Revamped Unit Greets New County Health Chief

Conceding that years of administrative neglect have impeded the delivery of public health services to San Diego County residents, county officials on Monday unveiled a plan to revamp the Department of Health Services and introduced the two men appointed to run it.

Dr. J. William Cox, former surgeon general of the U.S. Navy, will take a leave of absence from his job as associate director of San Diego State University’s Graduate School of Public Health to direct the county health department for at least two years, Chief Administrative Officer Norman Hickey announced.

Assisting Cox will be Steven A. Escoboza, now the assistant director of the county’s Office of Employee Services, Hickey said.

Cox and Escoboza will direct the department’s four existing divisions and four new divisions Hickey created after an internal review of the department found problems in its management.

“We have lacked a strong top- and middle-management team, philosophy and system,” Hickey said at Monday’s news conference.

Several members of the county Board of Supervisors--all five supervisors attended the news conference--said they hoped that the reorganization and the appointment of Cox would end the chronic problems at two major county health facilities. They said the key change in the department would be the addition of a unit to plan for and review the performance of programs, a function that was eliminated in the wake of budget cuts in 1978.

Supervisor Susan Golding said such a planning unit might have been able to detect and avoid problems at the Edgemoor Geriatric Hospital and at the Hillcrest mental health hospital. Substandard patient care, maintenance and management at Hillcrest prompted the federal government to end reimbursement for patients in the Medicare program earlier this year.

“If you have good long-term planning, you can avert many of these crises,” Golding said.

Supervisor Brian Bilbray said the health programs ended up “on the rocks” because the department lacked effective direction.

“We’ve had plenty of people who could run the ship, but we didn’t have anyone navigating,” Bilbray said. “That navigation capability needed to be injected into the process. Now we’re not only going to be talking about where we are but where we’ve been, where we’re going and how we’re going to get there.”

Supervisor Leon Williams said the county board’s decision to eliminate long-range planning was made during budget cuts brought on by the passage of Proposition 13 in 1978.

“Previous boards had cut the health department to almost no substance and expected it to run,” Williams said. “Now we’ve added some substance.”

Cox, too, said he saw the lack of planning and oversight as the department’s major problem. He said restoring such practices would be his first priority.

“Things that are working well, let them continue to work well,” he said. “Things that are not working well, we’ll come to some agreement about what corrective action can be taken, set in place a control or monitoring system to be sure that those actions are leading to what outcome we want, and proceed from there.”

Cox said the creation of divisions for drug abuse, alcohol and environmental health services will give those programs new visibility within the county bureaucracy and in the community. But he said it was too soon to tell whether the programs themselves would receive any increased emphasis by the department.

Cox will be paid more than $90,000 a year and Escoboza will earn about $62,000. The entire reorganization plan is expected to cost the county about $700,000 annually. The department has an annual budget of about $150 million and 1,900 employees.

Cox said he was making a two-year commitment to the job, after which county and SDSU officials will decide at which institution his services are most needed. He compared the two-year hitch to the many he worked during his long career in the Navy.

“I went through a 30-year naval career incrementally--two, three, four years at a time,” Cox said. “As long as that challenge was there and the need was there and I felt I could make a positive contribution and have the confidence of the people to whom I reported, I’d say I’m happy where I am and I’ll go where I’m sent.

“When I say two years, that’s a commitment on my part,” Cox added. “If they’re satisfied with me and there’s still a job to do, there’s no reason I wouldn’t be willing to consider continuing in the position.”

Cox, 58, was surgeon general of the Navy from 1980 until 1983, when he retired to take the job he now holds at SDSU. From 1978 until 1980, he was commanding officer of the Navy Hospital in Balboa Park. He held various positions with the Navy in Washington and Philadelphia from 1963 until 1978. Cox also served in the Philippines.

Hickey said Cox, who will take the post in January, will be given wide latitude to suggest changes in the reorganization plan unveiled Monday. Hickey said Cox would also have the power to select new managers for the eight divisions within the department.

For now, the new divisions will be headed by the same administrators who managed them as programs: Alcohol services will be directed by Robert Reynolds; drug services will be directed by Melinda Newman, and environmental health will be headed by Gary Stephany.

The existing divisions will continue under their current managers: Paul Simms will head physical health; Kathy Wachter-Poynor, mental health; Dr. Donald Ramras, public health, and William Burfitt, management.

No deputy director has yet been appointed to head the new division of planning, evaluation and policy analysis.