NAMI Report

March 21st, 2011 by admin No comments »

The National Alliance on Mental Illness released a report this month that included policy recommendations for states to consider including educating the public, families and peers about mental illness and incorporating behavioral health screening into primary care.  The good news is that we’re on the mark here in Arizona as we’ve already begun to implement most of the national recommendations.

This spring we began rolling out Mental Health First Aid, which is an evidence-based public education program designed to teach non-professional people about mental illness.  The program teaches a five-step process to assess a situation, select and implement appropriate interventions, and help a person in crisis or who may be developing the signs and symptoms of mental illness.  We’ve also taken steps to integrate behavioral and physical healthcare by hosting the Arizona Integrated Models of Care in Behavioral Health and Primary Care Forum which brought together people from the behavioral and community health fields.

We’ve also creatively found other ways to increase of peer support organizations participation, developed greater transparency for consumers to choose treatment options that are best for them with our on-line dashboard, opened opportunities for consumers to help transform the behavioral health system with our Raise Your Voice forums, and released a toolkit on Integrating Culturally Diverse Communities into Planning for and Responding to Emergencies.

Japanese Radiological Emergency

March 18th, 2011 by admin 3 comments »

All of us are exposed to natural radiation on a daily basis. It mostly comes from space (called cosmic rays) as well as natural radioactive materials found in the soil, water and air.  People can also be exposed to radiation from human-made sources like X-ray machines.

Radiation doses are usually measured in units called milli-Sieverts.  On average, people are exposed to approximately 3.0 milli-Sieverts per year.  Most of this (80%) is from naturally-occurring sources (i.e. cosmic radiation) with the rest coming from the medical use of radiation.  If a nuclear power plant doesn’t work properly (as is the case right now in Japan), radioactivity may be released into the surrounding area by a mixture of products generated inside the reactor (“nuclear fission products”). The main fission products are radioactive cesium and iodine.

We’re working with our federal and local partners and 3 of our state agencies to keep close tabs on the radiological situation in Northern Japan.  Most of the radiation is dissipating rapidly in the environment (because of distance and the short half-life of the elements released).  The international community and the federal government have been doing some modeling and some of the models suggest that very low levels of radiation is crossing the Pacific Ocean.  The models suggest that there could be very small increases in natural radiation in North America including Arizona in the coming days.  The levels would be very low and of no health consequence, but nevertheless measurable by the sensitive instruments that already exist and routinely test for radiation all the time.  For example, if the situation in Japan would continue as-is for several weeks, the total exposure in N. America would be comparable to the amount of radiation that you would get flying from AZ to New York (about 0.04 milli-Sieverts- or about a 1% increase from average annual background).

The EPA posted a new Japanese Nuclear Emergency website today, which includes a daily data summary.  Today’s update shows that the US’s radiation air monitors showed typical fluctuations in background radiation levels today.  As I mentioned earlier, the models suggest that there could be slight increases in the coming days.

Between the state and federal agencies monitoring the situation, we’re confident that there would be no health consequences to the people in Arizona.  But, there are stories that some folks are buying potassium iodide (which saturates your thyroid with iodide) because they’ve heard somewhere that it would provide some benefit (it doesn’t under the current circumstances).  We’re concerned that people are taking medication that they don’t need and could create problems for themselves.  That’s why we put out a notice to the folks of Arizona today suggesting that they not take potassium iodide supplements because:

  1. It’s not necessary because of what’s happening in Japan and provides no benefit;
  2. It can be dangerous to people with allergies to iodine, shellfish or who have thyroid problems; and
  3. Taken inappropriately, it can have serious side effects including abnormal heart rhythms, nausea, vomiting, electrolyte abnormalities and bleeding.

There have even been some calls to some poison control centers over the last couple of days from folks that have taken potassium iodide thinking it would be a good idea (it’s not).

