Will Humble Professional Development, Public Health Law, Wills Blog

Petersen v. Hobbs: The Clash Over Director Nominations is Jeopardizing State Agency Effectiveness

Judge Blaney ruled for senate president Petersen in the Petersen v Hobbs case. The case, Petersen v. Hobbs, centers on the governor’s strategy to circumvent the Senate’s approval process for her nominees.

Oral Arguments Monday in Petersen v. Hobbs Agency Director Nominations Case

Most of you will remember the behavior of the newly created Senate Director Nominations Committee. In a nutshell, the committee chair refused to hear most of Hobbs’ nominees and the ones that did get time before the committee faced partisan prosecutorial attacks rather than honest hearings.

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

Governor Hobbs eventually withdrew her nominations for several agency directors. She then appointed Ben Henderson as the interim director for multiple agencies, with previously nominated individuals being chosen as Executive Deputy Directors, allowing them to effectively lead the agencies without the formal title of director, thereby sidestepping the need for Senate confirmation.

Gov. Katie Hobbs’ health director was sabotaged. So was Arizona

For the last several months, nearly all state agency directors have been making agency decisions and operational priorities without official confirmation.

The Senate sued in Maricopa County Superior Court, asserting that Hobbs’ approach undermines the legislative process and oversteps her executive authority.  This legal dispute not only affects current agency operations but also sets a precedent for how future administrations might handle similar conflicts.

Judge Blaney, in Maricopa County Superior Court ruled yesterday that while Hobbs was “arguably” within her powers to withdraw her nominees but that she didn’t have the authority call them deputy directors and still give them full authority as an official director.

See the Ruling

A secondary argument offered by the Hobbs legal team suggested Hobbs misused a state law allowing the appointment of deputy directors, saying that argument “… improperly elevates form over substance”.

However, Blaney’s ruling didn’t order Hobbs to turn in nominees to the Senate, saying he intends to hear arguments later this summer to resolve the conflict. A quote from the ruling says he will instead “… give these co-equal branches of government an opportunity to meet and confer in an attempt to reach a mutually agreeable resolution of this dispute.”

If Hobbs and Petersen can’t resolve the conflict themselves Blaney suggested he would impose a solution by mandamus, basically imposing a resolution.

Editorial Note: The timing of the ruling is actually good. Why? Because it gives the two an opportunity to each use their leverage during the budget negotiations to come up with a solution they can both live with. The sense of urgency to get a final budget may compel them both to come up with a compromise.

But, if they agree to a budget that doesn’t include at least a handshake agreement on director nominations, the case may actually go ahead to court for the resolution phase this summer.

With the Legislature out of session in just under a month, there will be no immediate problem for Hobbs – as 38-211 allows the Governor to wait to nominate agency directors until the 2025 legislative session begins in January.

The Senate may look quite different in January…  perhaps moving to a 15-15 tie, or out and out control of the Senate by the Democrats.

Either result would likely mean there’d be a new Senate President and elimination of the Director Nomination Committee, honest vetting of the nominees, and a more traditional confirmation process rendering the case moot.

Will Humble Family Planning, Public Health Law, Wills Blog

What is Direct Care Planning and Why is it Important?

Direct care planning is a game-changer for families dealing with healthcare. Think of it like having a detailed road map when you’re on a road trip—you know exactly where you’re headed and how to get there. For families, this means having a clear plan for their loved one’s care, making things way less stressful.

With direct care planning, everyone involved—doctors, nurses, family members—knows what’s going on and what the next steps are. It’s like a playbook that ensures everyone is on the same team and working towards the same goals. This clarity helps avoid mix-ups and ensures that the care is tailored to what your loved one really needs.

Plus, it helps you feel more in control and informed about the care process. Instead of feeling overwhelmed, you get to focus on supporting your loved one, knowing that there’s a solid plan in place. All in all, it’s about making healthcare smoother and more personal for everyone involved.

Completing advance care planning documents is a proactive, responsible step towards ensuring that your healthcare journey aligns with your personal values and wishes.

Why it matters: It helps you take control of the unpredictable, offering peace of mind to yourself and those you love.

Here are the five steps to help you with advance care planning:

  1. Think about what matters most in life.
  2. Talk with your doctor and loved ones.
  3. Fill out the documents.
  4. Share your wishes and your documents.
  5. Review and update your documents.

Use this guide from the Arizona Hospital and Healthcare Association to start your advance care planning today.

