In recent months, San Juan Basin Public Health has been caught between two counties that don’t see eye-to-eye on public health.
That may end soon.
The agency’s Board of Health on Thursday agreed to recommend SJBPH be dissolved. The decision came at the request of La Plata County Commissioner Marsha Porter-Norton, citing irreconcilable differences in the two counties’ public health goals. The recommendation will now move to Archuleta and La Plata county governments to decide whether to leave the agency and approach public health separately.
The move has been months in the making and comes as disagreements, heightened by the coronavirus pandemic, revealed differences in the two counties’ visions for public health.
“It’s many reasons that we have gotten to this point, but we have no intention of having this be a highly difficult or conflictual conversation with Archuleta County. It’s just clear that we have had some difficulties being a unified public health entity,” said Porter-Norton, La Plata County’s representative on the board of health, in an interview.
SJBPH declined to comment and board President Karin Daniels did not return a request for comment.
Archuleta County Commissioner Alvin Schaaf, the county’s representative on SJBPH’s board, did not respond to requests for comment.
In a statement, the SJBPH board said:
“The SJBPH Board of Health supports La Plata and Archuleta County’s efforts to evaluate how environmental and public health services are delivered to their constituents. The Work Session today allowed for a productive dialogue, and the Board of Health will be summarizing the discussion in a report it will provide to both counties.”
Thursday’s work session was led by Daniels and board Vice President Shere Byrd, but it was driven by Porter-Norton. The meeting was largely one-sided with La Plata County and the board seemingly speaking jointly to Archuleta County.
At the beginning of the meeting, the board noted that Schaaf attended the meeting virtually, but he was not present.
“The (public health) district is many years old, but there does come a time when I think we have to in a transparent and an honest way say how is this marriage is working. Because it is a marriage made by the two boards of county commissions,” Porter-Norton said. “You all do fabulous work. But at the end of the day, both of the county commissions have to decide if we’re going to stay in this district. It’s frankly very challenging for La Plata County right now.
“... We feel like to be in a good marriage and a good partnership, you need trust, you need a commitment to act as one voice. In this case, because we are a policy governance board, and so much relies on our executive director and our staff, we need to support them. And I think this relationship has had – not pointing fingers – a corrosive impact on the organization.
“We have to ask ourselves as leaders: How long are we going to let that continue? Every marriage is imperfect, but are we going to stay married and say, ‘We’re going to work on it, we believe in being in this together and we believe in the principles of public health and basic things that public health puts forth, such as vaccines, such as masks?’ These things have thrown a giant wedge in our ability to sometimes have a unified front.”
There was broad agreement among the board that La Plata County and Archuleta County want to approach public health differently.
“Archuleta County appears to want to have more local control over what happens, and we’re not local enough,” Byrd said.
Terryl Peterson, treasurer of the board, said a small minority of residents opposed to SJBPH and pandemic safety measures were driving the public health conversation in Archuleta County.
“They’re being validated by Archuleta Board of County Commissioners,” Peterson said. “My position is I want everybody to have good public health in Archuleta County and in La Plata County, but I don’t think this organization is going to be able to deliver good public health if we continue in this relationship.”
SJBPH’s board will now submit its recommendation to both boards of county commissioners.
Because the agency was formed by resolutions from both boards, it will be up to the commissioners to decide if the counties will leave the partnership and dissolve SJBPH.
Either of the counties can leave unilaterally, and the dissolution of the public health agency is a yearlong process, said La Plata County Manager Chuck Stevens.
Porter-Norton said during Thursday’s work session she wants La Plata County to hold public hearings to hear what the public thinks about a potential break before any decision is made.
Stevens said any decision was at least a month out. La Plata County staff members will now undertake research over the next few weeks to find out procedurally how the county could leave and what the impacts would be. He pointed to the end of May or early June for a staff member presentation to the commissioners.
