A friend who was a deputy director at the S.C. Department of Health and Environmental Control back in the 1970s called Friday to tell me how happy he was to hear that DHEC “finally has a psychiatrist.”
No word on whether Dr. Edward Simmer actually spent his first day on the job Friday smoking a pipe and taking notes while the beleaguered agency lay on the sofa complaining that “nobody understands me.”
But during his Senate confirmation hearing on Tuesday, the retired Navy captain and forensic and general psychiatrist said a lot that suggested he's up to the task of treating the agency’s split personality disorder — and doing it in a way that could make the patient whole rather than resorting to the lobotomy that powerful legislators are proposing.
Obviously, Dr. Simmer’s first task has to be everything COVID. That means not only getting the logistics right — making sure you have a huge phone bank and an easy-to-navigate online interface before you invite 80-year-olds to make vaccine appointments, for instance — but also getting communication right. If nobody understands DHEC, it’s because DHEC speaks another language.
The agency demonstrated that yet again on Tuesday when, hours after Dr. Simmer told senators he wanted to improve communication with public health partners and the public, it dropped a news release announcing that it had suddenly changed how it calculates its most-watched COVID metric, along with a mathematical explanation that still doesn't add up.
DHEC’s real and imagined shortcomings managing COVID-19 have revived perennial efforts to split the agency into separate health and environmental departments. Senate President Harvey Peeler told me in December that the prolonged search for a new director illustrated the agency's existential problem: No one could be an expert at managing a pandemic, protecting wetlands, regulating coastal development and hospital expansions, ensuring that drinking water is clean, restaurants are safe and earthen dams hold and all the other stuff the massive agency oversees.
His argument makes sense if you just look at what is. DHEC never has operated as a unified health and environmental agency; the parts have been walled off, with the public health side given short shrift and the environmental side more interested in protecting polluters than protecting the environment.
Cindi Ross Scoppe
But the idea of combining the two sides into one agency wasn’t crazy. It was brilliant.
The problem has been execution. And as I listened to Dr. Simmer explain what’s right with the idea, it occurred to me that perhaps we’ve had execution problems because we haven’t had a director in decades — if ever — who fully appreciated that idea.
What we've had were "agenciests" — experts at preserving the DHEC status quo, who built the relationships to accomplish that by serving as DHEC lobbyists before stepping into the top job. And then a bizarre string of anti-agenciests: a union-busting attorney with marching orders from the governor to trim down and shake up the agency, a utility executive and most recently a retired hospital administrator whose strongest credential was his seat on the DHEC board.
When Sen. Peeler tried to make the point Tuesday about the incompatibility of public health and environmental regulation, Dr. Simmer easily deflected the argument.
He would handle the environmental duties, he had already told senators weary of his lack of environmental credentials, by relying on the agency’s subject-matter experts, just like he would rely on subject-matter experts on the health side. (It’s worth noting that having no environmental expertise is the one thing he has in common with most if not all of his predecessors. It’s the M.D. that sets him apart from all but the first three directors.) And he returned repeatedly to the “synergy between health and environment.”
“Really much of what we do in environmental control is … focused on keeping people healthy,” he said, “so that they’re not exposed to toxic substances, landfills are not leaking into the water source, that asbestos — the number one thing we permit for is asbestos removal — making sure asbestos is being removed safely. A lot of these things have both a health component and an environmental component.”
That, to be clear, is why the Legislature added clean air and clean water to the state health department's portfolio in the 1950s and 1960s and kept adding more environmental duties after it created DHEC in 1973: to protect public health.
Dr. Simmer noted that South Carolina is one of three states, along with Colorado and Kansas, that combine health and environmental regulation in one agency and said he has already started looking at those other combined agencies.
“Certainly I will want to work very closely with those two states, learn how they do it, see what’s working for them, what’s not, have our team do the same thing, so we can share lessons learned and identify how we can best maximize the connections between health and the environment,” he said. “Because as I said I think there are some very important connections there, and I think there are certainly benefits to be gained by having that all under one roof so it works together effectively.”
I doubt he realizes the magnitude of the problem, but he did seem to acknowledge that DHEC might need work on that "work together effectively" thing when he asked senators to give him a year to “understand how the two sides are working together more in depth, and how we can potentially improve that” and report back with a proposal. “I think that’s an incredibly important question: not only the question of does DHEC stay the same (but) if we are going to change it, how do we change it to make all parts of it most effective?”
Even if senators back down, Dr. Simmer needs to follow up. Because such an important question is best answered by someone who appreciates why it's so important to approach the environment from a public health perspective.