Publicly Funded Family Planning in Arizona, 1940-2017

Publicly Funded Family Planning in Arizona, 1940-2017

One of our members (Kathy Clevenger) forwarded this interesting thesis from Nunez-Eddy, Claudia (Author) and Jane Maienschein, (Thesis advisor) this week.

I’m including it in this week’s update given the action at the legislature to restrict women’s reproductive choices.

Abstract

Nearly seven decades ago, the US government established grants to the states for family planning and acknowledged the importance of enabling all women to plan and space their pregnancies, regardless of personal income. Since then, publicly funded family planning services have empowered millions of women, men, and adolescents to achieve their childbearing goals. Despite the recognized importance of subsidized family planning, services remain funded in a piecemeal fashion.

Since the 1940s there have been numerous federal funding sources for family planning, including the Title V Maternal and Child Health Services Program, Office of Economic Opportunity grants, Title XX Social Services Program, Title X Family Planning Program, Medicaid, and the State Children’s Health Insurance Program, alongside state and local support.

Spending guidelines allow states varying degrees of flexibility regarding allocation, to best serve the local population. With nearly two billion dollars spent annually on subsidized family planning, criticism often arises surrounding effective local program spending and state politics influencing grant allocation. Political tension regarding the amount of control states should have in managing federal funding is exacerbated in the context of family planning, which has become increasingly controversial among social conservatives in the twenty-first century.

This thesis examines how Arizona’s political, geographic, cultural, and ethnic landscape shaped the state management of federal family planning funding since the early twentieth century. Using an extensive literature review, archival research, and oral history interviews, this thesis demonstrates the unique way Arizona state agencies and nonprofits collaborated to maximize the use of federal family planning grants, effectively reaching the most residents possible.

That partnership allowed Arizona ii providers to reduce geographic barriers to family planning in a rural, frontier state. The social and political history surrounding the use of federal family planning funds in Arizona demonstrates the important role states have in efficient, effective, and equitable state implementation of national resources in successfully reaching local populations.

The contextualization of government funding of family planning provides insight into recent attempts to defund abortion providers like Planned Parenthood, cut the Title X Family Planning Program, and restructure Medicaid in the twenty-first century.

Full Thesis here: Thesis Nunez Eddy.docx

Public Health Late March Legislative Roundup

There was a lot of action last week at the legislature, both in committees and on the floor. No doubt that you’ve already heard that a measure criminalizing the provision of abortion services after the 15th week passed both the House and Senate on a party line vote. The bill has no exceptions for rape or incest (see SB1164– abortion; gestational age; limit).

Governor Ducey is widely expected to sign the bill this week. By the time the bill takes effect 90 days after the end of the legislative session, the US Supreme Court will have likely upheld Mississippi’s law, which is almost identical. 

Once signed and in effect, any physician who performs an abortion past 15 weeks gestation (that isn’t a medical emergency) can be charged with and convicted of a Class 6 felony. Even if the doctor isn’t convicted, the bill states that her or his license to practice medicine “shall be suspended or revoked”.

Other high profile bills on the Governor’s desk are SB1138  and SB1165. SB1138 will place a ban on gender-related surgery for people under 18. The current standard of practice is to withhold gender related surgery until 18, but this bill would lock that into state law. SB1165 would ban transgender girls from participating on women’s athletic teams at public or private schools and at the collegiate level. The Governor is all but certain to sign both this week.

There are a host of both good and bad bills that are ready for floor votes in the House and Senate this week, so expect a busy calendar of floor votes shortly.

Many are bills that will harm public health’s ability to mitigate future infectious disease outbreaks, epidemics or pandemics. Below are the bad bills that will likely be on the Senate floor this week. In the House, we expect to see SB1009 come up for a floor vote (that one will greatly limits future public health emergency declarations).

  • HB2086 ADHS; school immunizations; exclusions 
  • SB1009 state of emergency; executive powers 
  • HB2453 mask requirement; prohibition 
  • HB2616 mask mandates; minors; parental consent 
  • HB2161 parental rights; schools; educational records 
  • HB2498 COVID-19; vaccination requirements; prohibition

Check below for all the bills in the floor hopper.  Several of the bills we’ve signed up for or against died last week (those are identified below too). Here’s our spreadsheet bill tracker for this week.

