Ventura County Supervisor Judy Mikels lashed out at county Health Care Agency Director Pierre Durand on Tuesday, accusing him and other top health officials of running the county's medical system as a fiefdom with little public accountability.
The Health Care Agency and the Behavioral Health Department, which the agency oversees, "do not believe they are part of the county," Mikels said. "They do not believe they have to report to the Board of Supervisors. They do not believe the Board of Supervisors makes policy.... But it is the board's responsibility to hold everyone accountable."
In a meeting Tuesday, Mikels joined her board colleagues in unanimously authorizing a study of whether to move Behavioral Health out from under Durand's control and have the department report directly to County Executive Officer Johnny Johnston.
The board also plans to review the performance of Behavioral Health Director David Gudeman. Critics say he has failed to provide needed mental health services and that he feuds with other county agency heads over which budget should be used to pay for treatment.
Johnston said his report on whether Behavioral Health should be a separate agency will take about a month to complete. Twenty-six other California counties, including Los Angeles and Santa Barbara, already follow that model.
Recommendations on Gudeman's future will come much more quickly, possibly in the next week or two, the county chief said.
"I've been working on this issue for five months, so I should be able to pull that together pretty quickly," Johnston said. "The real question is: Is the board satisfied? It was pretty clear to me that the board is not satisfied--nor is the community. My preliminary findings are that I am not very satisfied either."
Mikels' comments about the Health Care Agency are significant because she has in the past been one of Durand's strongest defenders on the Board of Supervisors. Her criticism could indicate that political support for the powerful agency head is slipping.
Durand's $242-million agency administers a web of health services, including Ventura County Medical Center, public health programs, the coroner's office and the mental health division. Durand is credited with updating the county's aging public hospital, opening a series of community clinics used by poor families and offering a low-cost health insurance program to county employees.
But his leadership of the Behavioral Health Department has been more controversial. Former Behavioral Health Director Steve Kaplan supported an attempt to move the department out of Durand's control. Kaplan said he felt that Durand was focusing on the hospital, not mental health services.
The move sparked a bureaucratic war and prompted several state and federal investigations. One federal inquiry into the county's billing practices resulted in a $15.3-million fine.
Kaplan resigned and supervisors, in a split vote, gave the job to Gudeman, Durand's hand-picked replacement. Critics say the turf wars have continued under Gudeman's watch.
Durand declined to comment.
Mikels, reached after the meeting, said she still admires Durand's abilities.
"Pierre is successful," Mikels said. "But there seems to be this migration from feeling like a part of county government to acting like a stand-alone agency already. And I always say, 'Where there's smoke, there's fire.'"
Gudeman defended his department and the Health Care Agency as being well-run. He said his department has increased mental health services even as his budget was slashed.
The mental health chief, a UCLA-trained psychiatrist, said he welcomes any evaluation of his performance.
"The board had a spirited discussion today and I hope the county will make wise decisions," he said. "I'm going to do what I'm told and do a good job as a physician and administrator."