D.C. Health Chief Focuses on Teamwork

"That makes me optimistic that he will come in here and put a whole different face on the department," Bell said.

Vigilance, whose accent reflects a touch of his British birth, had lived in the District before. He went to college at George Washington University and, after medical school at Johns Hopkins University, did several years of emergency medicine training at Howard University Hospital. But he never expected to be a practicing physician. His interests lie more in administration, he said. He also has a master's degree in public health from Johns Hopkins.

Here, he will confront a department long criticized for an inadequate response to the city's high rates of heart disease, obesity, hypertension and HIV-AIDS, to name just four health issues that Vigilance said he wants to keep front and center. The department also has been faulted for a poor record of recovering funds from Medicare and Medicaid, as well as for ineffectively spending federal dollars for certain projects. On Oct. 1, much of those funds will be pulled away for a new health-care financing agency. The goal is marked improvement all around.

"The department has been able to do X, Y and Z, but some of the other letters in the alphabet have not been hit," Vigilance said.

He will confront numerous competing agendas. Enrique Cobham, interim executive director of La Clinica del Pueblo in Northwest, said he hopes services to the city's burgeoning Latino population remain equitable to those for other minorities. At the same time, Cobham noted, health issues often transcend racial or ethnic lines. Take diabetes, for example. If Vigilance can truly work in concert with Latino and African American groups, "that's one area that may offer significant improvement," Cobham said.

The chairman of the D.C. Council's health committee would have the new director concentrate on nuts-and-bolts needs.

"The temptation is always to come out with a new program to make a big splash, but I candidly would like him to focus on the staff," David Catania (I-At Large) said. While such detail is not the most glamorous, training and organization might need the most attention. "Building a world-class bureaucracy is essential to delivering services," Catania said.

Sharon Baskerville, executive director of the D.C. Primary Care Association, will look for the big picture. After six months, she would like to see a new sense of mission and direction at the agency.

"A department that believes in and is confident in its director," she said. "A department that's working with its director instead of against him. A department that has a clear road map of where it's going."