GRAVES: Plan Aids Health Services : Plan Would Aid S.D. County Health Services

SAN DIEGO —  San Diego County’s ailing Department of Health Services got this prescription for its ills Monday: $1.3 million and more employees.

Clifford W. Graves, the county’s chief administrative officer, said the department needs plenty of money and people to overcome its many problems, particularly those at the Edgemoor Geriatric Hospital and the county’s emergency mental health hospital in Hillcrest.

In a 20-page report submitted to county supervisors, Graves asked for the $1.3 million to expand the department’s administration and to add 25 employees in the mental health services division.

“I believe we are taking dramatic steps today that not only address critical issues in health services but also resolve our deficiencies as well,” Graves said in a prepared statement released through a county spokesman.

Graves, whose future with the county is in doubt mainly because of the problems plaguing the health department, blamed those problems on cuts in administration ordered by him and the Board of Supervisors after the passage of Proposition 13 in 1978.

He said the department, which has an annual budget of $120 million, has been cut $700,000 at the administrative level since 1979.

“My analysis of the events that have recently surfaced concerning the two institutional programs operated by the Department of Health Services leads me to believe that administrative oversight of departmental programs has not kept pace with the . . . growth of the programs,” Graves wrote.

But he did not blame that on James Forde, director of the department since 1979. Instead, Graves said Forde needed more help running his programs.

Graves recommended:

- Adding an assistant director at an annual salary of $70,000 to help Forde oversee the department’s varied functions. Graves said he will soon propose similar positions for the Departments of Planning and Land Use, and Probation.

- Creating a “quality assurance unit” by paying a private contractor $335,000 a year to inspect county hospitals, with the goal of finding and correcting problems before the county is cited for them by other government agencies. Graves said the unit would act as an “internal auditor” for the department.

- Making the administrator of the Edgemoor Geriatric Hospital a deputy director of the health department, on par with existing deputies for mental health, public health and physical health services.

- Reorganizing the administration of the mental health division, giving the county’s two mental health institutions at Hillcrest and Loma Portal clearer chains of command.

- Adding 25 positions to those two programs, at a cost of $678,000. The new employees, Graves wrote, would improve patient care by decreasing the caseload carried by each mental health professional.

- Adding an emergency mental health center in North County at an as yet unspecified cost.

Although just $102,000 of the proposal’s $1.3-million cost would be paid by the county--the rest would come from the state--it was unknown Monday evening how the package would be received by county supervisors.

“This may be a case of being too much, too late,” said an aide to one supervisor.

The board is scheduled to evaluate Graves’ performance in a closed session June 19, but county government sources say Graves’ fate is all but sealed. It would take three of the five supervisors’ votes to fire Graves, who has been criticized for allowing the health department, under Forde, to deteriorate.

Edgemoor is in danger of losing federal Medicare and state Medi-Cal funds because of problems in the hospital’s medical records, nursing and dietetic programs. The state has fined the county $40,000 in the last year for violations at Edgemoor, including the drowning of a woman left unattended in a bathtub and the death of a legless man who fell out of bed and later suffered a heart attack.

The mental health hospital is under investigation by the state Board of Medical Quality Assurance and by state and federal health officials because of allegations that mentally ill patients are routinely released while they are still a danger to themselves and others. At the county’s request, the San Diego Psychological Society is reviewing several cases handled at the hospital, including those of a man who died four hours after being put in an isolation room and a man who was strangled by his roommate.