Doctor in the House

DHS' first chief medical officer brings his bedside manner to disaster management.

Patients used to visit Dr. Jeffrey W. Runge one at a time. Now he treats them by the hundreds of thousands.

Runge became the Homeland Security Department's first chief medical officer last fall. In the newly created position, he advises DHS Secretary Michael Chertoff on medical issues, oversees coordination with other departments and works to ensure adequate medical response to catastrophic events.

Runge walked into a firestorm when he arrived at DHS on Sept. 6, 2005. Hurricane Katrina had hit the Gulf Coast one week earlier. Soon after, concerns over pandemic flu swelled, and the topic began to consume his staff.

In February, Runge was appointed acting undersecretary for science and technology in addition to his chief medical officer position. (Retired Rear Adm. Jay M. Cohen assumed the science and technology post in August.)

Runge's life is busier now than it was in the previous four years, when he served as administrator of the Transportation Department's National Highway Traffic Safety Administration. Previously an emergency room physician in Charlotte, S.C., Runge now was responsible for safety policies that could prevent some of the injuries he used to treat. During his tenure, the agency marked record lows in highway fatalities and child fatalities, and an increase in seat belt use, which has topped 80 percent of drivers. He earned mostly praise from auto industry and safety experts, and surprised some, considering he had no experience in the field before his NHTSA appointment in August 2001.

"He's a very quick study on the business side," says Patrick Raher, a Washington attorney who represents Mercedes Benz and worked with Runge when he was at NHTSA. "He understood those issues. I was very impressed with how quickly he learned government, how government proceeds, how policy is developed." Runge says that it wasn't difficult to measure success against definable events such as car crashes, rollovers and fatalities.

"With traffic safety, it was very easy-we had very easy metrics, all these things that are stark before your eyes," he says. "We had a number, and then reducing that number gives you a degree of success. At DHS, it's different. If nothing bad happens, then we are a success regardless of whether we affected that nothing happening or not. And that's frustrating to those who are looking for measurements of success."

DHS was looking for medical incident management expertise when Deputy Secretary Michael Jackson approached Runge, the North Carolina native recalls. Jackson knew Runge from his stint as deputy secretary at the Transportation Department.

Over lunch in April 2005, Jackson told Runge about a meeting on the preparedness exercise TOPOFF 3, when Chertoff was discussing the simulated release of a toxic agent with other security officials. "The secretary looked around the table and said, 'Quick, what do we tell the people to do?' " Runge says. " 'Do we tell them all to go to the hospital, do we tell them to go home and take a shower, do we tell them to stick around for decontamination?' And nobody could really characterize for him what was happening to these people."

Runge started in his post with little guidance, $2 million in fiscal 2006 funds, approval to hire 10 employees and a windowless office in Northwest Washington. The bungled response to Katrina meant he faced complaints almost immediately that DHS failed to clearly lay out the emergency responsibilities of federal agencies and that coordination among departments was inadequate. During his first month on the job, Runge told the Associated Press he wanted to create a team of trained medical volunteers, unaware that such a team-the Medical Reserve Corps-already was operating out of the Surgeon General's Office. But Runge now says the coordination of responsibilities is clear.

"This all falls under the National Response Plan," he says, sounding almost indignant. "Whenever somebody asks me, 'Well, gee, we don't understand who's in charge of this, who's in charge of that,' it's because they haven't read the National Response Plan. It's very well laid out in there."

Just what are the responsibilities of different federal agencies? Runge grabs a piece of paper and draws a diagram called Haddon's Matrix, named after William Haddon, the first NHTSA administrator. "This is how we do injury control for traffic safety, but it's very apropos here," he says. The 3-inch by 3-inch grid divides an incident into the host, the vector and the environment, and marks the stages as pre-event, event and post-event. A distinct federal agency-ranging from the Health and Human Services Department to the Justice Department-is responsible for each of the nine squares. For example, the post-event environment is the domain of the Environmental Protection Agency.

Runge says he spent most of his time recently focusing on DHS' Science and Technology Directorate. His objective as acting undersecretary was to realign the research and development wing from a hobby shop-as it has been perceived by some-to an agency more closely aligned with the border patrol, emergency preparedness and other DHS programs that would use the technology developed. "They were doing some fascinating stuff but the [other DHS agencies] didn't really feel connected to S&T," he says.

Runge and many who know him refer to his approach as "data-driven."

"Around here we call it 'requirement-driven,' but you get requirements from planning, and you get good planning based on data," he says. "I'm not from Washington . . . and every time I ante up my quarterly taxes, I remind myself that we should be spending money only on those things that actually produce results for the people who are paying for them."

His changes could have ruffled feathers, but most say Runge is personable. "He's charming, he knows how to get along with people, knows how to butter people up and knows how to get things done," says Joan Claybrook, president of the Ralph Nader-founded public interest group Public Citizen. Claybrook says she often disagreed strongly with Runge when he led NHTSA, but she praises his candor: "He's easy to talk to, a very delightful person, and he was very generous with his time."

Juggling his many challenges as chief medical officer, Runge no longer has time to see patients. "I eat a lot of food that's been in the oven for three hours," he says. Still, a white robe hangs on his coat rack and a "no sniveling" sign sits in his office. Coordinating large scale medical response is how he practices medicine nowadays: "Injury control I consider to be the essence of public health."