Will Humble Reproductive Health, Wills Blog

Arizona Attorney General’s Clarification on Emergency Abortions: More Clarity for Clinicians & Pregnant Persons

Arizona Attorney General Kris Mayes’ offered a legal opinion last Thursday that marks a significant step forward in clarifying the legal framework surrounding emergency abortions in Arizona. This move comes as a relief for both pregnant women and healthcare providers navigating the murky waters of Arizona’s abortion laws.

Mayes’ detailed opinion provides much-needed clarity for situations where an abortion is necessary to save the life or health of a pregnant woman after 15 weeks’ gestation.

According to the legal opinion, abortions are permissible under state law if the woman’s life or health is at significant risk.

For physicians, the opinion provides a legal safety net, allowing them to perform their duties without the constant concern of legal consequences and implications for their license by clarifying that actions taken in good faith to protect a woman’s life or health will not result in legal action against healthcare providers.

See the Opinion: The meaning of “medical emergency” under A.R.S. § 36-2321(7)

For pregnant women in Arizona, this decision ensures access to essential, life-saving healthcare without the threat of legal complications. The opinion makes it clear that medical professionals can act decisively in emergencies, prioritizing the health and well-being of their patients.

Attorney General Mayes’ decision is a crucial affirmation of the rights and health of women in Arizona, ensuring that access to necessary medical care is not impeded by legal ambiguities even if the pregnancy is past Arizona’s 15-weeks’ gestation limit.

It represents a return to a more compassionate and medically sound approach to reproductive healthcare, providing a critical safeguard for both patients and providers in the state.

Voters will likely have an opportunity to clarify the limits of abortion care later this year when they vote on a likely voter driven constitutional amendment regarding abortion care.

You can read AZPHA’s argument in favor of that constitutional amendment here: Vote for Access to Sexual & Reproductive Health: Vote Yes on Proposition XXX

Will Humble Professional Development, Wills Blog

The Hertel Report 2024 State of the State Approaching

What: The Hertel Report 2024 Summer State of the State

Basics: Our summer conference in Flagstaff includes our bi-annual Arizona healthcare market update. Topics include the latest news on Medicare Advantage, Medicaid, the Marketplace, hospitals and healthcare systems, and organizations excelling in value-based payment arrangements including Accountable Care Organizations. Attendees will also learn more about Northern Arizona Healthcare’s next steps, Arizona’s rural healthcare landscape and the roles and responsibilities of Arizona’s HIE.

Host & Moderator:

  • Jim Hammond, Publisher/CEO, The Hertel Report

Guest Speakers:

  • David Cheney, NAH CEO
  • Marcus Johnson, AHCCCS Deputy Director
  • Chris Nez, Pathfinder Health, Director
  • Melissa Kotrys, Contexture CEO

When: Friday, July 12, 2024

  • 9:30am Networking & Refreshments
  • 10am Program
  • 12:30 Box Lunch – Stay or Grab & Go

Where: Flagstaff Medical Center – McGee Auditorium
How Much: $150 – Discounts Available

Registration Link: https://www.thehertelreport.com/product/2024-summer-state-of-the-state-in-flagstaff/

Community Partner Discount: $15
Use code at checkout   AZPHA2024

Will Humble Climate Change, Environmental Health, Prevention, Public Health, Wills Blog

Maricopa County Heat Deaths in 2023: A Crisis for the Homeless & a Call for Housing Reform

Maricopa County recorded a record-breaking 645 heat-related deaths in 2023, making exposure to heat the 10th leading cause of death in Arizona during 2023. Persons experiencing homelessness in the urban Arizona summer have a 500x higher risk of perishing from over-exposure to heat. That’s a 50,000% increased risk!

Arizona has always been hot. Yes, last summer was exceptionally hot. But can that alone explain the staggering increase in heat related deaths?

