An election is underway in Fort Collins, this time for a little-known and often misunderstood taxpayer-funded health district that is in the midst of both transformation and pain.
The Health District of Northern Larimer County’s leadership has been setting strategy and making changes at the organization, whose roots go all the way back to 1960.
But some employees and community members worry that in the midst of the district’s evolution, the community is losing access to care they’ve come to rely on, behavioral health care in particular.
Now, several of the candidates running to be on the Health District’s board of directors are highlighting their concerns about the treatment of employees and turnover in the organization.
The May 6 election will decide who will fill three board seats. There are seven candidates: Julie Field, Dr. Sarah Hathcock, Nicole “Coco” Peterson, Adryliana “Adry” Santiago, Averil Strand, Sylvia Tatman-Burruss and Lee Thielen.
To understand what the district is and where it is focused today, it helps to know where it has been.
What is the Health District of Northern Larimer County?
The Health District of Northern Larimer County is a special tax district that is tasked with filling health care gaps in the community. Today it offers low-cost dental care, behavioral health care, and help enrolling in health insurance. It also offers financial assistance with prescriptions. Some of the services are income-based, but not all of them.
But that’s not how it started.
The Poudre Valley Hospital District came into existence in 1960 as a response to hospital overcrowding in Larimer County. It was the first of its kind in the state, and it funded the development of what was then called Poudre Valley Memorial Hospital.
The district owned and operated Poudre Valley Hospital from 1962 to 1994. At that point, the operations were split into two because of concerns that the legal structure was making it hard for the hospital to serve its mission.
So the district created a private nonprofit entity, Poudre Valley Health System, to manage the day-to-day hospital operations under a 50-year lease agreement.
The Poudre Valley Hospital District was renamed the Health District of Northern Larimer County in 2002, and the hospital is now part of UCHealth.
Candidates for the board describe the Health District as a “gem” and a “unicorn.”
Last year, the organization had contacts with about 9,500 people.
“It’s unique in the country to have this,” said Julie Field, a current board member who is running for reelection. She said the creation of the hospital district was forward-looking and the decision to separate the hospital from the health district in 1994 was visionary.
“The Health District is a bit of a unicorn, and I think is a model for what communities can do when they are forward-looking,” Fields said.
The district is mostly funded by the property taxes of those who live within its boundaries, which cover the northern two-thirds of Larimer County. This includes the cities and towns of Fort Collins, Timnath, Wellington, Laporte, Bellvue, Livermore and Red Feather Lakes and even parts of western Windsor.
In 2024, the district projected it would collect $11.9 million in property taxes as part of its overall projected revenues of $15.3 million, according to budget documents.
Its top three priority areas are:
- Low-cost dental care
- Connections to mental health care for adults and children, including assessments, short-term counseling and connections to local behavioral health resources for children (CAYAC) and adults (Connections).
- Guidance on getting insured through Medicaid, Medicare, CHP+ and the Colorado Health Insurance Marketplace. This is called Larimer Connect.
The Health District also conducts health needs assessments in the community so it knows what the greatest needs are and can respond to changing needs.
The current executive director, Liane Jollon, was hired in 2023. And last year, the board of directors adopted a strategic plan that focuses on four areas: accountability, organizational excellence, health equity and collaboration with partners. This includes efforts around transparency and streamlining processes to become more efficient.
“The board engaged in some really deep thoughtfulness around ‘Could we rethink the way we’re working with partners? Could we empower partnerships to make an even bigger difference?'” said board president Molly Gutilla, who has served for seven years and is not running for reelection.
But some of the candidates running for the board worry the strategic plan, even if it’s a step in the right direction, isn’t being implemented in a way that supports the employees who carry out the work of the Health District.
“The organization is changing and evolving in new, strategic ways where we think we’ll be able to serve our community even better than before,” Gutilla said. “And with change comes some maybe disagreement or controversy.”
The Coloradoan asked candidates for their perspectives about the changes in the Health District.
Read their individual responses to questions about the future of the Health District here.
“My understanding is there have been big changes in direction in Health District, and that’s been really hard,” candidate Sylvia Tatman-Burruss said. “I don’t discount the pain that people are feeling from that change.”
Tatman-Burruss believes some of the changes needed to happen but said the district now needs to figure out how to move forward positively while not ignoring the collective pain.
