Supervisors Back Split in Health Department

A majority of the Los Angeles County Board of Supervisors supports splitting the Department of Health Services in two, separating public health functions such as bioterrorism preparedness and disease control from the beleaguered county hospital system.

But some supervisors said they might wait a couple of months so health department leaders can focus on fixing lapses in patient care and management at Martin Luther King Jr./Drew Medical Center.

Four of the five county supervisors told The Times this week that they were inclined to support a breakup, first suggested by Supervisor Don Knabe in April. Only Supervisor Gloria Molina declined to comment.

The county’s chief administrative officer issued a report last week outlining the possible benefits, including a greater focus on the increasingly complex public health programs. These initiatives are as varied as immunizing children, treating sexually transmitted infections, grading restaurants and investigating the sources of disease outbreaks.

The report said that public health, whose purpose is largely to prevent illness and injury among the county’s 10 million residents, has a different mission than the hospital system, which serves as a safety net for sick, uninsured patients. If public health is successful, health costs on the other end -- in hospitals -- should be lower.

“Public health is becoming a worldwide issue and Los Angeles County should be at the cutting edge,” Supervisor Zev Yaroslavsky said. “One of the ways in which to do that is to separate” the hospital and public health missions, he said.

Supervisor Mike Antonovich was equally supportive.

“This is a step forward and will provide public health with the ability to free itself from the strangling bureaucracy of the health department that is stifling reforms and its ability to protect the public,” he said in a statement.

The health department has more than 24,000 employees and a $3.5-billion budget. Public health accounts for about $650 million of that -- or 19% -- and 4,000 of the jobs.

Public health officials fear that the cost of hospital care, particularly treating the crushing number of uninsured in Los Angeles County, is pushing the Department of Health Services to the financial brink. They say that with a projected deficit of $1.4 billion within three years, the department could be forced to slash programs across the board, even those, like theirs, that are designed to save money in the long run.

Meanwhile, none of the supervisors said they were eager to quickly enact a forthcoming recommendation by the county civil grand jury to transfer control of the public hospitals to an independent health authority.

In a draft report obtained by The Times, consultants hired by the grand jury found that the supervisors devoted limited time to the health department. “Board actions in key operational areas were found to often be reactive and lacking follow-up, resulting in recurrences of some of the same problems,” the report by the Harvey M. Rose Accountancy Corp. said.

The report cited continued medical malpractice payouts and unauthorized moonlighting by physicians as evidence that the measures taken by the board “were not aggressive enough.”

Instead, the board became caught in a dysfunctional cycle, the report said.

“Particular episodes of the problem would be publicly revealed, usually through news media coverage. The board would then react to the particular episode, ordering the Department of Health Services to take some action that would supposedly prevent further episodes of the problem. However, these actions were never successful.”

The draft report also cited the county bureaucracy for delays in hiring and purchasing necessary equipment.

Formation of a health authority was the top recommendation of national healthcare experts consulted by The Times in December following a series on patient-care lapses and mismanagement at King/Drew.

Experts told the newspaper that the county supervisors lacked the knowledge and willpower to reform King/Drew and were incapable of running the hospital by themselves.

While some supervisors have off-and-on supported the concept of a health authority, they say creating one now would not solve the health department’s looming budget deficit.

“We need more money,” Supervisor Yvonne Brathwaite Burke said. “We can’t provide the services, we know that now. Do we simply put ourselves in a position of being bombarded by a whole new governance body and all the people they can put together on issues that we can’t really solve?”

Splitting the health department in two is easier because it could be done faster and more cheaply, officials said.

The Department of Health Services was created in 1972 by combining the health, hospitals and veterinary departments. Even if they are separated, Chief Administrative Officer David Janssen told the board, the programs should continue to work together.

Outside experts agreed.

“In an ideal setting, [the two programs] best perform when they’re integrated together and are working together,” said Linda Rosenstock, dean of the UCLA School of Public Health. “But the reality is that the healthcare side dominates the financial picture and dominates all the attention and all the visibility.”

Dr. Thomas Garthwaite, director of the health services department since 2002, said the hospitals and public health programs recently have been trying to collaborate more, so he has mixed feelings about the proposal. He acknowledged that public health officials are fearful of wholesale cost-cutting in the department.

But “I think we cut them only modestly during my tenure here and tried to protect them,” he said.

Public health staff have long complained about the difficulty of drawing attention -- and funding -- to their issues.

Between 2000 and 2002, for instance, public health had to return more than $10 million in state and federal grants because officials couldn’t spend the money in time. They blamed rigid personnel policies that blocked or delayed hiring new workers.

If public health were its own department, it would have a direct line to the Board of Supervisors.

“I would have a better confidence in our ability to maximize health protection with all the new fears and all the new scourges, the bioterrorism and the emerging infections,” said Dr. Jonathan Fielding, the current public health director.