Second Top Official Quits County’s Health System

The executive director of Los Angeles County-USC Medical Center resigned Thursday, further destabilizing the mammoth, ailing county health system just a day after its top administrator quit.

Roberto Rodriguez, a New Yorker who drew the wrath of doctors and employees at the hospital because of what they called a brash style and unorthodox financial decisions, had been under investigation for allegedly making $900,000 in improvements to the Roosevelt-era medical center, according to a confidential health department report obtained by The Times.

Among the improvements to the hospital--which is slated to be abandoned in five or six years--were tens of thousands of dollars in new office furniture and carpeting, auditors wrote in August. Though Rodriguez argued that the upgrades were critical to attract paying patients, the report found $432,000 of the renovations were unauthorized and recommended that he be disciplined.

Rodriguez’s resignation came just a day after that of Mark Finucane, who had led the county’s Department of Health Services for a turbulent five years and had brought Rodriguez to Los Angeles County.

The double resignations, coupled with the forced departure of county medical director Donald Thomas last year and a number of other vacancies in the $2.4-billion health department, leaves the agency with virtually no leadership as it faces a deficit that is expected to reach $847 million by 2005.

The health system is also facing what several county employees, including Rodriguez, said was a grand jury review of its clinics, emergency services and psychiatric care. It is not a criminal probe, prosecutors say; the grand jury compiles annual reports on problems in government.

Finucane and Rodriguez will both stay until June 30.

Meanwhile, supervisors say they must cut costs immediately to deal with the looming deficits, forecast to begin in two years at $184 million and grow every year thereafter.

“With Finucane gone, with Rodriguez gone, we’re in crunch time,” said Dr. William K. Mallon, a 14-year County-USC veteran. “We need to make critical decisions about this place.”

Both Finucane and Rodriguez had rancorous relationships with the Los Angeles County Board of Supervisors. The board frequently upbraided Finucane in front of others, and, county employees say, privately complained about Rodriguez’s performance.

The likelihood of encountering such tension, along with the dire troubles facing the gigantic system of clinics and hospitals, could easily make filling the top jobs difficult, several observers said.

“It was hard for them” to find Finucane, said Mandy Johnson, executive director of the Community Clinic Assn. of Los Angeles County.

“It took them more than a year to recruit him. . . . And I don’t imagine there are people out there who have had this experience who are champing at the bit to come to L.A. to help us out of our troubles.”

Rodriguez’ resignation on top of Finucane’s, she said, was a “stunning blow.”

At the same time, however, a review of internal documents and interviews with county sources has revealed widespread discontent and concern about the hospital director’s leadership.

Rodriguez spent about $900,000 refurbishing lobbies, offices--including his own--a chapel and a bus stop at the aging hospital. At the same time, Mallon and others said, he told hospital workers that there was not enough money to recruit nurses during a critical shortage of RNs.

“It’s embarrassing,” Mallon said. “They’re renovating the chapel so families have a place to mourn their loved ones” but neglecting the emergency room where patients die, he said.

Mallon and others complained that Rodriguez’s failure to remedy the hospital’s nursing shortage has left critically ill patients waiting 24 hours for treatment in the emergency room. With a sparse nursing staff, he said, it was frequently difficult for patients to receive such key treatments as dialysis.

Mallon said he had to send one patient who was at risk of dying of kidney problems to far-smaller White Memorial Hospital for life-saving dialysis because no nurse was available at County-USC.

Rodriguez contended Thursday that he had approved every request for more nurses but never had the resources to compete with the private sector by paying signing bonuses.

He also strongly defended his decision to upgrade the facility, saying that it was so “filthy” and run-down as to be inappropriate for patient care.

“If you went into the admissions office, you would not want to be taken care of [at the hospital],” Rodriguez said. “It was ugly, dirty, torn. There was not a chapel here. There was no place to sit down in the lobby.”

Because there is sparse reimbursement for caring for the uninsured population, the county must attract private patients, Rodriguez believes, and cannot do so in an unpleasant environment.

He renovated a bus stop, he said, because it was little more than “loose sheet metal on rotted posts that was ugly and a safety issue.”

Still, county investigators recommended that Rodriguez be sanctioned for undertaking some of the repairs without permission from the Board of Supervisors, according to the report.

Hospital employees say Rodriguez was forced from a previous hospital management job.

Rodriguez, whose family still lives in New York even though he has worked in Los Angeles for more than two years, acknowledges that he left Lincoln Memorial and Mental Health Center in the Bronx at the behest of his superiors, but said the change had more to do with politics than competence.

“I was appointed by a Democrat” who was loyal to then-Mayor David Dinkins, Rodriguez said. He was asked to leave, he said, several years into the Republican administration of Mayor Rudolph Giuliani, to make room for a Republican.

At least one supervisor Thursday said he felt a new administration might bring a fresh approach to the health agency’s many problems.

“Anybody who’s been around this county for any length of time knows that there has been a certain amount of inertia at play here,” said Supervisor Zev Yaroslavsky, who has been frustrated with the pace of reform under Finucane and his team.

“Both in the [health] department and at the political level, there has been a reticence to make difficult decisions that set upon a new course,” he added.

“But I think that most of the Board of Supervisors have come to the conclusion that the time has come to strap ourselves in and begin to make those difficult decisions.”

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