Bill Overview: Select Bills AzPHA is Supporting

Maternal/Child Health

SB1272 AHCCCS; postpartum care; eligibility; Passed Senate 26-2; Passed House Health & Appropriations; Ready for Floor Vote

Access to Care

HB2144 health insurance coverage; biomarker testing Passed House 59-0; Passed Senate Finance; Ready for Floor

Special Needs

HB2157 supplemental appropriations; community-based services SIGNED

HB2113 developmental disabilities; Down syndrome Passed House 59-0; Passed Senate Health; Ready for Floor- vote 3/24

HB2111 appropriation; healthy families program – Passed house 40-17; Still Needs Senate Approps

Social Determinants

HB2060 supplemental nutrition assistance program; Passed House 44-15; Passed Senate Health 7-1. Ready for Senate Floor

HB2484 forcible entry; detainer; filing fee Passed House 59-0; Passed Senate Judiciary; Ready for Floor

Environmental

HB2255 fireworks use, limitations, prohibition Passed House. Ready for Senate Floor

State Hospital/Behavioral Health

SB1716 state hospital; governing board; governance Passed Senate 27-0; Passed House Health 9-0.

SB1444 state hospital; administration; oversight Passed Senate; Passed House Health; Rules then Floor

SB1641 health care institutions; civil penalties Passed Senate 28-0. Passed House Health, Still needs Appropriations

SB1162 opioid prescriptions; intractable pain; exceptions Passed Senate 27-0. Passed House Health 9-0. Rules then Floor

SB1210 mentally ill; transportation; evaluation; treatment; Passed Senate. Passed House Health 8-0. Rules then Floor.

 

Bill Overview: Select Bills AzPHA Is Opposing

Vaccines/Disease Control

HB2086 ADHS; school immunizations; exclusions Passed House 31-28; Passed Senate Health 5-3. Rules then Floor

SB1009 state of emergency; executive powers Passed Senate 16-13; Ready for House Floor Vote

HB2453 mask requirement; prohibition Passed House 31-28. Ready for Senate Floor Vote

HB2616 mask mandates; minors; parental consent Passed House 31-28. Ready for Senate Floor Vote 

HB2161 parental rights; schools; educational records Passed House 31-28. Ready for Senate Floor Vote

HB2498 COVID-19; vaccination requirements; prohibition. Passed House. Passed Senate Government, Ready for Floor Vote

Social Determinants

SB1164– abortion; gestational age; limit Passed Senate 16-13; Passed House 31-26 – On Governor’s desk

Government

SB1175– noncustodial federal monies; appropriation Passed Senate 16-13; Ready for House Floor 

Recently Dead Bills

  • HB2382 appropriations, health programs, disabilities
  • HB2485 eviction dismissal
  • HB2033 juvenile offenders; monetary sanctions
  • HB2125 electronic smoking devices; retail licensing
  • SB1152– zero emission vehicles; plans
  • SB1154 transportation electrification study 
  • HB2226 fireworks use, limitations, prohibition
  • SB1298 government mask mandate; prohibition 
  • HB2043 employer liability; COVID-19 vaccine requirement
  • HB2145 electronic smoking devices; retail licensing 
  • HB2021 Drug Offenses, homicide, sentencing 
  • SB1123 disruption; educational institution; concealed weapon
  • HB2811 unlawful abortion medication; offense 
  • HB2787 Maricopa county; new counties

AzPHA Career Center

Finding the right talent and candidates seems to be getting harder in today’s competitive job market. Having those open positions in your organization is costing time, energy, and productivity. Posting your open jobs with the AZPHA Career Center is the best solution to get your positions in front of a niche audience, allowing you to create a pipeline of talented and serious candidates.

Posting on the AZPHA Career Center provides exposure to reach over 27,000 members and job seekers.

Join the Health Policy Academy

You don’t need to be a politician to influence health policy! Join the Health Policy Academy and work with lawmakers to become an advocate for quality health care legislation that supports patients and providers across Arizona.

This unique four-week program combines self-guided online content with an exciting three-day in-person immersion at the Arizona Capitol from April 12th-14th. Hear directly from legislators, advocates, and lobbyists as they demonstrate how policies are made and how you can apply your knowledge of health care to make a difference.

The cost is $1500. However, there’s a $300 discount once you sign up the total for the program is $1200. The cost includes lunch on April 12th and 13th, 2022

There’s never been a better time to expand your skillset and make a difference in health policy. Space is limited, so sign up today!

For more information, contact – ACE@asu.edu

Comment on CDC’s Opioid Prescribing Guidelines

CDC is updating the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain. Both healthcare professionals and members of the public who experience acute or chronic pain have expressed interest in understanding the recommendations outlined in the draft updated Guideline, and CDC highly values public and partner engagement and feedback in this process.

