Will Humble Assurance & Licensure, State Legislature, Wills Blog

Arizona State Legislature Increasingly Concerned About Abuse and Neglect of Nursing Home Residents Due to ADHS’ Neglect of Regulatory Duty During the Director Christ Era

A couple of weeks ago we wrote about the scathing Auditor General’s report about ADHS’ neglect of duty to follow up on nursing home complaints during the Director Christ era. Last week the legislature followed up on that report with a joint meeting of the House and Senate Health Committees.

The legislators heard first-hand from the Auditors about how terribly behind the department was in following up with nursing home complaint investigations from 2019 to 2021. They were very upset when they also learned that, instead of catching up and implementing recommendations from the Auditor, ADHS leadership simply reclassified the vast majority of high-risk complaints to low and medium to give the appearance that they were improving. Most formerly high-risk complaints were simply closed out with no investigation.

  • Between 7/1/19 and 4/21/21, under the leadership of former Director Christ and Assistant Director Colby Bower, ADHS lowered the priority level of 98% of their open high priority complaints, giving them months more time to investigate and giving the appearance they were making improvements (high risk complaints need to be done in 10 days vs months for the others).
  • ADHS leadership CLOSED 79% of those former high priority complaints without ever doing an investigation.
  • ADHS leadership CLOSED 82% of high priority facility self-reports after changing them to medium and then closing without an investigation.
  • In the second half of 2019 (before the 1st auditor general report) ADHS had classified 42% of nursing home complaints as high risk. After the report was published – the percentage of complaints classified as high risk dropped to only 4% (July – Dec. 2020).
  • ADHS did not post complaints on AZCARECHECK (the public disclosure site) unless there was an investigation…  but because they closed out the vast majority of complaints without an investigation, thousands of those complaints never made it to their website- further greatly limiting the ability of family members to make informed decisions.

The interim joint committee of reference is asking for quarterly reports from ADHS, told ADHS to be transparent about how they classify complaints, legislature will make sure CMS knows about the audit reports, the ADHS is supposed to fully cooperate with the auditors on follow ups. Sadly, there was no mention of urging state or county law enforcement or prosecutors to investigate the disturbing and potentially illegal findings in the Auditor General’s Report.

See our previous blog post: Auditor General’s Office Produces Scathing Review of ADHS’ Nursing Home Complaint Investigations During the Director Christ Era

Note: The unprofessional conduct documented by the Auditor General occurred while Director Christ was in charge of the agency and while Colby Bower was in charge of licensing. Both have left state government and now enjoy well-paid positions at Blue Cross Blue Shield of Arizona.

For a summary of what happened at the hearings and the damning findings of the auditor general’s report read these articles:

The entire 3+ hour hearing is posted here: Joint House Senate Nursing Home Complaint Hearing. To be honest, I’ve never seen a hearing quite like this in all of my 30+ years following state government.

This Thursday, the House Ad Hoc Committee on Abuse and Neglect of Vulnerable Adults will be meeting at 1:00 in HHR 1 to learn more about the disturbing findings.

Will Humble State Legislature, Wills Blog

Legislative Roundup

The state’s constitution gives one primary performance measure to the Arizona State Legislature: to develop a budget before the end of the fiscal year (June 30 at 11:59pm). This year that’s a week from Thursday.

I presume that there are negotiations happening behind the scenes – but nothing has leaked out since last Monday – when a draft budget that was supposedly negotiated by House and Senate (R) leadership & the governor’s office was circulated among legislators (see our previous blog post).

There were no budget hearings last week, and as of right now there’s nothing posted on www.azleg.gov to suggest there will be hearings this week.

The only real thing that happened last week at the legislature was a joint meeting of the House and Senate Health Committee to go over the Auditor General’s report about how ADHS (while Director Christ was in charge) fell terribly behind in nursing home complaint investigations from 2019 to 2021.

Instead of catching up and implementing recommendations from the Auditor, they simply reclassified the vast majority of high risk complaints to low and medium to give the appearance that they were improving. Many high risk complaints were simply closed out with no investigation. See our previous blog post: Auditor General’s Office Produces Scathing Review of ADHS’ Nursing Home Complaint Investigations During the Director Christ Era

Note: All the unprofessional conduct documented by the Auditor General occurred while Director Christ was in charge.

