County Begins Splitting Up Health Agency

Los Angeles County supervisors voted Tuesday to shelter the county’s public health agency from a possible financial meltdown and clashed over the pace of reform at Martin Luther King Jr./Drew Medical Center.

Supervisors unanimously approved the concept of separating public health functions such as bioterrorism prevention and disease control from the Department of Health Services, which also operates the county’s hospital system.

County officials had expressed fear that the health department’s looming financial deficit could force cuts in public health services unless the two were split.

Under the weight of providing hospital care for the county’s indigent, the health department is expected to plunge into the red by nearly $1 billion in three years.

By separating public health and hospitals, supervisors hope to help protect the public health budget from the hospitals’ problems.

“Our public health concerns cannot be put on the back burner,” Supervisor Don Knabe said in urging colleagues to support his proposal.

Earlier this week, the county grand jury also called on the board to separate public health from hospital services.

Grand jurors said in a lengthy report that the mission of public health -- to prevent illness and injury among the county’s 10 million residents -- is very different from the hospital system’s purpose of caring for the uninsured.

Dr. Jonathan Fielding, the director of public health, said he was optimistic that the split could be finished by October.

He said the agency would benefit from being cut loose from a department whose primary focus was county hospitals.

“I think we’re going to be able to be more nimble,” he said. “It’s going to help us in our efforts to be more responsive to public health emergencies.”

Though in agreement on the future of public health, supervisors squabbled Tuesday over the county’s efforts to fix medical errors at King/Drew in the wake of a recent review by federal inspectors that cited more mistakes.

Supervisor Mike Antonovich accused the county’s outside consulting firm of operating with a “seat-of-the-pants” attitude in the seven months it has managed the hospital.

“It’s like we’re in quicksand, and the harder that King/Drew struggles, the deeper it sinks,” he said.

His criticism drew a sharp rebuke from Supervisor Zev Yaroslavsky, who said it was unfair to place so much blame on consultants Navigant Inc. for the hospital’s ongoing medical problems.

“They’ve only been here seven months. You’ve been here 25 years. I’ve been here 10 years. Let’s take responsibility and put it right where it lies,” Yaroslavsky said. “Here.”

Over the last several months, Antonovich and Supervisor Gloria Molina have used the board’s weekly meetings to chastise county health officials and Navigant over the pace of reform.

Antonovich said the exchanges were critical to holding officials accountable.

But Supervisor Yvonne Brathwaite Burke questioned whether such actions would deter people from applying for the hospital’s top management jobs, which are vacant.

“I find it very difficult to urge people to take a position if they’re going to come before this board and ... be subject to the kind of public reprisals that they receive weekly ...,” Burke said.

The county has received seven applications for the hospital’s position of chief executive officer. Dr. Thomas Garthwaite, the county’s director of health services, said he had hoped to receive 10 to 15.