NEWS ANALYSIS : Finucane Hears the Call for Change : County: Supervisors give the outsider broad new powers to revamp the ailing health system.

In selecting Contra Costa County’s top health official, Mark R. Finucane, as the new director of Los Angeles County’s vast and troubled health care system, the Board of Supervisors has given him powers to save a department that is terribly out of step with health care of the 1990s.

In a display of both confidence in Finucane and the desperate straits that the county health department is in, the board gave him a $210,000 annual salary and broad latitude to bring in a team of top managers to help revamp the beleaguered network of hospitals, health centers and clinics.

“The executive structure of the L.A. County health care system is tired,” Finucane said. “They have been under siege for a long time. The gene pool needs to be expanded.”

Finucane said he plans to “bring in some people and maybe promote some people” because the task of turning around the nation’s second-largest health care system will not be done by a single individual. “It takes a lot of people shoving in the same direction.”

County health czar Burt Margolin said the fact that Finucane is an outsider will be an asset as he strives to change the way the county operates its $2.3-billion health system. “He will bring a fresh perspective to the problems of this county,” Margolin said. “He has a mammoth responsibility, an awesome task ahead of him. There is an enormous amount of restructuring that has to be done, in a very short time period with a number of major unknowns still out there.”

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Finucane said the county’s health care system must be fundamentally changed to survive. “I believe absolutely . . . that if this system collapses, it will be a public health disaster” for the entire southwestern United States. “We cannot afford to fail,” Finucane said.

As the state and federal governments cut back their commitment to social programs, he said the county has no choice but to restructure the way it provides health care to those most in need.

The county health department is beset by red ink, collapsing morale, management chaos, heightened competition from the private sector and an exodus of paying patients.

When Finucane takes over Jan. 15, he will face a slew of pressing problems.

How will the county replace County-USC Medical Center, the nation’s largest public hospital?

How can it make a transition from six large hospitals to an outpatient system in an era of sharply declining resources?

How does it best provide health care in a sprawling region with the highest percentage of uninsured people in the nation? And whom should it serve in a county with a large population of illegal immigrants?

“There is no talking around the fact that in a few years, the Los Angeles County health care system will be substantially smaller and will look substantially different,” Finucane said.

Rather than seeing himself solely as the leader of a vast public health care system, Finucane said he will be “a broker, a coordinator, an arranger of care” with the private system of hospitals and doctors. “I am not averse to public-private partnerships,” he said. “We cannot do it alone.”

If Finucane succeeds in breaking down the walls that have led to the development of the public and private health care systems, it will mark a major departure from the way the county has long done business. But he cautioned that he does not want to summarily turn health care over to private enterprise. “We’re going to be providing health care to poor people for a long, long time,” he said.

Finucane said the county must move away from overreliance on expensive inpatient treatment at county hospitals to a system that relies on primary care in the communities most vulnerable to health problems.

After meeting privately with each supervisor in the past week, Finucane pledged to put together “a team of first-rate professionals to manage the affairs of the department.”

Board Chairwoman Gloria Molina said the supervisors have very, very high expectations that Finucane will bring new leadership and new direction to a department beset by difficulties.

“We want to give him as much room as possible so that he can build a team of people that he will have confidence in and be able to work with in this department,” Molina said. “Some of us believe there need to be changes at the top, but it will be up to him. We want a real hands-on guy who is going to be accountable and who will have people he can trust and have confidence in.”

She expressed confidence that Finucane will bring a forceful new attitude to a department that has been laden with bureaucracy and slow to change.

“This is a department where you don’t put little happy faces on crises. You really have to have someone who will work with us as supervisors, not walk us over the cliff and then tell us to bail them out, like what happened here,” Molina said.

Finucane is likely to be put to the test soon, given the menu of problems and solutions facing him and the Board of Supervisors.

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Because the stakes are so high, Finucane said he believes that the supervisors have committed the political and administrative support he needs to change the system. But promises of change have a way of dissipating when the political pressure to maintain the status quo intercedes.

Two years ago, the supervisors hired Santa Clara County’s top executive Sally Reed as the county’s chief administrative officer. Her efforts to bring financial discipline to a county government that has long spent beyond its means have thrust her into political firestorms.

Almost weekly, Reed must fight the natural inclination of the supervisors to smooth over problems and avoid tough decisions.

None raised the temperature at the Hall of Administration more than her recommendation in June to close County-USC Medical Center to help erase a $655-million deficit in the health system.

The board turned to other outsiders, Margolin and a task force of health professionals to find a way out. Only by pursuing innovation did Margolin and state and federal officials find a means to temporarily stabilize the health system.

Still, Supervisor Mike Antonovich said Finucane “has complete latitude to move things around, to bring in a new leadership team and to implement his programs.”

Supervisor Yvonne Brathwaite Burke said she and her fellow supervisors have discussed with Finucane the need for him to bring new leadership. “‘We need an infusion of fresh blood,” she said.

But that can be expensive. Finucane’s salary will be second only to that of Sheriff Sherman Block, who is paid $212,259 annually. In addition, the new health chief, like other top county officials, will receive an additional 19%, or $39,900 a year, for fringe benefits. And Finucane will have his choice of receiving $525 a month as a transportation allowance or a county-leased car.

The county will pay his relocation expenses, but will not assist in the purchase of a home for him.

“You don’t elect a President and then keep the old Cabinet. It just doesn’t work that way,” Burke said. “You may keep certain people, but you don’t just walk in and keep everyone. We’re hiring him to do a job and he is going to have to have people who agree with him about what he is doing and how he will achieve it.”