The West Covina City Council made a bold statement by voting to terminate services with the Los Angeles County Department of Public Health last week as the community — and other local cities, many contemplating their own such moves — looked on.
The hard part, however, lies ahead: Creating a team that can deliver all the state-mandated services of an independent health department. It’s not just the roles amplified during the county’s response to COVID-19 outbreak, but also scores of other tasks including issuing birth and death certificates, inspecting restaurants, overseeing mental health and substance-abuse treatment and assuring that public-school students are vaccinated.
Perhaps the most challenging riddle to solve — lining up the dollars to pay for it all.
Councilmember Tony Wu, contending that the county’s pandemic-spurred limits on business and other decisions “damaged people’s freedom and lives,” said the key issue is control. The mission, he said, will be to tap local data and local expertise to forge local decisions.
“People are frustrated, very upset,” said Wu. “People are angry. My job is find a solution. The solution is what we are trying to do right now. It’s very hard. It’s not easy to do what we’re doing right now.”
“Obviously, we want to save all 86 cities to the greatest extent possible,” said Dr. Paul Simon, chief science officer for LACDPH. “We’ve faced unprecedented challenges with this pandemic so we know there has been a lot of frustration not only among cities but members of the public.”
Simon said his department wants to have open communication with West Covina leaders to better understand their concerns. But should the city break away, Simon warned: “It’s not a simple process.”
“There are some state requirements for what a health department must do,” he said. “And there is an approval process.”
And, Simon added, “It’s certainly a financial commitment.”
Complex and costly
Wu and other officials say they understand that creating an independent health department will be a complex, costly and time-consuming mission.
The effort will demand funding, expertise, technology and other resources from a city in the midst of significant financial constraints.
A California State Auditor’s Office report in December ranked West Covina the ninth most at-risk city in the state based on its fiscal health, warning that if leaders did not resolve ongoing structural budget deficits, the city of about 100,000 could face bankruptcy. The city’s reserve fund decreased from $20.5 million in 2014-15 to less than $10 million in 2018-19. The City Council declared a fiscal emergency in May, but current councilmembers have since put the blame on the previous administration and are working on a program — the report is due to the state auditor in July — to turn the city’s financial picture around.
Nonetheless, the breakaway is under way. The city’s first move: Send a letter to the Board of Supervisors communicating its intentions to terminate services from LACDPH by Monday. The annual deadline for cities to renew or terminate services with the county is March 1.
Next: Leaders will start mapping out staffing, structure, projected expenses to create and maintain the department, as well as possible funding sources. The county would continue to provide health department services until July 1.
The actual cost won’t be known for a while. But one of three California cities with its own health department is Pasadena, population 141,000, a mere 20 minutes or so away.
Pasadena’s public health budget has fluctuated between $12 and $13 million since 2015, according to Deputy Public Health Director Manuel Carmona. The budget will increase to around $17 million in 2021 as result of a three-year grant from the Centers for Disease Control, he said.
As for startup costs, the City of Roses probably wouldn’t be a fair comparison. Its health department’s launch date, which came even before the county’s, was 129 years ago.
Councilmember Brian Tabatabai provided a report from San Dimas, which also has researched the concept of breaking away from LACDPH, which estimated it would cost $60 million to $90 million to start a health department and $10 million to $15 million to maintain operations each year.
Meanwhile, West Covina officials were scheduled to meet with county representatives Friday to see if they could tap already collected tax dollars to help fund such a department. The county collects 1% of property taxes from West Covina for services. A third of that 1% goes toward Public Health Department services, which range from inspections and issuing licenses to providing education and assistance programs. In 2020, the county collected $31 million in property taxes from West Covina residents, about $10 million of which went toward public health services.
Public health officials, however, said last week the county will continue to collect those funds whether or not the city creates its own health department. Pasadena is not able to tap property taxes to fund its department, its officials said.
