Archive for the ‘General’ category

Medical Marijuana Sales Tripled in 2014

January 16th, 2015

DWe published our end-of-year annual medical marijuana report this week.  Dispensary marijuana sales were three times higher than in 2013.  Dispensaries sold over 9 metric tons (about 10 US tons) of marijuana in 2014 for an estimated gross revenue of about $110M.  There were 1,433,808 individual sales in ‘14 (among the 55,000 patients), with an average of 26 transactions/patient/year.  The average patient bought 166 grams of marijuana in 2014.  At 2 joints/gram, that’s an average of 1 joint per patient per day last year.

Transaction data is broken down by age group in the report.  Patients in the 18-30 age range had more transactions and sales than any other age group, representing 26% of total sales.  Fridays are the busiest day of the week at dispensaries, and New Year’s Eve was the busiest sales day in 2014.

The large increase in sales at dispensaries is probably because fewer patients were authorized to cultivate their own marijuana in 2014 (compared to 2013).  The Arizona Medical Marijuana Act allows patients that live further than 25 miles from a dispensary to cultivate their own marijuana.  Now that we have more than 85 dispensaries operating throughout the state, about 98% of patients live within 25 miles of a dispensary, and very few patients are now allowed to self-cultivate.

Ebola Epidemic Index Case Identified?

January 15th, 2015

ebolaA 2 year-old boy from Guinea appears to be what we call in our business the “Index Case” for the West African Ebola epidemic.  In epidemiology, an Index Case is the first documented case of an illness that spreads to others.  The 2 year-old appears to have been infected by playing in a hollow tree that housed a colony of free-tailed fruit bats (Mops condylurus).

A group of scientists made the connection on an expedition to Meliandou, the boy’s tiny village of 31 houses.  They took samples and collected and analyzed a host of evidence and concluded that the boy contracted Ebola from the bats or their droppings in the hollow tree.  The team’s findings are published in EMBO Molecular Medicine this week.

Arizona’s Paramedic Training: Excellent Results

January 14th, 2015

PArizona’s Paramedic training programs are taught by a combination of colleges, private training centers, and fire departments.  A typical Paramedic course is over 1,000 hours of class room, hospital and ambulance time covering anatomy, physiology, pathophysiology, pharmacology, terminology, and hours and hours of assessment and proficiency tests on a multitude of skills.

To become certified as a Paramedic in Arizona, a student needs to pass a national certification exam.  The written and practical test assesses comprehension and performance of the course material.  In 2014, 95% of the students that took the national certification exam passed (327/345).  That’s an improvement from 2013 when the Arizona pass rate was 89%…and a testament to Arizona’s Emergency Medical Services (EMS) training programs.  The national pass rate has remained steady at 86% for the past two years.  Great Job, Arizona EMS Training Programs.

Staying in the Saddle

January 9th, 2015

Rendered Arizona FlagWe’ve had a great run together since I accepted the Interim ADHS Director position 6 years ago.  I’m grateful to all of you for trusting me in this important position and for working together for the benefit of the folks of Arizona.  We’ve made tremendous progress toward our Vision of Health and Wellness for all Arizonans over the last 6 years.  The public health interventions we implemented are based on evidence and incorporate measurable performance measures to benchmark our progress.

We overhauled our regulation of licensed healthcare institutions by developing and implementing new and modern regulations that are aligned with evidence-based criteria.  Because the new regulations are focused on public health outcomes, we set the stage for improving the quality of care in Arizona’s licensed healthcare institutions for years to come.

We shifted the Department’s behavioral health system to focus on the core principles of Recovery and adopted outcome-based performance measures to monitor and to improve the effectiveness of Arizona’s behavioral health system, resulting in real and measurable improvements in people’s lives.  We integrated physical and behavioral healthcare for folks living with a serious mental illness – a reform that will continue to improve outcomes.  We implemented evidence-based interventions at the Arizona State Hospital that are measurably improving the quality of care for our patients and families.

