Former Social Worker Serves as Conscience of the County : Government: Chauncey A. Alexander’s cajoling and prodding championing indigent health care have won him victories and grudging respect.

In the crowded hearing room, a white-haired man stepped to the microphone. He spoke politely, but there was fire in his voice.

“I stand here representing the 50 agencies of the United Way Health Care Task Force,” Chauncey A. Alexander told county supervisors before issuing a familiar call: The local health-care system is “collapsing” and it is the supervisors’ responsibility to shore it up.

At 74, this retired social worker could be quietly spending his golden years on the golf course. Instead, for the last five years, Alexander has pricked the county’s social conscience, repeatedly reminding local officials that they must look after the health of their poor.

Lately, he has been working against the tide as money for indigent health care has steadily declined. But his constant cajoling, prodding and politicking have earned him victories--more money for prenatal care and local clinics--as well as the grudging respect of those he lobbies.

Supervisor Harriett M. Wieder complained that “his shouting and testifying on everything” is abrasive. Others have criticized Alexander for frequent “county bashing,” saying he blames local government for problems even when state or federal officials are at fault.

Still, Wieder included Alexander on a health committee she co-chairs with Supervisor Gaddi H. Vasquez. She said Alexander “is tenacious, which does give people respect.”

Added Tom Uram, director of the county Health Care Agency: “He’s championed the cause of the poor and underserved. That’s what you (have to) appreciate about the guy. He’s championed a cause where there was a void.”

A former mental health worker, agency director and lobbyist, Alexander was principal author of the task force’s pivotal 1987 report on Orange County’s growing health-care “crisis.” In a conclusion some officials found shocking, he wrote that 16% of the county’s residents could not pay for medical care.

The 1987 report was really “a fairly radical step for Orange County,” Alexander recalled recently at his Huntington Beach home where he was recovering from back surgery. “Everybody knew there were problems, but nobody knew the social nature of those problems. Not only that indigent people could not get health services, but also that their problems increased health-care costs to the wealthy. . . . No one had really said that before.”

Since then, Alexander and his task force have regularly reminded political leaders of the county’s growing health problems--trauma centers closing, overcrowded Medi-Cal hospitals, a county indigent-care system that doesn’t pay hospitals or doctors enough. “We have tried to keep the pressure on and to keep certain programs intact,” Alexander said.

Citing his recent surgery and plans to write three books, Alexander had planned to step down as task force chairman last month. But after a retired executive declined the job, the feisty, former social worker said he expected to stay on. “I’m not old enough to play golf yet,” he laughingly told a friend.

Although supervisors face a multimillion-dollar budget deficit, there still should be more money for health care, he insisted.

His brown eyes sparkled as he explained where the money could come from. “They can decide maybe we don’t have to build some county buildings today. It can go into people’s health care,” he said.

Alexander came by his political activism naturally. Growing up in Glendale in the 1930s, he watched his mother direct local chapters of the March of Dimes, the Salvation Army and the Democratic Party. Often she asked her son to stuff envelopes or set up meetings. Alexander learned early to fight for the rights of others.

“I’ve always been that way. It gets you in trouble lots of times,” he said, recalling an incident in fifth grade where “a big kid was beating up on a little kid. And I was a little kid. And I tackled the big kid. And he beat the hell out of me.”

Trouble or not, Alexander said, “I have a strong sense of social justice and one of community service.

“I’ve spent my life doing that--making organizations better, trying to help people. It’s not economically advantageous, I’ll grant you that. But it has an individual payoff. . . . You get 500 more slots for women in a perinatal program--that’s a payoff.”

Alexander has had six careers in his lifetime.

After working his way through UCLA, he was chief social worker at Patton State Hospital in San Bernardino County from 1940 to 1941. Before he left to run his own public relations firm, he tried to improve conditions for Patton’s patients.

“They would parole patients to nursing homes, to work as dishwashers,” Alexander recalled. “They’d wear them out, then drop them back into the hospitals, all strung out.” Alexander tried to restrict this practice, issuing a directive that the patients must work no more than 40 hours a week and their pay must be raised--from $16 a month to $65.