Will Humble Environmental Health, Injury Prevention, Wills Blog

Maricopa County Public Health Launches Heat Illness/Death Data Dashboard

Maricopa County Department of Public Health launched an interactive, online heat-related illness and death dashboard to help provide more accessible and timely data around countywide heat-related hospital visits and deaths.

The publishing of this tool coincides with a multi-partner, countywide heat preparedness and response effort already underway to prevent another summer of record-breaking heat deaths.

The dashboard will help public health officials and other key stakeholders involved in heat response activities monitor health impacts of environmental temperature and help inform outreach and interventions needed to help residents stay safe from extreme heat.

It features:

  • Near real-time data on heat-related hospital visits in addition to data on heat-related deaths
  • Comparative data for heat-related deaths and hospital visits for 2023 and 2024
  • Patient characteristics by age, race, and sex to show who is at highest risk from heat and inform prevention efforts
  • Patient characteristics on housing status and substance use involvement in heat-related hospital visits and deaths

In addition to showing daily county-level heat-related illness and deaths reported, the dashboard also will feature daily maximum and minimum temperatures to help illuminate the impacts of extreme heat.

The dashboard is perfected for desktop viewing. MCDPH has prepared a guidance document to support users as they navigate different features of the dashboard.

In the coming weeks, the dashboard will include an interactive map that displays heat-related deaths by sub-county geography and information about the circumstances of each death, such as outdoor or indoor and whether air conditioning was available or not functioning in the home.

Will Humble Medicaid, Wills Blog

AHCCCS Launches Member Emergency Department & Inpatient Admissions Dashboard

AHCCCS quietly launched a couple of useful accountability tools last week that can also be used for research: their new Emergency Department Visits  and Inpatient Admissions Dashboards. Both data sets are populated with deidentified claims information among Medicaid members in AZ.

The Emergency Department Visits Dashboard allows users to explore and interact with AHCCCS member data pertaining to emergency department utilization. The data is broken down by ED Utilization, Demographic Comparison, and Primary Diagnoses.

The Hospital Inpatient Admissions Dashboard displays AHCCCS member data pertaining to hospital inpatient admissions. The dashboard allows users to explore and interact with the data in a more insightful and visual way, which better communicates trends and important information. This dashboard is broken down by Inpatient Admissions, Demographic Comparison, Primary Diagnoses, and Length of Stay.

So, why is this a big deal? For starters, transparency! These dashboards are a win for anyone who cares about where and how healthcare resources are being used. But remember – these are just dashboards…  they don’t provide the kind of detailed data that researchers would need to do detailed analyses – but they do provide bottom-line trend data.

Will Humble Professional Development, Wills Blog

Get Your Staff Training in this Summer with the Western Region Public Health Training Center

Summer is here, and with it comes a fantastic opportunity for health departments, managed care, and provider organizations to level up their staff training without breaking the bank. Enter the Western Region Public Health Training Center, your go-to hub for free, top-notch public health and management training.

Western Region Public Health Training Center Home: (arizona.edu)

WRPHTC offers a diverse range of training topics that cater to the needs of today’s public health & healthcare workforce. From epidemiology and community health to leadership and project management, there’s something for everyone. The best part? These training courses are completely free.

Health departments can benefit big time from their offerings. Your team can improve their insight into disease prevention, data analysis, and health promotion. The knowledge gained from these courses can directly impact the community by improving public health outcomes while providing employee engagement and professional development.

Managed care organizations can use the Center’s courses too. Training courses cover crucial topics like healthcare quality improvement, patient-centered care, and health equity. By empowering your staff with these skills, you’re not just enhancing their professional development; you’re also elevating the level of care provided to your members.

There are courses tailored to provider organizations too, with topics like clinical management, healthcare policy, and effective communication – transforming how your team interacts with patients and navigates the complex healthcare landscape. Training your staff in these areas can lead to better patient outcomes and a more efficient operation overall.

Training is available online, making it easy for your team to take part without the need to travel or disrupt their daily work schedules. This means you can integrate learning into the summer season, traditionally a slower period, allowing for maximum participation and minimal interference with day-to-day operations.

In short, the Western Region Public Health Training Center is a treasure trove of knowledge waiting to be tapped into.

Take advantage of these free training opportunities this summer and watch your organization thrive. Happy learning!

Visit: Western Region Public Health Training Center
Will Humble Injury Prevention, Wills Blog

Arizona Motor Vehicle Driving & Conditions Among the Most Dangerous in the U.S.

