Health Official Rebuffs Proposal for an Overhaul

California’s top health official on Thursday defended the state’s ability to respond to bioterrorism and disease and criticized a government watchdog agency’s charge that the public health system is too disorganized to adequately protect lives.

Diana M. Bonta, director of the state Department of Health Services, rejected most suggestions in a report from the Little Hoover Commission as being reactive. Among other things, the report contains proposals to create a post of California surgeon general and to carve a new Department of Public Health from existing government agencies.

Bonta also scoffed at the independent commission’s suggestion that her department deals inadequately with hospital-acquired infections that kill about 8,000 Californians a year. Two part-time Department of Health Services employees work on infection control in more than 3,000 hospitals, clinics and nursing homes.

“Hospitals have their own infectious disease staff,” Bonta said. “Should we have enough staff to be in every hospital to check if they’re doing infection control? That would not be a good use of resources.”

The report missed the mark, Bonta said. “I was disappointed that they’re talking about a surgeon general.... The Little Hoover Commission report hearkens to ideas and concepts that were put on the table 30 years ago. They didn’t work then, they don’t work now.”

The Little Hoover Commission studied the state’s preparedness for a terrorism attack after Sept. 11, 2001, and found California’s public health system to be the weakest link.

The commission found the state’s system for tracking and controlling disease too deteriorated and decentralized to defend Californians against outbreaks of diseases such as the flu, let alone a deliberate attack using anthrax or smallpox. It called for a return to the more professional and less political structure California abandoned in 1970, with a physician as the state’s top health officer, a separate Department of Public Health and a Board of Health that deliberates in public.

The report concluded that Bonta’s department is overwhelmed by the job of insuring 5 million Californians with Medi-Cal, the focus of 90% of its budget. It found that state authorities learn of only 20% of the diseases that doctors and nurses are required to report, in part because the reporting system is not fully computerized. Fixes could be made quickly and without additional costs simply by consolidating the assorted public health branches of state government, the report says.

“These challenges would be formidable in good economic times, but with discipline they are possible even now,” Michael E. Alpert, chairman of the Little Hoover Commission, wrote in presenting the report to legislative leaders and Gov. Gray Davis. “These organizational changes can be made by better using existing personnel and other resources. Many of the specific initiatives can be paid for with federal funds coming to California to improve homeland defense.”

Bonta said she saw no need to overhaul the bureaucratic structure. California’s public health system is recognized nationwide, she said, and works well.

As evidence, Bonta cited the state’s handling of SARS, severe acute respiratory syndrome, which has infected 37 people in California -- all but four of them travelers to Asia -- and killed 111 people worldwide. She sent a letter to U.S. Department of Transportation Secretary Norman Y. Mineta on Thursday, asking him to formalize a way to screen airline passengers for SARS before they board flights in Asia bound for the U.S.

“It’s showing that we’re doing the kinds of things necessary to protect the public,” Bonta said.

Along with its criticisms, the Little Hoover Commission praised the Department of Health Service’s work insuring poor people and educating residents about obesity, sexually transmitted diseases, diabetes and other problems.

Bonta said she felt as if the Little Hoover Commission was calling for a perfect plan to handle any situation. “It’s not reality as to what we do on an everyday basis,” she said, “and what we do on an everyday basis, I feel strongly -- strongly -- is excellent.”