Thursday, 5 April 2018

Don't Know Much About Health Care and Public Health... but Appointed to Leadership Positions in US Government Health Care Agencies

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We have often cited bad leadership and governance of health care organizations as a major causes of health care dysfunction.  In particular, we have discussed how leadership is often ill-informed.  More and more people leading non-profit, for-profit and government health care organizations have had no training or experience in actually caring for patients, or in biomedical, clinical or public health research.  Obviously health care and health policy decisions made by ill-informed people are likely to have detrimental effects on patients' and the public's health.

One reason for ill-informed leadership is the doctrine of managerialism promoted in business schools.  This proclaims that people trained in business management should lead every type of human organization and endeavor.  According to this doctrine, there is no need for leadership by people from the disciplines most relevant to the mission and nature of particular organizations.  So, for example, generic business managers, not doctors, nurses or other health professionals should lead hospitals. Likewise, business managers should make health policy, rather than health care professionals, public health, or health policy experts.

Through 2016, our examples of ill-informed leadership in health care tended to be executives of hospital systems (e..g.,in 2014, here, on the mishandling of a patient with Ebola in a hospital system led by generic managers; and in 2013, here, on a luxurious hospital led by a former hotel executive).  Others were top executives of pharmaceutical corporations (e.g., in 2011, here, on previous Pfizer CEOs).

Now, however, the most ill-informed people in health care leadership seem to be running US government health related agencies.  Here are our latest examples, presented in order of initial reports found in the news media...

Charmaine Yoest, Assistant Secretary of Public Affairs, Department of Health and Human Services

Per NBC News, April 29, 2017

The White House says President Donald Trump is appointing the former president of a leading anti-abortion organization to a senior position at the Department of Health and Human Services.

Charmaine Yoest, who actively supported Trump in his campaign, will serve as assistant secretary of public affairs at HHS. From 2008 until February 2016, she was president of Americans United for Life, which campaigned at the federal and state level for tough restrictions on abortion.

Formerly,

Yoest began her career serving under Ronald Reagan in the Office of Presidential Personnel and was an adviser to former Arkansas Gov. Mike Huckabee's 2008 presidential campaign. Most recently she has served as a senior fellow at American Values, a conservative group in Washington.

I can find nothing to indicate she has any background or expertise in biomedical science, health care, or public health.

Note that according to StatNews, in February, 2018 she left her DHHS position, but only to go onto another health related position, at the Office of National Drug Control Policy.

Kellyanne Conway, White House Opioids "Czar"

As first reported by Newsweek, November 29, 2017,

White House counselor Kellyanne Conway will be the point person for the Trump administration's opioid crisis efforts, U.S. Attorney Jeff Sessions announced Wednesday.

President Donald Trump tapped Conway to help 'change the perception' about opioids and reduce addictions and deaths, Sessions said at a press briefing about the Justice Department’s efforts to combat the crisis. Sessions said Trump had made the epidemic 'a top priority for his administration, including every senior official and Cabinet member.'

Conway worked as a pollster before becoming Trump's campaign manager, and she now serves as a White House spokeswoman and Trump surrogate.

Also,

She has no formal experience in drug policy or law enforcement. Conway has a law degree and started her own polling company, The Polling Company, in 1995, often consulting on consumer trends. She worked as an adviser for several Republicans, including Mike Pence and Newt Gingrich.


An article in the Atlantic noted,

In the past, these czars have been selected for one of two principal reasons: outstanding knowledge of the underlying policy issues or shrewd understanding of the bureaucratic processes of government.

However,

Kellyanne Conway is neither of those things, obviously enough. A pollster before she joined the Trump campaign, she has emerged there as its most brazen and shameless cable-TV talker.

In addition, the Newsweek article stated,

She has become notorious for defending some of Trump's most blatant mistruths, and she pioneered the term 'alternative facts' to excuse the president's troubles with the truth.

One might hope that someone involved in policy regarding drug abuse would have at least some understanding of evidence-based health policy assessment.  However, Ms Conway's promotion of "alternative facts" suggest outright hostility to the such assessment, and even to the idea of the existence of an objective reality, at least to the extent such a rejection serves political purposes.

