A county health superagency

It became abundantly clear in January that the Board of Supervisors, without the benefit or bother of public input, was intent on consolidating three Los Angeles County health departments into a kind of superagency. After the supervisors voted to pursue such a merger, The Times unearthed a “confidential” memo to each of them from Department of Health Services Director Mitchell Katz, laying out the case for combining the departments of mental health and public health with Katz’s department, which chiefly handles public hospitals and clinics. “In response to your request,” the memo began, suggesting a discussion that had already been moving forward secretly — and unlawfully, because such policy moves are and ought to be subject to the scrutiny of professionals who provide services, patients who use them and taxpayers who pay the bill.

County officials later began a process of public outreach and hearings to enable the airing of thoughts and concerns, and there are many. The county created the Department of Mental Health in 1978 because the needs of the mentally ill and their families had for too long been shunted aside by the Health Services Department. The county’s public health mission — to prevent epidemics, for example — was likewise too often an afterthought. This page strongly supported carving out a separate public health department in 2006.

Nevertheless, in keeping with its original plan, the Board of Supervisors is poised this week to finalize the merger details, now that fiascoes of the recent past — the near closure of county hospitals and the management and oversight meltdown of the old Martin Luther King Medical Center — are several years behind us. The directors of public health and mental health have left or are leaving. Katz, meanwhile, is seen as a brilliant and creative leader who can mesh the variety of available funding sources to provide not just medical care but also mental health and addiction treatment, housing and other services in one seamless web.

One of the county’s chief failures has been its large, siloed departments that too often operate as jealous rivals rather than partners. If the health consolidation can cut through that, terrific. But the supervisors should not forget the failures that led them to create three separate departments in the first place. Leaders of the county’s mental health and public health programs should continue to have direct access to the county’s top policymaking and budget officials to ensure that their missions don’t again fall into second-tier status.