Our public health preparedness programs are world-class and our prevention activities continue to be used nationally as models of excellence and best practices.  We made tremendous strides toward: 1) Improving the State’s ability to prepare for and respond to communicable disease outbreaks; 2) Reducing obesity and smoking rates; 3) Lowering teen pregnancy rates; 4) Reducing healthcare associated infections; 5) Improving the public health effectiveness of Arizona’s pre-hospital system; 6) Reducing prescription drug misuse and abuse; 7) Improving survival after an out of hospital cardiac arrest; 8) Developing a modern trauma system in rural Arizona; 9) Improving maternal and child health in high-risk communities; and 10) Using data to drive our surveillance and intervention initiatives.

Our Operations teams have made our business operations more transparent, efficient, and customer friendly.  Our information technology, procurement, accounting, administrative council and rules, audit and special investigations and personnel teams implemented quality improvement measures that have and will continue to improve the efficiency of our Agency.

Finally, we’re on track toward national accreditation as a state health department, completing the State’s first comprehensive State Health Assessment in 2014.  We’re also on track to developing the first ever Arizona Health Improvement Plan.

This week Governor Ducey’s team asked me to stay on as the ADHS Director, and I accepted.  I’ll be working with our new Governor and his team in the coming days and weeks as we press ahead with our Vision of Health and Wellness for all Arizonans.

Teen Pregnancy and Births

January 7th, 2015

teenpregnancyTeen pregnancies and births continued to be a challenge for us in 2014, but we continued to see encouraging results.  Having a baby as a teenager impacts the mom, the dad, the baby and the whole community.  Teen parents often don’t finish high school, which in turn, reduces their ability to financially take care of their newborn – resulting in an estimated $11B per year in increased health care, foster care, incarceration, and lost tax revenue nationwide.

Arizona’s teen birth rate decreased 10% in the last year according to last year’s Preliminary Birth Data for 2013.  Since 2009 our teen birth rate has dropped more than 30%…from 10,725 in 2009 to 7,222 in 2013.

We’ve been providing teen pregnancy prevention education since the mid 1990’s.  This sustained effort with evidence-based interventions is one factor that has contributed to the decline in teen pregnancies.  There are literally thousands of kids around the state learning about healthy relationships and the impact of having a baby before they are ready.

Another example of evidence-based program is the home visiting program run by the Nurse Family Partnership.  First-time moms who enroll work with registered nurses in a home setting find the support they need to have a healthy pregnancy, improve their child’s health and development, and become more economically self-sufficient.  A number of the first-time moms that enroll in this program are teen mothers that receive information and support on a number of topics including how to prevent a subsequent pregnancy.

American Medical Response’s Application Approved

January 5th, 2015

LAW hammer on computer folder. 3D Icon isolated on white backgroThis morning I approved American Medical Response’s (AMR Maricopa) application to operate ambulances in Maricopa County (called a Certificate of Necessity or CON).  I approved the Certificate of Necessity after reviewing a host of evidence presented to an Administrative Law Judge and her Order recommending approval.  The official notice will be posted on the Office of Administrative Hearing website this week.

In order to operate an ambulance service in Arizona an applicant needs to demonstrate that: 1) there’s  a “public necessity” for their services; 2) they have the finances and operational skills necessary to operate the service; and 3) they can provide high quality clinical care and evaluate their service with a performance improvement plan.

Our Agency will be requiring AMR to comply with the statutes and ground ambulance rules.  In addition, we’ll be requiring AMR to:

  • Negotiate with cities and towns to improve response times;
  • Work with hospitals to meet bedside arrival time requirements for inter-facility transports;
  • Have a robust, on-going benchmarking and performance improvement process that encompasses all components of the EMS system from emergency medical dispatch through emergency department arrival;
  • Collect and submit electronic patient care reports consistent with our EMS Bureau’s guidelines;
  • Adopt clinical guidelines and operating procedures for time sensitive illness and injury; and
  • Initiate guideline-based pre-arrival instructions for all callers accessing 9-1-1 for assistance.

The CON requires AMR to emphasize communication and coordination with Arizona communities and hospitals and requires AMR to undergo accreditation with a national accreditation organization.

