As Tri-County Health breaks up, different approaches play out in Douglas, Adams, Arapahoe counties

Price tag of new health agencies will vary

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The embattled Tri-County Health Department lists 10 staff members as its “executive team,” a collection of leaders that oversee priorities like emergency preparedness, disease surveillance and environmental health.

Arapahoe County has scooped up six of those leaders — plus Tri-County’s former director of nursing — to work for its upcoming single-county health department as Tri-County prepares to dissolve at the end of this year. Adams County will absorb one of those 10 leaders, plus Tri-County’s former policy expert.

Douglas County has not hired any of those key Tri-County staff members.

Dr. John Douglas, head of Tri-County, says he doesn’t think the politics surrounding Tri-County’s decisions on the pandemic played a role in general in determining which counties the health agency’s high-level staff will end up working for.

But the disparity is one example of how the new health departments among the three counties are likely to shape up in different ways as the decades-old partnership fades away, fractured largely by Douglas County’s disagreements with Tri-County over COVID-19 policies.

While Tri-County’s breakup began with Douglas County’s exit, Adams County’s elected leaders have shown enthusiasm in leaving — though that’s not due to an opposition to Tri-County’s mask mandates earlier in the pandemic.

“Adams County, we’re in a growth period right now — we’re in a position financially where we have the resources to stand up our own health department,” said Lynn Baca, an Adams County commissioner who called the transition a “once-in-a-lifetime” chance and a door to better fulfilling the unique needs of county residents.

Large difference in staff numbers

The process of the three counties pulling out of Tri-County began with the Douglas County commissioners, who decided to immediately leave the health agency last September after months of disagreements over COVID-19 protection measures. Douglas County formed its own health department and decided to contract to continue receiving many public health services from Tri-County until at least the end of this year.

Tri-County — the public health agency for Adams and Arapahoe and formerly Douglas counties — became a magnet for attention during the earlier stages of the coronavirus pandemic as it issued mask mandates for schools and the general public. But Tri-County’s regular work includes providing no-cost cancer screenings, overdose prevention, free nurse visits, restaurant and child care facility inspections, and other services, according to an Arapahoe County news release.

Among the several Tri-County leadership staff who will come aboard the Arapahoe County health department, Jennifer Ludwig, who served as Tri-County’s deputy director, will take the helm as the Arapahoe County health department's new director.

Asked whether there was a collective sense among Tri-County leadership that they wanted to work in Arapahoe County because of how much that county aligned with Tri-County leadership amid the pandemic, Douglas, the health chief, said: “That may have played in the thinking of some people, but I don’t think it was a general theme.

“I think people were more interested in ‘Where do I currently live?’” Douglas said. He added: “It’s probably based in part of the perception of ‘Who am I going to work with, who’s my boss?’”

Baca echoed that, saying: “2020 kind of threw all of us on our ear, and people are looking at work-life balance, and I think it was proximity to employment” that factored into staff’s decisions.

Though the Douglas County Health Department hasn’t announced high-profile hires of former Tri-County staff, the new department will absorb a small number of employees from the outgoing agency.

“To date we have hired two people from Tri-County. Expect probably about 10 more,” a statement from Douglas County said. 

The Douglas County Health Department has floated a possible staff organizational chart consisting of about 35 full-time employees and two contractors, according to an April 19 work session with county commissioners.

The upcoming Adams County Health Department, meanwhile, plans to hire a total of about 170 employees, though that number could change, according to Baca.

“We have at least 60 staff members coming over from Tri-County Health in various positions,” Baca said.

Asked how many lower-level Tri-County Health employees are expected to work for the Arapahoe County health department, Arapahoe County said in a statement: “We don’t have specifics yet, but as mentioned, hiring staff is a top priority for (Arapahoe County health) leadership, and Tri-County employees certainly have a lot of relevant experience and expertise.”

Staff shortage squeezing agency

Douglas, the health chief, has said internal polling has shown a vast majority of current Tri-County staff have shown interest in moving to one of the new county-run health departments and expressed optimism that there would be a significant carryover. But Tri-County itself has become thinner.

“Every place saw the great resignation going on, and we weren’t immune to that," Douglas said . “Last year, we probably were running 30% to 40% more staff choosing to leave than previous years."

The loss of staff has “certainly had an impact” on Tri-County’s services, Douglas said.

With “restaurant inspections, we’ve had to do some triage,” Douglas said. “We’ve had to prioritize riskier settings.”

Tri-County has seen longer wait times for its clinics, said Douglas, adding the health agency had to make some reductions in its sexual health clinics. That area includes family planning, contraceptive services, and sexually transmitted disease and HIV testing services, Douglas said.

Asked whether Tri-County is in danger of having to stop some services before the end of the year when the health agency is formally scheduled to end operations, Douglas said: “I don’t see any in particular that would be predictable that we would have to stop.”

Last year, Douglas County commissioners quickly formed the county’s new health department — giving the county autonomy on public health orders such as mask mandates — but the county also decided to contract to have Tri-County provide all public health services, such as restaurant inspections and clinical matters, through the end of 2022.

But the Douglas County Health Department has already begun taking some services into its own hands. The county health department oversees vital statistics and emergency preparedness and response, and it will soon take over environmental health services and WIC, the federal grant program, Special Supplemental Nutrition Program for Women, Infants, and Children.

Any other services are to be fully transitioned by mid-December, according to a statement from Douglas County.

In the other two counties, officials said they have not heard concerns that Tri-County would be unable to perform through the end of the year.

“We haven’t seen any indications that it won’t be able to do so,” said Luc Hatlestad, an Arapahoe County spokesperson.

Costs, services may differ

To start their own public health agencies, Adams and Arapahoe counties could run into costs up to millions of dollars each, according to a consulting firm that studied the benefits and drawbacks of the counties' potential decisions to handle public health services alone.  

