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Public health dominated doctor's long career

He's known for a love of Mexican food, the occasional appearance as Superman and for being the friend you'd want as a lifeline on Who Wants to be a Millionaire.

Dr. Rice Leach, who began working in public health the week after Medicaid started in 1966, retired last week, just days after the approval of the national health care reform bill.

"In the ensuing 44 years, I've seen a lot of stuff," Leach said recently with a touch of understatement.

That stuff includes working in places as different as Wounded Knee and Washington, D.C. The first 20 years of his career were spent mostly in poverty-ravaged Indian reservations in the West, where he worked extensively on AIDS prevention. That was followed by a two-year term as the chief of staff of the Surgeon General's Office.

Born at Lexington's St. Joseph Hospital and educated at Sayre School, Leach, who'll be 70 soon, came home to Kentucky in 1992 to become commissioner of public health. In that post he was instrumental in the cleaning up of radiation in the Martha oil field in Eastern Kentucky.

He resigned in 2004 to come to the Lexington-Fayette County Health Department, and he speaks respectfully of the 17,000 lives "we take care of."

Although, as he puts it, "I've always had a thing about helping people," his diagnosis of serious melanoma, or skin cancer, in his 20s shaped his career.

After graduating from University of Kentucky Medical School, he thought he'd spend two years in public health. But the diagnosis in the 1960s was dire. "I didn't think I'd be alive in five years," he said.

He couldn't get private insurance. It helped him learn firsthand some of the vagaries of the public health care system. For example, because he was a federal employee, he was eligible for care at Walter Reed Army Medical Center in Washington but had to pay his way there from his health service post in Louisiana.

With typical self-effacement, he said that by the time he was confident the cancer wouldn't return — about 10 years into his career — he was halfway to being able to retire, so he thought he'd stick with it.

He also talks with similar nonchalance of meeting his Guatemalan-born wife, Mireille: "I went down to South America for an internship and came back with a wife."

But his description of his current staff reflects his commitment to the job: "There are not a lot of lunkheads in the bunch. Lunkheads don't last long. This has got to be a mission."

It is a mission that Leach approached in a straight-shooting, occasionally crusty manner, said Dr. Steve Davis, who worked with Leach in Frankfort for 12 years.

But Leach, who ended his career as executive director of the primary care center at the health department, has a fun side, too. He invited his staff to celebrate his 60th birthday with a Mexican fiesta with lots of spicy food and good Latin music.

Davis, who is now deputy director of the Department of Public Health, remembers advice Leach gave him early on: You will make a lot of decisions every day that will have real impact on people's lives, but "at the end of the day see if you can tell the newspaper, if you can tell your wife and you can tell the IRS the things that you've done, you'll be OK."

Davis said Leach is one of the smartest people he knows. Davis said he'd agree to go on Who Wants to be a Millionaire only if Leach could be all of his lifelines.

During his time at the public health department in Frankfort, Davis said, Leach believed strongly that "the president of our company is the government; the board of directors is the General Assembly," because they represent the will of the people.

To that end, it was paramount to carry out the rules they put forth, no matter his personal beliefs.

Looking back over a multi decade, much-lauded career — his résumé includes dozens of special awards and citations — Leach said one his proudest achievements was the painstakingly delicate process of crafting a brochure required in 1998 by the General Assembly to be given to every woman undergoing an abortion.

In the end, both sides of the debate accepted his compromises, Leach said.

It is those kinds of unheralded but important tasks that marked Leach's tenure, Davis said.

Leach had a knack for getting the most out of people who worked for him. Friday staff meetings where often contentious, Davis said. One particularly heated debate ended with an angry staff member going to an office and locking the door for hours. The irate employee fired off a pointed missive to Leach, slipping it under his door.

The next day Leach and his employee talked out their problems. As the discussion ended, the story goes, Leach said, "Now, about that letter" and returned it unopened to the employee, adding, "I figured you might want to take another look at it before I read it."

Although Leach spent his career in management, he "is still the kind of guy who will put on his white coat and come down and treat patients in the clinic," said Dr. Deborah Stanley, the Lexington health department's medical director.

Initially, Stanley wasn't thrilled that Leach was coming on board. She'd heard him give a speech that she interpreted as him saying health departments shouldn't be in the primary care business — her field.

But early in his tenure she saw that he cared not only about the mission of the health department, but also about its staff. His first Halloween he came to work dressed as Superman, which was mentioned in a good-bye poem penned by one of the staff.

During a walk through the clinic in his last week of work Leach was greeted with smiles, back slaps, high fives, the occasional one-armed hug and the hint of tears.

Leach has some opinions about health care reform. He expects, in some ways, history to repeat itself.

"There was a lot of moaning about socialized medicine before Medicaid," he said. But soon, with more people being helped, the detractors went quiet. But, by the early '70s, when Leach was getting his master's degree from Harvard, people suddenly starting fretting about the cost of the program, he said.

He expects the current health system to follow a similar curve.

As for the bill itself, "I can't say that I'm for it because I don't know what is in there." But "it always costs more than anybody says it will."

The current health care system is being strained by the increased medical needs of aging baby boomers and the growing number of those unemployed in their 30s and 40s who don't have health insurance.

The ultimate positive outcome, he said, is that private health providers will have to be more competitive to survive and be more accountable.

Competition can lead to a broader view of how to help people and foster cooperation, he said. He points to the example of the collaborative effort between the health department and Fayette County Public Schools to put a nurse in every school. Having medical care easily accessible helped dramatically reduce the number of days students missed, specifically those with asthma.

As for retirement, Leach said he wasn't quite sure what he'd do in his off time, then listed a number of commitments he's made.

Whatever it is, cooperation will be the watchword, agreed Davis and Stanley, both citing a favorite Leach saying: "There are no sides when your canoe springs a leak; we are all in this together."

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