Delightful AZPHA Awards Event

AZPHA held our annual awards event last Thursday at the University Club of Phoenix. It was a delightful evening with terrific weather and engaged awardees & attendees. We recognized four outstanding folks for their contribution to public health – each in their own distinct way.

Dr. Theresa Cullen was recognized with our Senator Andy Nichols Honor Award for her outstanding contributions to public health throughout her career including during her tenure at Pima County.

Dr. Cullen personifies the exceptional public health leader worthy of this award, demonstrating outstanding commitment to advancing health equity in Pima County, Arizona, nationally, and globally.

Her distinguished career has spanned three decades as a family physician, clinical director and national health IT expert and advocate, working with Tribal Nations, the Indian Health Service and the Veteran’s Administration in the US Public Health Service.

Dr. Cullen’s advocacy has improved health systems, access to services and influenced equitable policies. Dr. Cullen’s tireless commitment to protect and promote the health of our communities, especially those most at risk for severe outcomes, was evident through the COVID-19 pandemic. COVID-19 was the third leading cause of death in Pima County in 2021, compared to being the leading cause of death for the State.

Under her leadership, PCHD pursued and recently achieved reaccreditation from the Public Health Accreditation Board. Her establishment of an office focused on health equity, policy and community engagement and her recent hiring of a tribal liaison reporting directly to her is a testament to her commitment to systems change and advancing equity.

Dr. Cullen, like many public health leaders across the country, weathered many personal attacks through the pandemic and during her short-lived nomination to be become Director of ADHS. During the toughest of times, she serves with fortitude, tireless energy, and grace.

I believe she is the ideal candidate to receive the 2023 Senator Andy Nichols Honor Award.

Lindsey Perry was recognized for the terrific work her team at the Arizona Auditor General’s Office has done in recent years holding state agencies accountable – including uncovering ADHS’ misconduct ignoring nursing home complaints during the Ducey Administration (corrective actions is now underway under the new administration).

State government is responsible for ensuring the health and safety of Arizonans in so many ways. Ensuring state agencies are effective at their various missions protecting the public is dependent on agencies doing their job, which requires agencies to be held accountable for meeting their mission. Ideally, that accountability comes from governor’s office oversight of agencies. Sadly, some administrations make agency oversight a low priority.

Luckily, Arizona has a lead Auditor General (Lindsey Perry, CPA, CFE) who has built a robust team of professionals who do hold agencies accountable. The accountability Ms. Perry’s team brings to the table is critical to ensuring the health and safety of Arizonans.

In 2019, Auditor Perry’s team published a report disclosing that the ADHS’ Licensing Division had not been properly investigating complaints at AZ Nursing homes.

That report’s findings alerted the legislature, the media and stakeholders to address the agency’s shortcomings – who then pressed the agency to correct the problem. The Auditor’s 30 month follow up report found the agency reclassified nearly all high-risk complaints at nursing homes as low risk as a means of deceiving the public into thinking the problems had been corrected.

That watershed report led to legislative hearings and additional funding for the agency. It was also a major factor in compelling licensing division leadership changes at the agency. Those changes are now leading to positive reform and better protection for seniors.

Haley Coles received our Rising Public Health Star award for her amazing work with Sonoran Prevention Works with harm reduction and saving lives. From one of her nominations:

Haley Coles burst on the Arizona public health scene a few years ago with compelling advocacy to change Arizona laws (e.g., Good Samaritan Law, legalizing needle exchange programs and fentanyl test strips). In terms of public health programming, she’s been the driving force behind Sonoran Prevention Works – who has established themselves as a leader in public health operational work in harm reduction and Narcan distribution. Her organization has saved countless lives in Arizona amid the opioid/fentanyl crisis.

