Amid the peak of Missouri's COVID vaccine rollout and just four years on the job, Randall Williams has stepped down as director of the state's health department, effective immediately.
Gov. Mike Parson's announcement did not give a reason for Williams' departure. Robert Knodell, Parson's deputy chief of staff who has played a key role in the state's vaccine distribution, will serve as acting director until a permanent replacement is found.
"Dr. Williams has been a huge asset to Missouri, especially this past year in dealing with COVID-19," Parson said in a written statement. "We greatly appreciate all the work he has done for the people of our state and wish him the best in his future endeavors."
Williams has been the highest- profile member of Parson's cabinet, even before COVID-19 swept across the state. And his departure from the Department of Health and Senior Services comes as the state continues its efforts to vaccinate all Missourians while hundreds of COVID cases continue to be reported each day.
His resignation also caps a tumultuous tenure as the state's top health official - from allegations of conflicts of interest surrounding the state's nascent medical marijuana program to national headlines accusing him of tracking women's menstrual periods.
Williams first joined Missouri's health department in 2017 after he was appointed by then-Gov. Eric Greitens. He came from North Carolina, where he had overseen the state's health department and held various leadership positions since 2015.
His time in North Carolina was also marked by controversy, most notably when he reversed a "do not drink" health warning over the objections of some scientists. The water in question had been contaminated with high levels of a toxin found to cause cancer.
The move was the subject of a lawsuit and caused state scientists to resign in protest.
In Missouri, Williams' decisions have also repeatedly spurred pushback.
In 2018, lawmakers slashed eight positions from his department following his refusal to release information about the spread of the rare Bourbon virus, which had killed a state employee. The department defended its decision saying to do so would have violated health care privacy laws.
In the legal battle over licensing renewal for the state's last abortion clinic, it was revealed Williams had requested a spreadsheet be made to track women's menstrual periods who had visited Planned Parenthood in order to identify those who had undergone failed abortions.
The House minority leader called on Parson to investigate whether patient privacy was compromised as a result.
In 2019, Williams also advised Parson to veto funding for a "time critical diagnosis" program that helped ensure severely-ill patients could be connected to hospitals that could treat them most effectively. The move received swift pushback, and Parson narrowly avoided his veto being overturned by a legislature overseen by his own party.
Under Williams' watch, the department has also come under intense scrutiny and faced multiple lawsuits for its process of awarding medical marijuana licenses after the program was approved by voters in 2018.
More recently, Williams has become the most prominent face of Missouri's response to the COVID-19 pandemic and subsequent vaccine rollout.
Amid the pandemic, the state resisted calls from leading medical associations to institute statewide restrictions, like a mask mandate, and instead left decisions on health orders primarily in the hands of local officials.
It wasn't until March that the state counted antigen tests in its data, resulting in more than 80,000 previously uncounted COVID-19 infections being added to Missouri's total tally.
The vaccine rollout, the likes of which hasn't been seen since polio, has had a slow start, ranking last in the nation in January in terms of the percentage of residents who had received their first shot. Residents and lawmakers were also outraged over what appeared to be a surplus of vaccine in rural areas while residents in the metro areas drove hours to secure a shot.
While just more than half of U.S. adults have received at least their first dose of a COVID vaccine, Missouri continues to lag toward the bottom of the nation with a little over a third of residents receiving their initial dose.
The department has also been found to have violated the Sunshine Law multiple times, most recently being ordered this month to pay nearly $138,000 in legal fees after an appeals court found it had "knowingly and purposefully" violated the law.
House Minority Leader Crystal Quade, D-Springfield, released a statement ticking through all the controversies of Williams tenure and asked how he managed to keep his job for the last four years.
"With his sudden and unexplained resignation," Quade said, "one can't help but wonder what finally convinced the governor to show him the door."
Rep. LaDonna Appelbaum, a St. Louis Democrat and ranking member of the House Health and Mental Health Committee, criticized the governor's decision to tap Knodell to run the department "as our state is still in the midst of a public health crisis."
