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Brash nominee for surgeon general seems ready to slip Washington's reins

THE BALTIMORE SUN

WASHINGTON -- The Arkansas Legislature had just rejected a cigarette tax that state health director M. Joycelyn Elders, the woman tapped to become the next U.S. surgeon general, had fervently lobbied for.

Knowing his boss' five-alarm temper, Tom Butler, the director's longtime deputy, pulled Dr. Elders aside and went through his usual routine with her in the face of defeat and a gathering press mob. "Are you calm? Are you OK?" he asked.

"Yep," she said. "No problem."

With that, the firebrand of Arkansas turned to the cameras: "They sold our children to the cigarette industry!" And she took off from there.

Restraint is not a word in Dr. Elders' dictionary. This is a woman, a 59-year-old pediatrician and sharecropper's daughter who's called her right-wing opponents "mean, ugly and evil," who's labeled anti-abortion leaders "very religious non-Christians," who's told members of Congress they were "slave masters" who have to get over "their love affair with the fetus."

This is a woman, a mother of two grown sons, who has made a name for herself during her five-year tenure as director of the Arkansas Department of Health by pushing contraceptive availability in schools and sex education starting in kindergarten, who keeps on her desk a condom-sprouting "Ozark Rubber Plant" for some yuks, who takes her coffee black and her talk straight and her battles loud.

"If I feel something's a problem, I say it's a problem," says Dr. Elders, who will speak tomorrow at the Johns Hopkins University School of Hygiene and Public Health. "I think people understand that better, they appreciate you, and when you get through, they know what you've said."

So what's a bold, aggressive, blunt-speaking, wave-making woman like this doing in Washington, specifically in the control-crazed Clinton administration?

Going against the grain.

Throwing off the reins

As she splits her time between Little Rock and Washington waiting for Dr. Antonia C. Novello to relinquish the gold-braided surgeon general's uniform next month, there's already evidence that Dr. Elders is resisting attempts to rein her in.

Last week, her new Washington handlers turned a reporter and photographer away from a scheduled interview at her office here, saying that Dr. Elders had decided not to speak to the press before her Senate confirmation hearings. But the next day, with Dr. Elders back in Little Rock, she immediately returned the reporter's phone call, willing to talk and unaware and displeased that her D.C. office had canceled the meeting.

"I'm new to them, and they're new to me," she says, suggesting it may take a while for the two to understand each other. "There are lots of -- I won't call them problems, but we've got to learn to work that out."

It's not surprising that the Clinton media machine is trying to muzzle its audacious nominee as she prepares for what could be contentious confirmation hearings this summer. Dr. Elders has never been shy.

She says if she has the authority as surgeon general to declare a local health emergency in Baltimore and allow Mayor Kurt L. Schmoke to experiment with a controversial needle exchange program as he has proposed, she will do so. The program has been rejected by the Maryland General Assembly twice.

"In relation to the AIDS crisis, anything that we can do that will make a difference and reduce the spread of this disease we need to do," she declares.

With directness like that, she has become so high-profile in her native Arkansas that, even though her husband, Oliver, is the winningest active high school basketball coach in the state, at the mention of the name "Elders," everyone thinks of Joycelyn.

She says she plans to pursue on a national scale the agenda she has pursued in Arkansas.

Depending on whom you talk to, that is either a blessing or a curse.

"She has been the most visible and ardent spokesman on behalf of women and kids that this state has had," says David Rickard, research analyst for the Arkansas Advocates for Children and Families.

"When you can't see the facts because you're blinded by your own agenda, you become a dangerous person. That is Joycelyn Elders," says Dale Morfey, president of the Westark Christian Action Council, who has tried unsuccessfully to bring lawsuits against the health director for her participation in abortion-rights rallies.

"I cannot imagine the damage she would be able to bring if she's allowed to function as surgeon general."

