When the Tri-County Health Department announced that it would mandate masks across Arapahoe, Adams and Douglas counties starting July 24, Douglas County had had enough: On July 10, its attorney told Tri-County that Douglas County intended to withdraw from the department after more than fifty years, giving the required one-year's notice.
While the move caught many by surprise, Douglas County's ties to Tri-County Health Department had been unraveling for decades.
The impending divorce for irreconcilable differences will mark the end of a relationship that goes back to the 1960s. When the South Platte River Flood devastated parts of sparsely populated Douglas County in June 1965, the Douglas County Board of Commissioners decided to join the large health department that covered adjacent counties, and formally became a member of Tri-County Health in 1966.
The health department, which comprised Adams, Arapahoe and Jefferson counties when it formed in 1948, had room for another county: In 1958, fast-growing Jefferson County left to create its own health department.
In the decades since Douglas County joined the department, the population it served continued to explode. Today, Tri-County offers public-health services for a swath of Colorado that now holds over 1.5 million residents. Douglas County has gone from a population of just under 5,000 in 1960 to over 350,000 today.
With growth came growing challenges...and disagreements.
"I do think it’s fair to say that there have been disagreements that have emerged, really over decades, of Douglas County leaving the health department," says John Douglas, executive director of Tri-County. He notes that while population growth was a factor, there have been other divisive issues.
"Over the last three or four years, it’s become bluntly more political — not dissimilar to the national partisanship," Douglas explains. "They say, 'Gee, we're a pretty conservative county, we're pretty Republican in an arrangement with counties that are less conservative, and we're subject to the same nine-person board of health.'"
Most Colorado counties have their own health departments. Some, such as counties in the northeast corner of the state, gang up to form a regional health department. There are definite benefits to regional departments, including economies of scale that help keep costs low. The downside, at least according to elected officials in Douglas County, is that regional health departments can dilute local control of public-health decisions.
Sixteen years ago, Douglas County got serious about exploring a divorce from Tri-County, even setting up a committee to review the possibility.
"In the final analysis, they felt that they were getting an extraordinary amount of service at an extraordinarily low cost," says Richard Vogt, the health department's executive director from 2001 to 2013. "What they found in that particular study in 2004 is, if they were to establish their own health department, it would cost them three times as much money, and it would also mean that they would have to redevelop a whole health department from scratch, which would take years."
The 2020 Tri-County Health Department budget calls for a payment of $2,515,693 from Douglas County. That figure is calculated by multiplying a per-capita cost of $7.10 by the county's estimated population. Douglas County's fee accounts for about 5.5 percent of the department's total $44 million budget in 2020.
The Douglas County Board of Commissioners, which initiated the withdrawal process, says that it will have numbers on how much it will cost to form a new health department by the end of the week.
"The county already pays for office space in Douglas County for Tri-County Health," Lora Thomas, a Republican county commissioner, said on 630 KHOW's Ross Kaminsky Mornings on July 10. "We already pay over $2 million."
According to Vogt, though, office space wasn't a big factor in the 2004 estimate of a separate county health department tripling costs. "It would have tripled their operational costs, and they basically would have to rehire individuals — individuals who, right now, are very scarce already," he notes. "Epidemiologists, public health officials. This is a time when public health is being stretched to the limit."
Douglas, the department head, says that Douglas County is getting good value now from Tri-County. "As a general rule, there are likely to be enough efficiencies that it will make things more expensive for them," he says.
But Abe Laydon, another Douglas County commissioner, sees potential savings. At a July 14 Board of County Commissioners meeting, he said that eliminating duplicate services offered by both the county and the health department could be "a wonderful opportunity to save some money."
At the meeting, ten residents of the county spoke against splitting off from Tri-County. "An exploration as to the most cost-effective measures will actually continue to be the case," Laydon assured them. "The big difference from my vantage point is a strong recommendation based on science, which I urge, and a mandate which could subject our citizens to fines or criminalize them."
Even if setting up its own department could be costly for Douglas County, elected officials value the autonomy the move would give them over public-health decisions.
In March, after Tri-County Health issued a "shelter in place" order to combat the spread of COVID-19, Republican state lawmakers from Douglas County asked the Board of County Commissioners to cut ties with Tri-County.
"It is our understanding that at least two of you opposed this heavy-handed application of governmental power," the lawmakers wrote. "To those who did oppose the action, thank you for standing for the Constitution and with the majority of your constituents here in Douglas County. We consider it unacceptable that a contracted health agency could somehow ignore the will of a majority of our elected and accountable Douglas County Commissioners."
That rebellion was temporarily quelled when Governor Jared Polis issued a statewide stay-at-home order. But even Polis has not made masks mandatory — though he's certainly recommended them strongly — and when Tri-County's mask mandate came down earlier this month, that was the final straw for Douglas County commissioners.
Ironically, Douglas had recommended to the Tri-County Board of Health that Douglas County be included in the mask mandate only if the Douglas County Board of Commissioners chose to opt in, since Adams and Arapahoe counties had far more COVID-19 cases.
"There is a distinction," Douglas acknowledges. But his recommendation was overridden by the Board of Health, which on July 9 voted 5 to 4 in favor of a mask mandate for all three counties, with unincorporated parts of counties and individual municipalities having the option to opt out.
Instead, all of Douglas County is opting out, in favor of going its own way.
"This [Tri-County] Board of Health has told us, they don’t care what our needs are. So we are going to create the Douglas County Board of Health that is responsive to the needs of our citizens," Thomas told Kaminsky on his radio show. "Our citizens know how to take care of themselves in Douglas County."
And now the Douglas County Board of Commissioners appears set on taking care of those citizens through a new health department.
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Not every citizen agrees on this course. Ethan Reed, a seventeen-year-old senior at Legend High School in Parker, recently started an online petition to get Douglas County to stay with Tri-County Health.
"I just personally believe they aren’t taking this virus seriously and its risks," Reed explains. "I believe their actions are putting our lives and my community in danger."
Tri-County's Douglas is concerned, too. "I was particularly disappointed that they chose to make this decision really without any notice in the middle of a pandemic, the worst public health crisis in any of our living memory," he concludes. "It will clearly take a lot of effort to work out a meaningful transition. And we don’t have a lot of extra bandwidth to work on that right now."
The Douglas County Board of Commissioners will host a virtual town hall at 4:30 p.m. today, July 15, to discuss the decision to withdraw from the Tri-County Health Department. John Douglas, the executive director of the health department, will also participate. Learn more here.