Heat Deaths, Homelessness & Affordable Housing

I argue that the increase in heat related deaths in 2023 is due to a combination of last summer’s exceptional temperatures combined with the increase in homelessness, the decentralization of persons experiencing homelessness after ‘The Zone’ was cleared making it more difficult to provide hydration and other services, the bolus of evictions that occurred following the end of CDC’s eviction moratorium, and the difficulties getting persons experiencing homelessness into substance abuse treatment.

Persons experiencing homelessness bear an enormously disproportionate share of the heat-related deaths. According to the report, nearly half of the heat-related deaths were individuals experiencing homelessness. Imagine trying to survive relentless 110-degree days without access to air conditioning or even a consistent place to rest. This isn’t just a tragedy; it’s a policy failure.

Maricopa County Public Health 2023 Heat Deaths Report

In public health we often talk about how certain things put people at more risk for a bad outcome. For example, people who smoke one pack a day for 20 years have a lung cancer risk 20 times higher than non-smokers.

By comparison, persons experiencing homelessness in Maricopa County face a 500-fold increase in risk from dying from heat exposure. That translates into a 50,000% increased risk!

What’s driving this crisis? The shortage of affordable housing is a significant factor. Restrictive zoning laws have created an environment where affordable housing is scarce, forcing more people onto the streets. These policies not only limit where affordable housing can be built but also increase the cost of developing new housing projects. As a result, many low-income families and individuals find themselves without options, worsening homelessness and increasing vulnerability to extreme heat.

The Heat Crisis is a Housing Crisis – The New York Times

Furthermore, cities in Maricopa County have often prioritized luxury developments over affordable housing, a trend that needs urgent reversal. The need for more inclusive and flexible zoning laws has never been clearer. We desperately need to prioritize affordable housing developments and make it easier to zone them.

Local Initiatives Providing Some Relief

However, it’s not all bad news. In response to the deadly 2023 summer, Maricopa County and the Maricopa Association of Governments have significantly ramped up their heat relief efforts for 2024. They’ve expanded cooling and hydration stations across the county, increasing the number to over 200 locations. These stations provide critical respite from the sweltering heat and are now more accessible to underserved communities, a direct response to gaps found last year.

MAG | Heat Relief Network

A key change is the extended operational hours for these facilities, now open 24/7 during extreme heat advisories. Additionally, emergency transport services have been enhanced to ensure quick access to cooling centers for those unable to reach them. The county has also launched a new mobile cooling unit initiative, deploying air-conditioned buses to hotspots where homeless populations are most vulnerable.

In 2023 and 2024, the Maricopa County government implemented several key initiatives to combat homelessness. They significantly increased funding for emergency shelters and transitional housing, focusing on expanding bed capacity and improving access to supportive services. The county also launched comprehensive outreach programs to connect individuals experiencing homelessness with critical health, employment, and housing resources. Additionally, they partnered with local organizations to develop affordable housing projects and provide permanent supportive housing for the most vulnerable populations.

These measures reflect a proactive approach, prioritizing immediate heat relief but don’t get at the broader systemic issues that worsen vulnerability to extreme heat – the lack of affordable housing.

Arizona’s Housing Trust Fund Making Some Progress

Arizona has taken significant steps to address its affordable housing crisis through recent changes to the Housing Trust Fund. In FY2024, the state expanded the fund’s capacity, allocating $150M non-lapsing funds to the fund, helping to promote the development and maintenance of affordable housing units. This increase marks a notable shift from the previously limited funding, enabling more substantial investment in low-income housing projects.

Key changes include the prioritization of projects that serve the most vulnerable populations, including those experiencing homelessness and low-income families. The state also streamlined the application process for accessing these funds, making it easier for developers and non-profits to participate in creating affordable housing. Additionally, new regulations encourage the inclusion of green building practices, ensuring that the housing stock is not only affordable but also sustainable.

AHCCCS Enhances Supported Housing for Individuals with Serious Mental Illness

AHCCCS has also taken significant strides to improve supported housing for individuals with serious mental illness.