Senator Theresa Hatathlie was recognized with our Policymaker of the Year award for her heroic efforts “… shining the light on the harms being done to vulnerable people, persisting in her advocacy which is leading to real changes for the better” – Senator Mitzi Epstein. From one of her nominations:

Senator Hatathlie is the first public official to highlight the tragic human tracking in Arizona – holding early Senate hearings and bills highlighting this public health disaster. She was the first official to publicly disclose this human trafficking and Medicaid fraud disaster in which to people were picked up in white vans and driven to the Phoenix area from places as far away as the sprawling Navajo Nation. In some cases, the people allegedly didn’t even know the location of the homes where they were staying. We later learned in announcements by Governor Hobbs & Attorney General Mayes that hundreds of millions of dollars in fraud were also involved.

Senator Hatathlie was also a major player in the development of Operation Rainbow Bridge, an effort to find and get needed services to hundreds of tribal members that were victims of the trafficking, that affected as many as 7,000 Native Americans recruited to illegitimate sober living homes in recent years.

 

Nonprofit Grant Opportunities

Nonprofits have a unique ability to engage in developing meaningful public policy that builds healthier communities. This can range from sharing of information to conducting research to grassroots or direct lobbying.

Regardless of the tactics, public policy must be responsive to community needs, and community-based nonprofits play an invaluable role in ensuring these needs are reflected in meaningful public policy.

Vitalyst offers technical assistance to nonprofits focused on any of the Elements of a Healthy Community, and financial assistance may be offered to those working to advance issues included in Vitalyst’s Public Policy Agenda.

Grant Process

  1. Vitalyst Discovery intake form. *Be sure to click “Advocacy and Public Policy Capacity Building” when identifying your interests;
  2. Advocacy and Public Policy Selfie. Upon submission, you’ll receive a confirmation email prompting you to complete the final step;
  3. Schedule a consultation with Vitalyst Staff to discuss the recommended next steps.

Learn more here: Advocacy and Public Policy Capacity Building

Public Health Careers Clearinghouse

Public Health Careers Clearinghouse

Did you know you can learn about key high-demand public health professions and positions at www.publichealthcareers.org? The site has numerpous video profiles of public health professions and a nationwide public health job search portal.

  • Infectious/communicable disease control
  • Chronic disease & injury prevention
  • Environmental public health
  • Maternal, child, family health
  • Access to & linkages with clinical care, including public health nursing and nutrition sciences
  • Laboratory sciences
  • Program administration, grants management and finance, and executive leadership

I especially liked the FAQ part of the portal – especially for early career professionals and new graduates: FAQs | Public Health Careers.org

Heat Deaths Set Record in Maricopa County

Maricopa County Department of Public Health’s heat associated death weekly report this week reported that there have been 425 heat deaths confirmed so far in 2023, with 200 additional deaths still under investigation.

This large public health problem and threat isn’t just due to the record-breaking heat we had in July. It’s also because of the continuing regional affordable housing & homelessness problem. In fact, nearly half of the heat related deaths were among folks experiencing homelessness (44%) – making homelessness far and away the number one risk factor for heat related death.

The 2023 Point in Time homelessness county estimated there are 4,900 unsheltered people experiencing homelessness (the denominator).

See MCDPH’s October 2023 Heat Report

One hundred eight (108) of the heat associated deaths were indoor. Of those 81 had a nonfunctioning air-conditioner. An air-conditioner was present but not being used in 11 deaths, and another 11 deaths had no air-conditioner. There were two deaths where there was no electricity.

There has been a new record set every year since 2016. 2022’s record of 425 was 25% higher than the previous record set in 2021. Based on preliminary data, 2023 will set another record, though MCDPH expects it’ll be several months before all investigations are completed and data are finalized.

For their part, MCDPH will continue its work with partners to reduce heat-associated deaths by:

  • Analyzing data from its recent cooling center survey to understand how people find out about them and what can be done to increase usage
  • Hiring a Cooling Center Coordinator position to implement strategies learned from the cooling center survey to increase access to cooling centers in Maricopa County
  • Working with stakeholders to find additional funding and partnerships to enhance heat-relief strategies in Maricopa County
  • Hosting planning meetings with community, government, and faith-based partners to update Maricopa County’s Climate and Health Strategic Plan

Of course, the solution to this increasing public health threat is multi-sectoral since the primary determinant (homelessness) is a multi-sector problem requiring zoning and other policy changes and resource interventions at the state & local level.

