Health Director Confronts Racial Disparity

As if the enormous financial problems facing the nation’s second largest public health care system weren’t enough to deal with, Los Angeles County’s new health services director has been thrust into the middle of a long simmering legal and political battle over the racial makeup of his department’s work force.

Pressed by a recent county Civil Service Commission decision--and under the watchful eye of the U.S. Equal Employment Opportunity Commission--Mark Finucane vowed to confront the emotionally charged issue of diversifying a work force that does not reflect the county’s changing racial makeup.

More than three years after the EEOC directed the county to increase the recruitment, hiring and promotion of Latinos in the health department, Finucane has pledged to create and co-chair a task force on diversity in a health system where Latinos have long been underrepresented.

Finucane, backed by the Board of Supervisors, has said he is dedicated to “diversifying the work force of the health services department not just from a numbers standpoint, but from a power standpoint.”

But critics say the county has been far too slow in meeting the goal of its September 1992 agreement with the federal government.

In the lengthy agreement, settling long-standing allegations of discrimination, the health department denied discriminating against Latinos, but promised to expand its recruitment, hiring and promotion efforts.

At the end of last year, the Los Angeles County Chicano Employees Assn. asked the federal agency to extend the agreement, which expires this month, because of “the county’s failure to make a good faith effort” to comply with it.

“They have made no effort to promote Latinos,” said Gil Moreno, the union’s chief counsel and general manager. “You just connect the dots, and there is a picture of willful noncompliance.”

Finucane said his goal is to make the $2.3-billion health system and its sprawling network of hospitals, health centers and community clinics more representative of the county as a whole.

“Obviously, right now, that suggests Latinos,” Finucane said. “In eight years, it may be a different group.”

County documents show that at the end of last year, Latinos were underrepresented and African Americans were significantly overrepresented in the department’s full-time work force of nearly 21,000 employees.

While Latinos are 34.6% of the county’s civilian labor force, they represent 25.4% of the health department’s full-time staff. By contrast, African Americans make up just under 10% of the labor force, but more than a third of the health department’s full-time employees.

Before Finucane agreed to take the top health department job, he said he was warned that he inevitably would face a wrenching problem that “no one has ever dealt with--the underlying tension that changing population is causing in the health care system. . . . If we don’t deal with this underlying tension, it will cripple the department’s effectiveness,” he said.

As an outsider, Finucane knew that the long avoided issue of racial discrimination--especially at Martin Luther King Jr./Drew Medical Center--could not be ignored any longer.

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His second day on the job, Jan. 17, the county’s Civil Service Commission affirmed a hearing officer’s sweeping conclusion that the hospital and affiliated medical school near Watts has an “unwritten policy of maintaining itself as a black institution and of placing black candidates in positions of leadership . . . to the exclusion of nonblacks.”

The commission concluded that an Indian doctor was discriminated against after being passed over for the post of chairman of the hospital’s troubled emergency department.

The question facing the supervisors this month was whether to appeal the commission’s decision in court.

But the overriding issue has been the hospital’s failure to adapt to the rapidly changing character of the communities it serves, which have been transformed from almost exclusively African American enclaves in the 1960s by repeated waves of Latin American immigration.

In a private conference room far from public view, Finucane made a passionate argument that the county must confront the racial issue head-on and not appeal the discrimination case. The four supervisors on hand took his advice.

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It would send the wrong message to appeal the finding of discrimination, Finucane said. Rather than fighting old battles anew, it was time to move on.

Finucane said in the interview that he had hoped the issue wouldn’t be elevated to his A-list in his first year. Instead, it ended up there his first week.

“It was a ball that was pitched at me earlier than I would have liked. I could just not afford to wait,” Finucane said.

“Any successful health care organization has to reflect the population it’s targeting,” he said. “We’re going to reflect it in the diversity of our employees, the populations we serve,” not just at “Martin Luther King hospital, but throughout our work force and in every program we operate.”

