So are pool and darts. Also video games and pinball.
And you can even participate in axe throwing if that’s your thing.
But leave the dancing shoes at home. For the moment, Arizona remains a dance-free zone.
The changes come as the state Department of Health Services has decided that these activities, which have been forbidden for months under the COVID-19 emergency restrictions, can now be conducted – if certain precautions are taken.
There was no immediate response from the health department to questions about why the sudden change in what’s allowable.
But nothing in the risks from the virus has changed substantially since at least August according to the agency’s own “dashboard” which determines the restrictions on business. In fact, the percent of tests for the virus that have been coming up positive actually is showing an upward trend.
What has changed is that Gov. Doug Ducey and state DHS Director Cara Christ are defending themselves in court against a lawsuit brought by more than 100 bar owners charging that their rules are unlawfully discriminatory. That is because restaurants have been able to open and operate pretty much normally now for months, albeit with some occupancy limits, while bars face additional hurdles not only to open but, if they do, to the kinds of traditional activities that have brought in customers.
Attorney Ilan Wurman, who represents the bar owners, told Capitol Media Services that none of these changes will end that lawsuit. He said there are still unjustified restrictions on how his clients can do business, particularly in comparison to what some places licensed as restaurants have been able to do.
But Wurman said they will make a difference.
“It’s a huge deal,” he said.
For example, he said, some of his clients were promoting special nights for pool or darts tournaments, even though those contests didn’t generate a lot of cash themselves.
“But no one was showing up to have a drink,” Wurman said, without the “draw” of the games.
Still, things won’t look exactly the way they did before the governor enacted his emergency restrictions in March.
Take karaoke.
The person with the microphone has to be at least 12 feet away from the closest customer. Health officials have said that things like singing tend to project moisture particles farther than the normal six-foot “social distancing” barrier.
But with plexiglass dividers in place, six feet is acceptable.
Microphones have to be disinfected or changed out between customers.
And while it may interfere with hitting some of those high notes, participants have to keep their masks on.
More interested in a game of pool?
That, too, is now OK, but with a maximum of four players for a table and no one else gathered around. There has to be that six-foot physical distancing between the players and other game areas. And if players don’t have their own equipment, everything else needs to be disinfected between each group’s use.
Arcade and video games have their own set of rules, with just two players to a machine – and no spectators or cheering section behind them. There also are the physical distancing requirements, whether it’s the six feet of space or closing off every other machine.
Plus, of course, masks are mandatory.
The new rules also account for bowling and even axe throwing, with only the active participant permitted to be out of his or her chair and a limit of no more than 10 players and observers.
And if you have your own bowling ball – or axe – please bring it.
The rules are set up pretty much so that those who are not participating in any activity are supposed to remain seated except to play or go to the bathroom. Standing, mingling and dancing remain off limits.
In fact, the rules say if there is a dance floor it has to be closed off to the public or “repurposed” for more seats to allow greater social distancing among patrons.
Arizona has not actually been game-free all this time. Wurman pointed out that some enterprises that sell alcohol but are licensed as restaurants, like Dave and Buster’s, have had arcade games all along.
What this does, he said, is level the playing field and allow facilities licensed as bars to compete head-to-head.
A sports bar is empty before it closed early Monday, June 29, 2020, in Phoenix. Arizona Gov. Doug Ducey has shut down bars, movie theaters, gyms and water parks amid a dramatic resurgence of coronavirus cases. (AP Photo/Matt York)
The number of confirmed coronavirus cases in Arizona has now surpassed 100,000, and younger people, not the elderly, make up more than half of them, state health officials said Monday.
The Department of Health Services said more than 62,000 of the 101,441 reported cases involve people younger than 44.
Department Director Dr. Cara Christ said it’s people between 20 and 44 who can drive community spread of COVID-19. Younger people have a much lower risk of serious illness from the virus, although some do get very sick or die.
“That’s the biggest concern, is that they’re not at risk, they’re out in public potentially getting exposed.,” Christ said. “They’re also more likely to be asymtomatic or only have mild symptoms, and then potentially could bring it home to an individual who’s at high risk for complications.”
“It’s a huge fear,” she said.
Two weeks ago, Republican Gov. Doug Ducey allowed cities and counties to require face masks to help prevent the spread of the virus. The majority of the state’s population now is under a mask order. Last week, Ducey ordered bars, gyms and movie theaters to close for three weeks in Arizona, which leads the U.S. in new virus cases per capita. The action has drawn criticism from Republicans and defiance from one metro Phoenix chain of health clubs.
But Christ said those nightclubs, bars and gyms are where transmission is more likely. And she pushed back at a gym chain that has sued to challenge the closure order, saying telvision news video showed Mountainside Fitness was not taking needed steps to prevent transmission.
“They’re not requiring masks, they’re not requiring physical distancing, we don’t witness them spraying down the machines afterward,” Christ said. “And we know that when you exercise you’re inhaling and exhaling more forcefully, which increases the transmissibility of the virus.”
Lawyers for Mountainside, which operates 18 gyms in metro Phoenix, were in court Monday and argued that no COVID-19 cases have been traced to an Arizona gym. They also said the state has no rational basis for shutting down gyms that were following the state’s protection guidelines, while letting restaurants and hair salons remain open.
The governor’s attorneys said the order is sound because there’s an increased likelihood of being infected with COVID-19 through respiratory droplets when people exercise vigorously indoors.
A judge said he plans to rule Tuesday on the request to throw out Ducey’s order to shut down.
Totals released Monday by state health officials include an additional 3,352 confirmed cases and one new death. However, they said the figures may be an undercount because of a lag in reporting from hospitals over the weekend. The number of reported COVID-19 deaths stands at 1,810.
Arizona remains high in terms of positive tests and coronavirus hospitalizations. While the test positivity rate nationwide is around 9%, Arizona’s total is around 13.4%, and last week was above 23%. The number of hospitalized COVID-19 patients on Sunday was 3,212, a new high, according to state data. Hospital capacity statewide is currently around 89%.
Arizona’s has seen cases double in the past two weeks, a huge rise that Christ hopes will begin to slow in a week or two as the impact of mask and closure orders is felt.
Ducey reopened the state on May 15 after a six-week stay-home order and other closures, and cases started climbing about two weeks later, after crowds started re-appearing at bars and nightclubs and more people started circulating.
Christ said younger people especially didn’t think they could be affected, and went out.
The mask and bar closure orders are aimed at them in particular, she said.
“We did a really great job messaging to our vulnerable populations, our elderly, our long-term care facilities and out congregate settings about the risks,” she said. “And I don’t know that our younger population associated the risk of COVID 19 with them.”
Worldwide, the number of infections is thought to be far higher than reported numbers because many people haven’t been tested and studies suggest people can be infected without feeling sick.
The coronavirus causes mild or moderate symptoms such as fever and cough for most people. But for some — especially older adults and people with existing health problems — it can cause more severe illness, including pneumonia, and death.
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Associated Press writer Jacques Billeaud contributed.
The number of Arizonans hospitalized with positive or suspected cases of COVID-19 shot past 1,000 on June 1, raising questions from the state’s former health chief about whether Gov. Doug Ducey should have abandoned his stay-at-home order.
The figure, a record, comes amid what has been a steady upward trend since the Department of Health Services began tracking the numbers in early April.
Gov. Doug Ducey
It also follows the setting of another record last week, with 635 positive cases reported from tests conducted on May 26.
There is some fluctuation in those daily numbers, with reports sometimes taking days to be filed with the state. And even the Department of Health Services says that illnesses within the past four to seven days may have yet to be reported.
But here, too, there is a general upward trend.
Overall, the state reported 24 new deaths on June 2, bringing the total for Arizona up to 941.
And the Biodesign Institute at Arizona State University, which keeps its own records, said there has been a steady increase in the number of new cases.
Using a 7-day average, the institute says the state is generating an average of 519 new cases a day. By contrast, on May 15, when the stay-at-home order expired, the average number of new cases was 378 a day.
And that move followed Ducey agreeing to allow bars and restaurants to reopen and to ease restrictions on other businesses.
Will Humble
Will Humble, executive director of the Arizona Public Health Association, told Capitol Media Services the figures give him some concern.
“What it tells me … is that the stay-at-home order was working, because when it ended, it started popping back up again,” he said.
But Humble, himself a former state health director, said the trend also says something else.
“I’m afraid there’s no seasonal effect, or not a significant one,” he said.
“I would have expected to see a moderating effect because of the really high temperatures over the last two weeks,” Humble said. “Instead, you see this uptick in cases starting on the 26th (of May) which continues today.”
What makes the 26th significant, he said, is that the stay-at-home order ended on May 15.
From there, there’s an incubation period of about a week. And then, Humble said, it can take four to six days for lab tests to come back.
Humble said there are several take-aways from the data, particularly the number of patients in hospitals.
“Number One is to keep real good eyes on hospital capacity numbers over the next week,” he said.
“Up until now, there’s been a sense of complacency I think, even in my own mind, that we were going to have plenty of hospital capacity,” Humble said. “But when you see the trends since the 26th, which reflects the end of the stay-at-home order, it makes me believe that at some point there might be a threshold where we’re going to be bumping up against ICU bed and inpatient capacity.”
The most recent figures from the health department show hospitals overall are using 82% of their inpatient beds and the same percentage of intensive care unit beds.
“We don’t want to end up looking like New York and northern Italy,” Humble said. “I didn’t think that was possible two weeks ago.”
Humble said there may be another shoe yet to drop.
He cited several high-profile cases where patrons were swarming in and around reopened bars and restaurants over the Memorial Day weekend, virtually none of whom were wearing masks. There also was a crush of people lined up for tubing on the Salt River, also without facial coverings.
“That was about two weeks ago,” Humble said. “This week is the week I’d expect to see numbers popping up because of the behaviors that happened over Memorial Day.”
He acknowledged that he is looking at the issue strictly from a public health perspective. But Humble, who served under both Democrat and Republican governors, acknowledged there’s a political component in the decisions that have to be made.
“This is a decision for elected officials, especially the governor,” he said. “What’s their tolerance level for having an increased number of cases, recognizing that that has a real-life impact in the community and people’s lives, balanced against his concern about GDP and employment, etc.”
Patrick Ptak said his boss is having no second thoughts on the decisions he made to ease business and travel restrictions.
“The governor stands by his actions,” Ptak said. He said Ducey’s decisions have been guided by recommendations of public health experts and criteria set by the Centers for Disease Control and Prevention to determine what restrictions can be lifted.
Still, he said, the numbers are no surprise.
Cara Christ
“As we continue to increase testing and slowly phase in reopening, we expect to see continued cases of COVID-19,” Ptak said. And he said that, despite the more than 1,000 patients hospitalized with the virus “our hospitals are well equipped and have the capacity to ensure anyone who needs health care has access to it.”
A spokeswoman for current state Health Director Cara Christ echoed the comments about the expectation of continued cases of the virus.
“We know COVID-19 is still in our community, and we encourage everyone to take steps to remain healthy, especially those most vulnerable to COVID-19,” said Holly Poynter. She did not answer questions of whether Christ believes the easing of restrictions was a mistake.
The moves the governor has taken to ease travel and business restrictions he first implemented in March due to COVID-19 apparently have had some impact on his desire to restart the state economy.
New figures from the Department of Economic Security show that only 22,290 Arizonans filed first-time claims for jobless benefits in the week just ended. That is as low as it has been since the outbreak and the gubernatorial orders restricting travel and business activity.
It also brings to nearly 626,000 the number of Arizonans who have sought unemployment aid since the governor’s restrictions were first imposed.
DES also says 59,086 people applied last week for the separate federally funded Pandemic Unemployment Assistance. That is generally available to those who are not entitled to regular jobless benefits, like the self-employed.
But the agency said most of those are people who had first sought regular jobless benefits but were not qualified. Still, DES spokesman Brett Bezio said he could not say how many of the Pandemic Unemployment Assistance applicants already are counted in that 626,000 number.
Bowing to a barrage of bad press, the Arizona Department of Health Services on Thursday reinstated the group of COVID-19 researchers it fired May 4.
In an email sent to the Projections Modeling Team, the department announced an “ongoing partnership” with Arizona State University, which oversaw the work of a group of researchers from the state’s universities.
The department said the work was halted because it worried it was taking too much time from the team of researchers, epidemiologists and economists who it wasn’t paying.
Instead, the state said it would rely on the Federal Emergency Management Agency’s model, which is not public. But the researchers felt their work for the state was too important to stop.
“Since [the “pause”], the Universities and team members have expressed a willingness to continue doing this work,” the email read. “We are grateful for their dedication and we look forward to an ongoing partnership.”
This email surfaced after one volunteer modeler told Yellow Sheet Report that the “pause” was clearly political and a step towards a half-baked justification of reopening Arizona as soon as possible. Dr. Joe Gerald, director of Public Health Policy and Management at the University of Arizona’s College of Public Health, said Gov. Doug Ducey cited unreliable data during his May 4 press conference to announce loosening his stay-at-home order and suggested the cancellation by the executive furthered an effort to reopen the economy..
Additionally, Gerald said the group thinks the Governor’s Office is lifting restrictions too quickly and the moves are short-sighted, if the ultimate goal is leading Arizona down a path of fewer cases and deaths.
“We know more people are going to get sick and more people are going to die. Maybe that’s a tradeoff we’re willing to make,” Gerald said.
Ducey’s chief of staff, Daniel Scarpinato, said that the governor didn’t order the “pause” in the team’s work, didn’t receive a heads-up that it was coming and said that if it were a political decision, it would be a pretty poor one.
“It’s a DHS public health decision that they made – we didn’t make it – we obviously support their decisions because they’re the experts,” he said. “
Scarpinato said the Governor’s Office doesn’t micromanage the department or its director, Cara Christ.
The model was originally developed to estimate resource needs and disease transmission rates, but Lant’s team ran into problems with insufficient testing data and answering the question of when the state could safely reopen became more important. Lant said he and the team also have to deal with a rabbit hole of clarifications, like the degree of the reopening, the tradeoffs of reopening, and what the meaning of “safe” is.
But one thing remained clear, out of the five scenarios the model ran, opening at the end of May would be the “safest” option that would be the least likely to lead to a dramatic increase in COVID-19 cases, Lant said.
Gov. Doug Ducey won’t impose any new restrictions on individuals or businesses despite what appears to be a record number of daily COVID-19 cases and a trend that is pushing even higher.
And he has no plans to extend a moratorium on residential evictions once a federal ban on ousting tenants expires at the end of the month.
The Department of Health Services on Tuesday reported 12,314 new cases. That’s a figure that hasn’t been seen since the beginning of the pandemic.
There also were 23 more deaths, bringing the Arizona total to 6,973.
The numbers reflect what was reported to the agency on Monday, a figure that could include a spike in tests over the weekend. And with delays in those reports, the agency eventually sorts the tests based on the actual date the test is administered.
But what cannot be denied is that even the department’s own day-by-day delayed analysis, after sorting the numbers by actual test dates, shows there were a record 7,645 cases actually reported for Nov. 30. That compares with the June 29 peak of 5,452, the day that the governor concluded he had made a mistake in allowing bars, gyms, water parks and movie theaters to reopen.
Doug Ducey
“We’re fixing it,” Ducey said at the time when asked if he had screwed up in allowing bars to reopen six weeks earlier.
Since that time, though, the governor has relaxed his restrictions, allowing businesses to operate, abeit some at reduced capacity and if they promise to follow certain health protocols.
Those restrictions, though, appear to not be working.
It isn’t just that there are more people testing positive. That could be seen as a result of wider testing.
There’s also the fact that the percent of positive tests also is up — sharply.
For the current week, 23% of those who were checked out were found to have the virus. That compares with 18% the past week and 14% the week before.
The latest spike in positive tests could have repercussions down the road.
At last count there were 3,157 patients in Arizona hospitals with positive or suspected cases of COVID. The last time the figure was that high was July 17.
There also are 744 intensive care beds in use, also the highest since July. And while they represent just 43% of ICU capacity, the number of available beds, including people hospitalized for other reasons, dropped this week as low as 143, which is within 8% of total capacity.
Other indicators point to things getting worse absent some change in conduct.
The Institute for Health Metrics and Evaluation is predicting an average of 55 deaths a day by the end of the year, eventually reaching 73 by the third week of January. That’s even with a rapid rollout of vaccine to the highest risk individuals.
Joe Gerald (Photo by Kris Hanning/University of Arizona Health Sciences)
In his latest forecast, Joe Gerald, a doctor at the Zuckerman College of Public Health at the University of Arizona, predicted dire problems with access to critical care due to shortages of space, personnel and critical supplies.
“If not addressed within the next one to two weeks, this crisis will evolve into a humanitarian crisis leading to hundreds of preventable deaths,” he wrote. “At this point, only shelter-in-place restrictions are certain to quickly and sufficiently curtail viral transmission.”
And even the latest report about Arizona from the White House Coronavirus Task Force, one of the sources Ducey has said he has relied upon, urges Arizona to do more.
“Mitigation efforts must increase,” the report says. That includes “no indoor gatherings outside of immediate households.”
And Ducey’s reaction to all this?
“It’s clear the numbers are moving in the wrong direction and are having a tremendous impact on our health care system,” said press aide C.J. Karamargin. But he had no announcements of any changes in the current regulations.
Ducey does have other powers to deal with the pandemic above and beyond health precautions.
In March he imposed a moratorium on evictions of renters affected by COVID-19, whether due to themselves or a family member with the virus or simply by virtue of having lost a job because of the outbreak. He said this is health related because keeping people in their homes helps prevent the spread of the virus.
Ducey extended his order several times before allowing it to expire at the end of October. But the governor noted at that time there would be no immediate effect because the federal Centers for Disease Control and Prevention had imposed its own moratorium.
That federal bar itself self-destructs at the end of this month. And on Tuesday, citing the rise in COVID-19 cases and that Dec. 31 expiration, Democratic legislative leaders called on the governor to once again protect tenants from losing their homes and apartments.
But Karamargin sad the governor has no plans to step up, saying it’s a federal issue.
“This issues underscores the need for Congress to act,” he said.
Karamargin acknowledged, though, that the governor did not wait for federal action earlier this year. But he said Ducey believes that this should be part of the discussion going on in Washington about the next step in federal coronavirus relief.
But there was no commitment from Ducey to act if there is no new federal moratorium by the end of the year.
Rep. Kirsten Engel, D-Tucson, said that makes no sense given that the governor has advised people that the safest place to be is at home.
“You can only stay home if you have a home,” she said.
The most recent survey by the U.S. Census Bureau shows about 14 percent of Arizonans said they were caught up on their rent. And about 56,000 said they are very or somewhat likely to lose their homes or apartments in the next two months.
While Ducey is unwilling to react to the numbers, legislative Democrats have shown no such reticence.
Some of what they want is not new, like a statewide mask mandate.
