Will Humble Climate Change, Wills Blog

Climate and Health Advocacy Boot Camp

DATES: RUNNING THURSDAYS SEPTEMBER 29 – OCTOBER 27, 2022

TIME: 12 – 1:30 P.M. AZ Time 

Health professionals are the most trusted voices in society and our collective voices are needed to prepare communities to effectively respond to the climate crisis.

Through this 5-week bootcamp, you will grow your network by joining colleagues around the country to learn strategies to effectively channel your voice and action as a health professional to address the “greatest health threat” of the 21st Century.

Video recordings will be available for asynchronous view following each session.

Register Here
Will Humble Climate Change, Wills Blog

Public Investments in Electric Charging Infrastructure Makes Economic Sense: Here’s Why

There are many rational reasons why the government should invest in emerging markets especially when their products have tangible public health benefits. Some people argue we shouldn’t invest public dollars in electric charging infrastructure – that the private sector should take care of it- like with gas stations. 

Here’s a summary of how gas stations and electric charging are different from the dispassionate point of view of an economist: former AzPHA Board member Dr. Matt McCullough:

  • Gas stations are a mature market while electric charging stations are a very new/emerging market. Government involvement in new or emerging markets is far more common—and economically rational—than government involvement in mature markets.
  • A first-mover disadvantage exists where consumers shy away from EVs due to “range anxiety” since relatively few EV charging stations exist. This leads to a smaller EV market share, which leads to fewer EV charging stations being built. Which leads to more “range anxiety.” Basically, if you don’t build it, they won’t come.
  • EV charging stations face a first mover disadvantage (nobody has much incentive to build the first EV charging station but once others exist the incentive changes/grows). This means that we should not necessarily expect the private market alone to quickly create a robust charging network.
  • Compared to electric-powered vehicles, gasoline-powered vehicles impose much different societal costs in terms of externalities. When there are externalities—meaning the full costs of consumption of a product are not borne by the producer/consumer—there is some rationale for government involvement in the market. This is especially true when the mature market has externalities that the emerging market can help reduce.
  • Simple market forces won’t necessarily produce a coordinated network of charging stations. The tragedy of the commons suggests that while overall EV producers (and society) will recognize the value of a robust, coordinated network of chargers, there’s little incentive for any one EV company to build this on their own. It makes more sense for any given company to sit on the sidelines while the other companies pay for things.
Will Humble Climate Change, Environmental Health, Wills Blog

ADOT Turns in Strong Electric Vehicle Infrastructure Deployment Plan

It’s not often that we have an opportunity to praise state agencies during the Ducey administration… but this week we’re happy to be able to praise the Arizona Department of Transportation.

A couple weeks ago ADOT turned in their draft Electric Vehicle Infrastructure Deployment Plan to the Joint Office of Energy and Transportation. It took our consortium to couple of weeks to dive into the details and assess how good a job ADOT had done using the National Electric Vehicle Infrastructure Formula Program to help Arizonans. The Joint Office will review the draft plan and supply comments by Sept. 30. Changes may be made before the Sept. 30 approval date. 

We’re delighted to report that ADOT did a good job- a remarkable statement to be able to make about a state agency during the Ducey administration.

ADOT’s plan includes annual goals and an annual assessment that can lead to revisions as the agency believes necessary. In the first year, ADOT’s plan includes upgrading existing DC fast charging stations within one mile of Alternative Fuel Corridors and closing charging gaps with new stations.

Their plan also recommends that the Arizona Corporation Commission craft utility rates to offset the lifetime cost of the charging station. That’s important because utility rate plans that incentivize charging during off-peak hours can benefit both the EV owner through reduced costs and Arizona utilities through improved electrical grid utilization.

The ADOT plan ADOT has six goals:

  • Reduce range anxiety by closing gaps in the EVSE network along Arizona’s Alternative Fuel Corridors.
  • Support the development of an EVSE network that is resilient, fair, accessible, and reliable.
  • Engage stakeholders and the public in the planning, development, and installation of EVSE.
  • Find potential new Alternative Fuel Corridor locations during the outreach process.
  • Use efficient contracting and procurement mechanisms to maximize the amount of infrastructure that can be built, consider future needs, and reduce risk to support the EVSE network’s long-term viability.
  • Use data and performance metrics to evaluate EVSE installation and operations to inform the development of program improvements

The bottom line is that ADOT’s plan sets the stage for the next administration to be successful in using National Electric Vehicle Infrastructure funds, helping more infrastructure to support faster market uptake of electric vehicles in Arizona.

