For the second time in 13 days, the Tri-County Health Department board of health gathered virtually on Aug. 30 to discuss public health orders regarding whether students should be required to wear masks in school.
By the time the meeting was over, the board canceled the public health order imposed at its previous meeting, overturned an “opt out” policy it instated last year and heard allegations from a member that it was “tainted with an atmosphere of coercion.”
The furor was just the latest development in the saga of the regional health department’s woes.
Tri-County has found itself in a bind during the coronavirus pandemic as it has attempted to balance the health needs of the three counties in its jurisdiction while public health becomes an increasingly polarized topic.
The political division has created turmoil for the agency, with officials from across the region suggesting it will likely result in an imminent dissolution of the seven-decade-old department. In Aurora, which sits in three different counties, that could mean a future of increased costs, uncertainty and confusion.
For Aurora Mayor Mike Coffman, the dismantling of Tri-County Health would be, in his words, “just awful.”
“I really want to keep it together, and it’s in the best interest of the city and the taxpayers in the entire region,” he recently told the Sentinel, after sponsoring a non-binding city resolution imploring regional law and policy makers to keep Tri-County intact. “I understand that some of the decisions were controversial, but they also helped to navigate us through a very difficult time where I felt they were making the best decisions with the information they had.”
Throughout the pandemic Coffman has regularly met with Tri-County officials, who he said worked hard to keep businesses open and operating as safely as possible throughout the pandemic. More often than not, frustration came from the state health department, not Tri-County, he said.
Dr. John Douglas, the executive director of Tri-County Health handed the far-fetched task of tempering political maelstroms while simultaneously working to save lives in the past year, said he sympathizes with Coffman’s stance.
“I do understand Mayor Coffman’s frustration,” he said. “I think it would cause a headache, but it’s hard for me to say how big of a headache.”
The Tri-County Health Department was originally established in 1948 as an organ serving Adams, Arapahoe and Jefferson Counties, which at the time boasted modest populations of about 40,000, 50,000 and 55,000, respectively, according to U.S. Census data. Each of those counties now play host to more than half a million people each.
Jefferson left the collective in 1958 — setting the precedent for a Colorado county leaving an existing health department — only to be replaced by Douglas County eight years later. Officials in the county, which technically covers a small sliver of southeast Aurora, were prompted to join the larger collective after a devastating flood in June 1965 upended several communities along the banks of the South Platte River. At the time, just a few thousand people called Douglas County home, according to Census data, though the current figures pin the jurisdiction’s population just south of 380,000 residents.
The board of health is the policy making body for the department, and consists of three members from each county. Board members are appointed by their respective county commissioners to serve five-year terms. They are not term-limited and are not required to have any specific qualifications besides living in the county.
In his open support of keeping Tri-County intact amid pandemic-induced tumult, Coffman said the way in which the board is made up ensures balance and is a fair approach to public health decisions. By being appointed by county commissioners, the political will of residents is recognized on the board.
Under normal circumstances, Tri-County Health is charged with completing relatively banal tasks such as restaurant and pool inspections, administering routine vaccinations and keeping tabs on diseases like West Nile Virus that infect local mosquito populations during the summer months.
But like thousands of public health agencies across the nation, the local health entity was thrust into the forefront of political discourse last year when the pandemic began.
“I don’t know that anybody really knew there was a board of health until recently,” Arapahoe County representative and board president Kaia Gallagher said with a laugh.
The other eight board of health members declined to speak with the Sentinel.
Initially, the majority of public health orders regarding COVID-19 came from the Colorado Department of Public Health and Environment or straight from the governor’s office. But beginning this spring, Colorado shifted to a policy of “local control,” giving county health departments authority over almost all decisions regarding how to manage the pandemic.
“I’m disappointed the governor is not being more proactive as we watch delta spread,” Douglas said of the increased localization of public health decisions. “The spin-off of that is, ultimately, the buck doesn’t stop anywhere.”
That has put Tri-County in the thorny position of having to decide whether to mandate mask wearing for some or all students in the new school year.
