At its April 18 meeting, the Archuleta County Board of Health (BoH) considered its response to a resolution passed by the Archuleta County Board of County Commissioners (BoCC) declaring the county a non-sanctuary county.
The resolution was covered in the April 18 issue of The SUN and states, among other action items, “Archuleta County calls on the Board of Health to issue proactive and responsive Public Health Orders regarding how an influx of immigrants would impact Archuleta County’s services and supplies.”
It also states that the county will not open shelters or provide services, other than emergency services, “to uninvited migrants and/or illegal immigrants that may arrive in unincorporated Archuleta County,” in addition to continuing to prioritize the needs of local citizens.
Prior to discussing the issue, the BoH heard public comment from Archuleta County Public Health Department (ACPHD) Public Health Educator Amy Nitchman, who noted that she was expressing her personal opinions and not speaking in her capacity as an ACPHD staff member or representing the department’s views.
She commented that declaring a group of displaced people to be “illegal” would not address the global problem of mass immigration caused by climate change, natural disasters and violent conflict.
She stated the county would benefit from working to identify locations with more adequate support for displaced populations and assisting them to relocate.
Nitchman commented that declaring the county as a non-sanctuary county is an “insufficient” response and noted that investing county resources in trying to arrest or deport illegal immigrants would be a “poor choice” for using limited county resources and would exacerbate already-existing racial and economic disparities.
“The county should focus on serving the needs of all humans within our county borders who are struggling with the social and economic determinants of health regardless of their country of origin,” she said.
She added that data indicates that sanctuary cities have lower crime rates, lower poverty rates and higher household incomes than those with non-sancturary policies.
She then asked how the county intends to enforce the resolution and if public health staff would be expected to report undocumented or illegal immigrants.
She also asked, if staff were expected to report undocumented immigrants, who those reports would be made to and in what time frame.
BoH chair Jon Bruss opened the discussion by reading the request made to the BoH in the resolution and noting that the agenda item was for the BoH to discuss how it wanted to proceed with this request.
ACPHD Executive Director Ashley Wilson outlined that the state directs public health agencies to serve all individuals within their jurisdictions who require services.
She noted that some services are limited to citizens, but that many services do not require any checks on citizenship or immigration status.
“I think those are very important factors in building trust with the community that’s here that needs to utilize our services, and, so, I would just ask us to use a lot of caution in how we would proceed given that we need to keep that trust with those communities because we do serve them, we want to serve them, they are welcome in our department,” Wilson said. “And, so, however we choose to move forward with creating wording, yes, will it impact the health care system in our community? Yes, it will. Do I have the capacity to do any large-scale response of things? No, I don’t. But, I do think that we do serve that population and are directed to serve them. … And, so, I feel like we are caught a little bit between both the idea of the heart of what the commissioners were doing when they passed this, around … large numbers coming into our community potentially versus what we as public health are charged to do, also knowing the limitations of what our capacity is. And, so, I just put that forward as you guys discuss how we as public health, as both the department and the board, would choose to formulate a response.”
BoH member and Commissioner Veronica Medina responded, “In my opinion, this resolution does not affect how you currently or have been doing business. … It is a statement. It also does not affect [the Archuleta County Department of Human Services] in any way. It’s not a requirement to change anything of how you’ve been working. My understanding how the public health question came up that day, you were on the phone with us, in case something does happen … how to respond. How can we prepare for an emergency, more than anything, not so much specific on legal status. It’s about how can we prepare for an emergency.”
Commissioner Warren Brown, who also sits on the BoH, commented that the resolution asked the BoH to prepare and plan for a potential influx of immigrants, but did not indicate that the BoH or ACPHD should not provide services to these immigrants.
Bruss asked how the county is defining a proactive order in this context.
“I guess I’m not too sure what is being asked of us,” BoH member Jennifer Cox commented.
Brown stated that the request was for the BoH to create a plan for how the ACPHD would respond to and provide services for a large number of immigrants arriving in the community given its limited resources.