Controversial school policies

Most of the extreme feelings and high-voltage confrontations Dr. Elders has generated have been related to her advocacy of school-based health clinics -- which can dispense contraceptives they choose to -- as a way to combat AIDS and teen pregnancy. Arkansas has been one of the nation's leaders in teen-pregnancy rates.

In her view, preventing pregnancy -- through services that are "user-friendly" to adolescents and "age-appropriate" sex and health education that begins in kindergarten -- is the key to tackling many of the nation's social ills and would make moot the issue of abortion.

"If we prevent unplanned, unwanted pregnancies, then abortion becomes a nonissue," says Dr. Elders, who, nonetheless, strongly supports the inclusion of abortion in a basic health benefits package. "I'm about prevention. I'm not about abortion."

To that end, she says the first thing she wants to do is make sure "every child born in America is a planned, wanted child."

Her critics, who have fought the school-based clinics and called for her resignation, point out that, during Dr. Elders' tenure as health department chief, the teen pregnancy rate in Arkansas has increased dramatically.

"If you were going to judge her success on the basis of one of the things she made a high priority, she was not successful," says Jerry Cox, sponsor of a 1988 amendment to the Arkansas Constitution prohibiting the use of state funds for abortion (and one of those she called "mean, ugly and evil").

But she and her supporters counter that the national teen pregnancy rate has increased just as fast. More to the point, the clinics are in only 24 of the state's 1,200 schools, and only four dispense condoms.

"She's spent most of the last five years just getting the community comfortable with the fact that we have a problem," says Mr. Butler. "She was willing to put the health department and her own reputation out on the line."

Taking the bully pulpit

In many ways, Dr. Elders, who says she never laid eyes on a doctor until she was in college, personifies the socially liberal mindset the Clinton team has brought to town.

Likely to use the position as a high-profile, provocative bully pulpit, much as former Surgeon General C. Everett Koop did, she says she won't be out there "promoting and pushing things the president would really disagree with" and will only stick to things she knows about.

Poor people is one of those things.

Born in the tiny farming town of Schaal, hidden away in the southwest corner of Arkansas, Minnie Joycelyn Jones and her seven younger siblings joined their parents in the fields, picking cotton, feeding the chickens and wild hogs, hauling water from the well.

College was hardly on young Minnie's agenda. But Philander Smith College, a historically black, church-supported school in Little Rock, offered a scholarship -- and a job cleaning the dorm -- to the valedictorian of her high school class. "That was me," says Dr. Elders.

With only an address and bus fare that her sisters and brothers scraped together from picking cotton, she took off.

When she came home, young Chester was shocked that his sister was asking people to call her "Negro" instead of "colored," and challenging some of the discrimination they'd accepted as a way of life.

One night she started to leave a drive-in movie theater when an employee told her she had to park in the back, but her siblings wept -- "We were not caught up in trying to change laws; we wanted to see 'Old Yeller,' " recalls one of her brothers, the Rev. Chester Jones, -- so she moved the car back. A little.

After college, she joined the Army and became a physical therapist, and then in 1956, courtesy of the G.I. bill, enrolled in medical school at the University of Arkansas, where she was the only woman and one of three black students.

There, she rose through the ranks to full professor, and established herself as a renowned pediatric endocrinologist specializing in adolescent diabetes.

Contention with Congress

"Congress will have trouble dealing with her," concedes Mr. Butler. "Some will love her, but some will hate her."

Her most important tango with Congress will come sometime after June 1, when Dr. Novello is expected to step down and Dr. Elders will take her place before the Senate Labor and Human Resources Committee.

Committee staffers say she is expected to be confirmed, but not without some lively sparring between the zealous abortion-rights advocate and such anti-abortion conservatives as Strom Thurmond and Orrin Hatch.

With that in mind, she has not yet packed up her house in Little Rock. Although she resisted accepting the job at first -- some say she had her sights set on health and human services secretary -- it's clear she's now hoping she and Washington will learn to like each other.

So far, she says, "I have not been uncomfortable . . . and I've been me."

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