Dr. Randall Smart is the new executive director of the Mark Twain Health Care District.
Stepping in for interim Executive Director Larry Blitz on June 25, Smart is ready to merge his 35-plus years of experience in the health care field to take the Calaveras County hospital district into the future of medical care.
“That’s one of the things that I’m really excited about on this board,” said Smart. “In this county, there are a lot of independent health care initiatives. If you can bring those together as a centralized board and you can make that process more efficient and provide a platform to provide services, what a great thing to do.”
As executive director, Smart will be responsible for the day-to-day operations of the Mark Twain Health Care District. He’ll also have to work with his former colleagues. The district is a public entity that leases the Mark Twain Medical Center to Dignity Health care, the hospital’s operator.
A member of the district board for five years, Smart didn’t take too long after resigning from his post to throw his hat in the ring for the executive director’s job. On June 5, Smart offered his resignation and on June 6, an application for the executive director’s seat was in front of the board for consideration.
Smart’s application was thrown in with almost a dozen other applications from across California.
The candidates were given scores by the board after their evaluations, but it’s safe to say that none of the candidates could compare to Smart’s pedigree as a well-traveled and well-experienced physician, not to mention his experience in Calaveras County.
Smart’s ties to the county were formed at an early age.
Smart was born in San Francisco in 1954 to Elliott and Colleen Smart, but he was raised in Murphys and San Antonio, Texas. As a youth in Murphys, he remembers his time at the Murphys grammar school and walking the halls of Calaveras High School as one of the many future movers and shakers of Calaveras County. But by the time his diploma reached his palm, he was ready to see what the rest of the world could offer and hit the road to expand his education.
“I then did what every 18-year-old does and I left for education, culture and the world,” said Smart.
He later attended the University of Texas, Austin, before enlisting in the United States Army in 1974. There, he served for four years as a combat medic and surgery technician. Seven years later he enrolled at the University of California, Davis, where he graduated with honors.
While working toward his degree, Smart put in work at Mark Twain Hospital as an emergency room and operating room technician. He did all of that while preparing for the Medical College Admission Test, better known as the MCAT.
“That turned out to be a great experience for me,” said Smart.
A success at UC Davis, he then received a scholarship offer to study medicine in Maryland at the Uniformed Services University of Health Sciences and served 20 years as an Air Force internist. An internist handles the diagnosis and nonsurgical treatment of diseases that attack internal organs, especially in adults.
“That was probably the best experience of my life,” said Smart, “to be surrounded by smart people who are passionate about teaching.”
As an internist Smart traveled across the globe setting up mobile surgical units in places like Germany, France and Africa as part of the Air Force’s Critical Care Air Transport Team.
By 2001, Smart was one of the thousands of emergency responders left on their heels as the country scrambled to respond to the horrendous Sept. 11 terrorist attacks.
For 10 to 14 days, Smart and his CCAT team waited at the Travis Air Force Base for a call from his superiors to take his team to the Pentagon in Washington, D.C., to help with any emergency medical services. Thankfully, that call never came and his team remained in the “standby phase” at the base.
Eventually, the team was told to stand down and about eight months after the 9/11 attacks, Smart was back in Calaveras County doing what he loves, providing health care to the people of Calaveras County at the various Mark Twain Rural Healthcare Clinics.
“When that was all said and done, and they were pushing me to run hospitals and do bigger stuff, I decided to retire and bring my skills back to Calaveras County and try to be a contributor. I love the county,” he said.
Smart eventually opened a private practice in Murphys and was elected to the Mark Twain Health Care District in 2012, and again in 2016. Smart’s private practice is still open and operational and he plans to split about half of his time between his new positon as executive director and his private practice.
“It was really educational to sit on a county health care board and understand what the opportunities and what the challenges are,” said Smart. “My very first day on the board I said, ‘I want to develop a pilot project for telehealth.’”
Telehealth is a system of virtual medical, health and education services that have recently come into vogue in rural or underserved areas. Smart eventually got his way, and the program was funded with about $30,000.
A nurse was hired, and a robot and camera were also installed for people to get a quick, helpful tip for their medical and health woes.
“It was a wonderful success,” said Smart. “But as I went through those five years, I realized that there is even more that we can do.”
Smart mentioned traveling from evacuation camp to evacuation camp to help administer health care to people impacted by the 2015 Butte Fire. The experience opened Smart’s eyes even further to the possibilities at the Mark Twain Health Care District.
“There are those kinds of opportunities,” said Smart. “The board has access to tax money and you can go to a community that’s growing like Valley Springs and say, ‘Let’s build a real clinic and provide very good health care.’”
As the new acting executive director, Smart wants to bring together the different medical platforms in the county in an effort to better serve the community.
The challenge might seem daunting, but the board certainly selected a man ready to tackle the job. Smart has an extensive history of taking on those executive challenges and finding a solution to what was previously seen as an insurmountable goal.
“I really enjoyed the networking and kind of the executive challenge,” said Smart. “Can you bring a hospital to the middle of nowhere? Can you have a good outcome? I loved that kind of work and there was a lot of that kind of opportunity.”
Smart, like a large majority of health care providers in rural areas, will have to tend to the future of their hospitals and the shapes of their organizations moving forward. For Calaveras County and the health care board, the elephant in the room is the future of Mark Twain Medical Center.
“The biggest thing on our plate right now is what we’re going to do with Mark Twain Hospital in the next 30 years,” said Smart. “The board really wants to be very accountable and very thorough. They are looking at every option.”
The one option that the district isn’t looking at, according to Smart, is an outright sale of the hospital.
“As far as I know, nobody on the board has any interest in doing that,” Smart said.
Affiliations with Adventist Health, Dignity Health and a possible independent option have been kicked around. None of the options are set in stone, but one thing Smart does know about the negotiations is its lasting impact on the community.
“That’s going to have an impact on this county for a long time, and frankly, in the last five years, something like 80 rural hospitals have closed. The majority of those have been critical access hospitals like Mark Twain.”
Smart said that in the next five years, somewhere close to 470 rural hospitals might close.
“We don’t want to be one of them,” Smart said.
Outside of the solvency issue, Smart will have to oversee the construction of a $6 million clinic in Valley Springs, $200,000 worth of new grants and over 500 health care properties operated by the district.
“There is a lot we’re doing and a lot that we want to do,” said Smart. “If you were to look at my desk right now there are stacks of stuff everywhere.”
But for Smart, he wouldn’t have it any other way. He’s working diligently to get up to speed on his projects and to understand where his focus will be needed.
“For me it’s been fun,” he said. “It’s been stimulating and I look at some of these challenges and it’s not painful at all. It’s something that I enjoy and I’m really excited about it.”