Dr. Mitch Katz cruises to the Edward R. Roybal Health Center in East Los Angeles on a bicycle. He's not allowed to take it into the elevator, so he hoists it on his shoulder to get to the exam rooms on the second floor.
"I'm not a very good car driver," he shrugged.
Katz isn't just a doctor, he's the Director of Health Services for L.A. County, running the second largest network of public hospitals and health clinics in the country, with 19,000 employees and a $4 billion annual budget. Yet he continues to see patients.
"I think it keeps people from seeing me as some clueless administrator," he said. "But mostly it makes me understand what works, what doesn't. It renews my soul."
Katz is in line for something bigger. The Los Angeles County Board of Supervisors on Tuesday will discuss whether to merge L.A.'s three health departments to create one enormous agency. Members of the board won't come out and say Katz is a frontrunner for the job to lead it, but they shower him with praise.
"Dr. Katz is responsible for a lot of good things," said Supervisor Mark Ridley-Thomas, who supports the merger idea. He says since taking over, Katz has improved patient care, cut down on wait times to see specialists and changed the culture — humanizing what was a massive bureaucracy.
"That’s Mitch Katz for you — and I think that’s what leadership is about," Ridley-Thomas said.
Katz has also won over homeless advocates, who praise his Housing for Health program. Homeless are frequent users of county health services, particularly high-cost emergency rooms and hospitals. In Katz's calculation, his department could save a lot of money by paying to house their "frequent fliers" to stabilize their deteriorating health.
"A hospital day costs anywhere from $1,500 to $3,000, depending on the level of care," he said. "We can house someone for under $1,000 a month."
The program procured 900 units, with the eventual goal of 10,000. Katz thinks it can even be extended to the jail system, which is also a primary provider of mental health services in the county.
"I can provide the housing, but I need mental health for the services," he said. And that's something a more comprehensive health agency could make happen.
But not everyone's happy about the proposed merger.
"The consumer and family voice would be lost in a larger bureaucracy," said Guyton Colantuono, director of Project Return Peer Support Network, a mental health services provider that contracts with the Department of Mental Health. Colantuono said he supports collaboration, but not at the cost of losing what the Mental Health department has built.
He said mental health, which has always taken a back seat to medical care, could lose its autonomy. Mental health advocates flooded the board when they first discussed the issue in January — and plan to again on Tuesday.
County Supervisor Sheila Kuehl said the departments haven't been collaborating well enough. For example, a patient could walk into one of L.A.'s county clinics with a fever, but then also need help with depression.
"You could get health services in one place, and when you go to mental health, they don't even know you've seen anybody and you start all over again," she said.
Greater collaboration could mean sharing facilities, so patients have one place to go for all their health needs.
"We are not serving our clients well by having these three different systems," she said.
A big advocate of the merger, Katz said uniting the departments under one agency would allow them to share resources and jointly focus on L.A.'s biggest problems — like homelessness.
"Let's choose the three or four projects that have the biggest impact," he said. "Let's put all of our resources towards those projects, and when we're done, then we'll go onto something else."