Will Humble Family Planning, Reproductive Health, Wills Blog

Pima County Judge Hears Planned Parenthood v. Brnovich Reproductive Health Case

Outcome Will Determine Whether Arizonans Will Have Access to Abortion Services

Arizona is one step closer to learning whether access to abortion is legal in Arizona and if so, under what circumstances. Pima Superior Court Judge Kellie Johnson heard the Planned Parenthood v. Brnovich case last Friday afternoon but didn’t make a ruling. She said she’ll make a decision within 60 days but not before September 20.

The case involves Brnovich’s motion to lift a 1973 injunction staying the implementation of a territorial-era law [ARS 13-3603] which is still on the books:

13-3603. Definition; punishment A person who provides, supplies or administers to a pregnant woman, or procures such woman to take any medicine, drugs or substance, or uses or employs any instrument or other means whatever, with intent thereby to procure the miscarriage of such woman, unless it is necessary to save her life, shall be punished by imprisonment in the state prison for not less than two years nor more than five years.

The injunction he’s trying to lift is from a case filed in Superior Court in 1971 by Planned Parenthood of Tucson who had challenged the law. After the federal court in Arizona wouldn’t take the case, Planned Parenthood sued then-Arizona Attorney General Gary Nelson in Pima County Superior Court.

Planned Parenthood made many arguments including an implied right to privacy in the U.S. Constitution, an overreach of police power and that low-income people were unfairly impacted because they couldn’t afford to go to another state for an abortion.

Superior Court judge ruled for Planned Parenthood in 1972 saying that that the 1864/1901 laws were unconstitutional and placed an injunction against enforcing it. Nelson appealed to the Arizona Court of Appeals, who initially overturned the Superior Court decision in January 1973. A few weeks later the U.S. Supreme Court made its landmark ruling in Roe v. Wade and the appellate court then reversed their decision and modified the injunction.

That’s the injunction that our illustrious Attorney General is trying to lift, and that Judge Johnson heard arguments about last week.

See this paper to read Planned Parenthood’s arguments in the landmark 1971 lawsuit

AzPHA Special Report: Restrictions on Women’s Reproductive Freedom in Arizona: 1884-2022

Regardless of whether Judge Johnson rules for Planned Parenthood or Brnovich – the loser will appeal to the Arizona Supreme Court – which is now packed full of Ducey appointees.

An Evidence Review: Does Withholding Abortion Services Harm Public Health?
Arizona Abortion Statistics & Clinic Regulations
Here’s a good 7-minute interview with AzPHA member Jen Piatt, JD by Ted Simons painting a clear picture of the legal lay of the land
Will Humble Public Health Law, State Legislature, Wills Blog

Several Measures Directly & Indirectly Impacting Public Health Will Be on the Ballot: It’s Time to Get Up to Speed

There are several high profile and very important election races that’ll be on the ballot this fall, none more important than the race for governor. With the state legislature sure to be even further to the right that the last one (with the loss of people like Speaker Bowers and Senators Boyer and Pace), and the state supreme court now packed with Ducey appointees, the only check and balance in the system we’ll have will be the governor.

The Secretary of State race is of course important because it goes to the core of our democracy (the SoS oversees elections). The Attorney General is also a very important position – although it has been badly politicized over the last 7.6 years. And then there’s the all-important US Senate race and all of the races for county attorneys, state legislators, school boards and many other positions.

It can be overwhelming for voters. On top of all of that, there will be at least 8 and maybe as many as 11 propositions on your ballot.

There will be 5 constitutional amendments including changes to how elections are handled, how voter initiatives need to be crafted and the threshold needed to pass them, property tax exemptions, and one that creates the office of Lieutenant Governor. These are all 100 Series measures because they change the constitution.

