Lena H. Sun and Alice Crites, Washington Post

ATLANTA — After five months in office, President Trump’s new director of the Centers for Disease Control and Prevention has been unable to divest financial holdings that pose potential conflicts of interest, hindering her ability to fully perform her job.

Brenda Fitzgerald, 71, who served as the Georgia public health commissioner until her appointment to the CDC post in July, said she has divested from many stock holdings. But she and her husband are legally obligated to maintain other investments in cancer detection and health information technology, according to her ethics agreement, requiring Fitzgerald to pledge to avoid government business that might affect those interests. Fitzgerald provided The Post with a copy of her agreement.

Last week, Sen. Patty Murray (Wash.), the senior Democrat on the Senate committee that oversees CDC, wrote that Fitzgerald is raising questions about her ability to function effectively.

“I am concerned that you cannot perform the role of CDC director while being largely recused from matters pertaining to cancer and opioids, two of the most pervasive and urgent health challenges we face as a country,” Murray wrote.

By her reading of the ethics agreement, Murray wrote, Fitzgerald is unable to engage in “key matters relating to cancer,” the second leading cause of death in the United States. Murray said Fitzgerald may also be unable to respond to the opioid crisis “given your apparent conflict with regard to opioids” and specifically with state-based electronic databases used to track and monitor the use of opioids.

In an interview, Fitzgerald dismissed those concerns, saying she was following ethics rules laid out by the Department of Health and Human Services, which oversees CDC. While her ethics agreement requires her to recuse herself from “many particular matters” in cancer detection and health information technology, those recusals are “very limited,” she said.

“I’ve been assured that I can participate in broad policy work,” Fitzgerald said. “I’ve done everything the ethics office said that I should do.”

The ethics issue comes amid broader questions about Fitzgerald’s leadership at the agency, a critical bulwark against disease that has been targeted for deep budget cuts by the Trump administration. Congress has restored most funding for next year. But over the next two years, CDC’s work helping other countries detect and control outbreaks is slated to fall dramatically, with ground staff reductions of about 80 percent.

Since her appointment, Fitzgerald has made few public statements, even while visiting Puerto Rico and the U.S. Virgin Islands after back-to-back hurricanes scoured the Caribbean. She waited 133 days before holding her first agencywide staff meeting, on Nov. 17. And the CDC had to cancel her first scheduled appearance before Congress, on the opioid epidemic, in early October, because she had not finished shedding financial assets that could pose a conflict of interest, a process she has since completed, aside from the remaining investments questioned by Murray.

Murray has also complained that Fitzgerald has on at least three occasions sent deputies rather than appear herself to testify on the federal response to the opioid crisis at congressional hearings alongside the heads of other government agencies.

Fitzgerald's relatively low profile is in sharp contrast to that of her predecessor, Tom Frieden. Frieden testified frequently on Capitol Hill, led regular media briefings on public-health issues from obesity to Zika, and was a prominent public face of the fight against infectious diseases in the United States and abroad.

Frieden constantly checked messages and often answered emails while talking on the telephone. CDC researchers said it was not unusual for him to call them directly, prompting some to ask whether he was too deep into the weeds.

“Frieden was, at heart, a scientist, and [Fitzgerald is] a clinician, and there is a difference between the two,” said one senior CDC official who requested anonymity because officials are prohibited from making such judgments publicly.

An obstetrician-gynecologist for 30 years, Fitzgerald served as a major in the Air Force and ran unsuccessfully for Congress twice in the 1990s. Named Georgia's public-health chief in 2011, Fitzgerald championed early child development, tobacco control and obesity prevention. She has been criticized for accepting funds from the Atlanta-based Coca-Cola Foundation for a childhood obesity program.

Her husband, Thomas Fitzgerald III, is an emergency medicine physician. The couple lives in Carrollton, Ga., about 60 miles west of Atlanta.

During a 36-minute interview with The Washington Post — one of only a few she’s given since taking the job — in the conference room outside her office at CDC’s sprawling headquarters in Atlanta, Fitzgerald said she has spent most of her first three months listening and learning about the agency. She said is strictly abiding by what ethics officials have directed.

Financial-disclosure forms show that she and her husband have combined assets worth $3.8 million to $16 million. A 48-page document shows that the couple’s portfolio has included a wide variety of health-care, pharmaceutical, food and tobacco holdings through companies and investment funds that, for the most part, are widely traded.

“My husband and I, you know, we have worked for 30 years,” she said, noting her time in the private sector. “And, you know, this is our retirement accounts. And so we have a diversified portfolio.”

She and her husband have holdings in two limited liability companies they are not able to divest from because of legal and contractual obligations that are not spelled out in her ethics agreement, dated Sept. 7, two months after she was appointed.

Those companies invest in two other entities, Greenway Health, a health information technology company, and Isommune, a biotech start-up focusing on early cancer detection, according to the agreement.

