Weekly Message – October 15, 2018

Dear Colleagues:

Well, my “Listening Tour” of the Commonwealth got off to a fantastic start in Charlottesville this past week. I hope you all have had a chance to see the news clip from the NBC affiliate in Charlottesville, and there was a good article in the October 12th issue of Charlottesville’s newspaper, The Daily Progress. Some 100 people filled the University of Virginia’s Alumni Hall on October 10th to participate in a Town Hall discussion with me about public health. Earlier in the day, I had a wonderful and enlightening discussion with the staff at the Louisa Health Department, who educated me about the health concerns of the population they serve. Later, in Charlottesville, I had the opportunity to go out on a restaurant inspection.

This coming week, the “Listening Tour” heads to southwest Virginia. On Wednesday, October 17th, I’ll be speaking at UVA Wise, and, on October 18th, I’ll join colleagues from DMAS and DBHDS at an event in Roanoke aimed at increasing provider participation in Medicaid expansion.

One of the major themes I’ll address during the tour is the need to ensure living conditions that promote health and foster well-being, including our most vulnerable populations – rural communities and communities of color. We seek to conduct our efforts to improve population health through a health equity lens. Along those lines, I want to encourage all those who can do so to attend this week’s “Health Equity Conference and Think Tank,” which is our Office of Health Equity’s inaugural national conference. The gathering, entitled “Sowing the Seeds of Health Equity: Growing Healthy, Connected Communities,” will be held October 17-18. Register today!

Finally, October is “Domestic Violence Awareness” month. We’re posting an infographic on our Web site to highlight the need to end domestic and intimate partner violence. Let’s all do what we can to end this violence.

Have a great week!


(Pronouns: he, his, him)

Patients Come First – Dr. M. Norman Oliver

This episode of the Patients Come First podcast features an interview with Virginia State Health Commissioner Dr. M. Norman Oliver about his focus on population health, a mid-career decision to attend medical school in his 40s, his work treating Native people in a small Alaskan village, his role with the Commonwealth, and much more. Send questions, comments, or feedback to pcfpodcast@vhha.com or contact us on Twitter (www.twitter.com/virginiahha) using the hashtag #PatientsComeFirst.

Weekly Message – August 6, 2018

Dear Colleagues

As I mentioned last week, the Deputy Commissioners, the Operations Directors, John Ringer (our Director of Strategic Planning), and myself recently held a leadership retreat. Our retreat focused on the functioning of the leadership team and working toward greater clarity on the direction of the agency.

As State Health Commissioner, I depend upon the team of Deputy Commissioners and Operations Directors. This team discusses the weekly activity of the agency, the strategic and programmatic direction of VDH, and fulfills a fiduciary responsibility as the financial stewards of the agency. I need their input, their counsel, and their decision-making authority to ensure the smooth functioning and well-being of VDH. I have asked that we establish a “Commissioner’s Leadership Team,” comprising the Deputy Commissioners and the Operations Directors. This Commissioner’s Leadership Team will take the place of the “Deputy Leadership Team.”

I noted last week, “Cohesive, behaviorally unified teams trust one another. They engage in unfiltered conflict and debate around ideas. They commit to decisions and action plans. They hold one another accountable to delivering against those plans. They focus on achieving results for the team. (See Patrick Lencioni’s The Five Dysfunctions of a Team for a brilliant depiction of what constitutes a good team.) Here’s a cartoon, depicting the five dysfunctions and the reasons teams need to overcome them:

Inattention to results. Focus on delivering measurable results: collective and individual, accountability, feedback. Avoidance of accountability. To take accountability require prior commitment: 100% buy-in. Lack of Commitment. Commitment follows health conflict: hear all  disagreedecisionbuy-inone voice. Feat of conflict. Health conflict implies candid debate: trust to speak opinion without fear of retribution. Absence of Trust. Building Trust requires vulnerability: courage to risk.

