Betty's In Charge

Is Dallas County's most explosive bureaucrat ruining the health department?

Betty Culbreath sits intently on the edge of her chair, her elbows planted on her desk and drawn tightly to her coiled frame. Tension emanates from her, like beams from the virescent lamps used to zap germs in the tuberculosis clinic several floors below her office in the county Health and Human Services building.

One of the most powerful administrators in Dallas County, Culbreath is visibly perturbed at the prospect of being questioned.

Her large almond eyes glare through a pair of red-rimmed glasses. She speaks in a steady, deliberate voice that is uncharacteristic of the veteran bureaucrat, who is better known for her blunt mannerisms and stinging outbursts.

For the first time in her 12-year county career, Culbreath's professional credentials have been questioned. There have been questions by doctors. Questions by employees. Questions by reporters.

Clearly, Culbreath is sick of the questions.
They have dogged her since last October, when the Dallas County Commissioners voted to merge the health and human services departments--two of the most essential county agencies--into one unit, a move prompted by the abrupt resignation of health department director Dr. Randy Farris. In the same stroke of the pen, the commissioners named the 55-year-old Culbreath as the combined departments' executive director.

The promotion made Culbreath the first non-physician ever put in charge of the health department. And, thanks to the whopping $22,000 raise that came with it, the former right-hand aide to Commissioner John Wiley Price is now in the top tier among Dallas County's 5,400 employees in compensation: She earns $90,000 a year.

In the relatively obscure world of Dallas County politics, Culbreath has become Price's most prominent protege. Since he hired Culbreath in 1985 as a low-ranking, $24,696-a-year administrative assistant, Price has taken Culbreath in hand and guided her straight up the county's employment ladder. And it was Price who worked hardest to give Culbreath her biggest promotion to date--the reins to the merged departments.

It's not that Culbreath isn't a capable administrator. In fact, she is widely respected as a bare-knuckled, no-nonsense manager--a reputation she earned first as Price's aide-de-camp, then during her five-year tenure as the director of human services, and finally during a brief stint in 1993 as the interim director of the county's juvenile department.

Since her most recent promotion six months ago, Culbreath--who has never been mistaken for a shy or retiring type--has taken the health department by storm, causing more than a few eyebrows to rise.

After promoting two of Price's political pals to act as her bureaucrats-in-chief--including Zachary Thompson, whom Culbreath took from a $36,060 salary to $68,124 in four short months--Culbreath promptly deleted six managerial positions. She trumpeted her reorganization as a great cost-saving measure for the county, although county records show that, with employee raises taken into account, less than $200,000 will be saved out of a $33 million budget for the combined departments.

But Culbreath's big focus has been on the day-to-day operations of the health department. Already, Culbreath says she has brought order and efficiency to what was once a disorganized department. Walls are being painted and floors mopped. Once-cluttered rooms are now clean, their contents placed on shelves and properly labeled.

But Culbreath's attention to detail goes way beyond whether the public restrooms are clean. "We don't allow anyone to pop popcorn before 11 in the morning. You'd be surprised how many people come here hungry, and to have the smell of food cooking is just obnoxious," Culbreath said proudly during a recent walking tour of the offices, located in a drab county office high-rise along Stemmons Freeway.

Although it's hard to argue against clean, orderly medical offices--and the prospect of fewer bureaucrats pushing papers in them--there's a much bigger issue at hand now that Betty Culbreath is in charge of protecting the health of the 2 million people who live in Dallas County.

AIDS? Tuberculosis? Syphilis? Meningitis? For the first time in the county's history, there's no doctor on call.

Culbreath may have her employees marching in uniform at her command--popcorn safely locked away in drawers--but critics question whether she has any grasp at all of the county's broader health issues.

Last month, in a series of interviews about her new job, Culbreath was asked to explain what the county's health needs are and how she plans to meet them. She paused before answering. "Well," she said. "I can't tell you what the health needs are for the county."

The health department is one of those government agencies that catches the public eye only when something has gone horribly awry. The rest of the time, its work goes unnoticed by the average county resident.

But in times of crisis, the swiftness with which the department diagnoses and responds to an epidemic is critical--and can save lives.

In Seattle, for example, public health officials issued an urgent medical alert in 1993 when hundreds of people became violently ill after eating fast food contaminated with a strain of E. coli bacteria. More than 700 people got sick, and four children eventually died during the outbreak. On a smaller scale, Dallas County health officials, led by Dr. Charles Haley, instantly warned residents in 1995 when they detected evidence of an encephalitis outbreak spread by mosquitoes. Twenty people were infected with the disease; three died. Health officials mobilized quickly to spray insecticides and monitor local hospitals for people with encephalitis symptoms.

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