Graves Begins Shake-Up of S.D. County Health Dept.

San Diego County Chief Administrative Officer Clifford Graves on Tuesday temporarily disbanded the county’s frequently criticized Department of Health Services and reassigned its embattled director, James Forde.

Forde has been blamed for widespread mismanagement within the department and for failing to improve the quality of care at Edgemoor Geriatric Hospital and the county’s mental health hospital in Hillcrest. Both county hospitals have come under state investigation of their management and treatment of patients.

Graves, without naming Forde specifically, said “the current management structure (within the Health Services Department) lacks the internal capability to make the judgments” necessary to correct the widespread problems.

Graves plans to temporarily assign county employees, not necessarily working in Health Services, to direct programs in the three major service areas--public health, mental health and physical health. In addition, he will assign a temporary deputy chief administrative officer to oversee the revamped programs.

Forde will temporarily work as a consultant under Graves, but it was clear that he would not be included in the administration of the restructured Health Services Department. His future at the county is unclear.

A permanent reorganization of the department will follow studies by several private consultants and might not take shape until after Graves leaves the county at the end of the year. On Oct. 8, the Board of Supervisors will decide how the consultants will be chosen and which areas of health services provided by the county they should concentrate on improving.

Graves said the interim measures were necessary to deal with what several supervisors described as a “crisis situation.” But while the supervisors agreed that the current health services structure was ineffective, they refused Tuesday to endorse Graves’ interim plan. Under county regulations adopted with the passage of Proposition A by voters last year, the chief administrative officer does not need permission from the supervisors to undertake the temporary moves.

The real showdown on the reorganization strategy could come at the Oct. 8 meeting. Graves said Tuesday that he would recommend that the private consultants study the various health services provided by the county rather than the bureaucratic structure of the department. Supervisors Paul Eckert and Brian Bilbray, who proposed the hiring of the outside experts, have indicated that they would prefer that the department’s operating procedures be immediately scrutinized.

Nevertheless, Eckert and Supervisor George Bailey voted to endorse Graves’ plan, but their motion failed when Bilbray and Supervisor Susan Golding abstained. Board Chairman Leon Williams was absent Tuesday and the proposal required three affirmative votes for approval.

Neither Bailey nor Eckert was enthusiastic about Graves’ proposal. “In a crisis time, I don’t think we should make it any more difficult (for Graves) to take the actions he sees necessary,” Bailey said in explaining his vote.

Eckert clearly had reservations about the plan, most notably concerning the role Forde would play. “I don’t want Mr. Forde sitting in the CAO’s office driving that (private) consultant’s report,” he said.

Forde said he was not certain what his duties in the CAO’s office would be. “I’ll do the best job I can,” he said. “I try not to take Mr. Eckert’s comments personally, and I would think any consultant they hire would be independent enough to come to his own conclusions.”

Forde refused to speculate on his future. “I’ll attempt to make this role as personally fulfilling as possible,” he said. “After that, I just don’t know.”

Bilbray and Golding, in refusing to endorse the plan, characterized the measures as window dressing.

“Basically, you’ve eliminated the health director and set up subdivisions under your office,” Bilbray said to Graves. “This seems like a bureaucratic shuffle, beating up a lot of dust without moving any dirt.”

Golding said she was “not comfortable with approving this. But since it’s within the purview of the CAO, it’s not necessary to approve or disapprove. I just want results.”