Wall Street Journal Examines Challenges Faced by Los Angeles DHS Director Garthwaite
The Wall Street Journal today examines the challenges faced by Los Angeles County Department of Health Services Director Thomas Garthwaite, whose main task is to tackle a projected $700 million deficit in the department's $2.9 billion operating budget for 2005. While the department in 1995 received a $1.2 billion federal bailout package, which was extended in 2000 and expires in 2005, the county is unlikely to receive further assistance from either the federal or state governments, the Journal reports. To offset the projected shortfall, Garthwaite has suggested eliminating about 5,000 county health jobs, closing one of the county's six public hospitals and 11 of its 18 clinics and cutting county funding of private clinics by 25%. Garthwaite estimates his plan would save about $150 million. If the county fails to receive additional funding, Garthwaite could propose "more drastic cuts" in October. Unlike previous county health directors, Garthwaite "appears to have" the support of the county's Board of Supervisors, the Journal reports (Rundle, Wall Street Journal, 7/15). Last month, the supervisors approved his proposal, which will be considered during public hearings set for this summer. After those hearings, the supervisors will vote on the plan a second time (California Healthline, 6/27).
Jim Lott, executive vice president of the Healthcare Association of Southern California, said, "The prime difference between [Garthwaite's] plan and previous plans is he actually talks about a redefinition and restructuring of the delivery system at a very basic level." Eventually, Garthwaite hopes to register every person who uses the department's services to track and coordinate their care and specifically manage patients with chronic conditions to prevent future hospitalizations. In addition, he wants to centralize heart surgeries, organ transplants and other complicated medical procedures at the University of Southern California Medical Center. Garthwaite used several similar tactics while working as a deputy and later chief of the U.S. Veterans Health Administration. For instance, Garthwaite helped institute a digital medical record system that tracked veterans from one facility to another, helping improve quality of care and keeping the system within a "tight budget." Nicole Lurie, a Rand Corp. senior researcher, compared Garthwaite's current situation to the one he encountered at the VHA, noting that "naysayers doubted" he could turn around the VHA system. However, she pointed out that the VHA has a central command authority and a central funding source -- the federal government -- while the county's power structure is "diffuse and pluralistic" and funding comes from various sources, including federal, state and local governments and private sources (Wall Street Journal, 7/15).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.