Last week, Toby Douglas surprised California’s health care community by stepping down as director of the Department of Health Care Services, the state department overseeing Medi-Cal, mental health services and programs for seniors. The department has an annual budget of about $9 billion and about 3,500 employees.
In a letter to stakeholders Friday, Douglas wrote he was leaving DHCS to “begin a new phase in my life and career.”
In his four years as director, Douglas oversaw enormous changes at the department, particularly the huge shift of Medi-Cal beneficiaries to managed care plans. More than 70% of the state’s Medi-Cal patients are now in managed care. He also oversaw a large expansion of Medi-Cal that added more than two million Californians to the program.
“It’s hard to be able to put it in a few words what he meant to the department,” said Mari Cantwell, chief deputy director of health care programs at DHCS. “His leadership was based on his incredible intellect — where he was able to understand all the complications of the Medicaid world, and simplify it enough for people to get it — and on his commitment and passion to the organization, wanting Californians to have better access to quality health care. He helped infuse that spirit in all of us.”
In a letter to state health officials announcing Douglas’ resignation, California HHS Secretary Diana Dooley wrote: “In addition to the success Toby has had in reforming and improving the Medi-Cal program, he has fostered a strong leadership team that will ensure a smooth transition, as well as continue our momentum toward achieving our ambitious policy initiatives.”
Douglas and the department have had their share of controversies over the past four years:
- Criticism of rapid changes in the dual-eligible pilot program;
- Criticism of the state’s handling of Denti-Cal and the Medi-Cal drug program;
- Eliminating adult day health services and then rebooting the program after a court settlement;
- Eliminating the Healthy Families program and losing autism services in the transition;and
- Struggling with criticism and concerns during the transition of the seniors and persons with disabilities into managed care.
When you make big changes — basically revamping the entire public health care delivery system in California — you will have your share of challenges, Cantwell said.
“Even in hard times we knew we were doing it for a reason,” Cantwell said. Those sea changes in integrative care “would not have happened without him as a leader.”
Cantwell, as one of the two chief deputy directors on the DHCS organizational chart, likely will be a candidate to replace Douglas.
“I love working in this department and I hope to continue working here,” Cantwell said. “I’ve worked here for three years. But yes, definitely it’s something I would consider.”
Cantwell said she hopes whoever steps into Douglas’ role would emulate the tone she said Douglas set among the staff.
“[As director,] he was always accessible and available,” Cantwell said. “He created a culture more like a family, which is hard with about 3,500 employees, that’s a hard thing to do. He cared about all of us as individuals. He wanted us to grow and learn and do better things, and to make sure we had time to take care of ourselves and our families. Overall he was an inspiring leader I would like to emulate.”
Cantwell said Douglas told her about his decision “a couple of days” before he sent out his letter to the health care community.
He did not tell her specifically what he has in mind for the new phase in his career, Cantwell said.
“He has not yet found where he’s going,” she said. “I know he wants to continue working in this area. Just in a new area.”
Douglas will not leave his job until January. Department officials hope to find a replacement before he leaves, Cantwell said.
“We all know everyone is going to leave at some point,” Cantwell said. “These jobs are very difficult.”
But, she said, any difficult moments have been more than offset by the work that’s been accomplished and the personal bonds made.
“I think it’s a balance, and it’s why he loved this job, even when there were times when it was really unpleasant.” The position itself as head of the department as well as the changes implemented within it, made him a target for any criticism of policy, Cantwell said.
“But it’s balanced and offset by the commitment that we get to have impact on people’s lives. To improve not just the quality of their health but also the quality of their lives. You take all the bad stuff, knowing that the work is important and it impacts people’s lives.”
In the halls of the department, she said, most people are coming to grips with the idea of the agency without the leader they’ve had for four years.
“I think Toby was well-respected by lots of people, but most people don’t realize how highly regarded he is to all the employees,” Cantwell said.
“People are sad. People are going to miss him,” she said. “We all like him as a person. People are trying to think about what the department looks like without him. He is a unique person.”