Key Movers and Shakers in L.A.'s Public Health System.

Mark Casanova

Title: Executive director

Organization: Homeless Health Care

Los Angeles 

Age: 44

MARK Casanova went to college way too late for the Vietnam-era protest movement, but that didn't prevent him from spending his student years demonstrating for affirmative action and other social causes.

Despite the rabble rousing, Casanova eventually graduated in 1984 from UCLA with a bachelor's degree in Latin American history. He later got his master's in marriage, family and child therapy.

Today he's still fighting to make the world a better place as executive director of Homeless Health Care, which seeks to get homeless people off the streets, treat them for health problems and train them for jobs. It is one of the few county agencies that specifically aims to help homeless addicts. As head of a staff of 33 working out of a downtown office, Casanova has a $2 million budget to work with 500 homeless clients a year.

Casanova not only raises money for Homeless Health Care, manages its programs, oversees its drug treatment programs and plans its future, he also lobbies in Sacramento and Washington, D.C. for more funding.

"Health care for the homeless is a right, not a privilege," he said.

Casanova has been fighting for the health care rights of the homeless ever since 1985, when he worked as a counselor and case manager with the Salvation Army. He joined Homeless Health Care two years later.

Casanova, who grew up in the San Fernando Valley, came to his profession in a roundabout way. He heard the call to help the homeless while sitting on a therapist's couch, dealing with his post-divorce trauma. "I saw what this woman (the therapist) was doing and I knew I wanted to help poor people and offer a service, like therapy, at no charge," he recalls.

Deborah Belgum

Dr. Shirley Fannin

Title: Director of communicable disease control

Organization: LA. County Department of Health Services 

Age: 63

IF it's flu season, you'll be hearing words of wisdom from Dr. Shirley Fannin. If there is an outbreak of tuberculosis, Fannin will be quoted on the radio and TV.

For 18 years, Fannin has been the county's director of communicable disease control, which means she is in charge of controlling outbreaks and preventing epidemics in both people and animals. She administers a complex system of tracking more than 60 diseases, from meningitis to chicken pox.

Fannin, who is single, has more than herself and her adopted daughter to worry about. She has nearly 10 million Los Angeles County residents to fret over.

Fannin grew up in Illinois and graduated from the University of Illinois Medical School, with postgraduate training at Fresno General Hospital. She came to Los Angeles in 1969 to work with Dr. Benjamin Kagen at Cedars-Sinai Medical Center as part of a UCLA fellowship in infectious disease control. She is a board-certified pediatrician.

For several years, Fannin was a professor at both UCLA and Cal State Northridge. She joined the county health department in 1975 as chief of the acute communicable disease control unit, and has been there ever since.

Deborah Belgum

Jonathan E. Fielding

Title: Director

Organization: Public health division, L.A. County Department of Health Services

Age: 57

JONATHAN E. Fielding oversees planning, evaluation and policy development for L.A. County's diverse public health programs, which means he has final responsibility for everything from closing down unclean restaurants to stopping a syphilis outbreak to researching cures for cancer.

If that weren't enough, Fielding is also a professor of health services and pediatrics at UCLA and writes an occasional column on health issues for the Los Angeles Times. As director of the county's public health division, which has an annual budget of more than $430 million and employs 3,600 full-time workers, he promotes public health by meeting with the media and local, state, and national groups.

As part of his vision to manage the health of the county's population, Fielding commissioned a study released in January that made Los Angeles the first county to keep statistics not only on the causes of death of its residents, but of the factors that contributed to their deaths.

The results tilt the focus for the county's prevention efforts away from the usual causes of death, many of which are impossible or difficult to cure, and toward the behavioral factors that lead to death.

For example, the leading causes of death are heart disease, stroke, cancer of the respiratory system and pneumonia. But the key contributing factors to death are alcohol dependence, homicide and violence, and depression.

The study has proven a key tool in focusing prevention efforts and may play into decisions made as the county increases its focus on outpatient services, said Dr. Anna Long, Fielding's chief of staff.

"He's been very visionary in helping us restructure and reinvigorate public health," Long said. "He came in with a good consideration of what needs to happen and to make sure we're doing our best in our core functions."

