Cutting bureaucratic red tape for the public good
originally published on USC News, March 27, 2015
By overcoming obstacles, health services official reforms public health and strengthens communities
How does policy work impact public health issues and the community?
Mitchell Katz, director of the Los Angeles County Department of Health Services, discussed the topic during an event hosted on March 3 by the USC Price School of Public Policy’s Bedrosian Center on Governance and the Public Enterprise and the USC Leonard D. Schaeffer Center for Health Policy and Economics.
Katz focused his discussion on the challenges he has faced in health care management in which the policy goal was clear, simple and sound, but bureaucratic difficulties needed to be overcome in order to accomplish the objective.
Once you figure out what you want to do, you just have to figure out how you’re going to do it.
“How I frame a problem is that once you figure out what you want to do, you just have to figure out how you’re going to do it,” Katz said. “Whatever the obstacles are, you have to figure out the plan to go over, under or through the obstacles, always keeping the goal in mind.”
Official with a cause
Katz joined the San Francisco Department of Public Health, where he worked for 19 years, in 1991 at the height of the AIDS crisis.
AIDS had become the No. 1 cause of death among men in San Francisco almost overnight, and there was an obvious prevention in needle-exchange programs. Because California law said syringes could be dispensed only with a doctor’s prescription, it wasn’t possible to get public funding or even funding from donations.
Katz searched for any law that could help his cause, discovering that state law allows counties to suspend laws in case of public health emergency. The county declared a public health emergency and had to renew that declaration every two weeks for nine years to allow 2 million dirty needles to be exchanged for clean ones.
Four state counties followed San Francisco’s example, and finally in 2011 the California legislature passed a law that needle exchange could be funded without an emergency order.
He looks back at the needle-exchange program as the defining event that set the tone for his career mind-set of not giving up on a goal just because the law was against him.
I’m not moved just because you tell me something good is illegal. I’m not going to back off.
“One of the funny ways my San Francisco experience has helped me throughout my career is that when someone tells me something is illegal, I’m like, ‘OK, how else can we do it?’ ” Katz said. “I’m not moved just because you tell me something good is illegal. I’m not going to back off.”
He later tackled the issue of doctors being forbidden by the California Medical Practices Act to prescribe antibiotics for STD treatment to the partners of patients. He found a countervailing rule that the health and safety code authorized local health officials to take all necessary measures to prevent the transmission of infectious diseases.
By going up the bureaucratic ladder from the San Francisco Medical Society to the California Medical Society to the California legislature, he eventually got state approval for partner treatment.
His other accomplishments in San Francisco included the elimination of the written consent previously required for HIV testing and the creation of Healthy San Francisco for employer-based comprehensive health care coverage.
In Los Angeles, Katz addressed the long waits for specialty care by creating e-consults that enable primary care doctors to send a specialist the patient’s test results and history for a recommendation, eliminating the need for the patient to wait on an in-person appointment.
Dr. Katz has a long record of reforming public health systems in ways that have improved the quality of life for thousands.
“Dr. Katz has a long record of reforming public health systems in ways that have improved the quality of life for thousands, including many people who are among our neediest and most vulnerable,” said USC Price Professor Raphael Bostic, who directs the Bedrosian Center. “His message of adaptability and perseverance in overcoming obstacles to reach good governance serves as an example for Price students in all areas of study.”
Dana Goldman, director of the Schaeffer Center, added, “Dr. Katz is a visionary leader who designs innovative, evidence-based solutions to some of the most complex health care access problems of our time.”