Will Humble Climate Change, Injury Prevention, Wills Blog

Maricopa County Launches 2024 Heat Relief Efforts

Maricopa County Public Health investing in community support to prevent another record-breaking year of heat deaths

In response to the largest number of heat-related deaths since tracking began, Maricopa County Department of Public Health is ramping up its heat response efforts for 2024 to expand the Maricopa County Heat Relief Network.

The Network was initiated in 2005 by the Maricopa Association of Governments and is comprised of public, private and non-profit volunteer organizations that all come together with one goal: reduce the number of heat related deaths in Maricopa County.

This year MCDPH is coordinating cooling and respite centers throughout the County along with ensuring that Maricopa County residents know how to access these centers.

In response to this assessment, MCDPH has developed a robust plan to support the community:

  1. Intergovernmental Agreements (IGAs) with Phoenix, Glendale, Chandler, Mesa and Tempe. In partnership with these large cities, cooling and respite centers will be available to those needing to get out of the heat. At least one heat relief site in each city will be open until 7 p.m. Monday through Friday and open on at least one weekend day. 
  2. Partnership with 2-1-1. MCDPH has contracted with AZ 2-1-1 to staff their call center with community health workers or promotoras that speak English and Spanish to help residents find cooling and respite centers, water and other heat relief support like utility assistance and A/C repair and replacement from 9 a.m. to 7 p.m. daily.
  3. Partnership with large organizations providing cooling and respite centers. MCDPH will also be contracting with larger non-profits providing heat relief center support to ensure that cooling and respite centers are staying open until at least 7 p.m. and on weekends throughout the county whenever possible.

MCDPH has invested in its workforce to support climate and health. It has hired a Climate and Health Program Manager, as well as a Heat Relief Coordinator to focus specifically on supporting the county’s heat relief site infrastructure. This work is in addition to MCDPH’s robust surveillance to track heat-related deaths, which it has done since 2006.

Every year since 2016, Maricopa County has set a new record in the number of heat-related deaths confirmed. To break this tragic streak, it will require everyone to play a role, and at the center of this is the Heat Relief Network.

Will Humble Professional Development, Public Health, Wills Blog

Oral Arguments in the Petersen v. Hobbs ‘Director Nominations’ Case Delayed Until May 20

After the shenanigans in early 2023 at the “Director’s Nominations” Committee it became clear that Governor Hobbs nominees to lead state agencies wouldn’t be getting a fair shake from the Committee or the Senate.

We posted a blog back then arguing that the Governor should use loopholes in the statute to get her nominees onto more stable ground: Time to Play Hardball with Agency Director Nominations? Here’s a Playbook

Hobbs ended up going with Option 3 from that blog post as outlined in Governor Hobbs Letter to Senate President Petersen. Hobbs first withdrew the 13 nominations of the agency directors that she had previously sent to the Senate.

The statutes about senate confirmation requirements are sufficiently vague and provide loopholes that gave Team Hobbs options to provide stability and governance options. See: 38-211 – Nominations by governor; consent of senate; appointment 

See: Senate committee doesn’t ‘vet’ nominees. It sabotages them

She then appointed a guy named Ben Henderson as the Interim Director for each of the agencies. Mr. Henderson proceeded to name the person who had previously been nominated to be director to the title of Executive Deputy Director.

State Senate President Petersen sued Governor Hobbs in Maricopa County Superior Court a few months ago. Several briefs have been filed by both parties, and Judge Blaney had scheduled the first round of oral arguments in court last week but later delated oral arguments until Monday, May 20: Civil Court Case Information: Petersen v. Hobbs. 

Maricopa County Superior Court CV2023-019899

My sense is this case will ultimately be appealed to the Arizona Supreme Court – so it may be several months to more than a year before we have a final resolution in this important policy matter. However, if the State Senate flips or ends in a 15-15 tie or if Dems take control of the chamber things could change rapidly and the case could end up being dismissed once a new Senate president is sworn in.

Note: The Chair of the Director Nominations Committee, Jake Hoffman, was recently indicted by an Arizona Grand Jury on numerous serious felony charges. Nevertheless, Senate President Hoffman has not removed Hoffman from his Director Nomination and Government Committee perches.