Visit the Federal Register to provide your comments on the draft Guideline update

You can visit their webpage detailing the process of updating the Guideline. Encourage people you know who have direct experience with the role of opioids in pain care and the importance of the patient-clinician relationship to visit the Federal Register, review the draft update to the Guideline, and add their perspectives to the Federal Register Notice

Submit and Comment

See below for instructions to submit a comment during the public comment period. More detailed instructions can also be found on the Federal Register Notice (FRN) webpage and in the FRN for this document.  

To locate the FRN and view the draft of the updated Guideline, you can either:   

To submit a comment to CDC, please view the methods outlined in the FRN under the “Addresses” heading and select which option you prefer:

Electronic comments via Regulations.gov

AHCCCS Enrollment Determination Grace Period to End

Nearly 500,000 Arizonans could lose Medicaid coverage (azcentral.com)

Arizona and the rest of the country will soon resume disenrolling state residents no longer eligible for coverage through Medicaid and Kids Care…  and many people currently enrolled will need to go through a process to see if they’re still eligible.

AHCCCS generally hasn’t disenrolled beneficiaries since the pandemic began in March 2020 unless they moved out of state, voluntarily disenrolled, aged out of the children’s program or died.

Once the grace period ends later this year many people with Medicaid or KidsCare coverage could be disenrolled because they no longer meet financial or medical eligibility requirements. AHCCCS estimates that 500,000 adults and children will need to go through the renewal process, which may require them to provide documentation. 

Those folks will get a letter in the mail at the address AHCCCS has for them. If they moved in the last 2 years and didn’t update their address with AHCCCS then they probably won’t get the letter, meaning they won’t respond in time resulting in disenrollment. That’s why it’s so important for AHCCCS members that have moved in the last 2 years to go to www.healthearizonaplus.gov website and confirm that the program has their current addresses.

Over 2.3 million people now get health coverage through the program, which is Arizona’s largest insurer.

Legislative Update

This is the last week to hear bills in their opposite chamber except for the Appropriations Committees, which receive an extra week. Anything that doesn’t make it on an agenda next week is mostly dead for this year, but of course, can always be revived as a strike everything amendment, or with a suspension of the rules. Nothing is truly dead until the legislature adjourns sine die.

Below is a summary list of the bills that we’re supporting and opposing. Notes in green indicate good bills that are being heard in a committee this week. Red denotes bad bills that are being heard this week. Yellow indicates that a good bill might be in trouble.

Here’s the spreadsheet tracker for our bills of interest courtesy of our interns Priscila Ruedas, Danielle Brooke King, and Garret Tomlin.

Most of the action this week will be in the House Health committee Monday afternoon, which will hear SB1162, SB1210, SB1641, SB1716 (all good bills) and SB1581 (a bad housing bill).

Bill Overview: Select Bills Progressing that AzPHA is Supporting

Maternal/Child Health

SB1272 AHCCCS; postpartum care; eligibility; Passed Senate 26-2; Passed House Health & Appropriations; Ready for Floor Vote

Access to Care

HB2144 health insurance coverage; biomarker testing Passed House 59-0; Passed Senate Finance; Ready for Floor

Special Needs

HB2157 supplemental appropriations; community-based services SIGNED

HB2113 developmental disabilities; Down syndrome Passed House 59-0; Passed Senate Health; Ready for Floor

HB2382 appropriations, health programs, disabilities DEAD

HB2111 appropriation; healthy families program – Passed house 40-17; Still Needs Senate Approps

Social Determinants

HB2060 supplemental nutrition assistance program; Passed House 44-15; Senate Health Hearing Wednesday

HB2484 forcible entry; detainer; filing fee Passed House 59-0; Passed Senate Judiciary; Ready for Floor

HB2485 eviction dismissal; sealed records Passed House 50-8; Needs Senate Commerce Vote

HB2033 juvenile offenders; monetary sanctions; repeal Passed House 58-1; DEAD

Tobacco

HB2125 electronic smoking devices; retail licensing – failed but on reconsideration for vote in 2 weeks

Environmental

SB1152– zero emission vehicles; plans Passed Senate 16-13. Assigned to House NERW 

SB1154 transportation electrification study committee Passed Senate 16-13. DEAD

HB2226 fireworks use, limitations, prohibition Passed House 42-17. DEAD

HB2255 fireworks use, limitations, prohibition Passed House. Senate Approps Hearing Tuesday

State Hospital/Behavioral Health

SB1716 state hospital; governing board; governance Passed Senate 27-0; House Health Hearing Monday