For more information on the emergency in Japan, including answers to some frequently asked questions, visit the Arizona Emergency Information Network (AzEIN) website at email questions to

Palo Verde Nuclear Generating Station Full-Scale Exercise

Our preparedness team recently participated in a federally evaluated Palo Verde Nuclear Generating Station Full-Scale Exercise to test our response to a simulated radiation contamination at Palo Verde.  The exercise simulated an event whereby people, food or drinking water could become contaminated because of a release of radioactive materials into the atmosphere.  During the exercise we practiced and successfully tested our capabilities to coordinate with other agencies in responding to this type of incident.  Our focus under the response plan included the providing contamination control measures to protect the public from eating or drinking any contaminated food or water, guidance on the health effects of radiation exposure, distributing potassium iodide (there is a stockpile here in the state and nationally), coordination with the CDC, and support for local public health agencies and hospitals.  Here’s a link to our Emergency Response Plan including our Radiological Response Plan.

AZ Bills Related to Marijuana

March 16th, 2011 by admin 42 comments »

Controlled Substances

A few years ago, an Arizona law was passed that established a Controlled Substances Prescription Monitoring Program which requires pharmacies and medical practitioners who dispense Schedule II, III, and IV controlled substances to a patient, to report prescription information to the Board of Pharmacy on a weekly basis.  The purpose of this legislation is to improve the State’s ability to identify controlled substance abusers and refer them for treatment, and to identify and stop diversion of prescription controlled substance drugs in an efficient and cost effective manner that will not impede the appropriate medical utilization of licit controlled substances.  Despite the passage of the Arizona Medical Marijuana Act, marijuana remains classified as a Schedule I controlled substance- but because of the way the Act was written, physicians would have no way of checking the database for their patient’s marijuana use as a Qualified Patient.

House Bill 2585 would require the Board of Pharmacy’s controlled substances monitoring program database controlled substances monitoring program database to include people that have a medical marijuana card issued by ADHS.   If the bill passes and is signed, we would share the data regarding who our Qualified Patients are (for marijuana use) so that doctors have access to that information before making a decisions about how to manage their patient’s medical condition- just like they can with other controlled substances.


Another Bill being evaluated is House Bill 2541, which addresses some gaps in current statute around the employer employee relationship.  Under Arizona Medical Marijuana Act, the existence of marijuana metabolites does not mean that employee is under the influence of marijuana.  House Bill 2541 does a few things to help employers be able to navigate the change in law.  Most significantly, the bill more clearly defines the term “impairment” with a set of symptoms similar to what we would all commonly understand.  Things like slurred speech, the inability to walk, appearance, and strange behavior are outlined as impaired.  This is pretty much what a police officer looks for when doing a field sobriety test for a suspected DUI.  It also clarifies that an employer can take action against an employee who is impaired at work.

Another part of the bill defines a new term called a “safety-sensitive position” which is exactly what it sounds like, a job that could impact the safety of the public or other employees.  Things like operating heavy manufacturing equipment would fall under this category.  The importance of this definition is that the law also allows employers to exclude employees from performing safety-sensitive jobs if they believe the employee is engaged in current drug use.

Lastly, the bill also helps protect employers from legal action by defining “good faith” and outlines some ways that an employer can act in good faith when determining if an employee is impaired.  This bill goes a long way towards helping employers keep the job site safe and gives them clear direction when they have an employee that is a medical marijuana card holder.

Mental Health First Aid Rolling

March 15th, 2011 by admin No comments »

The first round of Instructor Training for Mental Health First Aid was completedin Tucson and our efforts are already paying huge dividends.   23 new trainers graduated from the intensive 5-day training program and are now certified Mental Health First Aid Instructors!   The new trainers include peers, family members, behavioral health providers, T/RBHA staff, Pima Community College and Cochise College employees, community health center providers, a faith-based leader, and a person from the Veteran’s Administration system.   We’re scheduling 2 more of these 5-day Instructor Training courses for the coming months and dozens of the 12-hour community training classes as well.  Our goal is to get thousands of Arizonans trained to:

  1. assess a situation;
  2. select and implement appropriate interventions; and
  3. help a person in crisis or who may be developing the signs and symptoms of mental illness.