AHCCCS’s broader strategy focuses on increasing the availability of supported housing units, enhancing wrap-around services, and fostering community partnerships to ensure holistic care. By prioritizing stable housing, AHCCCS aims to reduce homelessness, hospitalizations and improve overall health outcomes for those with serious mental illness.

One of the program’s initiatives includes the development of a new shelter and treatment facility on the grounds of the Arizona State Hospital. This facility aims to provide comprehensive care by integrating housing with mental health treatment, addressing both immediate needs and long-term recovery goals. The innovative approach will offer a secure environment where individuals can receive continuous care, reducing the risks associated with homelessness and untreated mental health issues.

Summary

Public health interventions to provide lifesaving hydration and cooling relief are a welcome and badly needed resource to save lives. Recent increases in investments in affordable housing via the Housing Trust Fund are also helpful as are initiatives by AHCCCS to improve supported housing resources for persons at risk of homelessness as a result of their mental illness.

However, despite these interventions, if we continue on our current overly-restrictive affordable housing zoning path, we’re unlikely to make a significant impact reducing homelessness – and heat-related deaths among our most vulnerable populations.

The 2023 death toll is a clarion call for policy change, not just interventions like hydration and cooling centers, initiatives using the housing trust fund and AHCCCS’ efforts to help persons with a mental illness.

We also need policies that address one of the root causes of homelessness: overly restrictive local zoning requirements that make building multi-family affordable housing developments very difficult and, in many cases, impossible.

Perhaps the next legislative session will have a critical mass of legislators to implement statewide policy changes that compel cities with overly restrictive zoning to back off and take a more humane approach to zoning policy.

Will Humble Firearm Safety, Prevention, Wills Blog

The Importance of Safe Firearm Storage: Protecting Lives and Communities

Time and again data show that having an unsecured firearm poses substantial risks. Both AZPHA and the CDC have consistently highlighted the urgent need for responsible firearm storage to mitigate these risks and safeguard lives.

Gun Violence in Arizona – Data to Inform Prevention Policies – AZPHA

In a new MMWR last week CDC underscored that that firearms are a leading cause of injury and death in the United States. In 2021 alone, firearms were involved in 47,286 deaths, a staggering statistic that reveals a 23% increase in firearm-related fatalities since 2019.

Unintentional injuries, suicides, and homicides make up the bulk of these tragic incidents, many of which could be prevented with proper firearm storage.

Firearm Storage Behaviors — Behavioral Risk Factor Surveillance System, Eight States, 2021–2022 | MMWR (cdc.gov)

Safe firearm storage is not just about preventing theft or unauthorized use; it is fundamentally about saving lives. The CDC’s data shows a troubling trend: approximately 40% of households with firearms do not store them securely, leaving them accessible to children and individuals at risk of harming themselves or others.

Firearms should always be stored unloaded, locked, and separate from ammunition to reduce the likelihood of accidents and misuse.

The issue of firearm safety is particularly pressing in Arizona, which has one of the highest rates of gun violence in the nation.  Our report from last year found that Arizona had more than 1,200 firearm deaths in 2020, with a significant number resulting from unsecured firearms in homes.

Arizona’s statistics reflect a broader national challenge and highlight the urgent need for better education and policies around firearm storage.

Communities can take proactive steps to address this public health crisis. Passing statewide safe storage laws (sometimes called Child Access Prevention laws) are the best intervention.

Promoting awareness about the importance of safe storage and implementing community-based interventions, such as providing free gun locks and educational resources, can also make an impact.

Examining the Impact of Minimum Handgun Purchase Age and Background Check Legislation on Young Adult Suicide in the United States, 1991–2020 | AJPH | Vol. Issue

Child Access Prevention laws are effective because they compel adults who own firearms to recognize their responsibility in preventing unintended injuries and deaths by adopting safe storage practices by exposing them to criminal and civil liability if they fail to do so.

