Health Chief Will Form New Policy Board

Staff Reporter

After spending nearly all his career at the Veterans Administration, Dr. Thomas L. Garthwaite takes the helm of the Los Angeles County Department of Health Services Feb. 1. The department is facing a rapid reduction in federal aid at the same time the size of the county's massive population of indigent and uninsured patients shows no sign of shrinking.

The 54-year-old Garthwaite, who is separated with two adult children, made his mark over the last seven years helping reform the Veterans Health Administration as deputy undersecretary and lastly as an undersecretary, a Clinton political appointment. The Business Journal spoke with him by telephone shortly after he completed a Caribbean cruise.

Question: Why would you want this job, especially after prior directors failed at reforming the department?

Answer: I got into medicine to try to deliver good health care to the people who need it. What I have done at the VA is to try and improve the quality and consistency of care to a deserving population. It seemed to me after talking to people about the issues in L.A. County there are a lot of people in need of good health care delivered as efficiently and effectively as possible. It seemed like a worthy challenge.

Q: What did you do at the VA that is relevant here?

A: We decreased the cost of care per veteran treated by about 20 some percent over a five-six year period. A lot of that was moving from an in-patient setting to outpatient and extracting other efficiencies. We consolidated 50-some medical centers to 20-some integrated systems. We decreased our total employment by about 20,000 at the same time seeing 900,000 more people.

Q: You think you can achieve similar reforms here?

A: I have no idea what is possible within L.A. County and probably won't for a while yet. But I think my reading is there a significant amount of efficiency to be gained by thinking as a system instead of thinking as independent facilities.

Q: But how do you overcome what is seen as the knee jerk reaction of supervisors to protect their turf whenever that's been tried in the past?

A: What we found worked (at the VA) was to be very open with the stakeholders and to share the data. Making public policy in an open fashion is a messy business but I think it's the only way you can to do it. Ultimately you are going to have the debate in public and ultimately it's going to be the data and facts that should carry the day. I think the supervisors are interested in making changes.

Q: How might that play out?

A: I will form my own policy board so that all our policies get debated broadly. What we did in the VA, basically what I implemented, is that instead of writing policy by the experts and sending it out and expecting people to implement we had a fairly large policy board. That allowed people who had to implement it to at least have input before we finalized policy. It almost always led to a better policy being written.

Q: Who might be on such a board here?

A: I am going to think more about that, but I would think it would include executives from the large facilities, some of the important folks from the larger programs, probably some stakeholder input - meaning some employee positions, nurses, different levels of the organization.

Q: You're taking the job just as the supervisors are debating whether to radically alter the political structure of the department, perhaps through the formation of a health authority. Doesn't that concern you?

A: I will always have to answer to somebody, whether that's the county supervisors directly or a health board. In my current job it's essentially the Congress and the oversight committees in the House and Senate. In a public job you end up reporting to someone responsible for the funding of the care and the quality of the care. I am comfortable with that.

Q: For most people taking this job, it would be a step up in size. For you, it's a step down. Does that make it easier?

A: There is nothing really close to the VA. That will help a lot.

Q: This job is considered one of the most demanding in government. Are you ready?

A: I am not in a 40-hour a week job. This doesn't appear to be one either. I am separated so that probably tells you something.

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