The pandemic has led many cities to question the effectiveness, size and reach of Los Angeles County’s Department of Public Health. On Feb. 23, West Covina voted 4-1 to create their own health department, and San Dimas City Council is keeping a close eye on the secession.
During the pandemic, some of the 86 cities and two islands under the LACDPH have questioned whether the department is too big to be effective.
LACDPH oversees the public health of more than 10 million Angelenos, with a staff of more than 5,000 and a 2020 fiscal year budget of $1.5 billion, according to an email from their communications department.
West Covina is not the only city to question the effectiveness of LACDPH. In December 2020, the city of Lancaster in the Antelope Valley issued a vote of no confidence for the department’s head, Director Barbara Ferrer. While the vote is largely ceremonial, Lancaster is mulling over developing their own public health department, as are Beverly Hills and Whittier.
“This pandemic has highlighted the health officer’s role in a city, in a county. Realistically some cities have been able to do well, and others have hurt,” said San Dimas City Councilmember Ryan Vienna during the Dec. 8, 2020 city council meeting.
During the meeting, Vienna asked city staff to look at what it would take to establish an independent health department.
In January, Assistant City Manager Brian McKinney’s presentation showed that establishing a city health department would be a costly venture. Additionally, he made a list of the responsibilities and duties that a public health officer is required to do, according to 2018 state code — the list was 27 pages long.
“I don’t think it’s realistic enough in the next 12 months or six months,” Vienna said during the meeting.
Though all members of the city council agreed it is too soon to make bold moves, they will be watching to see what they can learn from West Covina.
“I am cautiously open-minded about it,” said Councilmember John Ebiner. He said that the discovery and information gathered is still important because it shows the strength and weaknesses of our relationship to Los Angeles County.
“My philosophy in general is if we’re going to do something, we have to do it right, well and better than other cities of our size,” Ebiner said.
Councilmember Denis Bertone said that even if other cities go ahead with it, he is against it mostly for financial reasons.
“People are really getting tired of [COVID-19 restrictions],” Bertone said. “But one of the things I’d be afraid of is a negative effect on the city budget. You have to keep in mind, less money is also coming in because of COVID-19.”
West Covina votes to create its own health department
In West Covina, City Councilmember Tony Wu spearheaded the effort to split.
“We want to separate from Los Angeles [Public Health Department] because they are the worst county in America in terms of COVID-19 numbers,” said Wu in a phone interview. “It’s just too huge … and they don’t cooperate with local governments. It’s just a big giant, and it doesn’t want to change.”
Wu said that West Covina is a big city with enough resources to get grants and private money for services like women’s care, childcare, mental health, and homelessness.
In contrast, McKinney cited the highly competitive nature of state and federal grants as a barrier to funding for San Dimas during the January San Dimas City Council meeting.
The earliest time West Covina could start their new public health department would be July 1. In a Feb. 24 press release, the city said they do not anticipate having a health department at the level of Pasadena or Long Beach by then, but they do intend to provide services that are responsive to community needs.
“We know our local people,” Wu said. ”We know the retirement homes. We won’t neglect them.”
West Covina Mayor Letty Lopez-Viado said during a city council meeting in February that the county had not provided “services of the caliber that everybody would like.”
While they and a majority of the council agreed that Los Angeles County has been neglectful to smaller cities like West Covina, the lone dissenter, Councilmember Brian Tabatabai said the city is just not prepared enough to go it alone.
Tabatabai said creating a new health department should go beyond the pandemic. He said local elected officials should ask themselves if they had issues with the Los Angeles County Department of Public Health before the pandemic.
“All other cities who have considered this project, including San Dimas, are taking their time to study the feasibility of creating a city-run health department,” Tabatabai wrote in an email. “They are developing institutional knowledge and they are approaching the idea with the long term in mind, not as a reaction to Covid-19.”
There are only three cities in California that maintain their own public health department: Berkeley, Pasadena and Long Beach. All of them are over 100 years old. The city of Vernon has an environmental health department, but they have not been certified by the state, which is a critical step in becoming a completely independent public health department.