There will be 3 legislative referrals on your ballot. These will be 300 Series propositions because they were referred to the ballot by the legislature and then modify earlier voter initiatives. Those are about allowing Dreamers graduating from AZ schools to get in-state tuition at public AZ colleges & universities, changing what’s required in order to vote, and modifying how rural fire districts are funded.

On top of that, there may be 3 voter initiatives on the ballot (if they survive legal challenges by deep-pocketed special interests). Those cover transparency regarding campaign contributions, election laws, and guardrails for debt collection.

Over the last several years, AzPHA has become an increasingly credible source of information for Arizona residents… as such, we can play an important role in informing the electorate about the potential public health impacts of the various voter initiatives and referenda (good and bad).

[Because of our 501 c3 nonprofit status we’re not supposed to weigh in on candidates- but we can weigh in on ballot measures]

So far, AZPHA has only taken a position on the Predatory Debt Collection Act (Yes)… but our Board of Directors is open to taking a position on other measures. The first step in the process is to have our public health policy committee make recommendations to the board. The board then decides whether to ask AzPHA members whether we should accept the Board’s recommendation to support or oppose a measure.

AzPHA Public Health Policy Committee Meets Friday to Discuss Support/Opposition to Several Voter Initiatives & Referenda

We’ll be having a special AZPHA Policy Committee meeting next Friday (August 26) at 2pm to discuss several voter initiatives and referenda that may impact public health. By the end of the meeting, we hope to be able to make a recommendation to the AZPHA Board whether to support/oppose/or be neutral on 5 different initiatives or referenda.

Note: If you’re not a member of the Public Health Policy Committee, send me an email at [email protected] and I’ll add you to our policy committee basecamp.

If you plan on attending, please do some homework first. You can start by reviewing the following blog posts. There are links to the actual initiative or referenda language inside each post:

Initiatives
Legislative Referendum

You should also review the Publicity Pamphlet Summaries below. On Friday we’ll be focusing on the Initiatives and Referenda in bold. We may go further later and review other ballot measures, but we’re starting with the ones in bold below.

Voter Initiatives

Prop I-4-2022 – Voters’ Right to Know Act

Prop I-5-2022 – Predatory Debt Collection Protection Act

Prop I-16-2022 – Arizona Fair Elections Act

Legislatively Referred Initiatives

Constitutional Amendments

  • Proposition 128 – Voter Protection Act Fiscal Note
  • Proposition 129 – Initiatives; Single Subject; Title Fiscal Note
  • Proposition 130 – Constitutional Property Tax Exemptions Fiscal Note
  • Proposition 131 – Lieutenant Governor; Joint Ticket Fiscal Note
  • Proposition 132 – Initiatives; Supermajority Vote; Fiscal Note

Legislative Referrals (things that would change a previous voter initiative)

  • Proposition 308 – Tuition; Postsecondary Education Fiscal Note
  • Proposition 309 – Voter Identification; Affidavit; Fiscal Note
  • Proposition 310 – Fire Districts; Funding; Fiscal Note
Will Humble Climate Change, Wills Blog

Climate and Health Advocacy Boot Camp

THURSDAYS SEPTEMBER 29 – OCTOBER 27, 2022

12 – 1:30 P.M AZ TIME

Video recordings will be available for asynchronous view following each session.

Register Here

Health professionals are the most trusted voices in society and our collective voices are needed to prepare communities to effectively respond to the climate crisis.

Through this 5-week bootcamp, you will grow your network by joining colleagues around the country to learn strategies to effectively channel your voice and action as a health professional to address the “greatest health threat” of the 21st Century.

Will Humble Injury Prevention, Public Health, Wills Blog

Prior to the Ducey Administration, the ADHS & Academia Collaborated on Worker Safety

Former Director Christ Ended the Collaboration

During the Brewer Administration the ADHS and academia collaborated on several projects to better inform worker safety regulatory work including one that examined the utility of using the hospital discharge database to improve the effectiveness of ADOSH regulation of worker safety.

One such project resulted in the journal article below. Soon after former Director Christ took over leadership at ADHS all such collaboration stopped.

