Lawmaker Calls for 'Substantive Change in Culture' at State Health Department

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Assembly member Richard Pan (D-Sacramento) yesterday called for increased transparency and accountability in the Department of Health Care Services. He has introduced three bills designed to open up dialogue between DHCS and stakeholders. DHCS officials have voiced opposition to those efforts, and took the unusual step last month to write an official letter of opposition to one of those bills.

That resistance is the kind of thing Pan said he has continually run up against in his dealings with DHCS. He chaired a hearing Tuesday examining a two-year-long attempt to get DHCS officials to explain why their policy on blood tests for allergy and asthma patients was different from national guidelines. In those two years of discussion, Pan said, he has never received a real answer, only "stonewalling."

"I think it does speak to a culture over there at DHCS," Pan said.

"I mean, I'm the chair of the Assembly health committee and I can't get anyone to listen," Pan said. "God help anyone else who has a legitimate concern and wants to discuss it."

No DHCS officials commented today. One DHCS official – medical director Neal Kohatsu – responded to Pan’s complaints at the hearing Tuesday, saying DHCS would change its allergy blood-test policy. Pan said that was good, but that it shouldn't take two years of argument to make state policy align with federal guidelines. Pan said he plans to have a follow-up hearing next month to revisit this issue in some fashion.

Pan first heard of the conflict between state policy and national guidelines in June 2012. He wrote a letter to DHCS, informing them of the issue, then arranged a meeting with Kohatsu after there was little response from the department, Pan said.

"I sent reasoned comment back and it was blown off, and their resistance just increased over time," Pan said. "I didn't come in and say, 'Here's my evidence, you need to do this or that,' I didn't say that. I just wanted to know what they were basing their policy decisions on."

Pan said his concern goes far beyond allergy treatment.

"This is bigger than just fix the allergy thing. I've heard it over and over again from stakeholders. Complaints go one way and they don't get responded to. Directives go the other way and they don't allow any response. What is the public supposed to think?"

"There needs to be a substantive change in the culture at DHCS," Pan said. "Is anyone happy with stakeholder process outside of the department? I don't think so."

DHCS has a $90 million budget, Pan said, making it one of the largest single agencies in the state.

"With a program this big, they should try to back up their decisions, and not bluff their way out of it and be evasive," Pan said.

As a practicing pediatrician in Sacramento, he said, "When I can't provide quality of care because Medi-Cal won't let me provide the quality of care, it's not me that's hurt," Pan said. "It's the patient who suffers."