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'Mission Fit' 

Peers say Humboldt's health officer — new in town and under intense pressure — is exactly where she belongs

click to enlarge Humboldt County Health Officer Teresa Frankovich.

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Humboldt County Health Officer Teresa Frankovich.

The cards and short letters will show up from time to time at the Humboldt County Public Health Department addressed to Health Officer Teresa Frankovich. Inside, they have messages of thanks and support, sometimes offering expressions of gratitude for her personal sacrifice, sympathy for the pressure she's under and support for the cautious approach she has taken to protecting local residents from the COVID-19 pandemic. Often, she says they include things like, "... and I'm so sorry for all the terrible things people are saying about you," acknowledgments of the vitriol directed at the doctor on social media platforms, online forums and protest signs.

"I don't really do social media," Frankovich says in a June 16 phone interview with the Journal, at a time when a spate of resignations of health officials throughout the state had shone a spotlight on the pressure they are under and the abuse some currently face. "People have certainly told me about things being said but I don't read it."

Joint Information Center lead Public Information Officer Heather Muller says when Frankovich first issued a countywide shelter-in-place order, restricting residents to their homes except for essential outings in hopes of limiting spread of the disease, there was an immediate backlash from a vocal minority on social media. Muller put together a summary of what was being said.

"I told her, somewhat apologetically, that Frankovich seemed to rhyme with a lot of things," Muller says. "She laughed and said she'd discovered that in middle school, and here she still was. That was a couple of months ago and I haven't given her another summary since. I get the sense that she wishes people were kinder and more interested in facts, but whether they are or they aren't, she's going to do her job."

And Frankovich has become such a fixture in local media in the COVID age, perhaps the local official with the largest direct impact on the everyday lives and health of local residents, it's easy to forget she's new to the job and to Humboldt County. She moved to the North Coast from Michigan late last year and was announced as the county's "part-time" health officer Jan. 30. She had been on the job just 41 days when she declared a local health emergency due to the COVID-19 pandemic on March 11.

The Journal reached out to more than a dozen people who have worked with Frankovich, hoping to get a better understanding of her background and approach to the job. Together, they paint a picture of a caring pediatrician and dedicated public servant who is accessible, relatable, poised and unflappable.

"She always has the best interest of her population in mind. Always. Always. She always remembers, it's about the people," says Cari DiGiorgio, the public health director at the Western Upper Peninsula Health Department in Michigan, which fell under Frankovich's purview — along with a host of other rural health departments and clinics — during her decade-long tenure as medical director there. "We miss her tremendously. She oversaw four health departments. It was a huge territory and everyone misses her."

Closer to home, Open Door Community Health Centers Associate Chief Medical Officer Kelvin Vu, who lured Frankovich to Humboldt County in October with a job offer, recalls the first time he met her, last spring when she'd flown out for an interview.

"I thought, 'She is a treasure. She's experienced. She's compassionate and she's very mission driven,'" he says, adding the impression still holds true, though he'd now add "poised" to the list. "That's important when you are a leader in a time of crisis. You could be freaking out on the inside but when you're portraying it to the public, presenting to people who come to you for advice, you have to have poise."

Having grown up in a suburb of Detroit before moving with her family to Upper Peninsula, a rural stretch of northern Michigan bordered by three of the Great Lakes and the state of Wisconsin, Frankovich's route to Humboldt County was circuitous.

She double-majored in biomedical sciences and psychology while graduating with distinction from the University of Michigan before attending its medical school, where she chose to focus on pediatrics. Tory Starr, Open Door's CEO, says that choice alone is telling.

"People who go into pediatrics, you can kind of judge who they are a bit," Starr says over the phone, adding that it's a specialty that demands great communication skills, with the patience and warmth to deal with scared children and the ability to explain treatment plans to their parents. It's a specialty that necessitates personal connection.

Immediately after finishing her residency in pediatrics in Chicago, Frankovich had plans to get a master's degree from the University of California at Berkeley's School of Public Health, consistently rated one of the nation's best. She worked for a year to save money and then entered the program, working part time as a pediatrician in the Bay Area suburb of Martinez to make ends meet.

