DIVERSE CHALLENGES AWAIT NEW PUBLIC HEALTH DIRECTOR

On the front lines of San Francisco's medical marijuana battle 1 1/2 years
ago, Dr. Herminia Palacio turned the tide.

She hit upon a way to shield doctors who prescribe marijuana to ease the
pain and nausea of AIDS and cancer patients. California had legalized such
marijuana use, but most doctors were skittish about prescribing because it
conflicted with federal drug laws. The dilemma bedeviled San Francisco
health department officials.

Palacio's ingeniously simple solution was to create patient identification
cards that verified a doctor had approved the patient's need for medical
marijuana but kept the doctor's involvement anonymous.

The health department even divested itself of any knowledge once a card was
issued, returning all paperwork to the doctor in a move to prevent seizure
by federal agents.

"It was a wonderful solution," said Dr. Mitch Katz, San Francisco's public
health director. "It combined compassion and intelligence in a way no one
else had thought of. Only someone so devoted to the disenfranchised as Dr.
Palacio would have thought of it."

Palacio this month officially brought her intelligence and compassion to
Harris County. As the county's new executive director of Public Health and
Environmental Services, she'll face challenges ranging from low
immunization rates to bioterrorism preparedness to the West Nile virus, all
on a shoestring budget.

The budget problems already led Palacio's predecessor to resign after just
six weeks on the job. In August, Dr. Alfred Adams left for a similar
position in Florida, criticizing the political support he was receiving in
Harris County and saying the public health of its citizens is not a
priority on the Commissioners Court.

County Judge Robert Eckels and commissioners pooh-poohed such talk, calling
their current support of public health better than it's ever been. They
said last week that they still didn't understand why Adams left, because he
had their full support and hadn't fought with them over anything. They said
they have complete confidence in Palacio to meet the county's varied
challenges.

Yet they also acknowledged that the state's budget shortfall means Palacio
will have to do more with less. And Commissioner Steve Radack said Adams'
resignation provides an opportunity to revamp the health department, whose
coordination efforts with the city health department and other agencies
historically have been less than stellar.

Palacio said last week that such organizational matters are best left to
the Commissioners Court.

"Having been here two weeks, I'm in no position to have an informed view
about that," said Palacio, whose parents emigrated from Cuba in the 1940s.
"I'm still meeting staff and community members and getting to know this
big, diverse, densely populated metropolitan area."

Big, diverse, densely populated areas are Palacio's métier. At 41, she is a
practiced public health veteran and expert who has spent most of her career
in county health systems and the public health arena of academia. Her
interest in society's disenfranchised has focused on drug addiction and
women with HIV/AIDS.

Palacio's experience with large cities also predates her career. Small and
thin, she grew up in New York, blue collar and "Bronx tough," the latter a
result of a physique she describes as scrawny. "Survival wasn't about
physical prowess," she said. Her father drove a cab and her mother worked
as a seamstress, then a postal worker and finally a transit-authority staffer.

The young Palacio was both bookish and athletic, running track, playing
paddleball and frequently sequestering herself and reading. She initially
wanted to be an architect but abandoned the idea after she realized that
"even with a ruler, I had difficulty drawing a straight line."

She stayed in New York for college at Barnard and medical school at Mount
Sinai before heading off to her residency at San Francisco General
Hospital, that city's version of Ben Taub. Those were hard years, she
recalled, and not just because residents get so little sleep.

The problems she saw persuaded her to go back to school, to get a master's
degree in public health at the University of California at Berkeley.

"Before I set out to fix problems, I decided I needed to know better which
questions to ask," said Palacio, a board-certified internal medicine
physician who called Northern California the place where she "grew up
professionally."

"What I learned was immeasurable," she said.

Palacio stayed in academia for five years after her graduate studies,
teaching at UC-San Francisco before joining the San Francisco Department of
Public Health as special policy adviser to the director.

In that role, she championed the medical marijuana ID card and a similarly
controversial program to allow physicians to prescribe methadone for heroin
addicts. There are about 15,000 such addicts in San Francisco.

Palacio was also a leader in San Francisco's war on AIDS, framing new
strategies, creating mandated systems of tracking and alerting women to
their increased threat. She conducted many AIDS research projects, the most
prominent about HIV-infected women.

So well-identified is Palacio with AIDS that a lifesize image of her is
part of "AIDS: The War Within," a permanent exhibit at the Chicago Museum
of Science and Industry. In addition to the cardboard cutout, museum
visitors can press buttons on an adjacent computer to see and hear Palacio
talk about AIDS topics.

In 2001, when her husband got a neuropathologist position at the University
of Texas M.D. Anderson Cancer Center, Palacio relocated to Houston. She
took a professor of medicine post at Baylor College of Medicine before
applying to be director of the 600-employee county health department. In
December 2002, she was appointed to the job.

Although she misses California's hills and lack of mosquitoes, Palacio said
she is thrilled to be in Houston.

"This is such a welcoming, family-friendly town," said Palacio, who is
fluent in Spanish. "In contrast, San Francisco is older and has fewer
families with kids or pockets of different kinds of people. It's nice to be
amid such diversity."

Palacio said she's happiest hanging out with her kids -- a 10-year-old girl
and 7-year-old boy -- bicycling or otherwise exercising and dancing in her
living room.

She takes great pride in being a clinician, a primary-care physician who
believes the practice of medicine is as much an art as it is a science.

She acknowledged that Harris County's health problems will be different and
perhaps more challenging than those she dealt with in San Francisco --
crack and cocaine are bigger than heroin, AIDS is more a problem of
minorities, West Nile has become the scourge of summer and the population
is more spread out and less educated.

But she said the important thing will be to not lose sight of "the big
picture, the old standbys" -- poor air or water quality, bad hygiene habits
and low immunization rates.

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