Battered Health Department Chief Soldiers On

By Jack Leonard

April 29, 2005 12 AM PT

Times Staff Writer

On a recent walk through Martin Luther King Jr./Drew Medical Center, Dr. Thomas Garthwaite, Los Angeles County’s embattled health chief, introduced himself to an obstetrics nurse and asked what he could do to help her.

The nurse quickly ticked off a list: a better computer system to schedule patient appointments, more Spanish speakers to answer the phones, and, oh, how about getting the doctors to show up on time?

“Don’t give us too much at once,” Garthwaite said with a nervous giggle as he scribbled down her answers.

More than three years after taking the helm at the nation’s second-largest county health system, Garthwaite is under relentless pressure to reform a chronically underfunded and antiquated operation that treats the county’s poorest residents.

From the start, he has faced two crucial tasks: shoring up the finances of a health system that has survived on billion-dollar federal bailouts for nearly a decade, and improving care at county hospitals, most notably King/Drew.

Today, both problems remain unresolved. Garthwaite’s financial rescue plan is tied up in court and it remains unclear whether he will be able to turn around King/Drew.

Garthwaite’s bosses, the county Board of Supervisors, have begun to deliver the sort of public browbeatings that his predecessors endured in their final days.

Their frustrations boiled over this week after learning that King/Drew had paid $1.3 million for a year’s work by a radiologist who often claimed he worked 23 hours a day, seven days a week. Garthwaite sat silently Tuesday, his voice hoarse from laryngitis, as Supervisor Mike Antonovich called on him to resign.

On Thursday, Antonovich blasted Garthwaite as an “absentee health director,” criticizing his decision to take next week off and not join supervisors on a trip to Washington, D.C., to lobby for healthcare funding.

Garthwaite, 57, insisted he had no plans to step down from his $287,513-a-year position, although his search for a new job is an open secret.

“I’m driven by an internal pressure to try to do well and make the institutions as a whole do better,” he said. “It’s not any good to worry about how long I’m here.”

To supporters, the mild-mannered physician-turned-administrator has forged a bold path to do the nearly impossible: Reform a financially strapped, overburdened health system in a tumultuous political environment.

But critics say Garthwaite has failed to deliver.

“Part of the hope of hiring Dr. Garthwaite was to try to get a handle on some of those problems. That just simply hasn’t happened,” said Assemblyman Mark Ridley-Thomas (D-Los Angeles), who heads a legislative committee studying the county’s healthcare problems.

Garthwaite arrived with a reformer’s resume.

In seven years in the top two medical jobs at the Department of Veterans Affairs, he won praise for cutting costs and improving healthcare at the notoriously bloated and politicized bureaucracy.

County supervisors hoped Garthwaite would do the same in Los Angeles, taking on a pressure-cooker job that saw both of his predecessors step aside under fire.

He has brought a cool-headed, low-key approach to overseeing a $3.5-billion-a-year bureaucracy that treats about 800,000 mostly uninsured patients a year.

“He’s not a table pounder, he’s not a guy who goes out for show,” said Dr. David Altman, who worked under Garthwaite as chief medical officer of Los Angeles County-USC Medical Center until December.

Altman said Garthwaite made progress in centralizing the operations of the five public hospitals, which had long operated separately and were jealously protected by county supervisors representing the districts the hospitals are in.

The new director welcomed doctors and nurses to monthly meetings for hospital managers, encouraging them to share their best medical ideas. And he demanded that staff start tracking how often essential tests were given to county patients, such as asthmatics and diabetics.

To relieve overcrowding at county emergency rooms, he reduced the number of indigent patients his department accepts from private hospitals, a move that was once seen as politically off limits.

Most dramatically, Garthwaite pushed an ambitious plan to slash programs to ward off a looming financial shortfall that had been projected to hit the health department as soon as this year.

“He came into the department and he pretty much said, ‘The emperor has no clothes,’ ” said Jim Lott, executive vice president of the Hospital Assn. of Southern California, who commended Garthwaite for his “stellar leadership.”

Garthwaite won approval from the supervisors to make drastic cuts -- eliminating hospital beds and shutting down clinics. But the plan sparked an outcry, and much of it is stalled in federal court.

In the meantime, Garthwaite has yet to offer any alternatives as the health department slips toward a projected $1.4-billion deficit within four years.

