As the Tri-County Health Department breaks apart, Aurora finds itself standing amidst the wreckage — a city of nearly 400,000 straddling the three counties that for decades constituted Colorado’s largest public health agency.

And that has this diverse, fast-growing city east of Denver starting to look at how it will provide public health services — inoculations, restaurant inspections, contagious disease control — to its residents once Tri-County dissolves for good, likely by the end of next year.

The city has several ways it could go: contracting for service from each of the counties that once were part of Tri-County (Douglas, Arapahoe and Adams), standing up its own city public health department or pursuing the arduous and ambitious route of transforming itself into Colorado’s 65th county.

“This could be a major factor in pushing the city of Aurora into becoming a city and a county form of government,” Aurora Mayor Mike Coffman said.

Forming its own county, instead of floating in an amorphous middle ground beholden to three county governments, is an idea that has been discussed numerous times in Aurora but never gained sufficient traction to move forward. Coffman said his city’s need for reliable public health services could be the necessary nudge to move the concept from talk to reality, “since the responsibility for establishing local health departments is at the county level.”

To form its own county, Aurora would need to change its city charter and then get voters statewide to approve its formation. Broomfield, which had been in four different counties, was the most recent Colorado county to form in 2001, with voters approving its formation three years earlier.

But any discussions about public health services in Aurora are at a very early stage, given that the unraveling of the Tri-County Health Department began less than two months ago when Douglas County broke away to form its own public health agency after finding itself crosswise with Tri-County’s COVID-19 policies.

Adams County last week announced that it would echo Douglas County’s move, with a formal vote scheduled for Tuesday to notify Tri-County of its intention to go its own way at the end of 2022. Arapahoe County, which hasn’t said what it will do on the matter, will almost certainly be forced to go solo as well by default.

Tri-County has been around since 1948, and until last month, served 1.5 million people in the metro area.

There’s still time to figure things out. Tri-County is contracted to provide services to all three counties through the end of next year. But Glen Mays, professor of health policy at the Colorado School of Public Health, said Aurora “needs to be in active discussions” with the three counties about its unique needs.

“As Colorado’s most diverse city and one of the most demographically diverse cities in the U.S., Aurora faces some important issues about whether the three counties can fully and equitably meet the health needs of its population,” Mays said. “I think about the 160-plus languages spoken among Aurora residents, the many cultures and norms, the unique occupational settings and businesses, the environmental hazards and risks, the large medically underserved areas within the city, the issues of law enforcement and its health effects within the city.”

If the three new public health agencies in Douglas, Adams and Arapahoe counties are largely responsive to their own county populations and demographics, he said, “this would create difficult problems for Aurora in terms of unequal protection,” depending on where in the city residents live.

Dealing with separate health departments will “clearly create transitional challenges” for Aurora, said Tri-County spokeswoman Becky O’Guin, but it’s not an unprecedented situation. Look at Westminster, she said, which sits in two counties and is served by Tri-County in Adams County and Jefferson County Public Health on its west side.

“(They) have figured out how to navigate such a landscape,” O’Guin said.

There has been little friction in the delivery of public health services in the city of 116,000, said Westminster spokesman Ryan Hegreness.

“For us, this is always how it’s been,” he said.

The pandemic has required the city to work a little harder to get its messaging out to residents when it comes to differing COVID policies, like masking or capacity limits in buildings, between the two counties, Hegreness said. But there is cooperation, too, across county lines, with coordinated testing sites and vaccine clinics.

“Additionally, both agencies have a physical presence in Westminster by conducting street outreach to people experiencing homelessness,” he said. “Tri-County focuses on harm reduction surrounding drug use and COVID screenings. JCPH focuses on general health assessments, including COVID screenings, as well as hygiene item distribution.”

But Coffman, who decried the dissolution of Tri-County, worries about contracting out with three counties for health services.

“Not only do I think that it will cost our taxpayers more and be less efficient to stand up three separate bureaucracies, but none of them will have the depth of expertise that Tri-County has had because of its size,” he said.

Tri-County has 397 employees, and its budget this year is just over $55 million.

That leaves Aurora with the option of forming its own city health department, like Denver has, without necessarily going through the hoops of becoming its own county. Coffman said legal minds on city staff have indicated that as a home-rule city, Aurora has the ability to follow this course.

While this is a daunting moment for Colorado’s third-largest city, Mays said, it’s an opportunity for Aurora to “re-think and re-invent public health for its jurisdiction.” It has the University of Colorado’s Anschutz Medical Campus and the Colorado School of Public Health within its borders, which could “open up some very interesting possibilities for Aurora.”

“With some creative thinking, Aurora could emerge as a new national model for public health that is uniquely equity-focused, intergovernmental and multi-sectoral in its organization, financing and delivery,” Mays said.

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