The formal bonds that hold the public-health partnership among Adams, Arapahoe and Douglas counties together may be loosening, but the complete demise of the Tri-County Health Department, which has served them for decades, may be less certain to happen than it has appeared.

“My best-case scenario is, after a couple months, Adams County works with us and figures out they can provide what they want in terms of local control and (for their residents) in a two-county infrastructure,” John Douglas, executive director of Tri-County Health Department, told Colorado Community Media in an interview, expressing hope that Adams and Arapahoe could still work together.

He also envisioned a future where Arapahoe County partners with Tri-County “as some kind of independent entity” that Arapahoe might contract with — or even that Greenwood Village-based Tri-County gets “evolved” into a department of Arapahoe County.

He said he hopes that whatever Tri-County becomes could also work with Adams and Douglas counties at least in a transitional role to provide services and help them plan for what their evolution to new health agencies might look like.

When the dust settles, the outcome of the three counties' transition may be that each county gains its own board of health — the policy-making body that issues public health orders such as mask mandates, for example — thus freeing each from the need to contend with the political differences among the counties when shaping health policy.

And at the same time, the counties may end up with agreements to keep receiving day-to-day public health services from Tri-County Health, at least for some period of time, or they may partner with different entities.

Aside from COVID-19 mitigation, Tri-County provides services such as restaurant inspections, nutrition counseling, maternal and child health services, and disease control, among other functions.

Taking politics out of health

After the end of 2022 — when Douglas County could end its agreement to continue receiving services from Tri-County Health and when Adams County expects to move to a new health department structure — the costs of Arapahoe and Adams counties pulling away from Tri-County could be in the millions, according to a consulting firm studying the benefits and drawbacks of the counties' potential decisions to handle public health services alone.

Douglas County's leaders have long clashed with Tri-County Health during the coronavirus pandemic, announcing plans in July 2020 to begin the process of withdrawing from the health agency after its decision to require mask wearing in public.

Some of Adams County's leaders felt frustration with Tri-County's recent policymaking, too: Some commissioners voted to opt out of the health agency's school mask order this August before Tri-County removed the ability of counties to opt out of its health orders.

But Adams' message wasn't anti-mask — County Commissioner Eva Henry said at the time that she agreed with the intent of the order and supports mask-wearing.

“It's unfortunate, you know, that politics got into our public health system — it shouldn't be there,” Henry told Colorado Community Media. “And that was one of the reasons I voted to opt out of the mask order, to put it back in Tri-County's hands, to take politics out of the public health orders. Commissioners shouldn't be making public health decisions.”

Douglas told CCM that he felt the pandemic wasn't the only factor that led to the three counties starting to split up.

“I think if we wouldn't have had COVID, I think we would have continued with a three-county relationship,” Douglas said, but he added that the counties -- all of which are much more populous now that when they joined the agency -- have differences that eventually may have led them to break Tri-County up anyway.

But “I don't think it would have been right now if it hadn't been for COVID and public health orders,” he said.

Adams County Commissioner Emma Pinter felt that the breaking up of Tri-County isn't just tied to mask wearing.

“I think there's been fractures for some time between the three counties,” Pinter told CCM. “It just wasn't as heightened until we entered the pandemic and tried to do pandemic (policy) together.”

Asked whether there are moments during the pandemic she looks back on and wishes Adams had its own health department, Henry 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 said. “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.

Adams' industrial sites and environmental health concerns are important to that county's leaders, one example of a unique county aspect that lends itself to being handled by local leaders alone, according to Henry.

“Other counties shouldn't be influencing the public health of another county,” Henry said.

Difference in 'consistency'

For Adams County's Pinter, watching other counties give less support or less-consistent backing to John Douglas' policy recommendations was part of what motivated her to want to break from Tri-County.

“If you watch the votes of the duly appointed board of health members, those three Adams board of health members consistently voted together and in the interest of public health, in favor of Dr. Douglas' recommendations,” Pinter told CCM. She added: “If you look at the votes on the board of health members of Arapahoe and Douglas, the same consistency is not true.”

