Code Red

The bleeding won't stop. The city health director's job remains a revolving door as Dr. Hugh Stallworth is vanquished in a fierce bureaucratic battle.

"I understand that you are doing [the mayor's] work," Liberman replied. "[But] you are chipping away at what [Stallworth's] job is."

Kirkland fumed. She said the department's revenue stream was running on empty and making little or nothing from the clinical work it performed. Advisory board chairman Dr. Rick Kurz, former dean of Saint Louis University's School of Public Health, stressed that they'd only had a year to fix the problems.

"No, you have had more because I started cleaning this department out in '01," Kirkland snapped.

"But we didn't have a director then," Kurz responded.

Liberman added, "You cleaned it up pretty well -- you got a new director."

Refusing to go along with the budget cuts and washing his hands of St. Louis-style "closed" politics, the embattled Stallworth joined the swelling ranks of former health department directors two months later.

Stallworth refuses to go into the "graphic, gross details," of his departure but says, "I can tell you -- it is ugly in St. Louis. I feared for my reputation. It is just very, very ugly. I never know what's going to come out. I never know what's going to be said."

When Dr. Stallworth arrived at the department, political appointee Melba Moore was already entrenched as health commissioner, a post whose relevance has since faded, having been created during an era when the city had its own hospitals. When the hospitals were closed years ago, the two agencies were combined, but the health director and health commissioner appointments remained. Although the health commissioner technically reports to the health director, the department has, in reality, been a two-headed bureaucracy. The duties and responsibilities of the commissioner and director aren't well-defined. But in this instance, Moore and Stallworth each had a separate pipeline to the mayor. When the power struggle ensued, the outcome would be determined not by qualifications but by political connections.

Moore was appointed by Mayor Slay in 2001, the year an audit of the health department discovered $559,000 worth of checks had gone undeposited. Instead of making a trek to the bank, an employee simply stuffed the checks in a drawer and forgot about them.

Shortly into her tenure, Moore earned a reputation for putting politics above public health and pushing the blame for department failures onto subordinates.

In April 2002 the department failed to pay its pharmaceutical bills. Vendors wouldn't deliver supplies, including antibiotics needed to treat sexually transmitted diseases, and the department was forced to borrow drugs to meet the demand.

Moore blamed an employee, who was subsequently forced to resign.

Three months later, in July 2002, Moore was back in the news when it was revealed city health inspectors tried to shut down two restaurants, The Edge and Bar Italia. Health inspectors discovered a dead rodent behind the ice machine at The Edge, a favorite eatery for local politicians. The St. Louis Post-Dispatch reported that improper meat-storage temperatures and a mousetrap in the dining room led to low scores. Bar Italia, meanwhile, had failed to obtain a mandatory health permit.

Jeff Rainford, the mayor's chief of staff, called Melba Moore to intercede on behalf of The Edge. Ward 28 Alderman Lyda Krewson asked Moore for help with Bar Italia.

Moore intervened and the restaurants stayed open. When the news broke, she told the Post-Dispatch that the health inspectors were rude and unprofessional. A Post-Dispatch editorial followed: "Hello, Melba? Health Department inspectors exist to protect the public's health, not the sensitivities of restaurants that fail inspections."

In late August, the accounting firm of Rubin, Brown, Gornstein & Co. released another audit that concluded that the health department's late paperwork cost it $207,000 in HIV and AIDS money. The fiscal mismanagement occurred on her watch, but in an effort to dilute the bad news, Moore announced that the health department had persuaded Dawn Anderson, an RBG accountant, to assume the position of fiscal manager for the department.

Asked about his relationship with Moore, Stallworth says, "It didn't start out real bad -- but it got real bad."

Some advisory board members believe that Moore became the mayor's office eyes and ears in the health department and that Stallworth, clearly a man who didn't relish political intrigue and back-stabbing, let it happen. By washing his hands of the political role, Stallworth allowed his authority to be undermined and solidified an alliance between Kirkland and Moore, who then pushed their own vision of public health.

When asked if he riled the mayor's office and earned the reputation of a loose cannon because of his public campaign to protect his department from the budget cuts and clinic closures, Stallworth agrees it had caused friction. But he adds, "That wasn't the first turning point. There was another turning point, but I'd really rather not talk about that now. It got worse as there was a change in the mayor's staff, when one individual retired and another took her place."

Stallworth wasn't the only target. Brenda Quarles, respected for her work combating lead poisoning in the area, also had a short stint in the department. After Quarles criticized uncoordinated efforts within city agencies to fight lead poisoning, Moore fired her for allegedly missing a grant deadline.

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