In addition, a Politico article from February, 2018, suggested that in her capacity as opioids "czar," Ms Conway has operationalized her hostility to facts and logic in policy making in favor of political advantage and ideology,

White House counselor Kellyanne Conway has taken control of the opioids agenda, quietly freezing out drug policy professionals and relying instead on political staff to address a lethal crisis claiming about 175 lives a day.

By the way, while opioids "czar," Ms Conway has combined her hostility to evidence-based policy-making with contempt for ethical standards.  As reported by US News and World Report in March, 2018,

The U.S. Office of Special Counsel (not to be confused with the office of Special Counsel Robert Mueller) issued a report Tuesday calling for 'disciplinary action' against Conway for 'impermissibly mix[ing] official government business with political views about candidates in the Alabama special [Senate] election' which took place in December. Under the Hatch Act, federal employees are prohibited from engaging in political activities from their official positions, but Conway did just that, according to Special Counsel Henry Kerner, going out of her way to attack Democratic senatorial candidate (and ultimate victor) Doug Jones twice in television interviews in the run-up to the election.

Robert Weaver, Nominated to Direct the Indian Health Service

Mr Weaver's background and qualifications actually is in considerable doubt.  As reported first by CNBC on January 5, 2018,

President Donald Trump's pick to head the nation's Indian Health Service was hit by a bombshell report Friday that suggested he misrepresented his prior work experience to a Senate committee.

And a senator on that committee said later Friday that the story about Trump nominee Robert Weaver has raised 'very serious concerns' that he now wants answers to.

The Wall Street Journal quoted multiple former workers at what was once known as St. John's Regional Medical Center in Joplin, Missouri, who called into question Weaver's claims to the Senate Indian Affairs Committee that he had worked in supervisory and management positions at that hospital.

Weaver, 39, worked at St. John's from 1997 to 2006, according to his resume. His nomination to run the federal agency that provides health services to American Indians and Alaska Natives is pending before the Senate.

'I don't recall that name whatsoever,' Augusto Noronha, the hospital's chief financial officer from 1999 through 2005, told the Journal when asked about Weaver.

A former controller of the hospital told the newspaper, 'I've never heard that name before.'
Another executive said he remembered 'a subordinate named Rob Weaver who registered E.R. patients, gathered insurance information and collected copays, and who eventually supervised a few other patient-registration workers,' according to the Journal.

Weaver eventually declined the nomination, and then wrote a defense of his record in the Washington Examiner in March, 2018. There he stated,

I’ve spent the last decade of my life starting and operating successful businesses and creating jobs in Indian country that improve native peoples’ access to healthcare.

He acknowledged that he never completed college, and described his hospital work experience as purely administrative,

as an entry-level weekend admissions clerk. I then became patient access coordinator in 1999.

Thus he also had no training or experience in actually caring for patients, or in biomedical, clinical or public health research.

Teresa Manning, Deputy Assistant Secretary for Population Affairs, DHHS

I first learned about Ms Manning on the occasion of her resignation, as reported by the Washington Post on January 13, 2018, she

spent much of her career fighting abortion and has publicly questioned the efficacy of several popular contraception methods.

She

formerly lobbied for the National Right to Life Committee and worked as a legislative analyst for the Family Research Council.

She was notable for her skepticism that contraception even works,

she also has expressed deep skepticism of birth control overall, suggesting in a 2003 interview with NPR that 'contraception doesn’t work.'

I also can find no evidence that he has training or experience in actually caring for patients, or in biomedical, clinical or public health research.

Taylor Weyeneth, Deputy Chief of Staff, Office of National Drug Control Policy

as reported on January 14, 2018 by the Washington Post,

In May 2016, Taylor Weyeneth was an undergraduate at St. John’s University in New York, a legal studies student and fraternity member who organized a golf tournament and other events to raise money for veterans and their families.

Less than a year later, at 23, Weyeneth, was a political appointee and rising star at the Office of National Drug Control Policy, the White House office responsible for coordinating the federal government’s multibillion dollar anti-drug initiatives and supporting President Trump’s efforts to curb the opioid epidemic. Weyeneth would soon become deputy chief of staff.

