L.A. Area urban areas face an intense undertaking Some envision their own such agency, akin to what Long Beach, Pasadena, Berkeley and Vernon have. Others have been flirting with pooling resources among two or three other cities.
Just as the pandemic is at its worst, a handful of cities in Los Angeles County are seeking to break away from the county’s massive Public Health Department, seeking to create their own.
On Thursday, the city of Lancaster approved a city report on how to do it. That came on the heels of the city of Beverly Hills’ resolution to do the same earlier. Whittier, West Covina, Santa Clarita and Palmdale are all exploring the idea.
The county has initiated waves of restrictions aimed at battling the virus’ relentless recent surge, but the tipping point was the decision to shut down outdoor dining at the county’s 31,000 restaurants.
Add that to frustration city leaders expressed over physically distant downtown policymakers and the cities’ own independent streaks.
Some envision their own such agency, akin to departments operated by Long Beach, Pasadena, Berkeley and Vernon — the only other city-run health departments in the state.
Others have flirted with pooling together smaller mutlicity health departments or contracting for services with a neighboring city — or county.
Whatever the breakaway strategy, it won’t be easy.
Cities face substantial legal requirements in the state’s Health & Safety Code, to be approved by the state’s health department. Health officers and staff also face rigorous vetting. Assembling teams of trained professionals also isn’t cheap.
Experts caution that if you’re going to do it, make sure you’re ready — and aren’t doing it for the wrong reasons, like making a political point.
The scope of such an agency, even for a smaller city, is immense, they say. The expectations range well beyond restaurant inspections and immunizations for these departments, that were invisible to many until the current crisis thrust them into the spotlight.
“If you are going to form one, you better be prepared to provide the types and level of program and service the community needs across many many different areas,” said Lori Tremmel Freeman, chief executive officer of the National Association of County and City Health Officials.
“I just don’t think anything can happen very quickly,” said Freeman, who noted that gathering the expertise, mounting the needed certifications and scaling up the diversity of services provided by a health department is not an easy in normal times, let alone during a pandemic.
If cities were successful in their breakaway, they’d still be losing the scope and resources of the county, which legally has jurisdiction over public health functions in the county, save Long Beach and Pasadena, which report their own numbers and can choose not to adhere to the county’s health orders.
The county’s Department of Public Health is one of the largest such departments in the nation and is nationally accredited by the Public Health Accreditation Board.
With an annual budget over $940 million and a staff of more than 4,000, the L.A. County department has legal jurisdiction over a region of 10 million residents. Not all of those thousands are public figures, but such folks as Health Director Barbara Ferrer and Health Officer Muntu Davis have become the faces and voices of the county’s drive to beat back the deadly outbreak.
Before the COVID-era, the department was well known for its restaurant grading inspections. But its range of responsibilities go way beyond that.
It’s services are vast, including work in HIV and STD screenings; tuberculosis control; immunization; acute communicable disease control; community health services; maternal, child and adolescent health; women’s health; environmental health; emergency preparedness and response; children’s medical services; and health assessment and epidemiology.
It also works on broader environmental health issues, such as fostering health studies in such areas as Porter Ranch, in the San Fernando Valley, where the nation’s largest natural gas leak made headlines five years ago. And the debate in that community is arguably just as fierce today.
Lisa Derderian, spokeswoman in the city of Pasadena, said starting a health department is a “major undertaking.” Pasadena established its health department in 1892 according to the city’s website.
Derderian said it’s an advantage of an independent, smaller jurisdiction, where for decades the agency has forged ties with with local businesses. When a major event happens, enforcement teams are nimble and the agency’s focus is on a singular city.
Many of the responsibilities are the same as the county — from maternal care to child health to monitoring the public health at congregate settings, Derderian said.
Lancaster is a city that sees that kind of local touch as motivation to create an agency.
But there’s also a huge legal process involved to get certified by the state, local and national officials said. Even Lancaster Mayor Rex Parris said that a local agency in his city would need the force of the state to function properly.
The state assesses economic and geographic factors, establishes standards of education and experience for professional and technical personnel employed in local health departments and for the organization and operation of the local health departments. There are standards for the maintenance of records of services, finances and expenditures.
Much of the state’s code speaks to county’s authority to establish a health department.
On the county level, each board of supervisors “shall appoint a health officer who is a county officer,” for instance.
“The county health officer shall be a graduate of a medical college of good standing and repute,” according to the statutes. “His or her compensation shall be determined by the board of supervisors.”
All of which is set up now, in L.A. County.
“Existing county health departments have both specialized personnel and hospital and clinical facilities which a city would have trouble duplicating in short order. These include epidemiologists, inspectors, sanitarians, engineers, lab technicians, patient care professionals, and on and on,” said Howard Greenwald, a professor at USC’s Sol Price School of Public Policy.
Greenwald pointed to other barriers, including obtaining the funding to establish a health department.
“I’d guess that there would be fierce battles over funding, as cities competed with counties for resources,” he said.
Also, accreditation is a “tedious process and success depends on demonstrating capability and resources,” he noted.
“It is a lot, in terms of thinking about what’s needed and staffing, and Title 17 requirements,” said Davis, L.A. County’s health officer. “Those are things that are needed to be incorporated into what the health department does.”
Local officials stress they are not naive about the process — wary that they may be on the verge of creating a whole new layer of government that could prompt more difficult funding choices.
“The reason we want our own public health department goes beyond COVID,” said Parris. “It’s a plethora of programs that if we had local control of we could target those funds to areas where we need them. If you do it on a countywide basis it makes little sense for outlying areas.”
But they also added this is not something thought up in a day and don’t expect it to come overnight.
In Santa Clarita and Palmdale, tensions have been brewing for a while over the connection between local leaders and county policymakers downtown, some said.
“While we have traditionally valued the partnership with the county, that relationship is being increasingly strained,” said Palmdale Mayor Steve Hofbauer. “There has been an ongoing dialogue surrounding the actual fiscal value in allowing/contracting for some of the county services to our cities. There seems to be an effort by some to balance the county’s budget on our backs. We’ve seen that in the outrageous increase proposed for animal control services. Then there are comments made by some supervisors that their law enforcement pricing needs to be dramatically increased.”
Santa Clarita Mayor Cameron Smyth reached back in to history to note that his city has always had an independent strain in dealing with the county.
In Beverly Hills, Mayor Lester Friedman emphasized that it’s still early, but worth exploration, noting that his city on Tuesday voted a probe into the feasibility of a health department.
“I don’t think it’s something that something any city official wants to do, to create a whole new bureaucracy,” he said. “But if they are not getting the (necessary) response from the county department of health it really leaves us no other option.”
Collect By: pasadenastarnews.com