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Board Considers Health Agency Split

Posted on: Friday, 1 July 2005, 15:00 CDT

Pressure for change in Los Angeles County's health department mounted Monday when a civil grand jury report was released calling for a separate health authority, even as the county Board of Supervisors prepared to take up a motion today that would split the department into two agencies.

Both proposals would divide the current health department's responsibilities into the areas of personal health and public health.

The former would include operation and oversight of the county's hospitals -- including County Harbor-UCLA Medical Center near Torrance -- along with its health clinics and ambulatory care centers, all of which primarily serve poor and indigent residents.

The public health side would deal with broader, countywide health initiatives of all types, as well as a variety of other services, including drug and alcohol treatment.

The main difference is that the grand jury recommends creating a separate health authority to run the county hospitals and other personal health facilities. The Board of Supervisors would have oversight over the new agency, and should retain responsibility for the county's public and mental health programs, the report said.

Both proposals stem in part from the turmoil at the county's Martin Luther King Jr.-Drew Medical Center in Willowbrook, which has experienced a string of controversial patient deaths amid a breakdown in its medical care and training programs. Several of the latter are no longer accredited.

"When you have an issue like what we're having with MLK, I think it points to the weakness of a combined effort," said Supervisor Don Knabe, who introduced the board motion to split the health department into two agencies.

Knabe is not convinced a separate health authority is needed to run the county's hospitals and clinics. But several health experts said his motion is a logical first step in creating such an agency.

"This is a good step toward creating a health authority, although that's not the reason we would support" the motion, said Jim Lott, executive vice president of the Hospital Association of Southern California. "But it is a natural step toward creating a health authority."

Dr. Thomas Garthwaite, the county's director of health services, agreed.

"I believe that a health authority could be very helpful in running the department," which currently struggles to respond quickly to changes in patient and staffing needs, he added.

"We're stuck competing (with private hospitals) for patients and employees especially," he said. "We can't do that very easily. Everything takes a study, and government (job) classifications ... are very rigid," Garthwaite said.

"It kind of eats away at our whole fabric."

The grand jury report identified similar problems, noting that "adherence to county civil service rules means that the department's recruitment and hiring processes are lengthy and time consuming. Review and approval of job bulletins, selection criteria, position information and classifications can delay the hiring process."

The report also said an independent health authority -- which would need to be created by state legislation -- would be more flexible and efficient.

However, the report acknowledged that creating a health authority to assume some of the current responsibilities of the health department also would require exhaustive financial and administrative analyses. And it would likely raise sticky labor issues with the county's employee unions.

Lott said it would be worth it -- if the new health authority is structured properly.

"Nobody runs public health better than a county," he said. "That gets obfuscated by trying to run hospitals. So dividing the two is natural, because you want a governing board that's specialized in providing oversight of hospitals. It would be difficult to find a board that could specialize in both management and communicable disease control."

"By dividing the two branches, we allow the appropriate focus to be given to both," Lott said.

A majority of the five-member board supports Knabe's less sweeping motion to split the health department into public and personal health agencies. Some board members, however, have been wary about creating a separate health authority to run the county's hospitals and other health facilities.

A spokesman for Knabe said the split would be beneficial with or without creating a new agency.

"It could be the first step to the health authority, if that's a decision that the entire board wants to take. But that being said, the supervisor's position is also that the separation ... would work in either case," said Knabe spokesman David Sommers.

Source: Daily Breeze

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