The Stay shouldn’t impact most of our daily business in managing our current contracts.  Areas like the Office of Health Care Development and the Office of Individual and Family Affairs will need to restrict their activity related to the transition until the Stay Order is lifted.  Our legal staff will also be providing advice on daily work in those areas as it relates to preparation for integrated care versus actual transition of services.  More to come…

As I’ve written before, we started the process of revising the rules for Licensed Midwives about a year ago and we’re coming near the end of the process.  My main goal has been to improve the entire system- including coordination with EMS and hospitals as well as data collection and analysis, oversight, and emergency planning… with the goal of ensuring (to the extent we can) the health and safety of moms and newborns.

Anyway- one of the issues the demonstrators were discussing  is the administration of medications like oxygen and Pitocin by Licensed Midwives.  The current rules outline several emergency measures to be performed before emergency personnel arrive in cases where the health of the mother or newborn is at risk.  These rules outline guides for the administration of some medication (oxygen, Pitocin).  The rules currently in effect require a Licensed Midwife to identify a physician that has agreed to provide back up, consultation, and a prescription for these medications.

Some in the midwifery community would like the ADHS to grant the authority for midwives to obtain and administer medications on their own (without consulting a physician)…  however that would require a change in state law that I have no authority to make because it requires a statutory change.  When I explained that I don’t have the authority to permit midwives to obtain and administer medications without consulting a physician, a member of the committee (a midwife) asked us to remove all references to medications.  I’m inclined to keep the current medication rule language so at least these meds will be in scope (in consultation a physician).

Another provision that’s controversial in the current and proposed new rule asks women to take certain blood and urine tests as a condition of having a licensed midwife attend their homebirth.  In the draft rules, there are a handful of tests that women need to take if she wants to have Licensed Midwifery services.  These tests (HIV, Hepatitis B, blood glucose, and blood Rh factor) are the only way for the midwife to establish that the birth will be low risk and safe for the health of the newborn and mom.  The mom-to-be can still refuse the tests, but that means she wouldn’t be able to have a Licensed Midwife present during the home-birth because it wouldn’t be possible to determine if the birth is low-risk and suitable for a home delivery.

The parties on the Advisory Committee still don’t agree on several points.  Hopefully, the draft final rules for public comment that we publish next week will get the parties closer to at least grudging consensus.  If there’s still gross disagreement about the final regulations, we could always just scrap the entire effort and keep using the existing scope of practice.

I’ve talked a lot recently about how where you live impacts your health. ADOT and ADHS teamed up to produce the Active School Neighborhood Checklist. This handy tool helps bring together teams (which might include public works, parents, teachers and health professionals) to assess routes to school and decide what major challenges exist for the students who wish to walk or bike.  These teams provide a really great opportunity for bringing health into the conversation. 

Research is really producing many new tools to assess the built environment and how that impacts health. An easy tool to use is WalkScore, where you simply input an address and get a score output on a scale of 0-100, with 100 being “Walker’s Paradise.” In fact, check out what ASU is doing to examine the relationship between Walk Score and urban housing.

Fortunately, there are things you can do to protect yourself and your family. Stay Cool, Stay Hydrated, Stay Informed is the mantra – whenever you can, avoid the heat of the day. Go into an air conditioned place and cool off if you have to be outside. Drink lots of water – if you’re indoors all day, you should be drinking about 2 liters of water. When you’re outside, try to drink 1-2 liters every hour… and stay informed – a good place to do that is our extreme heat website. 

Our Extreme Weather and Public Health program focuses on heat related illnesses by enhancing surveillance and strengthening communication during Extreme Heat Advisory Days.  We’ve also developed innovative toolkits targeting identified vulnerable populations.  You can learn how to Protect yourself from heat with some resources on our website including our Heat Brochure and our School, Older Adult, and Outdoor Worker toolkits.  Also, here’s our Heat Emergency Response Plan.

Hygiene tips include not swimming when you (or your kids) have diarrhea, reminding your kids not to swallow pool water, and practicing good hygiene (shower before swimming and wash your hands after changing diapers).  And remember- little kids should have a swim diaper…  and always change diapers in the bathroom or diaper-changing areas (not poolside).  You can visit our Waterborne Disease site and a new CDC report about fecal contamination in pools to learn more. 

This year we’ll be holding a healthy swimming video contest to build awareness of safe swimming.  Kids can create a 2-minute healthy swimming video to help educate people about safe swimming including sun safety, staying hydrated while swimming, and preventing the spread of germs at pools, lakes, and water parks. The deadline for submission is June 16^th and the website has the complete details and contest rules. The winning video will be used in a statewide water safety campaign. Last year’s winning video is up on YouTube.

Heat is one of the most dangerous weather situations in public health – actually it’s the #1 weather-related killer.  Last year 152 Arizonans died from heat exposure….  with 80% happening in June, July and August.  The largest age group for heat-related deaths are people over 55 (75% are men).  We also had about 2,500 emergency department visits and 548 hospital admissions from heat illness last year.  You can see why we work hard to educate people about the danger of heat and hold a water drive every year via social media.  

We’re also launching our annual water drive this month.  Last year, team ADHS brought in more than 60,000 bottles of water that went to outreach groups and shelters for those who need help escaping from the heat, like the elderly, those who can’t afford to cool their homes and the homeless.

The Centers for Medicare and Medicaid Services put up $1 billion to entice better care and lower costs in healthcare.  CMS will award money to projects that specifically improve comprehensive health and wellness; improve care for people with special needs; reduce the cost for patients on AHCCCS and in Medicare; and for providers to change financial and clinical models. 

For example – a program that helps a population fight diabetes or one that helps integrate behavioral health care with primary care might be selected.  Funds are available to non-profits, communities, healthcare providers, provider groups, faith-based organizations – almost every type of company, government or partnership. 

Folks who are interested have to send in a Letter of Intent by June 28^th.  You can find out more on the CMS Frequently Asked Questions page.

Recently the hospital hit ten-month lows in the use of seclusion, restraint and patient falls… all as a result of new efforts that have been put in place to create culture change that engages patients and staff in the overall success of treatment.  The focus on Recovery, Trauma Informed Care using evidenced-based are all coming into full swing and present opportunities to even further improve the lives of patients on the campus.  Anyone interested in applying of for the position should submit an application through the State of AZ Jobs Site and look under the Department of Health in the agency section.