Garthwaite Quits County Health Agency

Los Angeles County health director Dr. Thomas Garthwaite resigned Tuesday, ending a tumultuous tenure of nearly four years marked by unrelenting budget woes and a deadly scandal at Martin Luther King Jr./Drew Medical Center.

The departure leaves leaderless a county Department of Health Services that oversees four general hospitals and a network of clinics that together treat about 715,000 patients a year, the vast majority uninsured. It also raises questions about who would want to replace Garthwaite.

“This is a thankless job. You could be the perfect person for this job and be under attack,” said Linda Rosenstock, dean of UCLA’s School of Public Health. “He’s been beaten up in public for a very long time.”

Garthwaite, 58, told the county Board of Supervisors in closed session that he had accepted a position as chief medical officer of Pennsylvania-based Catholic Health East, which has 31 general hospitals from Maine to Miami. He starts his new job in mid-January.

The mild-mannered physician who faced regular tongue-lashings from his bosses and endured repeated calls for his ouster, had been looking for a new job for months. He said he wanted to be closer to his family on the East Coast and focus primarily on his passion for improving patient care.

But he also suggested that he had tired of being publicly second-guessed.

“Hindsight is 20/20 and Monday morning is a great time to be quarterback, but I have to play them on Sunday,” he said in an interview. When decisions “don’t work, I get the blame and if they work, I don’t get much of the credit.”

Garthwaite, who has served in the post since February 2002, is the third health chief to leave in a little more than a decade. All have had uneasy -- and at times rancorous -- relationships with their bosses, the county Board of Supervisors.

Although he was handpicked by the supervisors after a nine-month search, Garthwaite turned out to be, by many accounts, less than ideal for the job. He arrived in Los Angeles after serving as the top medical officer for the U.S. Department of Veterans Affairs, a low-key administrator who brightened when discussing the implications of healthcare data. But the new job demanded political savvy and a thick skin.

Still, he racked up some successes, especially early on.

For instance, he helped craft a 2002 county ballot initiative that raised taxes to support an unraveling trauma care system. More recently, he earned praise for hiring a team of senior executives to help run his department, including a new administrator for King/Drew.

But Garthwaite, who earned $287,513 annually, will perhaps best be remembered for failing to find permanent solutions to the problems he inherited.

He delayed his department’s insolvency, but the budget shortfall still is expected to hit $866 million within three years. And he has admitted moving too slowly to fix King/Drew, which has been plagued by mismanagement and sometimes lethal lapses in patient care for more than a decade. Despite two years of reform efforts, the hospital has lost its accreditation and continues to risk losing crucial federal funding.

The firm he hired to turn around the hospital’s fortunes, Navigant Consulting Inc., has been repeatedly faulted by county auditors for failing to follow through on its own recommendations and overbilling the county for travel and other expenses. In addition, some county supervisors have accused the firm of withholding information about problems at the hospital. All the while, Garthwaite has defended the firm and even pushed for a contract extension.

Still, news of his departure renewed questions about whether anyone could do his job -- and whether his failures were, in fact, really those of the Board of Supervisors.

“He’s been kind of a scapegoat,” Supervisor Zev Yaroslavsky acknowledged.

Garthwaite fell victim to some of the same pitfalls that crippled his predecessors. The five supervisors demanded aggressive changes and then, at every turn, questioned his attempts to respond.

The county leaders “are not the easiest Board of Supervisors to work with,” said Robert C. Gates, who retired as health director in 1995. “They function themselves in a highly political environment.... It’s a tough environment to succeed in.”

Gates, who physically collapsed after a grilling by Supervisor Gloria Molina late in his tenure, said, “The board’s own conduct” -- verbally lashing him and his successors -- was one of the worst parts of his job.

“It should never happen,” he said.

Yet it happened to Gates’ successor, Mark Finucane, and it happened to Garthwaite, especially over King/Drew.

During one public dressing down last April, Molina ordered Garthwaite to move his office from downtown Los Angeles to King/Drew, which is in Willowbrook, south of Watts.

“Park yourself there,” she told him to hoots from the audience. “Take your schedule. Tear it up and spend every moment that you’re working for us on solving this crisis.”

