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The Arizona State Hospital is located on a 260 bed 93-acre campus in Phoenix providing inpatient psychiatric care to people with mental illnesses who are under court order for treatment.  Treatment at ASH is considered “the highest and most restrictive” level of care in the state. Patients are admitted because of an inability to be treated in a community facility or because of their legal status.

The Civil portion of the hospital provides services to people civilly committed as a danger to self, danger to others, gravely disabled and/or persistently and acutely disabled. Forensic patients are court-ordered for pre- or post-trial treatment because of involvement with the criminal justice system due to a mental health issue.

The needs of patients at ASH can be complex and the patients are vulnerable, so it’s critical to ensure the facility uses best practice treatment and is following a rigorous set of regulations. To achieve fidelity to best practice standards, it’s critical that the governance structure ensures accountability and is free from conflicts of interests.

The existing governance structure is insufficient to ensure quality care is provided at ASH. The fundamental flaw is that ADHS both runs & regulates ASH.

The lack of independent regulation & oversight of the Arizona State Hospital 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.

There is evidence that this occurred during the Ducey Administration.  For example, in 2021, ADHS’ licensing division investigated multiple suicides and a homicide and concluded that no operating deficiencies led to those deaths. Suicides and homicides only occur when there are deficient practices.

For context read this article by Amy Silverman: Patient deaths at Arizona State Hospital raise questions about staffing levels, lack of oversight, this piece by Mary Jo Pitzl at the Arizona Republic  and these important investigative stories by Stephanie Innes: Arizona State Hospital patients have died since 2015  and More oversight is needed at the Arizona State Hospital

AzPHA was a supporter of SB1710 during last year’s legislation because it was commonsense solution to governance problem that’s jeopardizing care at ASH by separating the operational functions of running ASH from the regulation of ASH. Sadly, there was a last second amendment that gutted all of the meaningful governance reform in that bill, and the Arizona Department of Health Services continues to both run and ‘regulate’ the Arizona State Hospital. See: Governance Reform of the Arizona State Hospital Goes Up in a Puff of Smoke

Fortunately, Senators Miranda and Shope continued to work with informed stakeholders, pursuing governance reform for our Arizona State Hospital. They even published a couple of op-eds in the Arizona Republic explaining their vision for improving care:

Arizona State Hospital Needs Independent Oversight, Isn’t Getting It 

Arizona State Hospital needs reform. Here’s how to do it 

That ‘off-season’ work bore some important fruit. A series of bills were just posted to the State Legislature’s website this afternoon with a set of bipartisan plans sponsored by Senator Miranda and several other legislators (of both parties) to improve services and governance of the Arizona State Hospital and other psychiatric care resources.

• SB1100 Arizona state hospital; private entity would direct the ADHS to go out to bid to identify a private entity who would operate the state hospital, removing the conflict-of-interest ADHS has by being responsible for both running and regulating the facilities.
• Another more desirable alternative is SB1688 (Gowan) state hospital; governing board; governance which would establish a 5-member Governing Board who would be responsible for hiring and managing the State Hospital Director. The state hospital would report to and serve at the pleasure of the Board. SB1688 got a unanimous (7-0) pass recommendation from the Senate Health Committee on February 13 and awaits a floor vote in the Senate.
• SB1102 civil reintegration unit; state hospital would provide a badly needed Civil Unit Reintegration Unit at the Hospital as outlined in ADHS’ Clinical Improvement and Human Resource Plan.
• Finally, SB1101 appropriations; secure behavioral health facilities would create and fund more secure residential treatment facilities for persons under a court order for treatment – a huge gap in the continuum of care – also identified as a gap in ADHS’ Clinical Improvement Plan.

AZPHA will be carefully following the progress of these bills and will be an active partner to help inform the debate as these important bills work their way through the legislative process this session.