Durand-Durand: Health Chief Seen as Savior, Dictator

To admirers, Pierre Durand is the cultured, disciplined savior of a county health system that nearly died. But the county’s health chief has nearly as many enemies, and they portray him as a ruthless numbers cruncher who hurts the system as much as he helps it.

His staunchest supporters agree he can be remote and hard to please, but they insist these traits hide a man who has a heart for the needy.

He is tough enough to fire 200 employees, but caring enough to rescue a public hospital and clinic system that serves the poor and uninsured, they say.

He is a bureaucrat who thrives on the controversies that have shadowed his steps since he took control of the county hospital 12 years ago.

He has created a health-maintenance organization system that competes with private hospitals to provide care for county workers, and he has built a controversial clinic system that pulls pregnant women--the moneymakers of poverty medicine--from every part of the county for delivery at the public hospital in Ventura.

And over the past year he has been a central figure in a controversy over mental-health services that has split the county Board of Supervisors, prompted state and federal audits and forced the departure of the county’s top mental health officials.

Durand will remain in the spotlight this week, with the state Department of Mental Health preparing to release the results of its two-month look into finances and programs at the mental-health agency under his control.

The Thousand Oaks resident, who makes $136,000 a year, is the first to say he likes the fight.

He tells friends and supporters the battles are worth it because his goal is to fix an unwieldy system that can only run well if he finds ways to pinch pennies and stretch dollars.

“This is real life,” Durand said in a 1994 interview. “We have to bathe the homeless. We have to deal with the mentally ill. We could be bureaucrats and go with what we have, but we drive the system and our product is more access for the poor.”

But critics say he is unnecessarily severe, a cold leader who manages by fear. And those traits have contributed to a costly hospital war and are driving talented employees out the door, they say.

Durand refuses to give up much about himself. He declined to be interviewed for this story, preferring instead to stand on what he sees as a record of accomplishment. To document that record, he provided The Times with newspaper and magazine clippings that praise his health-care system as innovative and cost-efficient.

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The essential Durand, however, is revealed in the details: Colleagues say he routinely sets his watch 10 minutes fast so subordinates will be late to his meetings. He can be sarcastic and dismissive with employees, reserving a cultured charm for superiors.

Yet the same man interrupts tours of the county hospital to talk to patients in Spanish. And he is a devoted father who speaks lavishly of his two sons, especially his oldest, Pierre Durand Jr., who is an orthopedic surgeon.

Supervisor Judy Mikels, a strong supporter, said the health-care chief is misunderstood.

“There are people who disagree with his style,” Mikels said. “But the bottom line is he has done his job. He has increased access to health care for people in the county and he has done it without increasing the taxpayer’s contribution. And he has done it in a manner that shows respect and compassion for patients.”

Fled Peru to Escape Political Unrest

Durand, 52, was born in Peru to a father of French ancestry and an Indian and Spanish mother. Peru was plagued by Third World poverty and unrest among the government, church and military establishments.

Durand has told colleagues his family was well off, holding tracts of land. But government officials forced his parents to give up some property and a teen-age Pierre fled to the United States to escape political troubles.

He worked menial jobs to get through college, eventually earning a doctorate in public administration from the University of LaVerne.

His ascent to one of county government’s top jobs began in 1974, when he was hired as an accountant in the auditor-controller’s office. Former Auditor-Controller Norm Hawkes recalls his new hire as a fiscal wizard, with a particular talent for setting up bond programs.

Hard-working and ambitious, Durand rose through the ranks to become chief deputy auditor by the mid-80s. His financial expertise and reputation for precision prompted his transfer to the Ventura County Medical Center in October 1986. Audits had revealed the county hospital was then $38 million in debt. County officials were ready to throw up their hands, threatening to shut down the clinics, Supervisor John K. Flynn said.

“When we got into trouble, my first reaction was ‘Get Pierre Durand,’ ” Flynn said. “He is a no-nonsense person. He has a reputation for getting systems in order. And he knew Medi-Cal billing.”

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Hospital billings then were still done manually, causing such a backlog that the county had to write off $10 million in uncollectable accounts. Some patients were never billed at all. Durand installed a computerized system that got the accounts under control.