Also,

Weyeneth’s only professional experience after college and before becoming an appointee was working on Trump’s presidential campaign.

He did have some sketchy job experience while he was in ... high school

Weyeneth was 'Director of Production' for Nature’s Chemistry, a family firm in Skaneateles, N.Y., that specialized in processing chia seeds and other health products. One résumé said he served in that job from 2008 to 2013, and two others indicate he stopped working there in September 2011.

In the summer and fall of 2011, the firm was secretly processing illegal steroids from China as part of a conspiracy involving people from Virginia, California and elsewhere in the United States and one person in China, federal court records show. Weyeneth’s stepfather, Matthew Greacen, pleaded guilty to a felony conspiracy charge last year and received two years probation and a fine.

Weyeneth was not charged in the investigation, known as Operation Grasshopper.

Then a subsequent Washington Post story raised further questions about his rudimentary employment history,

A former Trump campaign worker appointed at age 23 to a top position in the White House’s drug policy office had been let go from a job at a law firm because he repeatedly missed work, a partner at the firm said.

While in college, late in 2014 or early in 2015, Taylor Weyeneth began working as a legal assistant at the New York firm O’Dwyer & Bernstien. He was 'discharged' in August 2015, partner Brian O’Dwyer said in an interview.

'We were very disappointed in what happened,' O’Dwyer said. He said that he hired Weyeneth in part because both men were involved in the same fraternity, and that the firm invested time training him for what was expected to be a longer relationship. Instead, he said, Weyeneth 'just didn’t show.'

By then he had the distinction of being called "an emblem of the White House's recklessness,"  in an op-ed by Kathleen Parker.  He was gone from this job in a few days, only to end up as "a mid-level official in the Office of Community Planning and Development in the Department of Housing and Urban Development (see Politico), but at least will seemingly have nothing to do with health care or public health.   

Jim Carroll, Deputy Chief of Staff, Office of National Drug Control Policy

After the resignation of Mr Weyeneth, the administration came up with a nominee to run the Office of National Drug Control Policy, a position that was vacant while Mr Weyeneth was there, as reported by the Associated Press on February 9, 2018,

President Donald Trump has tapped deputy White House chief of staff Jim Carroll to serve as the administration's next drug czar.

Carroll's position as head of the Office of National Drug Control Policy will make him the most public face of the administration's efforts to fight the opioid epidemic — an effort critics say hasn't gone nearly far enough.

But,

Carroll does not appear to have any public health experience. He worked for the Ford Motor Company before joining the administration and also worked for the Justice and Treasury departments.

But the White House said that after law school, Carroll spent five years as the assistant commonwealth attorney for Fairfax, Virginia, where the majority of the cases were drug-related and he worked directly with those affected by drug abuse.

He also worked with attorneys facing substance abuse issues at the Virginia State Bar.

He may have worked with substance abuse issues from a legal standpoint, as a lawyer, but again he has no  training or experience in actually caring for patients, or in biomedical, clinical or public health research.

Discussion

 Again, it stands to reason that people entrusted with running US government health care, public health and health policy should have some level of knowledge of biomedical science, health care, public health and/or health policy.  I dimly remember that before the Trump administration, many such leaders did have such background.  Not any more.

This is only the latest examples of amazingly ill-informed people taking important responsibilities in government agencies having to do with health care, public health, and/or health policy.  Remember the brew-master with power over major policies in the Veterans Administration having to do with the huge VA health system (look here); or the White House economic adviser who did not seem to understand what health insurance does (look here); the Director of the Office of Management and the Budget who said people who make bad dietary choices do not deserve health insurance (look here)? and then there were all the appointments to health care related leadership positions of people whose main qualification seemed to be they would come through the revolving door after being lobbyists for health care corporations, e.g., look here

How are we to survive these times?  We need health policy leadership that is well-informed, understands the health care mission, avoids self-interest and conflicts of interest, and is accountable, ethical and honest.   (Of course, we have often said we need leadership of health care organizations with these characteristics.)  Right now, we are not coming close.  Preventing even worse health care dysfunction would seem to require wholesale replacement of the current US executive branch leadership that has influence on health care.




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