Reginald Bolding
Reginald Bolding, the incoming House minority leader, does not dispute the governor’s assertion that most of the state already is covered by local ordinances. But he said that’s not enough.
“We believe that more Arizonans will accept and take that responsibility for themselves and their neighbors,” Bolding said, saying the current situation creates “mixed messages.”
Senate Minority Leader Rebecca Rios wants an absolute ban on gatherings of more than 25. The current state restriction is at 50, but with a provision that allows for a local waiver.
Ducey did add a requirement last week for local authorities to demand and enforce mitigation measures on such gatherings like masks and social distancing.
Rios, however, said that’s not enough. And, unlike Ducey, she would have no exceptions for religious services, political gatherings and other activities that the governor has carved out as protected by the First Amendment.
“The reality of the situation is, we’re in a crisis,” Rios said. “And if everybody wants to pick and choose who they think should be exempt, then it doesn’t work.”
It’s not just Ducey who won’t recommend changes in what Arizona individuals and businesses should and should not be allowed to do.
“The number of cases added to the dashboard today is concerning but not unexpected,” said Health Director Cara Christ on Tuesday.
She said the agency anticipated an increase two weeks after the Thanksgiving holiday, the normal incubation period for the virus, as families gathered in increased numbers. In fact, in anticipation of another spike after the December holidays Christ is urging people to take additional precautions and limit contacts beyond their immediate families.
The state’s top health official testified October 8 she cannot say when the current COVID-19 health emergency will be over, the governor will rescind his orders, and Arizonans will be able to get their lives back to the way they were before.
In fact, Cara Christ said a decline to minimal levels in the benchmarks her agency created to determine the risk of spread won’t necessarily lead her to recommend to her boss, Gov. Doug Ducey, that he dissolve his orders and give up the emergency powers he assumed in March. She said there are other considerations.
But Christ also said that it won’t take the virus being gone for there no longer to be an emergency. She said it may be that Arizonans are just going to have to live with it.
What currently makes any disease an emergency is that it could overwhelm hospitals. That, Christ said, is why there was a declaration in March by Ducey, with the rapid spread of the coronavirus.
At some point, though, she said that won’t be the case.
“That would change with COVID-19 as we continue in this pandemic,” Christ said.
“And then it would just be like living with the influenza,” she continued. “At that point it wouldn’t be a public health emergency anymore.”
Ilan Wurman
Christ’s comments came as she was being questioned in a hearing in Maricopa County Superior Court by Ilan Wurman.
He represents more than 100 owners of bars that remain unable to reopen and operate the way they used to due to the Ducey-declared emergency. And Wurman is trying to convince Judge Pamela Gates that the restrictions on bars make no sense, especially when other businesses, including restaurants that serve alcoholic beverages, are allowed to be open.
All that relates to when Christ thinks the emergency – and the restrictions on business operations, including bars imposed by Ducey – will or should go away.
“That’s hard to predict now because we learn new things every day,” she testified.
One issue in the case is how long Ducey can exercise his emergency authority.
Wurman said there are indicators. He pointed out the Department of Health Services has established “benchmarks” to determine the risk of spread of the virus.
These look at three issues: the number of cases per 100,000 residents, the percentage of tests for the virus that come back positive, and the percentage of patients showing up in hospital emergency rooms with COVID-like symptoms. Each of those can be listed as having a substantial, moderate or minimal risk of spread.
Wurman wanted to know at what point those benchmarks will get to a point when the emergency will be over.
“It’s a little bit difficult,” Christ responded.
“Those benchmarks weren’t established to determine an end to the public health emergency,” she said. “They were really established to set benchmarks for business to be able to reopen and schools to go back into session.”
That didn’t satisfy Wurman.
He told her to assume there will be no vaccine, no “therapeutic” to effectively treat the disease, and no “herd immunity” where enough people have contracted the virus, survived and now have antibodies. Given all that, Wurman asked Christ when she would be willing to recommend to Ducey that he rescind his emergency orders.
“If we were consistently at very, very low cases, if CLI (COVID-like illnesses) stayed low and the percent positivity remains low, below that 3%, we may make that recommendation,” she responded. But no promises.
“Again, it’s hard to predict,” Christ said.
Wurman pressed harder.
“If all three of the benchmarks established by your department indicated we had been at minimal transmission for eight weeks, would that be sufficient for you to recommend repeal?” he asked.
She never responded after attorneys for the state objected, saying she had already answered the question.
One thing Christ did say is that the emergency declaration really isn’t primarily about preventing people from getting sick and wiping out the disease.
“The public health emergency is really protecting our health care system, making sure we keep as few people from getting sick or dying and having access to those resources than it is just eradicating the disease,” she said.
Christ did concede that she could not say whether a single case of coronavirus had been traced to a bar in Arizona. But she said that’s not because none has happened.
“I’m not privy to the contact tracing investigation findings,” Christ said.
But the health director said she remains convinced that the risk of spread is higher at bars than at other businesses.
Some of it, she said, has to do with lack of ventilation indoors.
“There are ways that that can be increased,” Christ said. “But alcohol does tend to affect one’s ability to physically distance and make good decisions.”
And then there’s the environment.
“They tend to have music,” she explained.
“It requires people to speak louder, projecting more droplets into the air, putting more virus,” Christ said. “It also requires people to lean in and get closer to individuals when they are talking because it’s going to be loud.”
Initiatives face a strong possibility of not collecting enough signatures to land on the November ballot with the COVID-19 becoming widespread, and the latest projections of cases could mean a shelter-in-place policy is coming.
Though Gov. Doug Ducey said on March 23 that the state is “not there” yet, calls from the state Legislature and U.S. Sen. Kyrsten Sinema add to the pressure the governor is facing to make that ultimate decision.
And it could spell doom for ballot initiatives this year after Dr. Cara Christ, the Department of Health Services director, said on March 25 that mid to late April could be the peak of cases with May the peak for hospitalizations.
Of planned 2020 initiatives, only Smart & Safe Arizona, the effort to legalize recreational marijuana, says it has already collected enough signatures to get on the ballot.
Arizonans for Fair Lending, an initiative that would outlaw auto title loans, was the first effort to die, but before COVID-19 had a crucial impact in the state. It announced on February 3 that it was closing down for lack of financial backing.
But now, efforts like Invest in Education, Save Our Schools, Outlaw Dirty Money, and others have to change their approach to collect signatures before the July 2 deadline. Both education initiatives must collect at least 237,000 valid signatures of registered voters before the deadline, but neither has had ample time so far.
Invest in Education has had roughly one month to collect, and Arizona Education Association President Joe Thomas wouldn’t say how many signatures they’ve collected, but said they are ahead of schedule.
Invest in Education made its first attempt in 2018 and collected enough signatures at the time, but was thrown off the ballot for a legal reasons. This year they touched up the language only to face another challenge – coronavirus.
Thomas said they are taking two approaches to collect at this point – sending people home with petition sheets to get family members and close friends to sign and send those back, and a door-to-door approach, while still abiding by the social distancing rules. He said organizers are dropping petition sheets at people’s doors and distancing themselves from potential signers who can use their own pens. This follows a clause in state statute that says the petition gatherer must be present to witness voters signing the sheet.
That plan could be ineffective if Ducey ever decides to order the state to stay home.
California Gov. Gavin Newsom already issued a “shelter-in-place” policy requiring everyone to remain at home to help diminish the coronavirus spread, which forced ballot initiative drives to shut down.
If Arizona follows suit it would have the greatest impact on initiatives and local candidates seeking election, though local candidates have a much earlier deadline to meet – April 6.
Statewide and legislative candidates can collect signatures digitally through a feature on the secretary of state’s website called E-Qual.
Although a 2016 law actually allowed for local candidates to collect online, and while a judge might agree that’s unfair, there’s probably no legal remedy for those who fail to make the ballot.
Elections attorney Kory Langhofer said COVID-19 has “every other elections lawyer” he knows asking questions about ballot access and whether campaigns could mount a successful legal challenge to delay the signature deadline or lower the number of signatures needed to qualify for the ballot due to the pandemic.
“There’s an argument to be had here, but it’s unlikely to succeed,” he said. “A crisis like this is obviously not common, but it’s also not unprecedented.”
Save Our Schools has also started sending petitions to people’s homes, and announced in a tweet that organizers are “100% committed to stopping reckless private school voucher expansion & protecting AZ tax dollars.” Organizers asked supporters to visit YesSosAz.com to request a petition packet in the mail “for the fam & friends you’re seeing within the confines of safety precautions.”
Stacy Pearson
Stacy Pearson, senior vice president of Strategies 360, who is leading the marijuana legalization effort, along with Invest in Ed and Second Chances, Rehabilitation and Public Safety, which would increase public safety and reduce recidivism, said though her other campaigns are ahead of projections at this point, it won’t stay that way for long unless they come up with creative solutions to the problem.
“We’re trying to make sure that we’re both collecting safely and legally,” she said.
Pearson also didn’t provide the number of signatures each effort has secured so far, but each initiative needs at least 237,000 valid signatures – or more realistically, at least 340,000 signatures, in order to provide a cushion for rejected signatures.
Invest in Ed and Second Chances, Rehabilitation and Public Safety filed just five weeks ago, so in a normal year, they would be “on track” by collecting roughly 19,000 signatures per week, or about 100,000 signatures so far. With the coronavirus pandemic grinding public life to a halt, those last 240,000 signatures are going to be much harder to get than the first 100,000.
If Ducey orders state residents to stay at home, collecting those signatures will be even harder, if not impossible, given that initiatives can’t turn to the state’s online petition process.
On top of that, depending on what happens at the Legislature for the remainder of session, it’s possible there won’t be a referendum on the ballot either. Lawmakers theoretically have until August 5 to pass referrals through, according to the state Constitution, which states ballot referrals must go to the Secretary of State’s Office no later than 90 days before the general election.
Other initiative efforts that stand to face the same challenges, include Democracy and Accountability Act, which aims to bar lawmakers from voting on legislation that benefits them financially; Arizonans for Fair Elections, which would provide an overhaul of the state’s election laws, making it easier to vote and limiting spending from corporations, among other provisions; and Stop Surprise Billing and Protect Patients Act, which is intended to prevent insurance companies from discriminating against people based on pre-existing medical conditions.
The Arizonans for Fair Elections initiative has suspended operations and is playing it by ear to determine if it will pull the plug on the initiative amid the coronavirus pandemic.
Anabel Maldonado, a campaign manager for the Fair Elections Act, said organizers don’t see a way to ethically comply with public health directives while circulating signatures.
“In order to keep from risking the health of our circulators and Arizona residents, we suspended both paid and volunteer signature collection late last Tuesday [March 17],” Maldonado said.
Originally, the campaign said it had only suspended paid signature gatherers.
Maldonado said organizers have already collected “close to half” the signatures needed, but she said it’s a waiting game.
“Our teams are on standby, just in case,” she said. “Additionally, we are working with our partners to figure out what is the safest way we can organize digitally to help identify our supporters.”
Then there is also Outlaw Dirty Money, which is a constitutional amendment and has to collect even more signatures than initiatives.
Backers need to collect 356,467 valid signatures and, despite its early launch, is facing challenges. The campaign sent out an email on March 23 asking petition gatherers to turn in their sheets so organizers know where they currently stand.
Terry Goddard, the campaign’s chair, wrote that they already have 270,000 signatures, which is roughly 77% of the way to the minimum. Of course, that doesn’t leave any cushion.
“The challenge is that our volunteer effort will be curtailed by the health care emergency. We do not want our volunteers at risk,” Goddard wrote, later adding that the campaign hopes people will turn in their signatures within the next seven days.
Goddard said the campaign actually paused in-person signature gathering on March 18.
“We are looking at all options going forward,” he said, adding that before the state of emergency and other fallout of COVID-19 they were “on track to qualify easily for the ballot.”
He said in addition to the 270,000 collected signatures, there are at least 10,000 more that haven’t been returned. Outlaw Dirty Money finds itself in a pickle of attempting to follow health guidelines while also trying to listen to potential voters.
“We want to abide by the spirit of the governor’s executive order and not endanger anyone’s safety but also must respect the rights of thousands of signers who want to get this proposal before the voters in November as well as the hard work of thousands of volunteers,” Goddard said.
If the “shelter-in-place” does happen, on top of Legislative action at a standstill, Arizona could be looking at its shortest ballot in years.
Pima and Coconino counties are again at substantial risk for the spread of COVID-19 according to standards set by the Department of Health Services.
But don’t look for new restrictions on businesses.
The agency reported Tuesday that more than 100 of every 100,000 residents of the two counties are testing positive for the virus. That is categorized as substantial.
Two other factors — the percent of tests coming back positive and the percent of hospital patients who show up with COVID-like illness — remain in the moderate range.
Under the rules adopted by the agency earlier this year, having even one of three factors in the substantial range for two weeks in a row — which is what the situation now is — precluded the opening of certain businesses in that county, including movie theaters and fitness centers. All three had to be at least in the moderate range for even limited operations of certain businesses.
But state health officials said Tuesday they will not apply the same rules about all three being moderate in this case. Nor will they order any businesses to be re-closed.
With state Health Director Cara Christ looking on, Gov. Doug Ducey answers questions Thursday about the spread of COVID-19 and how while he expects the infection rate to rise he does not intend to once again close any businesses. (Capitol Media Services photo by Howard Fischer)
Instead, agency spokesman Steve Elliott said the decision was made that the only way a county will move “backward” to a point where it used to be — when certain business could not operate at all — is if all three of the benchmarks go back to the substantial range, which has not happened.
The reason for that decision, he said, is that the overall situation in Arizona is better than it was in June and July.
That’s when Gov. Doug Ducey initially removed many restrictions on business operations. The result was a sharp increase in infection rates, with new cases topping 5,400 a day statewide.
For the past month, the number of new cases has not topped more than 800 a day.
Gubernatorial press aide Patrick Ptak said Tuesday the change in how the rules and the benchmarks are being interpreted is justified.
“We’re in a very different place,” he told Capitol Media Services. Ptak said there’s no reason to close businesses just because one indicator now shows the risk of substantial spread as long as the others remain in the moderate range.
And what if the number of people testing positive went up not just to 100 for every 100,000 residents — the trigger for substantial spread — but to 500?
“That’s a bogus hypothetical,” Ptak responded.
Part of what’s different, he said, is that the spike in infections appears to be localized.
“We know that the universities are driving this,” Ptak said.
“What the data is actually showing is we have a targeted reason for these increases,” he said. “We should have a targeted approach.”
And closing some businesses on a county-wide basis, Ptak said, does not fit that definition.
“Closing water parks because cases around universities is not the right approach,” he said.
The action comes as a 14-day voluntary shelter in place order at the University of Arizona ended Tuesday as school officials sought to drive down infection rates among faculty and staff.
Part of the problem, according to UA President Robert Robbins, is that the virus has been spread not in classrooms but at what he said were large, off-campus gatherings.
In deciding to leave business operations intact in the two counties despite the increase in infection rates, Elliott pointed to what he said are “strict mitigation strategies” designed to help prevent another spike like the one that occurred in June and July.
One of those strategies is that there is now a requirement that restaurant patrons must wear masks when they are not “actively eating or drinking.” But those mask requirements were a long time in coming.
For months Ducey refused to impose a statewide mask mandate. In fact, he even blocked city and county officials from enacting their own.
It was only in June, facing that rising tide of infections, that the governor relented — partly — allowing for local mask orders but still refusing any state restrictions.
Elliott said other things are different now, which is why the department does not believe there is a need to re-close businesses.
For example, gyms and fitness centers, which were allowed to open their doors, have to operate at just 25 percent capacity. There also are occupancy restrictions at other businesses.
And the state has established a “hotline” where people can report violations of the requirements.
Elliott also cited what he said is broad access to testing, with fast turnaround results, and enhanced contact tracing by the state and counties.
Getting vaccinated against Covid may soon be as simple as a flu shot.
Dr. Cara Christ, the state health director, said Friday she is looking at allowing walk-ins, at least at state-run inoculation sites.
That would allow people to avoid the issues of trying to get an appointment online or through a phone line. And those portals provide access only to state-operated sites.
Cara Christ
Getting an appointment elsewhere, including pharmacies and grocery chains, requires individuals to go to each facility’s specific web site to set up a time.
All this comes as the latest figures show that just a quarter of Arizonans are fully immunized, though 37% have gotten at least one dose of a two-shot routine.
Christ said those figures are a bit misleading as they are is based on the total number of Arizonans. But the vaccines now available are approved only for those either 16 or 18 years and old, depending on the manufacturer.
“It’s actually a little bit better when you look at the eligible population,” she said. And Christ said she is counting on many of those folks who have gotten their first dose coming back as scheduled in three weeks.
Still, the health chief acknowledged that still leaves Arizona far below where she said the state needs to be to have “herd immunity,” the point at which enough people are inoculated to prevent wholesale spread. Christ has previously put that at 70%.
While some of that may be based on “vaccine hesitancy,” there’s also that question of convenience.
The concept of walk-up Covid vaccination is not new.
Philadelphia found a sharp increase in inoculations after some groups there reserved vaccines for those who can just stop by. That also helped close the gap on racial disparities as the Black Doctors COVID-19 Consortium found it was reaching people who were computer illiterate or had other issues.
There also were positive results in reaching minorities at sites run by the Federal Emergency Management Agency.
Arizona, said Christ, will be following suit.
“You’ll start to see that happening,” she said, particularly as the demand for appointments goes down at the state-run sites. Christ said that’s already happening, with a “significant decrease” in requests at both the University of Arizona and the Yuma Civic Center.
“They are going to start looking at taking in walk-ins, just letting people come in and get the vaccine whenever they are available, not based on an appointment,” Christ said. And she said that also is going to happen elsewhere at state-run sites as demand for appointments tapers off.
But that’s not all. Christ said she anticipates that also will start to happen at community “pop-up” locations, short-term sites at specific locations.
There’s something else at play, albeit a bit longer term that also will allow for more on-demand immunization.
“As they get more vaccine, the federal partners will open up that ordering so that health care providers will just be able to order it just like they do all the other vaccines,” Christ said. And that will make the vaccine available in doctors’ offices.
“We do know that our medical providers play a large role in people trusting and getting vaccinated,” she continued.
“So they can say, ‘I’ve got the vaccine, I recommend it, here’s the reasons it’s safe, and we can just get it to you today,’ ” Christ explained. “That reduces barriers and gives our health care community more opportunities to vaccinate.”
The ease of getting inoculated could become more important now that Pfizer, one of the three companies authorized to manufacture vaccine for use in the United States, is saying it is “likely” that people will need a third dose within 12 months of getting fully vaccinated. And Albert Bourla, the company’s CEO, also said it is possible there will need to be an annual vaccination.
Christ said there are ongoing evaluations of how long the vaccine’s effects will last.