He was joined a year later by Phillipp K. Wessels, who was hired as Health Care Agency director. Wessels came from the private sector and was credited with turning around the deficit-ridden Scenic General Hospital in Modesto.

Together, they devised a plan for slashing operating expenses, including laying off 200 of the hospital’s 1,200 employees. They also copied what had worked so well in Modesto: Instead of closing neighborhood clinics, they began expanding them, adding new doctors and extending hours into evenings and at lunch.

The clinics were far removed from the old model of public care. Durand’s clinics were converted into semi-private providers, operated by private physicians. The doctors held contracts with the county, but hired their own staff members, billed patients themselves and controlled costs.

They could not turn anyone out the door, but in return the doctors reaped economic incentives. If they reduced red ink, they would keep part of the savings.

Easy access to clinics made it convenient for poor residents to get health care, cutting down on the county’s costly emergency room care. Setting up clinics in poor neighborhoods also increased the county’s Medi-Cal and Medicare billings, bringing more money to the hospital’s treasury.

Decrepit Conditions at Clinics Recalled

The change was dramatic. Clinics that had been losing money began posting profits and tripled patient loads. The clinics recorded about 300,000 patient visits last year. Before Durand’s reforms, the county’s subsidy to the public hospital was $10 million annually. Today it is $5.6 million.

Health care that was once delivered in dreary offices by burnt-out staff members is now available from top doctors in modern, clean offices. Flynn recalls the decrepit condition of county health facilities before Durand took over.

“One clinic in the Colonia didn’t even have a sink for the nurses to wash their hands,” Flynn said. “Pierre fixed them. He fixed everything. He is responsible for what we have today.”

But along the way, Durand has made plenty of enemies. Beneath a veneer of cultured sophistication, detractors say, lies a cold and ruthless competitor. Durand is obsessed with winning at any cost, they say.

His refusal to back down from a fight can be blamed, in part, for the public hospital’s costly simmering feud with neighboring, private Community Memorial Hospital, some say.

That battle began, in part, because Community Memorial’s administrator, Michael Bakst, saw Durand’s clinic expansion as unfair government competition for his hospital’s privately insured patients. When the county announced plans to spend $51 million to build a new outpatient wing of the public hospital, Bakst swung into action.

Community Memorial, situated two blocks from the Ventura County Medical Center, mounted a $1.6-million campaign to defeat the expansion at the ballot box in 1996. An infuriated Durand did not give up. A few months later, Durand submitted a scaled-down proposal to the Board of Supervisors, who initially approved it. But the board rescinded its vote after Community Memorial threatened a lawsuit.

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A committee of physicians meeting at the time concluded that any attempt to bring about compromise was being thwarted by personal enmity between Bakst and Durand.

“The hospitals were fighting each other for no apparent reason we could see except that both hospitals had very strong leadership that was paranoid,” said Jack Broms, a retired Ventura surgeon. “They were thinking that the other one was going to get them all the time.”

Durand was also criticized for opening clinics in areas already served by health facilities offering care to low-income residents. Roberto S. Juarez, who operates four nonprofit clinics in Ventura County, cried foul in 1994 when Durand threatened to open a county clinic in Fillmore. Juarez accused Durand of setting up an “empire” that would funnel Fillmore’s Medi-Cal patients to the county hospital.

The clinic eventually opened in nearby Piru, draining patients not only from Juarez’s clinics but also from Santa Paula Memorial Hospital. Bill Greene, administrator of Santa Paula’s community hospital, agreed the county system has eaten into the Medi-Cal market in Santa Paula, Fillmore and Piru.

Durand’s Critics Within Government

But Greene said he does not fault Durand for putting the county in a competitive position.

“I’d rather they not be there,” Greene said. “But the county’s clinics system is a model for other counties and it has been quite successful.”

Supporters say the counterpoint to Durand’s steely resolve is his compassion, a side he does not show often in public. Dr. Mark Sussman, chief anesthesiologist at Ventura County Medical Center, recalls sitting with Durand over a cocktail at a medical seminar to talk about providing good health care for the poor.

“He tells you it’s his mission. He grew up in Peru and saw indigents being abused and he wants things to work better here,” Sussman said. “It’s real and it’s inspiring.”

