As for Douglas County, when Tri-County issued a shelter-in-place order in March, some Republican state lawmakers suggested that the commissioners explore joining the health department for El Paso County. That county more closely matches some of Douglas County's values; most notably, both counties are red politically.

Douglas County leaves, while Adams and Arapahoe counties stay:

Tri-County has gone through different formations before. In 1948, Adams, Arapahoe and Jefferson counties partnered to form the Tri-County Health Department. In 1958, fast-growing Jefferson County left to create its own health department. After Tri-County operated for eight years in a bi-county partnership, then-sparsely-populated Douglas County joined the fold, once again creating a health department trifecta.

The lineup could shift again after Douglas County leaves, if a nearby county determines that it could save money or simply get more bang for its buck by joining Adams and Arapahoe counties in the Tri-County partnership.

Or Adams and Arapahoe counties could ride it out as a two-party partnership. "I feel like the Douglas County commissioners have given us no choice," says Pinter. "At the bare minimum, we would have to completely restructure the Tri-County Health Department at a time when we’re facing the largest global health pandemic that we’ve seen in a hundred years."

Douglas County creates its own board of health, but contracts with Tri-County for services:

Current Douglas County commissioner Lora Thomas, who is running for re-election, would like to see the county create its own board of health, but continue contracting with Tri-County for services.

"There’s an incentive for Tri-County to work with us. Because we want services; we just want the control of those services coming from Douglas County residents, not Adams County representatives," Thomas told Westword on July 17. "I’m going to keep working on a deal. I believe there’s a deal to be done that will benefit both Tri-County Health and Douglas County citizens."

"If that's what Douglas County is proposing, we'd definitely consider it," says Jeff Baker, a Republican Arapahoe County commissioner. "It seems like a fairly reasonable proposal. We’d have to see the details, of course, but we’d definitely consider that."

But while Thomas once supported the idea of continuing to contract with Tri-County for services even after Douglas County leaves the partnership, she's become less specific. "We would like to see a proposal that’s a win-win for everybody be developed soon so that everybody can continue taking care of our citizens and businesses," Thomas now says.

A win-win proposal might not be so easy to push through, however. "If Douglas County thinks this puts them in power for negotiations, well, there’s no longer a Tri-County as of July 2021, so it doesn’t put them in a position at all to negotiate," says Adams County commissioner Henry.

And Dr. Richard Vogt, former executive director of the Tri-County Health Department, doesn't believe such an arrangement would be tenable. "It just does not exist throughout the U.S.," Vogt says. "It needs to be an agreeable agreement between the entities, so that everybody feels like they are being treated fairly. I’m talking about all three counties. This is not a situation where it’s a pick-and-choose-type scenario."

Democrats win a majority on the Douglas County Board of Commissioners and try to stay in Tri-County:

The two Democrats running for open seats on the Douglas County Board of Commissioners have been sharply critical of the county's decision to begin withdrawing from the health department.

Lisa Neal-Graves, who is running for a seat being vacated by term-limited commissioner Roger Partridge, believes that the decision to begin withdrawing from Tri-County Health was all about political expediency, and calls it an "atrocity." She says that Douglas County should have done its research before deciding to opt out.

Darien Wilson, the Democrat running against incumbent commissioner Thomas, also believes that the decision to leave was "politically motivated," terming it "foolhardy." She wants Douglas County to stay in the Tri-County Health Department partnership, "if they'll have us back."

Some commissioners in the other Tri-County counties are willing to consider Douglas County rejoining the fold. "I’m open to those conversations, but all four of my colleagues would have to be open, too," says Pinter.

Republicans maintain a majority in Douglas County, but reconsider departing Tri-County:

Even if Republicans retain control of the Douglas County Board of Commissioners, they could decide that the negatives outweigh the positives of pulling out of Tri-County.

Like commissioners in Arapahoe and Adams counties, they seem generally satisfied with the services provided by Tri-County. While politics have complicated matters, after the election the practical benefits of staying with the agency might outweigh any political points scored by leaving the award-winning Tri-County Health Department.

According to Thomas, Douglas County doesn't yet know the cost of forming its own health department; staffers are still crunching the numbers. In the meantime, she notes, "Everybody is at the table working together, so that we have a good, good outcome for citizens, agencies and our businesses."

During Vogt's tenure as executive director, a study showed that if Douglas County were to form its own health department, its operational costs would triple. If the current analysis shows the same losses of economies of scale, Douglas County could definitely reconsider leaving.

And current executive director Douglas, whose staffers are worried about job security if Douglas County splits off, would definitely be open to keeping the three-county setup intact. And in the meantime, he says, "We are absolutely still serving Douglas County as a health department. We consider that to be our obligation."