Fielding is currently on a leave of absence and was unavailable for comment.

Milo Peinemann

Mark Finucane

Title: Director

Organization: L.A. County Department of Health Services

Age: 52

MARK Finucane may be feeling like a death-row inmate who has just been given a five-year reprieve. He has just completed months negotiating with state and federal officials to secure a $1.2 billion, five-year bailout for the county's health department. Without the reprieve, the county's public health system would have been on the rocks.

It is the second time the county has received a billion-dollar, five-year Medicaid waiver that allows the federal government to reimburse the county for outpatient services, not just inpatient services. And it was no easy sell -- state and federal officials alike were digging in their heels -- trying to pass the buck. In the end, Finucane and his colleagues prevailed.

But that's not to say Finucane can afford to rest on his laurels. He is in charge of operating a vast public health care network that comprises six county hospitals, 39 health centers, six comprehensive health centers, two residential rehabilitation centers for drug and alcohol abuse and 23,000 employees. He oversees a $2.6 billion annual budget.

Finucane was named the county's director of health services in 1996, at a time when the department was having a series of financial problems. There was debate on the size of a new facility being planned to replace earthquake-damaged County-USC Medical Center. The department needed to become leaner by laying off employees and more funds needed to be found to accommodate a system that was serving more than 2 million people with no health insurance.

Since his arrival, the Board of Supervisors has agreed to build a 600-bed replacement hospital for County-USC. In addition, the department has reduced its staff by 15 percent and found more state and federal funds.

Before working in Los Angeles, Finucane was director of the Contra Costa County Health Services Department from 1994 to 1996. From 1977 to 1984, he held a series of senior executive positions with the San Francisco Department of Health and San Francisco General Hospital.

Deborah Belgum

Liz Forer

Title: Executive director

Organization: Venice Family Clinic

Age: 43

IN 1995, three critical clinics on the Westside were threatened with closure in the face of L.A. County's public health care crisis, because county funds were no longer available to pay for them. Liz Forer played a key role in keeping them alive.

Under Forer's leadership, the Venice Family Clinic formed a coalition of four hospitals and three community clinics with a goal of privatizing services at the two county clinics. The clinic now operates these former county facilities and has increased the number of patients they treat by 30,000 a year. In the process, it has created an efficient system of primary care for people with low incomes and no health insurance.

Forer has been director of the Venice Family Clinic, the largest free clinic in the United States, since 1994. The clinic also serves as a department of the UCLA School of Medicine.

Forer currently serves on the board and executive committee of the California Primary Care Association of Los Angeles County. She is also on the advisory board for the Santa Monica UCLA Medical Center. She has master's degrees in social work and public health from Columbia University.

She worked for five years as executive director of a nonprofit community health center in East Harlem, N.Y., where her responsibility was the expansion of the center's primary and preventive health care services. She later headed a department at a New York City public hospital that was aimed at making the hospital more accessible to residents of the surrounding community.

Norinne De Gal

Randall S. Foster

Title: CEO 

Organization: Martin Luther King Jr./Drew Medical Center

Age: 49

AS head of Martin Luther King Jr./Drew Medical Center, Randall Foster's biggest concern during the current era of cutbacks at county hospitals is trying to shuttle clients away from his center and toward community clinics.

"Our struggle has been to provide more ambulatory care to patients," he said. "During the last four years, we have transferred more programs to six community clinics that link up to our 92-mile (coverage) area."

Foster has also spearheaded a drive to treat patients through "telemedicine." In the past two years, several community clinics in South Central and southwestern Los Angeles have begun offering computerized eye exams to determine whether people need glasses, which can be handled at a clinic, or whether they need eye surgery, which must be done at the county hospital. Telemedicine saves the county health department both time and money.

Since 1996, Foster has been head of King/Drew Medical Center, a hospital that serves 1.2 million people who are racially diverse and tend to be economically depressed. The challenges at the hospital go way beyond those found in a typical suburban private hospital. Fifty percent of the newborn infants in the neonatal intensive care unit are born to drug-addicted mothers, for example. In 1995, King/Drew treated 39 percent of L.A. County's gunshot victims. The 537-bed medical center has one of the busiest trauma centers in Los Angeles County.

