Wednesday, September 30, 2015

THOUGHTS ON LA COUNTY HEALTHCARE CONSOLIDATION/MEMORIES OF OCR ENFORCEMENT HISTORY OR LACK THEREOF

MItch is a good man who did a great job in SF as director of the AIDS office and then SFDPH. I was shocked but plesaed that LA hired him but for awhile he seemed to be swallowed up. I think the reorganization makes sense, could be more efficient and allow for better coordination. Mental health is always fighting for and deserving of more resources; his opposition to forcibly medicate persons with mental illness is not relevant to the re-org. 

http://www.latimes.com/local/countygovernment/la-me-mitch-katz-20150929-story.html

 My biggest pet peeve with LA County Health and Hospitals - lack of qualified and proficient interpreters for patients and family members with limited-English proficiency required by Federal and often but too frequently not effectively enforced by OCR, the agency I worked for. In recent years there were too many anecdotes about the lack of qualified Spanish-speaking interpreters in LA County-USC (General Hospital) a facility surrounded by perhaps the largest Latino community in the nation and a large number of Spanish speaking staff.

Just as pathetically, many doctors reported the failure of their attempt at interpretation by computer or over the internet as being woefully inadequate, and worse, inaccurate. Admittedly I was forcefully passionate on this issue from the beginning, before HIV arose, envisioning an elderly non-English speaker in a hospital unable to communicate or learn English. OCR did a lot of good on this issue in a lot of places over the years. My blog may have the description of our significant effective intervention in Phoenix with many hospitals in 2002 shortly after the LA office opened, one of OCR's most notable accomplishment.

But what has taken me 3 paragraphs to provide background for was the standoff I could never resolve near the end. Overwhelmed by HIPAA complaints without the provision of adequate additional resources to handle them, OCR rejected my pleas - and it may not surprise you to know they were sorely agitated by my never ending efforts - to open a discretionary compliance review over the issue at LA County. OCR is allowed but not required to conduct reviews, it's a tool used quite effectively over the years. But OCR is required to investigate complaints and those must be the priority when resources are limited. Meanwhile the advocates who were the source of many of the anecdotes I was hearing refused to file a complaint fearing our LEP Guidance Memorandum not strong enough, despite the fact that bringing LA County UP to meeting those standards as we had done in Phoenix would have been a massive improvement and helped so many of those limited English speakers they claim to represent. Unable to overcome this standoff or conundrum my biggest frustration.

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