Wilson explained that part of the scope of work for the ACPHD’s emergency preparedness funding for 2025 was to create a population surge plan, which would cover situations where the county must take on a large number of displaced people, whether due to immigration or a nearby natural disaster.
She stated that this plan would be required, but that it could be worked on early and the BoH could issue direction that this plan should be created and updated more quickly.
She added that this plan would not be specific to undocumented immigrants.
“Nor should they be,” Medina said.
“It needs to be inclusive to everybody,” Brown added.
Wilson commented that the population surge plan could also cover public health responses to large influxes of tourists during the summer.
She added that the BoH needed to give clear direction on what it wanted from staff, but that this plan is related to these issues.
“Well, I think, with just the small information you’ve provided, what you’re required to do fits what is being asked,” Medina said. “I don’t think there is anything different, in my opinion, that needs to be done other than what is required.”
Bruss expressed confusion about what was being requested of the BoH in terms of an order, stating that any influx of population into the community might be a strain on the health care system.
“But that’s not public health,” he said. “Public health is very different from resources that are needed for individual care within the health care system, and I think we need to be very clear about that. So, maybe the ask is really of health care providers in Archuleta County and what the burden would be on them.”
Bruss explained that public health is “really dependent upon unified collective action against an external threat” such as chronic or communicable diseases, or toxic exposures.
“It doesn’t ask your nationality, it doesn’t ask your origin, it doesn’t ask your … racial background,” he said. “What’s needed is for an action that protects and prevents disease for an entire community regardless of where you’re from.”
As examples, he commented that pandemics do not differentiate on nationality or citizenship and that refusing care to people of a specific nationality in the community who are carrying a “high-mortality communicable disease” puts other residents at higher risk by allowing the disease to spread.
“You’re not going to ask somebody who is from another place,” he said. “We don’t ask Texans or New Mexicans or Oklahomans … where they’re from and why they’re bringing a communicable disease into our county.”
He added that a clear distinction between medical resources and public health needs to be maintained, adding, “I’m just concerned about this ask of Board of Health to issue proactive and responsive public health orders because … I’m not sure that we can come up with something that is going to be, ‘OK, this is the impact from an influx of immigrants,’ when in fact what public health needs to be thinking about is, ‘What is the impact from the external threat?’ not necessarily from the people who are residing here in Archuleta County regardless of their status. So, anyway, I just would like some more clarity on that before we engage in this process.”
Brown commented that he largely agreed with Medina that the emergency planning that is occurring concerning population surges would likely address the resolution’s requests.
He added that, although public health would not be providing care directly to a surge of people coming into the county for any reason, it would have a key role in coordinating resources.
Wilson explained that the public health department would manage requisition of scarce medical supplies or vaccines within the community and efforts to obtain more resources through mutual aid.
She noted that emergency preparedness also extends to public health’s response and coordination with other agencies to events like drought or wildfires.
In response to a question from Bruss, Wilson noted that certain public health programs require that the department ask about citizenship, but that most programs do not.
She stated that most programs that require questions about citizenship are federally funded.
Bruss asked if denying noncitizens services from these programs is putting other residents at risk.
Cox commented that she was also wondering about this, adding, “I fear that an unintended consequence of this is now that we’re going to make people not seek care in a public health risk thinking that they’re going to get turned in if they come seek care.”
Wilson noted that there is no requirement to report anything about citizenship.
Cox commented that a patient may not know this and that she is concerned that patients might not seek care due to the resolution, even if they know that care is available and accessible to them.
Wilson commented that this is a risk for any program that delineates based on citizenship, but that public health does not control this and that public health’s job is to find other programs that those who do not qualify based on citizenship can use.
“There is never a turn-away of service; we might just not be able to provide it in that same avenue or pay for it with the same dollars,” Wilson said. “Those are just grant requirements that any nonprofit or anyone else who has funders on various levels is held to, and, so, I think that it’s our job to understand what they need, where they fit and then get them where they need to go.”
Bruss asked whether the request from the BoCC was for the BoH to assess the potential impact of an influx of immigrants or to create a plan for resource allocation for such an influx.
Cox asked how this would be different from the emergency plans the department is already creating.