She said it is known it does provide protection for at least six months. That, the health director said, means there may need to be a booster. And that presents its own logistical issues, especially if the state has to once again set up inoculation sites.
“What we hope is by the time people would need a potential booster that we would have enough vaccine to where it’s in health care providers’ offices, that it’s in all of the pharmacies across the state,” she said. “And it would just become a normal thing just like your annual flu shot.”
All this is occurring against the backdrop of both Christ’s agency and the Centers for Disease Prevention and Control urging providers to pause the use of the Johnson & Johnson vaccine. That followed reports of six cases in the United States — none in Arizona — where those who got the single-dose vaccine developed blood clots.
Christ said that was done out of an abundance of caution as federal officials said they want to “take a pause, see if any more cases occur to see if they can get more data to make clearer recommendations.”
But she also said this amounts to one case out of every million doses administered. And she noted that there are a certain number of these blood clots that occur even in non-vaccinated people.
State health chief Cara Christ fields questions Wednesday about COVID-19 along with Gov. Doug Ducey. (Capitol Media Services photo by Howard Fischer)
Arizona’s health director said today statewide cases of COVID-19 could peak in mid to late April and hospitalizations will peak in May.
“Over the last few weeks we’ve seen these numbers continue to climb and we expect greater increases as we move forward,” Arizona Department of Health Services Cara Christ said. “We will continue to take steps designed to protect our healthcare workers and increase capacity in our health care system.”
Christ’s announcement comes weeks after she and Gov. Doug Ducey danced around the question of how long the pandemic will last and when Arizona can expect relief. In order to prepare for that projected peak, Christ, her department and emergency management staff around the state are working to secure more hospital beds, ventilators and personal protective equipment for health care workers.
When the peak arrives, according to the department’s models, the state could need an additional 13,000 hospital beds and an additional 1,500 ICU beds — that’s on top of the current 16,000 beds and 1,500 ICU beds the state has.
Three hours after Christ said that projection, she walked it back in a tweet in order to provide “some perspective” about the significance of them.
“Our numbers are based on worst case projections from the beginning of the outbreak based on data from Wuhan,” Christ tweeted later. While the department and state plan for the worst, the state is working to slow the pace and reach of the spread.
“The numbers provided earlier today assume nothing is done to mitigate the spread between now and then,” Christ tweeted. “We’re hoping all the things we’re doing now will mitigate the spread.”
As of Wednesday, the state has reported 401 case in 11 counties — 251 in Maricopa County, 49 in Pima County, 37 in Navajo County, 23 in Pinal County, 23 in Coconino County, four in Yavapai County, two in Graham County, three in Yuma and one each in Cochise and Santa Cruz Counties. The state is expected to get a better idea of how far-reaching the spread of the pandemic is and who the virus affects most and why as private-sector testing companies are now required to report all results of COVID-19 tests or a weekly aggregate number pursuant to Ducey’s recent executive order.
Christ has said a more expansive and public collection of data gives Ducey and everyone else a clearer picture of how bad the problem is, where the virus is spreading and helps them decide what to do about it.
In addition to increasing testing capacity and surveillance, Christ said hospitals across the state are working with the National Guard, looking for spare space to add more beds and looking at “non-traditional” areas like ambulatory surgical centers and respiratory training facilities for ICU care, and other large venues like the coliseum on the state fair grounds for recovery care for those who are ready to leave the hospital but can’t.
The state also needs more ventilators, and it requested 5,000 ventilators, five times the number it has on hand now. Christ said Monday she wants the state to get up to 4,500 to 5,000.
As those demands change, so does the threshold for care, which is why it will be hard, if not impossible, for the state to say at any given point that it’s doing enough or more than enough.
“The estimated need is rapidly evolving and as we gather new data with a potential surge of COVID-19 patients we expect it to be above and beyond our current capacity of beds,” Christ said. “Our hospitals and staff are on the front line of this response, and their continued ability to care for our communities, in a safe manner is critical in Arizona’s success in overcoming COVID-19.”
But, Christ and Ducey still would not give an approximate end-date to the pandemic and how long the drastic social distancing and business closure measures could last — because they don’t know.
Ducey again reiterated a new favorite phrase that allows him to vaguely address how long this pandemic could last: “This is going to be a marathon, not a sprint.”
Ducey has fallen back on the “marathon” line at every public event since he declared a state of emergency, stressing that the decisions he makes are guided by health experts like Christ – who continues to say when asked she doesn’t “want to make predictions.”
On Wednesday, Ducey directly addressed people criticising him for being vague.
“Anyone who tells you when they know this will be over, they are guessing,” Ducey said. “We’re in a position right now where we can plan ahead, we can be proactive. But we have to deal with the issues in front of us.”
Ducey said that to a thinned herd of reporters at the state’s laboratory for COVID-19 testing. It was the smallest showing since Ducey and Christ started holding the briefings, which were once packed with reporters and state officials standing shoulder to shoulder. Now most were attending remotely on a video conference application.
When faced with more questions about details of the projected peaks, Ducey ended the conference.
“In closing — in closing the idea is to reduce the number of deaths, reduce the number of illnesses,” Ducey said. “That’s what we’re focused on every day, That’s what the decisions have been today, and that’s what they’ll continue to be.”
Editor’s note: This story has been revised to include further comments from Arizona Department of Health Services Director Cara Christ to explain that projections are based on worst case scenarios.
A healthcare worker performs a COVID-19 test at a drive-thru testing center Tuesday, Dec. 8, 2020, in Phoenix. Arizona on Tuesday set a new daily record with over 12,300 additional known coronavirus cases as the number of hospitalized patients approached levels similar to the peak of last summer’s surge, with the state’s seven-day rolling average continuing to climb in the past two weeks as have the rolling averages for daily deaths and daily COVID-19 testing positivity. (AP Photo/Ross D. Franklin)
There’s nothing that can stop the wave of COVID-19 cases, deaths and hospitalizations coming this month, public health officials say.
It’s going to make for a gloomy Christmas.
Doctors and health experts alike have been warning of this possibility since early October as cases began to climb in Arizona’s “second wave” after a rather quiet September. November came along and was worse than June when Arizona began it’s reign as one of the worst hit places in the world, which lasted through July. Now, less than two weeks into December, it’s pretty clear this will be the worst month on record in every way for the virus that has already taken more than 7,000 lives of Arizonans.
“We’re gonna have a horrible Christmas,” said Dr. Andrew Carroll, the medical director at Atembis and serves on the Board of Directors of the American Academy of Family Physicians.
He said hospitals are expecting to reach capacity in the next couple of weeks and at this point, nothing can be done to prevent it.
“The lack of mask mandates, the lack of gathering sizes and industry shut down, especially over Thanksgiving holiday, is going to be the tsunami we’re going to get hit with in the next two to three weeks and we’re already flooded,” Carroll said.
Doug Ducey
Gov. Doug Ducey has made it clear he will not impose any new restrictions — a position he has held for months — but even if he did it would be too little too late.
Will Humble, executive director of the Arizona Public Health Association, once again called out Ducey and Arizona Department of Health Services Director Dr. Cara Christ for slow walking their efforts to combat COVID-19.
“[Ducey] could have done a full-on stay-at-home order, the likes of which we had in April, and we would still have a terrible hospital crisis,” he said.
Humble said a mask mandate with enforcement on the businesses rather than the individual would have been the smart move, but again, it’s too late for it to have an impact likely before January. Instead, Humble said, Ducey is prioritizing making businesses survive the pandemic rather than the individual.
Putting the burden on the businesses would be a way to encourage enforcement of masks, especially since Ducey won’t issue a statewide mandate. He claims 90% of Arizonans already have an order to do so. That number, though, may not be as accurate as Ducey and his staff make it out to be.
Ducey’s office said it gets the number from Covid Exit Strategy, a website dedicated to tracking all COVID-19 information nationwide from cases and deaths to mask mandates and other policies. It consists of national health experts.
Covid Exit Strategy says Arizona has 91% of the state under a mask mandate, and it gets its number from a survey conducted on Facebook using a sample size of fewer than 6,000. It’s unclear what methodology is used for the survey and if the sample size is even made up of Arizonans. A representative from the site could not be reached for comment.
Still, wearing a mask is just one prong in preventing further exposure and spreading the virus. Carroll said he wishes more would have been done.
A healthcare worker finishes up organizing COVID-19 tests at a drive-thru testing center Tuesday, Dec. 8, 2020, in Phoenix. Arizona on Tuesday set a new daily record with over 12,300 additional known coronavirus cases as the number of hospitalized patients approached levels similar to the peak of last summer’s surge, with the state’s seven-day rolling average continuing to climb in the past two weeks as have the rolling averages for daily deaths and daily COVID-19 testing positivity. (AP Photo/Ross D. Franklin)
“As a physician, I would like to have full shutdowns in areas with high disease incidents of certain industries, which we know increase the transmission of the illness like bars and clubs,” he said.
He thought Ducey’s decision for restaurants expanding outdoor seating was a positive step, but the lack of limitation on public and private events was “pandering” to businesses, and Ducey’s refusal to shutter bars and clubs means transmission rates will likely not start to decline anytime soon.
Dr. Monica Kraft, a pulmonary physician at the University of Arizona and Banner Medical in Tucson, paints an even more dire picture of what’s going on in southern Arizona where the Pima County Office of Emergency Management issued a public health advisory on December 9 that hospitals have reached capacity.
Things are so bad, Kraft said, that a patient of hers who did not have COVID-19 couldn’t receive treatment for an asthma attack because no rooms were available. And the pharmacy was backed up, so she couldn’t receive medication there as a backup option.
“I’ve never been in a situation where the [emergency department] couldn’t do some very basic things because that place was so full. And it’s no fault of the physicians and nurses and staff – it’s there wasn’t capacity,” she said.
That’s what really did her in, she said, adding that everybody on staff is worn so thin with how bad COVID-19 has been and it’s going to get even worse.
Arizona crushed its previous record of new cases reported in a single day on December 8 with more than 12,000. The five highest days on record have all come this month.
Ducey announced on December 3 that money would go to hospitals to pay for staff, but the real question is where the staff will come from.
Andrew Carroll
Kraft and Carroll both acknowledged how something like this would have worked great in the summer months because at that point many states were not hitting a peak in cases and hospitalizations. But now, every state is getting slammed equally hard, which means doctors and nurses won’t be able to lend their services elsewhere.
“I think we have some traveling nurses that are able to come, but you can imagine everybody’s looking for the travelers,” Kraft said, adding that the travelers were saviors in the summer. “Now we fast forward a few months, and everyone’s searching at the same time so nobody really has staff to spare.”
Carroll said the workers that helped over the summer at this point have found jobs in the Midwest or in Texas where hospitals are “well under water” to keep with the tsunami metaphor that Arizona would not be able to get any out-of-state assistance.
“The well has run dry I think, but I could be wrong. I’m hoping I’m wrong,” Carroll said.
Kraft did note that as bad as things are now, they could still get even worse if the crisis reaches a level where triage comes into play.
Triage is a scorecard type system where patients are broken down into levels for who can receive a certain type of care. The worst level is when doctors get to decide who lives and who dies. It’s the worst case scenario hospitals have to think about during the pandemic, but Arizona has never reached that point and Kraft says her hospitals haven’t even scratched the surface in conversations about it.
“We don’t ever want to be in that position,” she said, adding that while there hasn’t been a discussion about triage yet, it’s something she and other doctors think about a lot. “We don’t have any plans to implement at this point. It’s on the table just because when you see trends like this, you sort of have to think about disaster medicine.”
A general view of the Pfizer Manufacturing plant in Puurs, Belgium, on Friday, Dec. 4, 2020. Pfizer and Moderna have developed vaccines for COVID-19, and Arizona will get as its share of both vaccines — assuming both are given final approval this month by the Food and Drug Administration for emergency use — based on the fact that Arizona’s population is about 2% of the nation. (AP Photo/Olivier Matthys)
Kraft told Arizona Capitol Times it would only reach that point if there are zero beds available for patients to fill and the numbers continue to go up.
With no new mitigation efforts and no idea when Arizona will reach its winter peak, the vaccine appears to be the only light at the end of the tunnel, but it’s something that shouldn’t be the only piece of hope Arizonans have to minimize the impact, Humble said.
Ducey announced on December 8 how the vaccine will be handled. The first shipments will arrive in Arizona sometime next week and will first be distributed in Maricopa and Pima counties. That will be the Pfizer vaccine, according to a Department of Health Services spokesman.
The state is expecting 383,750 doses by the end of December and will prioritize “health care workers, residents of long-term care facilities, educators and vulnerable populations.”
One week after the state’s two largest counties receive shipments of 47,000 doses to Maricopa and roughly 11,000 for Pima, all 15 counties, at least four tribes and some nursing facilities will receive doses, as well. Rural counties will receive shipments from Moderna, due to temperature storage capability.
It’s important to note that receiving shipments of the vaccine is not the same thing as people being able to line up to receive it.
Kraft and Christ both said it’s looking like June will be when the virus will be “under control.”
The state’s top education official said Monday that a new spike in COVID-19 will force local schools into the “impossible decision” of whether to shut their doors to in-person learning to prevent students and teachers from getting sick.
“Without serious changes from us, the adults making daily choices that determine the virus’ path, we cannot expect these numbers to head in a safe direction,” Kathy Hoffman said.
But state Health Director Cara Christ, while making multiple suggestions for dealing with the spread of the disease, said she’s not prepared to recommend new restrictions on individual and business activities.
“We continue to monitor the data on a daily basis,” she said. And the health chief said some “mitigation strategies” are being discussed should counties, now considered at “moderate” risk of spread of the virus, move back into the “substantial” category they were at earlier this year.
“We would work with the local health departments to identify what strategies we could implement,” Christ said. But she stressed there would be no universal model.
Cara Christ
“Each community is going to have different factors playing a role,” Christ said.
Christ detailed how the state is now approaching 260,000 confirmed cases of the virus.
More significant, she said, is that 9% of the tests administered last week came back positive. And Christ said there has been an increase in the number of people showing up in hospitals with COVID-like symptoms.
That, in turn, affects the question of whether students learn in class, online or a combination of both. Hoffman said these are not equivalent.
“When our schools close to in-person instruction, it is devastating to our communities,” she said.
“Parents are thrown in flux as they try to decide the best model for distance learning, whether at home or at an on-site learning center,” Hoffman continued. “Educators must adapt quickly, transitioning from in-person and hybrid to distance learning.
And then there are the effects on children, separated from friends and, as Christ said, at greater risk for depression and suicide.
What her agency is doing in conjunction with the Department of Education is setting up a pilot program for free weekly testing of teachers.
But John Carruth, superintendent of the Vail Unified School District, said what is happening in the classroom is not the problem.
“Both our experience and what I think our Pima County data are showing is that transmission is happening in the community and not within our schools, which is encouraging,” he said. Carruth said that shows the key to keeping schools open is dealing with what occurs elsewhere.
Kathy Hoffman
Christ does have some answers to that, specifically with recommendations for what families should be doing this Thanksgiving to prevent these traditional family gatherings from turning into spreader events.
It starts, she said, with moving celebrations outside or a local park.
If that can’t happen, Christ said “create spaces” indoors so people can distance from one another, open doors and windows for better ventilation, and reduce the number of people gathered around the table.
“And consider celebrating virtually with your college-age students or your higher-risk and elderly relatives,” she said.
While the state determines the standards for how and when businesses can operate, that isn’t the case for schools. Instead, the state provides “guidance” for local districts, along with reports of COVID-19 case and trends, and then leaves it to school officials to work with local health departments to figure out how to respond.
Quintin Boyce, superintendent of the Roosevelt Elementary School District in Phoenix, said it’s not a simple yes-or-no answer.
“We understand that school is the best place for students, but not at the expense of safety,” he said.
Complicating the situation, Boyce said, is that many of the students in his district live in multi-generational households with not just parents and siblings but grandparents, too.
“That influences the decision that we make,” he said.
So it turns out that some areas of the state, like the near south side of Tucson, may not be quite the COVID-19 hotspots that newly released data would show.
The numbers released by the Department of Health Services on Sunday show the 85714 zip code with 64 confirmed cases. By Monday it was 67.
That’s more than any other single zip code in the state.
But here’s the thing.
State health officials report that if they don’t know the home address of the patient, they include it in the zip code of the medical provider, followed by the address of the facility that reported the case.
And what’s not clear is how many of the cases listed for 85714 — the area between Ajo Way and Irvington Road — are simply patients at Banner University Medical Center South.
The fact that the 85714 data may include the hospital does not necessarily mean there isn’t a hotspot on Tucson’s south side.
The 85706 zip code just south, down to Drexel Way, reports 49 cases.
But there are some indications the data are skewed.
Consider: the 85714 zip code, according to most recent census data, has 15,138 residents. So the rate of infection would be about 4.5 per 1,000 persons.
By contrast, the 49 cases in 85706, with 58,266 residents, comes out to 0.8 cases per 1,000 residents.
And in the area to the west of both zip codes, the 32 cases in 85746 translates to 0.7 cases per thousand.
In the Phoenix area, the 85008 zip code with Valleywise Medical Center — the old Maricopa Medical Center — shows 28 cases, versus from just 6-10 in the zip code just to the west. When population is figured in, that comes out to less than 0.5 cases per thousand.
And the rate is just a fraction of that in the 85006 zip code with Banner University Medical Center in Phoenix where fewer than 10 cases were reported,
Questions about hospital data aside, there are other gaps in the data.
Results for zip codes where Native Americans constitute a majority of the population were not released, though the health department provided no specific reason for suppressing the data other than they were waiting for tribal approval. But the statewide totals, including the fact that 15 percent of the 122 deaths as of Monday due to COVID-19 were of Native Americans, appears to incorporate those missing numbers.
Still, there are some data points that appear to support the disproportionate affect on Native Americans.
In the 86047 zip code, the area around Winslow, the 48 cases translates out to about 2.3 per thousand. And with 52 cases, the 86040 zip code in and around Page comes out at about 4.7 cases per thousand residents, a figure higher than even the zip code around Tucson’s Banner Hospital.
That, however, may not be true statewide.
Most notably, there are no reports of COVID-19 cases from Fort Huachuca in Sierra Vista. State officials had no immediate answers for the gap — and whether the 16 cases reported in Cochise County and 3,702 statewide include any military living on the base.
Ditto Luke Air Force Base in Glendale.
There did appear to be some data from Davis-Monthan Air Force Base. But the zip code for that base listed five or fewer cases, versus more in adjoining zip codes.
Even some of the statewide data appears to lack specifics.
The health department said it did not know the race or ethnicity of 63 percent of those with a confirmed diagnosis and 49 percent of those who actually died.
The limits of the data drew a warning from Pima County health officials.
