It has seemed mission impossible: hiring someone to run Los Angeles County's mammoth, troubled health department.
For more than two years, the task of heading a $3.5-billion agency that serves the county's neediest and sickest patients has fallen to an interim director who has made it clear that he does not want the top job permanently.
It remains uncertain if the vacancy at the top of the Department of Health Services, which is plagued with chronic financial woes and overburdened emergency rooms, will be filled anytime soon.
The latest candidate to come close to a vote is Daniel J. Snyder, a former hospital executive for the U.S. Navy and several private hospital companies. But the county's elected supervisors appear lukewarm toward him and delayed a vote originally scheduled for early June.
William T Fujioka, the county's chief executive, said this week that the search for a new chief continues.
It is no secret why heading the health department is considered an undesirable job by many potential candidates. Aside from having to operate with a budget gap in the hundreds of millions of dollars, the department chief has to answer to five supervisors, all fiercely protective of the hospitals in their districts and legendary for second-guessing directors' decisions.
Few longtime observers hold any hope that an attractive candidate will soon raise a hand.
"There are five bosses, they're intentionally political, they are divided," said Dr. Brian Johnston, an emergency room physician who has long kept tabs on the department. "They have a lousy track record on healthcare, and they have successfully managed to blame a succession of directors."
Jim Lott, executive vice president of the Hospital Assn. of Southern California, said he's tried unofficially to recruit candidates for the position.
"There's been a dearth of applications the county would find to be the type that they want, because the rancor and the political malaise we have here has gained nationwide attention," Lott said. "The good candidates have been scared away."
The department has a storied history of dysfunction. A new chief will face a deep budget gap unlikely to be eliminated anytime soon.
The supervisors and the department have managed to keep the hospital system afloat over the last 15 years with the help of billions of dollars from the federal government. Despite talk eight and 15 years ago of closing the county's flagship hospital, County-USC Medical Center northeast of downtown; Harbor-UCLA Medical Center near Torrance; or Olive View-UCLA Medical Center in Sylmar, the three remain open.
But failures have been significant, most notably the county's inability to turn around Martin Luther King Jr./Drew Medical Center in Willowbrook. In 2007, the hospital that opened seven years after the 1965 Watts riots shut down its emergency room and inpatient services after repeatedly placing patients at risk of major injury and death.
The new chief will have to act on plans to reopen King hospital by 2013.
At the same time, the department needs to find a path to financial security even as it prepares for national healthcare reform to take effect. One concern is that reform will mean fewer federal dollars for public hospitals as people with new access to insurance turn to the private sector. Currently, 70% of people seeking care at county facilities have no insurance.
"This is the largest healthcare delivery system on the West Coast. This isn't a training ground," Lott said. "You need a highly charged, highly trained and highly experienced [person] to do this."
Robert Tranquada, a former medical director at County-USC who is now retired, said the difficulties of the L.A. County job are well known in the field.
"There are good programs in New York, Chicago, Denver and Seattle and so on, and many other places where very experienced people could be sought," he said. "But I don't think anyone would want to be in the position the last several directors found themselves in: taking public heat every Tuesday and not being able to focus on what they do."
Numerous independent reports are virtually unanimous in calling for the Board of Supervisors to turn control of the department over to an independent authority, led by experts in managing healthcare systems. But such an approach would take away much of the supervisors' power and influence, and the board has not been eager to take that advice.
"They are very much in a reactionary perspective," said Lark Galloway-Gilliam, executive director of Community Health Councils, a nonprofit health advocacy and education organization. "If you just cut it loose and let it run like a hospital — like a Kaiser — it would be in better shape."
The independent authority concept, however, is being applied to King hospital. The county and the University of California have reached an agreement to create such an authority that will be responsible for opening and running King.