Help wanted, desperately

THE LOS ANGELES COUNTY Board of Supervisors is engaged in a familiar hunt for a new director of the county’s public health and hospital system. Dr. Thomas Garthwaite, who resigned to take a private hospital job on the East Coast, threw in the towel last week after nearly four years. He had a rough ride, including a court’s rejection of his budget-cutting plans and a political uproar over his attempts to fix deep dysfunction at the county’s King/Drew hospital complex in Willowbrook.

Garthwaite ran a vital system of public medical care that is always on the edge of scandal, bankruptcy or both. It is plagued by the loss of paying patients, burdened with job rules that strangle efficiency and governed by politicians who must find someone else to blame when things go wrong.

The want ad for the next director might read: Must be willing to take personal abuse from elected officials and community activists. Must promise with a straight face to fix problems that stem from the unfixable, including civil service regulations and union contracts. Must cobble together funding from unreliable government sources or face draconian cuts. Will pay well for a public job, but no comparison to what a healthcare industry CEO could make.

That will take one dedicated public servant.

In an ideal world, there would be better ways to care for uninsured patients, many of them illegal immigrants. Universal healthcare, the holy grail of health-policy wonks, would eliminate the need for a separate county-run system over time. If the restrictions of Proposition 13 were eased, the county would be able to raise and keep its own money, as the better-run and better-funded New York public healthcare system does. If county supervisors were willing to cede control over billions of dollars a year, an independent health authority could insulate the department from direct politics and, according to independent studies, diminish or revise the rigid rules that govern employment and staffing.

Unfortunately, none of this is likely to happen, despite a brief revival of proposals for a health authority after The Times’ exhaustive series on King/Drew last year. Additionally, as Times staff writers Jeffrey Rabin and Rong-Gong Lin reported last week, the funding from federal and state bailouts runs out with the next county budget, and the public health system will, without new funds or deep cuts, slide into a near billion-dollar deficit in three years.

The renewed budget crisis could at least force the county to reassess how it provides care. It could provide some leverage to ease union rules and force a harder look at bloated staff levels. Supervisors are already considering cutting the public health system in two -- one agency for healthcare delivery and one for all the rest, including things such as restaurant inspections. This would provide better control over how the healthcare budget is spent and allow the next director to focus on hospitals and clinics.

There is at least a hint of opportunity in the changes ahead. Settling back into business as usual is not an acceptable option.