Garthwaite, though, has drawn the most intense criticism for his handling of King/Drew.

Under his watch, the hospital in Willowbrook near Watts has come under fire for a series of healthcare lapses, including deaths.

In October 2003, with the hospital earning failing reviews from regulators, Garthwaite sent in a team of his own managers to run it. But medical errors persisted, and the federal government repeatedly threatened to cut off funding to the hospital.

Last year, he proposed shutting the hospital’s trauma center -- a plan that sparked furious protests from some black leaders who watch over the hospital built after the 1965 Watts riots.

But medical lapses have continued. In the last month, federal regulators started investigating five more deaths tied to medical mistakes. And on Thursday, the acting pediatrics chairman resigned after auditors alleged he worked at his private practice on county time and then lied about it. With his departure, half of the clinical departments at the hospital now lack permanent chairmen.

Antonovich accused Garthwaite of not “taking charge.”

“He’s a Gen. McClellan,” Antonovich said, referring to the Civil War commander notorious for his caution. “Working at a snail’s pace is not going to do the job.”

Garthwaite conceded that he has made mistakes but said the hospital was making slow but steady progress.

“We sent a platoon. If we had known how deep the problems were, we could have sent an army,” Garthwaite said.

He took partial credit for the county’s decision to hire a turnaround firm to run the hospital -- a move federal regulators insisted on. And he called his successful push to close the trauma center an important victory.

“Obviously, there will be a few bumps in the road,” he said. “I think we’re all frustrated.”

So far, Antonovich is alone in his call for Garthwaite to step down. Because he serves at the will of the board, his job depends on the support of at least three of the five supervisors. At least one, Supervisor Yvonne Brathwaite Burke, said she believes he has “done a good job ... in an impossible situation.”

Supervisor Zev Yaroslavsky said he sympathized with the demands on a health chief who must please five bosses, but was disappointed that Garthwaite was not willing “to stick his neck out a little more.”

Three weeks ago, Supervisor Gloria Molina angrily ordered Garthwaite to move his office to the hospital until its problems were fixed.

Garthwaite said such criticism comes with the job.

“There’s never been a director of the health department who hasn’t been in the hot seat,” he said.

Indeed, his predecessor, Mark Finucane, resigned after five years of browbeating by county supervisors. And Finucane followed Robert C. Gates, who once collapsed after a barrage of questions from supervisors.

“Frankly, the L.A. County board doesn’t have a good record of backing its managers,” said Gates, who now runs a health program for the indigent at Orange County’s Health Care Agency.

“The board should say, ‘This is the manager we selected,’ and fully support him,” he said. “If they don’t have a director like that, they should get a new one. That said, I’m not sure that there’s a human being on the face of the Earth that they would fully support.”

To some, Garthwaite’s banishment to King/Drew appeared humiliating, but he called it a “rewarding experience” that gave him hope “that victory is possible here.”

On Monday morning, he strode down the hospital’s long, fluorescent-lighted corridors, talking to nurses and doctors. Several touted improvements: Patient waits were shorter and medical charts, once rarely at hand, were delivered on time.

When he marched into the general surgery area on the third floor, he was greeted warmly.

“It’s nice to see you in person!” a nurse squealed. “You’re a very good-looking man.”

“Aging rapidly,” Garthwaite replied with a laugh.

Times staff writer Charles Ornstein contributed to this report.

(BEGIN TEXT OF INFOBOX)

Dr. Thomas Leonard Garthwaite

Birthplace: Port Allegany, Pa.

Age: 57

Home: Santa Monica

Education: Bachelor of arts in biological sciences, Cornell University; M.D., Temple University.

Career highlights: residency in internal medicine at the Medical College of Wisconsin, Milwaukee; chief of staff and associate dean at the Zablocki Veterans Affairs Medical Center Milwaukee and the Medical College of Wisconsin, Milwaukee, 1987-95.

U.S. Department of Veterans Affairs: deputy undersecretary for health, 1995-99; undersecretary for health, 2000-02.

Los Angeles County: director of health services since February 2002.

Family: Divorced with two children; engaged this month

Quote: “There’s never been a director of health services who hasn’t been in the hot seat. It’s the nature of the job.”

Los Angeles Times