PHOTO: The initial staff for the new Archuleta County Public Health Department, December 12, 2023.
The new Archuleta County Board of Health held its first unofficial meeting on Tuesday, December 12, at the County admin building. Several members of the public attended, mainly out of curiosity, I assume.
The Board — County Commissioners Veronica Median and Warren Brown, and citizen members Stacey Foss, Jon Bruss, and Jessica Cox — were introduced to the new medical director Dave Schaeffer, a local physician with Pagosa Medical Group, and to the new Archuleta County Public Health Department staff, who will take over management of our community’s public health from San Juan Basin Public Health (SJBPH) on January 2. (January 1 being a holiday, of course.)
The first “official” meeting the BOH will be held on January 4 at 1pm, with a second meeting scheduled for January 18 at 3pm.
Board member Stacey Foss is a Addiction and Substance Abuse Counselor with Authentic Solutions Consulting in Pagosa. Dr. John Bruss specializes in Infectious Disease at Pagosa Springs Medical Center. Dr. Jessica Cox is a radiologist with Pagosa Springs Medical Center.
The meeting featured a generally upbeat atmosphere.
We don’t yet know how hard this work is going to be. Hopefully, no pandemics in the near future. COVID definitely ruined the formerly upbeat atmosphere at SJBPH.
SJBPH will be dissolved after December 31, after serving as the public health district for La Plata and Archuleta counties for over 70 years. One of the final projects by the SJBPH staff was a survey and 97-page analysis of local health needs, which you can download here. Presumably, this ‘assessment’ will provide some of the crucial data Archuleta County will need to effectively address public health in our community.
From the Assessment introduction:
Local public health agencies are required by the state of Colorado to complete a Community Health Assessment every five years as a component of their overall Public Health Improvement Planning process.
Enhancing population health requires the efforts of not only the local public health agency, but also of government, non-profits, healthcare organizations, and community members. This is especially true this year, as SJBPH will dissolve and be replaced by individual county public health departments in each county on January 1, 2024. SJBPH has taken this opportunity to prepare a Community Health Assessment that serves the counties’ individual needs and can be used by the entire public health system, including partner organizations, to inform their own strategies to improve community health and to seek funding for innovative programming.
Part of the Assessment data was derived from a survey of 427 (28%) respondents from Archuleta County and 1,118 (72%) respondents from La Plata County. The number of respondents of the survey purportedly allowed for statistical validity for the population size of each county; however, when breaking the number of respondents by race or age group, it was no longer statistically valid. That seems unfortunate, considering that it might be guiding our new Department’s decisions for the next few years.
Here is some data that might appear statistically valid, except it asks a question that the general public had to answer based purely on (uninformed?) personal opinions, and regarding undefined terms.
What does “Very Healthy” mean? Or “Somewhat Healthy”? And what does it mean for an entire community to be “Healthy” or “Unhealthy”? I have no idea, and I presume the respondents also had no clear idea. In my humble opinion, data is relatively meaningless when terms are not clearly defined for the people surveyed.
I hope our new public health department can do better in the future, when they design the next community health assessment.
However, the first meeting of the Archuleta County Board of Health had other concerns to deal with. County Attorney Todd Weaver had to give the Board an overview of government transparency rules — specifically, the Colorado Open Records Act (which requires public access to financial and administrative records, but not to individual medical records) and the Colorado Open Meetings Law (which requires BOH meeting to be held publicly and to be properly noticed to the public.). Department Director Ashley Wilson explained that the BOH will elect board officers at its first meeting in January, when they will also consider the board bylaws.
The Department is required to develop a ‘Five Year Public Health Plan’ which will be approved by the BOH. And the BOH will be responsible for developing policies to guide the Department.
Ah, yes. Policies. One of the reasons for the dissolution of SJBPH was a disagreement over policies, between the La Plata County Commissioners and the Archuleta County Commissioners, especially around the COVID crisis.
A study conducted by an Archuleta County work group in 2021 — before the dissolution of SJBPH had been confirmed — looked at the cost of providing public health in other Colorado counties, with the goal of clarifying what a dissolution might cost the Archuleta County taxpayers. The final report ran to 148 pages.
The Committee’s conclusions, however, were more simply stated.
In conclusion, we learned much about the different health structures and services among those that we contacted and those that provided information. There are many more questions to be asked and research to be done…
…BOCC may consider exploring additional questions with both SJBPH and the community to stay open to learning about the public health landscape and gaps that can be addressed in a responsive manner. Toward this end, BOCC may consider formal public outreach or polling as a next step to see what the public needs are and who the public health clients are and will be in the future.
One of the differences that became apparent in the Committee’s research was different ‘per capita’ expenditures among the six different agencies included in the report.
San Juan Basin Public Health was the only agency included in the study that served more than one county. So… not exactly an ‘apples to apples’ comparison. But still, significant ‘per capita’ differences were apparent.
Here are the budget and ‘per capita’ comparisons from the report:
Alamosa County: Budget, $1.2 million; expenditures per capita, $73.92
Montezuma County: Budget, $2.4 million; expenditures per capita, $91.40
Delta County: Budget, $1.3 million; expenditures per capita, $40.11
Gilpin County: Budget, $0.4 million; expenditures per capita, $73.44
Grand County: Budget, $2.4 million; expenditures per capita, $91.40
San Juan Basin Public Health: Budget, $8.6 million; expenditures per capita, $124.87
This doesn’t tell the full story, however, because when you look at the amount contributed to the SJBPH district by the Archuleta County taxpayers, the contribution amounted to only $20.60 per capita — half the amount budgeted, per capita, for the lowest funded county in the Committee’s research: Delta County. The lion’s share of the SJBPH budget was covered by grants.
Suggesting that maybe Archuleta County taxpayers are getting an incredible bargain, through our membership in SJBPH?
But the financial cost of running the Archuleta County Public Health Department remain hazy. Much will depend on accessing state and federal grants, and on final decisions about what services Archuleta County wants to provide, beyond the services legally required by state law.
Bill Hudson began sharing his opinions in the Pagosa Daily Post in 2004 and can’t seem to break the habit. He claims that, in Pagosa Springs, opinions are like pickup trucks: everybody has one.