Foster's 12-hour workdays are filled with as many as seven meetings, usually discussing ways to make the hospital run more efficiently.

His first job was working at County-USC Medical Center while he was an undergraduate. His job was to drive one of the underground trams that transfers supplies from one wing of the hospital to another. His second job was registering patients in the facility's emergency room. Sixteen jobs later, he became head of King/Drew. For a man who grew up in South Central, it was like coming home again, he says.

Deborah Belgum

Martin Gallegos

Title: Chairman

Organization: Assembly Health Committee

Age: 43

ASSEMBLYMAN Martin Gallegos has focused his legislative efforts on managed care reform. He was the author of AB 78, which created a new statewide Office of Managed Care. The new office, employing close to 300 people and already a model for other states looking to improve their health care oversight, will be a source of information to HMO patients as well as a regulating body.

Gallegos, D-Baldwin Park, said the idea behind the Office of Managed Care was to streamline the appeals process when people have a complaint against an HMO and to make the office more consumer-friendly than the state Department of Corporations, which previously oversaw HMOs.

Gallegos has also authored bills such as AB 974, designed to provide "continuity of care" by requiring HMOs to continue to pay for prescription drugs for patients with long-term conditions -- even if those drugs are later removed from the HMO's formulary. The law also requires managed care plans to provide consumers with a copy of their formulary list, enabling prospective and current enrollees to compare health-plan pharmacy benefits.

Since 1985, the assemblyman has maintained a private chiropractic practice with his wife Rita in Baldwin Park. In 1999, he was honored by Families USA Foundation with its Consumer Health Advocate Award. The San Gabriel Valley Chiropractic Society named Gallegos "Doctor of the Year" in 1997-98.

He was educated at East Los Angeles College, Occidental College and Los Angeles College of Chiropractic.

Norinne De Gal

Dr. James G. Haughton

Title: Medical director, public health programs and services

Organization: L.A. County Department of Health Services

Age: 75

As medical director or e county, Dr. James Haughton is responsible for administrative duties related to public health programs.

It keeps him busy.

"One of the biggest challenges working in public health in Los Angeles County is that we're an international venue, with five airports and one seaport," Haughton said. "What (public health crisis) happened anywhere else in the world yesterday can happen in L.A. today."

When an unusual case of a disease appears, Haughton and his staff play detective to track the origin and minimize an outbreak.

Last year, a child traveling from London was diagnosed with meningitis. Haughton and his crew had to track down passengers from the same flight to warn them of their exposure. The search led to people who had made their way throughout L.A. and to faraway places like New Zealand, Hawaii and London.

"We have incidents like that with some frequency," he said.

Among his many duties, Haughton also oversees programs to control communicable diseases. He spearheaded a program this year to control a syphilis outbreak, primarily among gay men, by distributing condoms and providing free testing.

Haughton, a trained OB/GYN, also manages the county's public health laboratory - the second-largest lab of its kind in the state - which performs such functions as molecular testing and development of new testing methods.

In addition, he oversees the county's 11 public health centers and supervises public health offices, nurses, investigators and other workers, while managing the health department's relationships with Medi-Cal and other groups that provide health care to patie[acute{n}]ts receiving public assistance.

"I shift gears 10 times a day," said Haughton, who joined the Los Angeles County health department in 1993 with years of experience in executive positions at public hospital and health agencies in New York City and Chicago. He received his medical degree from Loma Linda University College of Medicine, and has a master's degree in public health from Columbia University School of Public Health and Administrative Medicine.

Laura Dunphy

Mandy Johnson

Title: Executive director

Organization: Community Clinic Association of L.A. County

Age: 52

As executive director of the Community Clinic Association of Los Angeles County, Mandy Johnson heads a group that services 39 free and community clinics working with low-income patients, the majority of whom are women and children.

Most of these patients are working families with two and three jobs but no insurance. The association provides member organizations with technical assistance and a clear voice in public forums, especially when lobbying for health care for the poor and uninsured. Johnson stresses increasing early access to primary health care to avoid long-term medical costs, especially for children who go untreated by their impoverished parents.