After getting her public health degree, she spent a year as the project director of a clinical trial of a potential immune globulin for botulism, a rare and potentially fatal illness that primarily affects infants. But then, in the midst of the Gulf War, for reasons unclear, the military bought up the existing supply of a drug crucial to the study, leaving Frankovich looking for whatever would be next.

"There was someone who was recruiting for a pediatrician up in Fortuna," Frankovich says, adding that she'd come to love life on the coast, visited the practice, liked the staff and decided to take the position.

Frankovich only stayed about three years but the city — and Humboldt County — left an impression. She made some good friends, she says, and fell in love with the area before her Midwestern roots called her back to take a position in Chicago. She worked in primary care pediatrics for a handful of years more before taking on more administrative roles, first as the medical director of a pediatric office for a small clinic serving 7,000 patients, then as a section head for a provider with 25,000 patients, then as health director for a nonprofit that worked in multiple counties providing a variety of children's health programs. In 2008, the position of medical director in Upper Peninsula, Michigan, opened up. Frankovich says her father was ill at the time and she jumped at the chance to move back home.

DiGiorgio says the job was simply massive, with Frankovich providing oversight for all clinical public health programs for 10 counties spread across 10,000 square miles. That included everything from STD clinics and the Women, Infants and Children supplemental nutrition program to school-based health centers, communicable disease surveillance and opioid overdose prevention programs.

Despite the sprawling nature of her job and territory, DiGiorgio says Frankovich was always tremendously accessible.

"You could reach her at any time," she says, adding that Frankovich was incredibly knowledgeable about both the business and medical sides of public health, yet extremely approachable.

A registered nurse, DiGiorgio says Frankovich was also refreshingly devoid of pretense and seemed to know clinicians and staff by name everywhere she went.

"You almost forgot she was a physician at times," DiGiorgio says. "She's just fun. Her sense of humor — I don't want to say it's sarcastic but, well, she had a unique sense of humor. And you could talk to her — you just never felt that nurse-doctor thing. She's just very personable and actually cared about people as individuals."

In June of 2018, torrential rains dropped more than 7 inches of water on Upper Peninsula in a single day, causing widespread flooding that devastated parts of three counties. DiGiorgio says she watched in awe as Frankovich stepped in to handle portions of the response, politicking, coordinating and doing all she could to make sure residents got the services they needed. Perhaps most impressively, DiGiorgio says the stress of the moment never seemed to touch Frankovich.

"If it gets to her, she doesn't show it," she says. "She's just a workhorse. I've never heard her yell."

The following year, Frankovich says her husband, a lifelong Michigan resident, retired after a lengthy career as an attorney, first as a county prosecutor then in private practice specializing in employment law.

"When he was looking at retiring, he said, 'I'd really love to live someplace else for a change,' and I thought, I have just the place. I think you'll love it,'" Frankovich says, adding that she'd always thought of the possibility of returning to the Pacific Northwest generally and Humboldt County specifically. "And when I started seriously thinking about it, some friends out here said, 'You should really check out Open Door.' I did some research and reached out to them and asked if they were interested in a pediatrician. I just love that model — I just love the idea that they serve everyone. That was really appealing to me from an access-to-care standpoint."

When she met Vu and his colleagues for the interview, she says she was dazzled — relieved to find they shared many of the same areas of interest, like mitigating the impacts of traumatic childhood experiences on lifelong health outcomes. It felt like a fit and soon Frankovich was moving to Humboldt County, excited to get back into primary pediatric care.

Frankovich had only been on the job with Open Door a short time when she caught word that former Humboldt County Health Officer Donald Baird might be retiring from the half-time position. The chance to simultaneously work in public health and primary care pediatrics immediately appealed to Frankovich, so she says she asked Open Door if it would have a problem with her applying.

Vu and Starr say everyone at Open Door was supportive, recognizing the countywide impact Frankovich could have as the county's health officer and the depth of experience she would bring to the position. The county announced her hire Jan. 30, issuing a brief press release with a photo of her attached, her broad, easy smile framed by shoulder-length blond curls. Local media posted the announcement but the public took little notice. Within three weeks, Frankovich would announce Humboldt County's first COVID-19 case and everything would change.

