L.A. County merging three health-related departments into mega agency

Los Angeles County supervisors voted Tuesday to consolidate three health-related departments that deal with physical health, mental health and broader public health issues into a single agency.

The move is intended to create a more efficient system and to help better coordinate care for patients who currently have to deal with three different bureaucracies. Together, the three health operations have a budget of nearly $8 billion, accounting for 29% of the county’s budget.

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Critics warn that in the past -- before mental health services were separated from the larger health department in 1978 and public health in 2006 -- the needs of the hospital system often trumped other health programs. The three departments will maintain their own budgets and directors under the larger umbrella organization in the new model.

The new health agency is intended to eliminate red tape for patients, so they are not required to register multiple times with different county agencies to receive services. Officials also hope health workers in different programs will share records more easily.

Over the past year, county supervisors have frequently spoken of the need to eliminate “silos” of bureaucracy.

The new health agency will be tasked with a wide range of responsibilities, including connecting homeless patients to housing programs, improving health services for foster children and youths in the juvenile probation system and reducing overcrowding in psychiatric emergency departments at county hospitals.

The board has also assigned the health department the job of managing a diversion program intended to shift mentally ill people who commit crimes out of county jails and into treatment programs.

Some critics warn the new agency will be taking on too much and be unable to effectively manage such a sprawling array of consolidated programs.

Mitch Katz, a physician and director of the Department of Health Services, who will probably be named the new agency’s top executive, said the new management structure will be more effective and efficient.

“It’s always my belief that by working together, things cost less, not more,” he said. “We haven’t taken on any responsibilities that the county doesn’t already have…. It’s my hope that we have not taken on anything that is greater than our ability to handle.”

Supervisor Mark Ridley-Thomas said saving money was never the main purpose of the reorganization.

The purpose is “better patient care, better outcomes for communities,” he said. “The systems will talk to each other effectively. That hasn’t been the case.”

Previous meetings discussing the health agency proposal had been packed with both supporters – including unions representing county doctors – and opponents. Tuesday’s vote was largely seen as a foregone conclusion and only a handful of audience members commented on either side. Several came to voice support for Katz. Others called for checks on his power.

One source of criticism has been the possibility that Katz would continue to directly manage the system of hospital and clinics the county runs and be the chief executive of the larger umbrella health agency.

“The mental health and public health communities would be immensely concerned about the prospect of the [health services department] director also leading the health agency and technically reporting to himself with regard to the health department,” said Bruce Saltzer, executive director of the Assn. of Community Human Service Agencies, part of a coalition that pushed back against the consolidation.

Saltzer said such an agency chief wearing those two hats shouldn’t be simultaneously “reviewing the budget of the other two departments, influencing the organizational structure, overseeing a very broad scope of operations and evaluating the performance of the department heads.”

The board did not appoint a health agency director Tuesday or decide whether the agency director could also serve as the head of one of the three departments within the new organization.

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