Health Authority Could Best Address Hospitals

#5 HEALTH CARE

Sacred cows are almost always costly, especially when they exist as part of a multibillion dollar business.

That’s certainly been true at the Los Angeles County Department of Health Services, with its array of protected programs that long have stood in the way of reform despite the department’s repeated fiscal near-collapse.

Over the past decade, restructuring initiatives have been only partially successful, as labor, community advocates and other interest groups have fought to largely maintain the status quo. That has been especially evident with the nightmarish reports of patient deaths and drug administration errors at Martin Luther King/Drew Medical Center despite years of red flags about the quality of care and administration of the facility. This health center, largely run by and serving African Americans, had become a “third rail” of local politics that no supervisor dared touched lest he or she be branded a racist. Now, the hospital’s festering problems threaten its closure.

The good news is that it doesn’t have to be this way.

Creation of a separate governing body for the department in the form of a health authority would go a long way toward solving many of these problems.

A health authority, unlike other structural alternatives, would still allow supervisors a vested political and monetary interest in the system, but place day-to-day operations in the hands of an expert body properly insulated from the intensity of local politics.

It is not the ultimate solution. The department, with its 25,000 employees and $3 billion annual budget, would still be under-funded in a county where over a third of the population is uninsured, making the county health system one of the primary sources of care for 2.5 million residents.

And it wouldn’t be politically easy, since the establishment of such a health authority requires enabling legislation at the state level, where much compromise would be needed to get any bill to the governor’s desk. Labor leaders, as well as some supervisors, could be expected to oppose it.

However, a properly organized authority would give the department something it has long needed: a governing body well schooled in the complexities of health care, with enough independence to carry out needed reforms.

Throughout the nation, local health departments are administered in various ways, including a health commission in San Francisco, a public benefit corporation in New York and autonomous health districts as close as the Antelope Valley.

Establishing a Los Angeles County health district makes little sense since its board would be elected by popular vote just as current supervisors are. A commission could easily be created through the vote of supervisors, but would offer few advantages since the board is likely to retain control of the appointments, giving the new body little political authority and simply creating another layer of administrative bureaucracy.

The idea of a health authority, on the other hand, has gained the most currency with the establishment of such entities in Denver and Alameda County in the Bay Area.

Moreover, three studies of the Los Angeles County health department over the past decade, including one by the county’s own alternative governance task force in 2002, have recommended establishment of a health authority in one form or another.

Any health authority board should be made up of individuals with some experience in health affairs. (And they would not be distracted, as supervisors are, with other huge problems.)

Supervisors would still have a significant role, including the power to appoint at least some of the authority members. If they didn’t, the legislation would probably never get off the ground. But the enabling legislation would give the authority jurisdiction over daily operations, as well as such matters as how services should be delivered. (Should expensive neonatal intensive care service be at every public hospital or consolidated?)

In order to mollify powerful labor unions, county employees could be transferred over to the authority, which would recognize existing contracts but have the authority to negotiate new ones. The county’s ossified civil service system would be dumped, as would its bureaucratic purchasing rules.

The idea of a health authority has been bandied about for years, but supervisors have resisted giving up their roles. However, with the department seemingly out of control at times, most recently borne out by the scandals at Martin Luther King/Drew Medical Center, supervisors should finally realize it’s an idea whose time has come.

Moreover, with the department again facing a $700 million deficit in the coming years, officials will be forced once again to go hat in hand to Washington looking for more federal money. A radical change in the department’s governance may be the only way to get any.

HEALTH CARE

Proposal: Reform the governance of the Los Angeles County Health Department through the creation of an independent health authority

Obstacles: Opposition from labor over potential job losses, from community groups over possible service cutbacks, and from some supervisors over the loss of political control

Cost: Set-up should be relatively nominal in comparison to the department’s $3 billion budget, but would likely run into the millions. Would be offset over time by greater operational efficiencies.

Time Frame: Up to five years