Former California public health czar bringing experience to Sonoma County, but not for long

Sonoma County’s new health officer is a veteran public health official who’s been through it all, from pandemics to anthrax scares to fires and floods.

During her career, which has spanned four decades, Dr. Karen Smith has gone from running a public health lab in Marrakesh to leading public health teams in Santa Clara and Napa counties to becoming California’s top health official.

That’s the good news.

The bad news is that as “interim” health officer, Smith will only be around until a permanent replacement is appointed, which could be soon, according to Sonoma County Health Services Director Tina Rivera.

“We have conducted a nationwide search and plan to go to the Board of Supervisors soon with a recommendation,” Rivera said in an email Tuesday.

Smith was brought in to fill the gap left by interim health officer Dr. Kismet Baldwin, who left her post last week to become health officer for San Mateo County. Baldwin, who previously was deputy health officer, took the leadership role after the county’s pandemic-era health czar, Dr. Sundari Mase, left in early April for a job with the federal Centers for Disease Control and Prevention.

Smith says she’s happy to help “keep the machine running” until her replacement arrives, and she said she has her fingers crossed that COVID-19 continues to moderate, allowing the county’s public health staff to shift resources to core issues that for three years took a back seat to pandemic response.

These include environmental health, suicide and mental health wellness, the opioid and fentanyl crisis and racial and ethnic health care disparities. Smith said Sonoma County, through countywide partnerships like Health Action, already had been addressing these issues before the pandemic struck.

But here and in public health departments across the country, resources had to be diverted to confront the pandemic.

“One of the conversations I want to have so that I can be as effective as possible, is what are their priorities,” Smith said. “Now that COVID appears to be moderating, it’s time to look back and say, ‘What did we pull from for COVID and what can we re-energize or reinvigorate?’”

Smith likely won’t have any trouble leading the county’s public health staff; her resume is impressive.

Raised by a father who was a high school teacher and mother who was a secretary, she grew up in Sparks, Nevada. After attending the University of Nevada, Smith transferred to the University of Michigan, where she received a degree in microbiology in 1980.

The following year, she went into the Peace Corps for three years, spending nearly a year in Morocco where she ran the public health lab in Marrakesh and another two years in Thailand working in a small district hospital in the middle of the country.

After her Peace Corps tour, Smith returned to the United States and had every intention of going back overseas after receiving a master’s degree in public health at Johns Hopkins University. But, she said, “life changes” — and instead she ended up working a couple of years toward a Ph.D. from UC Berkeley in parasitology, the study of parasitic diseases.

Then she decided she’d rather go to medical school and enrolled at the Stanford School of Medicine, where she later completed her internal medicine residency and an infectious disease fellowship.

In 1997, she became the tuberculosis control officer for Santa Clara County, a deputy health officer position she held for eight years before she was named Napa County’s health officer in 2004.

Prior to coming to the North Bay, Smith’s experience had largely focused on communicable diseases and emergency preparedness. It was the age of smallpox bioterrorism scares, anthrax letters and the unprecedented 9/11 attacks and their aftermath.

During the first SARS epidemic in the early 2000s, Smith answered a call for infectious disease doctors and specialists to help respond to the outbreak in Toronto, Canada. Her work there spurred her interest organizing large-scale responses to such public health emergencies.

In Napa County, however, she soon learned that the scope of public health reached far beyond infectious disease and bioterrorism. The range of public health issues included maternal and child health, community nutrition, vital records and much more.

“I had quite a learning curve, but also had a really wonderful team,” Smith said. “Napa is much smaller than Sonoma County, so the public health department was also smaller, but we had the same sort of panoply of issues … we had fires and floods, as well.”

Smith said she loved working in Napa County and would likely have stayed there until hitting retirement age. But in 2015, she was tapped by the state secretary of Health and Human Services to become the state’s public health officer and director of the California Department the Public Health.

It would seem a big step up for the head of a small county public health department. However, while in Napa, Smith became part of the California Conference of Local Health Officials, CCLHO, and eventually became the organization’s vice president. The state organization, which represents 60 county health offices, has significant cachet with state health officials and is an advisory body to the state public health department.

In 2015, when state Health and Human Services Director Diana Dooley found out that state Public Health Officer Director Dr. Ron Chapman was leaving she asked the conference of health officers what they were looking for in a replacement. Smith wrote Dooley a letter that outlined a number of ways the state public health agency “did or didn’t work” with local health officials.

“It was basically a laundry list of all the things that I thought could really be improved,” she said. The letter effectively put her on the secretary’s radar for potential candidates. When she was offered the position, her reaction was, “I’m not qualified to do that.”

“At the time, I had like 63 employees,” she said. “But (Dooley) disagreed and convinced me that I actually was qualified for the job.”

Smith retired from that post in 2019, the year before the pandemic. When COVID-19 reached the Bay Area, Smith’s expertise was once again sought. Santa Clara County’s public health officer, Dr. Sara Cody, and Smith had worked together years before, when Smith was that county’s tuberculosis control officer and Cody oversaw control of communicable disease response.

Early in the pandemic, Smith was among Cody’s key advisers for her expertise in setting up incident command systems and organizing public health staff to respond effectively to emergencies. Cody eventually led a half-dozen other Bay Area health officers in ordering the unprecedented “shelter-in-place,” with Sonoma County following suit days later.

Decades of experience

Gabriel Kaplan, the director of the county’s public health division, said he first met Smith when she was state public health director. At the time, he was with the Colorado Department of Public Health and Environment.

Kaplan said in an email he was “impressed by her intelligence, her cutting-edge thinking, and her passion for health equity and the public’s well-being.”

“I was thrilled when she and I spoke and she expressed a willingness to help us in this interim period,” he added. “We have landed a real star.”

The county health officer serves as the chief medical officer and top health policy official for the county, and is granted authority from the state to declare public health emergencies, issue health orders and impose penalties for noncompliance.

Early in the pandemic, public health departments across the country scrambled to mount an effective response to the disaster. It was widely reported that funding for public health agencies had suffered in the decades leading up to the pandemic.

Smith’s decades of experience gave her a different take on the nation’s public health funding problem. She recalled a conversation she had with then-Gov. Jerry Brown following her appointment as the state’s top health officer. Brown remarked, “Oh, yes, public health, you're chronically underfunded,” she said.

Smith thought about it for a second before she responded.

“I said, ‘I’m not sure that it’s that we’re chronically underfunded so much as that we’re inappropriately funded,” she said.

Public health funds are often episodic, with huge boosts aimed at such things as bioterrorism, natural disasters and pandemics or the latest disease to make headlines. But such funding inevitably dries up.

“We spend a lot of time and effort in training a whole cadre of people across the country, and then they get laid off because you don’t have money anymore,” she said.

She said the key is maintaining a “core infrastructure that isn’t dependent on a disease du jour-stream of funding.” Public health staff, such as epidemiologists, shouldn’t be waiting around for the next pandemic, she said.

“You have to train those people, but then you have to employ them and you have to keep them employed in the system,” Smith said. “We lose a lot of expertise every time these surges in funding go away.”

You can reach Staff Writer Martin Espinoza at 707-521-5213 or martin.espinoza@pressdemocrat.com. On Twitter @pressreno.