Several health experts said Garthwaite was set up to fail because the Board of Supervisors has steadfastly clung to control over health decisions rather than ceding it to an independent authority with health expertise.

Such a move has been endorsed by Garthwaite, the county’s civil grand jury and outside experts because they say it would give the health system greater latitude in making contracting, personnel and medical decisions outside of a political system.

In several instances, Garthwaite tried to make bold decisions -- but he was forced to retreat.

In a controversial move shortly after his arrival, he proposed closing Rancho Los Amigos National Rehabilitation Center in Downey, a renowned specialty hospital for victims of stroke and traumatic injury. He also recommended cutting the number of beds at the flagship County-USC Medical Center.

The Board of Supervisors approved the cuts, but federal judges ruled them unlawful and halted them.

Garthwaite drew the ire of community advocates again this August when he proposed closing the obstetrics, pediatrics and neonatology wards at King/Drew. But once more he was forced to abandon his plans -- this time, because his own department belatedly discovered that the move would have cost the hospital $29 million in government aid.

One of his lasting, signature changes was to close King/Drew’s prized trauma unit earlier this year to focus on fixing the rest of the hospital. But this move was by far his most unpopular, creating a rift with many elected officials and community groups that never healed.

“Mr. Garthwaite’s lack of competent leadership is the major cause of many of the problems at King/Drew Medical Center,” said Rep. Maxine Waters (D-Los Angeles) at a board meeting in August. “I’m hopeful he will be gone sooner than later.”

Supervisor Yvonne Brathwaite Burke, whose district includes King/Drew, summed up Garthwaite’s tenure as a “mixed bag.”

“He came at a difficult time, and he had to make some very difficult decisions,” she said. “Did he make the right ones? Who knows?”

Yaroslavsky, who has generally backed Garthwaite, said the health director should not be held completely responsible for the failings of his department. “The entire county government is responsible for that, not just Dr. Garthwaite.”

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Times staff writer Rong-Gong Lin II contributed to this report.

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(BEGIN TEXT OF INFOBOX)

A rocky few years

Here are some key dates in the tenure of Dr. Thomas L. Garthwaite:

February 2002: Garthwaite arrives at the county Department of Health Services after serving as top medical officer for the U.S. Department of Veterans Affairs.

June 2002: On Garthwaite’s recommendation, L.A. County supervisors vote to close 11 of 18 county health clinics and convert a Lancaster hospital into an outpatient clinic to cope with a looming deficit.

January 2003: In another cost-cutting move, supervisors on Garthwaite’s recommendation vote to close Rancho Los Amigos National Rehabilitation Center in Downey and cut 100 beds from County-USC Medical Center.

April 2003: In a major blow to Garthwaite’s financial recovery plan, a federal judge blocks the closure of Rancho Los Amigos.

May 2003: The same judge says the county cannot cut the beds at County-USC.

August 2003: Martin Luther King Jr./Drew Medical Center is notified that it is losing its accreditation for the training of general surgeons.

November 2003: The state faults King/Drew in two patient deaths. The report accuses hospital staff of failing to notice when one patient’s heart stopped and the other stopped breathing.

December 2003: Officials announce a major management shake-up at King/Drew after inspectors accuse staffers of neglecting basic patient care. Garthwaite sends in crisis and turnaround teams to oversee managers and nursing staff.

September 2004: County moves to shut down King/Drew’s trauma unit, eliciting protests. A national accrediting group recommends revoking the hospital’s accreditation.

October 2004: Supervisors hire Navigant Consulting to restructure and manage King/Drew’s day-to-day operations. Rep. Maxine Waters (D-Los Angeles) calls on Garthwaite to quit, citing his proposal to shut the trauma unit.

March 2005: King/Drew’s trauma unit closes.

April 2005: Garthwaite acknowledges that problems at King/Drew persist as several more patients die after lapses in care. Supervisors order him to move his office to the hospital. One calls for his resignation.

October 2005: Garthwaite warns that the hospital may fail an upcoming federal inspection, which would cost $200 million in federal funds. An internal memo says patient-care errors continue. A plan to close three of King/Drew’s wards is dropped.

November 2005: Garthwaite announces his resignation.

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Graphics reporting by Rong-Gong Lin II

Los Angeles Times