Epidemiologist Resignation Points to Bigger Problem in State Departments - North Carolina Health News
By Rose Hoban
Timeline by Catherine Clabby
In a stunning twist in the debate over how well state officials are handling potential contamination of drinking wells near coal ash waste dumps, State Epidemiologist Megan Davies resigned on Wednesday evening. In her resignation letter, she accused leaders in the administration of Gov. Pat McCrory and the Department of Health and Human Services of intentionally misinforming the public about the matter.
“I cannot work for a department and an administration that deliberately misleads the public,” Davies wrote in her resignation letter.
Her resignation comes after revelations of internal debates within DHHS and the state’s Department of Environmental Quality over how to address increased levels of chemicals in private wells of people living near North Carolina’s 32 coal ash impoundments at 14 Duke Energy sites. Those debates were revealed in a series of sworn depositions given to attorneys from the Southern Environmental Law Center which represents environmental groups in a federal lawsuit against Duke Energy.
++ August 2014: North Carolina General Assembly passes Coal Ash Management Act (CAMA). It requires Duke Energy to shut down coal ash waste dumps on 14 properties and a survey of drinking wells near the waste.
State toxicologist Ken Rudo, in a deposition released last week, asserted that when officials from the McCrory administration sent “do not drink” letters to the well owners, they simultaneously downplayed the risks.
In her deposition, Davies testified that State Health Director Randall Williams, months later, was concerned about the political fallout of maintaining the do-not-drink advisory.
After Rudo’s deposition was made public last week, McCrory’s chief of staff accused Rudo of perjury in an unusual late evening press conference. On Wednesday morning this week, DHHS and DEQ released a joint editorial savaging Rudo, saying the 30-year DHHS veteran had exaggerated health risks. The editorial questioned his scientific integrity and said Rudo created “unnecessary fear and confusion among North Carolinians who are concerned about the safety of their drinking water.”
++ As directed by CAMA, state health and environmental officials use state groundwater regulations to assess health risk levels in well water near coal ash plants. That involves a formula establishing the level above which hexavalent chromium poses a one-in-a-million risk of causing cancer. (Source: Davies deposition, page 82).
Davies, a national leader in her field, said her decision to resign came after reading that editorial.
In her resignation letter Davies said the administration’s description of Rudo’s decision-making distorted a process that included many people and the approval of ranking DHHS officials, including a former secretary.
Her resignation not only rips the cover off DHHS’ internal debate , but also reveals an increasingly politicized atmosphere within the department , leaving, at a minimum, an impression of a department where decisions reflect political expedience, rather than public protection.
Former health officials from North Carolina and around the country say those impressions can undermine the public’s trust in the credibility of a governor’s administration and imperil public health in the process.
In conversations Wednesday many former health officials spoke of the tension high-ranking state employees live with, that of serving their governors and departmental secretaries while also serving their consciences. It’s a delicate balancing act that can cost individuals their jobs and reputations, but more significant, the public’s health can be undermined when people lose confidence in these agencies.
++ Mina Shehee, an environmental program manager at DHHS, has the Agency for Toxic Substances and Disease Registry at the Centers for Disease Control and Prevention confirm that North Carolina level uses the correct “cancer slope” calculation. (Source: page 53, Shehee deposition)
++ DHHS leaders, including then-DHHS Secretary Aldona Wos, review and approve the approach used to set levels for hexavalent chromium. (Source: Davies resignation letter.) North Carolina joins California in having the lowest health levels for metal in the country.
Tellingly, most former health officials would not speak on the record. Jeff Engel, North Carolina’s State Epidemiologist from 2002 to 2007 and State Health Director from 2009 to 2012, was an exception.
Weathering political pressure is often part and parcel of a health director’s job, said Engel, now head of the Council of State and Territorial Epidemiologists, based in Atlanta. He recounted the pressures of his old positions and said he’s heard from some of his members about the political squeeze they’ve experienced.
“There is a lot of partisan stuff going on,” he said, citing, for example, how some states have aggressively countered threats such as Zika virus, while others have foot-dragged.
“Then there’s always the differences between a red state and a blue state in terms of their view and philosophy on the role of government,” Engel said. “It’s the issue of the nanny state. ‘Are we overreaching? What is the role of government here?’”
“That always affects public health.”
++ March 2015: Rudo summoned to the governor’s mansion for a meeting with press secretary Josh Ellis to discuss the wording of the letters sent originally to warn well owners of contaminants. He says McCrory called Ellis during the meeting. (Source: Rudo deposition, page 42)
Different political affiliations don’t have to derail a professional relationship between public health experts and members of the executive branch in the states where they serve, said Dave Gifford, who was the Rhode Island health director from 2005 to 2011.
He recounted being from a different party than his governor.
“We had different views on things, but we never went there,” said Gifford. “And if we had to go there, I’d have to make a decision as to whether I could work for the governor or not.”
