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Doctor's warning to Douglas County: Now is not the time to leave Tri-County Health

Splitting up a health department can be difficult
Posted at 7:21 PM, Jul 10, 2020
and last updated 2020-07-10 22:53:09-04

DENVER — After a more than 50 year partnership, Douglas County has announced its intentions to separate from the Tri-County Health Department.

Tri-County Health consists of Adams, Arapahoe and Douglas counties; the department offers more than 60 programs and services to about 1.5 million people in the region, making it the largest in the state.

What’s the point of a health department anyway?

Along with enforcing health laws and regulations, health departments are responsible for doing things like inspecting buildings, monitoring air and water quality, implementing programs to control infectious diseases, running vaccination programs and working on chronic disease prevention, among other things.

“Increasingly, counties have looked at models of banding together and coming together and pulling their resources into a district and multi-county framework,” said Glen Mays, a professor of health policy for the Colorado School of Public Health.

Creating multi-county health departments can save counties money and streamline resources in the region.

“It’s easier to support that full range of public health activities when you have a larger population and a larger tax base,” Mays said.

While there can be economic benefits, policy disagreements can cause a split between the counties.

On Thursday, Douglas County commissioners made it clear they do not support the idea of a mask mandate and are willing to leave the Tri-County Health Department as a result.

Breaking up is hard

This is not the first time Tri-County Health has been dumped; Jefferson County was a member of the original formation of Tri-County Health but decided to leave in 1958 to create its own health department.

Eight years later, Douglas County decided to join the department. Now, it’s getting ready to venture out on its own once again.

However, forming an independent health department can be difficult.

“There are a range of complexities both legal and policy wise,” Mays said. “There are standards that have to be met, there are state requirements, there are federal accreditation requirements.”

On the policy side, over the next year, Douglas County will now need to create its own board of health and figure out how that board of health is going to be comprised.

In the past, some counties have chosen to simply allow the county commissioners to serve as the board of health, however that can present its own set of challenges if none of the commissioners have a medical background.

Setting up an independent health department can also be expensive. According to the 2020 Tri-County Health budget, Douglas County contributes nearly $2.5 million, Adams County contributes around $3.8 million and Arapahoe County contributes around $4.7 million.

This translates into a per capita contribution of $7.10 per citizen.

Douglas County is much smaller than the other two counties so it contributes less. The challenge for the county will be making that $2.5 million stretch enough to cover an entire health department of its own or finding money from elsewhere to make up the rest.

“The money to run the health department comes from a mix of federal, state and local sources, and so if you can’t get a federal grant or state money, the locality has to come up with the funds,” Mays said.

That could mean higher taxes if the county can’t find all the money it needs.

A bad time to break up?

Along with dealing with all of the challenges of trying to create a new health department, the COVID-19 pandemic adds another layer of complexity.

“Even our best health departments around the country are finding that they are understaffed and under-resourced for responding to this pandemic,” Mays said.

He doesn’t think now is an ideal time for the three to break apart given the challenges and uncertainties of the pandemic, even if Douglas County's infection rate is lower.

Dr. David Beuther from National Jewish Health agrees. As a medical professional, Douglas County resident and parent, Dr. Beuther says he was disappointed when he learned about Douglas County’s decision, so he denounced the idea on social media.

“It’s a horrible message. I think there’s plenty of time in the future to talk about whether Douglas County is different enough that they should have some different health department, but the disruption this might cause,” he said. “I don’t know that you want to be making mistakes or changing horses midstream in the midst of a pandemic.”

Dr. Beuther serves as a pulmonary physician and the chief medical information officer at National Jewish Health. This year, he served on the Douglas County advisory board to help reopen schools in the fall.

He supports the mask mandate and is afraid that if people don’t start to take masks more seriously the state could need to shut down again.

“I guess what drives me is a sense of justice and fairness, and it does not seem fair that we’re going to pretend the pandemic does not exist because we have privilege or we have a little bit lower population density,” Dr. Beuther said.

He points to Denver as an example of how the mask mandate is working, saying that while cases have slightly increased there, in Adams, Arapahoe and Douglas counties, there has been a significant acceleration in the number of cases. While the numbers are still on the low-end, he says they are getting worse by the day.

“My message for the Douglas County commissioners is please reconsider and maybe get some broader views and broader opinions here,” Dr. Beuther said. “People aren’t trying to cause trouble; we’re here to help you try to do the right thing and we share the same goals. It’s just that some of us are using evidence and others are using politics.”

The split from Tri-County Health will take about a year if the county decides to follow through with the action.