Pragmatism, Idealism Mark Health Chief : Government: Despite work with labor unions and in Nicaragua and Cuba, Dr. Molly Joel Coye enjoys the support of Republican governors.

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When Gov. Pete Wilson named Dr. Molly Joel Coye to run the state Department of Health Services, the announcement mentioned a study of mercury poisoning in Nicaragua on a long list of her accomplishments.

What the release by the Republican Administration left out was that the study took place a decade ago, on behalf of Nicaragua’s Marxist Sandinista government.

After Coye and her co-investigators were finished, the Sandinistas shut down a chemical processing plant that had been operated by a multinational company with headquarters in the United States.


Coye recently recalled her horror at what she found in that plant: “There were puddles of mercury on the floor and terrible exposures to workers.” Signs warning of the hazards of mercury were found hidden in the desks of the plant’s managers. A third of the workers showed signs of brain damage from mercury poisoning.

Those who know California’s new public health director see no contradiction in her passionate commitment to the workers of Nicaragua and her ability to work with Wilson, an ex-Marine who was a strong supporter of U. S. efforts to overthrow the Sandinistas.

They describe her as a 1960s Vietnam War protester, some say a left-wing liberal, who now wants to effect change from inside government--an idealist with a pragmatic streak who has won the respect of Republican governors in two states.

The 43-year-old Coye has been an adviser to unions on worker health and safety issues, a federal occupational health investigator and, from 1986 through 1989, New Jersey’s health commissioner.

It is not clear how much Wilson knew about Coye’s work in Nicaragua--or, for that matter, in Cuba later--before he named the onetime Democrat, now independent, to the health post this month.

Wilson’s aides say Coye is another example of the governor’s willingness to put personal ideology aside to get the best people he can to fill top Administration jobs. What attracted Wilson’s attention, they say, was her work in New Jersey under another Republican governor, Thomas H. Kean.


“We weren’t terribly aware of (Coye’s trips to Nicaragua and Cuba), but I don’t feel it is terribly relevant,” said Kimberly Belshe, Wilson’s deputy secretary of health and welfare, who helped identify candidates for the job. “Her trips to Cuba and Nicaragua were done as a public health expert. . . . She got appointed not because of what her political background has been or her role as an activist has been, but because she is the best in the country.”

As New Jersey’s health commissioner, Coye became a national figure in public health circles largely because of her innovative approach to vexing problems that faced her state--such as ensuring access to health care for the poor and uninsured. However, New Jersey officials point out that not all of Coye’s innovations have withstood the test of time, largely because of the escalating cost of providing health care.

When Coye takes office early next month, replacing Dr. Kenneth W. Kizer, she will find a state in the middle of an unprecedented budget crisis. Wilson has nevertheless proposed increasing state spending on health care for pregnant women and young children, family planning and preventive programs.

Wilson first heard about Coye while he was a U. S. senator, Belshe said. He was particularly impressed with her efforts in New Jersey to improve health care for pregnant women and infants--programs that are similar to what the governor would like to implement in California.

Belshe pointed to a New Jersey program called MOMS--Maternal Outreach and Managed Services--an effort to provide medical care to uninsured, low-income women and infants not eligible for Medicaid benefits.

The program was lauded in a 1989 editorial in the New York Times as a model for every state in the nation. Wilson has proposed a similar program in California, calling it AIM--Access for Infants and Mothers. His plan calls for using $90 million in cigarette tax money to buy health insurance for 25,000 uninsured pregnant women and their babies.


But New Jersey’s MOMS was never enacted. Officials there say the ambitious program, intended to reduce infant deaths and disabilities among the poor, was never more than a proposal announced by Coye at a press conference in her final weeks in office. The program was blocked by incoming Democratic Gov. James J. Florio.

“MOMS died on the vine after she left office (in December, 1989),” said Ron Czajkowski, spokesman for the New Jersey Hospital Assn.

But officials give Coye considerable credit for a New Jersey program called HealthStart, a major expansion of health benefits for the poorest pregnant women and their babies under the state and federal Medicaid program.

The program now reaches 23,000 women a year, providing expectant mothers with a package of benefits including doctor visits, psychological counseling and nutrition advice. The cost is almost three times that state’s usual Medicaid payment of $468 per baby.

“We said that being poor is a risk factor by itself and therefore anyone poor enough to qualify for Medicaid needed all of these services,” Coye said.

HealthStart was targeted at health problems of New Jersey’s blighted inner cities, where 18 of every 1,000 infants died within the first year of life in 1985--almost twice the national average.


Just how effective the four-year-old program has been in reducing infant deaths and disabilities is uncertain.

The program appears to have had an impact, said Susan Lenox Goldman, New Jersey’s assistant health commissioner. The statistics are clouded because of a surge of infant deaths and disabilities among babies born to mothers using crack cocaine.

As a result of the crack epidemic, the infant death rate rose sharply in New Jersey in 1988, at a time when the death rate in California and the country as a whole was continuing to drop.

“We were expecting worse,” Goldman said. She said the infant death rate in New Jersey’s urban areas now appears to be falling.

Coye is generally applauded for establishing another program that placed a surcharge on all New Jersey hospital bills to cover the costs of patients who have no way of paying for hospitalization themselves.