See: Governor Katie Hobbs Pulls Nominees from Partisan Political Circus Created by Extremist Jake Hoffman
Will Humble Reproductive Health, Wills Blog

Governor Signs Repeal of the Near Total Ban on Abortion Care: AzPHA’s Draft Voter Initiative Argument

You undoubtedly know that both the legislature narrowly passed and the governor signed a bill repealing the near total abortion ban that was originally passed during the first territorial legislature in 1864.  It’s unclear when the repeal will actually take effect – most likely around October 1 (90 days after the end of the legislative session).

Meanwhile, as a result of the state Supreme Court’s decision awhile back, that very same territorial law is set to take effect at the end of June, meaning – unless something changes – there will be virtually no abortion care in Arizona during July, August and September. Beginning in October that care would be restored up to 15 weeks gestation.

Meanwhile, folks working on the Arizona Right to Abortion Initiative continue to be busy collecting signatures to place a constitutional amendment on the ballot that would place the right to abortion care in the state constitution.

AZPHA has a series of Resolutions in place (going back decades) AzPHA Resolutions on Women’s Reproductive Rights Go Back to 1938 and AZPHA will be supporting the Act.

Every cycle the Arizona Secretary of State generates a publicity pamphlet for the ballot to support voter education which is mailed to registered voters ahead of the general election. The pamphlet includes arguments in support of and against citizens’ initiatives and legislative referrals.

The publicity pamphlet is a key educational resource for voters to use while navigating the ballot, or before going to the polls.

AZPHA has a history of including arguments for and against ballot propositions focusing on the good and bad public health impacts that could occur to help inform voters. Last cycle AZPHA placed arguments for or against 4 of the 10 ballot propositions.

We’re working on arguments for up to 5 of the ballot measures that’ll be on the ballot – including the Arizona Right to Abortion Initiative. Below is a working draft of what we’ll be including in the voter guide: 

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Vote For Sexual & Reproductive Health Fairness

Vote Yes on Proposition xxx

We urge you to vote Yes on Proposition xxx because it helps ensure sexual and reproductive fairness for all Arizonans.

Arizona’s record of ensuring fair reproductive health policy equality is checkered. You’re no doubt familiar with the law from 1864 that criminalized abortion care has been repealed (for now).

While the Arizona Public Health Association is grateful for the sensible repeal of that territorial-era law, we also know a similar restriction could be revived at any time by the state legislature.

In fact, a resurrection of that territorial era abortion ban may be just a couple of legislative sessions away…  that is unless we change the Arizona State Constitution to protect abortion care by voting YES on the Arizona Right to Abortion Initiative (Proposition xxx).

A large body of published evidence shows policy restrictions on sexual & reproductive health care cause health inequality and harm public health outcomes. Public health evidence shows that unreasonable restrictions on access to abortion negatively affect the provision of care, the availability of patient-centered services and reproductive autonomy.

Policy solutions that center and promote sexual and reproductive health equality like Proposition XXX are essential for building fair reproductive health care.

We hope you’ll join us by voting YES on Proposition XXX & continue to help us strive for other evidence-based reproductive freedoms like:

  • Ensuring sexual & reproductive health care programs provide person-centered care;
  • Requiring all health insurance plans and programs to provide comprehensive coverage for all contraceptive options;
  • Ensuring patients have multiple options for accessing reproductive health care;
  • Strengthening federal Title X Family Planning; and
  • Removing restrictions that silo abortion care.

Access to abortion care with reasonable restrictions is also a core element in reproductive care fairness.

Please vote YES on Proposition xxx

Will Humble Nutrition, Wills Blog

USDA Improves Nutrition Standards for Free & Reduced Lunch Program

USDA finished changes to the nutrition standards they expect participating schools to follow who take part in the USDA’s free and reduced breakfast/lunch programs. Schools across our country are serving breakfasts and lunches to nearly 30 million children every day.

Healthy school meals are the main source of nutrition for more than half of these students and are an essential part of the educational landscape.

USDA says their new standards were”… shaped by a host of stakeholders, including parents, devoted teachers, school administrators, school nutrition directors, and industry leaders, and are informed by the latest Dietary Guidelines for Americans”.

