County Health Chief Endures

Dr. Thomas Garthwaite, the embattled director of Los Angeles County’s Department of Health Services, looked a bit tired Tuesday as he sat in a room behind the Los Angeles County Board of Supervisors’ auditorium listening to his bosses discuss funding for emergency rooms.

Garthwaite has weathered political attacks for the last month, ever since he proposed that the county close the trauma unit at the troubled Martin Luther King Jr./Drew Medical Center. The controversial proposal has some community leaders calling for his ouster.

As the board meeting dragged on, Garthwaite rolled his eyes when a longtime critic came to the podium to speak. But at one point, he got a somewhat unexpected boost from Supervisor Gloria Molina.

“I just want to state for myself that Dr. Garthwaite has made a strong recommendation for us,” she said. “I thought it was important that some of us should speak up.”

Garthwaite, 47, clenched his fist and smiled. Carol Meyer, head of emergency services in the health department, gave him two thumbs up.

Being the leader of a massive health bureaucracy such as Los Angeles County’s is never easy. But the last year has been especially trying for Garthwaite, who arrived with fanfare nearly three years ago with a mandate to fix the operation.

Because of budget shortfalls, he made the unpopular proposal to close the Rancho Los Amigos National Rehabilitation Center in Downey, sparking public outcry and lawsuits that have stalled the plan. He’s also dealing with a bitter labor dispute with county nurses, who have been without a contract for a year.

But his biggest challenge has been King/Drew Medical Center.

The county-owned hospital in Willowbrook, just south of Watts, has been reeling in the last year from a series of lapses in patient care, including several that contributed to patient deaths, according to regulators.

The latest revelation came Monday, when the county confirmed that a 28-year-old patient died Thursday after a nurse turned down the audio alarm on his vital-signs monitor, then failed to notice that the man’s heart was barely beating.

Garthwaite has proposed closing the trauma center to allow officials to reallocate resources to other crucial hospital functions. Closing the unit, which last year treated about 2,150 critically ill patients, is crucial to saving the rest of the hospital, he argues.

But the plan has made him a target of those trying to keep the trauma center open. They contend that Garthwaite is putting the lives of South Los Angeles residents in jeopardy by forcing severely injured patients to travel farther to trauma centers at other hospitals.

At a news conference outside King/Drew on Monday, Rep. Maxine Waters (D-Los Angeles) said she would “not allow the community to be violated, put upon, to be disregarded, to be disrespected.”

She and others accused Garthwaite and other county officials of failing to fix King/Drew’s problems and said new leadership was needed.

“He made the wrong decision; now he needs to make the right decision,” Waters said.

Despite the criticism, Garthwaite said he has no intention of quitting.

“I like the job,” he said in an interview Tuesday. “Healthcare jobs in general are difficult. Healthcare jobs in the political arena with chronic under-funding are even more difficult. I enjoy the challenge.”

To supporters, he has become an easy scapegoat because he was brave enough to make tough decisions.

“He’s a very soft-spoken, cerebral kind of individual who doesn’t mix it up the way other politicians or department heads might do,” said Supervisor Zev Yaroslavsky. “But my experience with him over the last several years is his medical knowledge and medical perspective and medical judgment are exceedingly strong and sound.”

Garthwaite studied medicine at Temple University and completed more training in internal medicine and endocrinology at the Medical College of Wisconsin in Milwaukee. He said he was “suckered into” administration when he complained that it took too long to get a consent form approved for research.

He was placed on the committee that oversaw research -- later leading the panel and, several years later, serving as chief of staff of the Veterans Administration Medical Center, which is affiliated with the college.

In 1995, he joined the U.S. Department of Veterans Affairs and, four years later, was promoted to undersecretary of health, overseeing the largest healthcare network in the country.

At the VA, he won praise for helping a notoriously bloated and politicized bureaucracy shift its emphasis from pricey hospital care to cheaper treatment in clinics.

Garthwaite was selected to head the county’s health department at the end of 2001, after a nine-month search.

Because Garthwaite is a physician, unlike previous top executives of the health services department, he makes recommendations based on years of medical experience, Yaroslavsky said.

“That’s why I think the proposal he’s made with respect to King hospital is being taken as seriously as it is by the board,” he said.

“It is news that the director of health services is throwing political caution to the wind and just making a medically based proposal in the interest of saving the hospital and improving the quality of care to the citizens of Los Angeles County. That’s not something we saw in his predecessor or his predecessor’s predecessor.”

Supervisor Yvonne Brathwaite-Burke, whose district includes King/Drew, gave Garthwaite credit for stepping into a bad situation at the facility and for managing the other county hospitals well.

But she said she was frustrated because Garthwaite has not articulated a coherent plan for King/Drew’s future.

“With Martin Luther King, he has talked about what he will take away, not what he will leave there,” said Burke, the only supervisor not to support moving forward with a public hearing on the trauma center closure. “He has not responded to what he sees as the configuration at MLK.”

Garthwaite acknowledged that he has not accomplished all his goals. He said he was frustrated at not being able to hammer out a contract with nurses, who say they are severely underpaid compared to colleagues at other hospitals. He said there is a limited amount he can do about that because the county administrator’s office handles labor negotiations.

He also said he would like to hold doctors and nurses more accountable and reward them better based on merit. But the county has a fixed salary structure, he said.

Garthwaite insists that he takes all the criticism in stride.

He wished his critics would take a look at the facts he has presented -- or even call him for more information, he said.

“The only person I’ve talked to directly has been [state Assemblyman] Keith Richman. I called [Los Angeles City Councilwoman] Janice Hahn because of some of her comments and we had a lengthy conversation,” he said. “We need to save this hospital.”