Trust is a foundational behavior of well-functioning teams. As I explained last week, we did some work on further building trust among the senior leadership team. One of the tools that we used for this work was to develop a “Team Covenant” that put into written form the behaviors needed to ensure a highly reliable, well-functioning team. Here’s the covenant of the Commissioner’s Leadership Team:

VDH Commissioner’s Leadership Team Covenant

We will:

  1.  Come to CLT not as advocates for our own shops, but with VDH’s strategic goals foremost in mind.
  2. Assume positive intention and full trust.
  3. Speak up and share divergent views.
  4. Encourage constructive dissent.
  5. Pledge that, once we have made a decision, we will be unified and committed to the decision’s success.
  6. Communicate with respect and professionalism.
  7. We will always ensure we are very clear about “who, what, when” and assign ownership for follow up when we make a decision or decide to decide later.
  8. Innovate and challenge the status quo.
  9. Be clear on who has the appropriate decision rights.
  10. Have the courage to acknowledge when we fall short or break this Covenant, and will work with our Team members to get back in Covenant.

If you catch one of the deputies, an Ops Director, or myself acting in accordance with our covenant, let us know. Reinforce that behavior! Of course, we’re human beings; so, if you notice us breaking our covenant, give us a little nudge to help us get back on track. I hope other leadership teams in the agency will emulate us and develop covenants of their own. If we all start behaving in congruence with our values, VDH can go from being a good organization to a truly great one.

Have a great week!


(Pronouns: he, his, him)


Weekly Message July 30, 2018

Dear Colleagues:

The Deputy Leadership Team (DLT), Operations Directors, and John Ringer (our Director of Strategic Planning), met in a retreat on July 27 and 28. The focus of this day-and-a-half-long leadership retreat was to enhance the functioning of the team and to work toward greater clarity on the direction of the agency. Over the next several weeks, I’ll discuss the various issues we grappled with at the retreat and the results of that work.

Today, I’d like to tell you all that we spent a good deal of time exploring the characteristics of highly engaged and well-functioning teams. Cohesive, behaviorally unified teams trust one another. They engage in unfiltered conflict and debate around ideas. They commit to decisions and action plans. They hold one another accountable to delivering against those plans. They focus on achieving results for the team. (See Patrick Lencioni’s The Five Dysfunctions of a Team for a brilliant depiction of what constitutes a good team.)

Trust is a foundational behavior of well-functioning teams. At the retreat, we did some work on further building trust among the DLT members and Ops Directors. Of course, building trust in any team occurs over time through shared experiences, multiple instances of proven follow-through, and developing an in-depth understanding of the unique attributes of each team member. However, we used the retreat as a way to accelerate that process through some focused work. We learned a lot about each other’s personal histories. We identified the unique strengths we each bring to the team, as well as the things we each struggle with in advancing the work of the team. We also revisited the personality profile we each completed as part of the “Leadership Essentials” course that many of you have taken, as well. Understanding the behavioral preferences and personality styles of team members helps to build trust and team cohesion.

One of the lessons we reaffirmed in our retreat is the importance of aligning our behavior with the core values of the organization. The core values of VDH are accountability, communication, diversity, equity, excellence, integrity, respect, and stewardship. You can find these values listed and expanded upon in the VDH Code of Ethics, which I encourage you all to read. In a future “Weekly Message,” I’ll talk about some steps we took at the retreat to help us behave in a manner that is congruent with these values.

Meanwhile, the VDH senior leadership team is refreshed, rejuvenated, and re-energized following our retreat. We return to the central office hopeful about our ability to help you all be successful in your work and in the ability of VDH to play a central role in improving the health and well-being of the Commonwealth.


Have a great week!


(Pronouns: he, his, him)

Antibiotic Awareness Week

November 13-19 is U.S. Antibiotic Awareness Week. This annual event serves to raise awareness about safe antibiotic prescribing and use. It is important for us to know when we need antibiotics, when we do not, how best to take antibiotics, and what side effects may be caused by antibiotics.

Inappropriate use of antibiotics is a leading cause of antibiotic resistance around the world. Antibiotics are some of the most prescribed drugs, but up to half of prescriptions are not necessary or effective.  Every year in the United States, at least 2 million people get infected with bacteria that are resistant to antibiotics. And at least 23,000 people die because of these infections. When bacteria become resistant, antibiotics cannot fight them and the bacteria multiply. Some resistant bacteria can be harder to treat and can spread to other people.  By working together to appropriately use antibiotics only when they are necessary, we can decrease the number of infections caused by bacteria resistant to antibiotics.

