Dr. Roxane Angiulli Townsend

In the early afternoon of Aug. 31, 2005, a wide-eyed National Guardsman approached a cluster of cots in the corridor of the New Orleans Arena, home to the NBA Pelicans. Two days earlier, Hurricane Katrina had hit New Orleans. The previous day, Lake Pontchartrain had breached two levees and flooded the city.

The Louisiana Superdome, connected to the Arena by a bridge, teemed with people. Rain poured through the roof, toilets overflowed and the only generator left - a lone sentry standing between about 16,000 refugees and total darkness - was threatened by rising water.

To Dr. Roxane Townsend, then 48, all the guardsmen seemed impossibly young. And this one was panicked.

“I have a lady, she’s about to have a baby!” he said. “She’s down in my truck.”

The doctor grabbed an obstetrics pack and followed him and a nurse, wading through eight inches of standing water in the parking lot.

The young woman was sprawled on her back in the bed of a two-and a-half-ton military vehicle flinching with pain.

Just after dark, the woman delivered her baby, but there were life-threatening complications. She was moved to the top of the evacuation list, awaiting helicopter transfer to a hospital hundreds of miles away. That same evening, a different guardsman demanded Townsend’s attention - someone had grabbed his gun while he was showering in the Superdome and shot him in the leg.

“It was an amazing time. You really got to see the best and worst of people,” says Townsend, now 56, who left Louisiana a year ago to become the chief executive officer of UAMS Medical Center and the vice chancellor for clinical programs.

She recalls an emergency medical technician, in town for a conference, who somehow found a way to cook a hot meal for the medical team and their patients, and Tulane graduate students, who cleaned bathrooms and helped care for developmentally disabled adults evacuated from a group home.

Four days after the hurricane, Townsend caught a helicopter back to Baton Rouge to find nine people and two dogs sheltering in her house, in a city with bare grocery shelves and a doubled population.

A few weeks later, on her morning commute, she noticed people jogging around the Louisiana State University lakes. How could they simply jog, she marveled, while she treated patients in an assembly center and a field house?

“She’s certainly not afraid to roll up her sleeves and get in the middle of it,” says Fred Cerise, who was, at the time, the secretary of the Louisiana Department of Health and Hospitals and her boss.

For Townsend, Louisiana represents three decades, two marriages and three careers. She thought her story might end there, but it hasn’t.

WELCOME TO TV-LAND

Townsend was born in Vandergrift, Pa., a mining town, on Aug. 29, 1957, to a family whose dynamics resembled those of Leave It to Beaver (a show that first aired about two months later).

She was the second child of two girls and two boys. Her mother was a homemaker, and a few years earlier, her father had traded coal mining for construction. Her father taught her mother to drive (none of her mother’s sisters drove), and on Thursday nights, her mother went to ladies-only card parties. Every Saturday, her parents went dancing.

“They did polka and waltz. They were great jitterbuggers. My mom is 83 now, and she still says to me all the time, ‘I really miss going out dancing,’” Townsend says.

Townsend won math contests at her Catholic grade school, played rummy with her rowdy Italian extended family and took dance lessons at the neighborhood studio.

“My sister danced, so I danced,” says Marci Morgenlander, five years younger than Townsend. “My sister was a cheerleader, so I was a cheerleader … I looked up to her from a very early age.”

The two shared a bedroom until Townsend followed her older brother to Duquesne University, a Catholic college 35 miles north of their hometown. She studied nursing because it was a flexible career that would allow her to follow her future husband wherever his job might lead.

THE NURSE, THE DOCTOR, THE BOSS

Townsend runs Arkansas’ biggest public hospital. She has been the secretary of the Department of Health and Hospitals for the state of Louisiana, overseen quality control at 10 hospitals simultaneously, operated a public HIV clinic and a private practice and appeared before legislators to discuss health-care funding.

It has been a long road for the nurse who, at 22, followed her husband to Texas and Alabama for his military job.

In her first nursing job, for a Humana hospital in Alabama, Townsend was promoted to director of education. Later, Humana transferred her to a hospital in northern Louisiana, where she joined a clogging group (but eschewed ruffled skirts), got divorced and, at the urging of her pediatrician sister, applied to the University of Louisiana’s Medical School in New Orleans.

