At a time when private healthcare is increasingly connected and holistic, critics complain that Los Angeles County’s sprawling public health system is neither.
A patient who arrives at a county hospital emergency room with a broken arm faces a bureaucratic maze. If he needs follow-up physical and mental health service, as well as substance abuse counseling through the county system, he might have to fill out different sets of forms at three different clinics. And his health professionals in one department won’t have access to health records maintained by the other departments.
On Tuesday, the Los Angeles County Board of Supervisors took a significant step to change that. The board approved a sweeping reorganization of its $8-billion health system, combining three separate departments into one super agency with a mandate to cut red tape, boost efficiencies and improve the quality of the healthcare it provides.
The move will have far-reaching implications for the hundreds of thousands of people who receive healthcare services from the county.
The consolidation has sparked concerns in some quarters about whether such a massive bureaucracy will work and whether certain specialized services — or broader programs dealing with issues such as environmental health — will suffer from neglect. They noted that all three departments were once unified, but then separated in reforms intended to ensure that the county’s huge system of hospitals and medical clinics didn’t pull too much money and attention from other health programs.
But board members said Tuesday that it was time to try a more connected system.
The goal is “better patient care, better outcomes for communities,” Supervisor Mark Ridley-Thomas said. “The systems will talk to each other effectively. That hasn’t been the case.”
The new health agency will be given the task of addressing an expansive range of issues, some of which fall outside the traditional healthcare realm. The priorities approved by the supervisors include connecting homeless patients to housing programs, improving health services for foster children and youths in the juvenile probation system and reducing overcrowding in psychiatric emergency departments at county hospitals.
The board has already assigned the Department of Health Services a major new responsibility: managing the diversion of mentally ill inmates from county jails and into treatment programs.
The Department of Health Services currently runs the county’s four hospitals and 19 health centers, serving about 670,000 patients a year, while the mental health department provides treatment to 250,000 people a year in clinics, board and care facilities, juvenile halls and camps, and other facilities. Public health is responsible for a wide range of programs, including substance abuse treatment, HIV prevention programs, inspecting restaurants and nursing homes, and investigating disease outbreaks.
Some critics say that the new agency is taking on too much and won’t be able to effectively manage the vast range of programs.
Mitch Katz, the director of the Department of Health Services, who is likely to be chosen to run the new merged agency, said the adopted structure will prove more efficient, as well as being better able to bring in money through grants and other sources.
“It’s always my belief that by working together, things cost less, not more,” he said. “We haven’t taken on any responsibilities that the county doesn’t already have…. It’s my hope that we have not taken on anything that is greater than our ability to handle.”
The three departments will maintain their own budgets and directors under the larger umbrella organization. The supervisors voted unanimously Tuesday to formalize the new structure, which had been tentatively approved in August.
Earlier board hearings on the proposal were packed with supporters — including unions representing county doctors — and opponents. Tuesday’s vote was largely seen as a foregone conclusion and only a handful of audience members commented on either side. Several came to voice support for Katz. Others called for checks on his power, if he is chosen to lead the new agency.
One source of criticism has been the possibility that Katz would continue to directly manage the county’s system of hospitals and clinics and be the chief executive of the new, larger health agency.
Under the framework approved Tuesday, the agency director would be responsible for evaluating the performance of the three departments’ directors and would conduct “strategic review” of their budgets, although the supervisors would have the final say.
“The mental health and public health communities would be immensely concerned about the prospect of the [Department of Health Services] director also leading the health agency and technically reporting to himself with regard to the health department,” said Bruce Saltzer, executive director of the Assn. of Community Human Service Agencies, part of a coalition that pushed back against the consolidation.
Saltzer said such an agency chief, wearing multiple hats, shouldn’t be simultaneously “reviewing the budget of the other two departments, influencing the organizational structure, overseeing a very broad scope of operations and evaluating the performance of the department heads.”
The board did not name a director of the new agency Tuesday or decide whether that person could also head of one of the three branches within the organization. The county is recruiting candidates for its top mental and public health positions.
Having settled the question of the agency’s structure, several board members said they hope to quickly fill those management posts, which will be key to making the new mega-entity perform as hoped.
The organizational uncertainty had delayed the appointments, Supervisor Don Knabe said.
“You don’t want to bring someone new into a situation where they don’t know what they’re getting into,” he said.
Former public health Director Jonathan Fielding said continuity of leadership is important to the operations of his former agency.
“These times of uncertainty always can lead to morale issues and concern about the future, and that can detract from the job a little bit,” he said.