The department initially “strongly recommended” that all students and teachers wear masks when indoors due to the increasing transmissibility of the delta variant, which now accounts for about 98% of COVID-19 cases in the state, according to Douglas. After initially declining to act on that recommendation, local districts, including Cherry Creek and Aurora Public Schools, implemented mask mandates for some or all students.
The board of health then decided to hold a public forum on Aug. 17, where it solicited input from residents about whether they would support a full or partial mask mandate in schools. About 2,000 people signed up to speak at the meeting, and another 10,000 filled out a survey the department put online, a sign of how much of a political lightning rod the issue had become.
Some speakers lambasted the department for what they saw as government overreach. Others were frustrated that school districts were not taking action to impose mask mandates and asked the health department to enact one.
After spending two hours in executive session, the board reconvened the next day, where it voted 6-2 to institute a mask mandate for children ages 2-11 in schools and childcare centers and the employees that interacted with them.
Days later, the Douglas County Board of Commissioners voted unanimously to opt out of the order. The opt-out provision was created by the board of health in November after Douglas County submitted its intent to withdraw from Tri-County altogether. The policy required Tri-County to consult with the board of health and county officials before issuing public health orders, and gave county commissioners the ability to opt out of public health orders.
As part of the policy, Douglas County committed to staying in Tri-County through 2022.
“Our leadership has spent too much time focusing over the past couple of months on trying to solve the political concerns of the Douglas County Commissioners,” representative Julie Mullica said at the meeting.
“Anti-science and anti-public health policy interference from elected leaders puts us all at risk and only fuels the partisanship and mistrust that we have,” she said.
After Douglas County opted out of the mask mandate, Adams County followed suit, with the board of commissioners voting 3-2 at its Aug. 24 meeting to leave.
Commissioner Eva Henry, who voted in favor of opting out, said that she supported the mask mandate but not the opt-out order, which she said turned health decisions into political decisions.
“The reason why three of us took that very hard vote was to push Tri-County to do the right thing and be a health department and actually issue health orders and mandates instead of putting it in the political arena and into the laps of commissioners,” Henry told the Sentinel. “ … They needed to be pushed. If we had just gone along with the orders nothing would have happened, and we would still have the opt-out.”
Arapahoe County Commissioners were slated to decide whether to also ditch the Tri-County order on Aug,. 31, but ultimately nixed the item from the agenda.
After two of the three counties voted to dismiss Tri-County’s order, the board of health reconvened for a special meeting on Aug. 30. Douglas expressed frustration both with the state’s policy of local control and the opt out provision, which he said was hindering the department’s public health mission.
“The current opt out policy has created concern and confusion,” Douglas said, asking the board to rescind the order.
The board ultimately rescinded the opt out policy and instituted a new public health order requiring all students and school district employees to wear masks. Douglas County representatives Dr. Linda Fielding and Kevin Bracken (representative Kim Muramoto was absent) voted against both orders and criticized the board sharply.
Fielding attempted to get the meeting declared void, saying that the topic did not qualify as a special meeting, and at one point accused other board members of corruption.
“This is a compromised meeting,” she said. “It’s tainted by an atmosphere of coercion.”
Fielding did not provide details about her allegations, which concerned at least one board member being under undue influence, and the board plans to meet in executive session sometime in the near future to discuss the issue.
The Douglas County Board of Commissioners was set to hold its own meeting at noon Sept. 1 to discuss how officials may handle the new mandate. The meeting was held after press deadline, and a spokesperson for Douglas County said the board would not release any official position on the new edict prior to that meeting.
The Douglas County News Press, citing conversations with Douglas County commissioners, said on Aug. 31 that the recent move by the Tri-County board of health would prompt them to accelerate breaking away from the three-county co-op and
create their own department of health.
Douglas County first declared that it would break with Tri-County in July 2020 after the board of health imposed a mask mandate across the three counties to curb the spread of COVID-19. It rescinded its intent to withdraw after the passage of the opt out policy, but in January it signaled that it intended to establish its own health department starting in 2023.
Gallagher with the Tri-County Health Board believes the impending trifurcation is a matter of when, not if.
