By Abby Sewell
January 22, 2015
Los Angeles County officials Thursday released a previously withheld "confidential" memo that outlined a proposal by the director of Health Services to consolidate two other health-related agencies under his department.
County supervisors voted unanimously last week to move toward integrating the departments of Public Health -- responsible for controlling disease outbreaks, managing substance abuse programs and conducting health inspections -- and Mental Health with the Department of Health Services, which runs county hospitals and clinics.
Proponents said consolidation would save money and provide more comprehensive services to patients. Mental health advocates pushed back, voicing fears that mental health concerns would be buried in a larger agency.
In a Jan. 2 memo to the five supervisors marked "confidential," health services Director Mitch Katz laid out the rationale and a proposed structure for a merger. There had been no public discussion of the proposal when the memo was sent.
"Although the greatest benefits in care integration and financial savings through efficiencies would come from a full integration of the three departments, this would be a large undertaking that would be time consuming and disruptive of current activities," Katz wrote.
"Instead, I propose the three departments operate as an agency, with the current director of health services serving as the director of this new unified health agency," he wrote.
According to the memo, the public health and mental health departments "would remain as distinct individual operations with separate financial structures, just as each of the hospitals within the current DHS operates as its own division with its own financial reporting."
The directors of the mental health and public health departments would serve on the executive team of the consolidated department, Katz said. Current mental health department Director Marv Southard would remain in his position. The public health director's role is currently vacant. Under Katz's proposal, the new director would be selected by the supervisors and the health services director.
Katz also laid out the board's next steps if it were to proceed with the proposal, including private discussions with the county's interim chief executive officer and the leaders of the mental health and public health departments.
Katz said in an interview after the release of the memo that the board had asked him to come back with a proposed plan during a closed-session discussion in December. He said he had marked it confidential because he was unsure whether the supervisors would move forward with the proposal.
"If they read it and said, 'Terrible idea,' seems better from my point of view that it ends there," he said.
Supervisor Sheila Kuehl said in a previous interview that Katz had brought the proposal up during discussions about the search for a new health director.
Katz said he had proposed himself as the head of the combined agency because his department is the largest of the three and is a substantial mental health provider. Before coming to Los Angeles, he ran a combined health department in San Francisco.
The preliminary proposal approved by the board did not specify which of the three departments would take the lead in the merged agency.
Some advocates complained last week that the board appeared to pushing the proposal through without public input. In response, supervisors agreed to include public health and mental health officials -- as well as officials from the Sheriff's Department and the County's agricultural department, and community groups -- in a process to draft a proposed structure for the consolidated agencies.
Katz said he thought the public process had worked as it was supposed to.
"It seems to me that what happened is exactly how all of us who believe in open government should want it to happen," he said.