Before Randall Williams became health director in Missouri, and a principal figure in the state's response to the COVID-19 pandemic, he played a key role in a controversial decision to tell North Carolina residents it was safe to drink their water.


He was named North Carolina's top health official in 2015, shortly after authorities had advised hundreds of residents living near coal ash pits across the state to avoid drinking their well water. There were concerns that elevated toxin levels posed a contamination risk.


Months later in 2016, over the objections of some government scientists, Williams' signature appeared on a letter telling those same residents the water was safe. When asked later about the decision, Williams explained that his role involves dual responsibilities.


"Part of my job as State Health Director is to protect the people's health," he said, according to a deposition in a lawsuit filed by environmental groups. "But also part of my job is to not unduly alarm people."


Ken Rudo, then a toxicologist for the North Carolina Department of Health and Human Services and one of the officials opposed to the decision, said Williams is guided by a third factor: politics.


"Obviously he had taken his desire to be a politically-guided state health director to Missouri, which is really a shame for people who need a health protector as a state health director. Which clearly he is not," said Rudo.


Williams, an obstetrician and gynecologist by training, is no political novice. He ran unsuccessfully for mayor in Raleigh, North Carolina in 2011. In his five years as a public health officer, he has figured prominently in a series of a disputes where politics and public health have clashed.


Now he's Gov. Mike Parson's top health adviser as Missouri navigates a pandemic on a scale unseen since 1918, where decisions can carry life-and-death consequences.


As the governor lays the groundwork for lifting restrictions put in place to slow the virus' spread by May 4, Parson says he has full confidence in Williams, who was hired by then-Gov. Eric Greitens in 2017.


"He's been here every day, seven days a week, doing his job trying to do his best for the people of Missouri," Parson said. "His heart couldn't be any more pure about what he's trying to do for the people of this state."


But as Parson's administration draws national criticism for allegedly responding too slowly to the coronavirus threat, others aren't so comforted by Williams' high profile role.


"If Randall had been the state health director here (during coronavirus)," Rudo told The Star, "I would be frightened for the health of the people who live here with me."


Not 'draconian'


When Williams testified to a Missouri House committee on March 2, six days before the state reported its first coronavirus case, he offered a glimpse through the lens with which the Parson administration would view its role in responding to the pandemic.


"We do not intend to be draconian," he told lawmakers when asked about issues like school closures. "We think those decisions, 98 percent of the time, will be made at the local level."


Parson's handling of coronavirus' spread across Missouri has largely reflected Williams' testimony. He rebuffed pressure to follow other governors and order all schools closed. All eventually did so on their own over the course of a few weeks, and he more recently ordered they remain shuttered through the end of the academic year.


On April 3 he issued a statewide stay-at-home order that public health experts said is too deferential to local government. The directive came about two weeks after leaders in the Kansas City and St. Louis areas issued more stringent orders on their own, and after 41 other governors issued statewide orders.


He defended his decision by citing his March 21 prohibition on gatherings of more than 10 people.


Late last month, a Facebook post by one of Williams' top deputies only deepened the misgivings of critics. Adam Crumbliss, director of community and public health for DHSS, posted a message that compared the risk of coronavirus to that of common strains of influenza. It echoed much of the conservative social media commentary at the time.


"You are at no greater risk of dying today than you were before the first case of COVID-19 emerged," he wrote, listing the diseases that killed many more Missourians than the virus, such as heart disease, cancer and chronic lung disease.


Parson's campaign Facebook account liked the post.


Crumbliss told The Star in an email that he wasn't trying to play down the risk of coronavirus.


"To the contrary, there are always inherent risks in every aspect of life," Crumbliss said. "Further, I remind everyone in the post that we should be taking appropriate steps - such as what we have taken - to flatten the curve and protect our Missouri citizens."


The state created a void in leadership in the early stages of the pandemic, said state Rep. Kip Kendrick, D-Columbia., leaving local leaders to make difficult and unpopular decisions about stay-at-home orders and school closures on their own.


