From left, Arapahoe County Public Health Department Public Health Director Jennifer Ludwig and Public Health Commissioner Shawn Davis introduce themselves to Rosie’s Diner General Manager Mario Camacho, Nov. 7, 2022. Arapahoe County Public Health Department staff visited a few Aurora restaurants on the afternoon of the seventh.
Photo by PHILIP B. POSTON/Sentinel Colorado

When the clock strikes midnight  Dec. 31, the 58-year Tri-County Health Department partnership between Arapahoe, Adams and Douglas counties will come to an end ,and a new journey for what local leaders hope to be a more targeted approach to public health will begin.

Tri-County’s conclusion was sealed last fall when first Douglas County and then Adams County voted to exit, driven primarily by disagreements over public health orders put in place during the pandemic, and the counties have spent the last year forming their own health departments and planning for how they will be run. Tri-County will officially cease to exist at the end of this year, and the new health departments will come online at the start of 2023.

With just a couple weeks until that shift, The Sentinel spoke to public health officials about what that transition will look like and what residents should expect in the new year.

“Our goal is to try to make it as seamless as possible,” said Jennifer Ludwig, director of the new Arapahoe County Public Health.

That sentiment has been echoed throughout the three counties, as well as the Colorado Department of Public Health and Environment. 

State health department staff have been meeting with the county for the better part of the last year, said Matt Jackson, who works as a senior public health systems and liaison professional with CDPHE. 

“I think everyone’s ultimate goal is to ensure that there’s continuity of public health services, and that that will continue,” he said. “…We’ve all kind of agreed we want to have as smooth of a transition as possible.”

All local public health agencies are expected to do work in communicable disease prevention, environmental health, family health, disease and injury prevention, behavioral health and access and linkage to health care, Jackson said. Now that the counties will operate separately they can choose where to focus more heavily and which areas they want to
prioritize. 

Leading the way

Ludwig will direct the Arapahoe County health department, and Kelly Weidenbach will lead the Adams County department. Both former Tri-County employees, Ludwig previously served as the department’s deputy director and has had a career in public health in Colorado for almost 30 years. Unlike Tri-County, where Dr. John Douglas served as both executive director and chief medical officer, Arapahoe County decided to split the role into two parts. 

Dr. Christopher Urbina will temporarily serve as chief medical officer while the county conducts a search for a permanent candidate. Urbina has previously served as director of Denver Public Health and as Colorado’s chief medical officer, along with teaching at CU Anschutz. The chief medical officer is an advisory role, and serves as the on-call physician and gives medical advice as needed.

“We really do have the staffing and expertise in house to be able to handle most things, but there’s always something that would need a physician consultation and that would be his role,” Ludwig said. The search for a permanent candidate is currently underway.

The county established a five-person board of health over the summer that was responsible for hiring Ludwig and recommending the 2023 budget to the county commissioners. The members include outgoing commissioners Nancy Jackson and Nancy Sharpe, pathologist Dr. Heather Signorelli, Littleton-based Doctors Care CEO Bebe Kleinman and CDPHE healthy equity commission member Shawn Davis.

Jennifer Ludwig, Public Health Director for Arapahoe County Public Health Department discusses her plans for the future of the new health department during an interview with The Sentinel.
Photo by PHILIP B. POSTON/Sentinel Colorado

Weidenbach, in Adams County, said in a statement to media over the summer that health equity is among her top priorities in the position that will serve a minority majority population, which the county said in a news release has “faced compounding issues the new health department plans to address.”

“…We often talk about raising the voices of communities and populations that may have been historically undervalued, underrepresented, and who experience adverse or disproportionate outcomes,” Weidenbach said. “We will also be really looking around recovery from the COVID-19 pandemic — looking at places where the community may have lost traction on important health issues such as mental health, substance abuse, and physical and mental well-being.”

In Douglas County, a board of health has taken on several aspects of public health over the last year, though an agreement was made with Tri-County that the department would continue services through the end of 2022. 

Michael Hill was named director of the Douglas County department in February. He was previously working for San Luis Obispo County Public Health Department as the health agency director.

The people who do the work

While much is new at the three health departments, a bulk of the staff is not. Ludwig will be joined by many other former colleagues from Tri-County come January. 

The Arapahoe health department will begin with 155 permanent employees and 40 temporary employees for its COVID-19 operations. Of the 155 employees, 150 are coming from Tri-County, along with many of the COVID-19 group as well. Ludwig said she is extremely glad that so many people from Tri-County, who she described as “experts in their field,” are continuing to serve in their previous role in the new department.