2023 sees 425 confirmed heat-associated deaths in Maricopa County (azcentral.com)

News Flash • Maricopa County, AZ • CivicEngage

AZPHA Welcomes Barbara Lang as New Cochise County Health Director

Some welcome news out of Cochise County this week: Barb Lang has been selected as the new Health Director of Cochise County (Called Cochise County Health and Social Services). Cochise County has been a longstanding Organizational Member of AZPHA.

Barb will be an asset to the people of Cochise County and to Arizona’s public health system. She is a proven good decision-maker and has substantial depth in public & behavioral health.

Lang has more than two decades of wide-ranging experience in public health and healthcare administration & behavioral health. She worked at ADHS for several years as our head of Behavioral Health Licensing.

She also served as AHCCCS’ Behavioral Health and Intergovernmental Administrator and Chief of Behavioral Health Licensing at the Arizona Department of Health. For the last few years she’s been the Chief of Standards and Compliance and Chief Privacy Officer for Community Bridges.

Barb’s depth in behavioral health will be a welcome experience addition to the cohort of county health officers.

From Cochise County’s news media release: “Throughout my work, I have always ensured that rural communities have not only a seat at the table, but also a voice. I believe establishing comprehensive plans that consider the diversity and individualized needs of unique geographical regions in Arizona is integral.” 

Congratulations Barb – we look forward to working with you and your team at Cochise County!

October is Domestic Violence Awareness Month

During DVAM, advocates, professionals, survivors, and community stakeholders unite to bring attention to lives lost to domestic violence, celebrate progress made in advocacy, and connect with others working in the field.

Everyone can play a role in bringing about change.

Events to raise awareness of domestic violence and its impact on individuals, families, and communities take place throughout the year. The Maricopa Association of Governments host a regional events calendar for the Phoenix area.

Further statewide events and resources can be found through the Arizona Coalition to End Sexual and Domestic Violence. Further national  materials can be found through the Office of Family Violence Prevention and Services.

The National Domestic Violence Hotline has immediate resources for those fleeing violence, too.

We Installed a Solar Power System at Our House: This is Our Story

We decided we’d look into getting a rooftop solar power system at our house back when the Inflation Reduction Act passed, locking in a 30% tax credit for installing a rooftop solar energy system. With the generous tax credit, we figured this would be a good time to put the money on the table and reduce our utility bills while doing our part to lower our family’s carbon emissions.

Getting Started

I was reading this City of Phoenix newsletter that comes in the mail. In it, I saw this little blurb about how you can sign up for this free co-op called Solar United Neighbors. Solar United signs up lots of people interested in installing rooftop solar. Once they have enough people signed up, they go out for a collective bid. Using their scaled-up negotiating power, they can get better terms. This is what I liked the most, they do the price negotiating for you.

I signed up for the Solar United Neighbors co-op in early June 2023. By July 15, I got an email from a company called Sunny Energy, who was awarded the bid. I got my contact at Sunny Energy some basic information, like the last couple of years of our SRP utility bill and our address – and he said he’d come back with a bid for what makes the most sense given our roofline, sun exposure and electricity use patterns.

Sizing Your System

We talked about how much capacity we wanted before he came back with a proposed site plan. He explained that if you buy an oversized system it’ll take you longer to get your ‘payback’ – which is basically the number of years it’ll take to make up for your initial solar investment with lower utility bills.

Whenever you’re making more energy than you need at the time you have to sell it back to your utility at fire sale prices. The sell-back prices vary depending on the utility you have and what the AZ Corporation Commission has approved as a buyback rate.

How much SRP will pay you for your extra electricity depends on the plan that you pick. On the Customer Generation and Average Demand price plans the excess energy you make and send back to them is credited to your bill- but that plan comes with a monthly fee. You’ll get back the same value you would have paid for that energy had you purchased it from SRP.

