Frustrated at the lack of a comprehensive plan for downsizing the nation's second-largest public-health system, the Los Angeles County Board of Supervisors voted Tuesday night to postpone this weekend's scheduled layoffs and demotions of nearly 5,200 health workers until Oct. 15.
After stinging words of criticism for top county health officials, the supervisors delayed the layoffs and demotions until a plan to restructure the vast system of hospitals, health centers and community clinics is developed.
Meanwhile, the board voted to turn over four of the community health clinics, on the Westside and in the San Fernando and Santa Clarita valleys, to private operators. And with the infusion of the $364-million federal rescue package, the supervisors agreed to take a $50-million grant from the Metropolitan Transportation Authority but reject a $100-million loan from the agency.
The supervisors were clearly agitated because, after months of crisis, the massive Department of Health Services is still struggling to decide which services should stay and which should go as the county shrinks its huge health network.
A dearth of answers from top health department officials left the supervisors with only one real choice: Buy more time.
"This board needs to be in control of this situation because this department has not been," declared board Chairwoman Gloria Molina.
After a three-hour meeting that dragged into the evening, Molina denounced as "namby-pamby" a proposal by the department and health czar Burt Margolin to restore most health programs threatened with closure. Instead of voting on it, the board ordered Margolin and health officials to return next Tuesday with a comprehensive plan for downsizing the department and eliminating the prospect of a deep deficit next year.
"It's very frustrating," Molina said. "From Day 1, we have been counting on the department to give us thoughtful recommendations, and they have not been coming. Then you ask them questions, and you can't get a straight answer."
As the livelihood of thousands of health workers hung in the balance, the supervisors were still trying to understand the implications of the federal bailout announced Friday, which is expected to avert closure of county hospitals, all six comprehensive health centers and 28 community clinics.
"The board has suspended layoffs and done very little else," said Supervisor Zev Yaroslavsky, the lone dissenter on postponing the layoffs and demotions. "They are always looking for excuses not to do something, and there will be a thousand and one excuses between now and Oct. 15, trust me."
The two-week delay will cost the cash-strapped county at least $2.5 million.
While postponing the layoffs of health employees--from doctors and nurses to lab technicians and janitors--the board made clear its displeasure with the department that oversees the spending of more than $2.1 billion annually.
Yaroslavsky bluntly told county health officials that he lacks confidence in their ability to deliver a dramatically different and less costly health-care network.
"We've got to change this system," he said, complaining that the "power structure"--health officials and the unions representing health workers--are resisting change.
The supervisors were particularly upset with new financial projections showing that the county would still face a $192-million deficit in health services when the next fiscal year begins in little more than nine months.
Against that backdrop, Margolin identified the first seven community clinics that would be privatized. He said the clinics would be taken over by "highly qualified" private medical groups or hospitals beginning Nov. 1 for a three-year period.
After Molina objected to privatizing three clinics, the board voted to proceed with contracts on the four others: the Venice and Yvonne B. Burke clinics on the Westside, which would be taken over by the Westside Health Crisis Coalition/Venice Family Clinic, and the Canoga Park and Valencia clinics, which would be absorbed by the Northeast Valley Health Corp. A decision was delayed on contracting out the Pico Rivera clinic to Presbyterian Intercommunity Hospital of Whittier and the Bell Gardens and Northeast clinics to the Community Health Foundation of East Los Angeles.
Margolin said the private groups have agreed to give laid-off county employees the right of first refusal for employment during the first year of their contracts with the county.
But an array of speakers criticized the proposed privatization, warning that it would inevitably lead to a reduction in services to the poor and uninsured.
Gilbert Cedillo, general manager of the Service Employees International Union, Local 660, accused supervisors of using the county's fiscal crisis to press for privatization and engage in union-busting.
Molina shot back: "This board has never moved forward any union-busting tactic. I resent [the accusation] that we have been union-busting."
Walter Gray, assistant director of the health department, drew applause from the small audience at the Hall of Administration when he said some of the bidders for other clinics should not be considered.
Gray, representing the department in the absence of Director Robert C. Gates, complained that some providers were bypassing the department and taking their cases for privatization directly to supervisors. "We have had some providers that, very frankly, I wouldn't allow to touch a patient," he said.
Yaroslavsky abstained on the issue of whether to take the controversial $100-million loan from the MTA. With Supervisors Deane Dana and Mike Antonovich voting no, his move effectively prevented more borrowing like that in previous years, which has contributed to the county's fiscal crisis. Molina and Supervisor Yvonne Brathwaite Burke voted in favor of the loan.
In another development, county personnel chief Michael J. Henry submitted to the board the names of the three candidates "certified" by a search panel as finalists to replace Gates, who is retiring Nov. 1 under a cloud of criticism.
After interviews with at least nine candidates, the panel recommended that the supervisors consider Robert S. Caulk, director of the Sacramento County Health and Human Services Department; Mark Finucane, health director of Contra Costa County, and Dr. Jonathan Weisbuch, medical director of the Los Angeles County health department.