Scoppe: The new sheriff at DHEC tackles TB and … DHEC

Associate EditorJuly 19, 2013 

— THE MOST obvious difference between Catherine Templeton and all the former DHEC lobbyists who came before her as director of the state’s health and environmental agency is that she has no health or environmental experience. Which also was the first strike against her.

The most important difference just might be that she’s the first director who isn’t entangled by webs of allegiance to the way things always have been done. The first director whose reflexive reaction to criticism isn’t to defend the agency — or to attack the critics — but to acknowledge fault. The first director who walks that thin line between gratuitous government bashing and disarming candor (“Somebody said I wonder if something is going to happen while you’re at DHEC. I was like, ‘Oh no; something happened yesterday and the day before; I have just yet to find out about it.’ ”).

But even after 16 months on the job — 16 months of clearing out the upper echelons and terrifying middle managers with her incessant imperatives to front-line employees to “throw your supervisor under the bus” — she keeps crashing into reminders that the 3,500-employee agency retains much of the famously byzantine culture that seems permeable only when compared to, oh, the Budget and Control Board.

Reminders like an encounter with an immunization nurse during one of her unannounced visits to local health clinics. “We see a gazillion children” for the Women, Infants and Children program, she says. “There are babies crawling all over the floor. … And when I go in to the immunization nurse and say, ‘How many of them did you ask if they’re up to date on their immunizations?’ she says, ‘Oh, that’s a good i-de-a.’ ”

As she repeats the nurse’s response, she drags the words out mimickingly, and you nod knowingly. Because while change for the sake of change is no better than maintaining the status quo for the sake of maintaining the status quo, sometimes the status quo desperately needs changing. And for all the smart, dedicated people who work at DHEC and throughout state government, you’ve seen and known too many others just like that immunization nurse. And for all the concerns you might have about some of Ms. Templeton’s policy positions, you know she’s spot-on when it comes to tackling the agency’s insular, moribund culture.

Of course, Ms. Templeton has not come by to talk about immunization. She has come to talk about tuberculosis, and how her agency “screwed up” the investigation into an outbreak at Ninety Six Primary School. About why she fired the people she believes are responsible for the 10-week delay in notifying parents and testing students, more than 50 of whom were infected by a sick school janitor. And if this story is more dramatic, at least in her telling, the root cause is not much different from dozens of stories she could recount.

She says she learned about the outbreak not because DHEC employees followed her directive to contact her when they thought something was wrong, but “serendipitously,” during one of those unannounced visits to the Greenwood health clinic.

That’s when she happened upon a TB nurse from another clinic, who was there helping with the then-nine-week-old probe. It was odd that additional staff would be brought in to help with a single investigation, Ms. Templeton says, and as she asked questions, she was disturbed to find “no sense of urgency” and a mentality of “if it’s not on my desk, I don’t care.”

“It was sort of, ‘ We-ell, it’s not going well. We don’t really know what we’re going to do, haven’t really heard what we’re supposed to do.’ And I was like, ‘From who, and from what?’ ”

The more answers she got, the more concerned she became: Investigations are supposed to start within 24 hours after the clinic is notified of a positive TB test, but this one took six days. And when it started, the clinic manager had the janitor come to the clinic for treatment.

“I can’t even give a better analogy than that’s like taking him to the clinic” to give him his treatment, she says. “You don’t take him to the clinic where we see babies for WIC, nursing mothers, pregnant women. You don’t take anybody into a vulnerable population or any population who has tuberculosis.”

The alarms kept going off: The janitor was uncooperative, but the nurses running the investigation hadn’t put him under orders to stay home. They had no idea which children were in a room that shared a vent with his work area, or how many children, or for how long, and they didn’t investigate conflicting answers from school officials.

They did test teachers who were in that room, and when Ms. Templeton asked why the students weren’t tested, “the response from the nurse was, ‘Well, the teachers were taller.’ ” She pauses for several seconds and then continues: “I mean, do I need to be a nurse to understand that doesn’t make any sense whatsoever? I presume it was because the vent was higher, but how would they know because they didn’t go look at the facility” for more than two weeks.

Ms. Templeton says the explosive claims by three fired nurses that they had asked Columbia officials for permission to test children and inform the public were “not inaccurate” — which was one reason she also fired the state TB director. But she says that didn’t excuse them for violating multiple DHEC policies and that, beyond that, “they should have known better” than to let the investigation drag out so long.

They should have known better not just because they were experienced professionals, she says, but because she had been inundating her employees with videos and memos and speeches drilling in her message: “ ‘You go around your middle manager and you email me, you go around your supervisor and you email me, if there’s anything that’s going on on the ground that you don’t think is right.’ ”

That message is central to her effort to overhaul a management structure that was “very diffuse,” characterized by “a lot of ‘this is my company, this is my sandbox, this is my money.’ ” As a result of her changes to that structure, she says, “this is probably the first example of being able to hold people accountable for the lackadaisical policy failure, violations, that type of thing.”

The nurses’ attorney says Ms. Templeton should have known about and addressed the TB crisis sooner, and he’s right. Whether it was reasonable to expect her to have known is another question, and state senators will explore that question at a hearing next month that is expected to look critically at her response to the crisis.

An equally important question may be how quickly you can expect people to learn to take responsibility when they have been marginalized for their entire careers, taught if not told that they have no authority, that all they’re supposed to do is come in and check items off a to-do list for eight hours and then go home.

But whatever the answer to that question, it can’t be indefinitely, because we’ve endured that for far too long, to always bad results. And if Ninety Six can help transform that culture, then perhaps something good can come out of all the worrying and waiting and wondering that the community has had to endure as a result of it.

Ms. Scoppe can be reached at cscoppe@thestate.com or at (803) 771-8571. Follow her on Twitter @CindiScoppe.

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