Here are the top line changes that will be implemented over the next couple of years:

  • Reduced added sugars in school breakfasts;
  • Making it easier to offer healthy proteins at breakfast;
  • Scaling back sodium levels;
  • Incentivizing fruits and vegetables and whole grains;
  • Making it easier for schools to accommodate vegetarian diets and the cultural and religious food preferences of students.

To learn more about the updated school nutrition standards, please visit the USDA Food and Nutrition Service website.

 

Will Humble Behavioral Health, Marijuana, Wills Blog

Biden Administration to Reschedule Cannabis Under the Controlled Substances Act

What Are the Implications?

In a surprise move, Biden Administration insiders have signaled that a few executive branch agencies will be moving in unison to reschedule marijuana from what’s called a “Schedule I” drug to a Schedule III drug under the Controlled Substances Act.

What is the Controlled Substances Act?

The Controlled Substances Act is the main federal law that regulates many aspects of controlled substances. Drugs or substances are examined for their medical (beneficial) use, potential for abuse, safety and the likelihood that people would become dependent on the substance.

Congress enacted the CSA way back in 1970 so drugs with a potential for abuse could be available for medical, scientific, and research purposes, while trying to prevent them from being diverted for illegal reasons like drug abuse and trafficking activities.

What is the DEA’s Role?

The CSA is mainly under the prevue of the Drug Enforcement Administration (DEA), not the Food and Drug Administration. The DEA is housed within the US Department of Justice…  which tells you their mission is really enforcement of laws regarding who can possess drugs rather than how drugs are licensed, prescribed, and filled.

The DEA uses the Controlled Substances Act language to classify drugs or substances with those characteristics into one of 5 categories – ranging from Schedule I (those with no medical use and potential for abuse and dependency) – to Schedule V. Schedule V drugs tend to have legit medical uses and a low risk of abuse and dependency.

DEA’s algorithm for classifying drugs is based on these criteria:

  • Its actual or relative potential for abuse
  • Scientific evidence of its pharmacological effect
  • The state of current scientific knowledge
  • Its history and current pattern of abuse
  • The scope, duration, and significance of abuse
  • What, if any, risk there is to the public health
  • Its psychic or physiological dependence liability
  • Whether it’s an immediate precursor of a controlled substance

Here are some examples of where drugs lie on the Schedule spectrum:

  • Schedule I: Marijuana, ecstasy, heroin, LSD, and peyote
  • Schedule II: Methamphetamine, cocaine, fentanyl, Vicodin, oxycodone, and Adderall.
  • Schedule III: Anabolic steroids, testosterone, and ketamine, Tylenol with codeine.
  • Schedule IV: Xanax, Ambien, Ativan, and Valium.
  • Schedule V: Cough suppressants.

Alphabetical listing of Controlled Substances

A lower schedule number corresponds to greater restrictions, so substances in Schedule I are subject to the strictest controls, while substances in Schedule V are subject to the least strict. Schedule I drugs, where marijuana has been since 1970, aren’t authorized for anything.

That classification is a primary reason why marijuana was an enforcement priority for the DEA for many years. That has changed over time as more and more states adopted medical marijuana laws followed by laws that make it available for recreational purposes.

How Fast will Rescheduling Happen?

The rescheduling of marijuana from Schedule I to Schedule III won’t happen overnight. There is a defined process that needs to happen first. This week’s announcements were just the first steps in the rescheduling process.

The first step of the Office of Management and Budget to sign off on rescheduling marijuana to Schedule III. HHS has already recommended that marijuana be moved to a lower Schedule. After the public comment period (and a review by an administrative judge) DEA could publish the final rule.

After it’s rescheduled, marijuana would still be subject to various rules for Schedule III drugs and there could still be federal prosecution of people who traffic in the drugs without permission. Presumably, the feds will continue to mostly avoid prosecuting people for marijuana possession in states with medical or recreational marijuana laws (like Arizona).

However, it’s unlikely dispensaries operating in states like AZ would meet the federal Schedule III production, record-keeping, prescribing and other requirements… so those will be enforcement matters for DEA to still figure out.

