Fannin Assails County Health Officials in Bitter Attack

The physician in charge of disease control programs for Los Angeles County has accused county health administrators of concentrating on public relations “puffery” while botching efforts to contain epidemics.

In a scorching attack on the county Department of Health Services, veteran epidemiologist Dr. Shirley Fannin charges that for two straight years health officials fumbled programs to control venereal disease outbreaks.

First, she said, officials forgot to order the proper antibiotics in treating an outbreak of penicillin-resistant gonorrhea in 1986. The next year, she said, her memorandum alerting county supervisors to an alarming outbreak of syphilis was rejected, rewritten and watered down so much by other health department officials that when it finally went to the board it failed to adequately state the extent of the epidemic.

The syphilis rate has almost quintupled in some parts of the county since 1985, reaching its highest level since 1943.

Fannin’s comments on the venereal disease outbreak were included in a broad attack on health department policies contained in a 21-page memorandum to her superiors, a copy of which was obtained by The Times. Fannin’s paper--which one official described as a “declaration of war”--was prompted by a recently announced plan to reorganize the bureaucracy of the health department, which has 23,000 employees.

Fannin argues that the reorganization will “move the people who do the work of the health officer farther and farther away from decision making and from public health’s fair share of the health dollar in Los Angeles County.”

Stirs Debate

The proposed reorganization, ostensibly intended to save money and improve management, has prompted a bitter debate within the massive health bureaucracy over whether it will improve or disrupt public services.

For example, public health commissioner Omowale Fowles suggested in an interview that the reorganization could devastate preventive health programs.

“I have this vision of disease walking down the street, snatching people as they go by. We might be letting ourselves in for rampant, uncontrollable disease and epidemics,” she said.

But the head of the health department, Dr. Robert Gates, rejects such concerns. He said he is protective of public health preventive care programs and argued that the department is doing a better job of controlling epidemics than it did four years ago, when he took charge.

“It’s not going perfectly,” Gates said, “but we’re doing better and better given the resources we’re working with.”

He said the proposed reorganization would not cut money or staff from Fannin’s unit, but would consolidate management of the health department’s comprehensive health centers and neighborhood clinics, resulting in an annual savings of about $280,000.

“I see mostly pluses,” Gates said. “I don’t see the minuses that some people are seeing.”

The reorganization is scheduled to take effect July 1.

As the associate deputy director of disease control in the department’s Public Health Programs Division, Fannin supervises about 450 employees and administers seven programs designed to track and control the spread of AIDS, venereal disease, tuberculosis, measles, polio, mumps, and food-borne diseases including hepatitis A, botulism, shigellosis and salmonellosis.

She also heads a major public health laboratory where tests are done that are used as the basis for regulatory action, such as taking a food handler or child-care worker with certain infections off the job or removing a commercial product from grocery shelves.

During the last few years, Fannin has been in the public spotlight as a result of several major health problems, including the listeriosis outbreak in 1985 that was linked to tainted cheese and an outbreak last year of a deadly bacterial infection that causes spinal meningitis mainly in children.

Cautious Approach

Over the years, Fannin has often been a voice of caution, trying to calm the hysteria that frequently accompanies the onset of a new and mysterious epidemic. Her thorough, plodding investigation of a disease, combined with her reluctance to panic the public, have occasionally prompted accusations that she failed to promptly warn the public of impending perils.

But her attack on the health department has prompted countercharges that she is overreacting.

“Just because she’s Dr. Fannin doesn’t mean she’s right. She’s off base,” said Larry Roberts, a deputy to Gates who designed the reorganization plan.

Gates disputed most of Fannin’s charges, but conceded that she is right about “a problem” hampering the public health unit that conducts sanitary inspections of restaurants and apartments.

“This division, once noted for its honesty, integrity and competence, is hardly recognizable because the morale is so low,” Fannin said.

Fannin also charged that there has been a breakdown in the system that is supposed to dispatch public health nurses into the field to track down people with communicable diseases and educate them about preventive health measures. These nurses, she said, have been diverted from this “vital and necessary” task to work in short-staffed neighborhood health clinics. As a result, she said, the home visit “has almost become extinct.”

Gates responded, “I need to check into that.”

Charged Denounced

But the health chief did not hesitate to denounce Fannin’s charge that his administration “spends an inordinate amount of time with puffery.” Fannin pointed as an example to the “Patient Services Improvement Project,” which involved three top administrators handing out buttons to employees with the slogan: “We believe in being the best.”

Gates snapped: “If you think having clean, neat facilities and courteous staff is not necessary, then you won’t like the program.”

Fannin’s memorandum, entitled “Can Public Health Survive Another Reorganization?” blasted what she called the progressive erosion over the years of public health resources in the county health department. The crux of the problem, she said, is that the bureaucracy does not give her and other public health officials the authority they need to swiftly implement measures to control the spread of diseases.

The recent epidemic of penicillin-resistant gonorrhea, Fannin pointed out, “is a typical of example of the difficulty encountered . . . where the planning for the control of the epidemic is the responsibility of one group and the resources to bring about this control are under the direct authority of others.”

The strategy to control the outbreak, she said, fell apart when health administrators failed to notify health officers in the field that they were expected to implement the program. Then, on the program’s starting date, she said, she learned that “the districts did not have the antibiotic (needed to fight the disease) and it would take six (to) eight weeks to order it. We had already sent an advisory to private doctors in the community and were presuming that private practitioners were following the strategy. Our own department was not able to implement the . . . control strategy until February, 1987.”

Gates said that if ordering the drug and implementing the strategy were so important, “Why wasn’t she (Fannin) checking up on it? It seems to me she was sitting around on the sidelines waiting for everything to go wrong.”

Fannin retorted, “He’s looking for a fall guy. . . . I don’t sit around watching the system fail. That’s not my style.”

Fannin said she has repeatedly tried to call attention to the county’s syphilis epidemic, but that her memo to the supervisors on the issue was delayed and rewritten to the point where it was “less than forthright.” Gates recalled that the memo “had to be reworked substantially” and in its final form was not as “alarmist” as Fannin might have liked.

Fannin pointed out that, in the meantime, “It has come to pass that we have syphilis out of control in our south area.” This year 15 babies have been born with congenital syphilis and two of them have died, she said.

“It is hard to express the sense of failure a professional has when they see increasing morbidity and mortality from curable diseases in Los Angeles, California, in 1988,” Fannin wrote.

Fannin said in an interview that she had hoped for a reorganization plan that would “clarify and help the department go from problems to solutions, without wandering around with no power to implement.”

But instead, she said, the plan amounts to “business as usual. They’re not addressing the problem, that’s my disappointment.”

Syphilis Screening

In a separate action Tuesday, county supervisors took several steps aimed at addressing the inadequacy of syphilis screening in jails, the drop in turnout at screening clinics and the need for more money and manpower to control the epidemic.

First, the board asked the county Sheriff’s Department to explore the feasibility of routine blood testing of all inmates entering county jails--a practice that Supervisor Pete Schabarum said was discontinued in recent years as a cost-saving measure.

They also asked the health department to study the recent 40% drop in turnout for screening at county sexually transmitted disease control clinics. The department is to consider whether to lift the $20 screening fee imposed in 1986, which some believe has contributed to the drop in turnout.

Finally, the board ordered the health department director to advise state and federal health officials of “this emergency situation” and seek additional money and personnel to fight the syphilis epidemic.