For a summary of what happened at the hearings and the damning findings of the auditor general’s report read these articles: 

The entire 3+ hour hearing is posted here: Joint House Senate Nursing Home Complaint Hearing. To be honest, I’ve never seen a hearing quite like this in all of my 30+ years following state government.

Will Humble Social Determinants, Wills Blog

Should AZPHA Support the Upcoming Predatory Debt Collection Protection Act?

The Predatory Debt Collection Protection Act is a Voter Initiative effort that is currently collecting signatures with a goal of being on the ballot in Arizona this fall. The goal of the Initiative is to revise Arizona law to protect more assets from being sold to pay off debt collectors, ensuring Arizonans keep more of their bank accounts and wages and limiting interest rates that trap families in an unending cycle of debt.

Because the ability to earn a living wage and have access to sufficient resources to provide a sturdy family environment and ensure that families can make healthy choices, the Arizona Public Health Association Board of Directors is urging our members to vote to support the initiative.

Below is excerpted language from the Grand Canyon Institute’s Predatory Debt Collection Protection Initiative Policy Paper. We urge you to read the full policy paper and the voter initiative language before you vote whether to affirm the Board’s recommendation.

We Need Your Vote by 6/30/22 In Order to Submit Language to the Voter Guide

Go to AZPHA member poll page

Across Arizona, 30% of people with a credit file have debt in collections. This tracks closely with the national average of 29%. How these consumers experience the collections process can vary widely, due to minimal protections afforded by federal and state Unfair and Deceptive Acts and Practices laws. The absence of greater protections puts consumers at risk of predatory collection practices that can be financially devastating due to low thresholds for income and property protected against being seized by debt holders.

Medical debt stands out in the discussion of consumer debt. It is estimated to be the largest source of bankruptcies in the United States and exceeds $140 billion. Medical debt generally arises out of necessity, due to a medical emergency or persistent healthcare needs. Sixteen percent (16%) of Arizonans with a credit file have medical debt in collections, with a median amount of about $1,000 according to the Urban Institute based on an analysis of consumer credit files.

However, this understates medical debt, since it is not reported to credit agencies until it is 180 days past due and it is not always immediately moved into collections and debt moved to a collection agency is not always reported to credit agencies. Further, some medical debt is also disguised as credit card debt.

Further exacerbating the precarious situation that some debt holders find themselves in, an analysis of the civil court system finds that debtors almost never have legal representation, while creditors do, creating a legal imbalance. This is a growing concern given findings by the Pew Charitable Trust in 2020 of an alarming increase in the use of courts to collect on debts by businesses since the early 1990s. According to one study from 1993 to 2013, the share of civil claims for debt in state courts more than doubled from less than 12% to 24% of claims.

The protections in the Predatory Debt Collection Protection Act will provide greater protections for the issues raised above, bringing Arizona much more in line with the recommendations provided by the National Consumer Law Center to enable those in debt to pay off what they owe without placing them in a position where their ability to meet their daily living needs are not impacted by the loss of housing, transportation, or other resources. The Act also provides low asset Arizonans by limiting the ability of landlords to withhold security deposits and folk’s paycheck to paycheck by limiting the amount of wage income that can be garnished. The formula is calibrated to protect wages, so the person doesn’t get pushed below the federal poverty level.

The Predatory Debt Collection Protection Act initiative along three themes:

  1. The Initiative’s Impact on Arizona Law and Comparisons to Other States
  2. The Initiative’s Impact on Medical Debt
  3. The Initiative’s Impact on Debt Collection through the Courts

Because defendants owe money normally, their primary protection is the strength of the law that protects their earnings and assets. The Predatory Debt Collection Protection Act will significantly limit the occurrences of wage garnishment and when it occurs the amount will be less. The Predatory Debt Collection Protection Act will act as a de facto lawyer to help limit access to wage garnishments or direct removals from bank accounts.