If you pick the TOU Export and EV Export price plans, SRP will credit you just $0.0281 per kWh and subtract it from your bill (that’s a very low rate by the way). Here are the SRP solar price plans | SRP

By comparison, APS pays you $0.076 per kwh for your extra electricity, but they reduce that 10% per year for 10 years.  However, the Arizona Corporation Commission has opened the docket to explore dramatically cutting the buyback rate to just $0.053 per kwh, also subject to the 10% per year reduction. See: Corporation Commission Sets Stage to Drastically Cut Rooftop Solar Buyback Rates

Taking into consideration our energy use, the easily useable rooftop space, shade, and other factors, we decided to go with a 9600kW system – 24 panels on top of our garage. So far, we’re on SRP’s Export Plan – which is only paying us about 1/2 the value of the extra electricity we’re making. 

How Much Did It Cost?

The initial bid for the 24 panel 9600kW system was $22,000. The federal tax credit is 30% of that total, or $6,600, and with the state tax credit of $1,000, the initial cost of the system would have been $14,500. At the current utility rate for electricity, the 24 panels are expected to reduce our utility bill by about $200/month, meaning that the ‘payback’ for the system would have been about 7 years. We discovered that our very old service panel wouldn’t accommodate the solar system -so we needed a new panel to the tune of $3,000 extra. But that counts toward the tax credit too, so the new panel ended up costing just an extra $2K.

Note: To get the full 30% tax credit you need to have a tax obligation sufficient to cover the installation.

15% of the contract amount was due at signing. The second invoice was for 35% of the contract amount and was due upon design review. The 3rd invoice was also for 35% of the contract amount and was due prior to installation. The final 15% was due after installation and city inspections, but just before SRP comes out to install the new service meter.

Off to the Races

Once all the contracts were signed (about July 20) the whole thing went very fast. Within a couple of days, the Sunny Energy work crew measured everything. They built the plan using the measurements, developed the plan and turned it in to the City of Phoenix and SRP – who need to approve the plan and provide the permits. If you have an HOA, they may need to approve the plan as well. Both the City and SRP approved the plans pretty fast, within a couple of weeks. Note: State law preempts HOAs from unreasonably limiting rooftop solar installation.

Installation of the panels and the inverter (which converts the DC electricity to usable AC current) happened on August 17. Installation was done in about 3 hours from start to finish.

By August 25, just 5 weeks after we signed the contract, we were done except for installing the utility meter.

Inspections

Once the panels are up and the electrical system finished the fire department needs to inspect it. Once they say it’s ok, the city inspector needs to say it’s OK too (give it a green tag). The inspections happened really fast for us. There seems to be some kind of electronic tracking system because whenever one inspection was finished the next one happened right away.

Your contractor will submit a request to your utility company for a “Permission to Operate” your system. For us, that Permission to Operate required the installation of a new meter that will allow for your system to be commissioned.

Commissioning the Utility Meter

A couple days after the city gave their approval (green tag) I got an email from SRP scheduling the installation of the new meter… which was set for just 3 days from notification (September 1). Right after I got the notice from SRP that they’d be installing the new meter on 9/1, Sunny Energy let me know that they’d be out for the final walk-through on September 5.

Day 50: Making Electricity!

The technician arrived for the final walk-through on Sept 5, about 50 days after first contact with Sunny Energy. He hooked the signal generator on the inverter to our home Wi-Fi. The inverter can then send real-time data to you, which helps you see how much energy you’re consuming in the house relative to what you’re generating from the panels.

I was able to get a first reading from the panels at about 3:00pm on this sunny afternoon. It’s simple to log on to see your system. You can even see how well each panel is doing at the moment.

We turned on the system at about 3pm on September 5, a clear day with a high temp of 105F. Even with the A/C units running, we’re still making more power than we’re using. That will change with the time of day, season, and cloud cover – but it sure feels good to be making our own electricity!