Researching Marijuana will Become a Lot Easier

Marijuana’s status as a Schedule I drug has made it really hard to conduct authorized clinical studies that involve administering the drug. That’s created a bit of a conundrum: we’ve needed more research on Cannabis for a long time, but its Schedule I status was a huge barrier to actually doing it. Those barriers will be largely removed after rescheduling, making marijuana much easier to research for clinical/medical purposes.

Banking and Taxation Issues

Dispensaries haven’t been able to deduct rent, payroll or various other expenses that other businesses can write off because marijuana is Schedule I. Under the tax code, dispensaries are considered traffickers of an illegal substance because of its Schedule I status. Once Cannabis moves to Schedule III dispensaries will be treated like any other business.

Marijuana’s Schedule I status has been locking dispensaries out of banking services (especially loans). Rescheduling may not immediately (or directly) affect dispensaries’ ability to access banks because the federally regulated institutions are wary of the drug’s legal status, but that should change with rescheduling. Dispensaries have been trying to get the SAFE Banking Act to fix that. Some say passing the Act won’t be necessary if DEA actually reschedules.

Likewise, dispensary customers will likely begin to be able to use credit cards to buy product – but that remains to be seen as it’s the bank and credit card company’s decision.

Dispensaries operating in states like AZ currently don’t meet the federal Schedule III production, record-keeping, prescribing and other requirements so they’d presumably need to come into compliance with those requirements to enjoy the banking (and tax) benefits. Some in the industry worry that the IRS and banks would only consider medical marijuana dispensaries to be in compliance with new regulations – meaning retail dispensaries wouldn’t enjoy tax and banking benefits of rescheduling.

Why? Because Schedule III drugs require a prescription to be issued and filled by a ‘practitioner’. Recreational buyers don’t have a prescription nor are dispensary agents likely to be considered practitioners.

Will Big Pharma Get Involved & Compete with Dispensaries?

Once marijuana is rescheduled, pharmaceutical companies can start applying for licenses from the FDA for drugs/medications that use Cannabis. Once approved, those drugs could become available in local pharmacies.

Theoretically big pharma might see rescheduling as an opportunity to get a piece of the Cannabis action by applying for licenses to sell things like edibles for therapeutic purposes…  think gummies with a combo of CBD & THC as a sleep aid as an example. Like other drugs – they’ll need to prove to the FDA that they’re safe and effective to get them approved.

Honestly though, drug companies tend to like to get patents and drug approvals for medicines that are unique and have no biosimilar competitors because they can charge much higher prices. There are a host of competing drugs containing marijuana in states that have medical and retail programs – so I think it’s unlikely pharmaceutical companies will get involved, but I could be wrong. There’s no way FDA is going to approve marijuana buds etc. – so there won’t be any new competition on that front.

Will Humble Assurance & Licensure, Healthcare, Wills Blog

CMS Establishes Minimum Staffing Standards for Long-Term Care Facilities

Centers for Medicare & Medicaid Services pay for a big chunk of the care at skilled nursing facilities via their Medicaid and Medicare programs. As such – they have a keen interest in making sure the care for the people they’re paying for is good.

For the last couple of years, they’ve been reevaluating their standards and expectations for facilities that serve folks via Medicare and Medicaid (nearly 1.2 million residents live in Medicare- and Medicaid-certified long-term care facilities paid for by CMS).

See: Medicare and Medicaid Programs: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting Final Rule (CMS 3442-F) | CMS

Last week, after reviewing 46,000 public CMS just established new rules that will a total nurse staffing standard of 3.48 hours per resident day. CMS is also finishing enhanced facility assessment requirements and a requirement to have an RN onsite 24 hours a day, seven days a week, to provide skilled nursing care. 

See: How The Republic reported on resident harm in senior living facilities

CMS will also require states (ADHS) to collect and report on the percent of Medicaid payments that are spent on compensation for direct care workers, and support staff, delivering care in nursing facilities and intermediate care facilities, for individuals with intellectual disabilities. 

They’ll be offering hardship exemptions in limited circumstances to the 3.48 hours of nursing per resident per day and 24/7 onsite RN requirements if they meet several geographic staffing unavailability, financial commitment to staffing, and good faith efforts to hire.

Enforcement is largely up to the state health departments who contract with CMS to do the certification inspections, in our case ADHS.