“I feel very fortunate that we have such a great pool of applicants to bring over,” she said. “To be able to open our doors officially on Jan. 3 with that level of expertise is really exciting. I don’t think many startups have that luck.”

What would happen to existing Tri-County employees was a major source of concern when the split was first underway. The majority of them will be continuing on with one of the three new departments, Douglas said. 

Along with those going to Arapahoe, he said that 110 are going to the Adams County health department. He said he is encouraged that the new departments are going to be staffed largely by Tri-County alumni, who he said are “far and away” the best people to carry on the work.

Douglas County has picked up far fewer of the Tri-County employees. Colorado Community Media reported in August that the department had only hired two staff members from the department. 

A lab tech works in a Tri-County Health facility, Oct. 21, 2021. Beginning Jan. 1, 2023, Tri-County Health Dept. will cease to exist as the three counties begin a new targeted approach to public health, as individual entities.
Photo by PHILIP B. POSTON/Sentinel Colorado

Location, location, location 

New departments may come with new locations, but for the most part, Arapahoe County will remain familiar to local residents. The county’s health department will continue operating out of two buildings the county owns that were previously leased to Tri-County — the Altura Plaza Building in Aurora and the administrative office in Englewood off of South Broadway.

Arapahoe County has also secured the leases for two other Tri-County buildings, the office in Greenwood Village on South Willow Drive and the Aurora South building on Hampden Avenue. Altura Plaza and Englewood will be its two clinical facilities, and Altura Plaza will offer the most services overall, Ludwig said.

“It was important that we be in the same locations,” she said.

Budgets and funding

Arapahoe Public Health’s budget for 2023 is $21.3 million, according to county documents posted online. Of that, $6 million will come directly from the county, with the majority of revenue coming from state and federal funding along with grants and revenues from fees and permits. The budget is just shy of an initial estimation from an outside firm in 2021 that an independent health department for Arapahoe County would cost approximately $22.1 million. 

For comparison, Tri-County’s 2022 budget was $67.8 million and its 2021 budget $55.4 million.

“The County allocated $6 million from the general fund for 2023, which is a $778,000 increase from what the County contributed to Tri-County in 2022,” Arapahoe County spokesperson Chris Henning said in an email. “So, for that number, we’re getting most of the same services but for Arapahoe County residents only. In addition, Commissioners allocated $2.9 million in one-time ARPA funding for use as start-up costs.”

As far as state funding, most money divided up to local departments is on a per-capita basis, so what went to Tri-County will still be making it to the counties, Jackson with CDPHE said. 

“We really are anticipating the total funding, going to the three new health departments will be pretty similar to the amount that was previously allocated for Tri County,” he said. 

Tri-County Health Department signage will soon become Arapahoe County Health Department signage. The new department is utilizing existing infrastructure when the department officially opens Jan. 3. Photo by PHILIP B. POSTON/Sentinel Colorado

One city, three counties

The split was a source of particular concern for officials in the city of Aurora, which is part of all three counties that comprised the old department. Last December, Mayor Mike Coffman unsuccessfully lobbied to keep the partnership 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,” he said last fall.

Since then, city spokesperson Michael Brannen said that the new departments have worked to assuage the city’s concerns.

“Adams and Arapahoe Counties have been in communication with the city of Aurora about the transition from the Tri-County Health Department,” he said in an email. “We are confident that both counties will continue to provide excellent health services. Their staff have assured us that their clients will still be able to access the same quality services, at the same locations and in many cases with the same staff.”

Ludwig said that she plans to have more in-depth conversations with city officials in the new year, and that the department is focused on making services as easy to access for residents as possible. Many of the services that the department will provide are available to people regardless of what county they technically live in, she said.

Class action for schools

During the pandemic, Tri-County was the provider of public health information and recommendations for both Aurora Public Schools and the Cherry Creek School District. With the split, Cherry Creek will now shift to working with the Arapahoe County department.

APS, which has schools in both Arapahoe and Adams counties, will work with both new departments, Superintendent Rico Munn said. 

Munn said he met with the heads of both districts earlier in December and said the three entities appear to be on the same page.

“We feel good about the work that they’ve put in to be ready,” he said.

