Newly appointed state health director Dr. Theresa Cullen hadn’t seen the tweet yet, but she was neither bothered nor surprised that an Arizona legislator had issued a public call to block her Senate confirmation.
“Am I sweating it? No. I have no idea how it will go,” said Cullen, who has headed the Pima County Department of Public Health in southern Arizona since June 2020. “Could it be acrimonious? Yeah. I hope what people will see is that I just want to make lives better.”
Late last month, then-Gov.-elect Katie Hobbs, a Democrat, appointed Cullen to direct the Arizona Department of Health Services. Her salary will be $237,000 per year, and she’s scheduled to begin her new job Feb. 20, state officials said.
The state Health Department has about 1,600 employees, a current fiscal year budget of nearly $1 billion and a higher public profile, acquired during the COVID-19 pandemic. The pandemic enters its fourth year in March.
Cullen is technically a nominee to the director’s job. She must go through a Senate confirmation process to make her appointment official, although nominees may serve in their posts for up to a year before they need to be confirmed.
The state Senate is made up of 16 Republicans and 14 Democrats, meaning the approval of each of Hobbs’ nominees could hang in the balance of divisive politics.
For Cullen, the first stop in the confirmation process could be the Senate Health and Human Services Committee. It includes four Republicans and three Democrats and is chaired by Sen. T.J. Shope, R-Coolidge.
COVID-19 politics in Arizona and across the U.S. have tended to split along party lines, with some Republicans less trusting of COVID-19 mitigation measures, though that’s not always the case.
While the number of deaths from COVID-19 in Arizona has slowed and the pandemic is no longer daily headline news, divisive COVID-19 politics at the state level remain.
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Whether that will affect Cullen’s confirmation process is unclear, although newly elected Arizona Rep. Rachel Jones, R-Tucson, issued a public rebuke shortly after Cullen’s appointment to head the Health Department became public.
“Say NO to Cullen!” Jones tweeted Dec. 31. “We CANNOT allow this mask-pushing, vax-pushing, anti-science maniac to be confirmed as the DHS director. Legislators need to block her confirmation.”
Since she’s in the House and not the Senate, Jones doesn’t have any direct say in whether Cullen will be confirmed. According to state law, a governor’s nominees to state offices require confirmation only by the Senate, not the House of Representatives.
As of Thursday, Jones’ tweet had more than 15,000 views, 487 likes and more than 200 retweets.
Arizona Health Department hasn’t had a permanent leader since 2021
Cullen had not seen Jones’ tweet until a reporter pointed it out, though it did not faze her. A seasoned public health official, Cullen spent time in Washington, D.C., and has held posts with the Indian Health Service, the Veterans Health Administration and the U.S. Department of Defense.
She headed the Pima County Health Department throughout the height of the pandemic, assuming the directorship in June 2020. As a result, she’s already well-versed in COVID-19 politics at the county level, and her department was the target of protests, verbal threats and heated criticism on social media, she told The Arizona Republic in a recent interview.
As a public health official, Cullen made recommendations but ultimately it was up to local government to make policies like mask mandates.
“My recommendations are driven, at the time I make them, by the best knowledge I have, with the intent of decreasing suffering and saving lives,” Cullen said.
Under her leadership, Pima County put in place COVID-19 vaccine programs like Vax After Dark, which created a vaccine clinic in Tucson’s downtown-area bar district during evening hours to reach underserved communities. It also set up a program that brought the COVID-19 vaccine to homebound individuals.
Cullen said the COVID-19 vaccine has saved lives and her department made efforts to make it available to everyone in Arizona’s second most populated county.
The Arizona Department of Health Services has not had a permanent leader since Dr. Cara Christ’s departure in August 2021 for a job at Blue Cross Blue Shield of Arizona. Jennie Cunico, who is the state Health Department’s deputy director of operations, is the department’s acting director until Cullen takes the helm.
Former interim director Don Herrington recently retired, a department spokesman wrote in an email.
Christ, who was appointed to her job by Republican Arizona Gov. Doug Ducey, was the target of public criticism throughout much of the pandemic and was assigned 24/7 security detail because of persistent rancor over her department’s response to COVID-19.
The Republic reached out to all seven members of the Senate Health and Human Services Committee. One of them, Sen. Justine Wadsack, R-Tucson, replied.
“I look forward to the confirmation process in the committee where we will determine if she is qualified for the position,” Wadsack wrote in a Jan. 13 email.
Wadsack has spoken out against the COVID-19 vaccine and mask mandates in the past, but it’s not clear whether all other state Senate Republicans share similar views, nor whether that will matter when it comes to confirming Cullen. Kim Quintero, director of communications for the Arizona Senate Republicans, declined comment.