See Auditor General’s Office Produces Scathing Review of ADHS’ Nursing Home Complaint Investigations During the Director Christ Era &

 The Arizona Republic’s The Bitter End Series

Last week’s directive from Hobbs to agency directors ordering them to implement a hiring freeze (and send her a plan to cut 4% from their current-year spending and additional 2% cuts next FY) undercuts the department’s efforts to improve their performance.

Hobbs’ budget letter points to cuts, hiring freeze for Arizona government

Those moves cast an uncertain shadow on ADHS’ ability to hire and keep adequate staffing to ensure folks are receiving adequate care in licensed care facilities.

For now, I will give the administration the benefit of the doubt that ADHS Licensing (which lives mostly off licensing fees) and the Arizona State Hospital will be exempt from this new directive. For now, those positions in Licensing and ASH are still posted on AZ State Jobs

Will Humble Assurance & Licensure, Behavioral Health, Wills Blog

Hobbs Implements State Agency Hiring Freeze via a ‘Head Count Cap’

Governor Hobbs has ordered a hiring freeze for new state employees and instructed her department heads to send her a plan this week to cut $1.2 billion in spending out of their current and coming year budgets. That’s a 4% cut for the remainder of this fiscal year and a 2% reduction for next year.

The letter reportedly sets out a “headcount cap” for agencies like the Ducey administration did that will allow agencies to replace employee losses but not to fill currently vacant posts.

It’s unclear at this point how strict the hiring freeze will be and how easy it will be to get exemptions.

Editorial Note: ADHS desperately needs exemptions from the new policy for their licensing division, which is responsible for ensuring quality care in assisted living, skilled nursing, behavioral health facilities and the like. We have written extensively about the poor history the agency had during Christ and Herrington’s tenure – with a core reason for the poor performance the lack of inspectors. A hiring freeze would devastate their efforts to get licensing back on track.

Same goes for staffing at the Arizona State Hospital.

I’ll give another week or two to the administration before we begin advocacy to protect licensing and the state hospital from this new hiring freeze which would definitely jeopardize care at the Arizona State Hospital damage the Department’s ability to improve their licensing division’s performance.

See: Licensing & Regulating Care Facilities: A Root Cause Analysis of Arizona’s Failure to Protect Vulnerable Persons & Pathway to Redemption


More oversight is needed at the Arizona State Hospital, critics say

How The Republic reported on resident harm in senior living facilities

Report: The Arizona State Hospital lacking staff, treatment options

Will Humble Wills Blog

Public Health Journalism this Week

Hobbs’ budget letter points to cuts, hiring freeze for Arizona government | Daily Independent (yourvalley.net)

Legal group says Arizona’s 1864 abortion ban is back in effect (azcentral.com)

Syphilis is spreading rapidly in Maricopa County. This could slow it (azcentral.com)

Arizona health care: Report finds wide inequities in performance (azcentral.com)

Hobbs, Mayes launch website to help Arizona navigate changes to abortion laws (azmirror.com)

Medicare and Medicaid Programs: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting Final Rule (CMS 3442-F) | CMS

Will Humble Uncategorized

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

At first glance, the Arizona Corporation Commission might seem like it has pretty much nothing to do with public health. But when you scratch the surface just a little, you’ll discover that the Commission does in fact influence public health in important ways.

Last week we covered how the Commissioners have been using their authority to regulate electricity monopolies and how those decisions affect the social determinants of health.  This week we’ll cover how Commissioners decisions impact Arizona’s ability to limit carbon emissions.

Commissioners Set Stage Slash Rooftop Solar Buyback Rates

The “Value of Solar” rates set by the Corp Comm back in 2017 determine how much APS needs to pay home-based rooftop solar generators for their extra electricity. Those criteria were carefully set in 2017 after a multi-year evaluation by commissioners and staff.

Since then, folks have been using that formula to figure out what the return on their investment for the power they generate on their house.

That is all up in the air now that the Commission is reevaluating those rates – most likely to reduce them.

Back in October 2023 the Corp Comm voted (3-2) to open a new legal case to re-evaluate rooftop solar export rates – setting the stage for a future reduction in buyback rates. 

Commissioners Nick Myers, Jim O’Connor and Kevin Thompson voted to open the Value of Solar docket. Lea Márquez Peterson and Anna Tovar against the move.

