Douglas County’s first-ever public health director is focusing on the future as he builds an agency he hopes will reduce costs for local taxpayers.
In an exclusive interview with Colorado Community Media, director Michael Hill talked through his background, his plans for the department and his philosophy on public health.
“I’m not really going to be about trying to understand or fix people’s opinions of the past or what happened,” he said. “I just want to make sure we’re doing a good job as we roll out services.”
Hill, who previously worked as the health agency director for San Luis Obispo County Public Health Department in California, started in Douglas County on Feb. 28.
Hill’s annual salary was approved by the commissioners at $205,000. Dr. John Douglas, an infectious disease physician who leads the Tri-County Health Department currently makes $317,000. A recent physician leader of the Jeffco Health Department made $190,000 annually.
The new county director has 30 years of experience working in public health, has a bachelor’s degree in biology and has master’s degrees in public health and in public administration.
Hill’s previous health department served 285,000 people with about 900 employees. Now, he’s overseeing a significantly smaller team, serving 380,000 residents in Douglas County.
As of mid-May, the newly formed Douglas County Health Department employed five people and was set to add four more in the near future. In an April 19 work session with commissioners, Hill pitched a possible full organizational chart consisting of about 35 full-time employees and two contractors.
Douglas County pulled out of the Tri-County Health Department last fall after the county commissioners disagreed with the COVID-19 restrictions put in place by the agency.
The new health department is set to begin providing several services over the next few months, including vital records, emergency preparedness, disease surveillance, environmental health and community health. The board of health approved a list of services the agency will provide during a May 12 meeting.
Here’s how Hill answered questions on various topics:
Philosophy on public health:
“Over my career I’ve tried to interfere in people’s lives as seldom as possible but the reason it’s called public health instead of personal health is it’s about protecting the community. So if you have something bad and you’re running around spreading it to everyone, then maybe I need to interfere with your liberties a little bit to protect everybody else. That’s not our go-to move to try to interfere with people’s lives, it’s to try to educate people and help them understand how they can keep themselves and their neighbors healthy.”
Why he works in public health:
“I went to Florida, started looking for jobs and landed in one in the health department and it just seems to have been a fit … It just happened to me and I seem to be okay at it and mostly enjoy it, so I’ve kept at it.”
“I know I’ve made a difference in people’s lives. I know there are hundreds of people who are alive because of what I’ve done. There are thousands of people who are better off because of what I’ve done … I’m not doing this waiting for the thank you notes to come rolling in but I know I’ve helped these people. Whether they know or not is not important to me.”
Why he applied:
Hill said the challenge of figuring out the organization and solving various personnel and administrative problems interested him.
“I was sitting happily in my office in California when some recruiter reached out to me and said here’s this wonderful opportunity … The more I looked at it, the more I said `well that looks like a lot of fun.’”
New department’s costs:
“I’ve committed to the board of health and the commissioners that I won’t exceed the amount they were spending for Tri-County services over the years. So I’ve got to make sure I’m bringing in enough grants, allocations from the state, fees, whatever extra money I can to provide all these services. It’s not something I take lightly. The commissioners have stated before I got here that they weren’t going to spend any more money and my job is to make that true.”
“I’m pretty confident we can build an environmental health division that is right-sized so it doesn't cost more to do these things and it shouldn’t.”
Hill added that the health department will adopt the same fee structure as Tri-County for this year but may consider suggesting fee changes next year.
Transitioning away from Tri-County:
“As Tri-County is going to dissolve at the end of the year, I don’t believe 100% of their employees are going to stay until Dec. 31. So I’m trying to be ready to make sure there's not a gap in services so that we can jump in sooner.”
When the new health department was formed, one of the first decisions by the board was to contract with Tri-County to provide all public health services through the end of 2022.
Gaps in service:
“I don’t have really any qualms as far as the inspections part. Again the whole clinical area is so up in the air right now. I don’t think there will be any gaps because I’ll be trying to bring up services by fall and Tri-County will hopefully still be able to provide services until December so we should be able to back each other up.”
The department’s employees:
“So we’re trying to build an organizational culture by hiring people who again agree with this philosophy of not being out there — we’re not the police — our inspectors aren’t going to be out there with badges and guns trying to catch people our inspectors will be out there trying to find out what you’re doing and if you’re off track trying to help you understand how to get back on track.”
“We’ve already hired a few people from Tri-County and I’m sure we’ll hire more. We’re very open to their applications.”
What we don’t yet know about the health department:
“The big unknown is still in the clinical and nutrition and health education programs as far as whether we find people we can contract those services to and how many services the commissioners and board of health will let us bring in house to do … we didn’t draw a lot of interest when we were reaching out for contractors so we may have some other referral mechanisms set up.”
Hill said that the clinical services include vaccines, sexualy transmitted disease protection and family planning.
Contracting services compared to hiring more staff:
“On some level there’s an interest in not growing government by adding government employees but to grow the private sector. The reason I was looking at approaching outsourcing of these functions was the whole realm of employing nurses has gotten out of control recently so it’s hard to get nurses and it’s hard to keep nurses. I thought it would be easier to have other organizations go through that pain and we can just have enough pain of keeping the other health department services covered.”
Hiring a Medical Officer:
Under Colorado law, public health departments that don’t have a physician as their public health director are required to employ one as a medical officer to advise the public health director on medical decisions. The Douglas County Health Department discussed whether or not to hire a full-time medical director but Hill ultimately suggested contracting with one.
“There’s a very small need for a medical officer in this health department where we’re going to do almost no medical care so a full-time medical officer would be very bored in this organization. There’s not a lot of physician knowledge needed to run restaurant inspections or issue birth certificates … where there’s a benefit added by having a physician input certainly I’m happy to have them there but at one point somebody thought they should hire a $200,000 per year physician to sit beside me and watch me do my job and well, I’m a cheap guy I don’t think that’s cost effective or necessary.”
That officer will also oversee clinical contracts, he said.
The state of the pandemic:
“Right now if you look statewide there's an upward trend to the cases and case positivity and that upward trend is in our county as well. So we need to be prepared to ramp things back up in a hurry if we need to … A lot of the state testing sites went away so if something big happens again and there’s a big need for testing, we need to be able to figure out how to help make that happen.”
“I’m not sure we can call ourselves past the pandemic yet.”
What questions should Colorado Community Media be asking the health department or Hill? Let us know by emailing email@example.com.