That’s our story so far. I highly recommend signing up with Solar United Neighbors to get started and we were pleased with the service, communication and final result we got from Sunny Energy.

AZ Vaccine Congress Meets RE Plummeting Provider Participation in the Vaccines for Children Program

The Vaccines for Children Program makes sure kids whose parents can’t afford vaccines can still get their kids vaccinated. Funding for VFC comes via the CDC, who buys vaccines at a discount and distributes them to states. States distribute them to physicians’ offices & clinics that take part in the VFC program. ADHS manages the VFC program in our state.

The Arizona Partnership for Immunizations held a “Vaccine Congress” meeting last week to discuss potential solutions to major problems that have developed in Arizona’s Vaccines for Children program over the last 8 years.

The central problem discussed was the declining provider participation in the VFC program: Arizona lost 50% of its VFC providers during the Ducey administration – going from 1,200 to 600… reducing access to vaccine, lowering childhood vaccination rates and harming overall AHCCCS network capacity. 

Why the decline? Anecdotally, providers who left VFC over the last few years say they quit because of the administrative hassles imposed on them by the state over the last 8 years (ADHS not AHCCCS).

At the top of the list of grievances is ADHS’ punitive practice (during Director Christ/Herrington’s tenure) of financially punishing providers with wastage rates over 5% making participation financially difficult (see this letter to AZAAP members regarding ADHS’ policy). 

Arizona now only has 6 VFC providers per 10,000 Medicaid eligible kids, while the national average is 24 providers per 10,000 Medicaid kids…  meaning Arizona only has a quarter of the number of VFC providers per Medicaid kid compared with the national average.

For many years, clinics and doctors’ offices were required to be enrolled as a VFC provider to take part in the Medicaid (AHCCCS) program. The enormous drop in VFC participation was narrowing AHCCCS’ network so much that a couple of years ago AHCCCS had to remove that requirement as long as the provider refers the child to somewhere that’s still providing vaccines – often the county health departments. That has put an enormous strain on both families and county health departments and has been contributing to declining vaccination rates.

To shed more light on the causes of plummeting participation and to identify solutions the Arizona Partnership for Immunizations hired the OMNI Institute to explore why so many providers have quit VFC. 

OMNI’s report has 3 goals: 1) assess vaccine coverage gaps; 2) gather current and non-VFC provider perspectives on the challenges of participating in VFC; and 3) review and analyze the implications of federal policies and how states (including Arizona) interpret and implement those policies.

OMNI’s report will also have policy and operational recommendations for how ADHS can make better decisions and inform leadership changes that, if implemented, could stop, and potentially reverse the decline in provider VFC participation.

While OMNI’s report hasn’t been publicly published yet, the principal investigator was on hand at the meeting to present some of their results. 

I took screen shots of the PowerPoint slides presented last week (which had insightful findings about how ADHS can improve provider VFC participation). I’ve decided not to publicly disclose that content until after the full OMNI report is released to give ADHS senior leadership an opportunity to digest the findings and prepare & execute policy and/or staffing changes to address the report’s findings & recommendations.

Related: Righting Arizona’s ‘Vaccines for Children’ Ship

AZ Childhood Vaccination Rates Declined During the Ducey/Christ  Administration: Is it Bad Luck or Bad Policy & Management?

 Childhood Vaccination Rates Continue to Drop In the 2021-2022 School Year

Note: CDC’s VFC State Jurisdiction Operational Guide. provides key direction to ADHS regarding what kind of restitution they can impose and what criteria they need to consider before punishing VFC providers. One of the chapters in the Operational Guide states that: “CDC recommends awardees establish a restitution policy for federal vaccine doses (VFC and 317) that are lost due to provider negligence”. Further, it states that: “Vaccine restitution is the replacement of vaccine doses that were lost due to provider negligence. Restitution criteria are at the discretion of awardees.”

“Awardee restitution policies must state that providers are to replace vaccine on a dose-for-dose basis. This allows the restoration of doses to the VFC-entitled children for whom they are intended. Deviation from this method (e.g., purchasing equipment) may be considered if there are extenuating circumstances for an individual provider location.” 