SB1444 state hospital; administration; oversight Passed Senate; Passed House Health; Rules then Floor

SB1641 – health care institutions; civil penalties Passed Senate 28-0. House Health Hearing Monday

SB1162 opioid prescriptions; intractable pain; exceptions Passed Senate 27-0. House Health Hearing Monday

SB1210 mentally ill; transportation; evaluation; treatment; House Health Hearing Monday

Bill Overview: Select Bills Progressing that AzPHA Is Opposing

Vaccines/Disease Control

HB2086 ADHS; school immunizations; exclusions Passed House 31-28; Senate Health Hearing Wednesday

SB1298 government mask mandate; prohibition Passed Senate 16-12; DEAD

SB1009 state of emergency; executive powers Passed Senate 16-13; Ready for House Floor Vote

HB2453 mask requirement; prohibition Passed House 31-28. Ready for Senate Floor Vote

HB2043 employer liability; COVID-19 vaccine requirement Passed House. DEAD

HB2616 mask mandates; minors; parental consent Passed House 31-28. Not on Senate Education Agenda- Likely Dead 

HB2161 parental rights; schools; educational records Passed House 31-28. Ready for Senate Floor Vote

HB2498 COVID-19; vaccination requirements; prohibition. Passed House. Passed Senate Government, Ready for Floor Vote

Tobacco

HB2145 electronic smoking devices; retail licensing – failed but on reconsideration for vote in 2 weeks

Social Determinants

HB2021 Drug Offenses, homicide, sentencing House Judiciary 10-0. DEAD

SB1164– abortion; gestational age; limit Passed Senate 16-13; Ready for House Floor Vote 

SB1123 disruption; educational institution; concealed weapon DEAD 

HB2811 unlawful abortion medication; offense Failed House 28-31 DEAD

Government

HB2787 Maricopa county; new counties Passed House Government & Elections Committee 7-6. DEAD

SB1175– noncustodial federal monies; appropriation Passed Senate 16-13; Ready for House Floor 

Two Years of COVID Deaths in Arizona: Where We Stand in Eight Charts

March 16, 2022, marked a full two years since the first reported COVID-19 death in Arizona. During those 2 years, 28,547 Arizona residents have lost their lives due directly to COVID-19, while the total number of pandemic-related excess deaths now exceeds 38,000. Our new report provides a summary and graphical perspective of COVID-19 mortality in Arizona over the past two years in comparison to other states and the US.

Specifically, this report addresses the following indicators of COVID mortality in Arizona over the past two years:

  • Cumulative COVID-19 mortality rates per 100,000 residents;
  • Percent increase in total all-cause deaths compared to pre-pandemic
    deaths;
  • COVID-19 deaths compared to pre-pandemic leading causes of death; and
  • Changes in life expectancy in 2020 compared to 2019.

Our evidence review examines the epidemiology of death trends in the U.S. during the first 24 months of the COVID-19 pandemic. When looked at comprehensively, our review suggests that Arizona was the worst performing state in the U.S. as evidenced by the fact that Arizona:

  • Has the largest percent increase in all-cause mortality during the pandemic;
  • Is the only state in which COVID-19 has been the leading cause of death during
    the pandemic; and
  • Currently has the 2nd highest COVID-19 mortality rate in the U.S. averaged
    over the pandemic.

While the reasons for Arizona’s poor performance are multi-factorial, the strong link between pandemic-related death rates and public health policy decisions in Arizona (including prohibitions against proven effective interventions) suggest that a significant reason for Arizona’s poor performance are the policy decisions made by the Governor
and his appointed health directors during the first two years of the COVID-19 pandemic.

View Our March 21, 2022 Report

Two Years of COVID Deaths in Arizona: Where We Stand in Eight Charts

Yesterday’s Assaults at the Arizona State Hospital Highlight the Need for Governance Reform: A Primer

On Monday, November 1, 2022 two patients at the Arizona State Hospital’s Forensic Unit briefly held 3 ADHS/ASH staffers hostage. The forensic patients who attacked staff have been arrested and removed from the hospital. Thankfully, the ADHS staffers appear to not have been seriously physically injured.

See: Recent Attacks Spark New Calls for More Oversight for Arizona State Hospital & 2 Patients Arrested After Arizona State Hospital Workers Held Hostage

Spokespersons from ADHS claim that low staffing levels have ‘nothing to do with the situation’ despite the fact that ASH has more than 100 vacant positions, nearly 15% of the workforce. Also, the agency spokesperson (Steve Elliott) said staffing had nothing to do with the assaults way before the agency could have conducted a root cause analysis.