I encourage you to do these things to stay antibiotics aware:

  • Get the facts about antibiotics. Antibiotics do not work on viruses such as colds and flu, or runny noses, even if the mucus is thick, yellow or green. When antibiotics aren’t needed, they won’t help you and the side effects could still hurt you.
  • Ask your healthcare provider about the best way to feel better while your body fights off a virus. Pain relievers, fever reducers, saline nasal spray or drops, warm compresses, liquids and rest may help.
  • If you need antibiotics, take them exactly as prescribed. Talk with your healthcare provider if you have any questions about your antibiotics or if you develop any side effects. Be sure to talk with them if you have diarrhea, since that could be a Clostridium difficile ( C. difficile) infection, which should be treated.
  • Stay healthy and keep others healthy by washing your hands, covering your coughs and staying home when you are sick. Be sure to get recommended vaccines for infections like the flu.
  1. C. difficile is the infection most often associated with healthcare exposure and recent antibiotic use. In Virginia’s Plan for Well-Being, we track progress towards the prevention of C. difficile infections. In 2016, Virginia acute care hospitals reported more than 2,300 C. difficile infections. To meet the national prevention goal, hospitals would need to prevent more than 600 C. difficile infections per year.

Learn more by visiting: www.cdc.gov/antibiotic-use.

State Health Commissioner Comments on Opioid Addiction Declaration

These remarks were delivered on November 21, 2016 at 10am

Good morning.  This is Dr. Marissa Levine, Virginia State Health Commissioner here with key state agency colleagues for an important announcement about the opioid addiction crisis in Virginia.  Thank you for joining us this morning.

We are here today in the shadow of the Surgeon General’s report on Addiction in America released just last week which highlights the addiction crisis facing Americans and emphasizes the need for:

  • effective public health steps to prevent and treat substance use disorders
  • a shift in attitudes toward addiction
  • and a coordinated effort among multiple sectors at community and jurisdictional levels to implement proven approaches

We are also here on the Monday before Thanksgiving when families, friends and loved ones will be gathering

So it is no coincidence that I am here with you today because the facts clearly tell us that the consequences of opioid addiction in Virginia have risen to unprecedented levels and can now be classified as epidemic.  Some of the statistics include:

  • On average, three Virginians die of a drug overdose and over two dozen are treated in emergency departments for drug overdose each day.
  • Number of emergency department visits due to heroin overdose has increased 89% for the first 9 months of the year compared to 2015
  • During the first half of this year fatal drug overdoses increased 35% when compared to the same period in 2015
  • By the end of 2016, the number of fatal opioid overdoses is expected to increase by 77% compared to five years ago.
  • In addition, our Department of Forensic Sciences just this month identified the presence of Carfentanil in Virginia. This synthetic opioid is 10,000 times more potent than morphine and 100 times more potent than fentanyl and, given its presence in Virginia, could significantly increase the death rate trends from opioid overdoses.
  • And we have the continuing prescription opioid crisis most prominent in the far southwest region of the Commonwealth where we are additionally concerned about the growing prevalence of hepatitis C and HIV resulting from injection drug use.

 With all these facts (which are the story of the people of Virginia) facing us, today I am declaring a Public Health Emergency for Virginia as a result of the opioid addiction epidemic.

This declaration is an effort to raise continued awareness among all Virginians about this worsening problem and emphasize that we must treat it as a public health issue as we have done for other health emergencies.  Our law enforcement partners have repeatedly claimed that we cannot arrest our way out of this problem.  I have heard them loud and clear:

  • This declaration has no force of law and is not a Governor’s emergency declaration. It is also not an attempt to keep opioid medications from those with chronic pain such as those with cancer pain, who legitimately need those medications.
  • In my 14 years of public health experience in Virginia, I have seen time and again Virginians rising to the emergency, coming together to work collaboratively to solve challenging, complex issues. That is my hope with this declaration- that we come together to build upon the great work that has already started as a result of the Governor’s Opioid Task Force, General Assembly actions, the AG efforts, the work of the medical and pharmacy professionals and community coalitions around the Commonwealth. We are all working to support families and communities as they help their family members, friends, neighbors and loved ones get the help they need to fight addiction.

