By Jim Schutze
By Rachel Watts
By Lauren Drewes Daniels
By Anna Merlan
By Lee Escobedo
By Eric Nicholson
"That's why I've been very candid with Betty and want to help her," Anderson says. "We would be glad to sit down with her and craft a strategic plan for public health."
So far, though, Culbreath appears to be following her own counsel.
Ken Williams, the environmental health manager for Grand Prairie, says he has had no contact with anyone in the department since the merger. "They should be including us in the decision making, because we are ultimately their customer, and they don't know what their customers' wants and needs are at this point," Williams says. "The people who used to know that are no longer there."
"There hasn't been any communication," says Hatfield, who adds that Culbreath hasn't bothered to inform him who he should call in the event of an outbreak.
If a case of hepatitis were detected in the city, for example, Hatfield says he normally would have called Dr. Farris or Dr. Haley. "Now, I suppose I would contact someone on the communicable disease staff, but I don't know who that person is," Hatfield says.
With 155,000 students, the Dallas Independent School District is probably the county health department's biggest client. Dr. Richard Adams, the district's health officer, says he will have to bypass the county in the event of a medical emergency until a new medical director is hired.
"Dr. Haley has worked with us very closely for 12 or 13 years. Not to have that kind of expertise at-telephone is going to cause a problem for us," Adams says. "We'll just have to go elsewhere for the expertise."
Going elsewhere means calling on doctors at the Texas Department of Health, the national Centers for Disease Control, or the infectious control experts at the University of Texas Southwestern Medical School. But these doctors' resources are limited, and they don't have the same ability to act swiftly in times of emergency.
"The health department is the only one that has the authority to actually make an official public health decision," Adams says. "There are a lot of ways that the public health department needs to interact, and having an epidemiologist or a physician there with expertise in communicable diseases is just critical to the public health." Besides Stanfield, only two non-jail doctors remain on the health department's staff--Buu Nguyen and Barbara Gallagher. Both are highly trained in the area of communicable disease, but their workdays are consumed by patients who visit the department's TB and STD clinics.
The displacement of doctors from the department hasn't gone unnoticed among members of the Dallas County Medical Society, who have held a series of meetings to discuss these recent changes.
During an interview in late February, Dr. Roland Black complained that Culbreath had ignored the society's requests to provide information about the changes and did not respond to a written invitation to address its board at a March 4 meeting.
"I don't know why there's no receptivity from the other side of the river on this," Black said on February 26. "As of last night at nine o'clock, we've had no response from her or her office. It's not that we insist on being in the loop, but we'd like to be tangential to the loop. We'd like some information."
Culbreath could not have cared less.
"What are their goddamn concerns? If they got some concerns, why in the hell ain't they over here trying to help?" Culbreath told the Observer. "What the fuck have they done lately for the public health department?"
Culbreath finally did address the society during the March 4 meeting, expressing her renewed commitment to hiring a medical director and an epidemiologist. Although civil service documents show that Culbreath had set aside $66,000 to pay the new medical director, she told the board that the salaries for both positions have now been made negotiable in the hopes of attracting qualified candidates.
"The fact of us starting a constructive dialogue was accomplished last night," Black said after the meeting, adding that he will designate a liaison to work with Culbreath in the future. "The bridge has been built. I'm smiling today."
Seated in her sixth-floor office, coiled and stiff with tension, Culbreath doesn't sound very enthusiastic about the prospect of working side-by-side with members of the local medical community. In fact, the supposed arrogance and incompetence of the department's departed doctors continue to occupy her mind.
"We had people who thought that they owned certain parts of this agency. And it's real different in this health thing," Culbreath says. "Health-care professionals are kind of cliquish. They really believe that nobody has any sense but them."
To illustrate her point, Culbreath picks up a sharpened pencil and makes a mark on a piece of paper before her.
"Suppose you're a phlebotomist, and your job, all day long, is to be over in the HIV testing clinic, and all you do is draw blood. Somebody's got to furnish you with the needle. Somebody's got to furnish you with the tubes you shoot your blood in," she says, penciling two identical marks next to the first.