New County Health Director Vows to Act Fast

The first day on the job for Mark Finucane, Los Angeles County’s new health services director, offered an instant taste of the challenge he faces as he struggles to save the nation’s second-largest public health system.

Finucane found himself thrust into the middle of the county’s health crisis as soon as he arrived Tuesday at the Hall of Administration to receive the congratulations of his new bosses, the Board of Supervisors.

Nearly four months after the county’s vast and vital system of hospitals and health clinics was saved from collapse by President Clinton’s promise of a $364-million rescue package, none of the money has arrived.

Making sure it does now becomes one of Finucane’s chief responsibilities.

Federal officials are concerned that the county has not provided enough details on how it will move the huge health system from one emphasizing expensive hospital treatment to one geared to less costly, community-based preventive and primary care.

“They want meat on the bones,” said one county official.

So top county and state officials are headed to Washington for a round of face-to-face meetings Thursday with high-level federal health officials who want to know more about the county’s plans for sweeping changes in the way it delivers health care to the poor and the uninsured.

County officials who breathed a sigh of relief when Clinton stood at Santa Monica Airport in September now are holding their breath. They know the cash infusion is necessary not only to keep the health system intact but also to keep the financially struggling county afloat.

But the county’s request for a waiver of federal Medicaid rules to change the system to emphasize outpatient care is still making its way slowly through the federal bureaucracy.

“We’re generally on track,” county health czar Burt Margolin told the supervisors. “This waiver in my judgment is not in jeopardy.”

Campbell Gardett, a spokesman for the U.S. Health and Human Services Department, said federal officials are eager to meet with county and state representatives.

“We want to talk to them about the details,” Gardett said. “We want to carry out our agreement.”

Even before he was officially sworn in as the head of the county’s biggest department, Finucane assured the supervisors he understands the importance of restructuring the county’s system of hospitals, health centers and community clinics.

“I realize that is my No. 1 assignment,” he said. “I’ve got to get to it fast.”

The former Contra Costa County health services chief pledged to come back to the supervisors soon with a schedule on how he intends to revamp the vast department with a $2.3-billion annual budget and 23,000 employees.

“The reason that I was hired was to manage a restructuring of the health care system, make it look different than it looks today,” he said in a brief interview. “That is the essence of the waiver.”

Hampered by the budget impasse that led to back-to-back shutdowns of the federal government and last week’s blizzard that crippled the nation’s capital, state and county officials have been unable to meet with their federal counterparts to resolve remaining issues involving the county’s waiver application.

John Rodriguez, deputy director of the state Department of Health Services, said that if federal decision-makers need more details, they will get them.

“We gotta do what we gotta do to get their support,” Rodriguez said. “We need the money. L.A. needs the money. We’ve got to get ite. . . . I think we’re close. We can’t let it get screwed up now.”

Finucane said the concerns raised by federal officials are part of the “regular give and take” of negotiations.

Margolin said the face-to-face meeting has been planned since September’s marathon negotiations in Washington produced tentative agreement on the $364-million rescue package.

The promise of the money averted the closure of county hospitals, health centers and clinics, but was not enough to avoid sharp cutbacks, primarily in outpatient services, which cost more than 3,000 health workers their jobs last fall.

“It was an initial . . . down payment on a promise to restructure the system and to do it over five years and do it in a way that was to the satisfaction of state and federal agencies,” Finucane said.

Supervisor Gloria Molina cautioned that the waiver alone is not a panacea for the myriad problems facing the health system, including intense competition from private hospitals and medical groups for Medi-Cal patients.

Nevertheless, Molina stressed that the county is “going to be in a very difficult situation” if the waiver is not approved and the money received.

Supervisor Deane Dana was more blunt. “It would be no joke,” he said.