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Los Angeles County weighs merger of health agencies

Supervisor Antonovich says a merger of health agencies would 'break down bureaucratic barriers'

Amid a change in top leadership at Los Angeles County, the Board of Supervisors is considering a major overhaul of the way the county provides health services to its 10 million residents.

Supervisor Michael D. Antonovich wants to merge the county's public health department — which is responsible for preventing and responding to disease outbreaks, running substance abuse programs and inspecting restaurants, nursing homes and other facilities —- and a separate mental health agency with the Department of Health Services, which runs county hospitals and clinics.

The proposal has been championed by Mitch Katz, the director of the health services department. Katz is favored by at least some of the supervisors to oversee the consolidated agency.

The county broke off public health services from the larger medical care agency in 2006. At the time, a fiscal crisis in county hospitals raised concerns that other public health programs could be cut.

Antonovich now argues that merging the departments would "break down the bureaucratic barriers facing the county's patients, identify synergies, streamline operations" and "should result in budgetary savings." Fred Leaf, a former county health department director and an aide to Antonovich on health issues, said consolidation would lead to a "service delivery system that is more responsive to patient needs and can provide the care more effectively."

Katz said in an interview that the proposal offers tremendous advantages when integrating care for patients who may have a combination of physical, mental health issues and substance abuse problems. It would also make the county more competitive in vying for managed care contracts under the federal overhaul of healthcare, he said.

He has proposed to board members a management structure for the merger: The three departments would report to a single director and some of the administrative functions would be merged. The three agencies within the new department would retain separate budgets and would each be headed by their own director.

The public health director position is vacant, following the retirement of longtime Director Jonathan Fielding last year.

Fielding said in an interview that before the 2006 split, "public health was pretty much submerged and wasn't able to advocate for itself." If the supervisors approve the merger, he said, they should ensure that the directors of all three major divisions have direct access to the county's elected board members and the county chief executive to advocate for their programs.

Mental health department Director Marv Southard could not be reached for comment, but some mental health advocates expressed concerns.

Brittney Weissman, executive director of the Los Angeles County chapter of the National Alliance on Mental Illness, said mental health issues might take a back seat in the larger health agency. She noted a similar consolidation effort at the state level had been rocky.

"Mental health may not be priority No. 1 in a new health agency, whereas it is of upmost concern to the current Department of Mental Health," she said.

But Michael Weinstein, head of the AIDS Healthcare Foundation, enthusiastically endorsed the merger plan. He has feuded bitterly with the county public health department for years — sometimes in court — over contracts and what his group describes as a clunky response to disease control.

Weinstein said that under Katz's leadership, the health services department has become more open and transparent and has a record of "working closely and cooperatively with community partners."

A majority of the board appears to support the consolidation. Supervisor Sheila Kuehl, who joined the board in December, said she generally favors the concept, and Supervisor Mark Ridley-Thomas said patients would be best served through an "integrated healthcare delivery system."

The board could vote to give initial approval to the concept as early as Tuesday. Also on Thursday, interim Chief Executive Officer Sachi Hamai announced as part of a series of personnel and structural changes in her office that she would create an executive position in her office to oversee the potential consolidation of the health agencies.

abby.sewell@latimes.com

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