Imagining Douglas County without Tri-County Health

With Douglas County and the Tri-County Health Department headed for a divorce, triggered by the health agency's recent order on wearing masks in response to the COVID-19 crisis, leaders explained themselves and addressed the public over the issue at a pair of meetings.

The sessions came just before Gov. Jared Polis issued his own statewide order requiring mask wearing indoors on July 16, largely leapfrogging Tri-County's mask mandate a week earlier.

Still, at press time, Douglas County commissioners had not veered from the path, announced July 9, of ending ties with Tri-County Health in a year's time and set up their own public-health authority.

On July 14, the commissioners addressed the public on the matter, with the three commissioners, Roger Partridge, Lora Thomas and Abe Laydon, each explaining their reasoning.

About a dozen people submitted public comments at the virtual meeting.

“It's important to know we are listening to you and we have heard your voices,” Thomas said. “I think what we've heard most of all is you feel like we have abandoned you, like we've left you without a health department, and you're very concerned with what this is going to cost.”

Laydon said the county is working through options regarding cost and continuity of services; no details about the county's proposed independent health department have been finalized.

Laydon said he believes the county has a “wonderful” opportunity to save money while not duplicating services during this transition.

The Tri-County Health Department Board of Directors voted July 8 to require the people it serves in Adams, Arapahoe and Douglas counties to wear masks in public settings, with a variety of exceptions. It gave local cities and towns the option to opt out of the order.

Polis' statewide mandate, however, will not allow local governments to opt out unles they can meet a rigorous standard in showing that they have the virus under control.

At the July 14 Douglas County commissioners' meeting, Thomas explained the role of Tri-County's governing Board of Health, which adopted the agency's mask rule, and how they are appointed. The board is made up of three medical professionals appointed by their respective county commissioners.

Douglas County's representatives are Marsha Jaroch, a nurse practitioner, Paulette Joswick, a registered nurse, and Zachary Nannestad, who holds a Master of Public Health degree.

Thomas said the commissioners wanted the three Douglas County representatives on the Tri-County board to vote down the proposed mask rule. But while Jaroch and Nannestad voted “no,” Joswick voted “yes” on the July 8 mandate.

Tri-County Executive Director Dr. John Douglas at the time of his agency's July 8 mask order that it is less imperative for Douglas County to have a mask rule based on its current voluntary mask-wearing rate -- higher than neighboring counties -- and its level of COVID-19 cases and hospitalizations.

Douglas County has seen far fewer confirmed COVID-19 cases -- 1,427 as of July 19 -- than either Arapahoe (6,131) or Adams (5,115) counties, although it has seen a higher rate of cases adjusted for population over the first half of July than the other counties, Tri-County Health reports.

At the July 14 meeting, Laydon reiterated he is not against wearing a mask and he urges all citizens to wear one.

“The big difference, from my vantage point, is there's this strong recommendation based on science, which I urge, and a mandate which could fine or criminalize” residents, Laydon said.

Partridge said he wears a mask but agreed with his fellow commissioners that the mandate was overreaching.

“You really have to match those data up together, when we look at the number of tests, then we look at the number of positive tests, then we look at the severity (of those positive tests), then we look at hospitalization rates,” Partridge said.

After the commissioners spoke, several Douglas County residents provided comment in three-minute intervals. Every person who spoke during this time voiced opposition to the commissioners' decisions on Tri-County Health.

Stafford Black of Highlands Ranch said he worried about Douglas County becoming a viral hotspot.

“Douglas County is part of the larger Denver region. We are not an island,” Black said. “We should commend ourselves for keeping our numbers so low and for our mask-wearing rates…but if we don't take reasonable precautions, … that could easily turn in the other direction.”

Zach Sloan of Castle Rock said he was concerned the commissioners did not present any alternative to the mask mandate to ensure the public's safety. "What are we doing to be proactive instead of reactive?” he said.

“I do not support the Douglas County Commissioner's clearly partisan, political decision to sever ties with the Tri-County Health Department” and the decision to opt-out of the mask mandate, said another speaker, Brian Clarke of Highlands Ranch.

“A mask mandate is not about punishing citizens," he said. "It's about setting community standards and making clear what our priorities are as a community.”

The next day, Douglas, the Tri-County executive director, spoke at a virtual town hall meeting, moderated via telephone conference by Douglas County staff.

He referenced a June study from the journal Health Affairs, which looked at 15 states and Washington D.C. regarding the effect of a mask order.

He said the report indicated mask mandates reduced daily case rates by about 2% every day for 21 days after a mandate was signed.

Douglas said in the most recent data, 80% of Douglas County residents wore a mask without an order.

“It's good, but even better could help (curb the spread), if we can go higher,” Douglas said.

Douglas noted that the COVID-19 case rate in Douglas County is rising and looks similar to the curves seen in Arizona, Texas and Florida after Memorial Day. He said the county needs to introduce a mitigation plan to better curb the spread of the disease.

One caller into the meeting, who has a medical condition exempting her from having to wear a face mask, said she has felt bullied by people because of her inability to wear a mask. She asked how Tri-County and local leaders can reconcile health experts' advice to wear a mask while not feeling scrutinized by those in public.

“The issue of mask wearing has gotten hyper-politicized on both sides, and you've experienced a situation where you're feeling ostracized…and that's really an issue,” Douglas said. “You can't walk around with a sign on your neck saying, 'Here's my medical excuse'."

He added: "What we need to do is calm this whole thing down. Masks are important. For people who cannot wear masks, they should not be worn, and for all of us — whether it's me yelling at somebody or somebody yelling at me — all of our leadership positions need to seize the opportunity to dial the rhetoric down.”

Douglas acknowledged Douglas County has “natural advantages” over most places in the country when it comes to preventing community spread. He said the county has fewer people who work in essential industries, fewer communal living spaces and more spread-out housing.

“You don't have to have people in the hospitals if you have rapid community spread that impacts the opening of our schools,” Douglas said.

The county commissioners responded to comments and questions regarding cost effectiveness and makeup of the to-be-established Douglas County health board.

Partridge said the county will follow state guidelines of what is required from counties for a public health department.

“Medical people are one of the most important people on a health board, but we're all experts in our own health and Douglas County has proved that as the healthiest in the country.”

Partridge referred to a 2019 report by U.S. News and World Report, which placed Douglas County as No. 1 on its list of the healthiest communities in America. The report takes into account 10 metrics, including cancer prevalence, obesity, crime rates, housing quality and the poverty level.

Thomas said a feasibility study was not done prior to the commissioner's July 9 decision, in response to a caller question.

“Our concern is we could not allow the critical positions that affect the freedoms, liberties and livelihoods of Douglas County residents to be left in the hands of unelected appointees,” Thomas said. “We cannot put ourselves in a position where this happens again.”

Thomas stated the commissioners had issue with the fact appointed medical professionals were calling the shots for the entire system.

“What will be best for our citizens is letting them make their personal health decisions for themselves,” Partridge said.

Laydon added there are redundancies between Douglas County and Tri-County Health already. Douglas County provides certain mental health services, he noted.