Arizona Hospital Discharge and Emergency Department Database: Journal of Occupational and Environmental Medicine

Abstract: The goal of the project was to identify trends in emergency department visits and inpatient admissions for occupational injury and disease frequency and describe the financial impact from specific clinical groups known to have occupational risk factors.

Workers’ compensation cases among 19 million records in the Arizona statewide hospital discharge database (HDD) were assessed for seven clinical groups from 2008 to 2014, including back, cardiac, carpal tunnel syndrome, heat-related, psychiatric, pulmonary, and trauma.

Cases with cardiac, psychiatric, and pulmonary diagnoses were both frequent and expensive. Although incidence was generally stable, charges per case rose significantly over the time period.

Inpatient and emergency department records supply valuable data that complement other surveillance approaches for both occupational illnesses and injuries. Tracking charge as well as incidence data is useful.

Will Humble Injury Prevention, Wills Blog

Worker Safety Regulation Slipshod During the Ducey Administration: The Details

There are a number of important public comments in the record documenting the Ducey Administration’s slipshod implementation of worker safety regulations in Arizona. Below is among the most informative of the comments:

Establishing and adopting occupational safety and health standards is fundamental to OSHA enforcement. Enforcement of such standards is the keystone to protecting employees from exposure to hazards shown by research and experience to be harmful to employees.

As established by Congress in the 1970 OSH Act, states are allowed to form an OSHA-approved state plan provided they develop and enforce standards that are “at least as effective” as those established by OSHA. Adopting OSHA safety and health standards, when they apply, is not optional and must be completed in 6 months.

Additionally, adopting OSHA directives such as operation manual updates, inspection emphasis programs, and enforcement procedures is also important to maintaining an effective state plan.

As indicated by OSHA, the Industrial Commission of Arizona (ICA) failed to adopt in a timely manner, or even at all, several major OSHA standards and compliance directives. 

When the ICA fails, or delays, to adopt new safety standards and directives as required, workers under its jurisdiction are denied protections afforded by Congress. In the case of OSHA’s silica standard, the ICA adopted it some 27 months after OSHA was already enforcing it in states under Federal OSHA.

Simply, ADOSH cannot enforce standards before and until the ICA adopts them. To claim that ADOSH is at least as effective as OSHA when it has not adopted or created equal or better occupational safety and health standards to enforce is preposterous.

Other workplace safety & health responsibilities the State leadership failed to meet:

  • The ICA failed to promulgate OSHA-required occupational safety & health standards and to cooperate with Federal OSHA to maintain the state plan as effective as the OSHA program as required by Arizona Revised State (A.R.S.) 23-405.
  • The ICA frequently deleted citations before issuance after the initial burden of proof was established and, in some cases, severely reduced monetary penalties.
  • The ICA Commission was composed of four members instead of five as required by A.R.S. 23-401 for the better part of six of the last seven years. (Stacking the Commission to ensure diminished enforcement?)
  • Workplace safety & health enforcement inspections conducted by ADOSH fell from 1,218 in 2017 to 540 in 2020. The agency completed 530 inspections in 2019. ADOSH’s inspection goal in 2020 was 1,295.**
  • Serious, willful, and repeat workplace safety violations issued by ADOSH fell from 1,003 in 2017 to 444 in 2020.*
  • The number of safety and health compliance inspectors at ADOSH fell from 24 in 2017 to only 17 in 2020.**

The obvious conclusion: Arizona State leadership has failed to fully protect Arizona workers as required. Revocation of final approval and reinstatement of Federal concurrent authority in Arizona is warranted. Concurrent enforcement should remain in place until such time as State leadership clearly demonstrates the will to correct its deficiencies and maintain performance of at least the most fundamental requirements.

The fact that such action is warranted at all is a travesty. Retaining exclusive local jurisdiction over occupational safety & health enforcement provides several advantages to Arizona in terms of service and responsiveness. The privilege should have been better safeguarded by State leadership.

The State leadership’s performance in the issues discussed demonstrates a low regard for the rights of Arizona workers as guaranteed by Congress. It also reflects disdain for Arizona lawmakers who previously worked to establish the State Plan and maintain the privilege. Regardless, Arizona’s performance in enforcing occupational safety and health is unacceptable and must be immediately corrected if the Act is to mean anything at all.