She added that she wants to have a board of health “that always puts the wellbeing of our residents first.”

Before Douglas County exited Tri-County, the agency's board of health consisted of nine members — three each from Adams, Arapahoe and Douglas.

Christa Bruning, an Adams County spokesperson, signaled that the county plans to enter into some type of partnership for public health services in the future.

“Adams County intends to contract with a local health agency for many of its public health services starting in January 2023,” Bruning said. “It's too early in the process to know who that health agency is.”

Henry said Adams County is looking at Denver's health department model, in which Denver contracts to receive nonprofit services for “a lot of its programs.”

Adams could hypothetically partner with Broomfield or Jefferson counties, too, Henry said as an example. Those counties have their own public health agencies.

“And if Tri-County really wanted to survive, what they could look at is becoming a nonprofit and … contracting out to the three counties,” Henry said.

Douglas, the Tri-County health chief, said he has heard of the idea that his agency could become a nonprofit, but the legal ins and outs of that weren't immediately clear.

In Arapahoe County, where Tri-County's headquarters currently sit, Douglas said that “it could be we go away entirely and they (Arapahoe) hire our staff to work for them, or we stay as some kind of independent entity and they might contract for us, or we get evolved into a department of the county.”

Echoing Douglas, Pinter expressed support for leaning on Tri-County in some way as Adams transitions to a new public health structure.

“I think that in that transition, we have the opportunity to use the expertise of the staff of Tri-County Health. They've carried us through a pandemic … we owe a great debt of gratitude to the staff,” Pinter said, noting that the staff have faced a contentious and combative atmosphere toward public health officials amid the pandemic.

She said that over the next year, the county will need to think about whether it wants to contract with Tri-County for some period of time.

'Too early to speculate'

Arapahoe County commissioners Nancy Jackson, Nancy Sharpe and Jeff Baker declined through a spokesperson to be interviewed for this story. Luc Hatlestad, spokesperson for Arapahoe County, told CCM that Arapahoe's leaders preferred not to “go into the political” aspects of the situation regarding the counties transitioning to new public-health structures.

Hatlestad said he didn't know whether there have been specific conversations among county leaders about the idea of Tri-County becoming Arapahoe's health department, but that the physical headquarters being there and employees living in or around Arapahoe “would contribute to possibility of that happening.”

Regarding contracting public health services with a specific county or agency, Arapahoe hasn't gotten to the point where its leaders are planning whether to do that, but if that becomes a beneficial option, the county could consider that, Hatlestad said.

Still, he emphasized that Arapahoe County isn't at the stage where it has firm plans of how to transition to a new public-health structure. The county said in a statement that it's “too early to speculate how things will unfold.”

“Our board is going to use this an opportunity to explore whatever options we have to keep services at the level that our residents expect and deserve and also looking for ways to make intelligent fiscal decisions,” Hatlestad said.

Douglas County's elected leaders formalized the decision to leave Tri-County in a meeting Sept. 7, opting to form their own board of health — including two of the county's three elected commissioners — in charge of matters such as countywide public health orders. But the county decided to continue to receive all services from Tri-County through 2022, approving an agreement on Sept. 28.

However, on Oct. 27, CCM reporter Elliott Wenzler reported that officials of Douglas County’s new health department and Tri-County Health were discussing how to transition various COVID-19 services from Tri-County's administration to Dougco in the near future after a Tri-County official called a county order letting people opt out of mask-wearing rules "greatly concerning." A federal judge later temporarily blocked Douglas County's opt-out order at the request of the county school district, which had previously mandated masks inside its schools.

The Adams commissioners brought forward a resolution at an Oct. 26 public hearing to provide notice of Adams' decision to leave Tri-County. The vote was unanimous, Pinter said.

Arapahoe has appeared less keen to cut ties with the health agency, saying in an Oct. 19 statement: “The Arapahoe County Board of Commissioners is saddened that our neighboring counties have chosen to end the productive 55-year partnership with the Tri-County Health Department.”

“The Board intends to do what it can to support the many dedicated employees of Tri-County Health throughout this process,” the statement said.