The National Highway Traffic Safety Administration tracks injuries and deaths from motor vehicle crashes in the US through its Fatality and Injury Reporting System Tool and provides access to the data for policymakers at the local and state level. The data provides info for policymakers to analyze trends, identify high-risk areas, and develop strategies to enhance road safety.

Fatality and Injury Reporting System Tool (FIRST)

Arizona stands out in NHTSA’s most recent data update and not in a good way.

According to recent data, Arizona ranks 2nd in the US in pedestrian and bicyclist deaths at 4.6 per 100,000 persons (in 2022), second only to Louisiana. This alarming statistic underscores the necessity for interventions and enhanced safety measures to better protect pedestrians and cyclists with improvements in the built environment (mostly at the city level). Part of why AZ ranks so poorly in pedestrian deaths is due to the driving behavior of Arizonans – which is the 5th worst in the country (as measured by a constellation of injury and death criteria). Not sure what interventions are there though.

Building Momentum for a Safe System Approach to Reduce Road Traffic Injuries in the United States | American Journal of Public Health | Vol. 114 Issue 6

Another concern in the most recent NHTSA data is Interstate 17 between Phoenix & Flag.  I-17 was identified as the 9th deadliest stretch of highway in the US… highlighting the critical need for improvements along I-17 to reduce traffic-related fatalities and make it safer for all road users. Fortunately, ADOT is in the middle of a multi-year process to improve safety and congestion on I-17 (see ADOT’s I-17 Project Area Website).

More info, summary data available at States With the Best & Worst Drivers 

& NHTSA’s: Fatality and Injury Reporting System Tool

Will Humble Professional Development, Wills Blog

APHA Webinar: Public Health Service Loan Forgiveness Program

Jun 11, 2024 12:00 PM in Arizona

Webinar Registration – Zoom

Join Public Service Promise for a FREE expert-led webinar with Susan Polan, Associate Executive Director for Public Affairs and Advocacy, American Public Health Association. The webinar, for APHA members and anyone in the public health field, will explain how to obtain student loan relief from the Public Service Loan Forgiveness Program.

Betsy Mayotte, an expert on student loans and President of The Institute of Student Loan Advisors, will walk through the requirements of qualifying for the program and will answer general questions about how to navigate the application process.

The PSLF program is administered by the U.S. Department of Education and is designed to forgive the student loan balances of those employed by a government or non-profit organization.

Public Service Promise is a new non-profit that works with unions, along with non-profit and government entities, to educate public servants about the process for obtaining student loan forgiveness through the PSLF. Public Service Promise does not provide individualized financial counseling or legal advice.

Will Humble Air Quality, Climate Change, Public Health, Wills Blog

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

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.

This week we cover how the Commission’s decisions can have a direct impact on the air we breathe.

First things first, what is the ACC? They are the elected officials and staff who are tasked with regulating electricity, gas, water, and telecommunications. While that might sound pretty dry, the choices they make ripple out into our daily lives, especially when it comes to our health and air quality.

The type of energy the ACC promotes via their policy decisions can either help improve air quality or make it worse.  When the commissioners make decisions to incentivize renewable energy sources like solar and wind, they’re doing us all a huge favor. These clean energy sources don’t spew out harmful pollutants. That means no soot, no smog – just pure, clean air.

But…  when commissioners have the backs of the utilities that they’re supposed to be regulating rather than voters and ratepayers, they lead us down the path toward worse air quality. Legacy energy sources favored by many utilities like coal and natural gas are major polluters. They emit nasty stuff like carbon dioxide, sulfur dioxide, and nitrogen oxides. These pollutants can lead to smoggy skies and a host of health issues, from asthma to heart disease. 

Continued reliance on fossil fuels means more pollutants in the air, more health problems, and higher healthcare costs. It’s like a domino effect – poor energy choices lead to poor air quality, which leads to poor health.

But, when the ACC pushes utilities to include more renewable sources of electricity by scrutinizing their sources and provide them financial and regulatory incentives to shift solar farms, rooftop solar, or wind turbines, they’re cutting down on these harmful emissions. This shift not only helps fight climate change but also means cleaner, healthier air for all of us.

It’s not just about clean air. The ACC’s decisions also have a direct impact on public health. Cleaner air means fewer respiratory issues, less heart disease, and a lower risk of some cancers. It means fewer sick days and hospital visits, and more people living healthier, happier lives.