“We have yet to receive an official submission from the Governor’s Office specifying her (Cullen) as a pick,” Quintero wrote in an email. “We won’t comment on hypotheticals. Feel free to reach out again if/when that submission is made to us.”
‘I don’t think I should be seen as a threat’
Former Arizona Department of Health Services Director Will Humble said he was in his job for nearly a year before the state Senate confirmed his appointment by then-Arizona Gov. Jan Brewer, a Republican.
“These confirmations are almost never a problem,” Humble said. “When there is a problem, it’s usually when the Senate president won’t hear the person at all … Warren Petersen could kill a nomination just by not assigning it to a committee and not bringing the person to the floor.”
Senate President Warren Petersen, R-Gilbert, did not respond to messages from the Republic about Cullen’s confirmation. At a lunch sponsored by the Arizona Chamber of Commerce & Industry earlier this month, Petersen said, “if we see some far left radical lefties, there’s going to be some challenges” with confirmations.
Humble, who is now executive director of the Arizona Public Health Association, said Cullen will have some “heavy lifting” ahead of her but she’s got “just the right skill set” to tackle the challenges of the job.
“She’s been working at Pima (County) for a couple of years now so she knows from a county health department’s perspective how important it is to have the operations side running properly so that the counties get their contracts on time,” Humble said. “It’s I think really good to have someone with the lived experience … I really think she’s the right person. I think she’ll do a good job.”
A 1983 graduate of the University of Arizona College of Medicine Tucson, Cullen has a long and varied background in public health and health informatics, though her job as director of the Arizona Department of Health Services will be the first time she’s served as a public health official at the state level.
“I’m going to have to learn what the concerns are, what the different representatives, legislators are seeing in their communities, making sure that people feel like they have a voice,” Cullen said. “I don’t think I should be seen as a threat.”
Public health needs to be both transparent and responsive to local needs, she said during a Dec. 5 panel discussion titled “Reforming The Centers for Disease Control and Prevention,” hosted by the conservative-leaning American Enterprise Institute.
Cullen began her career as a family practice physician for the Indian Health Service in San Carlos, Arizona, and subsequently on the Tohono O’odham reservation in San Xavier and Sells. In December 2014 and January 2015, she spent two months volunteering with the Partners in Health Ebola Response Team in Sierra Leone, setting up an Ebola maternity unit at the Princess Christian Maternity Hospital in Freetown, she said.
Some of her more recent roles include chief medical information officer and director of health informatics for the Veterans Health Administration, including a one-year period as the acting deputy director for the Department of Defense/VA Integrated Electronic Health Record Initiative.
Cullen said one of her biggest tasks will be in moving Arizona forward after the trauma of the pandemic, which as of Jan. 14 had caused a reported 32,631 deaths. It has had ripple effects across the entire state, affecting not only the families of people who died, but kids who lost out on in-person learning, health care workers who cared for sick and dying patients and business owners and their employees who lost their livelihoods.
“It’s important that we acknowledge the pain that has happened,” Cullen said. “We are in uncharted territory … Public health has a large role in that, I think.”
Arizona did not fare well on some COVID-19 death metrics when compared with other states and both Ducey and Christ were criticized for not putting more mitigation measures in place, such as a statewide mask mandate and not having stricter shelter-in-place directives.
A federal analysis says Arizonans lost 2.5 years of life expectancy between 2019 and 2020, which was worse than the average U.S. drop of 1.8 years of life lost during that same time period. Arizona’s 2.5 years of life expectancy lost between 2019 and 2020 was tied for fifth-highest in the country along with Mississippi, CDC data shows. New York state, the District of Columbia, Louisiana and New Jersey were in the top four spots for life expectancy lost in that time frame.
The Centers for Disease Control and Prevention places Arizona’s overall pandemic death rate since early 2020, using real-time surveillance data, as second-highest in the country. The CDC ranking breaks out New York City from New York state and as of Jan. 18 ranked New York City as having the highest death rate, at 526 deaths per 100,000 people. Arizona’s rate is 446 deaths per 100,000 people. The national average is 329 deaths per 100,000 people. Mississippi, ranked third, had a COVID-19 death rate of 440 deaths per 100,000 people, the CDC data says.
Asked whether she had anything to say about the way Christ and Ducey handled the pandemic in Arizona, Cullen paused before responding.
“I wasn’t in their shoes,” she said.
Arizona Republic reporters Stacey Barchenger and Mary Jo Pitzl contributed to this article.