Los Angeles County has officially published a proposal to integrate its three main health care agencies–the Department of Health Services (DHS), the Department of Mental  Health (DMH) and the Department of Public Health (DPH).  Supervisor Mark Ridley Thomas has also added the Sheriff’s Department to this merger. A sixty (60) day feedback period involving the many stakeholders, including UAPD, has begun. It is incumbent upon our LA County doctors to be informed and to have a frank and open discussion about this plan before our union responds with an official opinion.

First, a bit of history. Many decades ago the departments all operated as a single entity. For various reasons the Board of Supervisors (BOS) separated the three main functions into the three current departments. Now, because of evolving changes in health care delivery and reimbursement, the County feels it is prudent to again operate as a single unified health agency. Better services and programs would be available to County residents, bureaucratic barriers would be dissolved, operations streamlined and finances optimized by the sharing of capital and expenses.

From our members’ perspective there are some obvious advantages to the merger. First, the UAPD has had a good working relationship with DHS. DHS would address the problems of the other departments regarding physicians being supervised by non-physicians  (custody, nurses, social workers who often hear grievances and make medical decisions). Also, DHS has been the only department in favor of manpower shortage pay increases.

However, some concerns about the integration were raised at a recent Town Hall meeting at Harbor/UCLA hospital. As expressed by one of our doctors –“adding another layer of bureaucracy could be asking for trouble.” The consultant to the CEO present at the meeting answered that no budgets or staff would be cut or redirected after the merger. But one only has to look at the Prison Receivership as an example of bureaucracy gone wild. There have been ever increasing numbers of new administrative positions created—CMO, CME, etc. The potential for undue oversight on our members must be considered. We made it clear at the meeting that UAPD must be afforded regular input if and when the integration goes forward. We also discussed how the performance of the merger might be assessed. Some form of evidence, survey and/ or metric must be developed to measure patient and provider access and satisfaction, provider productivity and reimbursement. These should be made available to the public at regular intervals. Finally, always having an MD at the helm of his new agency should be made a priority. Over the next 60 days we will be having meetings at LAC facilities to solicit your ideas and input; the next meeting is at Olive View Medical Center, CD-R Room, Wednesday 4/22, 11:30 am – 1 pm. I look forward to talking with you there.