“That’s the word, that’s the energy in the community around the Health District right now,” Tatman-Burruss said.
Mental health care program for children
Some of the candidates’ biggest worries are centered on the district’s mental health services: the CAYAC program that serves children and its adult Connections program.
CAYAC was created in 2016 to provide immediate assistance to families in crisis through psychological testing and psychiatric evaluations. Over the years, it grew to have multiple psychiatrists, therapists, nurse practitioners, psychologists and care coordinators, according to child psychiatrist Dr. Usha Udupa, who resigned from the Health District earlier this year.
Last year, the CAYAC and Connections programs had contact with about 4,200 people.
It served clients regardless of their insurance status, reducing wait times even for people who had traditional insurance but would have otherwise had to endure wait times of six months to a year.
More than 60% of the people who conduct evaluations, assessments and therapy have left within a year’s time, according to Ginny Mack, a mental health nurse practitioner who also resigned this year. There are no longer any psychiatrists or a medical director.
“I think (CAYAC) is not really able to serve is mission of addressing the gaps in our youth mental health care right now,” said board candidate Nicole “Coco” Peterson, who has accessed Health District services and also ran for a seat in 2022. “The Health District was able to get these kiddos in right away to see if they needed medical management, therapy, assessment and provide short-term care in a time of really high stakes and high stress” before they can get connected with a longer-term provider.
“There’s room for improvement because timely intervention and accurate diagnosis can change the trajectory of a person’s life,” Peterson said.
The resignations of Udupa and Mack were a major red flag, said board candidate Dr. Sarah Hathcock. She said her former colleagues at Salud Family Health are reeling from the impact.
Hathcock, a pediatrician, said she referred patients to the CAYAC program, and she knew they were in good hands. She didn’t have to check up to make sure care was happening, she had a direct line to the psychiatrists and could follow up with them in a collaborative way.
“It was something I’d never experienced before,” Hathcock said.
Prior to CAYAC, wait times for a psychological evaluation were a minimum of six months, Hathcock said, but CAYAC was able to bridge that gap.
She said when Health District staff inferred at a recent board meeting that some staff members who left just aren’t up for change, that description felt like a twisted truth.
In an interview with the Coloradoan, Mack and Udupa described a poor workplace culture, a lack of support and poor leadership at the Health District.
The providers’ departures and the fact that their roles haven’t been refilled led some to believe the district is reducing or ending its CAYAC program.
But Health District leaders say any claim that it is closing down or reducing those programs is simply misinformation.
“The service levels haven’t changed. We haven’t cut services. We haven’t ended services,” said Jessica Shannon, quality improvement projects manager with the Health District. “We have either looked at how do we do those more effectively, how do we build structures and processes and systems that make it easier for our staff to do incredible work, or how do we partner and have these services live in partnership.”
Field, who was first elected to the board in 2022, said one example of this is how the Health District has the process for assessments or referrals through CAYAC.
Before, if you had printed out the flow charts showing how clients move through the system, the pages would be more than an inch thick, she said. Now it’s one page, which makes it more easy to navigate and therefore more accessible, and that means more children can be served, she said.
Only six to seven patients were being seen each week, “which is not the highest and best use of that resource,” Field said.
At the April 24 board meeting, Shannon presented information about a new partnership with Poudre School District and SummitStone Health Partners to provide “a singular front door for health service referrals” that is truly collaborative, which makes it more effective and equitable.
“We really are investing in behavioral health infrastructure, systems and partnerships,” Shannon told the Coloradoan. “No one entity owns the solution or can effectively address this alone.”
In 2023, the district announced it would make changes to its screenings for cholesterol, blood pressure and diabetes, and there have also been worries about the Health District ending some of its direct services.
“When we stand up a program, there might be a huge need at that time, but as that need evolves over time, we have to align our resources with the greatest needs and we don’t want to duplicate services that exist elsewhere,” Shannon said.
While programs might have gone away from the Health District as a primary service, Field said, they are provided at partnership locations.
“We wouldn’t have closed them down from the Health District if we didn’t believe they didn’t have a safe place to be,” Field said.
Gutilla said the amount of direct services provided by the Health District hasn’t changed and they will always be part of the district’s portfolio.
70 employees left the Health District in 2023 and 2024
During a recent board meeting, board candidate and former interim executive director Lee Thielen listed the names of 43 people who have left the organization since spring 2024 and said there were at least two others.