Prior to assuming directorship of the association, Johnson served as a director of Los Angeles Homeless Health Care, the National Healthcare for the Homeless, and the St. Joseph Center in Venice. She is the former deputy director of the Venice Family Clinic and has 18 years of experience in primary health care management.

Johnson, who graduated from the University of Michigan and has taken advanced health care courses at UCLA, has been credited with restructuring the health care clinics that her group represents, especially as the cost of medical treatment escalates. She was out of town and unavailable for comment last week.

Frank Swertlow

Dr. Brian D. Johnston

Title: Chairman of the emergency medicine department

Organization: White Memorial Medical Center

Age: 62

DR. Brian Johnston first became interested in public health when he was a Peace Corps volunteer in the early 1960s on a remote island in the Philippines.

When he arrived to teach English as a second language, a cholera epidemic was raging. He saw that many of his students not only had trouble studying, they were dying of preventable diseases such as pneumonia, yaw and meningitis. Ever since, he has been an advocate for better health care for the poor.

When he returned to the United States, Johnston went to medical school at UC San Francisco and did his residency at Harbor-UCLA Medical Center. He has seen the raw end of the health care system, practicing emergency room medicine since 1973, primarily at White Memorial Medical Center in East Los Angeles.

"We see people every day who are not ting the health care they need - untreated hypertension and untreated diabetes," he said. "It is monumentally foolish not to treat these diseases because they become more expensive to treat when left."

Johnston has written countless newspaper opinion pieces pushing for more Medi-Cal funds for Los Angeles County and other areas, and has lobbied tirelessly for a larger facility to replace the earthquake-damaged County-USC Medical Center. He recently testified before an Assembly Select Committee on Health, urging the state to fund the county's health services department.

"A self-sufficient county is an absurdity if not an obscenity," Johnston said. "The county does not have the tax base to do the job. The health department in Los Angeles County is 94 percent funded by federal and state dollars."

Johnston takes a great interest in Los Angeles because he grew up in Hollywood, the son of a writer and an English professor. When he was a teen-ager, his family moved to Ajijic, an expatriate artist colony in Mexico, where his mother wrote novels and screenplays.

Johnston is married and has two children.

Deborah Belgum

Dr. Peter Kerndt

Title: Acting director, sexually transmitted disease program

Organization: L.A. County Department of Health Services

Age: 47

SIMPLY put, Dr. Peter Kerndt's job is to hunt down sexually transmitted disease and stop it from spreading -- a difficult job in such a diverse population as that of Los Angeles County.

The most recent outbreak is the spread of syphilis among gay and bisexual men. What concerns Kerndt the most about the outbreak is syphilitic sores that help spread HIV. The outbreak, Kerndt believes, means that "safe sex" could be on the decline among gays.

Before his current post, Kerndt served as director of the county's HIV epidemiology program for 11 years. In that role, he oversaw the county's official AIDS registry, conducted studies to determine the incidence and prevalence of HLV and AIDS cases, monitored trends of the epidemic among high-risk sub-populations, and managed vaccine preparedness studies.

"HIV as a sexually transmitted disease is the most challenging right now," he said. "But we have the ability to stop its spread."

Kerndt, who has published more than 30 papers in professional journals on HIV and other STDs, first encountered AIDS while he was at San Francisco General Hospital in 1979. "We didn't have a clue," he said. "I thought I wasn't a good enough doctor and I didn't know what was wrong."

Kerndt later helped identify the HIV2 virus in Los Angeles when a patient showed a new form of the crippling disease. He later helped identify another strain of AIDS, HIV Group 0, when a patient surfaced in Los Angeles.

Kerndt began his career in public health at the Centers for Disease Control and Prevention. Since 1987, he has provided clinical care and treatment at County-USC Medical Center's AIDS clinic.

Kerndt received his medical degree from the University of Iowa after earning his undergraduate degree in biology from Marquette University.

Frank Swertlow

Burt Margolin

Title: Director of public policy

Organization: Berliner, Candon, Jimison

Age: 49

BURT Margolin has the unprecedented distinction of having once been known as L.A. County's health czar, and he still plays a key role in the public health system.

Margolin was instrumental in helping the county Department of Health Services to convince the feds to come up with a $1 billion, five-year bailout five years ago. He was also instrumental in getting the most recent federal Medicaid waiver approved, dropping $1.2 billion into the health department's budget over the next five years and keeping the county health system afloat.

