Forgoing a national search for a new health director, Los Angeles County supervisors Tuesday turned to one of the county’s own to head a public health system still struggling with budget problems and the effort to turn around the notorious Martin Luther King Jr./Drew Medical Center.
Dr. Bruce A. Chernof, a 43-year-old internist who has been interim health director since December, will succeed Dr. Thomas Garthwaite in what is considered one of the most difficult jobs in local government.
“I think all of us on the board have been impressed with him,” said Supervisor Gloria Molina, whose tongue-lashings of county department heads in her 15 years on the board have become the stuff of county legend.
“He knows our system; he understands the system,” Molina said. “And I’d rather have someone who I’ve seen doing the work than some big name from somewhere.”
Chernof, a reserved man who grew up in Los Angeles and spent his early career at a county hospital in the San Fernando Valley, said he was excited to lead the second-largest public health system in the nation.
“I really love this system,” Chernof said, citing its mission to serve the community’s neediest patients. “It’s a challenge,” he said. “But it’s worth it.”
He has his work cut out for him.
Though the $3.7-billion system of public hospitals and clinics has made progress since it nearly bankrupted the county a decade ago, the county is still staggering under the burden of rising costs and the responsibility of caring for a massive uninsured population.
Last year, Los Angeles County served nearly 700,000 patients, two-thirds of whom had no insurance, including many who are illegal immigrants.
The costs of caring for the uninsured are fueling deficits that county officials earlier this year predicted could top $1 billion by 2008.
Chernof revised that projection last month, predicting that the shortfalls could be half that amount if voters approve a new tobacco tax in November and if the federal government increases funding for the state’s Medi-Cal program.
But the added money will not solve the system’s long-term problems. And adding to the uncertainty, the Bush administration is contemplating further cuts in Medicaid reimbursements next year, which county officials estimate could cost the health system another $200 million.
In addition, the county continues to struggle to contain costs and improve King/Drew, where lapses in care have left patients dead and disfigured and have led to decertification of some services at the public hospital in Willowbrook, just south of Watts.
Chernof has had a front-row view of the county’s challenges since he became senior medical director in 2004.
But unlike Garthwaite, who came to Los Angeles County in 2002 after helping to turn around the troubled $20-billion federal Veterans Affairs health system, Chernof has never headed a health system.
Before rejoining the county two years ago, the UCLA School of Medicine graduate spent seven years as a regional medical director for Health Net, one of the nation’s largest managed healthcare companies.
Chernof has also worked in the VA system and in the mid-1990s was an administrator at Olive View-UCLA Medical Center in Sylmar, one of the county’s public hospitals.
Garthwaite praised his former deputy as smart and dedicated to public health.
And Chernof got a ringing endorsement from Jim Lott, vice president of the Hospital Assn. of Southern California, which has long pushed the county to reform its gargantuan health system.
“This guy is a very practical problem-solver,” Lott said. “That’s what we need right now.”
Perhaps most critically, Garthwaite said, Chernof appears to have established a good relationship with the five strong-willed supervisors, who as the county’s elected executives have ultimate authority over the health system.
Chernof’s predecessors clashed frequently with the long-serving board. In one famous case, a county health director suffered a breakdown while being grilled by supervisors.
Shortly after Garthwaite left late last year, one of the nation’s leading public health officials quipped that the county would never find a national figure crazy enough to take the job.
Soft-spoken and deferential, Chernof has avoided any major showdowns with the supervisors in his six months as interim health director.
And all five spoke glowingly of his stated commitment to impose discipline at King/Drew and continue to explore ways to keep the health system financially afloat.
But Chernof, who will earn $295,000 a year, has already gotten a taste of what reporting to a board of politicians is like.
At last week’s public board meeting, Supervisor Zev Yaroslavsky sharply demanded why Chernof had not made more progress cutting costs at King/Drew.
“I don’t think he’s been fully tested yet. But that will come,” said Yolanda Vera, a veteran of county healthcare politics who is now with the nonprofit Los Angeles Health Action. “I wish him well and hope he will really lead.”