Gregg Pane, the District Health Department's third director in five years, acknowledges the challenges ahead. The department has more than 1,400 employees, a $1.5 billion budget and a history of trouble, most recently involving its delayed response to high lead levels in city water.

Pane is a former emergency room physician with experience in private and public organizations. For the past two years, he was a senior administrator in Detroit's Henry Ford Health System, which includes hospitals, clinics and an HMO.

He began his city job in September, and his title will be acting director until his expected confirmation by the D.C. Council this fall. Pane answered questions from staff writer Susan Levine about his health vision for the city.

QWhat do you see as the city's most pressing health need, and how do you hope to address it?

AIn areas such as infant mortality, cancer and some chronic diseases, we are performing poorly compared to national norms, and great health disparities exist within our population. We need to focus our resources and energies on those areas we most want to improve and then set clear performance expectations and targets to achieve. We have to collect the appropriate information and hold all parts of the health system accountable.

By emphasizing neighborhood outreach; quality, safe and coordinated health delivery; community preparedness; a safe and healthy environment -- we can gain efficiencies and perform better to greatly improve the health status of District residents.

Given the many indigent District residents still not enrolled in the city's health care system, what different outreach is needed?

The District has one of the lowest rates of uninsured in the nation, at about 12 percent. At the same time, we have some of the poorest performance on nationally accepted indicators of health. While having some form of insurance is critically important, as is outreach to those in need, it is imperative that we focus on executing better as a health system so that we improve access to care and ensure that those most in need of screening and treatment actually get the services.

Our outreach efforts [must] be more neighborhood-based, culturally sensitive, patient-centered. . . . We must ensure that Medicaid, the D.C. Healthcare Alliance (a public-private partnership to deliver care), public health services and health providers and hospitals are part of an integrated team continually focused on moving core measures of health in the right direction.

As a public health officer, how ready do you feel the city is for a future bioterrorism attack? With millions in unspent federal funds for bioterrorism preparedness, where should the District focus its attention with these dollars?

We recently held the largest disaster drill ever in the District, a two-day event involving all key elements of our emergency response system. Much will be learned from this exercise that can and will guide our future efforts.

The District has purchased over 2 million protective surgical masks, which are now being distributed. Hospitals have improved their decontamination capabilities and have better trained their staffs. We have purchased tents to improve our surge capacity, and 200 health providers have been trained to vaccinate for smallpox.

We need to work closely with our hospitals, clinics and advisory groups to determine how best to expend the remaining $5 million in federal preparedness funding so as to best improve our readiness and disaster capabilities.

We must do a much better job of involving the community in preparedness planning, so that we have realistic plans that are much more likely to be known, followed and effective.

We must also . . . demonstrate that this is a regional effort with our neighbors and we must have a strong connection with our federal partners.