“In 2013 the City of Los Angeles actually looked into [breaking away from LACDPH], but after months of analyzing the costs they found it to be way too expensive,” said Shawn Granger, who holds a master’s in public administration and is a doctoral candidate in public administration at the University of La Verne. He is researching inter-organizational networking in Los Angeles County during the COVID-19 crisis.
Granger also works as an information technology manager for the city of West Covina.
“A cheaper alternative could be to invest in a task force with the Los Angeles County Public Health to improve particular services that are getting the complaints,” Granger said.
Implications for San Dimas taxpayers
According to McKinney’s report to San Dimas City Council, San Dimas’ assessed property valuation is at more than $5.6 billion. Almost $15 million, or roughly 26%, is appropriated to Los Angeles County for their services, and roughly $4.7 million of taxes assessed on San Dimas property owners is used for county health and sanitation services.
If San Dimas were to create its own public health department, the portion of San Dimas’ 1% property tax from residents and businesses that currently goes toward the Los Angeles County Department of Public Health would most likely still go to Los Angeles County. The city of San Dimas would need to fund the health department mostly through highly competitive federal and state grants and through its general fund.
San Dimas resident David Estrada is a former union representative for public health workers in Los Angeles County.
“I object strongly to this – it frightens me,” said Estrada. “If you have a problem with the way Los Angeles County is handling things, you should step up and address it.”
He said that the LACDPH saves lives every day and that the reasons to look into splitting are mostly political.
How San Dimas’ budget compares
In comparison to Pasadena, which has its own public health department, San Dimas has a population of more than 33,000 while Pasadena is more than four times that size with a population of more than 141,000. San Dimas’ total adopted budget for 2020-2021 was $41.7 million while Pasadena’s 2021 fiscal year’s adopted budget is more than $877.7 million, more than 21 times larger.
Pasadena’s total budget for a public health department is $15.5 million.
West Covina’s money woes
“[West Covina] did not do the necessary work in order to outreach, study or develop what creating our own department would look like or cost,” said Tabatabai in an email. “There is simply no plan and no funds to create this huge bureaucracy.”
A report from the California State Auditor’s Office in November of 2020 entitled “West Covina’s Ineffective Fiscal Management Threatens Its Ability to Meet Its Financial Obligations and to Provide City Services” warned that West Covina could face bankruptcy if they did not find ways to become less dependent on their general fund and increase the amount of revenue.
The audit even goes on to say that West Covina’s efforts to address this shortfall falls short. According to the report, even West Covina’s sale of land to a development firm of $13.5 million is just a one-time revenue source that insufficiently addresses the city’s ability to generate revenue and rebuild its reserves.
The audit states, “If West Covina is unable to resolve its structural deficit, it risks becoming embroiled in the lengthy and complex process of declaring municipal bankruptcy.”
The work that goes into establishing a new public health department is an immense undertaking for any city. The LACDPH will continue to be the managing health department for West Covina until the city is certified by the state.
The next step for West Covina to separate is to determine state requirements, according to Granger. Then the city council will need to build an organizational chart, write policies and complete paperwork. They will need to hire a health officer and acquire the money to hire staff, proceed to hire that staff, and build all the required programs. Once all required programs are certified by the state, only then can West Covina begin to take over responsibilities of a health department. At that point, the city can negotiate to get their property tax money back from the county through a county referendum.
West Covina City Councilmember Tony Wu said there would be a volunteer health officer who would oversee the formulation of the health department and fill a necessary role to getting state certified. He went on to say that the start-up costs for building a new health department “would be free.”
During West Covina’s April 6 city council meeting, the city voted to create a health officer role and adopt health codes. The health codes of West Covina will very closely resemble that of Los Angeles County. In their research, West Covina staff found that it is illegal to have a volunteer health officer. The next day, West Covina’s Human Resources Department made the recommendation to pay the health officer an annual salary between: $154,368 and $187,644.
“Running a city is much like running a household,” said Granger. “We’d all love to have the best of everything, but a lot needs to be considered first.”