When Houston opened a dozen warming centers during back-to-back freezes in January 2026, the city’s new health director found herself offering advice from her clinical experience. 

“I wrote staffers a note giving them tips and tricks as an ER doc,” said Theresa Tran Carapucci, MD, MBA, FACEP, an emergency physician and past chair of the Emergency Medicine Foundation who became Houston Health Department Director in fall 2025. “How to manage overnights, what to expect with people arriving 24/7. It felt very familiar.” 

Translating direct frontline experience into system-level decisions has defined Dr. Tran Carapucci’s career, from working as an emergency physician, to advocating on behalf of emergency medicine at the Texas state legislature, to leading public health for one of the nation’s most diverse cities. 

Finding A Voice in Advocacy 

After earning an MD from Baylor College of Medicine, an MBA from Rice University, and completing her emergency medicine residency at the Mayo Clinic, Dr. Tran Carapucci went on to serve as faculty at Baylor College of Medicine, where she taught residents, continued clinical practice, and even became program director of the MD-MBA program she had completed herself. 

In 2016, as a new attending, she found herself paying close attention to politics and health policy. Encouraged by her mentor, she became active with the Texas College of Emergency Physicians (TCEP). When a position opened to lead TCEP’s government relations efforts, Dr. Tran Carapucci stepped in to help, despite not having a formal policy background. 

“I asked our lobbyists to give me an eight-hour crash course,” she said. “It was me asking questions and getting every answer that I needed to become an expert. I studied like it was a test, and I spent all my free time learning about the legislature.” 

Her early preparation paid off over the next several years as issues affecting emergency medicine emerged in the state’s legislative sessions. By 2019, when surprise medical billing dominated health policy debates, Dr. Tran Carapucci had already become a valued physician resource to lawmakers, so she was able to help shape legislation that ultimately became the No Surprises Act.  

Advocate, Not Activist 

Reflecting on the skills crucial to her success in the statehouse, Dr. Tran Carapucci cited her ability to communicate in plain language. “I became a trusted source as a voice of medicine for non-medical people,” she said. She also emphasized her willingness to work across party lines. “It’s ally building. It’s understanding that you may be opposed to each other on an issue today, and later the exact same day, there’s another issue that you need to ally on.” 

Lawmakers responded to Dr. Tran Carapucci’s balanced approach to the issues. “I was never forceful about any single issue, and I understood how to read the room and political climate,” she said. “I became trustworthy across many issues. To me that is being an advocate, not an activist.” 

From the ED to Public Health Leadership 

In 2025, when the longtime Houston Health Department Director retired, Houston’s Mayor John Whitmire turned to someone he trusted from his previous role as a Texas State Senator: Dr. Tran Carapucci. 

Although she now oversees a department of more than 1,400 employees spanning public health preparedness, disease prevention and control, environmental public health, and community health services, she stays true to her roots in emergency care. In her first six months on the job, she conducted deep dives into each division, accompanying staff into the field and participating directly in investigations. “I still consider myself frontline personnel,” she said. 

In addition to letting her frontline experience guide her policy decisions, her vision for the role centers on evidence-based, community-informed policies and broad collaboration across sectors. “I’ve been opening the doors of public health to say we will and want to work with everyone and anyone. Academic institutions, nonprofits, for-profits, there is no competition in my world.” 

And for emergency physicians considering similar paths beyond the bedside, Dr. Tran Carapucci offers reassurance. “As emergency physicians, our skill set is incredibly powerful, and it can translate everywhere. No industry is off limits.”