Asked if the current reality — working seven days a week, her life consumed by a single disease — seemed a possibility back in January, Frankovich pauses.

"Not like this," she says, adding that the disease was certainly on her radar but little was known about it, and there was no way to foresee the role she'd be thrust into: the public face of a government response, walking a community through a pandemic. "Honestly, I think I underestimated the impact of this and I think we all did as it landed here."

But if she didn't exactly step into the position with eyes wide open, those close to Frankovich say she hasn't blinked since. She quickly informed Open Door she'd need a leave of absence and started taking quick, decisive action to ready Humboldt County for what was to come.

One of the first things she did was reach out to Josh Ennis, who'd served as Humboldt County's deputy health officer under Baird. Ennis had left the position as he and his wife welcomed a third child but had stepped back in temporarily to fill a gap between Baird's departure and Frankovich's arrival. After majoring in genetics at University of California at Davis, he entered medical school there, studying emergency medicine. Along the way, he met his future wife, Marika Ennis, a Southern Humboldt native.

"She grew up here and wanted to be able to come back and serve this community, and Josh was up for that," says Stephanie Dittmer, president of the Humboldt-Del Norte Medical Society, adding that both fill emergency room shifts at St. Joseph and Redwood Memorial hospitals. "The two of them are a really nice example of how we should be able to grow our own doctors."

Frankovich says she "asked if he would be able to come on board and help and, to his credit, he felt a duty to do that."

Like Frankovich, Ennis has found himself working around the clock on COVID-19 response and colleagues describe him as detail-oriented, responsive and data-driven. While Frankovich handles much of the interagency stuff — meeting regularly with school districts, local officials, Humboldt State University and College of the Redwoods — and researching mitigation measures, best practices and the latest developments on the disease, Ennis has primarily been the point person on helping build surge healthcare capacity locally. He's regularly met with local hospitals and providers to think creatively to expand existing capacity, and worked with the state to construct the 100-bed alternative care site at Redwood Acres Fairgrounds.

From her perspective, Dittmer says it's pretty incredible what Ennis, Frankovich and their small team have been able to accomplish, pointing to the creation of a mobile COVID-19 testing site, the alternative care site, the expansion of the number local intensive care beds and the county's ability to conduct contact tracing investigations. For some context, while Humboldt County was conducting contact investigations from the moment of its first local confirmed COVID-19 case and worked quickly to train 30 additional investigators, Gov. Gavin Newsom said that, as of May 4, only 23 counties in the state were actively conducting such investigations, which are widely believed to be crucial in containing the spread of the virus. And while limited by supply chain issues and backlogs at corporate laboratories, Humboldt County has also tested for COVID-19 at rates that outpace all its neighboring counties.

"People have this image of public health as a big department that has all these things," Dittmer says. "No, it's a small group of people who have managed to ramp up this huge amount of resources for our county in a very little amount of time."

But Dittmer says one of the most impressive aspects of the work Frankovich has done so far lies in her ability to calmly and articulately explain the reasoning behind her public health orders and the complexities of a pandemic response to a disease that's still largely an unknown.

"In a time when all of this is groundbreaking and new, and every day we're learning more about this illness, it's really challenging to convey the complexity of the science," Dittmer says. "The skill that she has communicating the complex uncertainties of this particular novel pandemic, I just find it exceeds what we would normally expect in a physician. It says a lot about her personal expertise."

And that expertise comes from both a solid base of knowledge and constant vigilance, says Public Health Director Michele Stephens, adding that Frankovich regularly stays up late into the night reading the latest literature on COVID-19, from potential treatments to new manifestations of the illness, like the respiratory illness recently found in children.

Asked how much Frankovich has been working to keep up with the immediate response needs of Humboldt County, the complexities of protocols to ease shelter-in-place restrictions safely and the latest developments on the disease, Stephens pauses.

"A lot," she says. "She probably hasn't had a day off in over four months, worked through weekends ... a lot. I'll just say a lot."

