Many Say Finucane Can Save the System

They express their admiration in bold terms, these colleagues of Mark Finucane: He’s got the brains and the savvy to rescue Los Angeles County’s public health system. He’s the best man for the job. If anyone can do it, he can.

Then, more quietly, these same colleagues wonder: Why on earth would he want to try?

Taking over the county’s vast health system--the second-largest in the nation--will be a staggering task.

On Tuesday, county supervisors signed up Finucane for the job, luring him with a $210,000 annual salary and the sure-fire promise that every workday will bring new challenges.

Articulate and energetic, Finucane will step into the Department of Health Services director’s office Jan. 15. Right away, he’ll face towering problems--a bare treasury, a disgruntled work force and impoverished residents uncertain where to go for a tuberculosis test or an eye exam or an asthma treatment. Finucane, widely praised for his ability to cut through contentious politics without making enemies, is likely to be besieged by demands.

Supervisors will look at him to make cuts. Without, of course, shutting clinics in their districts. Union leaders will count on him to stave off layoffs. While still tweaking the $2.3-billion budget into stability. And the public will rely on him to reform a creaky bureaucracy. Without shredding services for the county’s poorest residents.

As one hospital executive put it: “He’s going to have to pull off some real magic.”

County supervisors clearly believe Finucane is up to the job. So do his friends and colleagues--and even his political foes.

“When faced with the largest challenge in health care in the U.S. today, I don’t think Mark could walk away from it,” said Dr. Jeffrey V. Smith, a supervisor in Contra Costa County, where Finucane has served as health director since 1984. “He’s an extremely talented person.”

“He’s one of the most qualified individuals in the country for this job,” agreed Dr. Molly Coye, a former colleague and now senior vice president of the Good Samaritan Health System in San Jose.

An unabashed liberal, Finucane will be called upon to slash the health department’s budget and reduce Los Angeles County’s responsibility for tending the needy. Daringly outspoken for a civil servant, Finucane has ripped into the Republican proposals to reform Medicare and Medicaid. Yet fellow administrators believe Finucane’s yearnings to assist the downtrodden will actually help him chop away at the budget.

Instead of just slashing across the board, they predicted, he will study each program, pick the winners, and toss away the losers. “Mark understands he has to make the tough cuts in order to accomplish the goal of providing better services,” Contra Costa County Supervisor Mark DeSaulnier said.

In his decade at the helm of Contra Costa’s health department, Finucane restructured the system to bring low-cost managed care to the unemployed, the homeless and the elderly. Even as he set up geriatrics clinics and assigned primary-care physicians to homeless people, Finucane managed to wipe out a $10-million budget deficit and trim the bureaucracy.

Finucane expanded the role of health services director far beyond the traditional jobs of overseeing hospitals and setting budgets.

He supported efforts to remove alcohol and cigarette billboards posted near schoolyards. In keeping with his fierce concern about guns and violence, Finucane pushed politicians to restrict the location of gun shops and served on the advisory panel for the national Cease Fire Education Project. He also studied the pattern of accidents in the county, then proposed relocating some traffic lights and stop signs to save lives.

“He really pulled off miracles in Contra Costa County,” Coye said. “He has a deep conviction that it’s his job to solve problems with the community, not just in the community.”

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For all the praise that trails him around, Finucane has never had to deal with a bureaucracy as complex, or a county as huge, as Los Angeles. His department in Contra Costa ran on an annual budget of just $330 million, and his vaunted belt-tightening resulted in only four layoffs. When he moves to Los Angeles, he will oversee 25,000 employees--more than 10 times the size of his Contra Costa staff.

He will also deal with a more diverse public. Just east of San Francisco, Contra Costa County sweeps from agricultural fields to industrial parks to upscale suburbs. But its population is nearly two-thirds white. About 13% of the residents are Latino, compared to 40% in Los Angeles County.

“He’s in virgin territory,” said Mike Wall, the president of Mt. Diablo Medical Center in Contra Costa County.

But several analysts said they thought Finucane would manage the switch to a larger scale. They pointed out that Los Angeles supervisors could hardly have hoped to find an administrator with experience managing such a sprawling department, unless they pulled one in from New York City.