Durand’s fiercest critics come from inside county government. Virtually everyone agrees he is an exceptional fiscal manager. But many county employees say he has become harsh and dictatorial since being named director of the Health Care Agency in 1995.

As head of the umbrella agency, he oversees a $201-million budget and 1,500 employees in the county’s public hospital, mental health department, public health offices and drug and alcohol programs.

Almost immediately after he was appointed, he began to clash with mental health Director Randall Feltman. Feltman had respect and clout for his role in building a system of mental-health services that is copied across the state.

Feltman believed Durand was trying to micromanage his department and refused to back down. Within months, Feltman was moved out of the Health Care Agency to work on welfare reform under Chief Administrative Officer Lin Koester.

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Durand named Stephen G. Kaplan as Feltman’s successor and director of a newly created Behavioral Health Department, which combined mental health and drug and alcohol services. But almost immediately Kaplan too butted heads with Durand.

Critics say Durand wanted to be hands-on in every department and was pitting managers against each other in a bid for control. With the blessing of Koester and Auditor-Controller Thomas Mahon, critics say, Durand was also transferring money from the mental health department’s budget to keep the county hospital afloat.

U.S. Audit of County’s Billing Practices

Kaplan’s solution was to propose that the Behavioral Health Department be separated from the health department as an independent agency. When that was rejected, Kaplan and social services Director Barbara Fitzgerald proposed merging their units to form a much larger Human Services Agency.

A majority of the Board of Supervisors initially agreed, voting in April 1998 to combine the departments. Within nine months they rescinded their vote after federal officials said the new structure violated Medicare billing rules and could cost the county millions of dollars in lost reimbursements. A federal audit is underway to look into the county’s billing practices.

With the mental-health agency back under his supervision, Durand moved quickly to bring Kaplan to account and reassert his control. Within a month, Durand had placed Kaplan on a 30-day leave of absence. Kaplan’s two top deputies took stress leaves and medical director John Wong was reassigned. Durand began installing hand-picked successors.

When an article detailing Kaplan’s departure appeared in a newspaper, Durand ordered a secretary to fax copies to all supervisors in the Behavioral Health Department. Many employees interpreted that as intimidation, suggesting their jobs were also in jeopardy.

“I have never seen so much fear running through a department as there is right now,” said John Chaudier, chairman of the county’s Mental Health Board. “From psychologists to clinicians to social workers. It’s across the board.”

Supervisor Frank Schillo defends Durand’s actions. Kaplan, who later resigned, knew full well the potential consequences if the merger did not succeed, Schillo said.

“Pierre doesn’t put up with insubordination,” Schillo said. “Kaplan screwed up. He planned and plotted a merger that obviously he never thought through.”

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Employees who complain are simply not willing to work as hard as Durand demands, Schillo said. Durand respects those who do a good job and those who don’t, “he lets them know it,” Schillo said.

Controversy is expected to again swirl this week as state auditors release a report on finances and programs in the Behavioral Health Department. State Sen. Cathie Wright (R-Simi Valley) requested the audit after Durand began restructuring the mental-health agency.

Wright alleged the turf battle, coupled with earlier transfers of money out of the mental-health agency, was disrupting Ventura County’s ability to deliver high-quality mental-health services. Durand and Koester have strongly denied those accusations.

At stake is $5.3 million in special funding the county receives each year to operate special mental-health programs that serve as a model for other counties. Whatever the findings, supporters say, Durand is sure to respond with precision and the support of his bosses.

Durand’s name is sometimes mentioned as a potential candidate to succeed Koester, who is retiring in December. But while three of the five county supervisors praise his economic skills, that will not very likely translate into support for the top county job, county insiders say.

Durand does not have the personal and political skills to smooth over the diverse opinions of a philosophically split board, they say. Meanwhile, Durand privately has told colleagues he intends to retire in three years.

Until then the disciplined Democrat, who plays soccer on weekends to stay fit, will keep fighting battles as they come and stay true to his beliefs, supporters say.

“He could relax a little bit, but that’s just not Pierre,” Flynn said. “His responsibility is health care and not much gets in the way of that.”