The pandemic thing

Pandemic tracking and prevention is some of the highest-profile work Tri-County has done over the past several years, a responsibility that will continue into the new year. Though no longer dealing with the responsibilities that they handled at the height of the pandemic, local health departments still play a key role in tracking COVID-19 case rates and outbreaks, coordinating with other agencies to offer tests and vaccines and disseminating information about the disease and how to prevent it.

Douglas said the three new departments have been working hard to ensure that the work Tri-County established will transfer over. The new department will have a COVID-19 response team, Ludwig said (composed of many of the same people), and the department will continue to take direction from the CDC and the CDPHE on how to best manage the virus.

The COVID-19 data dashboard that’s been a mainstay of Tri-County’s website for almost three years will not survive the transfer — Ludwig said the department is working up to building some type of dashboard but it may not be as detailed or be updated as frequently.

Signage outside of Altura Plaza, where the Tri-County Health Department is offering free COVID-19 vaccinations.
Photo by PHILIP B. POSTON/Sentinel Colorado

Disparate health issues

One of the driving factors that led the new counties to form individual departments was a desire to provide health services that are more specifically targeted to their residents.

“When Douglas County and other counties are ranked higher consistently when it comes to public health outcomes and we’re in the same organization, it means the status quo cannot continue,” said Adams County Commissioner Steve O’Dorisio during the county’s vote to leave the department last fall.

Though he has voiced concerns throughout the process about the counties’ abilities to provide the same level of services individually as Tri-County, Douglas said that it also presents the opportunity to work more closely with other county departments. 

“We tried hard but we potentially could have done a better job of working hand in glove with other county departments,” he said, such as the department of human services and the county jails.

One thing that Tri-County focused on over the past several years that he hopes the new departments will continue is branching out to focus on some things that aren’t seen as typical public health issues but are still significant, such as mental health and suicide prevention and the health effects of climate change.

“I hope our new health departments will have the support they need to really address some of the large issues that impact the well being of the residents in the communities,” he said.

Incoming Arapahoe County Commissioner Jessica Campbell-Swanson said that those were both “key concerns” brought up by residents during her campaign.

“I look forward to supporting our Board of Health as they build a community-centered department that works to improve our public health,” she said in a statement.

Legal ease

Tri-County and its three constituent counties are currently involved in an ongoing legal dispute with PERA, the state’s retirement fund for public employees. The lawsuit claims that the department is violating the procedures required by state law to exit a partnership with the retirement association, and either it or the individual counties owe PERA $50 million.

In September, an Adams County judge dismissed the three counties from the lawsuit but also denied Tri-County’s attempt to have the suit thrown out entirely, according to reporting from Colorado Community Media.

Douglas said that a stay has been placed on the lawsuit through 2023 and that it will pick back up sometime in the new year after PERA has finished conducting an actuarial assessment of the department. Tri-County is currently under a court-appointed receivership to oversee its financial affairs, and he said the receiver may also request to have the assessment independently reviewed.

Dr. John Douglas sits for a portrait at his home. Dr. Douglas is the Executive Director of the Tri-County Health Department
Portrait by PHILIP B. POSTON/Sentinel Colorado

Saying ‘goodbye’

Arapahoe County Public Health will officially open its door on Jan. 3, the first business day of the new year. Ludwig said that all the employees will gather in the same building in person at the start of the first day and plan to hit the ground running.

For his part, Douglas said he plans “to pop something bubbly at midnight” on New Year’s Eve. 

After that, he isn’t sure what his plans are for the coming year. He’s beginning with an extended period of personal time that he said he plans to fill with travel, time with his grandchildren and service on boards of some local organizations he belongs to. That may turn into permanent retirement or he may decide to re-enter public health at some point.

Douglas was with Tri-County for more than nine years. He said he’s proud of his time at the helm.

“I don’t think I’d ever worked at a setting that was as much fun professionally because we had so many opportunities to work in the community and make a difference in people’s lives,” he said.

Despite the stress and tragedy caused by COVID-19, on a professional level Douglas said that leading the department during the pandemic was a rewarding experience.

“I will look back on my years at Tri-County very fondly,” he said. “I’m sorry things have ended up going the way they have, although I do think folks have come together to make the best of a somewhat challenging situation.”

— Sentinel Managing Editor Kara Mason contributed to this story

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Jeff Brown
Jeff Brown
1 month ago

Next up: The City of Aurora’s exit from the Denver SCFD Ponzi scheme.

We pay between $7 and 8 million per year for cultural and scientific facilities. Now just look at the Fox Theater to understand how badly Aurora has been screwed.