When Toledo-Lucas County Health Department board members recently entered into a contract with a new part-time medical director, the coronavirus pandemic was well under way.
Gov. Mike DeWine had shut down Ohio’s K-12 schools. Colleges were telling students not to return to campus after spring break. Within days, bars and restaurants effectively closed, and families across the state were ordered to stay in their homes as more people got sick and more people died.
It was in this unprecedented time that Dr. J.A. Smith, a sports medicine physician with Mercy Health, stepped into his new role, finding himself among the handful of medical professionals and government officials now leading Lucas County’s response to a historic public health crisis.
Dr. Smith was hired March 13, records show. Since then the importance of the job before him, his colleagues, and his bosses seems to become more crucial every day.
Since then, too, many questions have been raised about how local institutions — including the public health department — are handling the coronavirus outbreak. They’ve been voiced during the near daily briefings held on the subject, and they’ve largely gone unanswered. How many people here have been tested for coronavirus? When will testing become more widely available? How is the local hospital capacity holding up?
While officials have been either unwilling or unable to answer such inquiries, they also declined interview requests with The Blade about Dr. Smith, who as medical director is responsible for providing medical guidance to the department on a day-to-day basis, as well as during disease outbreaks. He is also responsible for the medical supervision of all health department clinics.
Dr. Smith told The Blade Wednesday that he understands how his resume “doesn't look like it makes sense” for someone in his new role, but he is confident he’s a good fit. He took the job because he wanted to step up and serve his community at a time of crisis, he said.
His practice overlaps with surgery and family medicine, and he has established relationships with Lucas County’s hospitals and first responders through his work as medical director of the Glass City Marathon.
It is critical to be able to lead a team and communicate during a crisis, he said, which is something he learned to do through sports medicine.
“I know how to build a team and keep a team together,” Dr. Smith said. “This is a huge team effort, and the health department is leading that effort.”
Both he and other officials said Dr. Smith is one member of a large and qualified team of medical professionals and leaders working together to coordinate the coronavirus response in Lucas County.
But at least one Toledo city councilman, Larry Sykes, on Wednesday questioned whether Dr. Smith’s qualifications make him right for such a crucial position.
“You should have a doctor whose background is in infectious disease. This is the only person who should be talking about the spike and what we should be doing,” Mr. Sykes said. “If we don't have specialists doing it, we have a problem. This is not on-the-job training.”
Rising numbers
Health officials on Wednesday reported 23 confirmed coronavirus cases in Lucas County, up by 10 from Tuesday’s total of 13. Two people have died, six patients have underlying health conditions, and five had travel-related exposure to the illness. Individual cases could include both groups or neither. The cases range in age from 29 to 77.
Those latest figures come less than two weeks after the public health district’s board hired Dr. Smith, and agreed to pay him $100 per hour with a cap of $6,500 through Sept. 13.
But in a sign of how overwhelming the work now facing the department has become, Dr. Smith by Sunday had already worked 42 hours on the department’s coronavirus response, for which he’ll be paid $4,200 — or nearly two-thirds of what was supposed to be paid over the course of six months.
Health board members during a meeting Monday revised the terms of his contract and voted unanimously to increase the cap to $20,000 for his services.
It is unclear whether the board interviewed any other candidates for one of the agency’s top leadership positions, but Board President Dr. Johnathan Ross during the meeting emphasized Dr. Smith is intended to be a temporary hire.
He described the sports medicine physician as “pinch-hitting” because the department is required by Ohio law to have a medical director in place to meet the minimum standards required to receive state funding.
"To remind everyone, the reason this contract was entered into is that we had pressure to obtain a medical director, and this was done on a temporary basis so that we would be able to meet our obligation to have a medical director,” Dr. Ross said. “The future of this contract going into the next several months is obviously fluid like so many other things that we're involved with. We would like to, I would imagine, have a more formal process to look for a medical director than we were able to come up with under the circumstances."