The results of the November election are critical for our ability to pass common-sense firearm safety legislation like a Child Access Prevention law.

Fortunately, AZPHA is in a very good position to influence the discussions with our landmark report: Gun Violence in Arizona – Data to Inform Prevention Policies

Will Humble Public Health, Wills Blog

Public Health Journalism this Week

Sober living fraud allegedly continuing in Arizona – Arizona PBS

Five things to know about the legality of abortion in Arizona

Are extreme heat and wildfire smoke major disasters? – Los Angeles Times

Arizona has some of the dirtiest air in the nation. How to fix it

New claims against Arizona over Medicaid fraud total $2.3 billion

Governor approves ‘magic mushroom’ research, Molly therapy in Arizona

US Tools to Fight Extreme Heat Debated as FEMA Pressured to Act

Will Humble Firearm Safety, Public Health Law, Wills Blog

US Surgeon General Declares Firearm Violence a Public Health Crisis

The US Surgeon General recently declared firearm violence a public health crisis. While this is not a declaration of a public health emergency and federal agencies won’t get any additional regulatory authority from the declaration, it nevertheless underscores the urgent need to address the devastating impact of firearms on public health across the United States. The landmark report highlights that firearm-related deaths have reached unprecedented levels, with an alarming increase in homicides and suicides linked to gun violence.

See the Report: Firearem Violence A Public Health Crisis is America

The Surgeon General’s advisory emphasizes the role of public health in mitigating this crisis. It calls for a multi-faceted approach, including better data collection, enhanced mental health services, and robust community engagement to reduce firearm-related injuries and deaths. Importantly, it advocates for evidence-based policies such as universal background checks, safe storage laws, and interventions targeted at high-risk individuals​​.

This announcement aligns with findings from our comprehensive report which outlines the characteristics of the gun violence crisis in Arizona and offers effective policy interventions.

The AZPHA report identifies key issues, including the proliferation of firearms, lack of regulation, and the significant toll on communities, particularly among vulnerable populations such as children and minorities​. In Arizona, the situation is particularly dire, with firearm deaths surpassing the national average.

Indeed, firearms are the leading cause of death among kids 0-19 in Arizona, surpassing car crashes and poisonings (e.g. fentanyl).

See Our Report: Firearm Violence in Arizona – Data to Support Prevention Policies

Our report recommends policies like expanding background checks, implementing extreme risk protection orders, and promoting community-based violence prevention programs. These interventions are crucial for reducing the burden of firearm violence and protecting public health. Our hope is that the 2025 legislature will be open to considering and passing some of the foundational evidence-based laws that are known to reduce deaths like child access prevention laws.

This declaration from the Surgeon General is a welcome call to action, urging policymakers and communities to recognize gun violence as a pressing public health issue and to work collectively towards effective solutions.

Note: This report is an ‘Advisory’ rather than a full Surgeon General’s Report. Advisories provide recommendations for how the issue should be addressed. Surgeon General full reports by contrast are landmark publications. For example, in 1964, a Surgeon General Report concluded that cigarette smoking was a cause of lung cancer. That report and more than a dozen follow-ups sparked national efforts that helped cut smoking rates.  

Will Humble Uncategorized

Arizona Corporation Commission and Public Health Part VI: ACC Blows Huge Loophole in Utility Environmental Review Requirements

Last week the Arizona Corporation Commission exempted a 200-megawatt power plant expansion in Mohave County from environmental review. The exemption, granted to UniSource Energy Services (associated with Tucson Electric Power), allows the company to avoid the usual environmental scrutiny.

How did they do it? They split their 200MW project into four 50-megawatt units. The Commission bought their argument that, because each individual building (on the same parcel) is less than the 100-megawatt threshold, they don’t have to go through the normally required environmental review.

Their clever maneuver not only bypasses essential environmental regulations but also sets a potentially troubling precedent for future power projects.