There are many directions that each county could go if they choose to dissolve SJBPH. The public health entity could remain in its current form and either county could contract services. They could also form their own health departments under the counties.
“If the district is going to dissolve, then in all likelihood we’ll end up forming a county health department. I think that’s the most obvious answer,” Stevens said.
The next steps for Archuleta County are less clear. Under state statute, each county must provide public health services.
“I think that all options have to be on the table,” said Archuleta County Commissioner Warren Brown.
He said Archuleta County is in a difficult position as it weighs whether to disband SJBPH.
“It is impactful for both of our communities, respectively,” he said. “If this is what the board has said, I think we will have to just deal with it accordingly.”
San Juan Basin Public Health will continue operate normally in the interim and serve both Archuleta and La Plata counties as the counties decide how to proceed.
The relationship between La Plata and Archuleta counties has been strained when it comes to public health.
The Pagosa Springs Sun and the Pagosa Daily Post have documented pushback from Archuleta County residents against SJBPH’s public health measures during the coronavirus pandemic. Some residents have campaigned for months for Archuleta County to leave the public health agency.
In August 2021, the Archuleta County commissioners convened a “Health District Investigation Committee” to study the public health entities of other counties while looking at leaving SJBPH and assess the costs and consequences.
Brown, the commissioners’ liaison to the committee, said the effort was a fact-finding mission.
“I thought that would be valuable to me because it would give me some information that I thought would be pertinent in order to make a decision or even have an informed opinion with San Juan Basin Health and Archuleta County,” he said.
In March, the committee presented its findings, though it came to no conclusion about whether Archuleta County should stay or leave.
A snapshot produced by the committee showed that Archuleta County had a considerably smaller public health budget and spent less on public health per capita than Alamosa County, though Alamosa County has only about 3,000 more residents.
The snapshot also revealed that Archuleta County spends $20.60 per capita on public health while SJBPH spends $124.87 per resident on public health.
Archuleta County contributed about $275,000 to SJBPH’s budget in 2022, while La Plata contributed $1.15 million. Both are still a fraction of the more than $8.6 million SJBPH forecast for its expenses in 2022.
Porter-Norton said the actions of the Archuleta County commissioners with the investigative committee and in other public meetings made it clear that the county wanted to leave, which led to Thursday’s work session.
“These are conversations that are difficult, but they’re ones that are long overdue and needed to be held,” she said.
The fiscal and public health impacts of dissolving SJBPH for both La Plata and Archuleta counties are unclear.
La Plata County can likely stay within its budget while making up for the money Archuleta County contributes annually, Stevens said.
The fiscal impact of taking on public health independently worried Brown.
“As far as the financing goes and funding, that is certainly one of my big concerns,” he said. “... I think that this can be costly. We would have to hire staff to staff this at least to some degree. I’m sure that we would contract some services out. But I think as a responsibility to the taxpayer, the cost is certainly on my mind.”
Dr. Jon Bruss, a health board member, expressed concern during Thursday’s meeting that the breakup would impact health in Archuleta County.
“Splitting has its own headaches, and it’s going to have some major headaches,” he said. “I really am concerned about the citizens of Archuleta County because I think – no matter all the good intentions we have – they are going to be left probably in a disadvantage from a public health standpoint for many years.”
The Archuleta County commissioners would have a responsibility to limit that, Brown said.
“I think the county would have an obligation to limit the negative impact this could have,” he said. “How that works out in the end, I just don’t have an idea at this point.”
Both Porter-Norton and Brown portrayed any decision to dissolve SJBPH as whatever would be best for their constituents.
“I’ve said this all along: If staying with San Juan Basin Health is what’s best for our county, then that’s what we should do, and we should take an active part in improving our working relationship with San Juan Basin Health,” Brown said.
Porter-Norton argued it was a matter of each county aligning their actions with their public health goals.
“We just need to get to a point where the governance structure works for both of our communities,” she said.
ahannon@durangoherald.com
