For those who crave variety in their work and have a penchant for the unusual, Dr. Paul Bachner, has a career message: Don’t overlook public health.

As medical director of the Division of Laboratory Services for Kentucky’s public health department from 2013 to July 2015, Bachner expected the unexpected, whether it was an outbreak of food contamination, a suspected case of Ebola or a newborn with a life-threatening metabolic disorder.

“We would begin the day with a meeting of all the supervisors of laboratory sections and talk about what kind of testing we were doing that’s out of the ordinary,” said Bachner, who is now a consultant to the health department. “For example, we may have been informed by our colleagues in epidemiology that there was a Salmonella outbreak in a particular county; we needed to confirm that, identify the strain and track down the source. We had alerts involving tuberculosis within the past year.”

Although the state laboratory is not routinely staffed at night, Bachner said they’re prepared to test at any time for agents of potential bioterrorism, always with more than one person present. “We periodically have a white powder event, in which a suspicious-looking substance is sent to someone in government,” he says. “More often than not, it turns out to be talcum.”

Bachner is a University of Kentucky professor of pathology and laboratory medicine, and director of laboratories at UK HealthCare. Three years ago, the state contracted with the university to provide a director of laboratory services, an arrangement Bachner called uncommon.

“Public health is a wonderful career path, but I believe one of the reasons the state was interested in having us provide the directorship is that it’s difficult to find pathologists who know about this opportunity.”

The evolution of newborn screening was responsible in part for drawing an anatomic pathologist out of private practice and into the public health arena more than a dozen years ago. Dr. Stephanie Mayfield Gibson - who would eventually become the first woman and the first African-American to serve as Kentucky’s commissioner of public health - became director of the state’s public health laboratory when the state was preparing to expand its panel of screening tests for newborns from four disorders to 26.

“These tests would primarily be done by mass spectrometry,” Gibson said. “I had to get instruments, we had to build an IT system and I had to get staff to work on weekends. This involved moving to a different culture.”

Once the instruments were validated and the IT system was in place, Gibson went to Mayo Clinic laboratories for training in biochemical molecular genetics and how to interpret test results.

“We managed to go live a month ahead of the target implementation date set by the governor.”

The new testing was designed to diagnose life-threatening diseases such as medium- and long-chain acyl-CoA dehydrogenase deficiencies, Gibson said, adding that Kentucky had the highest rate in the nation of some of these disorders – one in every 100,000 babies – and one of the highest rates in the world. Today, the Kentucky public health laboratory screens about 62,000 specimens from newborns for about 50 inherited conditions each year.

Gibson is now the KentuckyOne vice president of population health and chief medical officer for KentuckyOne Partners, an accountable care organization.

“Being part of history, implementing the Affordable Care Act and the Food Safety Modernization Act in our state, has been a thrill,” she said. “Being commissioner of public health is a natural fit for a pathologist. I would love to see another pathologist in this position.”

The series will continue with Part Two in the December LabLink.