The mask mandates implemented during the pandemic left a legacy in region's health care. They fueled the breakup of Tri-County Health, the state's largest public health agency, serving Adams, Arapahoe and Douglas counties for more than seven decades.

Douglas County officials took issue with mask mandates put in place by the health agency. Looking back, Tri-County Health Director John Douglas, a doctor, said masks were meant to protect the public as the virus  swept through the metro area.

“I’m sorry the dynamics of the politicization of the pandemic put us in a place where we had to make choices, specifically referring to the mask mandate, that were going to create acrimony with Douglas County,” Douglas said.

Tri-County Health Department’s choices were tough to make, he added, acknowledging some divided public. Still, he stands by the agency’s decisions and, citing research, said masks helped slow the spread of COVID-19.

Douglas County's response was to opt out and create its own public health agency, which is now operating with a budget of its own.

That means Tri-County Health is left to fade away, toppled by the controversy, leaving each county to figure out how to provide and pay for public health services.

Public health departments do more than respond to pandemics. Tri-County Health provided no-cost cancer screenings, overdose prevention, and inspections to ensure the cleanliness of restaurants and health at child care facilities.

In the process of developing its own health department, Douglas County stayed ahead or on schedule to meet the Jan. 1 deadline. With restaurant and child care facilities already being inspected, and staffing levels at or above expectations.

Different plans

Tri-County Health marked its last day of regular business hours Dec. 30, nearly 75 years after the agency opened. But many of its former employees will still carry out public health services under the newly-formed county health departments.

The Adams County Health Department planned to hire a total of about 170 employees, though that number was subject to change, Lynn Baca, an Adams County commissioner, said months ago.

Adams expected “at least 60 staff members” from Tri-County Health to come aboard its new department, Baca said. She and another Adams commissioner didn’t immediately respond for comment seeking an update on the agency's progress.

In Arapahoe County, the new health department expected to hire “up to 180 people,” a county spokesperson said in August, though he didn’t specify how many were to come from Tri-County Health

In Douglas County, with one issue in hiring an accountant, department officials said they should be fully staffed by the end of January with more than 40.

Adams and Arapahoe both appointed former Tri-County Health leaders to head their new health departments.

Douglas County, wealthier and less-populated than its neighbors to the north, has “decided to run things in a somewhat different way,” said Douglas, the Tri-County chief.

“They made the assessment that the county in general has a much higher level of health outcomes,” Douglas said, noting that STRIDE Community Health, a nonprofit health-care provider with locations around the Denver area, will provide sexual health and immunization services in Douglas County based on a partnership with the county.

The outgoing health chief said “there’ll be growing pains in setting that up.”

“There are a lot of folks in Douglas County who don’t need the kind of services Tri-County Health Department provides, but it’s certainly not everybody,” Douglas said, adding he has admiration for STRIDE.

Looking to disease response, if a new public health emergency arises, Tri-County Health won’t be there to send help from one county to another, Douglas said.

While mutual aid could occur among the three counties, “I think that is an area where things might be thinner,” he added.

Costs, priorities vary

The process of the three counties pulling out of Tri-County began with the Douglas County commissioners, who decided to immediately leave the health agency September 2021 after months of disagreements over COVID-19 protection measures. Douglas County formed its own health department and decided to contract to continue receiving many public health services from Tri-County until at least the end of 2022.

Adams County leaders decided to break from Tri-County soon after Douglas County did, but Adams’ choice to go alone on public health “had nothing to do with the pandemic or masking,” Baca previously told Colorado Community Media.

Differences of opinion on public health policy didn’t just arise amid the pandemic, Adams County commissioners have told CCM, citing Arapahoe County's budget restrictions and Douglas County's priorities.

“We have different factors that affect our citizens in Adams County — we have air pollution, citizens working in industrial jobs. We’re addressing poverty. We have homelessness,” Baca said previously, noting Douglas County does not encounter those issues as much as other counties.

Different priorities could influence a difference in spending across the three counties.

Adams County's contribution to Tri-County Health's 2021 budget was $3.8 million, Arapahoe County's contribution was $4.8 million and Douglas County's contribution was $2.6 million, according to Tri-County.

The net cost for the first year of Adams County’s own health department could total between $11 million and $13 million, Baca has said.

“Our first year out, we’re looking at it’s going to be approximately 20 to 25 million dollars, with an estimated 12 to 14 million dollars in grants,” Baca has said.  

Arapahoe County Commissioner Nancy Sharpe has said the county's own health department will likely cost the county around $5 million per year, possibly even more.

Officials in Douglas County expect to keep costs down.

Fees could change

Douglas County’s new public health director, Michael Hill, previously told CCM the county’s health department will adopt the same fee structure as Tri-County initially but may consider suggesting fee changes later.

Asked whether fees for public health services will be higher under the Adams County Health Department compared to what the fees for the same services were under Tri-County, Baca previously said Adams County leaders haven’t discussed that level of detail during meetings.

She anticipated “that we would maintain the fee structure at least starting out. And then that would be a (future) board of health decision to make,” Baca previously said, referring to the policy-making body for Adams’ new department. She added: “We’re not looking at this decision to adversely affect any of our residents.”

This article was originally published by Colorado Community Media.