New health chief rolls into town

In the public imagination, San Francisco and Los Angeles have long been California’s odd couple. They’ve got cable cars, we’ve got freeways. They’ve got cioppino, we’ve got burgers. They’ve got the pennant-winning Giants, we’ve got…oh, never mind.

But soon San Francisco and L.A. will have someone very important in common:

Dr. Mitchell Katz.

Katz, San Francisco’s top health official since 1997, is set to leave the City by the Bay to become L.A. County’s director of health services in January.

His charge: to lead the vast county health care system into the future—fast. In the course of the next three years, Katz and his department will seek to reshape how care is delivered here. That means implementing national health care reforms that emphasize preventive care and increase access to outpatient services rather than continuing to pour resources into the large public hospitals that have long been the cornerstones of the L.A. system.

“Something I’d like to work on in Los Angeles is creation of a comprehensive ambulatory care system that includes both the private providers and the public providers,” Katz said, describing the county as the “glue” that would unite the systems. “Every clinic has to be clearly connected to a hospital that takes their referrals.”

He also wants to create a “system of record” in which each patient will have a “primary care home” and medical records in a centralized registry. That will make it easier for providers to know, for example, which patients have diabetes and to make sure they keep up with the eye exams their condition requires.

Katz, 50, said he is a “change agent, not a figurehead.” Even as San Francisco’s top health official, he still makes a point of working as a hands-on doctor for about one day a week—something that the Harvard Medical School grad intends to keep doing when he gets to L.A.

“You find out what’s working and what isn’t,” he said. Moreover, the frontline work creates credibility and a sense of shared understanding with the staff—which are important when it comes time to propose new ways of doing things.

“The natural response to an administrator is ‘You don’t know what it’s like to take care of our patients.’ Well, no one ever says that to me.

“When I’m in my room, I have my stethoscope, my prescription pad. I’m like anyone else.”

Katz, who will earn $355,000 a year in L.A., was recruited to come here two years ago but declined, citing unfinished work in San Francisco. That included seeing through the implementation of the award-winning Healthy San Francisco, a voluntary universal healthcare program that provides coverage to more than 54,000 people.

Making the move now, he said, just “feels right.” Many in the Los Angeles County Health Department, which is battling a large deficit and has not had a permanent leader for more than two years, have reached out to him by phone or email since his appointment, offering to do “everything they can to help me,” Katz said.

While Katz believes L.A. and San Francisco are far from polar opposites from a health care perspective—“I think they are more alike than different”—he knows that his management approach will have to change somewhat when he makes the move.

“I’m a very hands-on person,” Katz said. “I know every single health center in San Francisco that’s part of my department. Most of them I’ve actually worked in as a doctor. I can bicycle to any of them.”

In L.A., “I have to think of a completely different way to be. You can’t do a lot of walking around when it takes two hours to drive somewhere.”

The county’s vast sprawl can be even more daunting if you’re a self-described bad driver.

“I’m terrible!” Katz said. “It’s certainly going to be a challenge to me.”

Katz, a committed bicycle commuter in San Francisco, said he can often be seen pedaling around town in tie and jacket, his backpack stuffed with papers. “It’s not unusual,” he said, “for someone to yell out, ‘Hi, Dr. Katz!’ “

After he moves to L.A. in January (his partner, Igael Gurin-Malous, a teacher, and their kids Maxwell, 8, and Roxie, 6, will join him when the school year is over) Katz intends to continue his cycling ways.

He’s looking for a house in a neighborhood, perhaps Silver Lake or Los Feliz, that’s within biking distance of his new office and County-USC Medical Center. He knows he will need to get behind the wheel to get to more far-flung hospitals such as Olive View-UCLA Medical Center in Sylmar. “I’ll just have to do it,” he said.

But he doesn’t sound like he’s planning to become a Southern California car culture convert any time soon.

“I do not love cars,” he said. “I think that the world would be a better place if more people bicycled.”

Posted 10/25/10