Health Chief’s Woes : Troubles at 2 Hospitals Thrust Director Into Spotlight

James Forde is not a man who likes confrontation.

“It’s not my style to get excited and rant and rave,” said Forde, director of San Diego County’s Department of Health Services. “I really don’t like to have a lot of controversy embroiling around me. If I can avoid a confrontation and still achieve the objective, I certainly will.”

Despite his wishes, Forde today is at the center of more controversy than anyone in San Diego County government.

The county’s Edgemoor Geriatric Hospital in Santee is operating under a cloud of state and local investigations into its management and patient care, and the county mental health hospital in Hillcrest, chronically overcrowded, has been accused of negligence in the death of two patients, and of routinely releasing patients who are still a danger to themselves and others.

Even the county’s much-heralded trauma care system has not escaped turmoil: Forde’s department has confounded hospital executives by repeatedly changing the number of hospitals recommended for the network. Last week, the department cut by a third the fee each trauma care center must pay to the county after the hospitals complained that they were being charged for county costs not related to trauma care.

Since the three newest members on the county Board of Supervisors took office in January, the health department and Forde’s management of it have been frequent topics of board room debate and hallway gossip.

No one will say publicly that Forde’s $65,000-a-year job is on the line. But it’s no secret that Chief Administrative Officer Clifford Graves has been told by some supervisors to do whatever it takes to turn the health department’s fortunes around, even if that means firing the director.

Graves, whose own future with the county could rest on how he handles the health department, won’t say if he has pondered replacing Forde. But the county’s top administrator did acknowledge in an interview that the department’s public image is poor, and he hinted that such an image can sometimes be as powerful as reality.

“From the board’s standpoint and from mine, you can have 95% of your things going well, but if a couple of things are just constant irritants, you’re going to get uncomfortable,” Graves said. “Unfortunately, all the things going well down there tend to get overlooked.”

County supervisors have been more blunt.

“I’m very concerned that this board has had to wait for the state to tell us what we’re doing wrong,” Supervisor Susan Golding said at a recent conference on Edgemoor. “There’s been a real lack of administrative oversight.”

In an interview, Golding made clear her displeasure with the health department’s many woes. Ultimately, Graves will be held

accountable, she said.

“I have talked to Cliff Graves and told him it’s his responsibility to make sure the system functions well and functions with top administrators,” Golding said. “It’s not my job to remove or retain management under Cliff. It’s Cliff’s job to make sure the people we have working for us perform, be they Jim Forde or anyone else.”

Supervisor Brian Bilbray said he thinks the department still suffers from a backlash begun when the late J.B. Askew, county health director for 25 years, retired in 1975. Askew, an outspoken protector of public health concerns who clashed often with local politicians, was once described by former Gov. Edmund G. Brown Sr. as “San Diego’s growling bulldog of public health.”

“After Askew, it’s been really a low-profile kind of operation,” Bilbray said. “That was a natural reaction, but there’s been overkill. It’s swung so far it probably needs to go back the other way. I’ve always said I want strong management, that I’d rather have mistakes committed in being pro-active than by a lack of action.

“The department that should be probably the most dynamic is very lethargic. County health ought to be the most mobilized. It’s been bogged down.”

If J.B. Askew was famous, James A. Forde is almost invisible outside the local and statewide health care industry. Where Askew was a headline maker, Forde feels more comfortable behind the scenes, leaving the limelight to his boss and to his deputies, to whom he delegates a tremendous amount of authority.

“He’s very tenacious when he believes he’s right, and he fights very hard,” Assistant Chief Administrative Officer David Janssen said of Forde. “But once the decision is made, he gets on the bandwagon.”

“I’m a team player,” Forde, 58, said. “I will not go public in any confrontational manner. I’m not passive in terms of fighting within the family, but I do not believe in fighting outside the family.

“Once the CAO (Graves) makes a decision, that’s my decision.”

When Graves decided after Proposition 13 that the county could increase efficiency and save money by centralizing its maintenance operations, Forde argued against it, partly because he believed the aged and deteriorating Edgemoor Hospital buildings could best be kept up by a staff directly under the hospital administrator’s control.

But Forde lost that battle, and a short time later he could be found squarely on the other side of the argument when the Edgemoor Professional Review Committee recommended that the hospital administrator be given direct control over maintenance.

Forde rejected that recommendation in May, 1980, telling the Board of Supervisors in a report that Graves’ new administrative arrangement “had proven quite effective.”

Five years later, under mounting pressure from the review committee, the state Department of Health Services and the board, Forde has finally recommended that the policy be changed and has admitted publicly that he never favored it.

Forde has also been reluctant to publicly challenge members of the Board of Supervisors, an attitude that may have meant survival with past boards but has led the newer supervisors to find him weak-kneed or wishy-washy.

“People like (former Supervisors) Jim Bates and Roger Hedgecock would put on their spurs and go up one side of Jim’s back and down the other, and Jim would sit there and take it,” one former county official said. “They impugned his honesty, his integrity and his competency. Maybe he just didn’t fight hard enough.”

But Forde’s subordinates--whose divisions handle everything from inspecting the county’s restaurants to regulating hazardous wastes to providing complete physical and mental health care for the region’s poor --say they’re pleased with his willingness to fight for what they need.