Fitzgerald says she will “continue to be alert” to sell or transfer those holdings in the future. But until then, she is required to recuse herself from “many particular matters” in cancer detection and health information technology, including electronic health records and software to help medical practices manage revenue, the agreement states. The document does not list additional specifics.

Murray’s letter says Fitzgerald has an “apparent conflict with regard to opioids” and specifically, to state-based electronic databases known as prescription drug monitoring programs, or PDMPs. These databases contain information on controlled-substance prescriptions dispensed by pharmacies and prescribers and are used to track opioid use.

Her ethics agreement does not mention opioids or PDMPs. But the recent White House report on combating drug addiction and the opioid crisis recommends more support and funding for incorporating PDMPs with electronic health records and increased use of electronic prescribing, both of which are components of Greenway Health.

Greenway Health was listed among 20 prescribing software vendors working with Ohio’s prescription drug monitoring program during a CDC town hall teleconference for state and local officials in July. The event, titled “Promising Interventions to Improve Prescribing Practices Within States,” included talks from CDC officials and featured presentations from Ohio and Oregon officials.

Fitzgerald has also agreed to avoid participating in government business involving her husband’s consulting company, Thomas E. Fitzgerald III MD Inc., or any of his clients.

In the interview, Fitzgerald said she has no recusals regarding opioids or prescription drug monitoring programs. She added that any potential conflicts on her part will be handled by others at the agency. “Any particular thing that is a particular conflict, we have people who will step in and do that little tiny piece,” Fitzgerald said.

A CDC spokeswoman later issued a clarification. “Dr. Fitzgerald is able to speak about PDMPs as a tool in the opioid response, and she will continue to speak about the opioid public health emergency in general,” spokeswoman Katherine Lyon-Daniel wrote in an email.

Don Fox, acting director and general counsel at the Office of Government Ethics during President Barack Obama's administration, reviewed Fitzgerald’s financial disclosure and ethics agreement and the CDC’s response at The Post’s request.

The wording suggests that HHS ethics officials “have concluded that right now, she has to recuse herself from dealing with a particular policy or strategy on either PDMPs or on the opioid crisis,” Fox said in an interview. “The important thing here is what the ethics officials are not saying,” he added. “They’re not saying she can work on anything to do with PDMPs or the opioid crisis.”

Based on his federal government ethics experience, he said it was unusual that “you would go ahead and appoint someone who had significant parts of the job that they were unable to do, and where there is no visibility as to how long that situation would persist.”

The CDC has a budget of about $7 billion and more than 12,000 employees working across the nation and around the globe on everything from food and water safety to heart disease and cancer to infectious disease outbreak prevention.

At her all-staff meeting Nov. 17, Fitzgerald alluded to her low profile and explained that she had been learning about the agency and holding one-on-one meetings with staff. She also outlined a plan to streamline programs around a common focus within four major areas: noninfectious disease, infectious disease, public-health science and public-health service.

Unlike other Trump administration officials who have tried to clear their agencies of longtime staffers, Fitzgerald has made few changes among senior staff at CDC. She hired her former chief of staff at the Georgia health department and a new acting director in CDC’s Washington office. But Anne Schuchat, a highly regarded CDC veteran who served as acting CDC director after Frieden’s departure in January, remains the principal deputy.

Fitzgerald said she has been impressed by the passion of CDC scientists, their rigorous pursuit of science and the world-class work done there. Referring to scientists researching the neglected tropical illness known as Guinea worm disease, she said, “There are people who have studied that one worm for 30 years, and I don’t mean that derogatorily.”

But deep pursuit of science can result in silos that slow down the ability to respond to new health threats that require working together between areas of expertise, she said. One of her priorities will be to “reach across the entire agency” to improve communication within CDC and to the broader public.

Fitzgerald defended her decision not to use her Caribbean trip to deliver public-health messages. “I went to Puerto Rico to do a job,” she said. “I just think when we do routine work, we don’t necessarily send out a press release.”

Supporters inside and outside the agency describe her as engaged and personable and someone who asks good questions. “When you talk to her, she’s very there, and she is very smart,” the senior CDC official said.

Fitzgerald, who likes to be called “Dr. F,” prefers to get in-person briefings, is more comfortable in small groups and has asked staff members not to interrupt her during her lunch break, officials said.

Fitzgerald is viewed by some senior CDC officials as more attuned to politics than Frieden was. Given the polarized climate in Washington, the official said, “that may be a really good thing for a CDC director right now.”

In an email, Frieden said that Fitzgerald's approach appears reasonable and that she has “put excellent people in key positions.” But he added: “The key issue for CDC will be whether it has the budget support from the Administration and Congress to continue protecting the United States, and whether it continues to have scientific independence.”

Of her potential conflicts of interest, he said: “My impression of Dr. Fitzgerald is that she is committed to serving the American people, whether she is directly involved or delegates to the excellent staff at CDC. I am optimistic these issues will be resolved and that the agency will continue protecting the American people from health threats.”

Jonathan O'Connell and Steven Rich contributed to this report.

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You can read the full article by Lena H. Sun and Alice Crites here.