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Garthwaite Quits County Health Agency

Battered by budget problems, politicians and King/Drew woes since taking the post in 2002, he leaves a job that may be difficult to fill.

November 30, 2005|Charles Ornstein, Tracy Weber and Jeffrey L. Rabin | Times Staff Writers

Los Angeles County health director Dr. Thomas Garthwaite resigned Tuesday, ending a tumultuous tenure of nearly four years marked by unrelenting budget woes and a deadly scandal at Martin Luther King Jr./Drew Medical Center.

The departure leaves leaderless a county Department of Health Services that oversees four general hospitals and a network of clinics that together treat about 715,000 patients a year, the vast majority uninsured. It also raises questions about who would want to replace Garthwaite.

"This is a thankless job. You could be the perfect person for this job and be under attack," said Linda Rosenstock, dean of UCLA's School of Public Health. "He's been beaten up in public for a very long time."

Garthwaite, 58, told the county Board of Supervisors in closed session that he had accepted a position as chief medical officer of Pennsylvania-based Catholic Health East, which has 31 general hospitals from Maine to Miami. He starts his new job in mid-January.

The mild-mannered physician who faced regular tongue-lashings from his bosses and endured repeated calls for his ouster, had been looking for a new job for months. He said he wanted to be closer to his family on the East Coast and focus primarily on his passion for improving patient care.

But he also suggested that he had tired of being publicly second-guessed.

"Hindsight is 20/20 and Monday morning is a great time to be quarterback, but I have to play them on Sunday," he said in an interview. When decisions "don't work, I get the blame and if they work, I don't get much of the credit."

Garthwaite, who has served in the post since February 2002, is the third health chief to leave in a little more than a decade. All have had uneasy -- and at times rancorous -- relationships with their bosses, the county Board of Supervisors.

Although he was handpicked by the supervisors after a nine-month search, Garthwaite turned out to be, by many accounts, less than ideal for the job. He arrived in Los Angeles after serving as the top medical officer for the U.S. Department of Veterans Affairs, a low-key administrator who brightened when discussing the implications of healthcare data. But the new job demanded political savvy and a thick skin.

Still, he racked up some successes, especially early on.

For instance, he helped craft a 2002 county ballot initiative that raised taxes to support an unraveling trauma care system. More recently, he earned praise for hiring a team of senior executives to help run his department, including a new administrator for King/Drew.

But Garthwaite, who earned $287,513 annually, will perhaps best be remembered for failing to find permanent solutions to the problems he inherited.

He delayed his department's insolvency, but the budget shortfall still is expected to hit $866 million within three years. And he has admitted moving too slowly to fix King/Drew, which has been plagued by mismanagement and sometimes lethal lapses in patient care for more than a decade. Despite two years of reform efforts, the hospital has lost its accreditation and continues to risk losing crucial federal funding.

The firm he hired to turn around the hospital's fortunes, Navigant Consulting Inc., has been repeatedly faulted by county auditors for failing to follow through on its own recommendations and overbilling the county for travel and other expenses. In addition, some county supervisors have accused the firm of withholding information about problems at the hospital. All the while, Garthwaite has defended the firm and even pushed for a contract extension.

Still, news of his departure renewed questions about whether anyone could do his job -- and whether his failures were, in fact, really those of the Board of Supervisors.

"He's been kind of a scapegoat," Supervisor Zev Yaroslavsky acknowledged.

Garthwaite fell victim to some of the same pitfalls that crippled his predecessors. The five supervisors demanded aggressive changes and then, at every turn, questioned his attempts to respond.

The county leaders "are not the easiest Board of Supervisors to work with," said Robert C. Gates, who retired as health director in 1995. "They function themselves in a highly political environment.... It's a tough environment to succeed in."

Gates, who physically collapsed after a grilling by Supervisor Gloria Molina late in his tenure, said, "The board's own conduct" -- verbally lashing him and his successors -- was one of the worst parts of his job.

"It should never happen," he said.

Yet it happened to Gates' successor, Mark Finucane, and it happened to Garthwaite, especially over King/Drew.

During one public dressing down last April, Molina ordered Garthwaite to move his office from downtown Los Angeles to King/Drew, which is in Willowbrook, south of Watts.

"Park yourself there," she told him to hoots from the audience. "Take your schedule. Tear it up and spend every moment that you're working for us on solving this crisis."

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