"If the state had stepped in and provided some guidance, it would have taken a lot of pressure off school administrators, for example, who were trying to navigate so many difficult decisions anyway," Kendrick said


State Rep. Jon Patterson, a Lee's Summit Republican and chairman of the House special committee on disease control and prevention, said he felt Missouri was "way behind the curve" on COVID-19 but nevertheless defends Williams' work.


"It's easy for us to sometimes armchair quarterback and second guess. But these are unprecedented times and he's doing the best he can with the information he has."


Williams told the Star in an email that the role of government in crisis is to provide assistance coupled with expertise.


"I think my experience of taking care of patients for 30 years and working in public health over 30 years helps me understand just how crucial what we are doing is to saving lives," he said.


'The guy has nine lives'


State health directors usually work in near-anonymity, emerging for the occasional budget hearing or public service announcement encouraging people to get their flu shots. But even prior to the pandemic, the bow-tie-clad Williams was one of the Parson administration's most familiar faces.


Lawmakers cut eight positions from Williams' department as punishment for his refusal to release information about an outbreak of the tick-borne Bourbon virus., which he argued was confidential. And under his watch, DHSS has twice been found by courts to have violated the state's Sunshine Law.


The Missouri House launched an investigation earlier this year into the rollout of the state's medical marijuana program, focusing on accusations of conflict of interest both within Williams' department and the third-party vendor hired to review and score applications. The program has also drawn FBI scrutiny.


But nothing in his tenure with Parson has garnered Williams as much attention as his role in the ongoing legal fight with Missouri's only abortion provider.


Williams' department refused to renew the license of a Planned Parenthood clinic in St. Louis in June 2019. DHSS said the decision was based on a March inspection that turned up records of complications in four surgical abortions and the clinic's refusal to force some of its doctors to submit to interviews with state officials.


The license denial set off a legal battle, with Planned Parenthood arguing that the decision had nothing to do with patient safety and everything to do with the governor's anti-abortion politics.


As part of the legal discovery process, it was revealed that state investigators, looking for evidence of failed abortions at the clinic, had compiled a spreadsheet of patient information that included dates of women's menstrual periods. The revelation ignited a furor.


Williams was confronted with calls for his resignation.


"This guy has nine lives," said a long time statehouse lobbyist who is close to Parson and asked for anonymity to speak freely. "I honestly don't know how he's still around."


Risky water?


Williams started with the North Carolina Department of Health and Human Services in July 2015, not long after the state had put out an advisory warning hundreds of residents living near coal ash pits belonging to electric utility Duke Energy to not drink their water. Screenings detected the presence of hexavalent chromium and vanadium.


Hexavalent chromium, or chromium-6, has been linked to cancer.


Williams worked under to then-Gov. Pat McCrory's administration, a Republican who spent 20 years working for Duke Energy.


Environmental advocates and some officials in the health department were infuriated by Williams' role in reversing the health warning in March 2016.


Megan Davies, who at the time was the state epidemiologist for North Carolina HHS, had objected to telling homeowners that their well water was safe.


Asked in a deposition about why Williams supported reversing the earlier "do not drink" advisory, Davies said Williams had concerns about residents having to use alternate sources of water. (Duke Energy for a time was supplying affected homeowners with bottled water.)


"He expressed a lot of concern about the stress that people who had received the recommendation not to use water for drinking or cooking were experiencing as a result," Davies testified, "and that while there is risk in the well water, there is countervailing risk in not using your well water, and having to use bottled water or some other source."


Williams told The Star that other states have varying standards for chromium in water. North Carolina's is relatively low.


"I would just point out to you that the last time I checked, the recensions I made are still in place four years later under a democratic governor and his appointed leaders," Williams said in an email.


Rudo, the toxicologist who criticized William's reversal on the "do not drink" advisories in North Carolina, sees Williams' handling of the situation differently.


"[T]he State Health Director's job is to protect public health," Rudo said in his deposition testimony. "But in this specific instance, the opposite occurred. He knowingly told people their water was safe when he knew it wasn't."