HCA's Leadership Problem

What on earth is happening at Orange County's Health Care Agency?

Does the County have a significant leadership problem?

At the November 19, 2024 Board of Supervisors meeting, Supervisor Sarmiento presented Supplemental Item 30C, proposing a forensic audit of contracts directed or influenced by former supervisor Andrew Do. What followed was a lengthy and meaningful discussion of the various audits and reviews underway at the time, as well as thoughts and plans on how to move forward. Supervisor Foley  kicked the discussion off, seeking clarification on efforts already underway and how those compared to what was being proposed. Supervisor Sarmiento made excellent points comparing to the Anaheim situation, where the city brought in independent auditors for an objective viewpoint. Then-Chairman Wagner suggested that perhaps the issue isn't one of policies, but rather staff being unwilling to report potential issues, or management unwilling to escalate such reports for further analysis. Sarmiento expressed his lack of surprise that Wagner wasn't more supportive of the audits and chose to blame staff and management.

Perhaps the Board, along with their eventual approval of a forensic audit covering various funds and contracts for a period spanning nearly six years, should have explored Wagner's theory. And perhaps the Health Care Agency is bearing that out.

More than six months before that Board hearing, on March 7, 2024, the County's Procurement Office released a Request For Proposals (RFP) for an Administrative Audit of the County's Health Care Agency (HCA). This is just over three months after the first LAist article on Do's influence of contracts through HCA. This RFP resulted in a contract with Weaver and Tidwell, LLP: $75,000 for a 6 month term (June 13, 2024 through December 12, 2024).

Weaver and Tidwell is the same firm selected on October 14, 2025 to conduct the forensic audit first requested in November 2024, an almost $1.4 million dollar contract eventually approved November 18, 2025.

The initial Administrative Audit was to examine "... administrative operations including accounting, budgeting, facilities management, human resources, information technology, procurement and non-administrative functions supported..." Some of the specifics include:

• reviewing structure and operations to identify opportunities for increased efficiency;

• identification of improvements that could result in cost savings;

• review of the Director's Office operations and services;

• provide recommendations for "workforce retention and succession planning."

  • The "(o)bjective is to define critical roles within the department and the core skills associated with those roles to develop skills and assess competence."

• review effectiveness of internal trainings;

• review communication strategies and tactics internal to HCA;

• assessing the "efficiency and effectiveness of HCA's management tools, process, and practices"; and

• reviewing agency policies and procedures

What exactly is happening at HCA that their own executive leadership cannot identify or work on the above issues? The HCA hired an auditor to "identify critical roles and the core skills associated". Surely, something must have been found in this administrative audit.

In August of 2024, the HCA issued an RFP for an Executive Leadership Training Program. Seven months later, in March of 2025, HCA announced that Prism Leadership Group was selected for award before cancelling the solicitation one week later.

Between the issuance of that solicitation and the selection and cancellation, the HCA released another solicitation for Performance Management Professional Services. The scope, as described in the August 12, 2025 Agenda Staff Report, includes:

"... technical assistance, coaching, and training to build a strong performance culture with improved accountability and transparency."

Public Consulting Group, LLC was approved for a $477,925 contract for a one year term.

HCA, however, did not give up on leadership training for their executive team. A new solicitation was released September 30, 2025 with the following goals:

• Foster a culture of personal accountability and extreme ownership among leaders at all levels.

• Strengthen leaders’ ability to communicate clearly, decisively, and consistently across diverse teams.

• Improve performance in high-pressure environments in the HCA such as, but not limited to, public health emergencies, behavioral health crises, disaster response, and correctional healthcare incidents.

• Encourage ethical leadership practices that align with public service values, transparency, and   community trust.

• Promote cross-functional collaboration and systems thinking within complex government   healthcare settings, such as the HCA.

• Enhance problem-solving and decision-making capabilities using real-world scenarios and field challenges.

• Develop resilience and adaptability to sustain leadership effectiveness through change, uncertainty, and institutional constraints.

• Equip leaders with tools and habits for continuous growth, building organizational culture, reflection, and leadership development beyond the duration of the program for succession planning.

While proposals for the above were due October 30, 2025, there is currently no sign of an awarded contract, nor clear sign that the solicitation was cancelled. The specifics of this training, and notable the target audience, is described in the scope as follows:

"The program will be delivered in cohorts (1. Executive Leadership, 2. Senior Leadership, and 3. Senior Management), for up to 10 - 20 County employees per cohort..."

The HCA is hiring outside trainers for the top 30-60 executive managers.

What is happening within the County that the top 30-60 managers at one of the largest County agencies have to hire outside assistance to:

• identify areas for improvement;

• "... define critical roles ... and the core skills associated ...";

• review policies and procedures;

• "... build a strong performance culture with improved accountability and transparency.";

• "(f)oster a culture of personal accountability ...";

• "(s)trengthen leaders’ ability to communicate clearly ..."

• "(e)nhance problem-solving and decision-making capabilities..."

Seriously, how is it that HCA has an entire leadership team - from 30 to 60 executive managers, including the entirety of the Executive and Senior leadership teams - that are not equipped "... with tools and habits for continuous growth, building organizational culture, reflection, and leadership development ..."?

What are the hiring and interviewing practices that have resulted in such a team of senior and executive leaders? What are County executives doing to examine and correct the apparent institutional culture and practices that developed such a team? What shortcomings in current trainings have resulted in this team? Has anyone talked to line staff about the agency-wide impact of executive and senior leadership teams that need significant assistance and training from outside professionals? Why does the County not have rigorous examinations and trainings for executives and leadership that would identify such challenges before the culture permeates the entire team?

And further, in the middle of all this, why is HCA's Chief Compliance Officer out on leave? Her leave began just months after authoring a June 6, 2025 memo in which she raised serious concerns regarding potential fraud, as well as HCA staff - including at the executive level - not raising their concerns with the Office of Compliance, along with poor documentation and record keeping.