In 1988 Townsend, then 31, married a second time. Ten days later, she started medical school. But after a miscarriage, she put medical school on hold and “became a full-time fertility patient,” she says. During those two years, she followed her husband’s job again, this time to Baton Rouge.

“My parents were married forever. They had a family. ... That’s what I expected my life to be,” she says.

When she didn’t get pregnant, Townsend returned to school, and at 41, finished her residency at the now-closed Earl K. Long Medical Center in Baton Rouge. She stayed on for an additional year as chief resident.

“Not being able to have kids has been one of the biggest disappointments in my life,” Townsend says. “So, maybe, getting to take care of the 3,500 people who work for me at UAMS is my surrogate.”

Townsend attributes her impressive resume to happenstance rather than any deliberate path, despite the fact that she seems to be a deliberate person.

Her west Little Rock home is awash in neutral colors with intimate flourishes. There’s a large, abstract painting that was a med-school graduation gift from her former brother-in-law, and an interpretive rendering of white birches, painted by two friends as a parting gift when she left Louisiana. A large, framed photograph of a tiger, the LSU mascot, rests above the mantel. Now that she’s in Arkansas, she plans to replace the tiger with a piece of local art.

She’s sarcastic but restrained, eloquent, warm and conscientious. And she has exceptionally good posture. She sits upright in an armchair, hands folded in her lap, torso angled away from the crisp flames of the gas fireplace.

“Sometimes I’m still amazed that I have this career,” she says.

Her position as chief resident was training for the next big gig - chief operating officer of Earl K. Long.

In 2004, Kathleen Blanco, then governor of Louisiana, made Cerise a cabinet member. Cerise recruited Townsend as state Medicaid medical director, and during the gubernatorial transfer, she became the interim secretary of the Department of Health.

When Bobby Jindal succeeded Blanco in 2008, Townsend returned to LSU, where, as assistant vice president for health systems, she coordinated policy for seven LSU hospitals.

In January 2009, the administrator of Charity Hospital in New Orleans, the largest of the hospitals that Townsend oversaw, resigned. Townsend stepped in as interim CEO of the hospital, while retaining her position as vice president of health systems. In July 2009, the head of a different division left, and Townsend picked up another interim title - CEO of healthcare services. So she held responsibilities once split among three administrators, in a Katrina-crippled system where clinics had graduated from tents to a Lord & Taylor department store, among other places.

“She certainly understands the importance of getting it right for people who don’t have a lot of options,” Cerise says. “I always had confidence that if she was handling something, I didn’t have to be paying much attention to it.”

PATIENT CARE AND PUBLIC RESPONSIBILITY

“Health care is a right, not a privilege. I understand the dollars and cents enough to know we can’t do everything for everybody … but I do think there’s a basic amount of health care that everybody in this country deserves,” Townsend says.

Her approach is rooted in her childhood Catholicism, as well as America’s status as a developed nation, which places a high premium on human life.

“We’ve done some things that recognize how sacred human life is,” she says. “If you present to the emergency department and you have a life-threatening condition, regardless of the ability to pay, you have to be taken care of [by federal law] … but if you don’t have an insurance card, you can’t get a doctor’s appointment at a private office.”

This is why she supports “safety-net” systems that offer primary care in addition to emergency care.

For the majority of her career, LSU functioned as a safety-net system, but in mid-2012, the board began steps to privatize the state’s public hospitals. In theory, the hospitals would still accept all patients, but Townsend found the model more profit-centered than patient-centered.

Internal documents surfaced, revealing that Cerise opposed the privatization and had urged Jindal to support a Louisiana insurance exchange to relieve the state of some financial burden generated by uninsured patients. A few weeks later, the LSU board removed Cerise as head of the LSU hospital system.

“And then, right after we deactivated after Hurricane Issac, right after I spent 72 hours sleeping on the floor of my office in New Orleans, they let me know that they didn’t really need me to be the CEO [of the LSU hospital-system] anymore. They needed someone who thought the same as Gov. Jindal,” Townsend says.