Staffing shortages may or may not be a direct or indirect cause of yesterday’s assaults, but a longstanding governance conflict – the fact that the Arizona Department of Health Services both runs and ‘regulates’ the Arizona State Hospital almost certainly has played a role.

In this blog we explain the background about why it’s bad for a state agency to regulate itself and describe a simple and evidence-based solution that would have corrected the governance conflict was killed by Governor Ducey during the 2022 legislative session.

The Bill

AzPHA had been a big supporter of SB1716 Arizona State Hospital; Governing Board. The bill (by Senator Gowan) would have changed the governing structure for the Arizona State Hospital (ASH) from one in which the Arizona Department of Health Services both runs and ‘regulates’ ASH to a model in which ASH has independent oversight, building much better checks and balances into the system of governance.

SB1716 sailed through the State Senate with nearly unanimous support and was transferred to the AZ House of Representatives. There, it received a 9-0 pass recommendation by the House Health Committee. The bill then languished in the House Rules committee. Reliable sources tell me that Ducey governor’s office staff asked Representative Grantham to hold the bill in Rules, which he did…  killing this important bill.

SB1716 would have set up a new Governing Board which would oversee operations at ASH. The Superintendent would report directly to the Governing Board rather than the ADHS Director. Here’s an article by Mary Jo Pitzl at the Arizona Republic with more detail. The Arizona Department of Health Services would then be able to regulate the Arizona State Hospital free from conflicts of interest.

Why is that important? It’s simple. Right now, there is a huge conflict of interest because the ADHS Director is responsible for both running and regulating ASH. It’s never a good governance model to have an entity regulate itself! It’s very simple for the ADHS Director to send an implicit (or even explicit) message to her or his team to go easy on ASH to keep things quiet. Indeed, recent complaint investigations of serious allegations often find ‘no deficiencies’. That’s just hard to believe, especially when the fox is watching the henhouse.

For context read this article by Amy Silverman: Patient deaths at Arizona State Hospital raise questions about staffing levels, lack of oversight

ADHS Leadership has in the past suggested that there is independent oversight of ASH via the Center for Medicare and Medicaid Services & the Joint Commission. Their statements have been misleading. To clear things up, we prepared this review of how the Arizona State Hospital is actually ‘regulated’ under the current model. We close with a review of why this bill was so important.

Overview

There are 3 components to the Arizona State Hospital (ASH)…  the Civil Hospital, Forensic Hospital, and the Arizona Community Protection and Treatment Center (ACPTC). The regulatory oversight differs for the 3 components that make up ASH.

Civil Hospital

The ASH Civil Hospital provides treatment and care for persons that are court ordered to the facility for psychiatric care.  The Civil Hospital at ASH is run and regulated by the Arizona Department of Health Services (ADHS). ADHS’ Licensing Division is responsible for regulating the Civil Hospital which the ASH Superintendent is responsible for its operation.

State Licensure

State law allows healthcare institutions like ASH’ Civil Hospital to enjoy a Deemed Status license from the ADHS. That means that the Civil Hospital can hire an accrediting body to accredit the Civil Hospital. Once accredited, the Civil Hospital turns in the accrediting report to the ADHS Licensing division, and the ASH Civil Hospital receives a License from the ADHS – even though the ADHS doesn’t do an inspection of the facility before issuing the license.

The ADHS pays The Joint Commission (TJC) to accredit the Civil Hospital. ASH Civil started hiring TJC to do that work when I was Director. I think we paid TJC something like $10K for that service. Here’s a link to the deemed status licensing information about the Civil Hospital: Licensing Statement of Deficiencies (azdhs.gov).  ADHS accepts the accreditation in lieu of an inspection and issues the state license to operate on that basis.

While the ADHS doesn’t do any annual inspections of the Civil Unit (because of its ‘Deemed Status’), the ADHS Licensing division can send out surveyors to investigate complaints about the care at the Civil Hospital when they receive them. If the complaint is substantiated, the ADHS Licensing Division can require corrective action and has some enforcement authority like issuing civil money penalties or placing the facility on a provisional license or even seeking revocation.

You can see that ADHS ‘complaint investigations’ seldom substantiate the complaints they receive and seldom find deficiencies (with a few exceptions). Here’s the recent compliance record: Licensing Services Facilities Report (azdhs.gov)

CMS Certification

Because Medicare and Medicaid (AHCCCS in Arizona) pay for some of the services at the ASH Civil Hospital, CMS requires that the ASH Civil Hospital be Certified to their certification standards. However, CMS doesn’t do their own certifications. They contract with the ADHS Licensing staff on the 4th floor of the ADHS building to conduct the certification inspections.