Cross-cutting Marijuana Team Hitting on All Cylinders

March 14th, 2011 by admin 8 comments »

Under the provisions of the Arizona Medical Marijuana Act we had 120 days to get the entire program up and running.  A short timeframe for this complex program (to say the least).  That gives us until close of business on April 13, 2011 to have everything ready.  That means we’ll need to finish the Rulemaking (our goal is March 28), including finishing the regulatory system for approving, renewing, and revoking the registration of qualifying patients, designated caregivers, nonprofit dispensaries, and dispensary agents.  We also need to be finished with the development of a sophisticated information technology system that’ll track a whole host of data, including on-line application systems for patients, caregivers and agents.  The on-line applications will be ready for testing next week.  By the way, the applications for qualified patients, caregivers and agents will be 100% electronic with no-walk in traffic.  There are dozens of moving pieces right now, but pretty much everything is on track

We released our first “Notice of Intention to Bid” to find a contractor for secure registration cards and printer equipment today.  The idea is to find a vendor for the next year that will provide the cards, printer equipment, accessories, installation, technical support, training and equipment maintenance for the cards that we’ll be issuing for qualified patients, caregivers and dispensary agents.  We’ll be paying for this service with the card application fees that we’ll be collecting starting next month.  The bid is called ADHS11-00000543 on Procure AZ and it closes Friday, March 18 at 3 p.m.

Building Healthy Chefs @ AZ Pre-schools

March 11th, 2011 by admin No comments »

Our Bureau of Nutrition and Physical Activity just completed a series of free cooking-based nutrition trainings for childcare providers in Arizona.  The Cooking Matters curriculum from Share our Strength, as part of the Wal-Mart Foundation Health Initiatives, gives childcare providers the opportunity to learn how to prepare healthy meals and snacks on a limited budget and create a positive food environment for the children in their care.  The hands-on trainings are engaging and learner-focused while empowering providers to recognize their role in establishing healthy attitudes and behaviors towards food.

As a result of their participation, they’ll develop confidence in cooking and preparing meals and making smart choices about foods.  They’ll be able use these strategies to increase kids’ acceptance of healthy foods and maximize their food resources.  These free trainings directly align with our successful Empower program and new childcare rules.  This is a great example of leveraging resources and working across departments and programs within ADHS for a healthier Arizona.  Check out the pictures on the Flickr.

Well done and thanks to Adrienne Udarbe and Saidee White for their work on the demonstrations and implementation of the piloting of the curriculum, Helen Uganst in Child Care, who coordinated and recruited the participants, and Hazel Valdez who did the first two food demos as her externship for the Culinary Arts Program.

New Forensic Hospital Transition Team

March 10th, 2011 by admin No comments »

Construction of our brand new Forensic Unit at the Arizona State Hospital<> is proceeding on schedule, and we’re looking forward to turning the key late this fall.  To get ready, we’ve pulled together a “Transition Team” to start planning the transition.  The Forensic team has recently organized their treatment units and approaches to focus not only on psychiatric symptom stability but also pro-social skill development and engagement.  The transition into the new facility provides an opportunity for these new approaches to be applied to like groups of patients in their various phases of recovery with the ability to be organized by unit.  Our new transition team is looking for opportunities to develop staff teams for these units and groups of patients with skill sets to better meet the therapeutic needs of the patient group.  Additionally, we’ll study the new hospital environment and develop safe procedures for operation.  Having a safe environment will ensure the therapeutic environment will have the optimal outcomes for our patients.  By the end of 2011, the new forensic hospital will be fully operational with this enhanced organized approach.