Funding options will be among the topics when Dr. Basil Vassantachart, who has been working as a health advisor to the city, meets Monday with City Manager David Carmany and Transtech, a civil engineering and building and safety services company, to discuss staffing and administration.
“The initial start-up will have to be a model that operates like an enterprise fund,” said Carmany, suggesting that the city could collect fees for such services as inspections.
Vassantachart challenged local leaders to innovate.
“What options do we have to save as much money as we can for the city?” Vassantachart asked. “The concept here is everyone wants to spend money. We want to provide a service in a cost-effective way. We need to explore new methods, more innovations, pull resources together.”
Robbyen Bird, West Covina’s finance director, is preparing a budget to share with the City Council at its March 16 meeting.
Vassantachart, who is gathering a group of doctors to meet state requirements, said collaboration will be key.
“We should think about innovation of utilizing resources and collaborating with the community,” Vassantachart said. “We should pool every resource together, no redundancy. This way it will benefit everybody and find a solution to solve all these problems.”
Hard questions
Not everyone in West Covina City is as enthusiastic as Wu and Vassantachart. Some believe the council should have worked harder to prepare for such a move before the big vote.
Tabatabai, the lone councilmember to vote against the breakaway, said a more detailed report of the fiscal impact should have been presented at the special meeting last Tuesday.
“The money we pay to the county is non-reimbursable. We’re not going to get it back,” said Tabatabai. “To the residents, (we should) let them know, we’re going to pay for a service we can no longer get.”
“They (City Council members) haven’t done any research,” said Peggy Martinez, a 38-year West Covina resident. “They have done absolutely no analysis for financing this or anything.”
“The lack of communication with residents is a big deal,” the retired nurse said. “I’m in the process of trying to figure it out because they could not answer questions.”
“Based on the size of the L.A. County Department of Health organization and the manpower they have, we think we may not be served to the same degree,” said Charles D. Hinman, superintendent of the West Covina Unified School District. “It will affect us dramatically, unless the city can replace the services that we currently get from the county. That’s our biggest concern.”
Hinman called the council’s move a surprise. “If we had a little bit of advance notice, we probably would have made our own phone calls and talked to some individuals about what exactly is going on here.”
The district, Hinman said, would rather have seen a plan up front for a fully funded department that included doctors, nurses and social workers — “everyone that we would need to serve our district.”
Despite their concerns, Hinman said the school board plans to work closely with the city. “We value our relationship with the city of West Covina,” Hinman said. “We’re the largest employer in the city of West Covina. We’d love to continue the positive relationship we built.”
Staffing and standards
“A health department is a backbone for improving the health of the entire community,” said Dr. Ying-Ying Goh, director of the Pasadena Public Health Department and the city’s medical officer.
Goh’s team makes sure the city’s homes are free of such toxics as lead. They run the city’s tobacco prevention program. They monitor local disease spread and examine the ways economic and social conditions impact health outcomes. They create a community health improvement plan. They make sure the food you ordered from a restaurant came from a safe, sanitary kitchen. And much more.
Local departments must attain and maintain state standards for staffing, training and services. Lots of them. “These are legal requirements we have to meet,” Goh said.
Primary among them: “You have to have a medical doctor full-time to be your health officer,” she said. “That’s whose office where all the legal authorities reside.”
Goh added: “And you can’t just throw a doctor out there with no staff. It’s costly.”
Most of her department’s funding comes from the state, but Goh said it’s not enough to cover all the costs.
Grants help make ends meet, but those are temporary funding sources that may not get renewed from year to year. Sometimes, that means hiring and training someone, then letting them go when the money runs out.
Since the pandemic began, health department funding has increased — a big change after years of declining budgets — and Goh hopes to keep the money in her department when the pandemic is over.
“I don’t want us to come out of this pandemic and be in the situation we were in before with progressively — from year to year — a decreased amount of resources going toward the public health system,” Goh said. “That would just be shameful for us to continue making that mistake.”
Staff writers David Rosenfield and Bradley Bermont contributed to this story.