ADHS licensing staff go out and check at the ADHS ASH Civil Units to see if they’re adhering to CMS’ certification standards (which are a little different from the actual ADHS healthcare Institution regulations). ADHS Licensure then sends their report to CMS Region IX in San Francisco and the report is blocked, copied, and pasted and is sent back on CMS letterhead.

Civil Unit Summary

ADHS both runs and regulates the ASH Civil Hospital. ADHS leadership often suggest that there are checks and balances in the regulatory system to send the message that the monitoring of care is rigorous. The fact is that CMS Certification is not an independent review of care at the Civil Hospital because the work is conducted by ADHS Licensing staff.

While it’s true that The Joint Commission accreditation is separate from ADHS, the ADHS voluntarily pays TJC for the accreditation surveys and TJC views ADHS as a customer/client. TJC is not a regulatory body, and they have no enforcement authority. TJC Accreditation inspections that document deficiencies can sometimes jeopardize their contract with their customer, which has a chilling effect on documenting deficiencies.

Forensic Hospital

The ASH’ Forensic Hospital provides care for patients that are determined by the courts to be “Guilty Except Insane” or “Not Guilty by Reason of Insanity”.  The Forensic Hospital is also both run and ‘regulated’ by the ADHS Licensing Division.

State law allows healthcare institutions like ASH’ Forensic Hospital to enjoy a Deemed Status license from the ADHS. That means that the Forensic Hospital can also hire an accrediting body to accredit the Forensic Hospital. Once accredited, the Forensic Hospital turns in the accrediting report to the ADHS Licensing division and receives a License from the ADHS – even though the ADHS doesn’t do an actual inspection of the facility. The ADHS also pays The Joint Commission (TJC) to accredit the Forensic Hospital.

When the ADHS Licensing division receives complaints about care at the Forensic Hospital they can send out surveyors to investigate those complaints. If the complaint is substantiated, the ADHS Licensing Division can require corrective action and has some enforcement authority like issuing civil money penalties or placing the facility on a provisional license or even seeking revocation.

You can see that ADHS ‘complaint investigations’ seldom substantiate the complaints and seldom do they find deficiencies (with some exceptions). Here’s the recent compliance record: Licensing Services Facilities Report (azdhs.gov)

Because CMS doesn’t pay for services at the Forensic Hospital there’s no need for CMS Certification of ASH’ Forensic Hospital.

Arizona Community Protection and Treatment Center

The Arizona Community Protection and Treatment Center (ACPTC) provides residential and care services for people that are civilly committed by the courts to the facility as a ‘Sexually Violent Person’. The ACPTC is licensed by the ADHS Licensure Division. They are not accredited by The Joint Commission nor are they accredited by CMS.

Conclusion

The current governance structure for operating and regulating the Arizona State Hospital is fundamentally flawed because the ADHS both runs and regulates the facilities. The lack of independent regulation and oversight results in poor accountability and can lead to unchecked substandard care when ADHS leadership soft-pedals regulatory oversight to give the appearance that the facilities are providing care that meets standards.

SB1716 was a needed reform of the governance structure that would have move operational responsibility for operating ASH to an independent Governing Board. ADHS would continue to regulate the facilities but would be relieved of the conflict of interest that comes with running and regulating the same facility.

Sadly, Governor Ducey’s team killed the bill in House Rules this year…  but we are confident that this commonsense intervention will eventually prevail. In the meantime, there will continue to be a lack of checks and balances – making assaults like yesterday more likely.

New Journal Article: School Masks Worked (Pediatrics)

School Masking Policies and Secondary SARS-CoV-2 Transmission | Pediatrics

Abstract: 1,112,899 students and 157,069 staff attended 61 K–12 districts across 9 states that met inclusion criteria. The districts reported 40,601 primary and 3,085 secondary infections. Six districts had optional masking policies, 9 had partial masking policies, and 46 had universal masking. Districts that optionally masked throughout the study period had 3.6 times the rate of secondary transmission as universally masked districts.

For every 100 community-acquired cases, universally masked districts had 7.3 predicted secondary infections, while optionally masked districts had 26.4.

Secondary transmission across the cohort was modest (<10% of total infections) and universal masking was associated with reduced secondary transmission compared to optional masking.

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