Pre-March 28 Medical Marijuana Certifications

March 9th, 2011 by admin 40 comments »


As I was looking through a weekly publication in the Phoenix area I noticed that there are several physicians that are already advertising their services for medical marijuana evaluations and certifications for a fee.  Some of the ads and websites seem to imply that the certifications that physicians are writing right now will be valid for getting an Qualified Patient identification card from the Arizona Department of Health Services once the law takes effect on April 14.  This is not the case.

The Department is still in the process of finalizing the Administrative Code (Rules) for the entire program- including the physician certification requirements that will be required when applying for an Arizona Medical Marijuana Qualified Patient Card.  While we haven’t completed the Rules, we’re certain that we’ll be requiring that applicants submit a written certification from a physician on a form developed by the ADHS that will include a series of physician attestations.  Since this form does not yet exist, whatever forms patients are receiving from physicians right now will not meet our future requirements for getting an ADHS medical marijuana qualified patient identification card.

Our goal is to complete the Rulemaking by March 28.  We also expect to publish the official required physician certification form on our website on March 28.  The official start for the program will be April 14- and that’s the first day that we expect to be accepting applications for AZ Qualified Patient Medical Marijuana Cards.  We will begin processing applications for cards on April 14; however the application will need to contain a physician certification on our final form that will be available March 28.  If a patient has had a medical appointment prior to March 28 and received some kind of certification or sheet of paper- the patient will need to ask their physician to fill out and sign the official form in order to receive an AZ Medical Marijuana Qualified Patient Card.

It’s not appropriate for me to give advice regarding whether or not folks should or shouldn’t see physicians right now for consultations regarding whether or not they could benefit from medical marijuana- but I felt compelled to get information out there that the forms that are being filled-out and signed by physicians right now won’t meet our future requirements for receiving an AZ Medical Marijuana Qualified Patient Identification Card from the Arizona Department of Health Services.

Assisted Living Technical Assistance

March 8th, 2011 by admin 3 comments »

Our Assisted Living Licensing Office is working hard to get the message out about important (and exciting) changes taking place in the program, like our new Online Renewal System.  Representatives from the Office are meeting with the Arizona Board of Examiners of Nursing Care Institution Administrators and Assisted Living Facility Managers, the Long Term Care Ombudsman, Adult Protective Services, AHCCCS, the Foundation for Senior Living, and the Arizona Board of Nursing, as well as various Assisted Living provider organizations, to give short presentations about the office and ways that we can work with the community and other agencies to protect the health and safety of Assisted Living residents throughout the State.  In addition to discussing changes in the Office, these networking meetings will help those organizations help us when we have facilities in need of our assistance.

Healthcare Associated Infections Report

March 7th, 2011 by admin No comments »

Good news this time.  The number of bloodstream infections in intensive care unit patients with central lines decreased by 58% over the last 10 years according to a new CDC Vital Signs report. This decrease saved 27,000 lives and $1.8B in excess health care costs. Bloodstream infections in patients with central lines can be deadly, killing as many as 1 in 4 patients who gets one.

Most hospital Infectious Disease Committees follow central line infections very closely these days. Back in the day (about 10-15 years ago), it was common practice to put in central lines at the bedside with only a pair of sterile gloves. Now most hospitals require full gowning, face mask, and cap, along with full sterile draping of the patient. This is even required now in many ORs for central lines put in patients right before surgery.

You can check out our website dedicated to preventing Healthcare Associated Infections.   We also help facilitate communication through the hospital association for facilities that are participating in the national collaborative “On the Cusp” to prevent blood stream infections.  Part of our strategic initiatives for 2011 is to help address blood stream infections in hemodialysis units so our prevention efforts will be extending beyond acute care hospitals.

By the way- a “central line” and a simple “IV” are different things.  Central lines are inserted into large veins  and are pretty big because they need to handle a large volume.  Simple IV’s usually go into veins.  IV’s have a much lower risk of infection.