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Meet Gale Burstein, the general in the war on opioids

Gale Burstein cut her medical teeth testing malaria drugs and fighting AIDS in Africa. She wrote national guidelines for the U.S. Centers for Disease Control. And her research on chlamydia rates among poor Baltimore teens landed her on the front page of JAMA, the flagship medical research journal of the American Medical Association.

Public health has long been Burstein’s calling. And now, Erie County’s health commissioner faces the biggest public health crisis of her career.

Over the past two years, the skyrocketing opioid and heroin drug crisis has claimed more than 300 lives in Erie County. By year’s end, more than 1,000 will have died from overdoses since 2012.

Attention to the epidemic exploded before the County Legislature in late 2015, when Debra Smith of South Buffalo showed up with roughly 60 parents, teachers and friends of victims. Smith recounted how her son, Nathaniel, had become addicted to painkillers after surgeries. He died of an overdose at age 26.

“I would have done anything for that child,” she told lawmakers, choking up as she demanded something be done.

By then, Burstein was developing the Opiate Epidemic Task Force. The task force launched many programs.

Among them:

• Training more than 15,000 people how to use Narcan, an emergency antidote.
• Launching a 24-hour Addictions Hotline to immediately link addicts to treatment.
Developing classes and treatment guidelines to help doctors and other health professionals work with patients in chronic pain or opioid withdrawal.

Not all her efforts have succeeded. Local police stations have floundered in efforts to become sanctuaries for treatment-seeking addicts. Community volunteers recruited to help those struggling with addiction have found themselves with little to do. And Burstein’s initial response to the indictment of Dr. Eugene Gosy and the temporary closure of his pain treatment center sparked backlash.

Nevertheless, Erie County’s efforts are attracting attention statewide. Burstein and County Executive Mark Poloncarz have toured the state in recent weeks, sharing practices that work in Erie County and promoting the work of the National Opioid Task Force.

Most weeknights, she sleeps three or four hours – and she’s fine with that.

“I just feel like there’s so much to do, and there are so many people eager to work with me,” she said.

Her energy is making a difference in the opioids fight, says Dr. Thomas Schenk, chief medical officer for BlueCross Blue Shield, and others.

“She’s still the glue that’s holding all of these efforts together,” said Schenk. “We would potentially have much worse outcomes than we have right now.”

Finding medicine

Burstein, 53, is driven. Family and colleagues say she’s always been that way.

Despite her 5-foot-1, 100-pound frame, she’s hard to overlook. Eyes naturally gravitate to her cropped, curly locks, beaded jewelry and loud, color-coordinated tights that disappear into black ankle boots during winter.

“She’s not a presence that’s going to scare anybody. But when she makes an argument, people will back up and realize she’s all there, and she’s the real deal,” Poloncarz said.

 

Burstein wears her signature style at a press conference with County Executive Mark Poloncarz.

The daughter of a dentist and special education teacher, the Kenmore native was born into three generations of high-achieving Bursteins, many of whom entered the health field.
For a brief time in 1992, 10 members of the extended family were “Dr. Burstein.”

“It’s a family tradition,” said Burstein’s father, Irwin, a periodontist.

 

As a pediatric resident on an international health track at Case Western University, Burstein worked with her husband, Dr. Peter Bloom, in the rural outreaches in Zambia. Together, they tested potential malaria drugs and witnessed children dying of brain infections. They climbed fruit trees and ate frozen cheeset hey got from neighbors to keep from starving during the drought.

Burstein later accepted her first full-time job as chief of pediatrics at Shongwe Hospital in South Africa in 1993, dealing with the dawn of another crisis – the spread of HIV and AIDS in a post-apartheid nation.

She treated infants and toddlers who failed to respond to treatment and were later diagnosed with AIDS. She recalled breaking the news to mothers that not only were their children infected, but that they had passed on the then-fatal virus to their children, and the mothers also were doomed.

It wasn’t the last time she dealt with tragedy.

Sex and disease

When local health insurers, addiction treatment providers and law enforcement officials met two years ago to consider how they might work together to fight the rising opioid crisis, Burstein walked in from another event.