Will Humble Public Health Law, Wills Blog

Summary of Enacted & Pending Bills Limiting Public Health Authority

Arizona isn’t the only state in the U.S. where state legislatures and governors are hostile to public health. Many states have enacted harmful new laws damaging public health authority, just like Mr. Ducey.

AZPHA PowerPoint: Laws Signed by Ducey So Far this Year Preempting Public Health Authority

In their regular 2021 legislative session, many states introduced or passed laws that restricted the ability of state and local public health officials, governors, and others to respond to the immediate threat of COVID-19, as well as future public health threats.

A second wave of similar legislation began in regular and special sessions in the fall of 2021 and has continued into the 2022 regular session. The table below details COVID-19-related laws and pending legislation, and broader enacted and proposed limitations on public health authority in all 50 states (and the District of Columbia) from January, 2021 through mid-May, 2022 for enacted laws and from September, 2021 through mid-May, 2022 for pending legislation.

This Report from the Network for Public Health Law identifies enacted laws and current state bills and identifies how they would limit public health powers (if enacted) to respond to natural disasters, disease outbreaks, and other health threats. These limitations are categorized within specific columns as follows:

1. Emergency Orders (providing authority to address a public health emergency);

2. Shifts in Authority (between levels of government and away from public health agencies and the executive branch); and measures related to public health interventions including:

3. Vaccines;

4.Testing;

5. Masks; and

6. Places (including, but not limited to business, schools, places of worship).

See the Full Report: Enacted & Pending Bills Limiting Public Health Authority
Will Humble Professional Development, Wills Blog

Join Us on Friday, June 24, 2022 for an Action Update from the Field – Gila County: Best Practices & Lessons Learned Responding to COVID-19, Fires, and Floods

Session Summary

Just when Gila County was hitting double digits in positive COVID cases in June of 2020 the Bush Fire hit, forcing Gila County leadership to shift resources toward the fire response. And that was just the beginning of the pandemic!

Learn how Gila County become the 1st County in the U.S. to move to vaccinating the general population while responding to the massive forest fires, evacuations, sheltering, flooding, and post-fire flooding damage.

Michael O’Driscoll, Director of the Gila County Health & Emergency Management will walk through the key policy and resource allocation decisions that led to their remarkable success, even resulting in national coverage by CNN.

Register Here

Michael O’Driscoll is the Director of Health & Emergency Management for Gila County Arizona. Michael Joined Gila County in 2011 and has more than 30 years’ experience in Emergency Management and Public Health and Emergency Preparedness. He has been integral in resolving large health disparity issues, vector-borne disease, foodborne outbreaks, ground water contamination, and hazardous materials complaints, among others—mitigating issues and ensuring public safety state-wide, across its various constituency populations.

Michael spearheaded Gila Counties community response to COVID-19 pandemic in 2020, coordinating contact tracing efforts, creating, and implementing streamlined vaccination protocols leading Gila County to become the first Local Health Department in the US to begin vaccinating general population of residents.

Where: Zoom (registrants will receive the link) 

When: Friday, June 24, 2022   9-10 am AZ Time

Cost: Free for AzPHA Members!

Will Humble Professional Development, Wills Blog

The Hertel Summer State of the State: Flagstaff, Friday, July 15, 2022

Discounts for AzPHA Members

The popular summer conference provides insight into health markets across Arizona including AHCCCS, Marketplace, Medicare, Medicare Advantage and local value-based trends including Arizona’s competitive community of accountable care organizations, value-based networks and direct contracting entities.

This year’s event features a panel of community stakeholders working to address health equity across the state and northern Arizona.

Attendees will also learn more about advanced alternative payment models from CMS including the new ACO REACH. The Flagstaff conference includes a full conference program, data reference pages and a directory to support post-conference networking. In-person attendees receive a boxed lunch.

2022 State of the State
Flagstaff Medical Center, McGee Auditorium

9 to 10am: Networking & Light Refreshments

10am – 12:30pm: State of the State Program

12:30-1:30pm: Boxed Lunch, stay or go!

