California Healthline Examines Bush Administration Health Post Vacancies

As the Bush administration begins its second year in office, there are several top positions in HHS left open, raising concerns among some lawmakers and policy experts. Some of President Bush's nominations are awaiting Senate confirmation, but candidates have not been formally nominated for the heads of the FDA, the NIH and the Administration for Native Americans. In addition, Bush has yet to name a replacement for David Satcher, whose four-year term as surgeon general expires in February (Brookings Institution Presidential Appointee Initiative). With HHS "short-handed," lawmakers have started pressing Bush to fill the empty slots, particularly since the Sept. 11 attacks on the World Trade Center and the Pentagon and the anthrax attacks. Paul Light, a senior adviser for the Presidential Appointee Initiative, which tracks and studies the nomination process for the Brookings Institution, said, "The policy makers at the top are there, but there are pretty significant gaps in the delivery corps" (Washington Post, 10/17/01). In a November interview with the Dallas Morning News, Sen. Ron Wyden (D-Ore.) said, "The nation needs an infusion of expertise and leadership at NIH, [National Cancer Institute] and FDA. ... At a time when considerable attention is focused on the threat of anthrax and smallpox and the necessity of biological detectors, it is essential that scientists are in place to lead important work in this field" (Morris, Dallas Morning News, 11/4/01). In addition, without a full staff of agency heads, the task of relaying important health information often falls to the secretary of the department, Tommy Thompson, even though many agency heads with expertise in their given fields might be better suited for such a responsibility. Given that it takes an average of three months from the time the White House announces a nomination until the time a nominee is confirmed, it may be some time until the open slots at HHS are completely filled (Washington Post, 10/17/01).

Making the Cut

In total, there are 17 positions at HHS for which Bush must put forward nominees and the Senate must confirm. Eleven have been confirmed so far. Typically, the White House Office of Presidential Personnel oversees the appointment process and screens potential nominees. When the OPP determines a candidate has the credentials for the position, the name is sent to the president's chief of staff. The chief of staff reviews the potential nominee, and then the process shifts from OPP to the Office of the Counsel to the President, which verifies that a candidate meets legal and ethical requirements. If the White House counsel clear a candidate, the FBI will conduct a background check. Once this process is completed, the White House will publicly announce a nomination. The formal nomination of a candidate starts the Senate confirmation process, which is dominated by the committee that has jurisdiction over the nomination. For HHS, the Senate Health, Education, Labor and Pensions Committee oversees the process. Typically, the nominee will meet informally with the committee chair while the committee members review the nomination. If the committee members do note support the nominee, members may hold more interviews or request additional information from the White House. After a confirmation hearing is scheduled and the committee votes, a floor vote is scheduled. If the full Senate approves the nomination, the appointee is commissioned and sworn into office.

Pending Confirmation

The following nominations formally have been sent to the Senate and are currently awaiting action:

Assistant Secretary for Management and Budget, Janet Hale: During the Reagan administration and previous Bush administration, Hale held a variety of positions at the departments of Housing and Urban Development and Transportation, as well as at OMB. After the elder Bush left office, Hale worked as the executive vice president of the University of Pennsylvania. In addition, she was the top lobbyist for the U.S. Telephone Association. Hale was nominated May 22, 2001 (National Journal, 6/23/01).
Commissioner on Children, Youth and Families Joan Ohl: Ohl previously served as secretary of the West Virginia Department of Health and Human Resources. During her tenure in Charleston, W.Va., Ohl focused on welfare reform and decreased the number of welfare recipients in the state by two-thirds. If confirmed, Ohl will oversee the welfare program (Associated Press, 7/10/01). Ohl was nominated July 10, 2001.
Assistant Secretary for Health, Eve Slater: Slater currently works in the pharmaceutical industry as senior vice president for clinical and regulatory development at Merck Research Laboratories. In her position at Merck, Slater oversees late phase clinical trials and over-the-counter drug development. A medical doctor by profession, Slater was chief of the hypertension unit at Massachusetts General Hospital from 1977 to 1983 (White House release, 10/16/01). Slater was nominated Oct. 16 (Washington Post, 10/17/01).

This story was written by California Healthline staff writer Darryl Drevna.

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