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Instead of calling her "Commissioner," Mary Madonna Ashton was often called "Sister." That was the first sign meetings would be different with a Catholic nun at the helm of a state agency. The second sign: more civil discourse and less cursing.

"You hear a lot more people from the old school saying 'son of a gun' when Sister Mary Madonna's in the room," Gov. Rudy Perpich later recalled.

He selected Ashton to be the first woman to lead the Minnesota Department of Health. The St. Paul resident was also the first non-physician and nun in the role, both of which sparked controversy in the 1980s.

"She made history … and set a very high standard for those of us who were privileged to follow her in the role," said Jan Malcolm, the current health commissioner who also held the job from 1999 to 2003 and considered Ashton a mentor. "Leading with grace and compassion, were really a hallmark [of her leadership.] … She just had a life of service."

Ashton was a public health pioneer who also led the former St. Mary's Hospital in Minneapolis, and started St. Mary's Health Clinics in St. Paul. She died Oct. 16 at the age of 99.

Born Alberta Ashton, she grew up in St. Paul during the Great Depression, the eldest of three girls in an Episcopalian family. While attending St. Catherine University, Ashton converted to Catholicism and decided to become a nun, joining the Sisters of St. Joseph of Carondelet in St. Paul in 1946.

Ashton got two master's degrees, started a career in medical social work and worked her way up to CEO of St. Mary's Hospital in 1962 — a notable accomplishment before she was 40, in a time when women held just 2% of the nation's hospital manager jobs.

"She was a person who opened up new doors for women in health care," said longtime family friend Matthew Foley of Chanhassen.

After 20 years as CEO, she was summoned out of the blue to Perpich's office.

The governor offered the 59-year-old the top job at the Health Department, a step away from the tradition of having a physician leader. Some people worried that Perpich, a Catholic whose election had been backed by abortion opponents, was making a political statement. Others called a nun in office an abuse of power, mingling church and state.

"I wanted someone who was a class-A manager, someone who could be tough and fair," Perpich said in 1990.

During her two terms, Ashton would prove to be both. She had high expectations for the department's 800-some employees, just as she had for herself.

Ashton was heralded for her work during the AIDS epidemic, fighting for funding for AIDS programs and for Minnesota to become the first state to make HIV a reportable condition. She also advocated for smoking bans in public places, helping set the stage for the state's smoking ban in 2007, Malcolm said.

"She led with incredible grace and skill during that time," Malcolm said. "I think she surprised a lot of people, frankly. … She really embraced the breadth of the public health responsibility and her role."

Over time, Ashton seemed to win over critics. Senators voted unanimously to confirm her second term. And when she resigned in 1991, a line of employees stretched down the hallway at her goodbye party. She was a humble, effective leader who catalyzed bipartisan support for public health initiatives, said Michael Osterholm, who worked with her as the state epidemiologist.

"She was a good leader and would do whatever was required to get the job done," Osterholm said. "She was remarkable."

After public office, she was CEO of Carondelet LifeCare Corp. and founded St. Mary's Health Clinics to serve uninsured people. The volunteer physicians, nurses and support staff now serve more than 15,000 people a year.

"Her spirit is still what makes the clinics work so well," said Sister Meg Gillespie, a longtime friend who is also on the clinics' board. "She just lived her mission of loving God and loving neighbor without distinction. She was focused on that more than herself."

She is survived by seven nieces and nephews. Services will be held at 11 a.m. Nov. 18 at Our Lady of the Presentation Chapel at 1880 Randolph Ave. in St. Paul.