So, the next time you hear about the ACC making a decision, remember it’s not just bureaucratic mumbo-jumbo. It’s about our health and the quality of the air we breathe.

Let’s keep an eye on their decisions and support the candidates who promote clean energy and a healthier future for Arizonans, our topic in Part V.

Will Humble Public Health Law, Wills Blog

AZPHA Ballot Proposition Arguments Filed

Every cycle the Arizona Secretary of State generates a publicity pamphlet to help educate voters ahead of the general election. The pamphlet includes arguments in support of and against citizens’ initiatives and legislative referrals. It’s a feature of the Clean Elections voter initiative from several years ago. The publicity pamphlet is a key educational resource for voters to use before voting.

As Arizona’s independent voice for public health, we’ve played a key role i5n helping voters to understand the public health implications of the various ballot measures. One way we do that is to send arguments for and against ballot propositions focusing on the good and bad public health impacts. Last cycle AZPHA placed arguments for or against 5 of the 10 ballot propositions.

This cycle the window for getting arguments filed is May 20th – June 20th. The arguments are posted in order they are received so it’s a good idea to get arguments early so voters see our stuff first.

There are already 6 ballot measures set for the 2024 ballot (not including the upcoming voter-driven Arizonans for Abortion Access). Three have direct impacts to public health / public health policy and a 4th will the AZ for Abortion Access initiative. The Open Primaries initiative also connects with public health by engaging more independent voters.

AzPHA Presentation: 2024 Ballot Measures

Last week our AZPHA Board of Directors approved our Public Health Policy Committee’s recommendation to take a position on 5 of the ballot measures. Our ballot arguments have been completed and filed with the Secretary of State.

Here are links to our Arguments:

Anybody can turn in an argument. Simply write up an argument (300-word limit) and submit it to the General Election Ballot Measure Argument Portal along with the $75 fee. Portal is open through July 3.

Will Humble Reproductive Health, Wills Blog

Hobbs Sparks Review of Arizona’s ‘Essential Health Benefits’ for Reproductive Health

One of the primary features of the Affordable Care Act was the establishment of marketplace health insurance plans that folks can buy – with most qualifying for subsidies scaled to income to make the plans affordable.

While the math for the subsidies was set by the feds, the coverage those plans offer in each state were a hybrid of criteria set by the feds (the 10 essential health benefits). Governors have some influence too, as they get to select a ‘benchmark plan’ that defines minimum benefits in each essential health benefit category.

Back in 2014, Governor Brewer picked the AZ State Employee ‘EPO’ Plan as the benchmark for Arizona’s Marketplace plans. Ever since then, Marketplace plans have needed to cover (at a minimum) the same benefits as the state employee plan.

Other commercially available plans need to be “substantially equal” to the state employee benchmark plan in scope, limitations, and exclusions (e.g. visit limits).

At the time, I opined on my ADHS Blog that the choice was a good one because it had a robust behavioral health component with fewer limitations, restrictions and exclusions than most other options- and already covers behavioral health services at parity (meaning behavioral health has the same level of coverage as physical health).

To my knowledge, the Ducey administration never made any changes to that benchmark plan.

Hobbs Proposing Changes

Last week Governor Hobbs issued an Executive Order that makes over-the-counter birth control options available at no cost to State employees, ordering an analysis of the costs & benefits of requiring expanded contraception coverage for other health insurance plans, and requiring AHCCCS to consider ways it can expand access to contraception for its members.

See: Katie Hobbs issues executive order expanding access to contraception

Buried in the Executive Order, but getting little fanfare, was a provision that directs ADOA and the Department of Insurance & Financial Institutions to examine the benchmark plan established in 2014 and look at the benefits & feasibility of setting a new benchmark plan that would mandate provision of additional reproductive healthcare benefits among commercial and marketplace insurance plans in AZ.

AHCCCS has been tasked with a similar charge – to examine benefits and feasibility of expanding Medicaid benefits among a host of reproductive health criteria (by June 30, 2024).

Hobbs issues executive order expanding access to birth control for state government workers • Arizona Mirror

Because the ACA is federal legislation and the law gives governors the authority to set minimum coverages by establishing a benchmark plan, her action won’t need legislative approval. AHCCCS would need approval from CMS to extend reproductive health benefits. 

Note: The Order is limited to examining Arizona’s essential health benefits through the lens of reproductive health.

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