She cited Knodell's work overseeing the vaccine rollout, saying "he shoulders much of the blame for the state's early failures to provide vaccines to urban and suburban areas."
Parson praised Knodell in his announcement, saying he has played a leading role in Missouri's COVID-19 response efforts and said "I am more than confident in him to take over as acting director of the Department of Health and Senior Services."
The Missouri Independent is a nonprofit, nonpartisan news organization covering state government and its impact on Missourians.
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EARLIER COVERAGE (by Summer Ballentine, Associated Press):
Missouri's health director resigned Tuesday amid the state's coronavirus vaccine rollout, Republican Gov. Mike Parson announced.
Parson did not provide an explanation for Department of Health and Senior Services Director Dr. Randall Williams' departure. Parson named his deputy chief of staff, Robert Knodell, to be the agency's acting director.
Parson's spokeswoman did not immediately respond to a request by The Associated Press for Williams' resignation letter Tuesday.
"Dr. Williams has been a huge asset to Missouri, especially this past year in dealing with COVID-19," Parson said in a statement. "We greatly appreciate all the work he has done for the people of our state and wish him the best in his future endeavors."
Williams was appointed to the job in 2017 by Parson's predecessor, former GOP Gov. Eric Greitens.
Greitens resigned in 2018 amid multiple scandals and in the face of impeachment, elevating Parson, who was then the state's lieutenant governor.
It's not unusual for governors to change department heads when they begin a new term. But many department heads picked by Greitens remained in their positions when Parson took over as governor.
Williams ended his tenure after taking on the unprecedented job of spearheading Missouri's health response to the COVID-19 pandemic.
He repeatedly urged Missourians to wear masks, social distance and frequently wash or sanitize their hands to help slow the virus' spread. He also backed Parson's decision not to require face masks throughout the state.
Williams faced numerous controversies as health director, perhaps most notably during a fight over Planned Parenthood's abortion license.
Williams said he tracked the menstrual cycles of Planned Parenthood patients as part of an effort to identify what the agency says were "failed abortions" at a St. Louis clinic during a 2019 administrative hearing.
House Democratic Minority Leader Crystal Quade in a statement criticized the tracking of menstrual cycles, the state's "failed response to COVID-19" and the health department's rollout of medical marijuana under William's leadership.
"Through it all he somehow managed to keep his job," Quade said. "With his sudden and unexplained resignation, one can't help but wonder what finally convinced the governor to show him the door."
Parson said Knodell has also been leading the state's COVID-19 response. But Knodell doesn't have a medical background as Williams does.
St. Louis Rep. LaDonna Appelbaum, the top Democrat on the House's health committee, called Knodell's appointment "troubling."
"Knodell has no background in public health, and as the 'czar' of the COVID-19 vaccine rollout, he shoulders much of the blame for the state's early failures to provide vaccines to urban and suburban areas," she said in a statement.
Missouri has a history of non-medical professionals leading the state health department.
Like Parson, former Democratic Gov. Jay Nixon named one of his top staffers - deputy chief of staff Peter Lyskowski - to serve as acting health director in 2015 when Gail Vasterling stepped down from the position.
Both Lyskowski and Vasterling were lawyers who previously worked for Nixon in the attorney general's office. Vasterling had been appointed as acting health director in 2012 following the resignation of Nixon's first health director, Margaret Donnelly, an attorney and former Democratic state House member who had run unsuccessfully for attorney general in 2008.
Former Republican Gov. Matt Blunt also named a top lawyer in his office - general counsel Jane Drummond - to take over as health director following the resignation of his first appointee, Julie Eckstein, in 2006.
Before becoming health director in 2005, Eckstein had been owner of a business that provided online information about community events and had previously led a coalition that sponsored local health care initiatives.
Associated Press writer David A. Lieb contributed to this AP report.