Choosing the correct structure of our new County health department is of the utmost importance.
Having served on the Health District Investigation Committee (HDIC) in 2021 and having a background in healthcare as a geriatric nurse, I’d like to present what I see as the way to structure a public health entity that best serves the people of Archuleta County.
There are three basic choices of how to structure a public health department. There can be a Board of Directors with NO representation by any County Commissioners. This is apparently the poor choice being made by La Plata County. This option absolves the County Commissioners of both authority and responsibility. The Board of Health becomes unaccountable, uncontrollable and this arrangement should be avoided at all costs.
The second option is to have a Board with ONE County Commissioner on the Board, much like the ineffective and problematic arrangement we had with San Juan Basin Public Health. Only one vote out of seven left Commissioner Schaaf as a “lame duck” with no say so at all. His vote did not count, his voice was not heard.
The third option is to have the Board of County Commissioners BE the Public Health Board. The BOCC would create a Committee or panel to accomplish most of the work while reporting to the BOCC. This is the only way to structure a Health Department that respects democratic rule and freedoms. It provides absolute accountability to the voters. The Board of County Commissioners will have total control: can hire, fire and veto the Committee’s actions and decisions. There would be no unaccountable dictates, mandates, reckless spending, and over-staffing. The health department would therefore be accountable to the citizens, with an inherent format protective of liberties and freedoms.
Authority and responsibility go hand-in-hand. A person given the authority to make decisions must be held accountable and responsible for the decisions they make. Only this third option provides for direct accountability though our elected Commissioners.
From the “Snapshot” provided by the HDIC, the counties that were comparable were investigated by the Committee were found to have chosen to operate under the control of the BOCC. Alamosa County has three County Commissioners on the Board along with a health professional; Delta County has three Commissioners along with two members of the community; Gilpin County and Montezuma have only the their BoCC, Grand County has three Commissioners plus a medical officer.
By operating under this third structure, these county health departments are under the control of the BOCC and are held accountable to the voters. Various committees and department employees should then be utilized in advisory and managerial roles wherein the accountable Commissioners have irrefutable roles in directing, controlling and changing health department policies.
I strongly suggest we avoid following the ineffective method chosen by La Plata BOCC. They are in the process of building a mini San Juan Basin Public Health department just like the one they chose to leave. After all the trouble to break free, why would we create another ungovernable entity? We don’t want or need another dictatorship running our health department.
The policy made now will be in place long after our current Commissioners are gone. It is their duty to protect the citizens from tyrants of the future. This is the chance for our BOCC to act in favor of the citizens.
Marybeth Snyder
Pagosa Springs
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