INDIANAPOLIS — When Indiana was hit by an opiate-fueled HIV outbreak and an ensuing statewide opioid crisis, then-Indiana Health Commissioner Jerome Adams traveled numerous times to the epicenter in Scott County.
“He made countless trips down there where it was all about the people in that town who were affected by it and not just what it meant exclusively for the state," said Julie Reed, vice president of the Indiana State Medical Association.
"We saw his compassion for people affected by that and the need for local solutions in a town that was so small it barely existed,” she said.
By July 2016, Adams had issued a standing order that provided easier access to Naloxone to help reverse opioid overdoses.
“He recognized that as health commissioner, he could issue a standing order for people to be able to have, including family members, quick access to Naloxone, to really address that rather than people having to individually one by one be motivated to go to physicians," Reed said. She called it "a great solution to a current crisis."
Adams, now serving as the nation's surgeon general, is one of many Hoosiers called to Washington to set national health policy for the Trump administration.
In his current position, Adams often talks about the opioid crisis to underscore that putting a human face on health helps the public to better identify with issues. He has said he wants to "reframe" how America talks about health.
Adams, an anesthesiologist and Maryland native, was sworn into the national post on Sept. 5 by his former Indiana boss, Vice President Mike Pence.
“Dr. Jerome Adams has an extraordinary gift for empathy,” Pence said at Adams’ ceremony. “I saw that empathy for which he is so widely known when he worked directly with the citizens who had been infected, worked with the CDC and brought the widest range of resources, policies and care to stem that epidemic that affected that community."
In October, in one of his first speeches as the country’s 20th surgeon general, Adams acknowledged the opioid crisis had hit home for him.
Wearing his formal Public Health Service dress blues, Adams personalized the crisis for about 50 people inside a U.S. Department of Health and Human Services auditorium in Washington, D.C.
His close family members had contracted HIV and one contracted hepatitis C, he said, “as a result of this epidemic."
One of the most prone groups to assist, he said, are baby boomers, many infected with hepatitis C as children during otherwise routine checkups years before infection controls were in place.
“We aren’t doing nearly enough for this group, but also it puts a face on hepatitis C that helps us overcome stigma,” Adams said. “If we can look at hepatitis C not as a disease for folks who many people unfortunately stigmatize and see as having moral failings but as a disease that affects a whole swath of folks, I think that we can help come further together.”
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Adams and Pence are among at least seven Hoosiers working on national health policy.
One of them is Seema Verma, a former Carmel-based health consultant, who was sworn in as the 15th administrator of the Centers for Medicare and Medicaid Services on March 14. With a budget over $1 trillion, CMS covers health costs for one-third of all Americans.
Verma has called herself the “architect” behind former Gov. Mitch Daniels’ Healthy Indiana Plan for Medicaid beneficiaries.
During her confirmation hearing in February, U.S. Sen. Ron Wyden, D-Ore., asked Verma about a reported $8.3 million she received in contract work with the state. While avoiding a direct answer to the question, she said she would recuse herself from issues posing a conflict of interest.
In that confirmation hearing, she said her mother was a breast cancer survivor due to early diagnosis and treatment.
“And a few years back, my neighbor, Aidan, was diagnosed with a stage 4 neuroblastoma. He was only 4 years old. A large tumor had been growing for some time, maybe since he was born, and it was wrapped all around his kidney. Aidan went through excruciating, painful chemotherapy, radiation, stem-cell treatment and surgeries, all experimental.
“This May, Aidan will celebrate his 12th birthday. And both my mom and Aidan are testaments to the grace of God and the ingenuity of the American health care system. I want to be part of the solution, making sure that the health care system works for all Americans so that families like my own and Aidan's have the care that they need," she said.
The ISMA's Reed finds a common trait between Adams and Verma.
“They’ve been really solution-oriented in their roles. They have been quick to recognize what the challenges were and really come up with solutions to address those," Reed said.
Other Hoosiers in Washington include Brady Brookes, former legislative director for Pence, who is deputy chief of staff for the Centers for Medicare and Medicaid Services Office of the Administrator (Serma’s agency), and Brian Neale, former health care policy director for Indiana, as the CMS deputy administrator and director for the Center for Medicaid and CHIP Services.
If he's confirmed, Alex M. Azar II, former president of Indianapolis-based Lilly USA, will join them as secretary of Health and Human Services.
Racial equity
But Adams may be the leader who could best personalize health policy.
On Dec. 1, he talked in Indianapolis not from a podium but while sitting in a comfortable chair on the same level as his audience at the annual conference of the National Black Caucus of State Legislators. He recommended that medical marijuana be tested by the FDA similar to other pain-relieving drugs and called for racial equity in addressing the opioid crisis.
He also told his audience of 125 of his approach in tackling the HIV outbreak in Scott County.
In late 2014, the largest HIV outbreak in Indiana history was identified in the rural county where there had been three cases in the prior decade. By Dec. 31, 2015, 189 individuals tested positive for HIV, leading then Gov. Pence to declare a public health emergency and initiate a syringe exchange program. Early reports linked a majority of the cases to drug abuse injections of opana, an opioid painkiller stronger than oxycontin.
Adams recalled, "I called a pastor. I called the local head of the chamber of commerce. I called the sheriff. Why did I call them?
"We know the science on almost any issue that you all want to bring up from a health point of view. We know the science. That's not the challenge. The challenge is how do we implement the science."