In a release Monday the agency pointed out that the information provided by the state reflects only individuals who have tested positive for the virus. But there also have been limits on how many people can get tested.
“Most tests so far have only been done for those who are very sick, are known contacts of an already confirmed case, or are healthcare workers,” the county release says. And that means the map released by the health department shows where concentrations of people who got tested live — to the extent the data includes home address — not necessarily where the chances of contracting the virus are higher.
State Health Director Cara Christ, in a blog post, acknowledged as much.
“While physical distancing is occurring, people do not always remain isolated within their own zip code when conducting essential business,” she wrote.
“Finally, zip code counts include anyone in that zip code who has tested positive, whether their infection occurred two months ago and has resolved or two weeks ago and is still active,” Christ said. “Thus, as zip code data is informative it should not be used to determine whether or not residents of a particular zip code are or are not at risk of COVID-19.”
A state lawmaker is seeking to force state health officials to do something they have previously rejected: allow the use of medical marijuana to treat autism.
The proposal by Rep. Diego Espinoza, D-Tolleson, would add “autism spectrum disorder” to the list of what a 2010 voter-approved law considers “debilitating medical conditions” for which a doctor can recommend the use of marijuana by patients. Espinoza said parents want that as an option for treating some of the symptoms as an alternative to other medications.
HB 2049 also would allow the use of marijuana by those who are suffering from opioid use disorder. Espinoza said he sees the use of marijuana as far preferable to people dying in his legislative district from overdoses.
The 2010 law allows doctors to recommend marijuana to those who suffer from certain listed conditions, ranging from cancer, glaucoma, AIDS and Crohn’s disease to seizures, severe nausea and severe and chronic pain. But the law also allows state health officials to add conditions themselves − if they believe it is medically justified.
Diego Espinoza
Parents of some children with autism made such a request two years ago only to have their plea rejected. That decision was upheld last year, with a state hearing officer concluding that the petition “failed to provide evidence that the use of marijuana will provide therapeutic or palliative benefit to an individual suffering from ASD.”
Espinoza’s bill would eliminate the need for health department approval or even medical studies by getting legislators to add autism into the list of permitted conditions in the Arizona Medical Marijuana Act. But he said bypassing the department does not bother him.
He pointed out that Colorado Gov. Jared Polis signed legislation earlier this year adding autism to the list of conditions for which medical marijuana can be recommended.
“In Colorado there are families that actually have results based on what their children have been experiencing by taking that medical marijuana,” Espinoza said. He said it appears to be a better alternative that other medications now available that can have side effects.
“So how could you deny, especially a parent that’s willing to try that … transition into this alternative to see if that would be a better alternative for them?” Espinoza asked. And he said there’s no reason for parents to have to move to Colorado to get the drugs they need for their children.
Nor is he deterred by the lack of the kind of studies that the health department recognizes as proving that marijuana is effective in helping children with autism.
“I can share with you that I have worked with constituents in my district that their sons and daughters in that realm have had tremendous results,” Espinoza said. “I’ve actually seen in first hand.”
Still, he acknowledged that the Arizona parents who are getting marijuana legally are able to obtain it because their children are having seizures, a side effect for some youngsters with autism. And seizures already is one of the conditions for which the 2010 law already permits medical use.
The use of marijuana to help those addicted to opioids is a different matter.
There is no evidence that anyone has petitioned the health department to add that condition to the list for which marijuana use is legally permitted. But Espinoza said there is reason to believe that it is a better option, particularly in a state which had been in the midst of an opioid epidemic.
“I have overdoses in my community it seems like every day,” he said. “And so if marijuana could be an alternative to help wean them off, then why not try that?”
The idea of marijuana as a legal option to deal with addiction has come up in Arizona before.
In 2018, then-Rep. Vince Leach, R-Tucson, agreed to language to a bill he was sponsoring to add opioid use disorder to what would allow doctors to legally recommend the drug. The measure cleared the House but faltered in the Senate.
And in 2017, as Arizona was facing an average of two deaths a day from opioid overdoses, state health officials started looking for ways to curb the abuse and addiction. State Health Director Cara Christ noted that chronic pain, one of the reasons that some people get hooked on opioids, is one of the conditions for which marijuana already can be recommended.
Still, she stopped short of suggesting that doctors start treating patients with marijuana.
“Each individual is going to be different,” Christ said, saying patients need to discuss options with their doctors.
Backers of expanding the medical use of marijuana will need to generate a great deal of support to get HB 2049 enacted into law.
That’s because the original 2010 law, having been approved by voters, can only be altered with a three-fourths vote of the Legislature. That means 23 of 30 senators and 45 of 60 representatives.
In this July 2, 2020, file photo, a trainer, top, at Mountainside Fitness, works with a client in Phoenix. (AP Photo/Ross D. Franklin, File)
Gov. Doug Ducey is moving to deny gyms and fitness centers the right to reopen despite a court order to the contrary.
In new legal briefs, the governor wants the state Court of Appeals to void the August 4 ruling by Maricopa County Superior Court Judge Timothy Thomason ordering him to provide them a chance to prove they can operate safely. Ducey is arguing that forcing the state to let them reopen before he and health officials believe it is appropriate could result in “death, serious physical illness, and a lack of hospital beds.”
And if that message is lost on the appellate judges, the private attorneys hired by the governor warned of dire consequences if they do not intercede. They said that Thomason’s legal conclusions will “open the floodgates” for others to challenge Ducey’s orders “which will hamper the governor’s ability to focus on the pressing battle against the pandemic.”
“Put simply, the superior court’s ruling threatens the lives of Arizona citizens and should be reversed immediately,” they wrote.
Doug Ducey
More immediately, the governor wants Thomason to stay his own order that requires him and state Health Director Cara Christ to have the rules in place by August 11 telling gyms and fitness centers exactly what they need to do and allowing them to open their doors if they attest they will comply with those requirements.
The stay that Ducey wants would be for a week after either the Court of Appeals refuses to consider the appeal or rules on it. And, if granted, it means that plans by Mountainside Fitness and other facilities to open next week will be shelved.
In filing the appeal, the governor’s attorneys cited a series of what they claim were errors that Thomason made in concluding it was wrong for the governor to shutter the gyms and fitness centers with no opportunity to show that they pose no more danger than other businesses the governor has allowed to open, from grocery stores to restaurants. And they said that the trial judge ignored the principle that the Constitution “principally entrusts the safety and health of the people to politically accountable officials of the states to guard and protect.”
Attorney Joel Sannes, representing Mountainside Fitness, said the governor’s legal bid is not unexpected. But he said he ultimately expects it to fail, even with the claim that people will die.
“On this issue, the governor bears a high burden of proof,” Sannes said.
“The governor actually needs to show evidence that there is a risk that people will die,” he said. “And that is where the governor has really fallen short.”
In essence, Sannes said, Ducey is claiming only that he has a “rational basis” for his conclusions that it would be unsafe to allow gyms and fitness centers to reopen, even if they follow the protocols crafted by his own Department of Health Services.
Those protocols include everything from mask and cleaning requirements to limiting the number of people who can be on site at any one time.
Timothy Thomason
“Their testimony at the hearing established that there are no contact-traced infections related to fitness centers,” Sannes said. “That is true both locally and nationwide.”
Nor, he said, was there evidence of any significant outbreak linked to fitness centers “unlike the very persuasive evidence of serious outbreaks associated with bars and nightclubs.”
Sannes said his most immediate goal will be to convince Thomason not to grant Ducey’s motion to stay his original order requiring a system in place by August 11, allowing these facilities to show they can reopen safely.
That would not void Ducey’s plea to the Court of Appeals.
But if Thomason denies the request for a stay, the governor and health department would have to start the process. Then, if Ducey ultimately convinces the appellate court that Thomason was wrong, it could allow him to once again shut the doors to gyms and fitness centers.
Thomason issued his ruling after hearing from experts called by Mountainside Fitness and EoS Fitness who testified about not just the virus but the relative risks posed by gyms and fitness centers, which are closed, versus other businesses which the governor has allowed to reopen.
The judge acknowledged testimony from Dr. Cara Christ, the state health director, about how the White House Coronavirus Task Force, in Arizona-specific recommendations, said the state should keep these kinds of facilities closed.
But Christ acknowledged that the state is not following all of those recommendations, including one for a statewide mandate on the use of face masks and another saying restaurants should limit indoor dining to no more than 25% of normal capacity. Instead, Ducey has left the question of masks up to local officials and is allowing restaurants to seat up to 50%.
The protocols crafted by Christ’s agency for gyms and fitness centers include:
– Mandated use of masks or cloth face coverings for all guests.
– Operate at 25% or less of capacity.
– Implement temperature checks or symptom screening at the door.
– Require reservations for fitness classes to limit the number attending.
– Provide hand sanitizer, disinfecting wipes, tissues and no-touch trash cans.
But Christ testified she is still not convinced that gyms and fitness centers can operate safely – even if they follow them.
“The person who has COVID-19, if they are breathing vigorously, they can actually concentrate the virus in droplets that could land on surfaces,” she said. “It also allows the droplet to transmit farther.”
Those who are not infected, Christ said, are breathing deeper – and often through their mouths – which allow the particles to get farther into the respiratory system.
Neither Thomason nor the appellate court has set a schedule to consider Ducey’s request.
In light of reports of sexual abuse at some Arizona shelters being used to house migrant children, Gov. Doug Ducey has called for immediate inspections of all Southwest Key facilities in the state.
Ducey, who said he is appalled by recent allegations of sexual misconduct within some shelters, said he has pushed the Arizona Department of Health Services to inspect the state’s Southwest Key facilities, some of which hold migrant children who were separated from their parents at the border.
ADHS expects to complete the inspections of the eight facilities that hold a combined 13 behavioral health residential facilities licenses Friday.
The investigations come after an HIV-positive youth care worker for a Southwest Key facility in Mesa was charged with molesting at least eight unaccompanied immigrant boys, according to ProPublica. The investigative news outlet also reported that a Southwest Key employee in Glendale was arrested for sexually abusing a 14-year-old girl.
Police logs and call logs from other Southwest Key facilities in Arizona also detail other allegations of sexual abuse by shelter employees.
“I’ve been horrified by some of the things that I’ve read in the paper about the situation,” Ducey told the Capitol Times Thursday.
As news coverage of the Southwest Key facilities ramped up, Ducey advised ADHS to inspect all Southwest Key shelters.
“No one wants to read these stories,” said ADHS Director Dr. Cara Christ. “This is one of the department’s priorities, and we’ve been taking it very seriously.”
Surveyors started investigating the facilities last week. Specifically, they are checking whether all employees have fingerprint clearance cards — cards issued by the Department of Public Safety after a thorough background check to disqualify people with certain crimes on record — on file within seven days of being hired.
They are also checking whether the facilities are providing continuous protective oversight of the children and if they are appropriately reporting any abuse or neglect to the correct entities, Christ said.
“We welcome a review,” said Southwest Key spokesman Jeff Eller. The Texas-based nonprofit has unaccompanied minor facilities in Arizona and Texas.
Christ will receive a comprehensive update once the investigations are complete. ADHS will then report its findings to Ducey and the federal Health and Human Services department.
ADHS will also call for a face-to-face meeting with Southwest Key representatives. In addition to reporting its finding to Southwest Key, agency representatives will ask the nonprofit to allow for more frequent monitoring of its Arizona facilities over the next year.
Typically, ADHS can only conduct routine facility checks or follow up on a specific complaint, but Southwest Key could waive that and allow the department to check its facilities more often, Christ said. The state has limited oversight over the shelters because they fall under the federal government’s jurisdiction.
So far, Christ said she has not heard of any major findings from the ongoing investigations.
Surveyors have found some minor issues, she said. For example, they found some instances, in previous years, where employees did not get their fingerprint clearance within the mandated seven-day window. But the facilities appear to have since changed their practices, she said.
Ducey and his wife, Angela, toured a Phoenix Southwest Key facility in June. They wanted to see how migrant children were being treated in the shelters. Ducey said the facility was clean and safe.
State Health Director Cara Christ discusses Monday why people should avoid crowds. The press briefing also featured Gov. Doug Ducey and, behind them, state schools chief Kathy Hoffman and Katie Hobbs, the secretary of state. (Capitol Media Services photo by Howard Fischer)
As COVID-19 cases in Arizona continue to grow, Gov. Doug Ducey and other state health care and political leaders are asking people to take extra precautions as state and commercial testing providers prepare for more people requesting a test for the virus.
Much needed relief for the state came Monday, after weeks of following strict guidelines from the U.S. Centers for Disease Control and Prevention over who can be tested and why, while having access to fewer tests than needed for everyone. Arizona Department of Health Services Director Cara Christ announced Banner Health and Sonora Quest Laboratories opened patient-friendly testing sites to allow anyone who has symptoms to get screened for the virus and possibly tested.
Starting Monday, per a standing order from Christ, people will be able to seek those screenings and no longer have to get direct approval from their doctor.
“They’ll have to attest that they have symptoms, but we are looking at expanding that with additional health care partners and looking at how we increase that capability,” Christ said. “This will expand the availability to more areas.”
Later in the week, Banner Health will be partnering with state and federal programs to provide testing to the state as well as these patient-friendly “collection sites.” Banner Health Chief Clinical Officer Dr. Marjorie Bessel said the group will provide more information later in the week and asked that anyone who does come for screening to call ahead of time to minimize the risk of infection to health care workers.
In addition to Banner, the state is partnering with several private-sector testing companies to handle an expected jump in requested tests, Christ said. With more laboratories testing, this will help the state make more informed decisions on how extensive the community spread is and when to take more action.
Ducey, flanked by Christ, Secretary of State Katie Hobbs, Superintendent of Public Instruction Kathy Hoffman, and private health care leaders took turns addressing dozens in a crowded room at the state’s main laboratory for processing the tests – just hours after President Donald Trump told Americans to avoid crowds of 10 or more people.
As of Monday morning, the state has 18 confirmed cases of COVID-19.
For most people, the virus causes only mild or moderate symptoms, such as fever and cough. For some, especially older adults and people with existing health problems, it can cause more severe illness, including pneumonia.
The vast majority of people recover from the new virus. According to the World Health Organization, people with mild illness recover in about two weeks, while those with more severe illness may take three to six weeks to recover.
Some were comparing Ducey’s and the state’s response to the virus slower than average, but Ducey pushed back and said Arizona is facing different circumstances and is working with the best information it has when it has it.
“We aren’t guessing,” Ducey said. “My decisions are being guided by data facts in science in consultation with subject matter experts. When the CDC makes new recommendations, Arizona will apply its guidance.”
This announcement came after Ducey and Hoffman announced the cancellation of state schools for the next two weeks and called for the cancellation of social gatherings, after Ducey said those things weren’t necessary at the time days prior at a separate briefing. Hoffman echoed Ducey, Christ and others at Monday’s briefing and said that sudden change is a symptom of a fluid situation.
“The situation is constantly evolving minute to minute, hour to hour,” Hoffman said. She, education and health care leaders and the Governor’s Office staff are still working to ensure their plans to patch the holes in the safety net of schooling many depend on will go smoothly.
Hoffman said the group is still figuring out securing a stable short-term situation for immediate needs, like meals for poor children and teacher and school staff pay. For longer-term issues like the possibility of resuming the current school year in as late as August, when the next school year is supposed to start, Hoffman said she and her team are “working on a plan” with stakeholders and accepting help from organizations offering online course resources for free.
“But if we got to that point where we’re closed for the rest of the school year, then we will be working with the federal government on things like testing waivers and not having to make up school days,” Hoffman said. “We’ll continue to be in close communication with our school leaders on what works best for their communities.”
Ducey didn’t give a clear answer for what long-term solutions the state is considering, if and when it permanently closes down restaurants and bars, a crucial piece to the Arizona economy, only that he will be leaning on the guidance from federal officials and following their lead.
“Those inform our decisions and we’re going to continue to make decisions as this unfolds over the course of time to protect public health in the state of Arizona,” Ducey said. “We’re not at that point.”
Ducey discouraged anyone considering celebrating St. Patrick’s Day, but stopped short of saying when he and the state would consider closing bars, restaurants and other public places. While people prepare for the possibility of having to stay at home more often and potentially be required to work from home, Ducey said people shouldn’t worry that grocery store shelves will go dry anytime soon.
“The fear that’s out there is, is very real,” Ducey said.“The supply chain for Arizona and for the United States of America will be protected. I would encourage people to buy what they need so that their neighbor can have toilet paper and necessary things for their food pantry as well.”
Meanwhile, Hobbs said the Democratic Presidential Preference Election should and will continue to move forward as planned. Hobbs and county election officials are ensuring voting places have drop-off boxes so people don’t have to leave their car, and that polling places are regularly, thoroughly cleaned for those who do have to come inside.
“We understand the apprehension that voters have right now,” Hobbs said. “This decision was not made lightly and what it all comes down to is that we have no guarantee that there will be a safer time to hold this election in the near future, and elections do not end on Election Day.”
Gov. Doug Ducey convenes a special session on the opioid crisis on Jan. 22. (From left) Senate President Steve Yarbrough, Senate Minority Leader Katie Hobbs, House Minority Leader Rebecca Rios, House Speaker J.D. Mesnard and a litany of other lawmakers and supporters joined the governor to advocate for various changes in law related to opioids. (Photo by Katie Campbell/Arizona Capitol Times)
Gov. Doug Ducey is claiming progress on getting the opioid crisis under control even as the rate of overdoses shows no sign of abating.
At a press conference today, the governor said the number of legal prescriptions for opioids written in June was down by about 40 percent from the same time a year earlier. And he said the total number of pills dispensed was down 43 percent.
He also said a larger percentage of people who have had overdoses are being referred for mental health treatment.
“This is significant measurable progress,” he said.
Lawmakers approved a package of new laws in January designed to confront the escalating problem of opioid abuse.
One key provision limits what doctors can prescribe, both in dosages and number of days. That is based on studies which show that the chance of addiction for someone prescribed pain pills doubles after six days and doubles again after 12.
Another provision is designed to prevent patients from “doctor shopping” to get more drugs.
Despite all that, other figures from the Department of Health Services show that people overdosing and dying of opiods from legal or other sources have not decreased.
In January, as the law was being adopted, the number of possible opioid overdoses was running between 126 and 152 a week. The figures since June 1 have ranged from 152 to as high as 224 a week.
Ducey concedes the point.
“We’ve said that there is a real challenge here,” the governor said.
He said lives are being saved, not only from tightening up on legal access to opioids but also the greater availability of naloxone, a drug that can be administered to counter the effects of opioids and help save someone who would otherwise die of an overdose.
Tony Morales, a detective for the Department of Public Safety, got to be the first officer from his agency to use the drug just this past week.
Morales said he heard a radio call from Douglas police being sent to investigate an unconscious man near Pirtleville. When they arrived, they called for someone who could administer Narcan, the brand name of the counter-opioid drug.