Utilities are now invited to design projects in smaller segments to stay under the regulatory radar and avoid environmental reviews, posing a risk to both the environment and public health.

This decision reinforces how important it is to elect Commissioners with a commitment to public health and the environment. More to come in our series highlighting the links between who you vote for in the Corporation Commission races and public health.

The AZ Corporation Commission & Public Health (Part I): Rubber Stamping Rate Increases & the Social Determinants of Health

The AZ Corporation Commission & Public Health (Part II): How the Commission Disincentivizes Clean Energy

The AZ Corp Commission & Public Health (Part III): Commission Rubber Stamps Southwest Gas Rate Increases

The Arizona Corporation Commission & Public Health: Part IV – Air Quality

The Arizona Corporation Commission & Public Health: Part V: ACC Election Important for Public Health

Will Humble Public Health Law, State Legislature, Wills Blog

Hobbs Vetoes Arizona’s Magic Mushroom Bill; Signs Bill Allowing Ecstasy (Molly) if FDA Approves its Use

Governor Hobbs vetoed Senate Bill 1570 this week, a proposal that would have directed ADHS to create a system to regulate & license psilocybin-assisted therapy centers.

SB1570 would have allowed persons who wanted to try mushrooms as a therapy for things like PTSD, depression, and hospice care to get it in a regulated environment. Right now, they can’t because the DEA has classified it as a Schedule I substance.

Had Hobbs signed the bill, it would have opened the door to psilocybin (commonly known as magic mushrooms) for therapeutic use in a controlled, therapeutic setting.

Unlike ketamine (which is legal for medical use and has shown efficacy in treating severe depression), psilocybin’s Schedule I classification means the federal government believes it has no accepted medical use and a high potential for abuse, severely limiting its availability for research and therapeutic purposes​.

See: Biden Administration to Reschedule Cannabis Under the Controlled Substances Act

During legislative committee hearings this session, numerous advocates highlighted the growing body of evidence suggesting that psilocybin (mushrooms) can provide significant relief for individuals suffering from things like PTSD, depression and hospice care (where conventional treatments have failed).

For now, psilocybin will remain inaccessible for many who might receive help from it, and people seeking relief through mushrooms will continue to have no legal way access the substance for medical use (in Arizona).

Governor Hobbs’ veto statement focused on her concern about the potential risks and the lack scientific backing for its therapeutic use. 

Meanwhile, magic mushroom research will continue using $5M in funding from last fiscal year under the oversight of Arizona’s new Psilocybin Research Advisory Council. Perhaps that research will provide the governor with the data she’s looking for to change her mind about mushroom’s potential therapeutic uses.

Hobbs felt differently about SB1677 and signed that measure, which would approve MDMA (ecstasy/molly) for treatment of PTSD in Arizona IF the FDA approves the drug (like psilocybin, MDMA is currently a Schedule I drug). The FDA is expected to make that decision this fall.

SB1677 also authorizes workers’ compensation coverage for MDMA (ecstasy/molly) treatment for firefighters and law enforcement under certain conditions (after FDA authorization).

See also: Governor approves ‘magic mushroom’ research, Molly therapy in Arizona

Will Humble Professional Development, State Legislature, Wills Blog

Webinar: Arizona’s 2024 Legislative Session – The Bills, the Budget & the Ballot Measures

Friday, July 12, 2024       9-10am

Arizona’s 2024 legislative session saw the passage of about a dozen laws that will be good for public health and state government accountability – especially in the areas of behavioral health and licensing of care facilities.

There were also many missed opportunities – mostly in the areas of behavioral healthcare and care home assurance accountability. Some detrimental bills were successfully vetoed or blocked.  

The budget saw across the board modest cuts for many agencies and sweeps of several professional license funds.

The legislature also placed 11 measures on the November ballot. AZPHA will be opposing 7 of them. Voters are likely to place an additional two propositions on the ballot.

This session will cover the Bills, the Budget and the Ballot Measures. Below is a PowerPoint summarizing what we’ll be covering in this webinar. 

