County Health Revamp Urged By Top Official
By LAURENCE DARMIENTO
Staff Reporter
The new head of the financially troubled county health department this week will outline to the Board of Supervisors plans to overhaul the county hospital network in a move that eventually could save hundreds of millions of dollars.
The changes include the possibility of layoffs and the politically sensitive issue of converting one or more of the hospitals into large-scale outpatient clinics.
“We are on the top of a luge track,” Dr. Thomas Garthwaite said in an interview previewing his presentation before the supervisors. “It will be very rapid, almost too rapid.”
Much of the overhaul needs to be set in motion by June in order to be implemented by the fall. The county is under the gun to reduce a projected $688 million deficit that largely stems from a steady decrease in a $1 billion federal bailout. The department’s $2.6 billion budget is projected to run a $364 million deficit in the fiscal year starting July 1, 2003. That will rise to $688 million the following year when the bailout expires.
Garthwaite, who made his reputation as an administrator cutting in-patient beds while increasing outpatient care at the Veterans Administration, said a similar move by the county would help close the deficit while minimizing reductions in care and possibly improving it.
“There’s a fixation on hospitals and hospital beds. It’s a big step to bring people in overnight,” said Garthwaite. “It’s not about retrenching services, but delivering healthcare in a different manner. In part, services may be restricted because we are tied to an in-patient model of care.”
Medical advances
Garthwaite cited new procedures, drugs and technologies that have minimized or eliminated the need for hospital stays. He noted advances in removing cataracts, which formerly required a hospital stay but is now an outpatient procedure.
“Let’s say we don’t need five fully functional inpatient hospitals,” he said. “But I can’t see any reason why we would not want more efficient and effective quality outpatient services.”
The county currently operates five acute care hospitals, including four teaching hospitals, as well as a rehabilitation hospital. Garthwaite was not specific about the hospital he might have in mind for the out-patient conversion, saying that any such decision would have to come after broad discussions with labor unions, community health advocates and other stakeholders.
Garthwaite also said that the county must determine whether high-end medical services are being offered largely to serve the interest of the medical schools that train students at the county’s four teaching hospitals.
With limited resources, he said, care must be driven by the needs of patients. The county must spell out what services it offers, not unlike the contract received by a commercial HMO member or a Medicare recipient.
“We need to define the benefit package, which has not been done before. Medicare does it. The VA has a technology assessment program,” he said. “There is pressure to cover all the things that training programs need.”
Garthwaite also said he is eyeing several changes that would affect the department’s personnel, including beefing up salaries in certain specialty areas. At the same time, he acknowledged that department personnel were facing potentially vast disruptions, including layoffs, unless the department is able to find new funds to cover the projected $364 million budget deficit for the fiscal year staring July 1, 2003.
Prior to Garthwaite’s arrival, the acting chief, Fred Leaf, laid out a plan that called for administrative cuts totaling less than $10 million. It also outlined more far-reaching proposals to consolidate service, expand outpatient care and even close hospitals, but no decisions were made pending the new chief’s arrival. Garthwaite replaced former department head Mark Finucane, who left last June.
The drastic move of converting hospitals to clinics would almost assuredly generate opposition. But Supervisor Zev Yaroslavsky, chairman of the board, said he welcomed Garthwaite’s proposals given the dire straits of the department’s finances.
“We hired Thomas Garthwaite because of the success he had at the VA in making the kind of changes that we need to make here,” he said. “The hospitals are the sacred cows of the health system. Nobody wants to touch them and that has to change.”
Effect on programs
Dr. Thomas Rosenthal, vice provost of the UCLA School of Medicine, said any closure or mass conversion of UCLA’s teaching hospitals Harbor-UCLA Medical Center and Olive View-UCLA Medical Center would obviously affect the programs there.
“There is no doubt about that. That is one of the things that calls forth our support to the county in minimizing these things,” Rosenthal said.
Garthwaite said that if layoffs are required, they could come as soon as October. The department has 22,000 employees and Local 660 of the Service Employees International Union represents 19,000 of them.
Bart Diener, a spokesman for the local, said the union is prepared to be flexible when it comes to restructuring the department, such as changes that will result offering more outpatient care while reducing hospital beds.
“We have known for some time that this is a system that must change and that is why we fought so hard to secure funding to retrain health care workers. We have nurses who are trained in in-patient settings and need to be trained for outpatient settings,” he said.
However, he said, the union will resist hasty layoffs aimed at downsizing a system that serves the largest single population of uninsured in the country, estimated at more than 3 million people.
He said that a political solution to the crisis must be found at all levels of government contributing more money to the department, including the county. Diener charged that the county’s general fund contribution to the department has declined over the last 20 years even as the system has taken on more patients.
