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The Knife

Facing the tightest budget in seven years, L.A. County’s new health-services director, Thomas Garthwaite, told a skeptical Board of Supervisors this week that he is willing to consider service cuts far beyond the $10 million reduction already approved.

But it won‘t be easy to do. In light of strong protests voiced against the $10 million round of shallow budget reductions approved Tuesday, Garthwaite could face a hurricane of opposition if he expects to cut $100 million from the Department of Health Services (DHS) as one supervisor suggested. And that’s not even considering what another supervisor termed the DHS bureaucracy‘s persistent institutional inertia that many believe has hindered seven years of federally mandated attempts to reform the agency.

”Usually, I consider myself a proponent of health-care access,“ said 1st District Supervisor Gloria Molina, whose district contains both County-USC Medical Center and one of the county’s largest indigent patient populations. Speaking to Garthwaite during his first public appearance before the board, she said, ”We need to dig deep enough to maintain services that are really needed . . . And we‘re looking to help balance the budget, right?“

The board foresees $360 million in DHS shortfalls over the next three years. The hundreds of millions in federal aid Washington gave the county to ease its costs and encourage a reformed health system from 1995 until last year are not likely to be repeated under the Bush administration, while Medicare coverage is being reduced. Garthwaite has repeatedly said he hopes to maintain or increase the breadth of current health services by cutting those that do not benefit the majority of county patients and by combining other services and medical facilities. He’s promised the board figures by June on the savings his plans will offer.

Garthwaite set as his own first priority reorganizing the DHS‘s ramshackle patient computer network so that patients’ profiles will be available to all county clinics and hospitals. He said he couldn‘t understand the previous DHS approach to information technology, which has failed to work for over a decade while costing the county hundreds of millions in outlays and legal fees. Garthwaite said the departmental ”redesign“ would be overdue, even if there were no budget problems. He particularly cited ”reviewing the agreements“ among the county’s three medical schoolteaching hospitals. In the past, various health officials have considered combining these into two or even one teaching hospital, but, politically speaking, such proposals have been regarded as time bombs.

He was mildly reproved by Supervisor Zev Yaroslavsky, who noted that, in the past, county processes have moved very slowly: ”I believe that there‘s also a lot of inertia left. That’s the old way of sitting back and waiting to be bailed out. That won‘t do this time, but the mindset still exists.“

Some officials believe that, by the time Garthwaite’s serious cutback proposals are placed on the table over the next three months, the regular board meetings will be thronged with protesters as they have not been since 1995, when the DHS was last on the verge of collapse.


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