 

Use the coupon AZPHA2022 at checkout to receive $15 off

Register Today
Will Humble Healthcare, Wills Blog

Arizona Burn Center – Valleywise Health Earns Re-Verification

The Arizona Burn Center – Valleywise Health announced Tuesday that they have been re-verified as an adult and pediatric burn center by the American Burn Association and the Committee on Trauma of the American College of Surgeons. Founded in 1965, the Arizona Burn Center is the only verified burn center in the state and one of the busiest in the country.

This achievement recognizes the Arizona Burn Center’s dedication and commitment to providing high quality burn care to patients across the Southwest. The Arizona Burn Center first received national verification in 2000. Read more here

Will Humble Professional Development, Wills Blog

48th Annual Rural Health Conference this Week in Flag

For the past 47 years, the Arizona Center for Rural Health has hosted the Annual Arizona Rural Health Conference in collaboration with the Arizona Rural Health Association, making it one of the longest continually running rural health conferences in the United States. 

View the final agenda: RHC22-Agenda

The Arizona Rural Health Conference provides an environment for networking and dissemination of pertinent information among professionals and community members from rural Arizona and the Southwest. On-line registration has ended but they traditionally allow on-site registration.

I’ll be giving the following presentations at the conference:

Infrastructure Law PPT

Harmful Preemption Laws Signed by Ducey PPT

Will Humble Behavioral Health, Wills Blog

Arizona State Hospital Governance Reform Remains in Limbo

One of our continuing priorities other than things in the budget is to get better governance in place at the Arizona State Hospital.  SB1716 Arizona State Hospital; Governing Board. The bill (by Senator Gowan) would change 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 sets 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’s 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. 

Editorial Note: I submitted a complaint to ADHS Licensing more than a month ago, after there were more than 7 Code Grays in a single day at the State Hospital (Code Gray’s mean that there was an assault bad enough to require a significant intervention). I received an automated response suggesting that they would follow up. To date I have heard nothing about what the status of that complaint is.

That bill continues to languish, needing a hearing in the House Rules Committee and then a floor vote in the House before going to the Governor for a signature (the bill had consensus support in the Senate). We’re continuing to make sure legislators know how important this bill is!

See: How is the Arizona State Hospital Regulated & Why is Governance Reform Needed?

Will Humble Social Determinants, Wills Blog

Ducey Administration Failure to Implement Unemployment Insurance Identity Verification Resulted in $4.4 Billion Dollars in Fraudulent Payouts

More than 31% of ADES Unemployment Insurance Claims Paid Out During the Christ/Betlach Leadership Era were Fraudulent- to the Tune of Billions of Dollars

The Arizona Auditor General’s Office plays a key role in keeping state government accountable in several ways. They help State agencies, universities, community college districts, counties, school districts, and other governmental entities work better by analyzing their operations and recommending improvements, so they spend and account for public monies appropriately, efficiently, and effectively. In fiscal year 2021, the Auditor General issued 171 audits, reviews, investigations, and follow-ups with 624 recommendations.

Their audits and reviews assess how various State governmental entities, such as State agencies and school districts are performing—that is, how well they are fulfilling their statutory mandates and serving Arizona’s citizens. Sunset reviews help the Legislature decide whether to continue or terminate (“sunset”) an agency. There were two key reports recently published that highlight this important work.

Unemployment Insurance Fraud

In a new report this week, the auditors found disturbing financial irregularities in which ADES (during the Christ Betlach leadership era) misspent and fraudulently distributed literally billions of dollars in federal funds. That report, published on May 25 for the Joint Legislative Audit Committee meeting found that:

During the time when Acting Director’s Christ and Betlach were in charge of the Arizona Department of Economic Security, the agency failed to put identity verification or other anti-fraud measures in place and ended up over $1.6B in fraudulent unemployment insurance claims out of the $5.1Billion dollars in total claims paid as of June 30, 2020. In other words, more than 31% of the unemployment insurance claims paid out through June 30, 2020 were fraudulent!

ADES paid an additional $2.8 billion in fraudulent claims between June 30, 2020 through September 4, 2021, for a total of $4.4 billion of fraudulent claims paid! See Page 4 of the Joint Legislative Audit Committee report.

It’s unclear whether any kind of punishment is in the offing from the federal government for this astonishing lack of attention to detail.

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