Public health officials know this tension comes with the territory when they accept their jobs, Engel said. But he also said elected officials can hold the risk of termination over appointees’ heads, who are often “at will” employees serving at the pleasure of their governor.
And resignations are rare, he said, because many professionals are reluctant to risk their family’s security on principle.
++ July 2015: Randall Williams takes over as state health director; state epidemiologist Megan Davies briefs him on process used to reach new health screening level for hexavalent chromium. (Source: Davies resignation letter)
++ Williams meets with staff members of Senate Pro Tem and Assembly Speaker who tell him letters advising people not to drink well water have alarmed people in ways disproportionate to the risks. (Source: Williams deposition, page 24)
“That’s why it took an incredible amount of courage for Megan to do what she did and she was able to do it on her terms, which is the highest principle I can think of,” Engel said, noting there are few positions available for high level physician executives like Davies.
“This is a decision to derail her career and she had her eyes wide open about that,” he said, calling Davies an “outstanding medical epidemiologist.”
A family practice physician, Davies was an officer with the CDC’s Epidemiological Investigation Service and was slated to be this year’s board president for the Council of State and Territorial Epidemiologists, a role she relinquishes with her resignation.
Davies, an eight-year veteran of the department, wrote of her “terrible loss” in leaving a job that “brings meaning to my life.”
Science vs politics
Both men agreed there are fewer public health topics more contentious, more easily misunderstood and riskier to political leaders than environmental health issues, where the science is constantly evolving.
“The fundamental reason is that the science is often not as strong as it is in communicable disease and protection,” Engel concurred. “The toxicity of some of these contaminants when you’re talking about safe drinking water is a little less certain than, say, a contaminated food supply or a child in a classroom with measles.
“No one will fight with you if you’re excluding that child from their classroom until that disease is over and no one will fight with you when you close the restaurant down when you find out that their salad bar is contaminated with Salmonella. But there’s always fuzziness on some of these toxicology issues around drinking water.”
Gifford said all that gray area presents communications risks.
++ March 2016: Letter signed by Reeder and Williams sent to well owners who were previously advised not to drink water due to elevated levels of hexavalent chromium or vanadium. The new letter says: “We updated our recommendation after extensive study of how other cities, states and the federal government manage the elements … we have now concluded that water out of your well is as safe as the majority of public water systems in the country.”
“There is nothing that’s risk free and there’s nothing that the public is more concerned about than infection and toxic exposure,” he said. “People have different levels of risk tolerance, how do you communicate that?”
Gifford noted many members of the public have a low tolerance for risks they don’t understand, even as they engage in more known – and riskier – behaviors such as smoking.
The information is often incomplete and inconclusive, Gifford said and, “You’re always having to balance multiple positions.”
But Gifford bemoaned the way that these issues of public health have become so politicized, from both sides.
“The discussion is always about who is to blame and how to prevent it from happening again and do it quickly,” he said, noting the media adds to the problem, in its search for sensational stories with easy-to-understand heroes and villains.
“It’s rarely an individual to blame and it’s never black-and-white as to how to solve the problem.”
Gifford said, in this environment, it’s hard to blame a governor’s administration for wanting to control messages about public health risk, “because every time something completely outside their control happens, they get blamed for it.”
++ May 2016: In her sworn deposition, Davies reveals discord among health officials saying that she opposed the letter rescinding the do-not-drink advisories because the language saying well water with elevated hexavalent chromium or vanadium compared to cities did not match data she saw from Raleigh and Charlotte. (Source: Davies deposition, page 58)
++ August 1, 2016: Rudo’s deposition released, the news that Gov. McCrory participated by phone in meeting discussing language in the letters causes a stir.
But an administration that minimizes risks to public health can put its own political integrity in peril.
The trick, he said, is striking the balance between minimizing or overstating those risks.
“If the communications are not well-crafted to appropriately communicate a balanced risk you can create more people who are afraid,” he said.
Any perception that a public health department is making decisions based on politics rather than science undermines the department. But, “when you start politicizing all these things, it takes away from being able to inform the public about them,” he said.
That’s why Davies skewered the McCrory administration’s “false narrative of a lone scientist in NCDHHS acting independently.” And she wrote that leaders from DHHS and DEQ misrepresented the process “used by NCDHHS to set health screening levels and provide public health recommendations to well owners.”
“They accused public health of being unprofessional and irresponsible and I couldn’t leave that out there,” she said in an interview Thursday. She also worried this erosion of trust could undermine the department’s ability to lead in the event of an emergency.
So, Davies spoke up, rather than allow that to happen.
++ August 9, 2016: Reeder and Williams issue a letter to media outlets criticizing Rudo for “questionable and inconsistent scientific conclusions.”
++ August 10, 2016: Megan Davies resigns “Upon reading the open editorial yesterday evening, I can only conclude that the Department’s leadership is fully aware that this document misinforms the public. I cannot work for a Department and Administration that deliberately misleads the public.”