2024 Arizona’s 2024 Legislative Session:

The Bills, the Budget & the Ballot Measures

Our Speaker:

Will Humble, MPH

Executive Director

Arizona Public Health Association

Register Here

Will Humble Public Health Law, State Legislature, Wills Blog

Legislative Session Hotwash: The Bills, the Budget & the Ballot Measures

Arizona’s 2024 legislative session officially ended last week with the passage and signing of a FY2025 fiscal year budget. The session saw the passage of about a dozen laws that will be good for public health and state government accountability – especially in the areas of behavioral health and licensing of care facilities. There were also many missed opportunities – mostly in the areas of behavioral healthcare and care home assurance accountability.

Some proposed detrimental bills were successfully vetoed or blocked, and there was a concerted push towards improving mental health services and expanding access to healthcare for underserved communities. These measures are crucial steps forward in addressing the state’s long-standing health disparities​

The budget saw across the board modest cuts for many agencies and sweeps of several professional license funds.

The legislature also placed 11 measures on the November ballot. AZPHA will be opposing 7 of them. Voters are likely to place an additional two propositions on the ballot: One updating the law around abortion care and another that would eliminate partisan primaries. AZPHA is supporting both of those measures.

The session underscored the critical role of public advocacy in shaping health policy, as community organizations and health professionals continue to fight for the resources and policies needed to protect and promote public health in Arizona.

Below is a PowerPoint summarizing the session from a public health point of view – including the bills, the budget and the ballot propositions. The presentation includes links to each of the laws, bills and propositions.

2024 Legislative End of Session Summary: The Bills, the Budget & the Ballot Measures
Budget Breakdown

The Arizona Legislature is required by the state constitution to adopt a balanced budget for each fiscal year (Article IV, Section 20, Part 2). That provision says the legislature needs to pass a General Appropriations Act (called informally a feed bill) which has appropriations for the different state departments, state institutions, public schools and interest on public debt.

This year’s “feed bill” is HB2897 and includes the primary budget provisions for state departments and agencies and focuses just on appropriations without including substantive law changes.

Statutory changes needed to reconcile the appropriations made in the feed bill and other changes are put into separate budget bills, called Budget Reconciliation Bills. Most years have a “Health BRB”, but this year there was just a Health Care BRB and a Human Services BRB, as there weren’t any changes needed in state law for ADHS to implement the budget (except for the provisions relating to the Arizona State Hospital in the Health BRB (see HB2903 below).

You can click on the links below for those BRBs to do a deeper dive.

The main ‘feed bill’ gave the ADHS a ‘lump sum’ reduction in their budget of about $719K. Interim Director Cunico has the discretion about what state fund to tap to cut. She has many options…  let’s hope she’s thoughtful and doesn’t pull those funds from a critically important service.

Any of you with ADHS special line-item funding should be asking the Director what she intends to cut and explain why it shouldn’t be your program and why before it’s too late. Here is that Feed Bill: HB2897

There were a few other details in the feed bill as well including:

  • A new $100K for an ADOA ombudsman to handle all the Arizona State Hospital complaints (a good thing).
  • $500K in ongoing funds & an additional $900K one-time funds for ADHS to improve their clunky Az Care Check IT system which is supposed to provide transparent information about the compliance of hundreds of care facilities – but by all accounts, is currently wholly insufficient.

A few funds were exempted from reverting to the general fund including:

  • The $1.2M FY2025 appropriation to support more licensing compliance staff won’t lapse until June 30, 2026.
  • The unused $1M in behavioral health care provider loan repayment program won’t lapse until June 30, 2025.
  • Old unused FY2023 nursing program funds won’t lapse until June 30, 2025.
  • The unused FY2024 appropriation for nurse-family partnership programs won’t lapse until June 30, 2027.
  • The $1M FY2025 appropriation for combating fentanyl won’t lapse until June 30, 2026.
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