Infectious Disease Preparedness & Response

December 31st, 2014

counciloninfectiousdiseaseThe Ebola virus, influenza, enterovirus, tuberculosis, and other emerging infectious diseases posed key public health challenges in Arizona during 2014, sparking important interventions.  In October the Governor issued an Executive Order establishing the Council on Infectious Disease Preparedness and Response to develop and implement a coordinated plan to ensure Arizona’s public health infrastructure is prepared for the outbreak of diseases like the Ebola virus, influenza, enterovirus, tuberculosis.

The Council examined existing preparedness plans and identified and filled key gaps in Arizona’s response plans and delivered a Report to the Governor that includes a series of new protocols and procedures that improve patient and community safety and strengthens Arizona’s public health and healthcare readiness to effectively deal with emerging infectious diseases.

There were 2 key pieces to improving our Ebola virus response readiness:

  • Developing a protocol for monitoring travelers and clinicians that are returning to Arizona from the affected countries.  A total of 41 persons have returned to Arizona from the affected countries since we began our active monitoring in October.  Thirty-two of them have completed their 21-day monitoring period and 9 are still being monitored.
  • Fleshing out the details of the emergency medical services and hospital response in case a returnee becomes ill.  The University of Arizona Health Network joined the Maricopa Integrated Health System this year by committing to become an Infectious Disease Treatment Center of Excellence.  As a result, Arizona is better able to develop a seamless infectious disease response plan as new infectious diseases emerge; ensure smooth patient transport; avoiding unnecessary healthcare worker and community exposures; and allow other hospitals to focus on screening and diagnosing patients.

Updated EMS Rules Finalized

December 26th, 2014

Emergency VehiclesEmergency Medical Services will also be improved thanks to some new rules that will take effect on January 1.  The new rules (filed last week) make it easier for a patient who meets certain criteria to be taken to someplace other than an emergency department.  The new rules also allow some emergency medical care technicians to carry additional medications they may need when treating a patient.

The Certificate of Necessity (CON) “Pipeline”

December 16th, 2014

EAmerican Medical Response’s (AMR) isn’t the only application in the pipeline.  A number of fire departments along with private groups are applying for CONs right now.  Some are farther along in the application process than others.

Why all the interest in running an ambulance company?  Rural Metro’s bankruptcy has probably played a role along with the Affordable Care Act.  Also, hospitals are now beginning to contract with Emergency Medical Services (EMS) agencies to help reduce the number of patients being re-admitted to the hospital for chronic disease management – a new revenue source for EMS agencies.

Administrative Judge Recommends Approving New Ambulance Service Application

December 9th, 2014

Emergency VehiclesLate Monday, an Administrative Law Judge issued an Order recommending that I approve American Medical Response of Maricopa’s (AMR) application to operate ambulances (certificate of necessity or CON) in all of Maricopa County.

We regulate ambulance services differently than most states.  In order to operate an ambulance here the applicant needs to meet a number of requirements including demonstrating that:  1) there’s “public necessity” for the services they want to provide; 2) they have the finances and operational skills necessary to operate the service; and that 3) they can provide high quality clinical care and evaluate their service with a performance improvement plan.

An application for a CON triggers a process that starts in our Bureau of EMS and Trauma System where we  evaluate the application to see if it’s complete.  Once that’s done, we notify folks in the area about the proposed CON.  If the application is uncontested, then it comes directly to me for a decision.  If the application is contested (as this one was), it goes to a hearing before a judge at the Office of Administrative Hearings.

The Administrative Law judge evaluates the application and the evidence presented during the hearing and issues a recommendation.  The Judge sends the recommendation (called an Order) to me, and I have 30 days to make a decision.  I can:  1) deny the application; 2) accept it as-is; 3) accept the application with amendments; or 4) allow the recommendation to take effect without acting.

The Judge reviewed several criterion in AMR’s application (public necessity, billing rate, fiscal and operational experience, clinical excellence, negative financial impact on the current provider).  The Order concludes that: “In view of the foregoing, it is recommended that the Director approve the proposed Application, directing BEMSTS to issue a CON to American Medical Response of Maricopa, LLC (“AMR”) upon AMR’s confirmation that it is ready to immediately assume all rights and responsibilities under that CON.”

Before I make a decision, I’ll review the hearing record, the application and the judge’s decision and Order.  I’ll be paying particular attention to how the Judge came to her conclusion.  Stay tuned.