How Colorado state law will help shape Douglas County’s new health agency

Choosing a health director a key first task for board

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As Douglas County proceeds with breaking away from the Tri-County Health Department and building its own public health agency, the next major step for the agency will be selecting a public health director.

The director, who will serve as the head of the county health department, will be required by state statute to hire all personnel for the new department, issue public health emergency orders and enforce all public health laws, among other duties.

Both the county director’s responsibilities and qualifications for the role are specifically detailed in Colorado law. Finding someone who fits those requirements will be one of the primary tasks for Douglas County’s new board of health. 

“I would say it’s going to be among the first things it’s important for them to address,” said Barbara Drake, deputy Douglas County manager.

The three Douglas County commmisioners agreed at a Sept. 7 work session that they would name two of their own to the health board — commissioners Lora Thomas and George Teal — as well as Dr. Linda Fielding, Kim Muramoto and Doug Benevento. Fielding and Muramoto serve on Tri-County’s board of health and Benevento is a member of the county’s public health advisory committee.

At press time, the commissioners planned to make those appointments official at their Sept. 14 meeting. 

Douglas County commissioners voted Sept. 7 to officially form their own health department Sept. 7 after more than a year of considering the action amid county leaders’ long-standing objections to Tri-County Health’s COVID-safety rules, including mask-wearing mandates.

Commissioners signaled in July 2020 that they planned to end their nearly 55-year relationship with Tri-County, then put that plan on hold in November 2020 when the agency agreed to let the county opt out of public health orders such as mask mandates and other COVID-related restrictions.

The county renewed the plan to leave when Tri-County’s Board of Health voted Aug. 30 to no longer allow counties to opt out of public health orders and imposed an indoor mask mandate for all students and staff at schools.

Tri-County previously served Adams, Arapahoe and Douglas counties. After Douglas County announced its intent to form its own health department, Adams and Arapahoe said they were also considering splitting. 

Requirements for new director

Colorado’s Public Health Act of 2008 provides specific guidelines for local health departments, which each county is required by law to have through either a county-specific department or an agency representing multiple areas, like Tri-County.

One section of the law is dedicated to the selection of a public health director, who serves at the pleasure of the local board of health and as the head of the department. 

The board of health can choose among physicians, physician assistants, public health nurses or other qualified public health professionals to act in the role. Whomever is chosen must have at least five of the past 10 years “of successful and responsible administrative experience in public health or a closely related field, including at least two years experience in supervising public health professionals,” according to the statute.

If the director is a physician — an M.D. or a D.O. — they must have attended a certified medical school and must be licensed to practice medicine in the state of Colorado. 

If the board of health chooses someone other than a physician as the director, they must also choose at least one physician to advise the public health director on medical decisions, according to the statute.  A non-physician director must have a master’s degree in a public health field.

In the Sept. 7 work session, Douglas County staff presented this information to the commissioners.

In response to a question from Commissioner Abe Laydon about the selection process, County Attorney Lance Ingalls clarified that unless the commissioners themselves were on a board of health, they “wouldn’t have any say” in who is chosen as the public health director. Later in that meeting, commissioners selected their board of health members, including Teal and Thomas. 

“I’m actually comforted by the statutory requirements for the director of the board of health because I feel that makes a bunch of our jobs really easy,” Teal said in the meeting.

The director for Tri-County, the agency that previously held jurisdiction over Douglas County, is Dr. John Douglas.

Other stipulations for new agency

The state public health act also stipulates the required services of a public health agency.

Any health department is required to “develop and promote the public policies needed to secure the conditions necessary for a healthy community,” according to the county staff presentation paraphrasing the statute.

That includes enforcing the laws of the state health board, investigating and controlling communicable diseases such as COVID-19, requiring quarantines and the closures of schools and public places when necessary and making health investigations and inspections, according to the county staff presentation.

The department also must have available laboratories to conduct investigations and must collect, compile and tabulate marriage, birth, death and morbidity records. 

In general, public health departments deal with the whole population’s health, as opposed to focusing on individual patients like a primary care physician would. 

The county health department is also required to provide administrative services such as communications, human resources, legal services and emergency preparedness.

“I think consistent with everything that Douglas County does, we not only want to meet this high threshold of statutory requirements but exceed it,” Laydon said in the meeting. “And make sure that every individual appointed to this public health board and that is providing services is of the highest caliber and of the highest pedigree in terms of expertise, experience and qualifications.”

Paying for a department 

The new board of health will also be required to present a health department budget to the full board of county commissioners. 

The county has not yet determined how the new health department will provide all of the required services to residents but it could be some combination of county-level services, contracted services with an entity such as Tri-County and other community partnerships.

County staff is also exploring how the county’s already-existing mental health initiative could take on some of the services of a public health agency, said Drake, the deputy county manager. 

As far as costs go, Drake said the county is still “trying to figure that out” as it looks at what state and federal dollars could help fund the department. One thing that makes that a challenge is different budget cycles for those entities, the county and Tri-County.

“An awful lot of public health funding is state funded or federally funded. What that means is you can have a county budget that includes all that state and federal funding as your budget, but that does not mean that the county is putting in that much money,” Drake said. “There’s no reason to think that we wouldn’t be eligible for that, what we have to figure out and sort out is the timing for those different sources of funds.”

While the county has paid for Tri-County services until the end of the year, Drake and her team are in talks with the agency about how to continue at least some of those services beyond 2021.

“We are very earnest in our desire to continue to work with Tri-County at least through the end of this year and to manage a smooth transition,” Drake said. “They’re professionals; we’re professionals, I think that there’s every reason to think that we will be successful in managing that transition.”

A spokesperson for Tri-County said decisions about contract negotiations with Douglas County would be left to their executive director.

The county hopes to use the community health assessment they commissioned in July to help them decide what services they will offer beyond those that are statutorily required. That assessment, which usually takes about a year to complete, is planned to be finished by the end of the year, Drake said. 

The county plans to use an assessment completed by Tri-County as the foundation for their document, she said.

“It’s very likely and very possible that the new board of health and a new public health director may want to go back out and do a longer version,” Drake said. “But it does give us a document to sort of show us what Douglas County people think and kind of a launching point for what our public health improvement plan should look like, which is designed to address what the (Community Health Assessment) is telling you.”

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