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Supervisors vote to consolidate health agencies

LOS ANGELES — The county Board of Supervisors voted unanimously Sept. 29 to create a unified county health agency, integrating the operations of the public health, mental health and health services departments.

Proponents, including the plan’s earliest champion, Supervisor Mike Antonovich, said they believe an umbrella agency will improve patient care, streamline access and reduce costs.

Those opposed said it will create more bureaucracy and further stigmatize mental illness.

Supervisor Mark Ridley-Thomas said he was optimistic about implementing a structure in which three separate departments remain, with a lead agency driving integration.

“The Department of Public Health and the Department of Mental Health have raised their concerns and raised them pointedly in some cases,” Ridley-Thomas said. “These systems will talk to each other effectively … about a year from now, we’ll see that we’ve done something good.”

Supervisor Sheila Kuehl acknowledged that “a lot of folks out there are still feeling a little nervous,” but assured those assembled at the Hall of Administration that “each department would continue to have direct contact with the supervisors” and communications would not be filtered through the lead agency.

Supervisor Don Knabe stressed that budgets for the three departments should be developed independently, and he charged interim county CEO Sachi Hamai with making sure that happens.

The board did not announce who would lead the agency, although Department of Health Services Director Dr. Mitchell Katz is widely assumed to be the frontrunner for the position.

Katz, who managed a combined health agency in San Francisco, outlined a plan for consolidation in January and proposed that he head the group.

Katz’s skill in managing a budget of more than $4 billion was on display at the Sept. 29 board meeting. He told the board that the Department of Health Services — which before his tenure routinely ran up huge deficits — had a $161 million surplus for the year ending June 30, 2015. Katz recommended setting aside $134 million in reserve.

Responding to a question by Knabe about the impact of merging departments and taking on responsibility for jail health services, Katz said he was confident.

“It’s always been my belief that by working together, things cost less, not more,” Katz said, adding that a single agency would have “opportunities to leverage new funding sources.”

But some see the move as a power grab by Katz and said the surplus money could be put to better use.

“I would prefer a surplus of zero dollars” and more people receiving care, said Genevieve Clavreul, a nurse with a doctorate in hospital management who often comments on county health issues.

The Department of Health Services is responsible for the county hospital system, while the Department of Public Health is responsible for managing outbreaks of communicable diseases, runs programs to promote health goals such as childhood vaccination and inspects restaurants and nursing homes.

The county operated a single health agency until 1978, when mental health became a separate department. Public health and health services were run as a single agency until July 2006.

Opponents said that history did not bode well.

The new structure “looks an awful lot like” that old agency and amounts to “a distinction without a difference,” said Bruce Saltzer, who represents a coalition of mental health providers.

Saltzer urged the board not to allow the new director to modify the organizational structure of other departments or draft performance evaluations for the other department heads.

While not naming Katz, Saltzer said putting any of the existing department heads in charge would raise a “clear potential conflict of interest.”

But others had nothing but praise for Katz.

“There are a number of people — and I would count myself among them — that would walk through a wall for the guy,” Brad Spellberg, chief medical officer of County-USC Medical Center in Boyle Heights, told the Los Angeles Times.

Strategic priorities for the combined agency were also spelled out and will include:

• Improving patient access and experience.

• Developing an effective way to serve homeless individuals.

• Reducing emergency room overcrowding due to patients in psychiatric crisis.

• Tailoring care to residents from different cultures and speaking different languages.

• Diverting mentally ill patients at risk of jail time.

• Linking vulnerable children to health care.

• And working to limit chronic disease and injury.