Brown stated that, in his opinion, the emergency plans already cover this situation and that the ask had been met.
Wilson stated that she would be willing to bring the BoH a list of the plans and have the board review them.
Bruss asked if the ACPHD would consider an influx of immigrants to be a public health emergency.
Wilson stated that these plans cover a wide range of jurisdictions and that a population surge plan would cover the impacts of a population surge on public health and how public health would respond to such an event.
Bruss asked how an influx would be defined.
Wilson commented that population surge planning originated from Hurricane Katrina and covers response to events like if a nearby community had to be evacuated due to a wildfire from a range of perspectives.
Bruss commented that a clear definition should be created for what a population surge is and what amount of displaced people would be required to impact local services.
Wilson commented that this topic is something the BoH should consider and pointed out that threshold for strain may be different between agencies.
She then asked what the BoH would like her to bring back to determine if the request had been met.
“Maybe the next step is to suggest that it’s already part of the system itself,” BoH member Stacey Foss commented.
Brown asked if Wilson could share a list of the plans the ACPHD is working on or has completed so the board could examine them.
Wilson commented that she could do so and that some plans might be of interest to the BoH or be things that she would recommend the BoH assess due to the potential for unique considerations in the county.
Wilson also proposed that the BoH could create a schedule to review the plans.
Foss recommended that the list of plans be presented to the BoH and that its members could raise questions about plans or suggest certain plans for review, which Cox expressed agreement with.
Bruss asked how the term “unhoused immigrants,” a term used in agenda documentation for the discussion, is defined.
Wilson stated that she did not have a definition, and Brown noted that the term was not defined in the resolution the BoCC passed.
Brown then asked County Attorney Todd Weaver for his input on a definition.
Bruss asked how the BoH would define which immigrants are unhoused or not.
Weaver commented that the resolution envisioned a busload of immigrants being dropped off in the county lacking any arrangements for housing.
He added that a specific definition would be difficult to create.
Bruss noted that he was “struggling” with the request, since, if the definition were not clarified, it would be difficult to create an order for a “something that might happen or might not happen.”
Weaver noted that this difficulty is why many definitions and plans are created after an emergency and that creating one before such an emergency is very difficult.
Bruss then raised the issue that immigrants may come from locations with varying levels of contagious diseases, making it a “very complex situation” to determine what risk an influx of immigrants might pose.
“So, coming up with these blanket orders or programs treating everything as equal may not be realistic,” he added.
Weaver commented that the BoCC wanted to have the BoH assess what risk the arrival of a large number immigrants would pose, how it would be assessed and what response could occur.
He added that this assessment could be short, and that the board would want “a plan or some vision of how we’re going to respond so that, if it happens, we know the steps to follow.”
He stated that this vision could also include how other agencies might be needed or become involved in a response.
Medina commented that “it sounds like that’s already what’s happening, so it sounds like maybe this request is already being fulfilled.”
She added that she does not believe that more needs to be done.
Weaver commented that he was not familiar with the plans that are in development, but that he was outlining his vision of what sort of plan might be needed, and is potentially already being created.
Wilson explained that emergency preparedness plans typically outline the steps for an emergency response and commented that the “hang up” might be that a plan is not a public health order.
She stated that a plan outlines steps, but that plans may have to be changed over the course of an event, such as how public health plans shifted during the COVID-19 pandemic.
“If a plan is what is being asked for, that can be done,” Wilson said. “If an order is what you’re asking, I think that feels like a different standard to me than us creating public health emergency plans, but … if the board just issues an order that we create the plan, maybe that’s enough?”
Foss suggested that the BoH should give Wilson a list of next steps to ask about and receive clarification on to help determine whether the current planning effort is sufficient or if there are additional needs beyond that to meet the request.
“So, it sounds like the ask for clarifications are: is it really about just knowing if there’s a plan in place, here’s where we think this may cover this and clarifying if there’s an additional ask beyond that,” she said.
“As long as a plan includes some definitions and thresholds,” Bruss added.
“It can be done,” Wilson concluded.
josh@pagosasun.com
