Supervisors Bend on Health Agency

Los Angeles County supervisors Tuesday took a tentative first step toward relinquishing control of the county’s health department--a major change the board has long resisted.

The supervisors asked their chief administrative office to report next month on alternative ways to run the $2.4-billion health agency, which is responsible for providing medical care to 2.5 million uninsured county residents.

In the last six years, two separate board-appointed commissions have urged supervisors to consider giving control of the health department’s daily operations to a public authority run by medical professionals. But Tuesday’s action marked the first time that supervisors followed up on the recommendations.

“There’s been tremendous resistance to a health authority here,” said Supervisor Zev Yaroslavsky, a longtime proponent of the idea who, with Supervisor Don Knabe, proposed the latest study. But, he added, “the situation we face is so acute . . . [that] maybe the heat is enough” to force the issue.

The Department of Health Services, which nearly dragged the county into bankruptcy in 1995, faces the prospect of a $884-million deficit in four years. Supervisors have been criticized for failing to quickly rein in spending.

The county is searching for a new health director to replace one it ousted, and officials openly wonder who would want the job. Reports in The Times on problems in patient care at County-USC Medical Center have renewed calls among doctors and others to get local politicians out of the health business.

These critics say the supervisors micromanage the department and hamper reforms by looking out for health facilities in their own districts rather than taking a broader view. As a result, each of the county’s six public hospitals operates as a virtual island, without even compatible computer systems for sharing patient information.

“Supervisors tend to become advocates for those portions of the system that are in their district,” said Dr. Brian Johnston, former chairman of the board of the Los Angeles County Medical Assn. “[Gloria] Molina defends the [County-USC] Medical Center; [Yvonne Brathwaite] Burke, King/Drew [Medical Center] . . . and they compete with each other.”

Knabe was one of two supervisors openly skeptical of forming a health authority. He said he was uncertain, for example, who would be ultimately responsible for management and medical problems.

But he said the idea is still worth exploring.

“We’re in the process of selecting a new [health] director, and we’ve all made the commitment that everything has to be on the table,” he said.

Supervisor Mike Antonovich, however, blasted the idea.

“The development of a health authority would only serve to create another level of bureaucracy,” he said. Until the federal government changes how it funds health care, he continued, “all the king’s horses and all the king’s men will not be able to put the system back together again.”

Supervisors have been privately discussing restructuring the management of the health department for several weeks, but it was unclear Tuesday, before a concrete proposal had been made, how they would vote on the issue.

Several board members have already concluded that the task of running the department may be too large for one health director.

In an interview last month, Burke suggested placing responsibility for county hospitals under a public authority that would draw its money from supervisors--an arrangement similar to the one used to run University of California hospitals.

In most versions of how an authority would be created, supervisors would appoint members and retain power over the total health budget but not daily decisions.

That is similar to arrangements the board has with county departments run by other elected officials--the sheriff and district attorney.

The board asked Tuesday for a report on how health agencies are run in other large, urban areas, as well as an evaluation of the cost, logistics and legal ramifications of ceding daily control over health to a non-elected board.

“The devil is in the details,” Supervisor Molina said.

She added, however, that she supports the concept because she believes health care would be improved if it were depoliticized.

But she raised a political concern about such an action, given the vast scope of the health department’s problems. “We would look like cowards,” she said.

Still, Los Angeles political consultant Joe Cerrell said he believes that the supervisors may well be serious about ceding control.

“I think they’d be very happy,” he said. “They see the health department as a financial pain, a financial drain. They get blasted by everybody, [and] there’s very little in it for them. What do they get to do? Go to a ribbon cutting for a new ward?”