Acting just months before his scheduled departure as San Diego County's top administrator, Clifford Graves on Friday proposed a sweeping reorganization of the Department of Health Services, including the removal of Director James Forde from his day-to-day duties as head of the massive and troubled department.
Graves' proposal, announced in a news release late Friday afternoon, calls for breaking the Health Services Department into three smaller departments headed by separate directors, each of whom would report to a new top-level bureaucrat in the office of the county's chief administrator.
The new departments would be physical health, mental health and public health services.
Forde, whose management skills have been unanimously criticized by members of the Board of Supervisors, would be moved to a temporary job in Graves' office, where he would help coordinate the dismantling of the department he has headed since it was created in 1979.
Graves' plan won quick endorsement Friday from Supervisor George Bailey and lukewarm support from Supervisors Paul Eckert and Susan Golding, though each said that the ultimate structure of the county's health care operation would be up to the county's new chief administrative officer, expected to be hired sometime this fall. Graves resignation July 3, effective by the end of this year, was prompted in part by the very problems this plan attempts to solve.
Supervisors will review the plan Sept. 10 and Graves said it could be in place by Sept. 25.
Graves could not be reached for comment Friday night, but in a prepared statement released by a county spokesman, the chief administrative officer said he had concluded that the health department's many woes could be solved only by an infusion of a new and expanded management team.
"In examining the department's capability to anticipate and resolve the myriad of problems it faces, it has become clear that the complexity of those problems require a greater degree of top-level management working in closer proximity to the source of patient care," Graves said in the statement.
Graves said interim directors would be appointed to run each of the new departments, and a interim deputy chief administrative officer would be named to oversee them. Permanent directors would be named by the incoming chief administrative officer. Four senior-level administrators will also be moved from other county departments to help bolster the health department leadership while a task force evaluates the new structure's management needs.
The reorganization was prompted by persistent patient care and management problems in two county-run medical institutions--the Edgemoor Geriatric Hospital and the mental health hospital in Hillcrest--as well as controversy over the operation of the county's much-heralded trauma-care system.
At Edgemoor, where the county's poor invalid and elderly patients go when they have nowhere else to turn, state inspectors in the past year found hundreds of deficiencies and fined the county more than $30,000. Included among Edgemoor's problems were the deaths of two patients--a legless man who fell from his bed and later suffered a heart attack and a woman who drowned after being left unattended in a bathtub.
Similar problems were uncovered at the county's mental health hospital, known as CMH. State officials last week threatened to close the 61-bed institution after determining that it was plagued with serious management problems and that two recent deaths at the hospital could have been avoided.
Announcement of the changes also followed weeks of pressure on Graves to fire Forde, as well as a failed attempt by one county supervisor to force Graves out of his CAO post early and replace him with an acting chief administrative officer until a permanent manager could be brought on board.
About the proposal, Supervisor Bailey said: "I don't have any problem in setting it up that way. That sounds pretty much like what we've been talking about."
Eckert said Graves' proposal matched the framework he expected to come from a private consultant about to be hired to investigate the health department's management and recommend any needed changes. He said the final structure of the county's health operation will not be known until after that report is in and a new CAO has been hired.
"It's very obvious that our program of management for the health department was no good," Eckert said. "It was built helter-skelter over an eight-year period with no real positive goals or directions. That's why we've suffered."
Golding, Graves' harshest critic on the board, said she was pleased to see a proposal but conceded she had qualms about moving ahead on the eve of a change atop the county's management. Golding said she had only been told of the proposed changes during a brief hallway chat with Graves as they attended the swearing-in of a new Superior Court judge.
"I've been urging Cliff to act," Golding said. "Now that he's acting I can't very well say 'don't act.' I don't know from a two-minute conversation that these changes are the right ones. But I do know that the majority of the problems at Hillcrest and Edgemoor are management and administrative and should have been corrected a long time ago."
Golding made it clear she would support, if not encourage, an effort by Graves' successor to take yet another look at the department's management.
"If we want the new CAO to have his or her own ship to run, which I think anyone of the quality we're looking for would want, then I think these major reorganizations would preferably be left up to the new CAO," she said.
Bailey and Golding said they would not quibble with transferring Forde to Graves' office, despite their criticism of his management skills.
"I see the reason for putting Forde up there," Bailey said. "He (Graves) has got no one else to go to for the history. He's not going to be managing. He's just going to be there as an information resource. It's the best you can do and still have his brains around."
Said Golding: "If Jim Forde is totally removed from the county today, we then have no one with top management experience or knowledge of the health issues."
Only Eckert expressed reservations about the plan to keep Forde around in a high-level administrative post. Supervisors Leon Williams and Brian Bilbray could not be reached for comment.
"I told Cliff that the sooner that Mr. Forde left the better off we'd all be," Eckert said. "He felt that Mr. Forde's knowledge of the past operation would be very helpful to the consultant firm. I said the only thing I would want him to do is an exit interview."
Forde could not be reached for comment Friday night.