On Tuesday, the true unraveling of the Tri-County Health Department begins, after 73 years of providing critical health services to a stretch of the metro area — from Brighton to Larkspur — that is now home to 1.5 million people.

Douglas County will create a board that day to oversee a new public health department of its own. Few in the politically conservative county know what that will look like and if it can be done at a reasonable cost.

Hastened by a global pandemic that has laid bare raw emotions and politics engendered by controversial health orders and restrictions, the move has generated headlines and pushback. Meanwhile, Adams and Arapahoe counties are left to figure out where they go from here. Do they stick together, or is it each to their own?

Aurora, which straddles all three counties, also will have to chart an uncertain path of how and from where its nearly 400,000 residents continue to receive public health services.

“This is the most expensive example of taking your ball and going home that I’ve ever seen,” Matt Bateman, a Parker resident, told the commissioners at a public meeting last week. “After a spat about masks — masks — we’re going to take our ball and go home?”

Douglas County’s decision was made in a unanimous vote by its three commissioners last week, and in reaction to the Tri-County Health Department expanding a mask mandate on Aug. 30 to all students and staff in schools. In doing so, Tri-County revoked the ability of its member counties to opt out of its health orders.

Douglas County cried foul, saying the revocation constituted a “breach” of a November agreement. Two days later, it formally began its withdrawal from an agency that administers 60 health programs — from infectious disease investigations to immunizations to restaurant inspections — and has a $66 million budget.

Jennifer Ludwig, Tri-County’s deputy director, called Douglas County’s decision “unfortunate.”

“To see it changing is really difficult, especially in the middle of a pandemic,” she said, “especially when the decision to do it appears to be all around politics.

“There’s more to Tri-County than responding to a pandemic and issuing orders.”

“OK … to move on”

The fast-moving events on the metro area’s east side look similar to what has been playing out in Southern California in recent months, where half a dozen cities in Los Angeles County — including Torrance, Beverly Hills, Whittier and Glendale — have explored breaking from the county’s public health department to form their own.

The cities’ central complaint revolves around what they see as overly restrictive COVID-19 measures. According to a story in Hermosa Beach’s Daily Breeze newspaper, West Covina is the only city to have actually taken the plunge so far.

Douglas County Commissioner Abe Laydon said the split from Tri-County was a long time coming. What started as a rural outpost on the fringes of Denver’s southern suburbs half a century ago, with less than 5,000 residents, the county is now home to more than 350,000 people. Douglas County joined Tri-County in 1966, replacing Jefferson County.

At last week’s board of commissioners meeting, Laydon compared the separation to an “empty-nest” situation.

“It’s OK for kids to grow up, to move on and do new things,” he said. “One theme that is abundantly clear for all of us regardless of your background as Douglas County residents — local control of your public health decisions is paramount.”

Douglas County last week had zero pediatric hospitalizations for COVID-19 and only one child in the county has died from the virus in 18 months, prompting one mother at the commissioners meeting to note “our kids are the least vulnerable to this disease yet somehow they are the most punished.”

Its partnership with Tri-County — the state’s largest local public health agency — will go through at least the end of 2021, giving it some time to figure out costs and logistics of standing up its own health department. Douglas County contributes $2.5 million to the agency annually, and Laydon said it has little debt, strong reserves and nearly $70 million coming its way in American Rescue Plan COVID-19 relief money, which he said can be put toward launching the health agency.

But Glen Mays, professor of health policy at the Colorado School of Public Health, said it’s simply going to cost more to start a new health department. Not to mention, he said, “you’re going to be building that plane while you’re flying it.”

Lost with the dissolution of Tri-County will be the “economies of scale” that an agency of that size can bring to the table, Mays said. The department provides services at a cost of $7.10 a person per year, according to Tri-County.

Douglas County will also face challenges drawing in the kind of medical and technical expertise that Tri-County has managed to attract with its 368 full-time employees. That total includes physicians, nurses, nurse practitioners, social workers, dental hygienists and dentists.

Barbara Drake, Douglas County’s deputy manager who is heading up the transition, said while it’s not yet clear how much it’s going to cost, the county already owns one of the buildings Tri-County operates out of in Lone Tree and leases another in Castle Rock. Douglas County will also be eligible for millions of dollars in state and federal grants, Drake said, just like Tri-County is today.

“My hope will be in a couple of years we will look back on this and realize the benefits we get from a single-county health department,” she said.

What’s next for Adams, Arapahoe

Breaking up with Tri-County will have spillover effects for Adams and Arapahoe counties. “Disappointed” is the word Arapahoe County Commissioner Nancy Jackson used to describe her reaction to the split.

“This is one of the issues,” she said. “Is this going to cost us more money?”

Arapahoe County contributed $4.8 million to Tri-County for services this year, and Jackson said the agency “has always been very responsive to our needs.”

The county is teaming up with Adams County to explore its options for what to do next, be it forming a two-county health agency or each going off on its own. A consultant report outlining possible paths for Adams and Arapahoe counties is expected in October.

Earlier this month, Arapahoe County pleaded with Douglas County to delay any departure until the three counties “are able to meet and discuss a mutually agreeable early exit strategy for Douglas County.” It even threatened legal action in a letter based on how much notice its neighbor gave about its imminent split, noting concerns over the possibility of “significant adverse impacts” to Arapahoe County from a breakup.

Adams County appears more open to going solo, an idea that long-time Commissioner Eva Henry said she has pushed for years.

“The people of Adams County have different health challenges than the people of Douglas County,” she said, citing the Suncor oil refinery in Commerce City and the county’s extensive oil and gas production sector that present air pollution and water contamination concerns. Suicide prevention and family planning, especially in communities of color, are also issues that ring louder for Adams County than its neighbor to the south, she said.

Adams County gives Tri-County $3.8 million a year to Tri-County for services.