She felt as if everything that she had built, personally and professionally, was crumbling.

“It’s a real sense of loss, to have worked all those years to create some quality things going on in health care, and to see all of that disappear. … Our mission by state law was to provide free care to anyone who lived at 200 percent of federal poverty level or below. And I believe in that mission.”

Morgenlander says her sister never lost focus.

“Unfortunately, everything that has to do with health care in this country has to do with politics … but I know what she and Fred [Cerise] tried to do together was for the greater good. … She wants to deliver the best medical care for as many people as she can.”

In the midst of the LSU-hospitals reorganization, Townsend’s second husband asked for a divorce, and a headhunter for UAMS came calling.

“I’d been married for 22 years and expected to be married for the rest of my life. On the heels of that, I interviewed in Arkansas, decided to take this position, moved myself up here, bought myself a house and realized, I can do this. I can do life on my own and start over again,” Townsend says.

‘TIME TO DECOMPRESS’

Townsend was attracted to UAMS because it seemed to be a stable public healthcare system.

“I think Medicaid expansion and the way Arkansas has done that, with the private option, is an excellent idea. … It allows people to do not just health care but wellness care,” she says.

In a recent week, she says, UAMS had 192 newly insured patients.

Townsend is working to increase primary care options within the UAMS system, which should reduce the need for emergency care. UAMS already has a primary care clinic in west Little Rock. There are plans for four more neighborhood clinics in the next two years, and her team is looking for an on-campus location to create an after-hours urgent care clinic.

But if the Arkansas House of Representatives doesn’t vote to re-fund Medicaid expansion, it could cost UAMS up to $16 million this year, and these primary care plans would be jeopardized, she says.

“Last March [due to federal legislation], we took a 2 percent cut on Medicare reimbursement. That translates to $3 million a year … and UAMS is dealing with the National Institutes of Health budget cuts. That’s another $10 million,” she says.

If the private option is upended, the hospital will trim some of its services, she says.

When the numbers seem too dismal, Townsend visits her nine nieces and nephews.

Sometimes she travels to their performances (two nieces are actors). This past year, she and her family caught the Tournament of Roses parade in California (Elijah McGinley, an organ donor, who died at Arkansas Children’s Hospital at 5 days old, was honored on a float), and Townsend and her niece, Andie Morgenlander, visited Andie’s sister Shawn in Argentina, where she was studying.

“My sister has been really wonderful about sharing her children’s lives with me,” Townsend says.

On a typical day, Townsend wakes around 5 a.m., checks her email and starts work in her breakfast nook, before logging 10 to 12 hours at the office. And this is, apparently, an improvement over her Louisiana schedule. “Most of the time, I’m home in the evening by 7 or 8. I have a little bit of time to decompress,” she says.

“I’m really glad for all the experiences I’ve had. … It’s not what I would have chosen, but because it’s what I have, I take full advantage of it. I wouldn’t have some of the good stuff if I hadn’t had some of the bad stuff.”

SELF PORTRAIT Roxane Townsend

DATE AND PLACE OF BIRTH: Aug. 16, 1957, Vandergrift, Pa.

CHILDHOOD NICKNAME: Rocky. My brother and I loved to watch The Bullwinkle Show, and he probably thought of me as that annoying little flying squirrel.

WHEN I WANT TO RELAX, I get a massage.

A MODERN CONVENIENCE I COULD REALLY DO WITHOUT: Smartphones are the root of all evil.

FAVORITE TV SHOWS: Mannix, Hogan’s Heroes, NCIS. My Dad loved cop shows, so I still love cop shows.

FAVORITE BOOK: I’ve read everything Patricia Cornwell has published. For lighter stuff, I’ve read everything that Robert B. Parker has done. And I’ve read everything that Dick Francis wrote.

IF I RULED THE WORLD, we would get people to be a little kinder to each other, and the world would be a better place.

THE BEST ADVICE I EVER RECEIVED: When my dad encouraged us to go to college, he told me, “You can be whatever you decide to be.” … I didn’t realize at the time what great advice that was. But as a woman born in the late ’50s, that really meant something.

A PHRASE TO SUM ME UP: painfully honest