“When I got on scene, I didn’t think this subject was alive,” Morales said. “He was blue, he was purple, he was unresponsive to anything we were doing to him.”
Morales said the man started breathing after he administered two doses. He added that the man, before being put into a helicopter, thanked him.
“To see him in the back of the ambulance, looking at us, talking, it was amazing,” Morales said. “I thought I was looking at a ghost.”
State Health Director Cara Christ said that kind of incident backs up the decision to train police officers and first respondents in administering the drug and providing them with kits.
“In an opioid overdose, minutes matter,” she said. Christ said her agency has provided more than 6,300 naloxone kits to 63 law enforcement agencies, with nearly 1,000 officers trained in how to administer the drug.
The result, she said, is officers have administered the medication 549 times to 405 people — some require multiple doses — since last June.
“In all but nine cases, the individual survived the immediate overdose and was transported to a hospital for further care,” Christ said. “That’s almost one life saved per day since our opioid emergency was declared.”
FILE – In this March 23, 2020 file photo, Arizona Gov. Doug Ducey, right, and Arizona Department of Health Services Director Dr. Cara Christ, left, provide an update on the coronavirus during a news conference at the Arizona State Public Health Laboratory in Phoenix. Ducey is urging Arizonans to be understanding and reasonable as people and businesses face April 1 due dates for bills such as mortgages, rent, utilities and internet service. Ducey posted on Twitter that “the world has changed since March 1” and that bills previously paid routinely “are now a struggle for many people and small businesses.” (AP Photo/Ross D. Franklin, File)
The passage of a federal stimulus package to help state and local governments weather the COVID-19 pandemic gives Gov. Doug Ducey discretion over at least part of a $1.5 billion sum — adding to tens of millions he already had at his disposal as part of an emergency spending plan passed by the Legislature in March.
At that time, some state lawmakers on both sides of the aisle were uneasy over the size of the checks they were cutting to the governor with little direction on how to spend them. Now, the amount of money at Ducey’s disposal to help mitigate the fallout of the virus has increased significantly — and Arizona, like other states, will be in the dark about how this money can be used until late April, when the federal government allocates the funding.
Already, this has created some confusion. And while the state might have to wait the better part of a month for further instruction from the feds, nonprofits, schools and other organizations that stand to receive aid say the need for more resources is severe.
“We’re seeing double or sometimes triple the usual demand in some areas,” said Angie Rodgers, who heads the Association of Arizona Food Banks. “To sustain that demand every month is going to be a real challenge. We’re going to need the government to step in.”
The Governor’s Office declined to comment on their proposed spending priorities.
DISCRETION
When state lawmakers worked a series of late nights in March in an effort to pass a pared-down budget and a pair of $50 million and $55 million appropriations to help the state fight the novel coronavirus, some on both the left and right questioned whether they gave Ducey too much discretion over emergency funds.
On March 12, Sen. David Livingston, R-Peoria, nearly derailed a fast-tracked bill that guaranteed the Department of Health Services continues to exist for another eight years and moved $55 million from the state’s rainy-day fund to an emergency fund Ducey or the department’s director, Cara Christ, could use to pay for public health emergencies.
David Livingston
Although Livingston ended up voting for the bill, he objected strenuously to the idea that the Legislature would hurry late on a Thursday to authorize $55 million with few restrictions, other than requiring that it be spent on public health and that Ducey or Christ notify the Joint Legislative Budget Committee when they planned to spend the dollars.
“I’m literally reading this as we’re handing the governor and the director a $50 million checkbook, and (saying) ‘notify us if you’re going to use it,’” Livingston said on the Senate floor.
Democrats in the House, meanwhile, were skeptical of the second $50 million appropriation, a key portion of a bipartisan budget deal struck in the Senate. That $50 million was to be used for housing assistance, homelessness prevention, food banks and economic assistance for small businesses, but House Democrats said the budget language gave Ducey too much discretion and publicly griped about the willingness of their Senate colleagues to cut Ducey a check.
“I’m always concerned when it’s up to one person,” said House Minority Leader Charlene Fernandez, D-Yuma.
House Democrats wanted to prescribe specific uses of the fund, affixing a multitude of hostile amendments to the budget deal that would direct some of those millions to specific programs — the Housing Trust Fund, for example — and to help specific groups of people — small business owners, people who use food stamps, and so on.
Pamela Powers Hannley
“We’re getting up to the $100 million number with no plan behind it,” Rep. Pamela Powers Hannley, a Tucson Democrat, said at the time.
And now that number, at least in the aggregate, far exceeds $100 million. With the passage of the CARES Act, the third COVID-19 response package to come out of Congress, the state might have more than $1 billion at its disposal, according to a preliminary estimate from the Joint Legislative Budget Committee.
The state is estimated to receive $4.2 billion in total, JLBC predicts. According to the bill, that money can only be used for “necessary expenditures” related to the pandemic. That $4.2 billion will be divvied among the state and local governments, agencies and other funds and grants.
When the feds distribute the money in late April, Ducey will have some amount of discretion over at least $1.5 billion of it, which must be spent on coronavirus relief, and $68 million as part of an education stabilization fund that he can distribute at will.
When Ducey spends that money, his office will have to keep receipts for an eventual federal audit. But for now, he and other governors don’t yet have directions from the federal government on how they can spend it.
Arturo Perez, director of state services for the National Conference of State Legislatures, said governors should expect definitive guidelines, rules and regulations from the feds on or before April 24, when monies are expected to be given to states. Perez said states have been given vague categories like health care infrastructure and facilities, medical and sanitation supplies and first responder overtime — and it’s as of yet unclear whether states can use that money to offset declining
revenues.
That’s something the JLBC and other states are still working to clarify, as they could interpret “necessary expenditures” and costs incurred from the pandemic to include lost revenue that came as a result of it. Perez said if that coming federal guidance isn’t favorable to that interpretation, states dependent on general sales tax could suffer.
“There is nothing, nothing comparable to what’s happening,” Perez said. “No one knows what folks are spending it on or what they plan to spend it on.”
HOUSING
As he begins spending the money provided by the state and federal relief packages, Ducey has frustrated non-governmental organizations, local jurisdictions and even some in his own executive branch by not communicating ahead of time.
On the morning of March 30, the Arizona Housing Coalition was set to begin a conference call with representatives from the Department of Housing, the Department of Economic Services, landlords, homelessness advocates and other housing stakeholders on how best to use the $50 million legislative appropriation.
Right before they began the call, they saw an announcement from Ducey’s office: $6.7 million of that $50 million was now off the table, allocated toward food banks and quarantine housing at homeless shelters. Nonprofit leaders who have been working on housing and food insecurity for years are frustrated by far-from-ideal coordination and transparency from the Governor’s Office, Arizona Housing Coalition Executive Director Joan Serviss said.
“We know that this $50 million has to do a lot of different things,” she said. “Fifty million dollars is a lot of money, but it has to go by so fast.”
Housing advocates would like to see more money available for the Department of Housing’s eviction prevention pilot program, which started with $2 million last spring to provide emergency grants and case management to families falling behind on their rent. Through a March 24 executive order, Ducey mandated a 120-day stay on enforcement of evictions for tenants who lose income or are forced to self-quarantine because of the pandemic.
But that order doesn’t prevent landlords from proceeding with evictions and charging tenants with associated legal fees. It just prevents constables and sheriff’s deputies from physically enforcing evictions.
“If there’s a moratorium on evictions, are we just delaying the impact for 120 days?” Serviss asked.
Nonprofit organizations serving people experiencing homelessness are seeking ways to expand temporary shelter space and ensure homeless Arizonans are able to get safe transportation to receive COVID-19 tests and treatment. Veterans Memorial Coliseum, which served as a temporary shelter for Hurricane Katrina refugees and hosts an annual resource fair for homeless veterans, could be an option if the Phoenix Suns and Mercury are willing to make exceptions in their contracts with the Coliseum.
FOOD
On March 30, Ducey announced a $1 million appropriation toward food banks across the state. The $290,000 earmarked for southern Arizona just about covers the cost of shifting the Community Food Bank of Southern Arizona’s five resource centers and one farmers’ market outside and complying with new Centers for Disease Control and Prevention guidelines, but doesn’t come close to covering increased demand for food, CEO Michael McDonald said.
The largest resource center in southern Arizona usually helps about 9,000 households in a month. It’s now on track to exceed 18,000, and staff who keep a database of families seeking help report that they’ve never before seen nearly one-third of the people seeking food.
“They’ve never needed to show up before,” McDonald said.
Every single dollar the state or private donors can provide helps. The organization suspended its community food drives out of caution and is focusing on purchasing and distributing frozen food provided by the U.S. Department of Agriculture and fresh produce from Mexico.
Government funding usually makes up about 20% to 25% of the food bank’s funding, with charitable giving picking up the bulk of the budget. As the economy worsens, food bank administrators question whether they’ll receive additional government support.
“People are really stretching and giving us funds now, but will they still be here six months from now when the economic effects linger?” McDonald asked.
And there’s more than just a need for food, said Tyson Nansel, communications director for United Food Bank. At United, much of the money that Ducey authorized March 30 will be used to pay for transportation and refrigeration — and possibly even staffing.
“We’re doing this almost at max capacity,” he said. “If our staff comes down ill from this, we are looking at hiring temporary workers to help fill the slots, in case this gets more serious. But it’s hard to find a Class A driver to take a semi out to rural Arizona right now.”
While the March 30 appropriation will help with immediate needs, uncertainty about the long-term demand for food banks — which has been astronomical since the virus began its spread — means that more money will likely be necessary, said Rodgers, of the Association of Arizona Food Banks.
“We’re grateful for the support we’ve received,” she said. “There will be more cost in the supply chain that we will look to cover.”
EDUCATION
And then there’s the matter of the education stabilization fund, around $68 million that Ducey can give to “local education agencies, higher education institutions, or other education-related entities,” according to JLBC.
That’s a broad list of recipients with no shortage of needs — schools are having to figure out how to maintain previous levels of education while delivering course materials in alternative formats, whether that means online or from school bus drivers dropping off packets to students’ houses.
Sylvia Allen
Ducey should consider using at least of some of the $68 million in discretionary education spending he’ll receive from the federal stimulus package to pay for summer school, Senate Education Committee Chair Sylvia Allen said.
Allen, a Snowflake Republican, has been closely watching as schools in her northern Arizona district adapt to sending written packets and meals home to students, and as her grandchildren who live in the Valley begin taking classes online. It’s clear that at least some Arizona students will need extra instruction over the summer to keep pace during the next school year, she
said.
“If you had a student that was behind to begin with, I’m sure this has been quite a shock to change how you learn,” Allen said. “I’m talking about full-blown come into school half a day and do core subjects.”
These fluctuations could aggravate the state’s achievement gap, a measure of the disparity in education achievement between wealthier and poorer students, said Rep. Reginald Bolding of Laveen, the top Democrat on the House Education Committee.
“A crisis like this will only increase the gap if measures aren’t taken,” Bolding said. “We should invest in technology for students, but also for teachers. We don’t want to take for granted that teachers have laptops and WiFi in their homes.”
There’s the additional challenge of ensuring that these alternative delivery methods are up to snuff, especially if they’re coming from third-party online education providers.
“The worst case scenario for us is to dump millions of dollars into a provider that’s going to produce inadequate results,” Bolding said.
The discretion Ducey holds over how to spend hundreds of millions of dollars particularly troubled Democrats who already fear that the governor isn’t taking the coronavirus criss as seriously as he
should.
Fernandez, the House minority leader, drew a comparison between Ducey and the big-city mayors – Kate Gallego of Phoenix and Regina Romero of Tucson – who have emerged as some of the most vocal critics of the governor’s response to the
virus.
“Those mayors, they’re not making decisions based on political whims, they’re listening to experts, listening to the science,” said Fernandez, who agrees with Romero and Gallego that the governor’s response to the virus – whether that means allocating funding or shutting down businesses – should be more aggressive.
“I’d rather look back and say we did too much,” Fernandez said.
Gov. Doug Ducey answers questions about the flu, COVID-19 and the use — or non-use — of face masks Monday, with state Health Director Cara Christ looking on. (Capitol Media Services photo by Howard Fischer)
The state’s top health official said Monday said she’s not concerned that nationally televised photos of Gov. Doug Ducey barefaced at a Trump campaign event undermines the state’s $3 million “mask up” campaign.
“I think we’ve done a really good job of getting the message out on the importance of mask wearing,” Cara Christ said at a press briefing. That includes Christ herself doing television commercials.
“There are circumstances where it may be safe to not do that,” Christ said in response to questions about the governor’s activities last week on the lawn of the White House. There are photos of Ducey in a crowd of others — also unmasked — waiting for the president to give a speech.
“But we would encourage everyone to wear a mask,” she said.
It isn’t just about COVID-19.
Christ several times on Monday said the same protocols about covering up are necessary to protect Arizonans as the state enters into a flu season. And the state had its worst flu season ever last year.
Even the governor, asked about his activities, acknowledged the message.
“I want people to wear a mask,” he said. “I’ve been consistent on this.”
And what about last week?
“People can exercise their First Amendment rights, whether it’s a protest or a political event, which is what I was at,” Ducey said. Anyway, he said, it “happened to be outdoors.”
The governor said, however, when he is indoors, he wears a mask. That includes grocery stores, businesses and even “when I’m in the office,” including places he cannot socially distance.
Yet Ducey was the only one at Monday’s event, including health experts, staffers from his office and other state agencies as well as the reporters and photographers, who was not wearing a mask. Even Christ kept her mask on while discussing the upcoming flu season.
But the governor said there was a good reason for that.
“I’ve heard from the deaf community that in addition to our skilled sign folks that they sometimes read lips,” Ducey said.
His weekly events are simulcast on YouTube. And there is an inset with an interpreter who is translating in real time.
“So, as a courtesy to them, while I’m answering questions I’m going to have the mask off,” he said. “Then I’ll put it on. And I’ll exit.”
Christ, however, kept her mask on during both her comments as well as to answer questions.
Ducey himself mentioned the importance of masks several times during Monday’s event to unveil the plans for this year’s effort to convince more Arizonans to get a flu shot.
That includes providing free immunization for those without insurance or with limited coverage. But Christ said while that provides the vaccine itself for free, people may still be faced with paying some sort of fee to a medical provider to administer it.
There also are plans for expanded availability.
“It’s simple: As early as next month when you stop by certain sites for a COVID-19 test you’ll be able to get a flu shot as well,” Ducey said.
The state also is trying to provide incentives for the more than 1.8 million people enrolled in the Arizona Health Care Cost Containment System, the state’s Medicaid program to get vaccinated. That includes a promise of a $10 gift card.
That led to questions about whether it’s too early to get vaccinated, given that the immunity is not permanent. Christ said she doesn’t see it that way.
“Our typical flu season runs October to March, with a peak of cases around February,” she said.
“But, as we always say, influenza is predictably unpredictable,” Christ continued. “So the sooner you can get vaccinated, the better.”
One big worry for health officials is having to battle both the seasonal flu and a potential second spike of COVID-19 cases. Yet the state continues to allow more businesses to reopen, raising questions for the governor about whether things will again get worse.
“We don’t know, OK?” he said.
“But we’re going to prepare as if it is,” Ducey said. “That’s the reason we’re talking about wearing a mask and socially distancing.”
And the governor said the state is being “incremental” in the decisions being made about what businesses can reopen and under what conditions.
Christ said she agrees.
“I don’t know if we know what the future holds,” she said. “We are anticipating that we will see additional cases.”
But Christ said the “benchmarks” the state uses to determine risk — infection rates, positive test rates and visits to hospitals by those with COVID-like symptoms — provides “flexibility.”
As of Monday, eight counties were listed as having “moderate” risk of spread, with Greenlee County at minimal risk.
“So if a county goes up to a higher level for two or more weeks we’re going to start working with those establishments to bring them back into requirements for that specific benchmark,” she said. And that could mean re-closing some businesses that have just been allowed to reopen.
Arizona Republican Gov. Doug Ducey arrives for a news conference to talk about the latest Arizona COVID-19 information Wednesday, Dec. 2, 2020, in Phoenix. (AP Photo/Ross D. Franklin, Pool)
On March 11, 2020, Gov. Doug Ducey placed Arizona under a state of emergency to combat the spread of Covid. The country declared Covid as a pandemic that same day.
To his harshest critics, Ducey’s efforts largely failed, and many directly blame him for the deaths of more than 16,000 Arizonans.
To his loyal supporters, he’s getting results. Arizona’s economy is one of the strongest in the nation and the vaccine rollout — despite several hiccups — has already inoculated at least 20% of the state’s population.
Ducey resisted calls for “extreme” measures put forth by both sides of the ideological aisle. He refused to impose a statewide mask mandate, angering the liberal base. But he also restricted business activity, upsetting conservatives.
And as Arizona’s cases skyrocketed in the summer and the fall, Ducey abandoned his early efforts at transparency. Specifically, the regularly weekly briefings went away, and he got testy with reporters in the sporadic ones he held.
Ducey and his staff refused to comment for this story.
Shut down, reopen, shut down again
A businessman by profession, Ducey acted cautiously, particularly when it came to calls to shutter business operations.
Before anybody really knew how bad Covid would get, Ducey put Arizona in a quasi stay-at-home order for a month, shutting the doors of “non-essential” businesses. He extended the order two additional weeks, but began to walk it back in early May to align with one of many visits by President Trump. He shut down schools in a joint-announcement with Democratic state Superintendent of Public Instruction Kathy Hoffman.
Ducey allowed businesses to begin reopening, but his critics said he had no plan in place to help slow the spread, insisting his administration implemented neither a comprehensive contact tracing effort nor a mask mandate and that the state allowed certain businesses to exploit a loophole and continue operating.
He refused to add any new mitigation measures as Arizona became a global hot spot around November through January.
The elderly
Many leaders said they were left out of the administration’s decisions – and the complaint emanated not just from mayors and other political rivals.
Things turned for the worse around Memorial Day, when bars took advantage of a loophole in the governor’s executive order to remain open amid a sharp rise in cases and deaths that disproportionately wreaked havoc on Arizona’s elderly population.
Some said his office only sought to mend relationships after mounting pressure and public shaming.
Dana Kennedy, the Arizona state director of the AARP, said her relationship with Ducey’s office became practically nonexistent after two meetings in early March 2020.
Kennedy said she had not heard from Ducey or his staff again until around June or July, when Ducey’s chief of staff reached out.
“My advocacy started working, and I got a call from Daniel Scarpinato where he said, ‘What do we need to do to repair this relationship?’ Kennedy said.
That led to the state setting up a task force for long-term care facilities.
And later, when vaccines became available, Ducey immediately prioritized vaccinating Arizona’s oldest residents, putting them in the same priority category as health workers, something Kennedy applauded.