“She’s walking around carrying a giant bag of condoms,” Schenk recalled. “She sat down at the table, plopped down this big bag of condoms and said, ‘OK, let’s get to work.’”

Many years of Burstein’s career were spent focused on sexually transmitted diseases and adolescent health.

“I’m probably one of the few physicians that really likes teenagers,” she said.

Her expertise and ongoing interest in sexually transmitted diseases shows in the purse that holds her cellphone and business cards – a blue clutch decorated with 12 wrapped purple condoms.

 

Gale Burstein's condom-covered purse is a conversation starter.

After Burstein’s stint in South Africa, she worked as a clinical instructor in Baltimore and encouraged all the adolescent girls who visited inner city clinics to receive testing for sexually transmitted diseases.

Her study of more than 3,000 girls from 1994 to 1996 found that one of every four sexually active girls who came to a city clinic for the first time had chlamydia, which often shows no symptoms but can cause infertility.

The highest chlamydia rates were found among 14-year-old girls.

Reporters descended on Johns Hopkins Hospital over two days to listen to Burstein’s findings and conclusions that sexually active girls should be tested for chlamydia every six months.

From Johns Hopkins, she joined the Centers for Disease Control and helped write national treatment guidelines for the treatment of sexually transmitted diseases. She also worked with states adopting rapid HIV testing, a breakthrough process that enabled doctors to receive an initial HIV diagnosis in 20 minutes instead of two weeks.

In 2005, she and her husband returned to Western New York. Burstein took a job with the county Health Department, doing clinic work and keeping track of local STD and tuberculosis cases. After four years, she quit in frustration as the county closed clinics.

“I felt like I couldn’t do much good here,” she said.

She joined Women and Children’s Hospital as an adolescent treatment provider and kept ties with the CDC. She loved her work with young people and still treats students at the Bennett High School health clinic a few days a month.

“When they trust you, it can really be a pleasure to speak with them,” Burstein said. “Many times, kids don’t have anybody to listen.”

Taking the job

The day after Poloncarz won election in November 2011, Burstein’s husband, an Amherst gastroenterologist, set the front page of The Buffalo News before her and suggested she apply to be health commissioner.

Her first reaction: not interested. The last time she worked for the Health Department, five county health clinics were shuttered in the aftermath of the red-and-green budget crisis. But friends and mentors pushed her to think about it.

On the last day for application submissions, Burstein sat at an airport gate, preparing to board a 6 a.m. flight to Florida for a meeting with Merck on their HPV vaccine. Her flight was delayed for three hours.

“So I opened up my laptop,’” she recalled, and sent her resume.

Health Commissioner Gale Burstein speaking with WGRZ reporter Jeff Preval during an Opiate Task Force meeting.

Burstein’s background impressed Poloncarz and his transition team. He assured her that he put a high priority on improving public health services.

“I just remember her being such an advocate for public health, not coming in and saying, ‘Well, I want to run the department a little differently,’” Poloncarz said. “I wasn’t looking for someone to massage a budget presentation.”

Burstein took the job.

“I had no idea what I was getting into,” she said.

Learning the ropes

Burstein’s office resembles a giant scrapbook. A Narcan kit, school artwork, lava rocks from Ireland, and documentary posters from her film-making sister are interspersed amid dozens of snapshot photos of her husband and children – Zachary, 18, and Joshua, 15 – from vacations and bar mitzvahs.

What you won’t find on display is her medical degree from the University at Buffalo or her master’s in public health from Johns Hopkins.

“Why would I want to look at that?” said Burstein, a Nichols School graduate.

 

Gale Burstein's office walls are covered with memories, not diplomas.

Burstein’s ego-free personality and friendly nature make it easy for her to find community partners, her advocates say. But that doesn’t mean she didn’t have a lot to learn when she took the job leading a county department of more than 400 employees.

“She took a crash course in Politics 101 and Public Policy 102,” Poloncarz said.

She eventually gained some success. In April 2014, the shuttered county clinic at 1500 Broadway reopened as the Erie County Health Mall.   Unlike the costly county clinic once located there, the Health Mall building is leased at a reduced rent to four private health clinics that provide primary care, addiction, adult and youth mental health, and dental services.

