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Dr. Randall Williams: In appreciation of Missouri

In Appreciation,

More than four years ago, I became a Missourian. As I told the Senate at my confirmation hearing, to be a good leader as DHSS director, you had to get up every day with courage, humility, and knowing what a privilege it is to serve the people of Missouri. It is a difficult role because the issues we deal with concerning people’s health are very important and generate tremendous responses from people since their health is so important to them. Sen. Doug Libla said I was the hardest working bureaucrat he had ever met, and Gov. Mike Parson said I worked harder than any Missourian during the COVID-19 epidemic, and that is because I knew how important our work was. 

Every time I go to the Capitol, as I drive into the parking garage, I read the words inscribed in stone more than 100 years ago: “Be Just, and Fear Not.” I believed then — and believe now — from my years as a surgeon, that to help people always involves risks and benefits, and it was never my goal just to lead the parade waving at people, but to actually help people improve their health by developing our subject matter expertise. The military historian Vegetius said the courage of a soldier is heightened by the knowledge of his profession. As the first physician to lead the department in 15 years, it was my mission to develop the skill sets and subject matter expertise to help people when the time came that they needed us — and that turned out to be a really good thing with COVID-19. 

I believe fervently that to help people you have to act and that required transforming our culture to one based on a bias to action. The motto of the United States Military Academy class of 2022 is, “For Many, Stand the Few,” and I would say that has defined our culture.  Gov. Parson represents 6.1 million Missourians, and they hope all of us will go to work every day to help him as he stands up for them. Gov. Parson had high expectations of us, and we established a new precedent that we would advocate for and defend the health of Missourians. As President “Give ’em hell” Harry Truman said: “I just tell the truth, and they think it’s hell.”

As the St Louis Post Dispatch recognized, we don’t run from controversy, and that is because it is our duty to protect health, keep people safe, and make sure that we as well as others as Mark Twain said “Do the right thing.”  

General John Pershing once said: “I love every inch of Missouri and every ounce of its air.” And I think I know why. I will never forget the awe I had for the Missouri State Capitol Building when I walked into it the first day I was in Missouri, and it would be fair to say it was love at first sight. Everyone was so gracious, and the Capitol was so stunning, and I remember thinking, “What an incredibly special place.” I spent the first 12 out of 16 weekends visiting every county and arriving unannounced to tour the facilities we oversaw like an episode of “Undercover Boss.” 

One of the sculptors of the busts in Missouri’s Hall of Fame said Missourians are defined by loyalty, independence, forthrightness, persistence, decisiveness, and plain old Missouri common sense. I would just add that there is innate goodness to help others that are in the people of Missouri’s DNA. At times it is strained — and I am all too aware of the differences in an incredibly diverse state — but I have been to every county, and I still feel it is foundational to what makes Missouri special. I often said I am a North Carolinian by birth, a Missourian by choice, but both are by God’s grace. To me, Missouri will always represent people who work hard, help others, and are steadfast in the beliefs of the fundamental values of our founding fathers. 

Gov. Parson always asked us to get better every day. I have worked a lot of 100-hour weeks trying to do just that. As Truman said in his last speech to the American people as president:  “I have tried to give it everything that was in me.” I get up very early in the morning — what the military calls oh dark thirty — before 5 a.m., and while I have run all over the world, time running with my dog Mo along the Katy Trail as the sun comes up over the Missouri River has brought me more joy than you can imagine. (Thanks to Kurt Erickson for the introduction to the Katy Trail.) We have tackled tough issues, but certain ones stand out that we were a part of on our watch:

  • The first real-time review of maternal deaths by our PAMR board in a state that ranks No. 44 in maternal mortality. We increased our ranking in women’s health by eight — the most of any state in 2019.
  • The first redesign of our $1 billion HCBS and CDS program since 1982.
  • Passage of the Good Samaritan law and universal Narcan availability law under my DEA law with the first reduction of opioid deaths in 2019 since 2015.
  • Implementation of Article 14 of the Constitution passed in 3,000 out of 3,200 precincts which created a medical marijuana program, and we did it the sixth fastest than every other state keeping patients as our north star while meeting all of our constitutionally mandated deadlines. To date, more than $2 million have been transferred to the Veterans Fund.
  • Started on Jan. 27, 2020, a COVID Incident Response and helped with a whole government approach to COVID-19. I participated in more than 120 press conferences from the Governor’s Office as we communicated, coordinated, and cooperated with all our federal, state, and local partners. For much of the winter of 2021, we had the second-fewest cases per capita of the 50 states here in Missouri, and Missouri was incredibly fortunate to have Gov. Parson as its leader during this unprecedented time in Missouri’s history.
  • Dutifully regulated all our regulated entities, such as hospitals, and actually enforced existing statutes. I testified multiple times such that abortion providers were held accountable for patient safety and following state laws — which they had not been doing.
  • The first Missourian in 75 years to be on the Executive Board and Board of Directors of ASTHO and the first physician to lead DHSS in 15 years. I worked hard with our federal partners to make Missouri a national thought leader in health.
  • Creation of the Office of Childhood to promote a holistic approach to children’s wellbeing.

I also realize these are tough times for public health leadership. Ernest Hemingway once called courage “grace under pressure” which is important to remember when you are getting credible death threats as I, and many other public health leaders, have. Senator Kit Bond told me the key to his success was to listen, and I have encouraged all at DHSS to do just that. Carved in the side of the Capitol are the words, Honor Opus Habet (Honor Has Its Burden) placed there in 1917. I saw them every day when I drove the four blocks to my apartment on Main Street in Jefferson City from the Capitol.

Yes, honor does have its burdens, but I would bear them readily again because one of the great honors of my life is that I was invited to become a Missourian. I am very appreciative to Gov. Parson who when he became governor invited other Cabinet members and me to continue to serve which allowed me to form friendships that I will forever cherish. As I told him recently, it was a privilege to serve with him, and I am thankful for our friendship and his leadership.

I will leave you with my thoughts on being director from the musical Hamilton: “Oceans rise, empires fall, it’s much harder when it’s all your call.”  

In both regulatory and policy matters, we made the hard calls at DHSS, and we briefed Gov. Parson who had the courage and strength of character to make many hard calls during COVID-19 and at other times — and Missouri is better for it. As we celebrate our state’s 200th birthday, I am thankful for the dedicated people at DHSS who never forgot that all Missourians, wherever they live and whoever they are, count on us every day to help protect their health and keep them safe. 

The next three years are going to be vital and exciting as DHSS receives almost $1 billion in funding to revise public health, and I hope all will work with Gov. Parson to build out the workforce and infrastructure for a solid foundation for many years to come. DHSS needs a director who can commit to that for three years as we move from rescue to recovery. And after four years of being away from my family, I need to honor the commitment I made to my 91-year-old mother, wife, and entire family that this would be my last year.

I will always remember a note I saw at a hospice site on a bulletin board from a patient when I was visiting a health department during my first year here. It said: “I have come to realize this.  The most important things in life are the people you love, the places you visit, and the memories you make.” 

I carry with me memories of so many people I came to love because they were so kind to me. Throughout my time in Missouri, people I did not know would constantly tell me they were praying for the governor and me in handwritten notes, phone calls, emails, texts, and when they would see me in stores. I will always associate the word Missouri with prayer.  

To all the Missourians who thanked the governor and our team at DHSS for the incredibly long hours we put in, please know we had a keen sense of duty, and I personally want to thank Gov. Parson and all Missourians for allowing me the high privilege to serve the people of Missouri who truly make this a very special place.