Dr. Ross referred all questions about Dr. Smith and the medical director position to Gretchen DeBacker, the public information liaison for the county’s Emergency Operations Center, which is handling the local coronavirus response.
The Blade also requested an interview with Health Commissioner Eric Zgodzinski to discuss the medical director position, but Ms. DeBacker said the department “will not be commenting any further on these personnel matters.”
Tina Skeldon Wozniak, president of Lucas County’s board of commissioners, did not return a call seeking comment Wednesday.
Mr. Sykes said he believes the health department needs a full-time medical director during the public health emergency. He blamed budget restrictions for keeping the position part time for years.
“Let this be a lesson. We cannot operate like this,” he said.
Dr. Smith’s predecessor, Dr. David Grossman, had been serving as part-time medical director since 2016 when on March 16 he and the health board “mutually separated,” officials said.
Dr. Grossman’s temporary role followed his nearly 20-year career as the Toledo-Lucas County health commissioner from 1999 to 2016. At the end of that period he was allowed to retire from his post as commissioner so he could collect his pension and then was re-hired as medical director in a 4-3 vote.
Health department records show he was paid $142,868 in 2016, including $49,209 in sick time payout. He was paid a salary of $53,530 in 2017 and a salary of $45,320 in 2018, in addition to $800 on contract that year.
In 2019 and 2020 he worked strictly on contract, records show. He was paid $9,600 last year and $1,200 this year.
Medical expertise
Dr. Smith began at Mercy Health as medical director of sports medicine in 2016. His biography on the hospital’s website says he works locally with athletic trainers at 25 area high schools to prevent and treat sports injuries.
He graduated from the Philadelphia College of Osteopathic Medicine in 2008, did a family medicine residency at South Pointe Hospital near Cleveland in 2011, and completed a sports medicine fellowship at Cleveland Clinic in 2012. He has worked with the Cleveland Cavaliers, Cleveland Browns, and Cleveland Indians as a team physician.
He has completed two courses of the Federal Emergency Management Agency’s National Incident Management System training program and is taking a third now that he is the health department’s medical director.
He still is working full time for Mercy Health, but he said that has slowed because most sports are suspended amid the coronavirus outbreak. Dr. Smith pointed to that as another reason he’s a good fit for the medical director position.
“Why not put someone like me in there and not take [a physician] out of the ER or take an infectious disease doctor away from working on this pandemic,” he said.
Ms. DeBacker said there also are six local doctors who are serving as unpaid advisers to the health department during the coronavirus outbreak.
“In this case, they have helped structure quarantine of our first responders, guidelines for social distancing, testing protocols, and more,” she said.
Dr. Smith said he can also lean on other medical experts at the health department, such as Gwendolyn Gregory, the director of nursing.
He said information about coronavirus and the state’s response to it changes every day, but he is working to build trust between the community and the local health department so that residents heed health experts’ recommendations.
“I feel that the health department is trying to put out as much information as they can to help people,” he said. “What they are doing has the best interest of Toledo-Lucas county first. These people care.”
News briefings
Dr. Smith was introduced as the department’s medical director during a March 16 coronavirus news conference. Such briefings have been held nearly every day since the full effects of the outbreak reached Lucas County.
Questions about testing and hospital capacity remain, but health department officials on Monday started providing more information about Lucas County’s confirmed cases than they have since the outbreak began. They included a breakdown by age, gender, whether the patient had exposure traveling, and whether the patient has an underlying health condition.
Then during Tuesday’s briefing, Mr. Zgodzinski confirmed a second death had occurred here, but he was unable to provide any additional details about the fatality.
On Wednesday officials did not hold a briefing but released a written update on the number of confirmed cases. The statistics lacked hospitalization figures, something officials said they no longer will release.
“We simply cannot keep up with accurate numbers. We have [patient privacy laws], we have family notifications... there is just so much with that particular statistic that does not allow us to be accurate every day,” Ms. DeBacker said. “As a result, we have decided to stop providing it.”
Staff writer Brooks Sutherland contributed to this report.
First Published March 26, 2020, 1:30 a.m.