But Kennedy lamented that Ducey and Cara Christ, the state health director, still wouldn’t allow numbers from long-term care facilities to be released and fought to keep any information sealed in court.
Kennedy said she felt hopeless at times.
“They felt like I was the only person who could help them. And I couldn’t,” she said about the aging community. She added that there hasn’t been any transparency from Ducey or Christ when it comes to the assisted living facilities or other long-term care facilities.
“I still to this day disagree with not releasing the information regarding assisted living facilities,” Kennedy said. “And to this day I could not tell you how many people have died in long-term care facilities.”
Arizona is among just a few states that hide that information from the public. What AARP Arizona knows is that least 2,500 residents of skilled nursing facilities have died. The true number, she speculated, is much higher than that.
“We know for a fact that there were a lot of deaths in our long-term care facilities, and they won’t release that information. They have it, but they won’t release it,” Kennedy said.
Deaths and transparency
Ducey started holding press conferences again toward the end of November.
More than half of all of Arizona’s Covid deaths would occur after his last public appearance on December 16.
And the last time Ducey publicly expressed condolences regarding a Covid-related death happened nearly a year ago.
“Our heartfelt condolences go out at this tragic loss of life,” Ducey tweeted about the second death from the virus.
Some lament that it’s not enough.
Among the 16,464 Arizonans who have died from the virus is Kristin Urquiza’s father, Mark. His death prompted Urquiza to launch Marked By Covid, which collects stories from people whose lives were upended by Covid.
Urquiza, who gained national attention, wrote a letter to Ducey inviting him to her father’s funeral, blaming him in part for her father’s death on June 30. She told the Arizona Capitol Times that her father believed the governor when he said Arizona was on the other side of the pandemic and decided to end the de-facto stay-at-home order in May.
At the time, bars briefly reopened and Ducey refused to allow cities to issue their own mask mandates. Ducey later relented, allowing local governments to issue mask-up ordinances in June.
“I haven’t received any condolence or outreach from the governor, Cara Christ or the Department of Health,” Urquiza said. “[They have all been] completely silent, and from everybody that I interact with who’s lost a loved one in Arizona, I don’t know a single person who has received a generic or a personal condolence from Doug Ducey.”
Loyal opposition, loyal critics
One of Ducey and Christ’s harshest critics is Will Humble, the former state health director who accused the state leaders of only acting after mounting pressure from experts, the public and media.
“How this Governor’s Office operated is that if you could embarrass them publicly they might consider changing direction,” Humble said.
Humble, who briefly remained in his health director role early in Ducey’s tenure, said the governor’s lack of transparency trickled down to nearly all state agencies, speculating that’s also the reason why directors from the Department of Economic Security and Department of Corrections also don’t hold news briefings.
Ducey’s supporters maintain that, despite the incessant criticism, Arizona sits with a robust economy despite early predictions to the contrary. They point to the governor’s innovative strategies to ramp up vaccination, notably by opening three statewide vaccination sites.
They note that the administration has acknowledged problems in the vaccine rollout, but that it’s working on fixing them and they see a light at the end of the tunnel shining just a tad brighter.
Meanwhile, it has been 85 days since Ducey’s last public appearance.
Getting a leg up on everyone else in his age group, Gov. Doug Ducey got his first dose of the Covid vaccine on Tuesday morning.
But his press aide insists he wasn’t jumping the line.
In an unannounced event, the governor got Dr. Cara Christ, the state health director, to administer the shot at State Farm Stadium. That is one of the state-run sites for inoculations.
Only later did his office put out a release, video and photos of the event. That included an explanation that, at age 56, he was now eligible.
And that followed the announcement Monday by Christ that the process is now open to anyone age 55 and older.
What the governor’s release did not say is that when Christ announced the change on Monday she said that no one could sign up to even get an appointment before noon. Ducey’s release came more than an hour before that.
And even then, anyone who did manage to get through the state registration system would not be scheduled until at least Thursday — if not later — with only about 50,000 doses available to the 55-plus crowd.
So was Ducey taking advantage of his position?
“The governor did not jump the line,” said Ducey publicist C.J. Karamargin. Instead, he said, the goal was to create a public service video.
“We had a message to get out about the importance of getting the vaccine, that we were opening up to a category that includes a lot more people,” Karamargin said.
What that did not include, he conceded, is an event with media who then would not just publicize the announcement but also be able to ask him questions about the state’s handling of the virus and other issues.
“We chose not to,” Karamargin said. “We chose to approach this important announcement by letting people know about it with a video and a press release.”
And the fact that Ducey did get inoculated ahead of everyone else in his age group for the PSA?
“This is what leading by example looks like,” Karamargin responded.
Maj. Gen. Michael McGuire explains Friday the role the Arizona National Guard will play in helping to restock grocery stores whose shelves have been stripped of many items by shoppers hoarding goods. With him is Gov. Doug Ducey and Cara Christ, the state health director. (Capitol Media Services photo by Howard Fischer)
Gov. Doug Ducey insisted Friday he has no intent to order Arizonans to stay at home as his counterparts in New York and California have done.
In his latest briefing, the governor said he sees no reason to go beyond his directive issued late Thursday to shutter bars, gyms and movie theaters in counties where there have been confirmed cases of COVID-19 and to allow only take-out and delivery services by restaurants. That currently covers nine of the state’s 15 counties.
And Ducey said Friday he has no intention to either expand the restrictions statewide or to add other kinds of businesses where there is close personal contact to the list of businesses that have to close their doors like spas and hair salons, even as the number of confirmed infections reached 68.
The state late Friday also recorded its first death, that of a male in his 50s living in Maricopa County with what state officials said were “underlying health conditions.”
The governor said broader restrictions are not necessary.
“I have no desire to shutter something that would not protect public health,” Ducey said.
The governor acknowledged that the restrictions he has ordered have changed, sometimes over the course of less than 24 hours. But Ducey said there’s a good reason for that.
A sign on the door to American Eagle in The Village inside the Yuma Palms Regional Center states the store is closed until March 28, due to coronavirus and to “Keep Smiling!”. (Randy Hoeft/The Yuma Sun via AP)
“Each escalation, declaration and executive order that I have put out has been with the guidance of Dr. Cara Christ (the state health director) and the Centers for Disease Control and Prevention.
But even without any stay-at-home directive, both the governor and his health director say that’s still their advice, albeit one without enforcement.
“Stay home, especially if you or a loved one have an underlying medical condition or are elderly,” Christ said. “If someone in your household has COVID-19 everyone in the household should stay home until you are recovered.”
And the health director said Arizonans should pretty much forget about actually getting testing to determine if they have the novel coronavirus.
“We continue to face a national shortage of test collection supplies and lab reagents,” Christ said. “There are not enough tests at this time for everyone who wants to be tested.”
But she said that, for those who do not have extreme symptoms like difficulty breathing, knowing whether they have COVID-19 or something else, testing really won’t help them.
“It’s important to be clear: There is no specific treatment for this disease,” Christ said. “And the result of a COVID-19 test will not change your clinical treatment while you are sick.
Friday’s briefing also provided the first indications of what role the National Guard, called out by Ducey late Thursday, will play in restocking stores. The governor said the bare shelves have nothing really to do with an insufficient supply but is instead a direct effect of hoarding.
“There is not a shortage of toilet paper or hand sanitizer or bottled water,” he said.
“This has been binge buying,” the governor said. “This has been caused by the very real fear that is out there.”
And the fact is, Ducey said, there’s no way grocers can keep their shelves stocked at the rate items are being snapped up. That goes to what he said will be the role of the troops.
“We can do big-scale logistics,” said Maj. Gen. Michael McGuire, the adjutant general of the Arizona National Guard. He said that particularly means moving large quantities of food “that final mile” between warehouses and grocery stores.
Ducey said that’s where the bottleneck is.
“It typically takes two trucks to restock a grocery store,” he said. “Today, in this environment, it’s taking 12 trucks.”
That’s where the soldiers fit it, driving trucks and unloading pallets of goods.
McGuire said there may be situations where soldiers are actually helping not just unload pallets of items but actually are ensuring that items get onto shelves.
“But I can tell you with only 8,000 of us we can’t stock every store in the state,” he said. More to the point, the general said that’s not what he has in mind for his soldiers.
“I hope that we are a bridging strategy to have those types of duties filled by community members that are not feeling ill that want to support their community, either go to work for these food companies or come in as volunteers,” McGuire said. He said the better use of soldiers would be for those things for which his troops have been trained.
Consider, he said, a situation where a commercial truck driver calls in sick.
“We have a commercial truck driver that can fill in that gap,” the general said.
“That’s better use for me than to have folks unpack pallets,” McGuire continued. “But we’ll do whatever we need to do to first bridge this gap.”
The general said the initial call up is only about 200.
He could not provide an estimate of how many soldiers eventually would be involved in the operation.
“Over the weekend, we’re going to be adding to that,” he said. But McGuire made it clear that there are Guard troops doing other jobs in the private sector that are better off where they are.
“If I pull in doctors, nurses, medics that are already working in our local hospitals, it’s a zero-sum game,” he said.
Groceries aside, one issue is medical supplies, particularly ventilators that may be needed for hospitals to treat people with respiratory problems.
Christ said the state has anywhere from 1,500 to 1,800 beds in intensive-care units. She said her agency is trying to find out where there are ventilators, not only as hospitals but out-patient surgical facilities and training centers.
“And we are putting in an additional request for federal ventilators,” Christ said.
The governor said Arizonans need to recognize that the situation created by the outbreak is not going to go away any time soon.
“We don’t have any illusions about this fight,” he said.
“We are in this for the long haul,” Ducey said. “I think it’s important that people begin to think of this as a marathon and not a sprint.”
Editor’s note: This story has been updated to reflect one death has been reported in the death.
Doug Ducey (Photo by Dillon Rosenblatt/Arizona Capitol Times)
Gov. Doug Ducey issued a “stay-at-home” order today, effective at 5 pm Tuesday until April 30, according to the Yellow Sheet Report.
The move is effectively what other states are calling a “shelter-in-place” order, though the Governor’s Office is trying to brand it differently by adding a mental health component and urging people to go outside while maintaining the six-foot separation.
“Throughout this process I’ve made it clear in Arizona we are going to take a calm and steady approach, making data-driven decisions and act with urgency to protect public health,“ Ducey said. “Today, I’m announcing that the time for further action is now.”
The order comes after President Trump extended the federal social distancing guidelines Sunday until April 30.
In a letter to Ducey urging him to enact the new requirements, Department of Health Services Director Cara Christ said based on the rate of spread and the US Centers for Disease Control and Prevention guidance, “I believe now is the time to elevate our guidance.”
Christ recommended highlighting in the order the “need for social connectedness.”
The executive order specifically urges Arizonans to “limit their time away from their place of residence or property,” except to conduct or participate in “essential activities”; for employment, to volunteer or participate in “essential functions”; and to utilize any services or products provided by “essential businesses.”
Ducey defined which businesses qualify as “essential” in an executive order last week (LINK).
Monday’s order also includes an exemption for sole proprietors of businesses, if the business is not open to the public.
Homeless people are also exempted from the order, though it encourages them to “obtain shelter as soon as possible” and practice safe distancing.
The order also asks people to limit their use of public transportation as much as possible. Essential functions conducted by governmental entities shall remain open, the order states.
Ducey gave no details as to how the order will be enforced or how long it would last and referred people to read the order, which outlines “enforcement measures.” The order appears to have baby teeth enforcement measures and most of the enforcement, according to Ducey’s Chief of Staff Daniel Scarpinato is local and discretionary.
The order allows anyone to utilize and participate in “essential activities” and no one will have to prove or justify what they’re doing outside their house when questioned by police. People who violate the order, except those experiencing homelssness, could be charged with a class 1 misdemeanor if they do not comply after they’re informed of the order.
He also would not say how long the order will be in effect and said it would reflect federal guidance, which recommends people continue to social distance for another month.
The order was necessary because the situation called for it, Ducey said, adding that he understood the fear many are having about the pandemic because of the way it’s being presented by national media, but not Arizona media. On national shows, Ducey said, the words “shelter in place,” are too powerful.
“When you use words like ‘shelter in place’ — well, that’s what happens during a nuclear attack, that’s when there’s an active shooter,” Ducey said. “We want people to stay at home. It’ll have the same effect.”
Ducey said when the “semantics are set aside,” the implementation and goal of his orders compared to other states are the same. The order essentially formalizes what Arizonans are doing: only going out when they need to to visit the long list of services Ducey deemed “essential,” which includes grocery stores, pharmacies, hair and nail salons and golf courses.
Taking care of a family member and a household pet of another are also deemed essential, according to the order, as well as any other business, service or activity that can maintain social distancing guidelines.
Ducey’s order also comes after mayors say he refused to immediately act on advice from public health officials to issue an order last Thursday. Nine mayors signed onto a letter (LINK) today following a conference call with Sen. Kyrsten Sinema, D-Arizona, who told them of the alleged urging by unnamed public health officials and Ducey’s refusal.
“We understand that public health officials in Arizona have already recommended the Governor issue a Stay-At-Home Arizona order immediately and we would like to know why the Governor has not followed that recommendation,” the mayors wrote.
“Arizona must not squander the opportunity to learn from the unfolding events in our sister states and immediately formalize a statewide Stay-At-Home order to ensure that we pursue every avenue to #flattenthecurve of this devastating pandemic.”
Mayors from Phoenix, Tucson, Flagstaff, Tolleson, El Mirage, Guadalupe, Winslow, Superior and Fountain Hills signed the letter.
It remains unclear what the superseding order means for recent proclamations issued by Flagstaff Mayor Coral Evans and Tucson Mayor Regina Romero, who recently defied Ducey’s “essential services” order last week by ordering the closures of more businesses.
If the order mirrors federal guidance, the order will remain in place until at least April 30, well past the tentative April 13 date on which the Legislature hopes to reconvene.
Andrew Nicla contributed to this report.
Editor’s note: This story has been revised to add more detail on the order.
Gov. Doug Ducey, R-Ariz., greets President Donald Trump as he arrives at Phoenix Sky Harbor Airport, Tuesday, May 5, 2020, in Phoenix. (AP Photo/Evan Vucci)
Gov. Doug Ducey won’t rescind his order denying Arizonans access to a drug to prevent COVID-19 that is now being used by President Trump.
The April 2 directive bars pharmacists from dispensing hydroxychloroquine or chloroquine unless they have a prescription from a doctor saying the patient actually has the virus. And even in that case, the governor limited the prescription to no more than a 14-day supply, with no refills without a new prescription.
It’s even more specific than that. It spells out that prophylactic prescriptions for the drug — essentially prescribing it to keep people who don’t have COVID-19 from getting it — “are strictly prohibited unless peer-reviewed evidence citing prophylactic evidence becomes available.”
And to date the only published study involves 62 patients in China taking hydroxychloroquine where the authors said the potential of the drug in treatment “has been partially confirmed.” But they also said there is the need for large-scale clinical and basic research.
The sole exception in Ducey’s April 2 order denying prescriptions for chloroquine and hydroxychloroquine are for patients taking the drug “for treatment other than COVID-19.”
The issue arises as the president said Monday he had started taking hydroxychloroquine. And the White House on Wednesday confirmed that Trump’s personal physician prescribed it to him as a preventative measure.
Cara Christ
That prescription could not be filled here in Arizona.
“We’re not denying Arizonans any rights and privileges,” Ducey said Wednesday during a briefing on the latest on COVID-19 in Arizona.
But even Health Director Cara Christ, a physician herself, acknowledged that the ability of doctors to prescribe chloroquine and hydroxychloroquine in Arizona is limited to patients who need it for some reason other than to prevent COVID-19. That includes treatment for malaria and auto-immune disorders.
During the briefing, the governor said the infection situation in Arizona has not changed sufficiently to permit changes in what businesses and activities he is allowing. But Ducey said he is “thinking ahead of what is next.”
“Our goal is we want to open up summer camps, schools and youth activities,” he said. “All the evidence we have seen for the last four or five weeks say it is responsible and prudent to plan ahead.”
But the only thing on which he had any suggestion of timing deals with public schools.
“We’re working with the education community, school leaders on a plan to safely resume school in the fall,” he said.
Everything else, he said, involves doing things “the Arizona way.”
“It’s going to be gradual and phased in” Ducey said. “We’re going to have a phased-in return based on recommendations of the CDC and health experts.”
That issue of what health experts recommend has come up with Trump’s disclosure of his use of hydroxychloroquine.
The president actually has been touting the drug since March, mentioning them in a White House briefing.
That resulted in the U.S. Food and Drug Administration issuing a warning last month saying the drug poses a risk of severe heart rhythm problems. For that reason, the agency said, it should be taken only in a hospital or as part of a clinical trial.
Meanwhile, the presidential mentions created a rush of sorts by people trying to get the drug. And it was that which an aide to the governor told Capitol Media Services last month that resulted in the directive denying the ability of people to get it in a bid to prevent contracting the coronavirus.
“It is limited to the diagnosis or the suspected positive for COVID-19 so that we’re not running into shortages for those individuals who are taking it for other reasons,” explained Trisa Guzman Glover, the governor’s director of boards and commissions.
On Wednesday, though, Ducey said no one is being denied anything.
“Of course, Arizonans can access needed pharmaceuticals and health care and medicine,” he said.
Christ said that’s not entirely accurate.
“It can be used if a physician feels that it is necessary,” she said. And in cases of COVID-19, Christ said, the order is “not to pre-prescribe it for anybody.”
“But they can use it under certain circumstances,” she said.
The Hill reported that White House press aide Kayleigh McEnany, in explaining Trump’s decision to take the drug, linked it to legislation he signed in 2018 allowing terminally ill patients to try medications that have not been approved by the FDA. She said the same is true for people who are “facing a fatal illness.”
Saying Arizona can handle the projected toll of the COVID-19 pandemic, Gov. Doug Ducey Monday quickened the pace for his plan to reopen the state.
Starting Friday, people can get a haircut and come next week, they can go to a restaurant with their family. Barbershops and salons can also voluntarily open on Friday if they limit how many customers they see, follow strict public health requirements and mask their workers.
This week’s phased reopening of retailers continues; today, shops can voluntarily open with social distancing measures and no in-store service, and on Friday they can open their stores if they can follow those same strict guidelines. But Ducey’s announcement that restaurants can reopen was a slight change, a day earlier than the “best-case scenario” he proposed last week.
That date was moved up because the state is testing more people and is starting to see a decline in COVID-like and flu-like illnesses and a smaller percentage of people being tested are testing positive. While Ducey said promising and adequate hospital capacity is a “green light” for more steps forward, if trends flip, Arizona will be ready to adjust, and that could mean rolling dates back
“We’re a lot smarter today than we were in January, February, March and April around this pandemic,” Ducey said. “If, God forbid, things were to turn in the wrong direction and spike, which we’re not seeing that side right now anywhere, Arizona is prepared.”
