Battling Politicians on Better Health Care : Medicine: James Lott brings political activism to formerly obscure hospital trade organization.

James Lott won’t be surprised if he commits political suicide in San Diego. Indeed, he may be on his way there already.

“I think it may be inevitable that I’m going to put the bullet in my own mouth,” says the president of the industry group representing all of San Diego County’s hospitals.

“At some point I’m going to tackle a problem that has to deal with health care policy in such a forthright and strong manner that it’s going to alienate the wrong person, or it’s going to alienate enough of the wrong persons one time too many.”

Lott, 41, is president of the Hospital Assn. of San Diego and Imperial counties, an industry trade group that he has brought from genteel obscurity to political activism over the last 18 months. The hospital council represents the business interests of 30 hospitals in the two counties.

No small reason for that lies in his willingness to organize, to get involved--and to volunteer pointed assessments of health care issues in San Diego County. Some flagrant Lott-isms of late:

* The county’s political sophistication in trying to deal with the state over the County Medical Services crisis is at a level “somewhere in the bowels of Civics 101.”

* Lott was disappointed when reporters failed to publicize his call for the recall of Supervisor George Bailey, after Bailey voted to end CMS while saying that doing so could kill chronically and critically ill people in the program.

* The 25,000 people a year served by CMS are so ignored in this community that “you could line ‘em up and just shoot ‘em, (and) . . . I don’t think it would mean anything. There would be little to no righteous indignation.”

Lott hardly pauses before emphasizing that, yes, he is speaking for the record.

“I used to worry about saying things like that,” he said with a smile. “I don’t worry about saying things like that any more, because it’s--it’s just stupid. “

It is this bluntness, perhaps above all else, that has made him both a visible force and a potential liability for those who say San Diego County is teetering on the edge of a medical care crisis for everyone, not just the poor.

A force, because already he is acknowledged as having raised both the visibility and the unity of hospitals in seeking solutions to financial problems caused for them by the vast numbers of uninsured people in the county.

A potential liability because his bulldozer approach, while tolerated so far, challenges what Lott sees as a San Diego leadership network that doesn’t easily admit outsiders.

Over the last two months, as the country tried to end CMS because of a dispute over state funding, Lott used the FAX machine like a shotgun--aiming critical letters at the Board of Supervisors but sending copies to all reporters.

The man who had to respond to the criticism at the time, Deputy Chief Administrative Officer David E. Janssen, generally rolled his eyes and looked scornful when asked about most of those letters.

Today, Janssen is less dramatic in assessing Lott’s actions: “I think some of it could have been done more smoothly, but from my standpoint he has been primarily cooperative.”

Frustrated at the San Diego legislative delegation’s inaction, Lott also admits to having offended Assemblywoman Carol Bentley at a meeting held in March, during the height of the CMS crisis. They have since patched up the rift, he says.

But, while contrite, Lott doesn’t intend to back away from pressuring legislators to act as a block on San Diego’s behalf.

“I don’t think it’s good enough for us to say that they aren’t any good and they haven’t done anything for us. I think we have to put them to the fire,” he said.

Overall, Lott has proven an effective advocate for hospitals as well as a catalyst for solutions to health care problems, says Paul Simms, director of physical health services for the county.

“I’ve been working on developing a perinatal care network for the county for five years, and I couldn’t get the hospital council to come to a meeting,” Simms said. “And when Mr. Lott came, he not only became actively involved but he has been able to provide hospital support for access to care for poor women that I couldn’t otherwise get.”

As for Lott’s style, Simms laughs.

“Mr. Lott has made it real clear that he will not necessarily agree with me,” he said. “But I make a distinction between someone I can work with and someone who will agree with me all the time.”

To take the head administrative post at the hospital council a year and a half ago, Lott left a position of statewide power and influence. He had spent nine years as staff director and chief consultant for the Senate Health and Human Services Committee, chaired by Sen. Diane Watson, (D-Los Angeles).

If Lott brought a special zeal to the committee’s oversight of the state’s health care for poor people, perhaps it was because of a childhood living as one of them in a Los Angeles ghetto. He grew up in South-Central Los Angeles, in Watts, with four brothers and a single-parent mother, Bertha Lott.

“My mother worked three jobs to make less than the federal poverty level, total,” he said. “So I worked in high school. I did gardening, landscaping, road work, odd jobs, worked at a taco stand--full time, 40 hours a week.”

Likewise, in college at Cal State Los Angeles, he worked, this time to support his wife and two sons. It was this job near the bottom of the medical ladder--working as a hospital file clerk on the graveyard shift--that got him interested in health care administration.

It also started him on a seven-year climb to assistant administrator at Los Angeles County/USC Medical Center. As a black man, he thinks he could only have done so working for a public agency.

“I can’t imagine how it could possibly have happened in the private sector, knowing what I’ve come to learn about the private sector,” Lott said. “It’s not always performance that counts. The public sector is just a much better milieu for minorities to progress.”

The hospital council, whose governing board is composed of Lott and executives of 14 area hospitals, hired him in November 1989.

A local study had concluded that uncompensated health care for the poor was threatening the entire hospital infrastructure in San Diego.

Lott was chosen to help hospitals try to prevent that by influencing public policies--from the way counties spend their health care money, to how the state reimburses hospitals for caring for Medi-Cal patients.

When the CMS crisis hit in February, Lott had his first chance to do the kind of social and political organizing that he sees as his forte.

He worked with community clinics to hold a press conference where the working poor clients of CMS told of cancer, heart problems and other life-threatening illness that would go untreated without CMS. The clinics bused dozens of patients downtown to tell the supervisors their stories.

Meanwhile, Lott arranged for hospital executives to lobby county supervisors individually and in person.

But the board still voted to abolish CMS because of a lack of state funding. (A judge later preserved the program by court order.)

Lott is perplexed.

“We gave it the best shot we had, and in the face of all of that they still voted to do what they did,” he said. “If you can’t get them with the old political network and you can’t get them with the (social activist) Saul Alinsky approach, just what does work?”

He shakes his head. “I think our community is immune to social activism. Absolutely immune to it. And that’s really discouraging, because that’s what I do best.”

“I’m beginning to believe what people told me when I came to this town, and that is that health care is not a priority here,” he added.

So Lott plans to put the hospital council’s efforts into trying to educate the community about why lack of health care is not just a problem for poor people.

“People don’t understand. They believe that if they have the money and if they have the insurance, medical care will be available to them,” Lott said. “That isn’t true. If you’ve got half of those 25,000 people in CMS landing in emergency rooms, logjamming them, it won’t make any difference if you have a Blue Shield card or not. You’re going to be triaged along with those other people.

“And if the five hospitals who are talking about downgrading their emergency rooms decide to do so, there are going to be certain corridors in San Diego where you’re going to have to travel farther distances to get emergency relief,” he said. “We’ve got to get that kind of message out.”

In an interview last summer, nearly a year after first coming to San Diego, Lott laughed about how slow the community had been to welcome him.

“When I came here everybody told me whom I should talk to, whom I should know. So the first few months I went around town meeting people, trying to find out how to break into this closed society,” he said. “I’ve met everybody who’s in! But I’m no closer than I was when I got here in the first place.”

Today, he figures he’s on the way, after having been invited to join the Rotary Club.

But elected officials can still expect to continue to hear his forthright pronouncements on health care issues.

“The decision-making network, the power politics, has not evolved to the point where it can deal with problems of this magnitude,” he said. “Our job is to make certain they know what the problems are--and that they don’t have excuses for not doing something about it.”