Finucane said he wants to address diversity in a less contentious way, so that the discussion “doesn’t turn into a range war” over numbers. In its hiring, he said, the health department should look for the “best possible person for the job” while keeping “an eye on who is living in L.A. County.”

What Finucane did not say is that he and county affirmative action compliance officer John Hill are scheduled to discuss the county’s progress in meeting requirements of the 1992 agreement in a telephone conference call with federal officials this week.

While those discussions go on behind the scenes, the issues raised by the Civil Service Commission’s findings are being hotly debated in public.

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Dr. Reed V. Tuckson, president of the Drew University of Medicine and Science, reacted strongly to the conclusion that the hospital and medical school have been discriminating against nonblacks, calling it “absolutely incorrect.”

“To us, it is impossible given our record of hiring,” Tuckson told the supervisors last month. “There are fine people of many colors who are working in our institution.”

But Supervisor Gloria Molina pointedly told Tuckson that the hearing officer’s report details “an unbelievable amount of discrimination against one person” and maybe others.

“My concern is, on its face, we look as ugly as those governors and those elected officials in Alabama and Mississippi years ago who denied black children [entrance] to our universities and our public schools,” Molina said. “I hope that is not the case here in L.A. County.”

Tuckson countered with statistics showing that the faculty, students and staff at King/Drew is more diverse than the county’s five other hospitals and two major medical schools.

As the debate continues, Supervisor Yvonne Brathwaite Burke, a staunch defender of the hospital that lies in her district, has been forced to the sidelines in board decisions concerning the discrimination case by a conflict of interest.

At one time, before being elected to the board, Burke was the private attorney representing the Indian doctor who argued that he was the victim of discrimination at King/Drew.

It was that case, filed by emergency room doctor Subramaniam Balasubramanian, which prompted the Civil Service Commission to conclude that he was a victim of a pattern of discrimination against nonblacks.

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The commission did not restore Dr. Bala, as he is known, to his former post as head of the emergency medicine department, a critically important job in a hospital that admits 80% of its patients through its emergency room.

Instead, another search, to be overseen by Finucane, is underway to select a new emergency room chief.

Both Burke and Finucane visited the hospital last week. They wanted to get the word out to doctors that change is in the works--at the hospital and throughout the health system. Not only will recent downsizing continue, but efforts to address the issue of discrimination will be a major priority as well.

“I said to them that we certainly were committed to diversity at the hospital,” Burke said.

Echoing Tuckson’s remarks, she said the hospital’s record of hiring and promoting minorities is better than other county hospitals.

“I will venture that there are discrimination cases at other hospitals,” Burke said. “We have discrimination cases throughout this county, in every department.”

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Indeed, the county’s agreement with the federal government followed a long federal investigation of discrimination at both King/Drew and County-USC Medical Center.

Burke conceded that more needs to be done, especially in attracting more Latinos to King/Drew, a hospital that increasingly serves more Latinos than blacks. “There are not that many Latinos,” she said.

“If there are more Latinos interested in coming there, we should actively try to recruit them,” Burke added. “But I think it is going to have to be countywide. If you are going to look at this issue and say there needs to be diversity, then there needs to be diversity everywhere.”

Burke said there is concern among black doctors and staffers who have built up King/Drew, a hospital established in the aftermath of the Watts riots of the 1960s, that it might be sacrificed in the name of diversity.

“If [someone doesn’t] have the qualifications and reputation, even if they are African American, they should go,” she said. “But you shouldn’t eliminate someone because they are black because of concerns that there are too many blacks there, if they have the qualifications.”

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The discussion of these issues underscores the tension that exists at the hospital and at Drew, the only African American medical school west of the Mississippi.

Against this backdrop, Supervisor Zev Yaroslavsky praises Finucane for stepping into a sensitive issue and wanting to move forward.

“This represents a new and aggressive way of dealing with health department problems,” Yaroslavsky said. “It is new because we are dealing with our problems instead of sweeping them under the rug. . . . In the long run it will be good for our clients, for our employees, for the hospitals and the health system.”