“When I have a problem, I pick up the phone and I call him,” said Kathy Wachter-Poynor, Forde’s deputy for mental health services. “He’s always available. He always gets back, and when he’s busy, he’ll suggest that we meet for breakfast at 7 a.m. if it’s urgent.”

During crises generated by the PSA jetliner crash in 1978 and the massacre at the San Ysidro McDonalds last July, Forde gave her division complete freedom to implement whatever mental health measures were needed to help hundreds of grieving citizens cope with their pain, Wachter-Poynor said.

“If you approach him with an idea, and sell it to him and show him how it can be paid for, he’s very receptive to going for it,” said Gary Stephany, chief of environmental health.

But employees farther down in the organization and their union representatives don’t have the same affinity for the top man.

“We have the feeling that Mr. Forde is very protective of his management people,” said Randy Prevo, general manager of the County Employees Assn. “Whenever something goes wrong, he has a tendency to look down at the workers and say they screwed up.”

Forde did just that when pressed in an interview to explain the problems at Edgemoor Hospital, the administration of which has attracted the attention of the state Department of Health Services, the auditor general and the county grand jury. Forde blamed the situation on a lack of money and on problem employees.

“There are certainly some things that have happened at Edgemoor that I don’t think should have happened, that had nothing to do with money, that had something to do with complete dedication to the job,” Forde said. “Maybe that’s difficult to do when you work under very trying circumstances.”

Forde showed the same tendency while explaining the role he played in reforming the New York state hospital for the mentally retarded at Willowbrook, an institution that made national news in the 1970s after newspaper and television stories revealed gross mismanagement. Forde, then a regional director for the state Department of Mental Hygiene, was sent to Willowbrook for six months as an interim measure after the department transferred the permanent head of the troubled institution.

Forde, then living in Schenectady, recalled the feeling he had each Monday morning as he boarded his flight for the commute to Willowbrook, on Staten Island.

“I used to go up the steps and it would be like a steel curtain would come down, because I wouldn’t know what to expect when the plane landed again,” Forde said. “There were too many instances of people just not doing the job, particularly over the weekend.”

A native of Brooklyn, Forde graduated from high school when he was 15 and then attended Brooklyn College sporadically, supporting himself by working odd jobs that included a stint as a lab assistant on the top-secret Manhattan Project, which was then developing the atomic bomb. Later, he worked in the fledgling CBS television network when its only affiliates were in New York, Boston, Philadelphia and New Haven, Conn.

Forde finished graduate school in 1955 with a master’s degree in public administration. He soon went to work in the state Department of Mental Hygiene in a move he says happened “almost accidentally” when he was matched with the department as part of an administrative internship program. Forde stayed there until 1976 when, tired of the cold and ice and looking for a change of pace, he came to San Diego.

After two years as deputy administrator of the county’s Health Care Agency, Forde was named the first director of the Department of Health Services when the county’s management structure was reorganized in 1979. There, he is responsible for the divisions of public health, mental health, physical health and alcohol and drug services, an array of programs with a combined budget of more than $100 million.

As a director, Forde is low-key and soft-spoken, like many administrators the subject of public attention only when his department has a problem. Forde concedes that he is not a natural when it comes to handling public appearances and the press, and reporters who have dealt with him during crises say they find him abrupt and uncooperative.

“He does not see himself as a showman,” said his boss, Graves. “He’s not a salesman or a glad-hander in any sense.”

Perhaps as a result, Forde gets little credit outside the department for his dogged anti-smoking efforts (he wears a tie pin daily featuring a cigarette in the familiar red circle with a line across it), and for such innovations as the trauma network or the unique county medical services program, which provides basic health care through a private agency for thousands of indigent adults.

Forde personally is not one whose name evokes awe. Many who deal with Forde at the county come away with little impression of him other than that of a man struggling to keep control of his vast bureaucracy.

“Jim’s a very nice man. But what that department needs is someone who will really kick some butts, and he’s not that type of director,” said one longtime observer of county government.

“When you run a department like that, you can operate with a maintenance mentality, where you put out the fires, or you can really be creative,” said one former aide to a county supervisor. “My experience with the health department was that they have barely been the first. That’s why you see all these problems.”

Some believe Forde’s department may be simply too large and too diverse for any one person to manage effectively.

“If I do something wrong, Jim Forde is the one who’s going to suffer,” said one middle-level manager who asked not to be identified. “There’s no way one man can know what’s going on this far down in the department. That’s true whether it’s mental health, Edgemoor or University Hospital. I’m in management, but I’m so far down the organizational structure that if I do something wrong, the worst they could do is take some authority away from me. You’re just not accountable.”

But Forde said his style of delegating authority makes the department manageable.

“I would think (the department) was too big if I was committed to knowing all the details and running every single facet of the operation,” Forde said. “But the way I run it, I don’t think it’s too big.

“I delegate a lot to my deputies, and I expect them to have good results,” he said. “When they have good results, I’ll take much of the credit, and when they have bad results, I get the blame. I think that’s why I gain their trust.”

Forde acknowledges that he’s on the “hot seat” and says he doesn’t blame the new county supervisors for wondering about his management, given the number of crises the department has faced since the first of the year. Although he has changed little in the way he runs his programs in response to the pressure, Forde did say he will return to his former habit of visiting one of the department’s many programs each Wednesday.

“You lose touch with what’s really happening if you don’t do that,” Forde said. “I think people want to see the people at the top. It shows you’re interested, and it shows you care. And they can’t accuse you of being an armchair administrator.”