"Acting" surgeon general under three presidents?

The Washington Post today reports the obituary of S. Paul Ehrlich, whom it identifies as “acting Surgeon General under Presidents Nixon, Ford and Carter”:

Why was Dr. Ehrlich the “acting” surgeon general for such a long period – why didn’t he ever become the surgeon general?

As far as I can tell, Nixon didn’t like the office of Surgeon General so he tried to eliminate it by not appointing anyone to fill the job.

Once Carter was in office, he appointed someone.

Ehrlch must have been the second in command and was left to handle all the work.

I assume that his appointment was never confirmed by Congress, and, as a result, he never officially received the office.

As seen here, there have been several times when the Surgeon General’s office has been filled by an acting Surgeon General.

Just to clarify, when the SG dies or resigns, or his four-year term expires without a successor being nominated by the President and confirmed by the Senate, the Deputy Surgeon General takes over as Acting Surgeon General. (If the DSG office is also vacant, then a lower ranking official in the Public Health Service does the same.) This is what happened to Ehrlich.

If a person is nominated by the President to be SG, but not confirmed, that person would be the Surgeon General-designate, but would not exercise any of the powers or duties of the office. It’s conceivable that Ehrlich was both ASG and SG-designate, but in fact I don’t believe he was ever nominated to be SG.

The Surgeon General’s web site provides some clues as to what apparently happened between 1973 and 1977. During Nixon’s first term,

In other words, it’s probable that neither Nixon nor Ford nominated a successor Surgeon General because they believed (and possibly hoped) that the position would soon be reorganized out of existence.

Then, after Jimmy Carter became President,

If a nomination was brought to the Senate, but not confirmed, the person could not serve as Surgeon General though. There could have been a recess appointment, but that would have expired at the end of the Congress.

The Surgeon General prior to Ehrlich had been fired by Nixon also and with all the other stuff Nixon had to deal with in 1973, it’s likely that picking a Surgeon General was high on his “to do” list and it just would have been another opportunity for the Democrats to wreak some havoc against him.