“In the area of uncompensated care--indigent care--we are the only state in the country that pays 100 cents on the dollar for the care of any person who does not have health insurance,” Coye said in a 1988 interview.


Now, three years later, New Jersey’s Uncompensated Care Trust Fund is in disarray, the victim of spiraling medical costs and the unwillingness of the federal government and private health insurers to pay a hospital bill surcharge that had climbed to 20%.

“It was an idea that didn’t fully work out,” said Dr. Harold L. Colburn Jr., a Republican New Jersey assemblyman who was a sponsor of the initial hospital care legislation. Colburn said that he became disillusioned with using a surcharge on hospital bills to pay for the program, but he remains laudatory about Coye: “I really question whether anyone could have done better under the circumstances here.”

As health commissioner, Coye tackled a variety of difficult issues--trying to reduce the high rate of AIDS among the state’s intravenous drug users, to cut the number of unnecessary Cesarean sections performed in hospitals, and to assure the public about the safety of the state’s beaches after used syringes and other medical waste began washing up on New Jersey shores.

But she was unable to escape the rough and tumble partisanship of New Jersey politics. She was accused of doing the bidding of Republican politicians in her role as chief regulator of nursing homes and hospitals--charges that she has denied.

Several New Jersey politicians, including former Gov. Kean, give Coye high marks for job performance, as do a number of public health officials around the country.

Kean said he had a lengthy and probing conversation with Wilson, when California’s governor was deciding whether to appoint Coye, then a professor at Johns Hopkins School of Public Health, to the state health department post.


Wilson especially wanted assurances that Coye would be a “a team player,” Kean said, someone willing to implement Administration policies.

“I had full confidence in her,” said Kean, who is president of Drew University, a small liberal arts and theology school in Madison, N. J.

Kean said he basically turned health policy for the state over to Coye. “We’d talk about the tough areas,” he said. “The one thing you can never have as a governor is a surprise.”

The two never talked about personal politics, Kean said. “I think she became a Republican, but not at my urging,” he said. In fact, Coye has remained an independent.

Kean also said he was unaware of Coye’s consulting in Nicaragua and in Cuba, where she attended a 1983 international pesticide conference at the invitation of the Cuban government.

Kean is highly critical of Cuban leader Fidel Castro--a stance that has personal significance because his sister-in-law is Cuban. “Members of her family were tortured following the Bay of Pigs,” Kean said. “And the early moves by (Nicaragua’s Sandinista President Daniel) Ortega were similar to what I remember as early moves by Castro.”


Nonetheless, he said Coye’s trips to Cuba and Nicaragua would not have mattered if he had known about them. “It had nothing to do with the job,” he said.

“Of all the Cabinet members, when it comes to testifying before the Legislature or appearing on television to explain a position, she was one of the best we had,” Kean said. “She was always terribly well prepared.”

“The woman was respected, there’s no two ways about it,” said Czajkowski, the New Jersey Hospital Assn. spokesman, whose group sometimes fought with Coye over hospital regulation matters. “I never saw her walk into a room, whether it was filled with government officials, hospital executives, health care providers, labor unions, or other special interests, and fail to command attention and respect.”

Coye turned to medicine after a promising start as a China scholar in the early 1970s, because she saw her career options limited to working for the CIA, the State Department or a university, she told The Times in a 1981 interview.

She was drawn to worker health and safety issues as a medical student after hearing a lecture at Johns Hopkins Medical School by Tony Mazzocchi, secretary-treasurer of the Oil, Chemical and Atomic Workers International Union. “She was interested in learning what the worker health field was all about and I said, ‘Why don’t you work with us?’ ” Mazzocchi said.

Coye began working for the union during her final year in medical school and in the past several years has produced papers on pregnancy complications in field workers and on the effects of pesticide poisoning.


“Her politics shaped her choices, there’s no question about it,” said Mazzocchi, who described Coye as pragmatic and never an ideologue. “Being flexible enough to play a very practical role in highly charged political arenas is no small feat.”

Coye said her travels to Cuba and Nicaragua were part of her role as a physician specializing in public health. “The governor is aware of my strong feeling that scientific exchange and professional assistance in terms of public health information and support should be available around the world,” Coye said. “I’m no expert in the area of foreign affairs and I act as a physician.”

Before the California job was offered, Coye met twice with Wilson.

“He wanted to know more about prenatal care and access to care for the indigent and substance abuse,” Coye said. “I was tremendously impressed by the governor, both by his knowledge in many of these areas and by his real interest in trying to support the development of new approaches that would emphasize prevention.”

“For me,” she said, “the touchstone of politics is public service. . . . I want to make sure that we spend precious resources on programs that make a difference.”

Profile: Molly Coye

Here is a look at Dr. Molly Coye, recently named director of health services in California: Born: May 12, 1948, in Bennington, Vermont. Previous post: Professor, chief of public health division at Johns Hopkins School of Public Health. Career: 1986-1989, health commissioner, New Jersey; 1980-1985, medical investigator for the National Institute for Occupational Safety and Health, San Francisco. Education: M.D. and master of public health, Johns Hopkins University, Baltimore, 1977; master’s in Asian history, Stanford University, 1972; bachelor’s in political science, UC Berkeley, 1968. Publications: Books on cancer prevention and China; numerous articles on occupational hazards, pesticide poisoning and AIDS. Hobby: Enjoys murder mysteries.