Department of Health Services Director Cara Christ said she and the state are aware of the concerns of opening up too quickly and want to avoid the possibility of prompting a “second wave” of cases, which is why they have been cautious to act. That’s also why the state isn’t giving future dates for further steps, because the situation could change as seasonal illnesses could rise and stress more resources.
“The concern is what do you do when you have a flu season, in addition to potential COVID cases that may be looking for the same resources,” Christ said. “That’s why we continue to work on getting alternate care sites in place, in case there were a surge coming in the fall at the same time.”
If positive trends do continue, Ducey said the state plans to continue to phase in a return to some kind of normal based on state and federal public health data and guidance through May and June. When restaurants and barbershops reopen, they can serve as many as they are able to if they can make the space and abide by public health guidelines, which for some could mean very close to full capacity.
As Ducey continues narrowing the list of closed businesses, gyms will be next, he said, though he gave no date. Still, in the face of mounting pressure to reopen the economy, the governor urged people to continue to have patience with his plan, which mirrors what he called “flexible” guidelines from the White House for economic reopening.
That three-phased plan aims to slowly open up businesses to normal operations while slowly reeling back social distancing measures for states that see fewer reports of COVID-19 and influenza-like illnesses for two weeks.
Under Phase One of Trump’s plan, all “vulnerable individuals” would stay home when they can and those who go out would continue to practice social distancing and avoid gatherings of 10 or more people. Some businesses would reopen with social distancing measures in place. Arizona has yet to satisfy the requirements of that phase, as it is still waiting for cases to drop consistently.
Ducey pushed back against the idea that the only thing that has changed since his last announcement was the mounting protests and Trump’s pending visit to Arizona, saying those factors had nothing to do with his decision. The governor called his first weekend of the “testing blitz” a resounding success and cited statistics showing that the number of tests coming back positive are decreasing.
But the pressure on Ducey to allow the economy to reopen comes from not just the more libertarian elements of his own Republican Party.
House Speaker Rusty Bowers, R-Mesa, told Capitol Media Services the pure numbers show that the harm to the economy is far outstripping the actual physical danger.
Bowers said he has done some analysis of the 362 deaths in Arizona so far. The vast majority — more than three-quarters — are among those 65 and older who may have had other health conditions.
What that leaves, he said, are the 82 for those age 20 through 64.
“Thirteen one hundred thousands of a percent that have perished, and we say we can’t trust the rest of enterprise to open up and use wise business practices,” Bowers said. “I’m just hoping that he will recognize that he can trust the rest of the working population to try to exercise themselves smartly in order to help us all put this behind us.”
Anyway, Bowers pointed out that the “essential” businesses the governor has allowed to remain open probably make up the vast majority of all of the firms in the state. Yet even with that, he said, the number of cases of the virus has remained small.
Senate President Karen Fann, R-Prescott, did not get into the numbers. But she told Capitol Media Services that Bowers is correct in his conclusions that businesses have figured out how to keep employees and customers safe.
“I’m hoping the governor sees it that way, too,” Fann said.
Ducey defended the speed of his changes.
“This is a step forward,” he said. “If you want to say I’ve been too cautious, I accept that.”
The governor said that pace is appropriate when talking about this kind of rapidly spreading virus.
“We understand much more today than we did six weeks ago,” Ducey said. “And I’m hopeful and optimistic as to what can happen over the next several weeks.”
Ducey said he plans to talk to Trump Tuesday about increasing Arizona’s testing now that some of the hot spots in other states have cooled off.
One of those places the state plans to ramp up testing is in long-term care facilities, which Ducey and Christ have been reluctant in being fully transparent in, refusing to list exactly where cases are being reported. Christ said DHS is working with its lawyers to determine if and when it releases more detailed data.
In the meantime, per an executive order Ducey signed today, relatives of those in those facilities who test positive or whose fellow seniors test positive for COVID-19 will be notified by that facility within 24 hours. If a family chooses to move their loved one out of a facility with cases and inquires about another facility, that facility will be required to say how many COVID-19 cases and deaths it’s recorded.
Howard Fischer of Capitol Media Services contributed to this report.
Gov. Doug Ducey is blocking government agencies and some businesses from requiring customers to prove they have been vaccinated against Covid.
But the owner of your favorite restaurant or grocery store remains free to turn you away if you aren’t fully inoculated.
In the latest use of his emergency powers Monday, the governor issued an executive order barring any state or local government from denying access to any building, business, facility, location, park or other space simply because that person has not provided proof of vaccination. The same executive order says vaccination proof also cannot be required by government agencies as a condition of receiving any permit, service, license or work authorization.
Ducey also said that any business that has a contract with the state to provide services to the public is similarly prohibited from demanding documentation of vaccine status of customers.
“The residents of our state should not be required by the government to share their private medical information,” the governor said in a prepared statement.
But Ducey’s claim that he is banning so-called “vaccine passports” doesn’t hold up under closer examination.
His restrictions on what businesses can and cannot do covers only firms with state contracts. Companies that aren’t getting money from the state are unaffected and can shun unvaccinated customers, just as they now are free to require their patrons to wear masks despite the lack of any statewide mandate.
Potentially more significant, the order as crafted also does not affect what employers can require of their workers. Firms can decide to hire only those who are fully immunized.
And Ducey’s order also contains other exceptions to his ban on people having to produce proof of vaccination.
For example, hospitals, nursing homes and other congregate care settings still can deny access to patients, residents, employees or visitors.
It also leaves undisturbed the current ability of schools, child care centers and universities to demand a student’s vaccination records.
But those laws address the normal childhood diseases, things like measles and mumps. There is no current requirement for children to be vaccinated against other viruses, including Covid.
Finally, Ducey’s order does allow state or local health officials to require people to provide documentation of their vaccination status during any Covid outbreak investigation.
The issue of vaccine passports has become a political issue since the Biden administration said it was developing standards for people to prove they have been vaccinated against the virus.
White House Press Secretary Jen Psaki said there will be no national mandate. But just the idea of it has raised fears that people might be asked for their papers.
It also comes nearly two weeks after the Senate Appropriations Committee approved an even broader plan. It would prohibit any and all businesses from demanding proof of vaccination for customers, regardless of whether they get money from the state.
HB2190, as currently written, also would bar businesses owners from making vaccination a requirement for employees. But Rep. Bret Roberts, R-Maricopa, said that language is likely to be removed if and when his measure goes to the full Senate.
The order also comes as Sen. Kelly Townsend, R-Mesa, is seeking a legal opinion from Attorney General Mark Brnovich on whether private companies can make vaccination proof a condition of being a patron or employee.
Dr. Cara Chrst, the state health director, said earlier this month she supports the idea of “vaccine passports” but does not want them to be something that people would have to show to enter certain businesses.
“It would be nice to have an electronic format of some of that,” the health director said. “But we’re not looking here at the department at making that a requirement.”
Still, Christ said, this isn’t a question for her agency.
“Business owners do have the ability to implement mitigation strategies,” she said, ways to protect against the spread of the virus. And that is not limited to masks and social distancing.
The order comes as the latest figures from the state Department of Health Services show that just 37% of Arizonans have received one dose of the vaccine and only about 25% are fully immunized.
“While we strongly recommend all Arizonans get the COVID-19 vaccine, it’s not mandated in our state — and it never will be,” Ducey said. “Vaccination is up to each individual, not the government.”
The scope of the governor’s order drew a sigh of relief from Garrick Taylor, spokesman for the Arizona Chamber of Commerce and Industry.
“We appreciate that this order has been narrowly crafted and does not impose new mandates on private sector businesses broadly,” he said.
The new order also spells out that it does not limit the ability of people to access their own vaccination records as well as to have them forwarded to anyone else.
In his first public appearance since last Thursday’s televised town hall, Gov. Doug Ducey issued four new executive orders aimed to curb the COVID-19 pandemic.
Among the executive orders are requirements for health care providers to report more data related to COVID-19 patients to the Department of Health Services; another requiring elder care facility staff to use personal protective equipment, check themselves for symptoms and provide electronic communication if visitation is restricted; another requiring elder care facility staff to use personal protective equipment, check themselves for symptoms and provide electronic communication if visitation is restricted; another allowing restaurants to repackage and sell on-hand items that are normally not packaged or resold, like paper goods, cleaning supplies and prepared food in bulk; another ordering out-of-state travelers from New York New Jersey and Connecticut to self-quarantine for two weeks or face a misdemeanor.
Ducey would not say exactly how the latter order would be enforced, but said DHS will work with aviation and airport authorities to help carry out the order. The order carries the same penalties of his stay-at-home order: a possible misdemeanor, which at worst is a $2,500 fine and six months in jail, although it’s not exactly clear how the state will ensure people are self-quarantining.
But Ducey suggested that it might not have to keep that close of an eye on people, because, while he wants to reduce panic, there is “enough out there to cause fear and anxiety in people” to begin with. Further escalation of those orders given the current situation or a more strict enforcement might do more harm than good, Ducey said.
“The police have better things to do than be breaking up groups of 10,” Ducey said. “So just follow the stay at home order, and follow the order when you, when you land at Sky Harbor.”
Ducey and DHS Director Cara Christ again refused Tuesday to release projections for how bad the COVID-19 pandemic could get.
When asked about projections and details of how the state calculates them at the end of an hour-long press conference, Ducey cut off questions, raised his voice and repeated himself to make a point.
“I’m not guessing, I’m doing everything responsible to make certain that Arizona navigates through this crisis with the least amount of infection and loss possible,” Ducey said. “I’ll close with a prediction for you though, we’re one day closer to this being behind us,” Ducey said.
Ducey and Christ have danced around that question for weeks while giving assurances they are being as transparent as they can be given the rapidly evolving information they get by the hour. While some states like Colorado have released data on how the virus is spreading and the federal government has even said it expects hundreds of thousands of people to die from the virus, Christ said Arizona will not release models or give insight into their range of predictions. And it likely never will because it wouldn’t do the public any good anyways, as it’s based on back of the napkin math, Christ said.
“The information that we have is really scratch paper,” Christ said. “We’re working with the universities to develop the actual modeling, but it changes every single day.”
Still, she said the latest projections indicate that the state may need fewer ventilators than it previously requested, and the state may have to return some of those supplies to the federal government. That came a day after the state dropped its request for 5,000 ventilators to fewer than 500.
Christ said the request was revised partially because of a dwindling national stockpile and partially because the state’s forecast of a worst-case scenario changed.
“That was before we knew the number of the ventilators in the state we knew what the use of those ventilators was and before we had better modeling,” Christ said. As the state’s modeling has changed, so has its expected use of hospital beds, ventilators and other supplies, which remain under full-capacity and are expected to remain that way as more supplies come in, Christ said.
Ducey then noted that other states are also returning ventilators and other PPE that they requested, saying that’s a good thing since the pandemic is hitting softer than expected.
When pressed if health care workers should feel safe, considering the lack of PPE, Christ wouldn’t answer directly, saying only that Arizona is coordinating private partnerships with companies like Honeywell, which announced recently that it would produce six million N95 masks for the state to prepare for the pandemic.
It is unclear what the state’s total PPE capacity is, how much the state is expected to get from local and national partners, who will get those supplies and how long they will last health care providers, as most of them are not reusable.
In this Nov. 6, 2012 file photo, Democratic Senate candidate Richard Carmona gives his concession to Republican Rep. Jeff Flake at a Democratic Party gathering, in Tucson. On Aug. 26, 2021, Gov. Doug Ducey announced Carmona will the state’s senior health advisor on Covid matters. (AP Photo/Ross D. Franklin, File)
Facing a slowing rate of Arizonans getting vaccinated, Gov. Doug Ducey on Thursday tapped former U.S. Surgeon General Richard Carmona to be his new senior health advisor on Covid matters.
But don’t look for the Tucson physician and 2012 Democratic candidate for U.S. senator to challenge the Republican governor’s beliefs that schools and universities should be prohibited from requiring students and staff to wear masks. Carmona said he accepts the facts as they now stand, what with the legislature banning such mandates and the governor signing them into law and now seeking to enforce those prohibitions.
“That’s probably is not something that I would have supported,” he told Capitol Media Services of the legislation.
“But that’s the way it is,” continued Carmona who currently is a professor of public health at the University of Arizona College of Public Health. “My sense is the futile debate about mask mandates, anything mandates, is not helping us advance the public health of the state.”
Ditto any talk about state-mandated vaccines.
“The perils of a democracy are often trying to balance the rights of the individual versus the collective right of society,” he said. Carmona said he dealt with that as surgeon general when he was dealing with people who want to smoke “but we know it’s deadly.”
He said the answer is doing “everything we can” to get people vaccinated. Carmona said it makes no sense to continue to debate about mandates and politics.
The move comes as the governor tapped Don Harrington, a 20-plus year employee of the Department of Health Services, to serve as its acting director. For the moment, he replaces Dr. Cara Christ, who resigned to take a job at Blue Cross and Blue Shield of Arizona.
Her last day is Friday.
It also comes amid increased criticism of both Ducey and Christ by doctors who say the state should allow school boards to mandate masks in public schools, particularly as those younger than 12 are unable to be vaccinated.
Both the governor and his now soon-to-be-former health director have supported taking that power from school boards. Instead, they contend this instead should be an individual decision by parents.
And Ducey signed legislation which, beginning Sept. 29, makes such orders by school boards illegal, though there are legal challenges to the validity of that law.
Gubernatorial press aide C.J. Karamargin said the creation of this new slot has nothing to do with the debate over masks.
He said the key purpose behind Carmona’s appointment is to try to boost the state’s vaccination rate. About 55% of Arizonans have received at least one dose, a figure that according to the Mayo Clinic is about five points below the national average. And fewer than half of all Arizonans are fully inoculated.
“That number needs to go up,” Karamargin said. “Dr. Carmona and Don Harrington are going to help us bring those numbers up.”
The problems are immediate.
On Thursday the state health department reported another 3,621 new cases of Covid. There also were 13 new deaths, bringing the statewide tally to 18,661.
At the same time, hospitals statewide reported they have just 730 beds available. That’s 8% of total capacity, a figure not seen since January, before the vaccine was available.
And there is now the more transmissible Delta variant.
“Given this situation, there is a new sense of urgency on everyone’s part to get everyone vaccinated,” including people who have been hesitant,” Karamargin said.
He said that the doctor’s role won’t be limited to that.
“The purpose of having someone with Dr. Carmona’s experience at the table is to provide honest, informed advice,” he said. “And Richard Carmona is the best possible person for that at this time.”
But that, Karamargin said, does not extend to debating the governor’s belief that schools and local governments should not be allowed to require people to wear masks.
“You’re making this a political discussion,” he said.
“This is not a political discussion,” Karamargin continued. “This is a health issue.”
Carmona, for his part, said he’s content to focus on the governor’s goal of getting more Arizonans vaccinated.
“Why? Because we don’t want to shut down,” he said.
“If we shut down like we did last year it will be even more catastrophic,” Carmona continued. “The unemployment rate goes up, we’ll have lots of businesses close and not be able to reopen, we won’t be able to enjoy our sports activities where large groups get together.”
That, however, leaves the question of what more he can do to get people vaccinated given the number of Arizonans who have so far refused.
Vaccination rates, which topped 78,000 a day in April, has now slowed to the neighborhood of about 15,000. And the state’s lower-than-average vaccination rate comes despite efforts of Christ and her agency to both convince people that the vaccine is safe and effective as well as to set up mass vaccination sites to make the process easier.
Carmona promised a new approach.
“I don’t think it’s fair to sit back and just say, ‘We did the best we can, we’ll just live with this,’ ” he said.
“We’re going to die with this,” Carmona said. “The fact is, morbidity and mortality is going to go up and we have to do something different.”
Still, the newly appointed advisor had nothing specific to offer at this point.
“I’m going to work very hard and look at every possible strategy to be able to move forward and to make sure that everybody gets vaccinated,” he said. “And, hopefully, we will prevail.”
President Donald Trump meets with Arizona Gov. Doug Ducey in the Oval Office of the White House in Washington, Wednesday, Aug. 5, 2020. (AP Photo/Andrew Harnik)
Gov. Doug Ducey will be wheels up to Washington D.C. for a quick trip on Thursday to watch the Republican National Convention with President Trump at the White House.
Ducey’s press aide, Patrick Ptak, announced via email late today that Trump extended an invitation to the governor and the First Lady of Arizona, Angela Ducey, to be there in person to watch as Trump accepts his nomination as the Republican candidate against Joe Biden, who became the Democratic nominee at last week’s Democratic National Convention.
This means for the second time in August, Ducey will not host a weekly press conference to provide an update on Arizona’s COVID-19 numbers, which have been continuing to improve. Throughout the entire month of August, Ducey has not held a typical press briefing reporters and the public have become used to throughout the pandemic.
Thursday is also supposed to be a big day for some businesses in Arizona’s three biggest counties that will likely be able to begin reopening. Arizona Department of Health Services Director Cara Christ announced in a blog post that Maricopa, Pima and Pinal counties were all on track to meet all of the state’s health benchmarks to reopen at partial capacity.
While Ducey is across state lines, Secretary of State Katie Hobbs, a Democrat, will become the acting governor.
Gov. Doug Ducey explains why he’s not implementing new restrictions even as he concedes Wednesday that the rate of COVID-19 infection in Arizona is on the rise. With him is state health chief Cara Christ. (Capitol Media Services photo by Howard Fischer)
Gov. Doug Ducey refused Wednesday to impose new restrictions or mandates on individuals even as his own health chief warned of an increasing number of Arizonans becoming infected with COVID-19.
The governor dismissed the idea of a statewide requirement for people to wear masks while outdoors, calling it unnecessary given various local ordinances. Nor did he clamp down on existing occupancy limits at bars, restaurants, gyms or movie theaters or seek to curb their hours of operation.
In fact, the one key announcement he made Wednesday was to provide $25 million to hospitals. But that is designed to allow them to hire more staff to care for those who become ill and give bonuses to existing employees.
And given the picture painted by Cara Christ, they will need it.
The health director said more than 10% of the tests conducted last week in 13 of the state’s 15 counties have come back positive for the virus, with only Pima and La Paz below that figure. And the rate of infection is above 100 per 100,000 residents throughout the state.
On top of that, Christ said, the number of COVID-19 patients in intensive-care units also is on the rise.
“These metrics are heading in the wrong direction,” she said.
So what works? Christ put in a plug for masks based on new research by the federal Centers for Disease Control and Prevention.
“We know now that masks provide more protection than previously thought,” she said.
But Ducey said he has no intent of imposing a statewide mandate for people to wear masks when they are outside, even following pleas from state schools chief Kathy Hoffman and Phoenix Mayor Kate Gallego.
“I want people to wear a mask,” the governor said, “Masks work.”
