La Plata County commissioners met this week to discuss the future of San Juan Basin Public Health for the first time after a recommendation by the agency’s board to dissolve the health district.
Commissioners spoke with county staff members for about an hour about the legal process for a breakup of the health district with Archuleta County, as well as the formation of a new public health entity. The meeting was meant to inform the commissioners as they consider the implications of leaving the district.
However, county staff told the commissioners any decision to leave SJBPH is months away and La Plata County must first conduct “due diligence” before the county makes a decision.
“During this period, we would like to start coordinating staff-to-staff with La Plata County staff and San Juan Basin Public Health staff to start looking under the hood just to see what’s out there,” said County Manager Chuck Stevens.
County Attorney Sheryl Rogers presented commissioners with two options for leaving the district. In the first, La Plata County adopts a resolution and unilaterally leaves SJBPH. It would require that the county give the public health agency and Archuleta County a one-year notice ahead of the dissolution of the district.
La Plata and Archuleta counties could also jointly agree to leave the partnership, a move that would allow the counties more flexibility as they close SJBPH.
La Plata and Archuleta counties have been slowly moving toward the dissolution of SJBPH since the coronavirus pandemic spurred disagreements between the two counties over their visions for public health centering on the issue of local control.
Archuleta County commissioners convened a “Health District Investigation Committee” in August 2021 to study leaving SJBPH and assess the costs and consequences, and after months of tension, SJBPH’s board finally recommended last month that the two counties end their public health partnership.
If the county decides to exit SJBPH, it would then be required to form its own county health agency or join or form another public health district with at least one bordering county.
Under Colorado law, each county must provide public health services. The Colorado Public Health Act of 2008 outlines the structure and some of the requirements of local health agencies. It also requires that they conduct a community health assessment every five years to ensure they are meeting the needs of the communities they serve.
Montezuma, San Juan and Dolores counties each have their own county health departments, while Hinsdale County is a member of the Silver Thread Public Health District with Mineral County.
The differences between a county-run health department and public health district are slight, essentially boiling down to who they serve and how their boards are constructed.
A county health department serves only the needs of its residents while a public health district must meet the needs of multiple counties.
In a county health department, commissioners can appoint the members of the board or serve as the board of health themselves. In a district, the board is appointed with at least one representative from each county.
The board of health serves an important role, approving the health department or agency’s five-year plan, which guides their work, and determining the public health services and priorities based on their community’s needs, Rogers said.
If La Plata County chooses to create its own health department, it would first decide on a board of health. The board would then appoint a director of the department, who would hire employees.
Unlike SJBPH, which is a separate agency, the employees would be county employees.
With a staffed county health department, SJBPH would then decide how to close down its operations.
“It’s not a merger, we're not bringing two organizations together. At the end of the dissolution, San Juan Basin Public Health would cease to exist,” Stevens said.
Both Stevens and Rogers said SJBPH would continue to provide services and meet the local health needs of both La Plata and Archuleta counties until they established their own health departments or joined another district.
“The baton would not be handed off until our own respective agencies are prepared to do it,” Rogers said.
With the legal process for leaving SJBPH now outlined, Stevens said the county was in a “due diligence” phase.
The commissioners directed county staff members to work with SJBPH to understand the agency’s financials, including audits, contracts, grants and other funding sources, as well as the wages and benefits of SJBPH’s employees.
Part of the due diligence stage will be seeking public input and establishing how much it will cost the county to transition to and then support a new model of public health. It will also include determining the fate of SJBPH’s employees if the district dissolves.
The public health agency currently employs 89 people, said Megan Graham, spokeswoman for SJBPH.
“We recognize that San Juan Basin Public Health has a tremendous set of very qualified employees already, but this whole process we will need to right-size the county and right-size the public health agency, and it will probably prompt some structural changes on both sides,” Rogers said.
The county will examine everything it would have to take on after creating its health department, Stevens said.
Staff members are also watching the dissolution of the Tri-County Health Department, which serves Adams, Arapahoe and Douglas counties on the Front Range, to learn any lessons the county might use if it chooses to create its own public health entity, Stevens said in an interview.
Rogers positioned the county’s review of public health as a chance to consider the needs of La Plata County residents.
“This is a really good opportunity to examine existing programs, existing needs and receive input from our own citizens and also stakeholders that are intimately involved in the different programs,” she said.
Stevens estimated that to complete all of the analysis the county needs to do it will take at least 60 to 90 days before county staff can submit a report to commissioners with a recommendation.
Commissioner Marsha Porter-Norton acknowledged that a move away from SJBPH is a big decision. She said commissioners will be thoughtful and careful, and that they will listen to the public while offering transparency.
“It is a very, very big decision that will impact our residents lives, so I am really glad to see this specificity around what we're doing,” Porter-Norton said. “Times of transition mean more communication, and hyper-communication is really important.”
County staff members are currently waiting for a report from SJBPH’s board that will outline recommendations for La Plata and Archuleta counties after the board’s decision on April 28 to advise that the health district dissolve.
The report is set to come out next week, Graham said.
“We’re anxious to see that report and evaluate the recommendations,” Rogers said. “The next step really is waiting on that and reviewing and gaining an understanding of those recommendations.”