Dr. Raquel Bono’s first job in the military was at a field hospital in Saudi Arabia, providing urgent care for troops wounded in the Gulf War. Her last military job was in Washington, D.C., consolidating the management of hospitals and clinics previously run by the Army, Navy and Air Force.
Starting out as a physician, she needed to display medical know-how under pressure. Later, she needed to employ political tact. Now Bono will have to do all that at once as Washington’s new coronavirus “czar,” tasked with managing Washington’s emergency health care response to the pandemic.
Gov. Jay Inslee recently appointed the retired Navy vice admiral as state director for COVID-19 Health System Response Management. Inslee has asked Bono to coordinate among the dozens of hospitals that public and private providers run independently in communities across Washington, and with mobile hospitals that the military has vowed to open here. The governor wants Bono to turn those facilities into a pandemic-fighting machine. She started work Monday.
“You’ll never guess what I’m going to do next,” she said when she called former Defense Health Agency (DHA) colleague Guy Kiyokawa over the weekend. “This is what you were meant to do,” Kiyokawa replied.
Inslee may hope his appointment serves a public relations purpose as well, reassuring anxious Washington residents that someone with an impressive military resume is involved and shielding the governor during some tough negotiations.
But Bono’s challenge is daunting. The pandemic hit Washington early and hard, racking up 2,580 confirmed cases of the COVID-19 illness caused by the coronavirus, including 132 deaths, as of Wednesday. Inslee has issued a stay-at-home order meant to slow the spread of the virus enough that a surge in patients doesn’t overwhelm the state’s hospital system.
State officials have for weeks been issuing daily reports on confirmed cases and deaths. But not until recently did they disclose how many people were being hospitalized with COVID-19-like symptoms, and they have yet to break those crucial numbers down by county.
Though Inslee appointed Bono to make high-level decisions about where health care resources should be allocated and where patients should be treated, she couldn’t tell reporters during a phone briefing Tuesday — her second day at work — exactly how many hospital beds remained available, nor how many ventilators and personal protection kits were still needed. She was still learning about the situation and requesting data, she said.
Washington officials are walking a tightrope. They need to demonstrate that Inslee’s social distancing measures are working but don’t want residents to think the precautions are no longer needed. “The best approach is being extremely transparent,” Bono said in an interview Wednesday.
The 63-year-old is trained as a trauma surgeon rather than in public health and has never lived in Washington, acknowledged Inslee’s chief of staff, David Postman; she lives in Northern Virginia and in an interview said the governor’s request was “totally unexpected.” But her other credentials will matter more, Postman contended.
“She’s surrounded by people now who know a lot about Washington,” including top epidemiologists, he said. “She’s coming in without baggage in the industry, in government here. She’s a new player.”
Before retiring as director of the DHA, Bono last year appeared as a witness as Congress scrutinized a Trump administration policy banning most transgender troops from serving in the military. Asked about that Wednesday night, she described the issue as “complex” and said her job involved representing the administration. She also said she honors anyone willing to serve in the military and would work to provide everyone in Washington with the best care possible.
“She has made clear that anything she said while working for the commander in chief doesn’t have any impact on the way she views health care and her job in Washington,” Postman said. “She has assured me that nobody has anything to worry about — a patient is a patient is a patient.”
A family affair
Bono was born in the Philippines, and her grandfather, an obstetrician, had served during World War II. Her family immigrated to the U.S. when she was 6 months old. Her father became a surgeon and joined the Navy Reserves. They settled in San Antonio.
When she was a child, Bono hoped to become a nurse so she could spend more time with her father at his hospital, she has recalled in multiple interviews. “Why not a doctor?” he asked, setting her down a career path that led to the Gulf War and the Pentagon.
Bono was the first female Navy medical officer to become a vice admiral. She’s told her new colleagues to use her nickname, “Rocky.”
“Tell the citizens of Washington they’re getting a relentless fighter,” her brother, Anatolio Cruz III (also a retired Navy vice admiral), told The Seattle Times.
When the Gulf War ended, Bono worked at hospitals on the East Coast and in various administrative jobs. Months after she became director for medical-surgical services at the National Naval Medical Center outside D.C., the U.S. invaded Iraq, said Donald Arthur, a former Navy surgeon general who was running the center at the time.
“As soon as we got there, the casualties started,” he said, crediting Bono for getting the wounded troops back stateside, overseeing their care and bringing their relatives from across the country to visit them, even as the Army took heat for neglect at its nearby medical center.
“She got hotels to donate rooms, taxis to donate rides, people to donate meals,” Arthur said. “She had the big picture.”
At the time Bono was selected to head the Jacksonville Naval Hospital in Florida, it was being slammed with malpractice lawsuits and critical media coverage. That was a “volatile time,” said another former Navy surgeon general, Matthew Nathan, who later hired Bono as his executive assistant. “She’s been battle tested.”
During a stint with the military’s Pacific Command in Hawaii, Bono helped run war games for potential pandemics, she said.
The idea to hire “a czar” for Washington’s COVID-19 response, Postman said, grew from conversations in Olympia about postponing elective surgeries statewide, and about which hospitals might send patients to a Navy medical ship that Inslee had requested.
The Washington State Hospital Association can convene its members but doesn’t issue directives. The state Department of Health doesn’t normally coordinate health care that way, Postman said.
“Some of our hospitals are for-profit, some aren’t. Some are attached to academic institutions, some are military,” he said. “These weren’t decisions that could be made by committee or consensus. We needed command and control.”
Though Inslee’s emergency may lend her authority, Bono tends to rely on “collective purpose,” rather than “positional authority,” she said.
Flattening the pandemic’s deadly curve “is something everybody can get behind,” she added. “Health care workers, no matter who we are and where we’re practicing, we want to take care of our patients.”
Bono’s Rolodex should come in handy as the state seeks more assistance from the military and D.C., Nathan, the former Navy surgeon general, noted. The leaders who can send help “will pick up the phone when she calls,” he predicted.
But in order to make decisions about where to send medical equipment, open mobile hospitals and route patients, Bono will need more information, she said, telling reporters during Tuesday’s phone briefing that better data would be her immediate priority. Oregon Gov. Kate Brown said Wednesday she was instructing her administration to release more data on available beds and ventilators.
Soon enough, Washington’s coronavirus czar will get a chance to deliver. Bono’s second phone briefing is scheduled for Thursday.