“Douglas County has already made its intent quite clear that it’s going to create its own health department, so I think that’s already been decided,” she said.
Douglas County has hired its own consultant to look at a future with its own health department, and a recently formed ad hoc committee of residents is expected to forward its own recommendations to county commissioners by year’s end. Just last month, Douglas County commissioners penned an open letter to Aurora City Council members, raising an eyebrow at the intent of Coffman’s resolution in favor of Tri-County and underscoring that “all options are on the table.”
There have been disagreements in the past between Douglas County and other representatives — Gallagher said the county’s board of commissioners expressed frustration with the health department’s decision to support Colorado’s 2019 sex education bill — but that the decision to leave appeared to be spurred by the 2020 mask order.
Consulting firm Otowi Group is currently working with Adams and Arapahoe counties to come up with recommendations for the future configuration of the health department, with a report due Sept. 30. The results should be released to the public in mid to late October, Tri-County spokesperson Becky O’Guin said.
Henry, with Adams County, said she’s wanted her jurisdiction to leave Tri-County for years due to an inequitable division of resources that favors wealthier residents who live in generally healthier pockets of the southern metroplex and leaves residents in neighborhoods like Original Aurora in the lurch.
“The health concerns and issues in Adams County are totally different than what they are in Douglas County,” she said. “ … We’re large enough to have our own health department.”
Henry pointed to the Suncor oil refinery and the expansive network of interstates that run through Adams County as roots of longstanding respiratory issues for her constituents.
If Douglas County exits the current department, the two remaining counties can remain in partnership or each form their individual health departments.
“Teasing apart any of the three will be challenging,” Douglas said. “We’ve been thinking about how to tease apart Douglas since last summer, so we have some ideas there, but none of it’s going to be easy. With teasing apart Adams and Arapahoe, one or two could have a remnant of Tri-County serving one or both, or you could blow us up and start from scratch, or you could split us up like Solomon and the baby.”
Arapahoe County Commissioner Jeff Baker said he favors the continued pooling resources in an effort to buoy care.
“I think there’s a benefit to all three counties to remain together; I would love for us to remain together, but I don’t know if that’s something that can be accomplished,” he said. “ … I kind of see Aurora and Arapahoe County as a Switzerland. We kind of joke that we are in-between Adams and Douglas County — we’re in the middle geographically and politically.”
Coffman agrees. Among his concerns are what it would mean for taxpayers and the confusion that would come along with three different health departments having jurisdiction over different parts of the city.
Dr. Eric Hill, medical director for the Medical Center of Aurora and Aurora Fire Rescue, said splitting the city into three health departments could also spur more paperwork for certain ambulatory certifications.
“If you have a large area that has three different counties that play by different rules your really have a really challenging model to try to sort out,” he said. “ … It’s unfortunate that medicine has become such a political hot topic.”
Some officials have whispered about Aurora, as a municipality, being forced to create its own health department, a possibility both Baker and Douglas lamented. It could also prompt Aurora officials to again consider turning the city into its own county, like Denver or Broomfield.
“I would hate to see Aurora have to stand up their own health department because that’s a county responsibility,” Baker said. “That would be us shirking our duties to go to that extreme.”
So far, Coffman and city staff have said they haven’t been actively preparing for that scenario.
If Adams and Arapahoe Counties elect to stay together, many questions remain about what a two-county health department would look like. Baker added that because many of Tri-County’s largest facilities are based in Arapahoe County, including the agency’s headquarters in Greenwood Village, folding portions of the current entity into a proprietary department for his jurisdiction could be smoother than it could be in Adams or Douglas.
“There are some definitive advantages for sharing the infrastructure costs across a larger population base,” Gallagher said. “From a public health point of view I think some variation in terms of moving Tri-County into the future makes sense.”
If the current trajectory holds, any diversion from the status quo would be a novel move in the annals of the state health care system, according to Douglas.
“Colorado has never had a breakup of a health department this size in its history,” he said. “Certainly what we are doing would be unprecedented, and unprecedented always brings uncertainty and unexpected issues.”
— Kara Mason, Managing Editor contributed to this story.