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"Lead, follow or get out of the way."
Lee Iacocca said it and Dr. Hugh Stallworth quoted it in an article written before he took command of the St. Louis Department of Health in the fall of 2002. For the rudderless department, the new health director seemed to be just what the doctor ordered -- a highly regarded professional who promised to bring a bold new vision to a languishing agency, an African-American who might even help to bridge St. Louis' racial divide.
Stallworth's arrival was preceded by rave reviews that impressed the search committee; he was a strong leader who could at last administer much-needed life support to a staff demoralized by years of mismanagement and financial chaos.
Stallworth practiced medicine for ten years and earned his public-health stripes during successful tenures in county health departments in California. He had valuable experience working with cash-strapped governments, having navigated Orange County's health department through bankruptcy.
Reporting to work in October 2002, the 58-year-old Stallworth inherited more than just a ninth-floor office in an old building where the elevators seldom worked. Before taking the job, Stallworth did some intelligence gathering and was keenly aware of the department's history of upheaval: six directors in ten years.
"What I came away with was the department was neglected. It was absolutely neglected -- fiscally, leadership-wise, politically," Stallworth recalls.
Other problems abounded. His second-in-command, health commissioner Melba Moore, had been beset by a string of scandals. Sexually transmitted diseases, HIV and childhood lead poisoning were off the charts. St. Louis ranked second in the nation for gonorrhea and third for chlamydia. The infant mortality rate was shameful, especially among African-American babies.
"What I found, whether it was talking to people from the medical schools, the undergraduate schools, the nursing schools, [was that] people did not know how bad the health indicators were in St. Louis," Stallworth says.
But where others saw setbacks, Stallworth found opportunities. The temperamental elevator was a chance for exercise, a nine-story climb he made two, three, sometimes four times a day. Immediately after his arrival, he set to work. He took an almost unheard-of step, suggesting partnerships with the St. Louis Board of Education. The two agencies, he envisioned, could work together to tackle the problems of violence, teen pregnancy and sexual diseases.
Stallworth included his department managers in preparing a long-term strategic plan. He stressed customer service. He reached out not only to the medical community but to all of St. Louis through speeches and panel discussions at public forums. After just a few months on the job, Stallworth was stunned when the mayor's office proposed slicing the health department's general fund by 11 percent. He enlisted the help of health department advisory-board members, encouraging them to write letters to key decision makers in the city. Let them know why the cuts would be disastrous, he implored them. Stallworth prevailed, but he would pay a price.
It was never smooth sailing for Hugh Stallworth, despite the ardent backing of the medical community and his board. Just a year after taking the job, it became painfully clear that he had fallen from grace and was no longer in charge of setting the city's public health agenda.
Stallworth's undoing came to a head on November 13, 2003, when Rita Kirkland, Mayor Francis Slay's take-charge executive director of operations, appeared for the first time before the health department's advisory board. At that stormy meeting, Kirkland suggested that the department take a new direction -- a direction with which Stallworth could not agree.
Almost from day one, the tension between Stallworth and the mayor's office had been building and now, with 2005 budget negotiations rolling around, the mayor's office -- and Rita Kirkland in particular -- went on the offensive. It was not a polite policy debate that transpired during that fateful November meeting.
A rail-thin woman who favors dark lipstick and red nail polish, Kirkland knows her way around City Hall, having spent twenty years working for the city in one capacity or another. In the summer of 2001, before Stallworth took over, Kirkland and Melba Moore had worked in tandem to bring a semblance of financial order to the reeling department.
These days, Kirkland is one of the mayor's chief arm-twisters, enforcing the mayor's plans and tolerating little dissent.
"It is no secret that the health department has been somewhat dysfunctional for the last 30 years, and we have been very lucky to have two good administrators in the last two years with Dr. Stallworth and Melba," Kirkland said at the meeting, according to a transcript of the session.
Kirkland wanted the advisory board to take a radical step: Eliminate four department clinics -- tuberculosis, sexually transmitted diseases, HIV and immunization -- and scrap the clinical part of the lab, which includes STD and TB testing. Kirkland proposed that ConnectCare, the region's so-called healthcare safety net for the poor and uninsured, could run the clinics. She went on to assure the advisory board that she and Moore had approached ConnectCare, and the healthcare group was in favor of the idea.
"We're not just talking about dumping services on ConnectCare, we are talking about working with them," Kirkland said.