"The good news with the new waiver is, turmoil and service cuts have been avoided," said Margolin, a private attorney who serves as a legislative strategist and lobbyist for the Health Services Department.

Margolin recently was appointed to the three-person team responsible for negotiating the extension to the Medicaid waiver. And on an ongoing basis he advises Mark Finucane, executive director of the health department, on how to negotiate with the state and federal governments to acquire more funding.

The 49-year-old former assemblyman was first brought in to help the county in 1995 as chairman of the county's Health Crisis Task Force, which reviewed a $655 million funding shortfall facing the county and looked at possible solutions. In 1996, the Board of Supervisors hired Margolin and his firm to lobby the state and federal governments on the county's behalf for a Medicaid waiver.

Margolin has had plenty of political experience. He was once chief of staff for Rep. Henry Waxman, D-Los Angeles. He then served as a state assemblyman for 12 years and ran for state insurance commissioner in 1994, defeated in the primaries by Art Torres.

Margolin grew up in West Los Angeles and attended UCLA. His wife is a clinical psychologist.

Deborah Belgum

Dr. Laurene Mascola

Title: Chief, acute communicable disease control unit

Organization: L.A. County Department of Health Services

Age: Not available

DR. Laurene Mascola is in the hot seat of medicine in the new millennium. As the head of the L.A. County Department of Health Services' acute communicable disease control unit, her duties include keeping track of more than 60 diseases, any one of which has the potential to create an epidemic.

Also added to her duties in this complex and dangerous world is dealing with the threat of bio-terrorism. Mascola oversees a. $550,000 federal grant to track bio-terrorism over the next three to five years, enhancing surveillance and creating a health alert network to warn citizens in the event of a bio-terrorist attack.

Mascola's main task, though, is to monitor diseases and try to control epidemics. She oversees L.A. County's programs for immunization, food and water safety, and insect-borne disease control, among others. Mascola, who is out of the country until the end of July and thus was unavailable for comment, received her medical degree from St. Louis University and trained for her current post at the U.S. Centers for Disease Control's epidemic intelligence service in Atlanta. She has worked for the World Health Organization in Ethiopia, India, Brazil and Nepal.

She previously was an expert member of the FDA's Food and Safety Committee, in addition to serving on numerous national and statewide panels on AIDS/HIV. She has been an advocate for screening women for AIDS and the HIV virus to reduce the spread of disease, especially to children.

Mascola received her bachelor's degree in biology at the University of Rochester and her master's of public health degree from UCLA. She is an attending physician at Childrens Hospital in Los Angeles and an assistant professor of pediatrics at the USC School of Medicine.

Frank Swertlow

Tecla A. Mickoseff

Title: CEO

Organization: Harbor-UCLA Medical Center

Age: 52

As a science student Marymount College, Tecla Mickoseff thought her studies would lead to a career m outer space; one summer, she worked as a student intern on the Apollo project. But that was the 1970s, and by the time she graduated the aerospace industry had started downsizing. Instead, Mickoseff got a job with the county Health Services Department as an administrative assistant, and found she loved it.

"I kind of fell into my job. I found working in the budget division of the health department was stimulating. Health care is always changing," she said.

Over the past 17 years, Mickoseff has seen many of those changes at Harbor-UCLA Medical Center.

The medical center is one of six county hospitals that care for the uninsured poor. Over the years, Mickoseff has seen the medical center's staff dwindle from 3,400 in 1992 to 2,900 today. "When I first got here, we had more inpatient services. Lengths of stay have come down and there is more emphasis on outpatient care," she said.

Still, the hospital is a large facility with 553 beds and a $285 million annual budget. The medical center gets 77,000 emergency room visits and 25,000 inpatient visits a year.

"We provide 99 percent of the uncompensated care in the community," she said. "We are important to that patient. And we are the backbone of the emergency and trauma network in this area."

Deborah Belgum

Gloria Molina

Title: Supervisor, Fifth District

Organization: LA. County Board of Supervisors 

Age: 52

As L.A. County supervisors wrangle with state legislators over the future of the County-USC Medical Center, at the forefront of the debate is Gloria Molina.