“Anybody going into this job won’t have had that kind of experience,” said Richard Cordova, executive administrator at San Francisco General Hospital. “Mark’s not coming [to Los Angeles] out of the dark. He knows a lot of people there already, and I think it’s going to be a very easy transition.”

Finucane describes himself as “intrigued by the challenge” of tackling Los Angeles’ problems. “I’m fascinated by it,” he said.

He figures the supervisors expect him to be an innovator. “It’s a tag that I have, and I’m proud of it,” he said. A long-distance runner known for his snappy wit, Finucane relishes the opportunity to prove his creativity.

But he knows the job will be daunting. A Contra Costa supervisor told him, half jokingly, that he might need bodyguards once he starts remodeling Los Angeles’ clunky health care system. Finucane responded by acknowledging “a little buyer’s remorse” at accepting the mammoth job.

“It’s a huge undertaking and there’s going to be a lot of frustration,” said Dr. David Werdegar, director of the statewide health planning office. “[But] he’s got the necessary zeal, energy and focus.”

Near the top of his agenda in Los Angeles, Finucane will have to take on the issue of how to rebuild, replace or revamp the earthquake-damaged County-USC hospital. He should find himself on familiar turf as he reviews the options: He was at the center of a battle about how to revamp an obsolete hospital in Contra Costa County.

Despite heavy opposition from some minority leaders, who wanted the county to concentrate public services in poorer neighborhoods, Finucane pushed for a brand-new hospital in the middle-class city of Martinez. Two supervisors protested, arguing that the county did not need to spend $125 million for a new facility when local private hospitals were half empty.

But Finucane, a skilled and aggressive lobbyist, won the fight, arguing that the county needed its own hospital, and could not rely solely on the private sector to help the needy. He wanted it built in Martinez, on the site of the county’s obsolete hospital, because it would be centrally located. The county provides transportation for poor residents from outlying areas, and contracts with local hospitals.

Opponents of the new hospital fear Finucane saddled Contra Costa County with an extravagant white elephant. Still, they respect him for articulating his views persuasively and for fighting cleanly, with no venom toward his foes.

“Mark is what I call a politician in the good sense of the word--he’s bright and he tries to be conscious of peoples’ feelings and not burn bridges,” said Supervisor Jim Rogers, who voted against the hospital.

Indeed, Finucane wins near-unanimous praise for his political smarts. His connections stretch from Sacramento to Washington, D.C., as he has served on state and national task forces studying health care reform.

Even better, from cash-craving Los Angeles’ point of view, Finucane has become an expert at securing money for health care. In Werdegar’s words: “He has a good nose for where there might be funds.”

Finucane will face a challenge negotiating potential job cuts or wage freezes with wary union leaders. Again, his experience in Contra Costa may cushion the transition. Finucane won support from the public employees union by meeting with the leadership before proposing any changes, said Henry L. Clarke, general manager of Local 1.

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Praising Finucane as a straight shooter, Clarke added: “I never caught him lying to us in terms of his position or the fiscal situation of the department.”

The union had fewer grievances against Finucane’s administration than that of any other county department, he said.

Although Finucane built his reputation as an adept bureaucrat, his colleagues attribute his success in part to getting away from the fluorescent lights and soulless sterility of the office.

A gourmet cook who adores Bob Dylan music, Finucane “knows how not to burn himself out,” said Dr. William Walker, Contra Costa’s medical director. He reads, skis, spends time with his two daughters--and frequently gets out to visit hospitals and clinics.

For a non-physician (he received a bachelor’s degree in literature), Finucane knows a good deal about medical procedures, colleagues said. He built Contra Costa’s health system around family physicians, rather than specialists, to emphasize preventive care. He organized a managed-care HMO for Medi-Cal patients, then offered the same program to county employees. And he set up a team to contact homeless people and sign them up for health programs as well.

Finucane said he believes his experience in Contra Costa will apply to his work in Los Angeles. Still, he acknowledges that he’ll have to learn a new system and build new relationships. “There is no cookbook for L.A.,” he said.

Times staff writer Jeffrey L. Rabin contributed to this story.