Here are some additional substantive comments in the public record. Here are some anonymous comments from likely ADOSH insiders: https://www.regulations.gov/comment/OSHA-2021-0012-0225 and documentation of inadequate staffing and mismanagement by the ICA of the OSHA grant: https://www.regulations.gov/comment/OSHA-2021-0012-0229

Link to current comments:  https://www.regulations.gov/docket/OSHA-2021-0012/comments?sortBy=postedDate&sortDirection=desc

Will Humble Injury Prevention, Wills Blog

OSHA Reopens Comment Period On Proposal to Revoke Ducey Administration’s Worker Health & Safety Program

Right now, enforcement of federal worker safety laws is the responsibility of the Arizona Industrial Commission via the Arizona Department of Occupational Safety and Health (ADOSH).

However, the US Department of Labor’s Occupational Safety & Health Administration (OSHA) has recognized a pattern of lax or even nonexistent enforcement of federal worker safety requirements in Arizona during the Ducey Administration & is in the process of revoking Arizona’s state plan- meaning the fed’s would take back the responsibility for worker safety compliance in Arizona.

Per the U.S. Labor Department: “In April, the Department of Labor issued the proposal in response to the Arizona State Plan’s nearly decade-long pattern of failures to adopt and enforce standards and enforcement policies at least as effective as those used by the department’s Occupational Safety and Health Administration.”

See: Slipshod Enforcement of Worker Safety Regulations Compels OSHA to Begin Revocation of AZ Industrial Commission Delegation Agreement

In a last-ditch effort to keep the enforcement of labor laws in Arizona, ADOSH conceded that they have been doing a bad job and committed to several measures to address concerns (e.g., increasing maximum penalty amounts and adoption of standards and enforcement directives that were past due). The Federal Register notice will include a list of Arizona’s completed measures.

Up until this point, Governor Ducey appeared to be willing to cede ADOSH authority to OSHA given his only public statement on this matter is that this action is a “political stunt and power grab”.

Rather than proceeding with revocation of the Department of Labor’s delegation agreement with Arizona, OSHA reopened the comment period for an additional 60 days on their proposal to revoke Arizona’s State Plan for Occupational Safety and Health.

The additional 60-day comment period will allow stakeholders the opportunity to comment on ADOSH’s actions and the impact those actions should have on OSHA’s proposed revocation of the State Plan’s final approval. After the Federal Register notice is published, stakeholders will be able to submit comments online using Docket No. OSHA-2021-0012 on the Federal eRulemaking Portal.

Editorial Note: The Ducey Administration has a long history of having been captured by industry when it comes to enforcement of worker safety laws. OSHA doesn’t revoke delegation agreements unless there is a long-standing pattern of non-compliance.

I’m sure OSHA knows full-well that nothing is going to really change during the last 140 days of the Ducey Administration. They might withhold their judgment about whether to revoke the state plan to see if they believe the next governor will actually be committed to worker safety.

____________________

Example of the Comments in the Public Record About the Ducey Administration’s Worker Safety Regulation Track Record
(It’s Not Pretty)

There are a number of important public comments in the record documenting the Ducey Administration’s slipshod implementation of worker safety regulations in Arizona. Below is among the most informative of the comments:

Establishing and adopting occupational safety and health standards is fundamental to OSHA enforcement. Enforcement of such standards is the keystone to protecting employees from exposure to hazards shown by research and experience to be harmful to employees.

As established by Congress in the 1970 OSH Act, states are allowed to form an OSHA-approved state plan provided they develop and enforce standards that are “at least as effective” as those established by OSHA. Adopting OSHA safety and health standards, when they apply, is not optional and must be completed in 6 months.

Additionally, adopting OSHA directives such as operation manual updates, inspection emphasis programs, and enforcement procedures is also important to maintaining an effective state plan.

As indicated by OSHA, the Industrial Commission of Arizona (ICA) failed to adopt in a timely manner, or even at all, several major OSHA standards and compliance directives. 