Molina has been fiercely opposing the plans to build a comparatively small, 600-bed facility to replace the earthquake-damaged hospital, which is the most important single facility in the county for treating uninsured patients. Molina wants a 750-bed hospital, but has been outvoted on the issue by her four colleagues on the board.

Nonetheless, Molina continues to battle over County-USC and other public health issues impacting her East Los Angeles district, pushing to increase funding for county health programs and increase capacity of county clinics. She has served in the California Legislature and on the Los Angeles City Council, prior to being elected to the Board of Supervisors.

Molina is also active in federal politics, having served in the Carter White House, and has even been identified as a possible vice presidential candidate. She serves on the boards of the Metropolitan Transportation Authority, the Mexican American Legal Defense and Educational Fund, the Southwest Voter Registration and Education Project and the National Hispanic Leadership Agenda. She is also vice chair of the Democratic National Committee.

Molina is a native Angeleno and the eldest of 10 children. She is a graduate of El Rancho High School in Pico Rivera and has attended East Los Angeles College and Rio Hondo College.

Norinne De Gal

Beth Osthimer

Title: Senior attorney for health policy

Organization: Neighborhood Legal Services 

Age: 44

BETH Osthimer is considered among the foremost local experts on public health care and has played a key role in the county's recent efforts to extend the federal Medicaid waiver. In essence, when supervisors and other legislators need counsel on public health issues, they turn to Osthimer - who is also frequently quoted in the media on health care issues.

Located in Pacoima, Neighborhood Legal Services provides legal aid to low-income clients in the San Fernando and Santa Clarita valleys and serves approximately 15,000 individuals and families each year. Osthimer heads up the group's Health Consumer Center, a health care rights advocacy center for the low-income residents of L.A. County.

As head of the HCC, Osthimer participates in little actual litigation herself, instead helping with overall strategizing on the cases for the attorneys assigned to them.

"I absolutely love my job; it revolves around expanding coverage for low-income people," Osthimer said. "It is not all straight legal issues; some of it is policy."

The ultimate responsibility for the health care needs of L.A. County's 3 million uninsured residents falls on the county government, but Osthimer believes that the state and federal governments need to share more of the responsibility.

Prior to her work with HCC, Osthimer worked for four years at Greater Bakersfield Legal Assistance and the Legal Aid Foundation of Los Angeles. She also spent two years in private practice.

She has a bachelor's degree from UCLA and is a 1983 graduate of UCLA Law School.

Norinne De Gal

Anthony Rodgers

Title: CEO

Organization: L.A. Care Health Plan

Age: 51

ANTHONY Rodgers has been chief executive of L.A. Care Health Plan practically since the organization was created in 1994. The plan, which has a large state contract to serve Medi-Cal recipients in Los Angeles County, began working with indigent residents in 1997. Its client base now consists of 580,000 people.

L.A. Care is a public-private consortium to administer health care to Medi-Cal patients. Because of the large number of poor who use L.A. Care, it has become one of the largest HMOs in the state and the largest public health plan in the United States.

"For the first time, many Medi-Cal beneficiaries have access to the same system of care utilized by the majority of Californians," Rodgers said.

Through the California Healthy Families program, L.A. Care also offers health care access to children who do not qualify for Medi-Cal, but whose families cannot afford private insurance,

Working in Los Angeles County's health system is nothing new for Rodgers, who started as a planner in the county Department of Health Services before moving on to Olive View Medical Center in the San Fernando Valley, where he was associate administrator.

In 1990 he was recruited to join Maricopa County's health department, the public health agency for metropolitan Phoenix.

Rodgers grew up in East L.A., near White Memorial Hospital, where he worked as a teenager. He received his undergraduate degrees in political science and economics and a master's degree in public health from UCLA.

One of his early jobs was working with the office of the Major League Baseball commissioner. He coordinated the collection of professional baseball players' lab specimens.

Deborah Belgum

Roberto Rodriguez

Title: Executive director,

Organization: LA. County-USC Healthcare Network

Age: 53

ROBERTO Rodriguez is in the hot seat when it comes to the major overhaul planned for county health services.