ADHS should immediately modify their vaccine restitution policy ’ Restitution policy should:

  • Identify examples of typical situations that may require restitution.
  • Set reasonable loss thresholds for when restitution is required.
  • Consider the size of loss, number of previous incidents involving the provider, and the provider location’s response to education and corrective action plans when determining loss thresholds or doses to be replaced.

The Operational Guide is clear that financial penalties aren’t an appropriate way to punish practices. Indeed, anything besides replacing doses requires ADHS to: “… submit written justification to [email protected] and receive CDC approval prior to allowing restitution using any method other than dose-for-dose replacement.”

Recommendations

The most urgent thing is to stop the bleeding of even more providers from the VFC program. While I haven’t read the OMNI report- seeing the presentation and listening to the folks in the room at the Congress leads me to these key recommendations:
  1. Immediately suspend assessment of vaccine restitution penalties pending the development of a new ADHS Restitution Policy. Make sure that remaining VFC providers are informed about the suspension of restitution penalties pending development of a new policy to prevent even more providers from bolting.
  2. Develop a new Restitution policy after getting input from providers including the county health departments.
See CDC’s VFC Requirements & Operational Guide

Corporation Commission Sets Stage to Drastically Cut Rooftop Solar Buyback Rates

The Inflation Reduction Act provides good incentives for folks to invest in rooftop solar – offering homeowners a 30% tax credit on the purchase of the system. That brings the ‘payback’ time way down from 11 years to 7 years at current utility rates (depending on the utility).

When rooftop solar people make more electricity than they need they can either buy a battery to store it or sell it back to the utility at something called a Rate Comparison Proxy rate (for APS ratepayers).

At the moment, APS rooftop people can sell their power back to the grid at $.076 per kWh the year following installation. The Arizona Corporation Commission already allows APS to reduce that buyback rate by 10% per year in accordance with the Value of Solar decision.

Last Wednesday the Commission voted 3-2 to go even further and allow utilities to pay customers drastically less for the electricity they produce, including for customers who already invested in solar based on an expected solar export rate.

There was near unanimity among speakers at the Commission hearing last week to urge them to keep things as-is. Solar groups even provided evidence that APS actually pays solar customers a lower rate for their excess energy than it pays for all forms of energy on the open market.

[APS pays an average of $0.08113 per kilowatt hour on the open market for wholesale energy in 2022 versus APS’ current repayment rate for solar of $0.076 per kilowatt hour – and substantially less for ratepayers who installed solar a few years ago].

Nevertheless, 3 of the 5 Commissioners voted to reopen the policy with the intent of dropping reimbursement for extra solar power by 37% in year one after installation with additional 10% per year reductions in subsequent years.

See Myers’ Proposal to Drastically Cut Buyback Rates

People buy rooftop solar systems for many reasons. Some financial, some just to do the right thing to offset their carbon production and some for a combination of both. While the federal tax credit of 30% in the Inflation Reduction Act is an important factor, energy buyback is also a factor, especially when it comes to customers sizing their systems.

Achieving carbon neutrality to mitigate climate change will require a public policy full court press. Discouraging rooftop solar customers from using their own money to invest in systems that generate more energy than they sometimes need reduces the clean rooftop solar energy that could be generated.

See: Arizona has rooftop solar energy pricing that works. Why fuss with it?

The Docket is now open for resetting reimbursement rates for excess solar energy produced by rooftop solar ratepayers. Whether and how much reimbursement will be cut is still an open question – as is whether the new lower rates would apply to people with existing systems or just new ones.

Editorial Note: Sadly, the remarks by the 3 Commissioners who voted to reopen the Value of Solar all had prepared remarks explaining their vote – suggesting their minds have already been made up to reduce reimbursement, perhaps dramatically and retroactively.

It’s probably just a matter of time before reimbursement drops dramatically – reducing incentives for folks to invest their own money on rooftop solar and be part of the solution. Elections matter. A lot.