“In the short term, separate, single county public health agencies would have access to less public health revenue, and perhaps services, and would incur transition costs for start-up and (the) dissolution of TCHD,” the Oct. 12 report by the Otowi Group says.

Working together in a two-county “district” public health agency would potentially make Adams and Arapahoe more competitive for grants and contracts, the report says.

Despite the potential chance at savings, the counties appear locked into going their separate ways.

“After Douglas County exited the partnership, we were moving ahead with setting up a two-district agency, but after Adams also withdrew that was moot, and that’s when we shifted our focus to a single-county health department,” Hatlestad said. “The motivations behind the Adams decision are still not clear to us.”

Differences of opinion on public health policy didn’t just arise amid the pandemic, Adams County commissioners have told Colorado Community Media.

Asked whether there are moments during the pandemic she looks back on and wishes Adams had its own health department, Adams County Commissioner Eva Henry has said: “Almost weekly.” She said she wanted to have the conversation “long ago” of Adams having its own health agency.

“Once a year, all the county commissioners get together and they talk about the budget” in the three counties, Henry told Colorado Community Media in October. “And talk about what we'll fund and not going to fund. With Arapahoe County's budget restrictions they have, and Douglas County's views, it made those decisions very hard.”

Adams has different budget policies than Arapahoe County because Arapahoe is “not de-Bruced,” meaning the county has different restrictions under Colorado's Taxpayer's Bill of Rights, Henry said.

“We have different factors that affect our citizens in Adams County — we have air pollution, citizens working in industrial jobs. We’re addressing poverty. We have homelessness,” said Baca, noting Douglas County does not encounter those issues as much as other counties.

Adams County going alone on public health “had nothing to do with the pandemic or masking,” Baca added.

Adams County's contribution to Tri-County Health's 2021 budget was $3.8 million, Arapahoe County's contribution was $4.8 million and Douglas County's contribution was $2.6 million, according to Tri-County.

The net cost for the first year of Adams County’s own health department could total around $11 million to $13 million, Baca said.

“Our first year out, we’re looking at it’s going to be approximately 20 to 25 million dollars, with an estimated 12 to 14 million dollars in grants,” Baca said.  

Arapahoe County Commissioner Nancy Sharpe has said the county's own health department will likely cost the county around $5 million per year, possibly even more.

"We anticipate that it will be more, we just don’t know how much more at this point," Sharpe said. 

Officials in Douglas County, whose health department is likely to be much smaller than those of the other two counties, expect to keep costs down.

“We anticipate that the new DCHD with services tailored to the needs (and) expectations of our county will ultimately cost less per year than $2.6 million,” the county said in a statement.

Douglas County’s new public health director, Michael Hill, has told Colorado Community Media the county’s health department will adopt the same fee structure as Tri-County for this year but may consider suggesting fee changes next year.

Asked whether fees for public health services will be higher under the Adams County Health Department compared to what the fees for the same services were under Tri-County, Baca said Adams County leaders haven’t discussed that level of detail during meetings.

She anticipates “that we would maintain the fee structure at least starting out. And then that would be a (future) board of health decision to make,” Baca said, referring to the upcoming policy-making body for Adams’ new department. She added: “We’re not looking at this decision to adversely affect any of our residents.”

At this point, Adams County is not looking at cutting any traditional services offered by Tri-County, Baca said.

Sharpe has said county residents should expect services to be offered through the county's new department, but depending on staff and budget constraints, certain services may not be at full capacity during the department's early days. 

According to Hill, Douglas County "will not directly provide any clinical services." The Douglas County Health Department’s proposed staff organizational chart, included in a June 14 Douglas County commissioners meeting, showed clinical services as planned on a contract basis. Hill has said that the clinical services could include vaccines, sexually transmitted disease protection and family planning. 

“Clinical services will be provided by others through yet-to-be-finalized agreements and will be available within Douglas County,” the county said in a statement.

A $50 million question

Looming over the cost of leaving Tri-County is an alleged $50 million fee Tri-County Health and the counties may owe to another government body.

At issue is a payment that the health agency may eventually owe to the Colorado Public Employees’ Retirement Association, or PERA, which provides retirement and other benefits to employees of government agencies and public entities in Colorado.

Members of PERA include public school teachers, many university and college employees, judges, state troopers, and other types of public employees.

If Tri-County Health is “allowed to withdraw from PERA without paying the withdrawal liability, all PERA members and employers will be negatively impacted,” a complaint in a lawsuit filed by the retirement association said.

Douglas County’s statement to Colorado Community Media said: “It is our position — and that of all three counties — that county citizens are not liable for that debt as none of our elected officials ever agreed to be part of PERA.”

But it added: “If the counties have to pay for any aspect of the dissolution of TCHD then Douglas County will pay its fair share.”

Health agency locations may remain

Once the three counties’ health departments are fully underway next year, residents will likely visit familiar locations for public health services.

“On our existing Tri-County locations, the county health department will be assuming those leases,” Baca said, so residents can visit the same locations they already know.

Arapahoe County already owns some of the Tri-County properties within the county — in Englewood and in Altura Plaza in Aurora, according to Hatlestad.

“We haven’t purchased or leased any other properties or equipment yet, but determining that is on the new leadership’s to-do list,” Hatlestad said.

As of spring, the Douglas County Health Department had begun to move into a facility in Castle Rock partially used by Tri-County currently. The agency also had plans to take over a Tri-County office, located inside the county Department of Motor Vehicles building in Lone Tree, sometime after Oct. 1. 

Reporters Elliott Wenzler and Robert Tann contributed to this story.

Tri-County Health Department, Arapahoe, Douglas, Adams, Colorado, COVID-19

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