Dr. Judith Monroe's appointment as commissioner of the Indiana State Department of Health returns her to the early days of a practice steeped in public health.
This time, though, the Carmel resident won't be treating patients living in tree houses. That's right, tree houses.
The 52-year-old Dayton, Ohio, native began her medical career in Morgan County, Tenn., in the heart of Appalachia on the eastern edge of the Cumberland Plateau. Through a National Health Service Corps program, Monroe spent four years there beginning in 1986, amid squalid living conditions.
"It was fascinating," she recalled. "The county had been without consistent medical care. I was the only full-time physician there."
During her first month, she performed more Pap smears than had been done in the previous two years. Many residents suffered from various types of cancer, due to the lack of basic prevention and treatment. And most accepted their fates and would die at home, she said.
Because there was no hospital nearby, those who sought treatment were admitted in Oak Ridge in the neighboring county. Monroe fondly remembers an 85-year-old man needing medical attention who had never roamed outside the county. She spent three days convincing him to make the trip before he relented.
As leader of the state's health department-the first woman to do so-Monroe's role is more administrative. But that doesn't mean she's content hiding behind a desk all day. On April 7, for instance, during National Public Health Week, she led a group of workers on a noontime stroll around downtown Indianapolis as part of the America on the Move program.
The idea is to encourage daily walking. Employees who participate can drop their name in a hat for a monthly chance to share a "healthy lunch" with Monroe, who is looking forward to the opportunity to meet more workers.
She also plans to travel the state to learn firsthand how communities are encouraging healthful lifestyles. To stay fit, Monroe enjoys biking and kayaking, and said she might even take one or the other with her on her trips sometimes to lead by example.
Monroe said the role of the health department is to monitor disease and injury and to promote, protect and provide for health care. Its 1,600 employees statewide-800 of which are in Indianapolis-inspect hospitals and nursing homes and provide oversight.
In regard to promoting healthful lifestyles, Monroe has her work cut out for her. The state's high smoking rate, 27 percent of the adult population, ranks fifth highest in the nation, according to the Atlanta-based American Cancer Society. The ACS helped develop Indiana's Cancer Control Plan, an ongoing initiative introduced last fall to promote the prevention and early detection of the deadly disease.
Monroe already has invited department employees and their family members to consider quitting smoking with the help of cessation methods. A healthier state could result in more businesses locating to Indiana, she reasoned.
Gov. Mitch Daniels named her to the post March 7 after leaders of the Indiana Academy of Family Physicians nominated her for the position. She interviewed with the governor and Mitch Roob, secretary of the Indiana Family and Social Services Administration. Under the new administration, Monroe serves in a new capacity as medical director of the state's Medicaid program.
Because the state spends nearly $5 billion annually in state and federal dollars on health insurance, the governor wanted to have someone with a medical background involved in the process, Roob said.
"It's not an insignificant sacrifice for folks to decide they're going to spend a couple of years, or four years, in the administration," he said. "The hours are long and the pay is not great. Judy is willing to live with that, because she comes from a background of real service."
Monroe will receive an annual salary of $140,000 overseeing the agency with an annual budget of $293 million. She earned her bachelor's degree from Eastern Kentucky University in 1975 and her medical degree from the University of Maryland Medical School in 1983. She performed her residency work at the University of Cincinnati, before setting off for Tennessee.
She and her husband, Dr. Robert Lubitz, director of academic affairs and research at St. Vincent Hospitals and Health Services Inc., arrived in Indiana in 1990.
Monroe began her duties then as director of clinics for the Indiana University School of Medicine's Department of Family Medicine. She served as the key representative for primary care to the Wishard Outreach Strategic Planning Committee that revamped service delivery through public health clinics such as the Cleo Blackburn Clinic.
In 1992, she moved to St. Vincent to direct the primary care center and family medicine residency program. In that capacity, she led programs to assist indigent patients. While Monroe is still seeing some patients and is involved in the residency program, Dr. David Harsha has stepped in as interim director.
Dr. Michael Wiemann, senior vice president and chief medical officer at St. Vincent, said the governor made a wise choice in appointing Monroe commissioner.
"She is a real hands-on practicing physician and educator, and she understands patient needs and the health care delivery system," he said. "She can take those skills and apply those to the larger picture of health care in the state of Indiana."
Her dedication to public health extended to her volunteering time for the Marion County Health Department's Indianapolis Campaign for Healthy Babies. The program lasted from 1995 to 1997 and explored the causes of infant deaths and where gaps existed in services.
"What I love about her is that she's a very culturally competent physician," said Dr. Virginia Caine, director of the Marion County Health Department. "She will be just as comfortable working in an urban metropolitan setting as well as a rural setting."
Indeed, at the end of her term as director of the primary care center, its Hispanic clientele had grown to include 50 percent of the patients, Monroe said.
The decision to leave, however, was agonizing.
"I lost a lot of sleep trying to decide if I was the person with the right background," she said. "I guess I feel a sense of calling, almost as though my career has prepared me for this."