Speaking to the Journal on June 15, Frankovich largely comes across as almost unflappably upbeat. Those close to her say she's almost always this way, a natural optimist. Told that those around her marvel at the way she seems to handle the pressures of her post — balancing the public health dangers of a contagious disease and the economic realities of shuttering the county — with grace, she's asked whether she's somehow able to block it all out.

There's a silence over the phone.

"No," she says, a strain evident in her voice for the first time in the interview. "It's a lot. It's challenging."

Those around Frankovich say she is keenly aware of the responsibilities inherent in her position — both the dangers of not acting forcefully enough to protect public health and the real impacts of the orders she's signed. So when they see the vitriol expressed on social media platforms — in recent weeks, the Lost Coast Outpost's Facebook page comments have included references to "Frankobitch," rants about "some woman doctor" and references to her as "diaper face" — they worry.

Throughout California, harassment has pushed health officers to step down. Most recently, Orange County Chief Health Officer Nichole Quick resigned after a vitriolic backlash to a facial covering order that included a death threat and necessitated a police escort. The situation has become so concerning in healthcare communities that California Medical Association President Peter Bretan issued a statement.

"California's response to COVID-19 and our success in flattening the curve has been driven by the leadership of our local county health officers," Bretan said. "The California Medical Association is deeply disturbed by news that some local health officers, many of whom have been working tirelessly over the last three months, have been subject to unfair and uninformed attacks and have become political targets for those seeking to vent their frustrations about what must be done to protect the public at large."

Dittmer says one thing she'd like the general public to understand is that the "sacred" duty that binds physicians to their patients extends to the larger community when they accept the role of a health officer.

"Physicians, when they take those public health roles, extend their idea of healing to a larger group, and when you do that, it should never be met with threats and fear and vitriol," she says. "It should never be met with that level of backlash and the fact that it is right now is just morally and ethically wrong. It's the same thing as if a physician in an office giving a diagnosis were confronted by a patient with a firearm. It just doesn't make any sense and it's really scary."

Vu agrees.

"It's sort of like you asking a doctor for medical advice and them giving it to you and you not only criticizing them but you start throwing out harmful, personal attacks," he says. "What benefit do they get from this? Nothing other than making sure everyone stays safe."

Asked about the resignations of health officers in other parts of the state, Frankovich concedes it's a "really stressful position to be in."

"The politicization of science and health is just really difficult," she says. "I think when things that are fairly straightforward — for example, masking — I feel like masking is a fairly simple thing that we're asking people to do. It's not expensive. It's not time consuming. But some issues such as that have become political."

Frankovich says people don't enter public health looking for the spotlight, adding that on a good day, "we just operate quietly and most people don't even know we're here." She also understands, as do those around her, that there's no sweet spot with public perception of an infectious disease response: You're generally seen as having overreacted if things go well or not having done enough if things go poorly.

While those near Frankovich are frustrated with the personal attacks and fearful of the backlash they've seen elsewhere, they also say she is a realist and task oriented. Just as those kids in junior high didn't throw her off track, neither will some name calling on social media. There's just too much to do and the stakes are too high.

"It's one of these rare instances for me where there's just really no way to make everyone happy," Frankovich says. "There's no way to satisfy what everybody feels they need. So having to say no, having to sort of explain why it's important to say no is always challenging. There's no road map for this. It would be really nice if we had some kind of tested path and all we had to do is navigate it. But only in retrospect are we going to have a really good understanding of what really worked and what could have been done differently."

Dittmer, for her part, thinks Humboldt County couldn't be in better hands. She says the medical society talks a lot about mission fit, ways to put the right physician in the right space at the right time to be of best service. Frankovich, she says, has found her mission fit.

"She has impressed me with how smoothly she is able to take the pressure," Dittmer says. "We physicians train to stay calm under moments of exceeding stress but this is just different and she has just stepped up to the plate with — just — grace."

Thadeus Greenson is the Journal's news editor and prefers he/him pronouns. Reach him at 442-1400, extension 321, or thad@northcoastjournal.com. Follow him on Twitter @thadeusgreenson.

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Thadeus Greenson

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Thadeus Greenson is the news editor of the North Coast Journal.

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