Los Angeles County supervisors are poised to decide whether to go forward with a proposed overhaul of three health agencies, the latest in a series of moves to restructure county government since last year's election ushered in a new board majority.
In January, Supervisor Michael D. Antonovich proposed a merger of the Department of Health Services, which runs county hospitals and clinics; the Department of Public Health, which investigates disease outbreaks, inspects restaurants and runs substance abuse treatment and STD prevention programs; and the Department of Mental Health, which oversees treatment programs for county residents struggling with the most severe forms of mental illness.
The proposed consolidation was championed by health services Director Mitch Katz, who would probably be tapped to head the new agency. County records show that Katz had raised the possibility of integrating the three departments with the county's then-Chief Executive William T Fujioka as early as July 2014, but the proposal did not move forward until two new board members took office in December.
When the proposal appeared on a board agenda in January, it drew an outcry from mental health advocates and others who said they were blindsided and had not been given a chance to weigh in. Amid the pushback, the supervisors commissioned staff from the county chief executive's office to gather more input.
A report completed last month laid out arguments for and against the plan, but stopped short of recommending a course of action. Christina Ghaly, a former deputy director of health services who led the study for the county's Interim Chief Executive Sachi Hamai, said, "It's the position of the CEO that, really, it's the board's call."
Proponents say the consolidation could save money by streamlining contracting and administrative duties, and would lead to better care. Patients served by the county "described weeks, months, and in some cases years, of being referred from place to place … of having to fill out an overwhelming amount of paperwork, of having appointments canceled without notice, of having their information not available when they went to the next site of care," the report said.
The initiative garnered support from unions representing county health workers and among county doctors and psychiatrists.
"A significant portion of the people we see have some combination of physical, mental, and substance abuse issues," said a petition signed by doctors from the three health departments, urging the supervisors to go forward with the move. "Today, the County's disjointed health system makes it difficult to address those needs in a comprehensive fashion. We would prefer to work together to care for County residents within a single, integrated agency."
But many mental health advocates and substance abuse treatment providers fear that those programs will take a back seat to providing care to hospital patients and that the public health and mental health directors will have reduced access to the Board of Supervisors to advocate for their needs. The departments would retain separate budgets and have their own directors under the proposed consolidation, but they would report to a single agency head.
A coalition of organizations opposed to the creation of a new health agency wrote that it "would give the director of that agency line authority over the directors of the Departments of Mental Health and Public Health, muting those departments' current autonomy and voice, and therefore the voices of their clients, family members and other stakeholders."
Retired longtime county public health Director Jonathan Fielding agreed. Public health was spun off into its own department in 2006, but had previously been merged with health services. Fielding said that under that arrangement, public health officials faced lengthy delays in getting authorization to hire staff, sign contracts and apply for grant funds.
"When you're a small part of a much larger department that has clinical responsibilities as their primary mission, it's very hard to get public health the kind of support that it needs and deserves," Fielding said. "There were several times I was very close to quitting during that time, because I was so frustrated."
Ghaly said that the mental health and public health directors should still have "regular and direct communications with the supervisors" under the new proposed agency.
"It's not the same as the merged model that people had negative experiences with," she said.
But advocates want the county to scrap the plan to consolidate the three health agencies into one and instead create an Office of Healthcare Enhancement, similar to an office that was recently created to help coordinate child welfare efforts by different county agencies, to help the three departments work more closely together. And members of the county Public Health Commission proposed appointing an independent third party to help the three departments find ways to further work together without merging.
The board is set to discuss the proposal Tuesday.