Missouri governor picks new acting health director after ouster of his original choice

Paula Nickelson, a longtime health department employee, will assume the role immediately

By: - March 1, 2022 1:57 pm
Gov. Mike Parson, Paula Nickelson

Gov. Mike Parson announces Paula Nickelson as the new acting director of the Missouri Department of Health and Senior Services on March 1, 2022 (photo by Tessa Weinberg/Missouri Independent).

Gov. Mike Parson announced Tuesday that Missouri health department veteran Paula Nickelson will be the agency’s new acting director, after his original pick for the job was ousted by conservative lawmakers and Missourians opposed to mandates.

Nickelson, a longtime Missouri Department of Health and Senior Services employee, will assume the role of acting health director immediately.

She replaces DHSS General Counsel Richard Moore, who briefly held the job after former Director Donald Kauerauf failed to be confirmed by the state Senate last month.

Asked why she was interested in taking the role after the fierce opposition Kauerauf faced, Nickelson said, “public health is a greater mission than any one human being.”

“I was interested in assuring that our public health system did not falter and we wanted to move forward quickly,” she said.

Nickelson has been with the state health department for over 22 years and has been deeply involved in Missouri’s response to the pandemic. She has served as DHSS deputy director since Feb. 1, said state health department spokeswoman Lisa Cox.

She takes the helm after two years where COVID-19 dominated the agency’s mission — and as the department prepares to transition to treating the virus as endemic, much like it does the seasonal flu. 

Parson didn’t commit to whether he would be submitting Nickelson’s name to the Senate to be confirmed to the position permanently this legislative session, or whether he would allow her to remain in an acting role indefinitely. Several of Parson’s cabinet members are currently serving as acting directors.

Parson said Nickelson could potentially be confirmed by the Senate “months down the road or next year,” but he made clear he believes Nickelson is the best candidate for the role even if her title is technically that of acting director. He said a national search to find a permanent director is not underway.

“I look at her as the director,” Parson said, “not so much the acting director.” 

The path to confirmation was where Kauerauf’s short tenure as DHSS director was cut short. The Senate failed to vote on Kauerauf’s nomination by a constitutional deadline — barring him from serving in the position for life.

Parson said he had not discussed Nickelson’s appointment with Senate leadership, and that he believed it was ultimately his decision to make.

“I’m not sure it’s necessary for the governor to go out and ask the Senate for their permission for me to appoint a director,” Parson said. “I think it’s their job to confirm the director. And they have that choice to make.”

Despite Kauerauf adamantly making clear his opposition to vaccine and mask mandates, conservative senators and anti-vaccine protesters remained unconvinced and rallied to oppose his confirmation.

Kauerauf had drafted an appeal meant to convince conservative lawmakers that was never sent and text messages and emails obtained by The Independent show the last-ditch effort Parson’s administration made to try to secure Kauerauf’s confirmation.

At the time, Parson had come out in Kauerauf’s defense, calling the events leading up to Kauerauf’s rejection “nothing short of disgraceful, unquestionably wrong and an embarrassment to this state and the people we serve.”

He said Tuesday he hadn’t expected Kauerauf’s confirmation to be met with such fierce opposition.

“But it did,” Parson said. “So we had to react to that and really just try to figure out how do we make sure that health department is still stable.”

Nickelson’s appointment marks the fourth director at the helm of DHSS since former director Randall Williams resigned suddenly and with little explanation in April 2021.

On Tuesday, Nickelson echoed a mantra of personal choice as she stressed that “comprehensive strategies” and “a layering approach to mitigation” are needed to curb the virus’ spread.

“With regard to COVID, masks, vaccine, social distancing and therapeutics all play a role,” Nickelson said. “All are useful and should be available to each of us as we make personal choices about how best to safeguard our own health, and the health of our family members in consultation with our personal physician.”

Nickelson has been heavily involved in the state’s pandemic response, including following the surge of cases over the summer when Springfield was the epicenter of the delta variant’s spread. She had overseen efforts at the time to award an emergency, no-bid contract to a Texas-based contractor to bring in temporary healthcare staff to aid strained hospitals and set up monoclonal antibody infusion centers.

Ultimately, a little more than 200 temporary medical staff ended up being sent to hospitals, while monoclonal antibody treatment centers averaged more than $5,600 per patient. The company has been paid over $32 million by the state so far.

She has also overseen the state’s antigen testing program, helped established the state’s first personal protective equipment warehouse, and was previously involved in Missouri’s response to the swine flu pandemic and the 9/11 attacks, according to a news release.

Rep. LaDonna Appelbaum, D-St. Louis, said in a statement after Nickelson’s appointment that she hoped Nickelson would not be “run out of town by vitriol and rhetoric” as Kauerauf had. But Appelbaum stressed she still had concerns.

“Acting Director Nickelson appears to be eminently qualified to lead DHSS, but I have pertinent questions about her role in our state’s botched COVID response — specifically in our state’s myriad contract staffing issues for hospitals and problems with antigen testing at the outset,” Appelbaum said.

Nickelson said Tuesday that addressing workforce issues, upgrading data and surveillance systems and tackling leading causes of death with a focus on health equity are some of her priorities in the new role.

Nickelson does not hold a medical degree, as former director Williams did, and has bachelor’s and master’s degrees in psychology and counseling psychology, respectively.

“It’s personal to me,” said Nickelson, a Fulton native, “that Missouri’s public health system functions and services our citizens optimally.”

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Tessa Weinberg
Tessa Weinberg

Tessa Weinberg covered education, health care and the legislature with the Missouri Independent. She previously covered the Missouri statehouse for The Kansas City Star and The Columbia Missourian, where her reporting into social media use by the governor prompted an investigation by the Attorney General’s office. She also covered state government in Texas for The Fort Worth Star-Telegram.