Central to the issue is the 10% annual reduction in how much utility companies must pay residential solar panel owners for extra energy produced by their home system that is then returned to the grid and sold to other customers.

The decision also reopens discussions about the 10-year export rate effective period and a grandfathering policy for net metering customers.’  Corporation Commission reopens debate over rooftop solar buyback rates

The Commissioners haven’t yet cut the export rates for current and future solar producing customers, but the stage is now set for the newly elected commission in 2025 to decide whether to slash existing and future solar customer export rates.

Note: the Value of Solar agreement in 2017 included very bad provisions like the elimination of ‘net metering’ of APS customers.

Rate Increases for Solar Power Generating Homeowners

Back in February, the Commission rubber stamped APS’ request to add a monthly charge of $2.50 to $3 for residential customers with rooftop solar systems, reducing the incentives for folks to install rooftop solar systems on their houses.

After pushback from consumers and rooftop solar advocates the Corp Comm recently granted a rehearing on whether an APS rate hike that included an added fee for solar customers is “just and reasonable”.

Attorney General Mayes also stepped in and argued the added charge on solar customers was “discriminatory” given both solar and non-solar customers receive power uniformly, and the decision generally violated customers’ due process rights.

“In this rate case, APS did not request an additional charge for residential solar customers at any point, nor did any party propose one,. No party had any reason to introduce evidence to refute the factual basis for the surcharge because no party had requested, briefed, or discussed the possibility of such a charge at any time prior to the close of the administrative record.”

The Corp Comm says the upcoming rehearing would be limited to “whether the rate should be higher or lower; whether the GAC rate constitutes an alleged discriminatory fee to solar customers and whether omission of the GAC is discriminatory to non-solar customers.”

Grid Access Charge Rate Schedules: Fixing a Just and Reasonable Rate of Return

Commissioners Scrap Clean Energy Standards

The Arizona Corporation Commission also killed carbon-free energy rules that were under consideration for years after watering down the plan which would have incentivized solar, energy efficiency and other clean power sources.

The changes that weakened what had been the requirements for electric companies to meet clean energy standards – turning them into “goals” rather than mandates.

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After you scratch the surface, it’s easy to see that who you vote for in the upcoming Corporation Commission race can have a big impact on policies to encourage more solar investment in Arizona… with the stage now set for an even more hostile policy environment.

Note: Three of the five Arizona Corporation Commission seats are up for election in November — those of Republicans Jim O’Connor and Lea Marquez Peterson and Democrat Tovar, who has announced she will not run again.

Last week we saw how the Corporation Commission impacts the social determinants of health by how they use their authority to scrutinize monopoly utilities electricity rate increases: Corporation Commission reopens debate over rooftop solar buyback rates

This week we covered how they can use their authority to either encourage or discourage carbon emission reductions (discourage mostly).

Next week we’ll look at the way the Corporation Commission has been rubber-stamping rate increases for another monopoly utility (and harming the social determinants of health): Southwest Gas.

Will Humble Professional Development, Wills Blog

Valleywise Health’s Dr. Michael White Honored by Becker’s Hospital Review

AzPHA member and Valleywise Health Executive Vice President and Chief Clinical Officer, Dr. Michael White has been recognized by Becker’s Hospital Review in its 2024 national list of “180 Hospital and Health Systems Chief Medical Officers to Know.” He was one of 2 Arizona chief medical officers recognized.

Dr. White is Chair of the Governing Board of the Creighton University Arizona Health Education Alliance, a partnership that includes Valleywise Health, District Medical Group, and Dignity Health St. Joseph’s Hospital and Medical Center.

In addition to his leadership roles, Dr. White is a practicing interventional cardiologist, using his top-tier medical credentials as a senior member of the cardiology team at Valleywise Health.

Dr. White is board certified in internal medicine, cardiovascular diseases, and interventional cardiology. He received his Bachelor of Science degree in biology from Creighton University. Dr. White received his medical degree from the Creighton University School of Medicine, where he also completed a residency in internal medicine and a fellowship in cardiovascular disease.

He completed a fellowship in interventional cardiology at Duke University in Durham, North Carolina. Dr. White earned his MBA degree from Creighton University in 2019.

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