Board candidate Averil Strand said by her estimates, it’s about 40% turnover overall. She and Thielen take issue with an FAQ on the district’s website that says the amount of turnover is typical for an organization its size.
“It’s not typical, it’s dysfunctional,” said Thielen, who in January asked the board to have a third party conduct a 360-degree review of management and the organization.
Mack and Udupa told the Coloradoan their attempts to give feedback were shut down and they felt retaliated against.
Both criticized Jollon’s leadership style, saying it doesn’t welcome dissent or collaboration and there’s secrecy and siloing that keeps employees from talking with each other. Udupa said the current leadership is lacking key background experience in mental health.
Additionally, Udupa said she had ethical concerns. When she announced her resignation, the adult psychiatrist was asked to see child clients, which was outside that person’s scope of practice, she said.
She also worried about the consolidation of CAYAC staff from a downtown office to the main office on Bristlecone Drive, saying it wasn’t a good fit for their clients.
“I don’t believe it’s a healthy organization if you’ve lost over 40% of staff,” Strand said. “It’s extremely concerning to me” that some of the very dedicated staff they’ve had for years left.
Shannon told the Coloradoan that turnover last year was actually down a bit compared with previous years: 32 people in 2024 compared with 38 people in each of the two years prior.
The FAQ acknowledges that the resignations in behavioral health were clustered together.
“People leave the organization for all sorts of reasons,” Shannon said, including moving out of state or pursuing growth opportunities. She said significant leadership transitions in the past three years have also impacted numbers.
After founding executive director Carol Plock retired in early 2022, the district then hired Robert Williams, who served less than a year. Jollon took the helm in summer 2023. In between the three, there were several interim directors, she said.
“This is really common across health organizations, I think, during COVID and post-pandemic,” Gutilla said. “Just a lot of rethinking and reorganizing and movement in organizations.”
“Liane’s been here long enough that we’re just starting to get our footing,” Shannon said.
Today, 81 people are employed at the Health District.
A news release at the time of Ploch’s retirement in early 2022 said there were about 125 employees, and about 20 positions were lost under Williams’ tenure, the former employees told the Coloradoan.
“Because we are tax funded, every time we have a staff opening, we’re assessing what is the true need and demand for services, and how do we appropriately and most effectively meet that need and staff that need,” Shannon said.
The website’s FAQ says the organization is restaffing based on the needs of clients and programs.
The Health District does not plan to hire another medical director. When the district looked at best use of taxpayer dollars and consulted with former medical directors, they felt the resource could be used in better and different ways, Shannon and Gutilla said.
The district is currently assessing the community demand and will hire the right permanent staff once they have a better picture, Shannon said. Until then, she said they have a fully accredited nurse practitioner to provide medication services.
Being heard
In addition to concerns about turnover, several candidates have accused the board of not listening to staff or community concerns about the changes.
Strand told the board in January that staff and community partners have felt belittled or berated.
When they resigned, Mack and Udupa both said they received no response from their director and no effort was made to recruit new providers. Supervisors also did not respond to questions about the district’s plans, they said.
Because they are not supposed to go directly to the board with concerns, they believe the board is getting incomplete information from the executive director.
But Gutilla said anyone, including employees, can come and talk at the public listening part of the meeting, and the board can receive emails. But there are internal procedures for grievances before a staff member goes to the board.
Board candidate Adryliana “Adry” Santiago said she believes there’s a way to hold the executive director accountable and address concerns while still being in alignment with that person.
“If staff is saying there is something going on with the work environment, the board has a responsibility to look into that,” she said. “I know that change is hard. I think there’s always going to be growing pains.”
Field said the board did respond to community and staff concerns and at its January meeting announced it would conduct a 360 review, including a culture survey.
“People raised a number of concerns in correspondence to us, we said we will open up additional time for public comment, and we did,” she said. “We specifically investigated the concerns and took action and are taking action based on those concerns.”
Gutilla and Shannon labeled the allegations about the district as misinformation and said it could be preventing people from connecting with the resources available.
Meanwhile, concerned candidates and former staff use the same label for the responses from Health District leadership.
“When you know what your goal is, and you’re trying to get there and you don’t have all the details yet, I think that’s sometimes hard for folks, but we’re trying to do this work with them and build it together, and it gets messy sometimes,” Shannon said.