When the ICA fails, or delays, to adopt new safety standards and directives as required, workers under its jurisdiction are denied protections afforded by Congress. In the case of OSHA’s silica standard, the ICA adopted it some 27 months after OSHA was already enforcing it in states under Federal OSHA.

Simply, ADOSH cannot enforce standards before and until the ICA adopts them. To claim that ADOSH is at least as effective as OSHA when it has not adopted or created equal or better occupational safety and health standards to enforce is preposterous.

Other workplace safety & health responsibilities the State leadership failed to meet:

  • The ICA failed to promulgate OSHA-required occupational safety & health standards and to cooperate with Federal OSHA to maintain the state plan as effective as the OSHA program as required by Arizona Revised State (A.R.S.) 23-405.
  • The ICA frequently deleted citations before issuance after the initial burden of proof was established and, in some cases, severely reduced monetary penalties.
  • The ICA Commission was composed of four members instead of five as required by A.R.S. 23-401 for the better part of six of the last seven years. (Stacking the Commission to ensure diminished enforcement?)
  • Workplace safety & health enforcement inspections conducted by ADOSH fell from 1,218 in 2017 to 540 in 2020. The agency completed 530 inspections in 2019. ADOSH’s inspection goal in 2020 was 1,295.**
  • Serious, willful, and repeat workplace safety violations issued by ADOSH fell from 1,003 in 2017 to 444 in 2020.*
  • The number of safety and health compliance inspectors at ADOSH fell from 24 in 2017 to only 17 in 2020.**

The obvious conclusion: Arizona State leadership has failed to fully protect Arizona workers as required. Revocation of final approval and reinstatement of Federal concurrent authority in Arizona is warranted. Concurrent enforcement should remain in place until such time as State leadership clearly demonstrates the will to correct its deficiencies and maintain performance of at least the most fundamental requirements.

The fact that such action is warranted at all is a travesty. Retaining exclusive local jurisdiction over occupational safety & health enforcement provides several advantages to Arizona in terms of service and responsiveness. The privilege should have been better safeguarded by State leadership.

The State leadership’s performance in the issues discussed demonstrates a low regard for the rights of Arizona workers as guaranteed by Congress. It also reflects disdain for Arizona lawmakers who previously worked to establish the State Plan and maintain the privilege. Regardless, Arizona’s performance in enforcing occupational safety and health is unacceptable and must be immediately corrected if the Act is to mean anything at all.

Link to existing public comments 

Will Humble Professional Development, Wills Blog

Guest Piece: AzPHA Member Dr. Len Kirschner: 57 Years of Medicare & Medicaid

57 years of Medicare & Medicaid

If you like anniversaries, here is one to remember. Saturday, July 30, is the 57th anniversary of LBJ going to the Truman Library to sign the Social Security Amendments of 1965. They were Title 18 and 19. The legislation has been described as two compromises and an afterthought.

Part A was a compromise with American Hospital Association. Part B was a compromise with the American Medical Association. Medicaid was an afterthought, added at the end of the debate.

It was going to be a really small program (were they wrong). At the signing, LBJ spoke about Medicare but not a word about Medicaid. Harry got Medicare card #1 and Bess #2. Their Part B premium was $3 per month. Mine is higher.

Prescription drugs were considered for Medicare, in 1965, but did not make the legislation. Prescription drugs were an option for states and, eventually, all added them to the benefits package for their Medicaid programs.

I have a copy of a letter from Joe Califano (Special Assistant to the President) to John Gardner, Secretary of HEW dated August 21, 1967. It is labeled as ADMINISTRATIVE CONFIDENTIAL and EYES ONLY. I got it from the archives at the LBJ Library. Joe wrote:

“Review the report of the Task Force on Prescription Drugs and make recommendations relating to the inclusion of prescription drugs in Medicare and on ways to reduce the cost of drugs.”

W signed MPDIMA in 2003, adding prescription drugs to Medicare. That did not solve the problem and the Senate is debating the subject this week. After 57 years you would think the Congress would get it right. Not likely.

Salud y Buen Suerte!

Leonard Kirschner MD,MPH

Colonel USAF (Retired)

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