Innovator Offered Top L.A. County Health Job : Medicine: Supervisors must still work out contract with Contra Costa’s Mark Finucane.

The Los Angeles County Board of Supervisors on Friday offered Contra Costa County’s innovative health services director the tough job of reforming and running the nation’s second-largest public health system.

After a long and difficult search, the supervisors met behind closed doors and settled on Mark Finucane to reshape the county’s vast and troubled Department of Health Services.

The deal has not been finalized, however. The details of Finucane’s pay and benefits package were being worked out after the supervisors met with him privately; the appointment is expected to be announced after the board meets Tuesday and ratifies a contract.

To assist him in the huge task of overhauling the $2.3-billion annual health system, Finucane plans to bring a team of high-level managers with him to Los Angeles, Supervisor Mike Antonovich said.

The sprawling system, with six hospitals, six comprehensive health centers and 38 community clinics, is the primary provider of medical care to millions of county residents who are poor or lack health insurance.

Suffering from a deep deficit in money and leadership, the health system was on the verge of collapse this fall until it won a reprieve with a $364-million federal rescue package.

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The money is only a temporary solution to a long-term problem of declining resources and a history of focusing the system on providing expensive hospital care rather than less expensive preventive and primary care. The supervisors have been taking their time in finding a successor to Health Services Director Robert C. Gates, who resigned effective last Wednesday.

Supervisor Deane Dana said he was impressed with Finucane, who emerged as one of two finalists for the top health department job. “He’s got a challenge, but he knows what has to be done and that’s important,” Dana said.

“We’ve got to get good management in there to make sure we are really doing it properly and clean the whole department up. I’m convinced there is a tremendous amount of deadwood in the department and I think we’ve got a lot of doctors that have been using the system in a lot of ways.”

“He has a tough job,” Antonovich said of Finucane. “He comes with experience, enthusiasm and a strong work ethic.”

Antonovich said he was impressed with Finucane’s efforts to establish partnerships between public and private health care providers in Contra Costa County, east of San Francisco. That county, with a $330-million health budget, operates a public hospital and contracts with two private hospitals.

In addition, as director of the Contra Costa County department since 1984, Finucane has earned a reputation as a leader in moving that county toward a managed care system for treating Medi-Cal patients and the indigent who lack health insurance. The Contra Costa County system stresses providing primary care.

Antonovich said the board members are united in their support for Finucane to do the same in Los Angeles County, which has built a health system that duplicates many of the services provided by private hospitals and doctors.

Board Chairwoman Gloria Molina and Supervisor Yvonne Brathwaite Burke declined to comment specifically on the choice.

“We don’t have any public statement on that as yet,” Molina said. “We have another closed session on Tuesday. Hopefully at that point we might be closer to getting you a decision.”

Dana said the board had no choice but to go outside the department to find someone to guide the county to a new day in health care.

“There was no way we were going to do it with someone from the present system,” he said. “You had to have a new face, a very strong person. Someone that could really change things and not have to worry about stumbling over people that were here.”

Supervisor Zev Yaroslavsky said he too was extremely impressed with Finucane. After checking with two dozen people across the state, Yaroslavsky said Finucane gets “very high marks” and “the county will be very well served” if he is health director.

“Finucane has very solid credentials and a good track record,” Yaroslavsky said.

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Faced with extreme financial difficulties, Finucane would have to move rapidly if he takes over after the first of the year to downsize and restructure the county’s health system, or it will again threaten to bankrupt the nation’s largest county government.

Contra Costa County Supervisor Jeffrey V. Smith, a physician who works for the county hospital in Martinez, described Finucane as highly qualified. “He’s very innovative. He’s very bright,” Smith said. “He’s not afraid to explore new options.”

During his tenure in the Bay Area county that runs from heavily industrial areas in the west to upscale suburbs in the east, Smith said, Finucane has brought “a very comprehensive approach” to health care.

The county has 13 outpatient clinics, special adult and mental health clinics, and partnerships with private hospitals. After much controversy, the county is also building a new hospital.

Smith said Contra Costa also was the first county in the nation to form its own health maintenance organization for Medi-Cal and other patients based on primary care doctors.

The department also operates a family practice training program for physicians in conjunction with UC Davis.

As director of the department, Finucane has supervised 2,300 employees. His new assignment would involve managing a diverse work force of 25,000--more than 10 times larger.

Finucane could not be reached for comment. A brief biography provided by his office says he was a member of the Health Care Reform Task Force established by former California Insurance Commissioner John Garamendi, and he played an advisory role in President Clinton’s unsuccessful health care reform effort.

He is past chairman of the California and national associations of public hospitals. As such, he has pressed for greater resources for public health care systems and efficiencies in controlling health care costs.