ISSUE 148: Special Section

Know A Good Doctor? We Do.

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Kentucky’s Top Doc, Steven J. Stack, MD, MBA, FACEP: His Finest Hour

“To each there comes in their lifetime a special moment when they are figuratively tapped on the shoulder and offered the chance to do a very special thing, unique to them and fitted to their talents. What a tragedy if that moment finds them unprepared or unqualified for that which could have been their finest hour.”— Sir Winston Churchill

The daily press briefings on COVID-19 in Kentucky were a constant presence beginning in March 2020. In March 2021, we asked Steven Stack, MD, commissioner of the Kentucky Department for Public Health, to look back and forward, something he’s done a lot of in the last 14 months.

MDU What has the last year of your life been like? Like Groundhog Day, a never-ending 48-hour shift in the emergency room?

STACK: Last year, in February 2020, I had just become commissioner for public health in Kentucky. I had just been to Washington D.C. and met with other state commissioners of public health. That was the last time I’ve been on an airplane. When I was president of the AMA I traveled constantly, so not to be on an airplane for 13 months is hard to believe. But so many other people’s lives have been upended as well.

It feels like both a lifetime ago and Groundhog Day because the challenges have been unrelenting and ever-present. We’d tackle one problem and another would be right there in front of us. Getting PPE, setting up testing, distributing treatments like Remdesivir. Now we’re getting the vaccinations rolled out, which is arguably the single most complex and most critical task we’ve dealt with.

MDU When did COVID-19 come on your radar and you have some idea of the magnitude of the virus and coming public health crisis?

STACK: In January 2020, I was working in the ER. Between the time I accepted the commissioner’s job in mid-January and my February 10 start date, it became clear to me that there was a problem brewing in the Far East. By the time I became commissioner, it was clear that this virus was not going to stay in the Far East, but impact people across the globe, including the people of Kentucky.

MDU What were those early days like for you as new commissioner with an explosive public health crisis coming your way?

STACK: This was my first opportunity to serve as an appointed public servant and administrator. I had to meet a team of more than 450 employees with a sweeping array of public health initiatives like diabetes prevention, cancer screenings, early childhood well-being, the WIC program, and running a highly sophisticated public health reference lab. Our department does restaurant safety and radon inspections and infectious and communicable diseases prevention. We do preparedness for emergencies and disaster responses, like the recent ice storm and flooding.

We all had to get to know each other in a hurry and learn what was available to us, what resources we had while this incredible crisis was happening before our eyes, presenting new challenges every day.

The governor and I had to get to know each other as we were standing together every day at the press conferences. One thing I hope we showed over the course of the year was the amazing amount of collaboration and collegiality we developed as a team while we tackled the problems in front of us.

It’s been a remarkable journey for all of us and so much was communicated, catalogued, and on display every day for the public in the press conferences.

MDU Rarely is the Kentucky commissioner for public health at a daily “must-see TV” press conference. But there you were. How did that experience transform your department?

STACK: Public health has long been underappreciated. COVID 19 has helped the public understand how important public health is to preserve health and prevent injury and disease. It mitigates or alleviates the harms of societal or individual decisions that cause people to live shorter or sicker lives and not reach their full human potential. Public health offers so much good for society. We usually operate under the radar. Maybe the public now has a more profound understanding of the many people who are heroes, who protect them every day and how varied our roles are.

Our teams worked tirelessly finding the PPE, storing it, cataloguing it, and shipping it out across the state to where people needed it. Then on to COVID testing, setting up the mobile labs, getting the test kits out into the public arena. Now we’re receiving and distributing and injecting vaccines. We are effectively running a large, startup pharmaceutical distribution company, building a network and bringing organization and consistency to statewide distribution of the vaccine. Those are enormous logistical undertakings. We’ve tried to bring complete transparency of our decisions to the public through the press conferences, so the public had awareness and insight into what was being done on their behalf.

It was very frustrating and unsettling for the public to have their lives shut down by an infectious virus, through no fault of their own. So, it was a transformational experience for me, for public health, and for the people of Kentucky

MDU How were you personally prepared for this experience?

STACK: No one could be prepared for the enormity of this task, and I could have never predicted what the past year has brought. I look back at my years of being an emergency physician, being interested in business and finance, getting a business degree, being a president of the AMA, dealing with the media, my advocacy work with other medical professionals, engaging lawmakers. I humbly admit that I drew on all of that experience and skill set and will continue to do so.

MDU Can you give me some examples of how your background and experience prepared you?

STACK: These times have been stressful and demanding. You’re dealing with many people who are hurting and in a great deal of hardship. It’s understandable that there’s frustration and anger and fear. So, you have to be patient and understanding. I believe that traveling across the country and meeting with doctors from all over, plus my decades spent as an emergency physician helped me understand that when anger boils over, it can be a person who is hurting and reaching out for help. That’s when we try to find solutions, to find common ground, to work with everyone to get through this problem together.

In my interactions with the governor, I had the great privilege, honor, and obligation in my role to be an advisor as he made a number of difficult decisions in the best interests of the people of Kentucky. I’m very grateful for the opportunity to serve in that advisory role and serve the people of Kentucky in a time of need.

MDU With so much time, energy, and resources being consumed by the coronavirus epidemic, what happened to the other core missions of the department of public health?

STACK: The good news is that we have a great number of very talented people who work in the Department for Public health, a dedicated team of civil servants who continue to get things done. As an example, every year there are approximately 2,400 Kentuckians who are diagnosed with colorectal cancer and about 850 die every year. We work with groups to make colon cancer screenings more easily available throughout the state, particularly for people with financial barriers.

In tobacco cessation, unfortunately we still have a large population that smokes and uses tobacco products. We have the Quit Now Kentucky program, a website and phone line to help people get off of tobacco use.

My colleague, Deputy Commissioner Dr. Connie White, works extensively with the Kentucky Perinatal Quality Collaborative that brings healthcare providers and facilities together to improve early childhood and provide safe, healthy deliveries so children get off to a good start in life.

And, remember when the opioid epidemic was the big epidemic that we were all talking about? We have a “harm reduction” team that addresses suboxone distribution and supports syringe service exchange programs for people across the state.

As commissioner, I have the privilege and opportunity to give a prominent voice for all the people and the work that’s being done with the hope that we can continue having the resources and so that the people of Kentucky know what’s being done on their behalf and take advantage of our programs.

MDU What accomplishment are you particularly proud of in your first year as commissioner?

STACK: I am most grateful for the team that I serve with at the Kentucky Department for Public Health. Hundreds of people who worked weekends, nights, and holidays, doing what had to be done throughout the last year. I think, in some small way, I was able to provide some reassurance to the people of Kentucky that we would get through this daunting and difficult time by providing the information they needed to empower them to make decisions to stay safe.

MDU What’s on your agenda for 2021?

STACK: Like everyone, I’m looking forward to a post-pandemic world. We are actively working to transform public health through legislation that was passed in 2020 to reconceptualize how we do public health in this state and to make it more sustainable because it has not been consistently financed.

First, we’ll be working on the vaccination outreach. Then creating a supportive environment for our public health care workers, fostering an inclusive understanding of the diversity of ethnic, financial, and cultural differences within our state. Both urban and rural, from Appalachia to Jefferson county. Exiting the post-COVID world with renewed energy to a stronger, better place.