Betty's In Charge

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

Most of the county health department's business, however, is routine. Its 178 employees ensure that the water supply is safe to drink and the air safe to breathe. They also carry out tasks such as inspecting houses and restaurants, collecting rats, and monitoring sewer systems.

The department also controls the spread of diseases such as AIDS and tuberculosis through a variety of immunization and early-prevention programs and clinics. If there's an outbreak, staff doctors and nurses act quickly to prevent illnesses and deaths by coordinating treatment among public and private health professionals throughout the county.

"A health department is basically a medical office," says Dr. Charles Haley, who resigned last month as the department's epidemiologist after more than a decade in the job. "The work is done under standing doctor's orders. A physician cannot take a medical order from a non-physician. Nurses can't give shots without an order."

In some ways, the health department also functions as a police force. It has legal authority to enforce quarantines, ranging from the routine confinement of people infected with disease to the removal and destruction of tainted food products.

"If you have a prostitute that is infected with syphilis, you have to go out and find that person and treat them, regardless of whether they want you to find them," says Haley, who has earned a national reputation for his public health expertise.

Since so many of the health department's functions require a doctor's authority, local medical officials were shocked by Culbreath's appointment as director of the health department. But commissioners made the move in such a stealthy manner that doctors never had an opportunity to organize any opposition.

The changes followed Dr. Randy Farris' announcement last September that he was resigning as the health department's medical director to take a job with the U.S. Public Health Service in Dallas. The department had stood alone since it was created, but Farris' departure paved the way for commissioners to fold it into the county's human services department, which Culbreath had headed since 1991.

The merger--and Culbreath's appointment as head of the combined departments--was carried out virtually behind closed doors, discussed in secret by the court and revealed to the public only as a done deal. When announced, it immediately set off alarm bells among area health professionals, who rely on the health department for a wide range of medical services.

The ill feelings worsened in December when word was leaked to the media that Culbreath was quietly reorganizing the department and eliminating several medical positions. Soon afterward, longtime employee Dr. Charles Haley announced he was resigning as the department's epidemiologist.

Until now, Haley has publicly declined to criticize Culbreath, citing new job opportunities as his sole reason for leaving his county post. But last month, in an interview with the Dallas Observer, he confirmed speculation that the new administration contributed to his decision to leave.

"I don't know that these changes are necessarily bad, but they were ones that I was uncomfortable with, and I didn't particularly want to stay," Haley said. "Decisions seem to be done in a more compulsive manner, rather than a deliberate one."

The departures of Farris and Haley--the department's two top docs, both of whom were highly regarded--left the department short of doctors. Only three physicians remain on staff today, besides those assigned to the jail, which has its own medical staff. This skimpy depth chart has made area health professionals wonder whether the department is even capable of making competent medical decisions on a day-to-day basis--let alone during a crisis.

"I was alarmed because of the turnover and the instability. Ultimately, if it [the department] fails, Parkland will be the recipient of that," says Dr. Ron Anderson, CEO of Parkland Memorial Hospital.

Anderson is hesitant to criticize Culbreath, however, whom he grew to respect while she served as a member of Parkland's board from 1989 to 1991. "Her heart for public work was always there for the patient," Anderson says. "When political things happened here, and she was John Wiley Price's appointee and he asked her to vote a certain way, she voted her conscience."

But Anderson's concern for the well-being of Dallas County residents goes far beyond any collegial admiration for someone. Although Anderson would never say so, he, more than anyone else in Dallas, understands how severely limited the county commissioners are in terms of understanding--or even caring about--public health issues. Middle-aged, white, heterosexual Republican men whose lives revolve around the Christian Coalition and the Rotary Club do not typically feel threatened by the galloping spread of sexually transmitted diseases.

Nonetheless, these are the men who approve Anderson's hospital budget and criticize him constantly for taking high-profile stands on controversial medical issues. Anderson--to his credit--spoke openly about the dismantling of the county health department, and what he's trying to do about it.

Anderson and some of his colleagues have been pushing Culbreath to recruit a replacement for Farris--who, according to county documents, Culbreath had considered not replacing in order to save money. Anderson would also like to see Culbreath develop an overall health plan for the county.

"A city this size should have a pretty clear plan for what it wants to accomplish--what its responsibilities ought to be in public health," he says.

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