St. Vincent’s Health Center, the building’s primary care clinic, logged more than 8,000 patient visits last year.

Burstein also won funding for improved lead poisoning prevention and treatment services, and she leveraged millions of dollars in state grants to expand family planning services.

But confronting the opioid crisis is what put Burstein to the test.

Facing an epidemic

Burstein radiates energy. She’s at the gym by 7 a.m., swimming 50 laps before heading to the office. She stays up through the early morning hours catching up on more work.

“She’s a bulldog,” said Dr. Paul Updike, an addiction specialist at Catholic Health. “I get emails from her at 2 in the morning. She’s exhausting.”

In 2015, Burstein began hosting meetings with treatment providers, health insurers and law enforcement agencies, building the foundation for a task force that eventually tackled the opioid emergency.

“You’re talking about competing agencies, patients, patients’ families,” Updike said. “How she manages to keep all of this float, I don’t have an idea.”

 

Burstein shared Health Department data at the quarterly Opiate Epidemic Task Force last month.

Smith, the South Buffalo parent who shocked county legislators with the story of her son's death from an overdose in 2015, was asked to head up the task force’s family support and advocacy subcommittee. At first, she was skeptical of the county’s commitment and the ability of a health commissioner trained in pediatrics to make a difference.

Now she uses words like “remarkable” and “underrated” to describe Burstein’s work.

Smith credited the commissioner for holding the medical community responsible for its role in the opioid addiction crisis.

“Her personality is so non-offensive and non-intrusive,” Smith said. “She was able to rope in a lot of people who would normally have buried their head in the sand.”

Erie County’s work has been noticed regionally and nationally. In recent weeks, Burstein and Poloncarz toured the state to discuss how Erie County has addressed fatal overdoses, collect new ideas and convey information from the National Opioid Task Force.

“Mark Poloncarz and Dr. Burstein, the dynamic duo there, they’ve come together in a way that will help other counties,” said Stephen J. Acquario, executive director of the New York State Association of Counties. “But they, too, are learning on the road.”

Trouble spots

Burstein picked up a small bust of Star Trek character Spock, her role model because of his cool, analytical mind. She held up her hand and offered the Vulcan “live long and prosper” sign. She also raised her  eyebrows one at a time, imitating Spock’s trademark expression.

“He was always in control,” she said of Spock.

In real life, control can be fleeting. Some projects Burstein pursued have not met expectations.

The program allowing drug addicts to walk into most local police stations and ask for drug treatment assistance required buy-in from law enforcement and community volunteers. But since its August launch, only 10 addicts have made use of it.

“Every agency that’s involved is disappointed in the numbers,” Daniel Rinaldo, a federal drug intelligence officer, said at a recent task force meeting.

The number of calls to the county’s 24-hour Addiction Hotline, run by Crisis Services, has plummeted since it was rolled out in August 2016. More than 70 called on the first day, but now only a half dozen or fewer daily calls come in.

Burstein also took heat for her public response to the crisis sparked by the indictment of Dr. Gosy, whose Amherst pain management practice temporarily left more than 9,000 patients without access to treatment or medication refills. The county had no say in what happened to Gosy or his practice, but Burstein was criticized for suggesting that patients suffering from severe pain should try to wean themselves off addictive painkillers and consider using over-the-counter pain relievers and alternative therapies.

Angry emails and social media posts called her remarks callous and complained the county Health Department had not done enough to help.

“As regrettable as the way that was received, she really had no choice,” Schenk said. “There was no alternative at that point.”

Dr. Nancy Nielsen, senior associate dean for health policy at the University at Buffalo’s Jacobs School of Medicine and Biomedical Science, was one of three physicians who stepped forward to temporarily take over Gosy’s practice. She credited Burstein for asking the Erie County Medical Society to brainstorm emergency solutions.

“She was perfectly willing to reach out to an organization she didn’t know much about,” Nielsen said.

Burstein said efforts to bring the opioid epidemic under control will continue to demand her attention. She and those she works with are prepared to meet that challenge.

“We’re still going strong,” she said.

As far as her initial reservations about the commissioner’s job, Burstein’s come a long way since then. She said, “This is the best job I’ve ever had.”

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