A legislative committee was told Nov. 17 that the Department of Health Services will have a behavioral health plan that will be accepted next month by a judge who for years has been critical of the state’s efforts to deal with the mentally ill.

With an agenda full of controversial issues, the Senate and House Health Committee of Reference also, after lengthy testimony, recommended continued life for state boards that license and regulate dentists and naturopathic physicians.

On the behavioral health issue, Maricopa County Superior Court Judge Pro Tem Bernard Dougherty ordered DHS last month to prepare a detailed report by mid-December on how it will comply with court orders under Arnold v. Sarn to remedy problems cited in a court-ordered audit.

Arnold v. Sarn is a class-action lawsuit filed more than 20 years ago, in 1983, on behalf of patients who were not getting mental health services from the state. Mr. Dougherty had the original case and continues to oversee it as a court monitor even though he retired as a judge in 2001. He said the audit showed that the state still fails to deliver adequate mental health services.

“We are aggressively pursuing corrective actions to these findings,” DHS Deputy Director Leslie Schwalbe told the committee. “We believe we can achieve resolution with the plaintiffs and the court monitor.”

Mr. Dougherty also questioned the state’s $450 million per year, three-year contract with ValueOptions, a large company that was rehired in July to manage and provide mental health services to 50,000 clients, 17,000 of them classified as seriously mentally ill. A state audit this year gave a favorable review to adult behavioral health services, but some clients have testified they were treated badly.

Ms. Schwalbe told the committee DHS did not adequately enforce its previous contract with ValueOptions.

“What we learned from our last contract throughout the system was it didn’t have enough teeth in it,” she said. “So, as of July1, quite frankly, we were able to take a higher level of enforcement on our contractors if they fail to perform.”

Ms. Schwalbe said DHS is preparing an analysis of future costs to take care of Arizonans who are considered seriously mentally ill. The cost five years ago, she said, was $500 million.

Arizona Medical Board

The committee then reviewed an auditor general report on the Arizona Medical Board, which Sen. Carolyn Allen, R-8, and Rep. Deb Gullett, R-11, requested after receiving letters about the executive director’s dismissal of certain complaints regarding patient care and alleged malpractice and high staff turnover.

The report concluded that most of the dismissals were justified but that high staff turnover hampered some investigations.

The Legislature this year rescinded its previously granted authority to the board’s executive director to dismiss complaints about malpractice. The board now must handle all such complaints.

The board, which has licensed 16,000 physicians, including 8,000-10,000 who are in active practice, is in the process of selecting a replacement for executive director Barry Cassidy, who has resigned effective next month. Four finalists from 80 applicants were scheduled for interviews Nov. 20.

“This is a board that is in transition,” said Stuart Goodman, the board’s lobbyist.

The case that got the most attention was that of Dr. Bradley Schwartz, a Tucson eye physician who was indicted last month for conspiracy to murder his former medical partner, David Stidham. The case drew questions from the medical community and members of the committee about why Dr. Schwartz was permitted to practice after federal drug indictments and an admitted addiction to narcotic and stimulant drugs.

“It’s all about patient safety, and you guys are on the front line,” Ms. Gullett told Mr. Goodman.

Last year the Medical Board placed Dr. Schwartz on probation and prohibited him from prescribing controlled substances. Mr. Cassidy said the board followed proper procedures in reinstating Dr. Schwartz’s license after he went through drug treatment.

Mr. Goodman told the committee, “The board acted responsibly and quickly on these issues. I don’t think we could have predicted the bigger, badder issue.”

“You can understand how I couldn’t possibly sit through this hearing without bringing this up,” said Sen. Toni Hellon, R-26.

Finalists for Mr. Cassidy’s replacement as of Nov. 18 were: Mary Blubaugh, executive administrator, Kansas Board of Nursing; Timothy Miller, bureau chief for Consumer Rights, Arizona Department of Health; Michael Kerns, deputy executive secretary, Arizona Corporation Commission, and Julie Chapkpo, executive director, Arizona Board of Dental Examiners.

Under the state “sunset” law that requires state agencies and boards to be reviewed regularly by the Legislature, the committee recommended 10-year extensions for the state Board of Dental Examiners and the state Naturopathic Physicians Board of Medical Examiners. The recommendations will be presented to the Legislature in the form of bills, which then must pass and be signed by the governor.

The committee heard lengthy testimony about specific treatment methods in both professions.

Although the use of amalgam, or “silver,” fillings is on the decline, there remains a long-running debate over their safety because they contain a mercury compound, and critics of amalgam fillings called for dissolution of the dental board, saying it has failed encourage dentists to inform their patients about the dangers of mercury.

“Rather than take its role seriously under sunset law, the committee chose to follow the wishes of the Arizona Dental Association,” Charles Brown of the Coalition for Mercury-Free Dentistry said in a press release issued after the hearing. “No Arizona agency merits shutting down and starting over more than the state dental board.”

Speaking on the board’s behalf, Dr. Rodney Mackert, professor of dentistry at the Medical College of Georgia, told the committee numerous scientific studies have shown amalgam fillings pose no danger to patients or dentists and their staffs, but their use has been cut in half with the development of resins and other alternative materials.

The dental board licenses and regulates more than 5,000 dentists, plus hygienists.

In a 2000 report, the auditor general found that the naturopathic physician board needed improvement in 24 areas, including fiscal management, licensing exams and procedures, bookkeeping and response to complaints. The audit also said the board violated open meetings law and had not guarded against preventing conflicts of interest among its members.

“In short, said Dr. Craig Runbeck, executive director of the board, “the board had developed an unwanted reputation.”

The board licenses and regulates 612 naturopathic physicians and students who promote the use of natural substances and remedies that they say allow the body to heal itself. Naturopaths also are permitted to prescribe certain narcotics and other drugs.

In 2001, the Legislature extended the board for three years to give it a chance to implement changes recommended in the audit.

Dr. Runbeck said all but one of the improvements have been made.

The committee approved a request from the board that the Legislature look into clarifying rules regarding naturopaths’ scope of practice involving intravenous administration of minerals, such as magnesium.

Kathy Boyle, executive director of the Arizona Pharmacy Association, testified that magnesium can be toxic and there should be a separate certification for its use.

Arizona, which has regulated naturopaths since 1935, is one of 13 states and the District of Columbia that li
cense and regulate the profession. —