Call for Health Panel Meets Early Resistance

Los Angeles County health czar Burt Margolin urged Tuesday that a special panel of experts be created to oversee the crisis-wracked Health Services Department, arguing that it would boost efficiency and reduce political meddling in the county’s $2.3-billion-a-year medical system.

But three of the five county supervisors immediately expressed serious reservations or outright opposition to Margolin’s proposed health authority, calling it unnecessary and worrying that its prestigious members might demand that the cash-squeezed county spend more on health care than it can afford.

The supervisors’ reluctance marked the first time they have broken with Margolin on a major issue since appointing the former state assemblyman last summer to find ways out of a budget crisis that threatened to wreck the nation’s second-largest public health system.

The concept of a health authority with significant power to manage the giant medical system is widely supported by health care professionals outside county government. They say it is a critical element in restructuring the county health network so it can stay afloat while its financial problems are addressed.

David Langness, spokesman for the Healthcare Assn. of Southern California, a group of mostly private hospitals that strongly supports a health authority, said he was not surprised at supervisors’ hesitance to surrender some of their power over health issues.

“My own feeling is that this sort of power-sharing agreement probably will not happen unless it is put to a vote of the people,” he said. “I think a popular vote would be likely to take responsibility for [the health department] out of the supervisors’ hands. But somebody’s got to put that together.”

The only supervisor who strongly favored a health authority was Zev Yaroslavsky, who said it was something that his board colleagues “should embrace and not fear.”

“We’ll end up with a much better product and make a lot less mistakes that we’re prone to make under the current system,” he said.

Margolin said a health board of seven health care experts from private medicine, academia, organized labor and business would inject badly needed expertise into the operations of the health department and free supervisors from making complex medical decisions they may sometimes not fully understand.

An authority, he said, also would help the health department react better to rapid changes sweeping the health care business and lessen supervisors’ tendency to treat hospitals and clinics in their districts as part of their political fiefdoms, rather than part of a crucial countywide system.

“Governance of the county health system is a central issue in determining whether the county will be able to confront a crisis which is far from over,” concluded a report Margolin submitted to the supervisors.

But after he made his recommendation, Margolin was peppered by questions and objections.

Supervisor Yvonne Brathwaite Burke said she supports the idea of a health authority but is concerned that its members might engage in tense budgetary standoffs with supervisors by demanding that more money be spent on health care than the county--which faces severe cuts in federal funding--could provide.

“It’s the kind of structure that sets up confrontation,” she said.

In an interview after the meeting, Supervisor Mike Antonovich echoed Burke’s concerns, saying he opposes an authority. A spokesman for Supervisor Deane Dana said he also opposes the idea.

Burke and Dana said they were hesitant to move forward with an authority without hearing from the newly hired Health Services Department director, Mark Finucane, who will not assume his post until Jan. 15. The supervisors voted 4-0 to hold a public hearing on Margolin’s report in February, after Finucane and a county efficiency commission have time to review it.

Burke said Finucane, now the head of Contra Costa County’s public health department, told her and other supervisors during his job interviews that he wants to assemble a panel of nationally known health care experts to propose a restructuring of the health system.

Margolin tried to allay supervisors’ concerns by saying they would retain power to accept or reject the health authority’s budget recommendations, and to hire and fire the health director.

In a related matter, the county Citizens Economy and Efficiency Commission told supervisors the county could save $1 million annually and slash patient waiting times by changing the way emergency patients are treated at County-USC Medical Center and at Hudson Comprehensive Health Center in South-Central Los Angeles.

The commission said the county should consolidate the six or seven treatment stations that patients must navigate at the two facilities, where average waiting times stretch up to 2 hours, 50 minutes.

Nurse practitioners, rather than higher-salaried doctors, should make initial judgments on treating emergency room patients, and a telephone line should be set up to give self-care information that could help keep patients out of expensive emergency rooms, the report said.

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