As head of the L.A. County-USC Healthcare Network, Rodriguez oversees the 750-bed County-USC Medical Center, along with a number of other health facilities that will play a key role in expanding outpatient services in the years ahead.

Rodriguez will be responsible for determining staff and equipment needs at the 600-bed facility planned to replace County-USC in 2006. Another pressing task is setting up a plan to retrain the thousands of county health workers who will be needed at the expanded network of clinics.

The changes have been triggered as part of a new federal waiver of Medicaid reimbursement rules, under which payment will be offered on a per-case basis, rather than 'for every occupied bed. As a result, the county now has a greater incentive to see more patients rather than add more hospital beds.

Over the next five years, the number of indigent patients treated by the county is expected to increase by a total of 2.5 million, according to Rodriguez. "It's going to take a lot of work," he said.

Rodriguez said it will be part of his job to get the uninsured to think like managed-care patients and visit doctors at clinics before emergency room trips and costly hospital stays become necessary.

"There's a culture out there about the emergency room that we need to change," he said. "It's not just about us changing operations."

Born in Puerto Rico and raised in the Bronx, Rodriguez was a National Urban Fellow at Yale University. He served in administrative, financial and human resources positions for New York City before being appointed in 1992 as executive director of Lincoln Medical and Mental Health Center there. He became executive director at County-USC Medical Center in November 1998.

Milo Peinemann

Gloria Romero

Title: Chairwoman

Organization: Assembly Select committee on LA. County Health

Age: 44

IT isn't just the county that is wrangling with L.A.'S crisis in care for the uninsured; the state Legislature is playing a key role, and at the head of its efforts is Assemblywoman Gloria Romero.

Romero, D-Alhambra, is chairwoman of the Assembly Select Committee on L.A. County Health, which is studying problems with the county health care system and trying to find solutions. She has led hearings with local and state officials, including the Los Angeles County Board of Supervisors.

The most pressing concerns of the committee are immediate-coverage issues, service issues and the effects of the Medicaid waiver cutoff in five years. The committee is also examining the future of the earthquake-damaged County-USC Medical Center, whose ambitious rebuilding program will require state funds.

Currently moving its way through the legislative system is the Romero-authored bill, AB 561. The law, if passed, would help educate parents about the availability of government funded health programs for their children.

Before becoming a legislator, Romero was a professor at Cal State Los Angeles. During this period she did research work on HIV/AIDS education and prevention.

Recently, Romero announced she will challenge Assemblyman Martin Gallegos, D-Baldwin Park, for the state Senate seat held by Democrat Hilda Solis, who has been elected to Congress. The race is already attracting attention because it pits two popular Latino leaders, both playing a key role in health reform in the state Assembly, against each other.

Romero holds a Ph.D. in psychology from UC Riverside and is also a graduate of Cal State Long Beach. In 1995, she became the first Latina elected to the Los Angeles Community College Board of Trustees.

Norinne De Gal

Marvin J. Southard

Title: Director

Organization: LA. County Department of Mental Health

Age: 51

THOUSANDS of people a year are drawn to Southern California because of its mild climate; unfortunately, many of them are homeless and mentally ill.

That's why L.A. County has the nation's largest public mental health system, serving more than 150,000 people who speak 90 different languages. About 60,000 of these patients are children.

The job of running the department falls to Marvin J. Southard, who oversees 1,600 employees in 23 programs and contracts with 118 community agencies and state hospitals.

"I want to ensure that people with mental illness have a better support system, especially with better drugs available," said Southard, who operates on an annual budget of $800 million. His goal is to expand the treatment for mentally ill patients to encompass their families, loved ones and even employers. He calls it the "holistic" approach to mental health treatment.

Prior to running Los Angeles County's mental health program, Southard was director of Kern County's mental health system. Before that he was vice president of mental health programs with El Centro Human Services Corp. in Los Angeles, where he was employed for 10 years.

Southard received his bachelor's degree from St. John's College in Camarillo. He received a master's degree in social welfare from UC Berkeley and his doctorate from UCLA. He is the president-elect of the California Mental Health Directors Association and a clinical associate professor of psychiatry and behavioral sciences at s School of Medicine.

Frank Swertlow