So with all of the above in mind I am taking one more specific step in an effort to lower the death rate and prevent deaths from opioid addiction:

  • I have signed a statewide standing order for Naloxone – the rescue medicine for opioid overdose. This could only have been accomplished in close collaboration and consultation with the Virginia Department of Health Professions, its Board of Pharmacy and the Virginia Department of Behavioral Health and Developmental Services.
  • This will allow anyone in Virginia who believes they or their loved ones are at risk of an opioid overdose to buy naloxone at any of our approximately 2000 pharmacies in the Commonwealth without first having to get a prescription.
  • As we speak we have begun distributing this order to the pharmacies. The pharmacy community has been a great partner in this effort and I know they will work diligently to implement this order as soon as possible.  Realize that it may take time before every pharmacy has the order in place so please check with your pharmacy first.
  • Unfortunately the statewide standing order does not cover the cost of the Naloxone but I am confident that our collective efforts will continue to work to make Naloxone available to everyone who could benefit regardless of whether they can afford it.

I realize that this declaration and the statewide standing order cannot in anyway minimize the loss already experienced by so many families as a result of the opioid addiction epidemic.  However if the declaration and statewide standing order save even one life from here on it will have been worth it.

This Thanksgiving, as we gather around the dinner table, let us be sure we are familiar with the signs of addiction and substance use. Visit the Commonwealth’s new website VAAware (www.VaAware.com) which offers resources on how best to discuss addiction with someone you love.  As we take inventory of one another also take inventory of the medications in our household, let us also be sure to dispose of unused, expired or unwanted medications in a safe manner. Thanks to the AG office, local health departments and other community resources have drug disposal bags.  You can find a location near you on the AG website. Authorized pharmacies and some local law enforcement agencies also collect and destroy unwanted drugs.  As you take inventory this week, if you identify that someone in your life is struggling with an opioid addiction obtain Naloxone to have on hand just in case. And you can learn more about Naloxone as a result of work by our colleagues at the DBHDS through their Revive! program.  That information is also available on the website mentioned.

I realize that this is not the cheerful Thanksgiving message you may have hoped to hear, but when we live in times of epidemic and emergencies it’s important to take every opportunity as an opportunity to be prepared and informed. As we have found in every emergency the better prepared and informed we are, the more likely that we will minimize the risk of the emergency and prevent death and suffering. And in the process we build stronger connections with each other and build healthier and resilient Virginians in healthier and resilient communities.  That is what I wish this Thanksgiving and holiday season and I do so hope that you have a safe and healthy Thanksgiving.

Listen to the November 21, 2016 Telebriefing

Learn more about Opioid Addiction in Virginia.

National Infant Immunization Week

National Infant Immunization Week. Immuzation. Power to Protect.First word and steps are some of the many childhood milestones. Parents and caregivers do a lot to keep their babies safe and healthy. Vaccination is one of the best ways parents can protect infants from diseases. National Infant Immunization Week celebrates the role vaccinations play in protecting our children, communities and public health.

Immunizations are recommended for all children starting at birth. Routine vaccination can protect a child from 14 diseases by age 2. Before the measles vaccine in 1963, almost every child had the disease. Now with vaccinations, many current doctors have never seen a case of measles. Today, vaccinations have prevented nearly 20 million people from disease.

Everyone has a role when it comes to improving health in Virginia.  If you are a parent or caregiver:

  • Talk with your child’s healthcare provider to have your questions about vaccination answered.
  • Keep your child up to date on their vaccines.
  • Keep all appointments for vaccines to ensure your child is fully protected. Some vaccines are given as part of a series over time.
  • While you are at it, make sure you are up to date with vaccines recommended for you.
  • Vaccines are safe, effective and proven to be one of the most effective ways to keep from getting sick. Give your kids a strong start for a healthy future.


  • About vaccines, the diseases they prevent and when you should get them. http://www.vaccineinformation.org/
  • If you do not have insurance or cannot afford the cost of vaccines, there are programs that can help. The Vaccines for Children program provides vaccines to uninsured and other qualified children. Call 800-CDC-INFO (800-232-4636) to find a Vaccines for Children program near you.