New Health Chief Needs Full Backing : Daunting task requires support on every level

The recent exodus of patients and employees from the beleaguered Los Angeles County health system is understandable. For months, the County Board of Supervisors had warned of the impending closure of hospitals and clinics, massive layoffs and transfers. Also, no new medical appointments had been scheduled. The result was that patients and employees made other arrangements long before an eleventh-hour, $364-million federal bailout averted collapse of the system. Because of this reaction among workers and the public, the county may lose $24 million in income--another bitter, unexpected blow.

To stave off further losses, county officials need to get the word out that public health facilities are up and running, and they need to hire several hundred employees, especially trauma nurses and other specially trained people, to provide adequate care. As stability returns to the system--which has six hospitals, six comprehensive health centers and 38 community clinics--the patients, and their Medi-Cal payments, also can be expected to return. Getting them back is one of many challenges faced by the county’s new health chief.

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HUGE OPERATION: The supervisors Tuesday hired Contra Costa County’s health director, Mark Finucane, to take on management of the huge Department of Health Services, which has a $2.3-billion budget and treats countless county residents who are poor or lack health insurance. The supervisors should give the new director proper latitude, but they should also avoid distancing themselves as they did in dealing with the talented Sally R. Reed, the county’s chief administrative officer, who was lured from the outside and often ignored on the inside.

Finucane will need some political guarantees, which the board indicates are forthcoming. There should be no second-guessing, no micro-managing. Give him a fair chance to turn the department in new directions. The ultimate responsibility, of course, remains with the supervisors, but they must stand firmly with their appointee from the outset.

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DIVERSE CHALLENGE: Finucane’s challenges include stopping the flood of red ink without causing a sustained flight of patients, revenue and employees--all without sacrificing quality in service. He must also tackle the fate of County-USC Medical Center, the antiquated but crucial centerpiece of the system, and deal with the ongoing problems at Martin Luther King/Drew Medical Center. In addition, the department must make the transition from costly medical treatment to cost-saving prevention, and to managed care.

Budget constraints are not expected to ease significantly despite the massive cuts ordered recently by the supervisors. The money just isn’t here--or in Washington or Sacramento.

In short, Finucane is being called on to do nothing less than salvage the health department--a department that directly or indirectly affects the health of millions--while performing within the boundaries of harsh fiscal realities. He’s on the spot.