Repercussions were quick. “I learned a political lesson,” Alexander remembered. “The following day, there was a representative of the governor in my office, saying, ‘What in the hell are you doing!’ ” The nursing home industry reportedly was upset. But the hospital superintendent supported him, Alexander said, and “fortunately we made it stick.”

In the early 1950s, Alexander got another mental health job, this time as director of the Southern California Society for Mental Hygiene. In that position he worked with reporters to expose political corruption and patient abuse in state mental hospitals.

From 1956 to 1967, Alexander served as executive director of the Los Angeles County Heart Assn., developing the nation’s largest heart association and training thousands of nurses, firefighters and others in what was then a new program--cardiopulmonary resuscitation.

From 1969 to 1982, Alexander was executive director of the National Assn. of Social Workers in Washington. There, he managed a 93,000-member organization, developed professional standards for social workers and sometimes testified on social needs before Congress.

He came to Huntington Beach to “retire,” to work on several books and teach part time at Cal State Long Beach. But in 1985 he was invited to join the United Way health task force and has been working full time ever since.

After spending nearly a year studying and describing Orange County’s health-care problems, Alexander and his task force became more political. In 1988, they lobbied hard to persuade supervisors to reserve a $6.1-million state grant for county clinics and other health services rather than spend it on other county projects.

“We took 15 to 20 organizations (to the supervisors) and said, ‘Look, this money belongs to health care, and we’re letting you know ahead of time,’ ” Alexander recalled. “ ‘We’re not trying to mousetrap you. . . . So we want the following things.’ And we got it.” Well, $5.8 million of it.

County health officials applauded that effort. But sometimes Alexander’s aggressive tactics angered them--and made United Way’s executive board “nervous,” he admitted. In December, 1989, when Fountain Valley Regional Hospital and Medical Center quit the county’s trauma system, Alexander wrote county health director Uram that the county should have used local funds to keep a fourth emergency center in the network.

Uram was incensed, Alexander said, “threatening United Way” by suggesting that county employees might not participate in that year’s fund-raising drive.”

Uram remembered it differently. “I called his boss once and said, ‘He’s overstepping his boundaries. . . .’ I didn’t threaten reprisal.” Uram added, however, that he had mentioned that the county was “the largest single contributor” to United Way and that its officials would be unhappy with Alexander’s letter.

In the end, Alexander said, United Way executives wrote a letter to Supervisor Thomas F. Riley, saying his letter was misinterpreted, and the incident was smoothed over.

Members of the task force credit Alexander with turning a cautious, business-oriented committee into a high-profile advocacy group for health care.

Until Alexander took the helm, the task force was “not a player” in county government, said Jean Forbath, founder of the SOS Free Clinic in Costa Mesa and one of the group’s original members.

But since then, “one of Chauncey’s major accomplishments has been to use channels, to bring the legitimacy of United Way to a very touchy subject,” Forbath said. And because of Alexander’s persistence, “the county has become more responsible; it knows there is a very effective watchdog out there.”

Under Alexander’s direction, the task force grew--from 12 members to 50. And the membership not only included representatives from hospitals and local clinics but also from the League of Women Voters, the Junior League, the Employers Health Care Coalition and the Orange County Chamber of Commerce.

Also under Alexander, the task force began a series of meetings with state and federal legislators, listening to legislators’ views of health problems and discussing solutions.

For all the lobbying he and his task force members have done, Alexander said he still believes that the Orange County public and their representatives “have to be educated. . . . We (have to) get the people aroused. It’s a slow process, I admit.”

Fellow task force members can’t imagine what they would do if Alexander were to step down as chairman. “If Chauncey doesn’t do it, there’s a real possibility the program will falter, will take a step backwards,” said John Rett, executive director of the Orange County Medical Assn. and member of the United Way task force.

But Alexander is more optimistic. “Even if I’m not on the task force, they (supervisors) will be hearing from me,” he said with a laugh. “And I can probably be more aggressive if I’m not on the task force.”