Randall Williams has experienced a whirlwind first year as director of the Missouri Department of Health and Senior Services.
Since Williams' nomination by Gov. Eric Greitens and his March 9 confirmation, the state has passed a number of laws aimed at safeguarding Missourians' health.
Missouri joined 45 other states when it passed the Universal Narcan Availability Law, essentially giving health care providers immunity from prosecution for prescribing, dispensing or distributing Narcan (or the generic form naloxone), a medication that can rapidly reverse opioid overdoses. North Carolina, where Williams was appointed public health director in 2015, began passing legislation to make the drug available in 2013, then refined legislation beginning in 2015 and through 2016. Williams was public health director in North Carolina until early 2017 when administrations changed.
Williams resigned while embroiled in a controversy over coal ash (the waste from burning coal for large plants like electric generation facilities). The ash is kept in large ponds. On Feb. 2, 2014, a drainage pipe under a Duke Energy pond in Eden, North Carolina, failed, releasing about 39,000 tons of ash in 27 million gallons of pond water into the Dan River. State health officials announced hundreds of wells near coal-burning plants were too contaminated with heavy metals to safely use. Williams said contaminants in water were well below federal standards and rescinded the do-not-drink order. A Duke University study later determined heavy metals in wells likely came not from the plants, but from underground volcanic rock.
Williams said Wednesday it's telling that his reversal of the order remains in place.
He has helped his new state catch up with his former on some health issues.
The opioid epidemic has been a focus of his first year in Missouri. In 2017, Missouri passed the Good Samaritan Law, making health care providers — who render emergency care or assistance at the scene of an emergency in good faith — immune from liability. The state health department worked with the governor's office on wording for an executive order establishing a prescription drug monitoring program.
He has visited all 114 counties and St. Louis in his first year.
"As cabinet directors, Gov. Greitens wants us to be state leaders," Williams said. "In my present role, much of my time is spent building partnerships and advocating for programs and policies that will improve the health of the citizens of Missouri and keep them safe."
It is important to visit the sites and see first-hand the work done by his department's 1,700 employees, he said.
A challenge, he noted, is getting health care to the folks who need it. One hundred of the state's counties don't have enough doctors, Williams said. While Missouri has 20,000 doctors, 12,000 of them are concentrated in three counties.
"We think it is vital that our communities have access to robust jobs, education and health care for the overall state to thrive," he said.
Williams arrived in a state with serious health concerns. It had fallen from being ranked 24th in health in 1990 to 40th last year, he said. And the state's health care was fragmented and unfocused.
Williams' recent election to the Executive Committee for the Association of State and Territorial Health Officials, an organization of public health agencies from across the United States and its territories, gives him access to information about what other states are doing. He feels Missouri's people and resources can reverse the trend toward the lower end of states' health spectrum.
Williams said he had a connection with Greitens before his nomination, although the governor wasn't aware of that when the health director appeared on his radar.
In 2011, Williams read a book that called on people in public service to be courageous and passionate. The book helped him decide to leave private practice and accept the job of deputy secretary for Health and Human Services in North Carolina.
Williams is now a cabinet director for Greitens, the author of the book, "The Heart and the Fist."
When Greitens — and later Williams — arrived in Jefferson City, they understood the opioid epidemic is a nationwide health crisis that will require cooperation across governments to overcome. The state has to do a better job of recruiting providers for underserved areas to improve patient care. It has to improve women's health, Williams said. The state's maternal mortality is 42nd in the country. One in four Missourians will be over 65 in the next 10 years.
"We have to control health care costs that are consuming so much of our resources that could be spent on infrastructure and other vital government functions," Williams said.
He felt like he had to start working immediately when Greitens called on him, so Williams lived in a hotel for his first three weeks as a cabinet member.
"Since I was doing very similar work in North Carolina. The transition was very easy, and this freed me up to go out and visit all the counties to get to know people and develop partnerships which are so vital to us being successful on improving health here in Missouri," Williams said.
This article was edited Feb. 13, 2018, to correct when Randall Williams left his job as public health director in North Carolina.