He said, though, a statewide mandate is unnecessary because local mandates already cover about 90% of the population. And Ducey said that the efforts by his administration to convince people to mask up “has got the maximum amount of compliance.”
Then there’s the issue of enforcement of a statewide mandate given the kickback from some communities and counties that have either rescinded their mask requirements or never put them in at all amid public opposition.
“What I want to avoid is some of the division and politics that have happened around this issue,” the governor said, saying he prefers “participation and cooperation.”
But the Institute for Health Metrics and Evaluation says just two thirds of Arizonans are masking up in situations where they are exposed to others.
And there’s something else.
IHME predicts that doing nothing — meaning no change in the law — will result in about 118 deaths a day by the end of January. By contrast, the researchers say that could be cut in half with a statewide mandate.
Ducey did announce he wants Christ and her department to work with officials at the state’s three main airports — Sky Harbor, Mesa Gateway and Tucson International — on what he called “inbound messaging” for passengers arriving from elsewhere “around the importance of wearing masks and information on where travelers can get tested.” He also wants the airports to set up on-premises testing sites available to travelers when they land.
But here, too, there are no mandates on visitors to get tested — or what happens if a test comes back positive. Instead, the governor said he anticipates that people will do the right thing on their own.
“We believe that if there’s testing that’s available and it’s easy with a rapid response, we’ll have more participation,” Ducey said.
“I have a lot of faith in Americans that if they realize that if they were positive or exposed to the virus in a significant way that they would quarantine,” he continued. “We just want to give them a way to know that.”
Ducey did agree with Christ’s assessment about things not getting better in Arizona any time soon.
“That’s not on the horizon,” he said, saying the state and the nation remain in a public health emergency. “And getting back to normal isn’t in the cards right now.”
Yet Ducey made another push for getting kids back into the classroom.
“I think children should be in school,” the governor said.
“I want parents to have options,” he continued. “And one of those options should be in-person learning.”
What it comes down to, Ducey said, is what he believes is in the best interests of children, even as schools have wrestled with how to provide instruction and keep the youngsters and staffers — and, by extension, their families — safe.
“Despite the best efforts of teachers and parents, no one can argue: Kids have already missed out on far too much learning due to this pandemic,” he said.
The governor said that having schools open for learning does not mean compromising safety.
“They’re already required to have mask policies,” he said. And Ducey said that Christ will be issuing an emergency directive designed to ensure those policies are followed not just in the classroom but also on school grounds and buses.
Christ also addressed the news on the national level about progress in developing a vaccine, saying she is anticipating having some available by the beginning of next year. But that, she said, will require navigating some logistical hurdles.
One is that this is going to be a two-dose series. That means whatever version someone gets the first time has to be the same version for a second shot anywhere from 21 to 28 days later.
And that, she said, will require the ability for her agency to call people back to remind them of the need for that second dose.
Arizona Republican Gov. Doug Ducey shakes hands with Rep. Michelle Ugenti-Rita, R-Scottsdale, after giving his state of the state address at the capitol, Monday, Jan. 8, 2018, in Phoenix. (AP Photo/Ross D. Franklin)
Arizona Gov. Doug Ducey will call for a special session on Monday to push a spate of changes to prescription and treatment laws in an effort to confront the opioid crisis engulfing the state.
The proposal attacks the opioid epidemic on multiple levels, from adding treatment options and access for people addicted to opioids to increasing penalties and oversight for doctors who prescribe the highly addictive medications and those who manufacture the drugs.
The special session plan comes after the state reported two opioid-related deaths per day in 2016. The governor declared a public health emergency last year, which allowed for enhanced reporting and data collection.
The Arizona Department of Health Services reported that more than 800 people have died of suspected opioid overdoses since June 2017, though the agency’s director, Cara Christ, said not all of those deaths will be proven to be related to opioids. Christ said she expects deaths in 2017 to top the year before.
Three-fourths of people who use heroin and are in treatment reported they started with painkillers, a 2014 study by the Journal of the American Medical Association found.
The fact that many opioid users started in a legal realm – the doctor’s office – underscores how the opioid issue is different from other drugs, said Christina Corieri, the governor’s senior policy adviser.
“Nobody is prescribing meth. Nobody is prescribing cocaine,” Corieri said.
The governor’s proposal sets aside $10 million for more addiction treatment for people who are uninsured or underinsured but don’t qualify for Medicaid.
The governor hopes committee hearings will be held on Tuesday, and wants to see the legislation approved by lawmakers and sent to his office by Friday.
The proposal is expected to have an emergency clause, meaning the money and the laws would go into effect immediately instead of at a later date, gubernatorial spokesman Daniel Scarpinato said.
In addition to the $10 million for treatment, the state wants to require behavioral health facilities and recovery homes to allow people who are receiving medication-assisted treatment, like methadone and suboxone, to receive care in those facilities.
The state would also join 40 other states by putting a Good Samaritan law on the books, allowing people to call 911 in the case of an overdose for any drug and not face prosecution. The proposal would still allow law enforcement to seize any contraband and charge people with any crimes not related to drugs. This part of the omnibus bill would expire in five years.
“The aim of this (provision) is to save lives,” Corieri said.
Under the proposal, doctors and medical students would be required to go through advanced training on opioids and how to prescribe them. Doctors would have to complete three hours of continuing education on opioids, and medical students would have to take three hours of courses on the drugs.
The state has to combat “bad education” from the past, when doctors were previously taught that prescription opioids weren’t addictive, Christ, the health agency director, said.
“These are so highly addictive. We need to teach our prescribers how to use them responsibly,” Christ said.
If approved, the omnibus legislation will increase access to naloxone, a drug that reverses the effects of an overdose, by allowing county health departments and ancillary law enforcement officials, like probation and corrections employees, to use it.
The proposal would crack down on bad actors, including doctors who overprescribe and drug manufacturers. While manufacturers can only be held civilly liable currently, Ducey’s plan would impose criminal penalties, including prison time.
The bill would expand a program, called the Angel Initiative, which allows people to turn in their drugs and request treatment. Currently, the program exists only in Maricopa County. The legislation expands it to all counties.
Doctors would be limited in the amount of opioids they can prescribe. The governor earlier instituted, through the state’s Medicaid program, a 5-day limit for first-time opioid users for prescriptions, with some exceptions for people who have cancer, traumatic injuries, surgeries, hospice care, end-of-life care or nursing home care. The proposal would expand the five-day limit to Arizonans who are insured elsewhere.
Opioid prescriptions would all be required to have a red cap on the bottle to let people know easily and quickly that the drug inside is an opioid.
The governor’s office expects the bill will receive significant bipartisan support, Scarpinato said, adding Democrats were involved in drafting the bill.
Doug Ducey (Photo by Dillon Rosenblatt/Arizona Capitol Times)
Gov. Doug Ducey and public health officials said Monday the risk of a coronavirus outbreak is low for the vast majority of Arizonans, but they urged people to take precautions to prevent one.
In the case the virus, known as COVID-19, spreads exponentially quicker than experts expect, Ducey has power to issue mandatory vaccinations, quarantine people and utilize the national guard and he said he would use it if the situation calls for it.
“I’m aware of the authorities under the governor and, if necessary and needed, I will use every tool possible to protect public health in Arizona,” Ducey said. His comments came hours after he was briefed by Vice President Mike Pence and senior administration officials and said his team and theirs are in “close and frequent communication.”
Ducey was joined by Dr. Cara Christ, director of the Arizona Department of Health Services, who helped the state navigate the H1N1 epidemic in 2009, the Ebola outbreak in 2014 and the measles outbreak in 2016.
While there is no current risk for a community-wide spreading of the virus, Christ urged people to maintain proper hygiene and businesses and schools to be ready to work remotely if needed. Christ, a medical doctor and infectious disease expert, said while she understands the news can make people afraid and nervous, people should rest easy.
“The top priority of every data driven and evidence-based action that we take is to keep our communities and families safe while having as minimal of an impact on Arizona’s daily lives as possible,” Christ said.
Starting Monday, the state began testing samples from people suspected to have the virus in the Arizona State Public Health Laboratory, on the same block as the state Capitol Mall, after being cleared to do so Friday. That clearing came after Rep. Greg Stanton, D-Arizona, wrote a letter to Pence and said, according to Maricopa County health officials, the kits used to determine if patient samples had the virus were defective.
Christ said the state was one of dozens working with the Centers for Disease Control and Prevention and said they were unable to validate the results correctly because of the way the test kits worked. As a precaution to ensure accuracy, the state sent the samples back to CDC labs in Atlanta, Georgia, and results were delayed by weeks.
“There wasn’t any difference in how that changed our testing,” Christ said. “So while we were able, we would have been able to do it faster here, the CDC was still able to provide testing for public health.”
After officials were able to determine that a portion of the test wasn’t needed to validate the results correctly, the state continued testing normally and didn’t tell the public because as of that afternoon, Christ said, the state had tested 26 people for COVID-19 and 24 were negative. One person, a young man with ties to Arizona State University, tested positive for it in late Januaryand has since recovered, while the results for the other person are pending.
Christ said that case in January was a “blessing in disguise,” that activated the state’s emergency response protocol and made it more aware of the issue.
In its facility, the state can test 450 samples per day, some of which could come from the same person depending on the sample, with a same or next-day turnaround. The department will be updatingits website daily with testing statistics and other useful information for the public.
But, Christ said, the public needs to do their part too. The best way to prevent a spread is by maintaining proper hygiene, cleaning and disinfecting frequently touched surfaces and items and staying home if one is feeling sick and seeking a medical evaluation.
On Saturday, Pence announced new travel restrictions and warnings for certain countries and said the White House’s task force is “very strongly” considering closing the U.S.-Mexico border if the situation worsens. While that issue didn’t come up in the conference call with Pence and the nation’s governors, Ducey said he is leaving that decision up to the federal government.
“My first concern is for public health, of course, and there’s going to be certain decisions that are made from Washington, DC,” Ducey said. “I’m going to defer to the subject matter experts in a situation like this, when you’re talking about a potential pandemic so that we make the proper decisions to protect public health.”
Gov. Doug Ducey answers questions Monday about COVID-19, its effects on the economy and how that could affect the state budget and his call for tax cuts. (Capitol Media Services photo by Howard Fischer)
Gov. Doug Ducey and Superintendent of Public Instruction Kathy Hoffman announced Sunday all public schools will be closed until March 27.
“As more schools announce closures and education administrators express staff shortages within their schools, now is the time to act,” Ducey said in a statement. “A statewide closure is the right thing to do. While this measure will not stop the spread of COVID-19, it will bring certainty and consistency in schools across Arizona.”
Kathy Hoffman
Plenty of schools had already taken it upon themselves to close down despite the advice from the state officials and Dr. Cara Christ, the Arizona Department of Health Services director. Roughly 40 districts and charters announced either closures, extensions of Spring Break or going completely online, including the state’s largest school district — Mesa Public Schools, which has 60,000 students.
“The health and safety of all our students is our top priority, and we’ve worked hard to keep our school doors open — schools provide important services and many families rely on them for nutrition, access to health care,” Hoffman said in the statement. “I am in close contact with school superintendents, teachers, and parents and will continue working closely in partnership with schools to ensure that our families needs are met.”
Hoffman and Ducey stressed that parents should keep their children at home “to the greatest extent possible,” and that they should not be cared for by elderly relatives, as they might be put at risk.
Families who can’t, should lean on the state’s partners in non-profit, faith-based and education communities, the two said. The state will also be working to ensure students on free or reduced lunch will continue to be fed and school staff out of work will receive pay.
The announcement vastly differs from the one Christ gave on March 12 where she said they are not recommending any widespread school closures.
“Schools are critical in the lives of our children and our families. And public health realizes that the role you play extends beyond just teaching our children- which is why it is so important that we do everything we can to keep our schools open and our children and teachers safe,” Christ said.
Sunday’s joint statement came less than an hour after Ducey tweeted that the state will follow the U.S. Centers for Disease Control and Prevention’s suggestion to cancel all public events and mass gatherings involving 50 or more people. Ducey clarified the recommendation didn’t apply to colleges, universities or businesses.
Ducey’s announcement is a clear change in tone. At a business luncheon March 11, Ducey said he “didn’t think twice about coming,” because he and the people there weren’t vulnerable.
Friday morning, Governor’s Office Spokesman Patrick Ptak said the office wouldn’t, “at this time” limit visitors, Ducey’s schedule or staff operations and stressed its focus remained on “prioritizing public health.” The office then on Friday cancelled an event in Graham County for the coming week and said Ducey’s schedule is “in flux” as he and Christ wrangle the state response to COVID-19.
Pima County Health Department confirmed the state’s thirteenth confirmed case of COVID-19 Sunday morning.
As Ducey and state health leaders re-evaluate their approach to contain the spread of the virus and treat those who are sick, the Legislature is expected to decide whether to suspend the legislative session in the coming days.
House and Senate leadership and staff, according to the Arizona Legislative Report, are considering several different paths forward for the session, after three lawmakers said they will not be returning to the Capitol during the outbreak. Leadership is considering passing a baseline budget to fund agencies and provide short-term certainty if the group decides to suspend or end session.
House Minority Leader Charlene Fernandez, D-Yuma, said she favors a plan to recess for two or three weeks and returning to pass a budget.
Gov. Doug Ducey answers questions Tuesday about his handling of the COVID-19 outbreak in Arizona and about when a decision will be made about removing some restrictions. With him is state Health Director Cara Christ. (Capitol Media Services photo by Howard Fischer)
Gov. Doug Ducey indicated Tuesday he’s not obligated to follow the president’s guidance on when to reopen the state’s economy.
Ducey said in a wide-ranging press conference that people can expect to return to some sense of normalcy “as soon as possible” and that could be as soon as May 1, depending on some conditions.
That’s when his stay-at-home order issued in March is set to expire, but that could be extended or shortened depending on what public health data shows and the guidance from the U.S. Centers for Disease Control and Prevention. When that opening comes, it will come in stages, not all at once, Ducey said.
“As we get closer to that date, we will be tracking even more closely the data, and continuing to work with public health officials on what comes next,” Ducey said. “We also want to plan ahead and be ready for when the time comes to restart our economy.”
This comes after President Trump tweeted Monday that he had the “ultimate authority” to reopen states that have instituted “stay-a-home” orders, not governors. While Trump is aiming for April 30, Ducey said today that his goal isn’t based on what Trump is doing and that he will “make the best decision for Arizona.”
“When somebody’s president of the United States, the authority is total,” the president said at a press conference Monday when asked about plans by some governors to start reopening their economies.
“And that’s the way it’s got to be,” Trump continued. “It’s total. And the governors know that.”
Ducey said he understood that Trump was saying he was in charge of federal guidance, but Trump said the president’s “authority is total” and “governors know that.” Ducey also said he didn’t “see the need” to join coalitions formed by Democratic governors, groups which coordinate health care supplies and share best practices and plan to decide together on when to open the economy.
Opening the economy is something that’s on his mind “every day” and that there’s “no way we can continue like this forever,” Ducey said, which is why he’s working with the Arizona Commerce Authority and Arizona Office of Tourism to field input from the business community for an economic recovery plan. This comes as the state faces a gloomy projected budget shortfall of $1.1 billion and continues to lose at least $35 million in state tax revenue and $1.2 billion in visitor spending from tourism, a field that has lost 40 percent of its workers.
Ducey again stressed that balancing public health and economic interests is tough and that there’s nothing “magical” about May 1 but that he wants to be hopeful. Whatever the state decides to do will be based on current public health modeling data, some of which Department of Health Services Director Cara Christ said she and her department are working to release after they simplify it for the public.
It’s unclear how safe it would be for the state to reopen come May 1 because the state and nation can only rely on projections that change by the day. That date coincides with some projected peaks for COVID-19 cases, but Christ downplayed the significance of that.
Christ said different models show different peaks and it’s not the only thing the state relies on when making those decisions.
“We will continue to make the decisions based on what we’re seeing in Arizona, based on the health of our health care system, the number and the rise of the tests that we have,” Christ said. “There’s a lot of different information that we’re looking at, and we’ll continually make those decisions.”
Those decisions range from if and when to reopen the state economy, whether Arizona could host Major League Baseball games with no crowds, something Ducey said he’s open to, and how the state conducts its elections.
Ducey also issued three new executive orders aiming to curb the effects of the COVID-19 pandemic, two of which expanded on previous executive orders. The orders expand telemedicine to workers’ compensation, require hospitals to report more COVID-19 related data and revised job training requirements for caregivers.
To date, Ducey has signed 24 executive orders aimed to expand the state’s understanding of the virus with more data that better informs other orders that increase social and economic interventions — like increased social distancing, closing businesses and amending social programs — and when to reopen the economy. These orders are temporary, Ducey said.
“When we get on the other side of this pandemic and we will get there it’s just a matter of time, these orders and authorities evaporate,” Ducey said. “We will be getting as close and as back to normal or better than normal, but this decision making and authority comes with the job, and I’ve embraced it.”
A coalition of school board members, educators, child welfare advocates and others is asking a judge to void a host of changes in state law approved in the waning days of the legislative session.
Attorney Roopali Desai is not alleging that any of these new laws, individually, is illegal. They range from whether schools and even universities can impose mask mandates and changes to election laws to banning the teaching of what legislators and Gov. Doug Ducey have incorrectly labeled “critical race theory.”
The legal problem, she said, is that these were combined with other unrelated provisions into what lawmakers call “budget reconciliation bills,” essentially a grab-bag of issues.
That, said Desai, violates constitutional provisions which clearly state that each piece of legislation “shall embrace but one subject and matters properly connected therewith.” And that same provision requires each element to be laid out in the title.
What that means, she is telling Maricopa County Superior Court Judge Katherine Cooper, is that each of the challenged provisions was illegally enacted — and cannot be enforced.
If Desai wins the case, the implications go beyond nullifying the challenged provisions and, most immediately, ending the legal risk that now exists for schools, colleges and universities which are requiring staff and students to wear masks while on campus. It also would force a major change in the long-standing practice of lawmakers doing what she called “horse-trading,” piling unrelated issues — many which had previously failed on their own — into a single package designed to corral the necessary votes.
Senate President Karen Fann, R-Prescott, said she could not comment until she reviews the lawsuit with attorneys. There was a similar response from Ducey who has opposed mask mandates and signed all the measures into law.
All this comes as the Department of Health Services, whose director Dr. Cara Christ has said she backs the decision by the governor and lawmakers to bar mandated mask use in schools, reported more than 3,000 new cases, a level that hasn’t been seen in six months.
At the same time, hospitals reported 1,590 in-patient beds — 18% of capacity — occupied by Covid patients. And 22% of intensive-care beds were being used by Covid patients.
Roopali Desai
The question of whether the Legislature violated the requirement limiting each measure to a single subject and having the title properly reflect what is in the bill starts with HB 2898, which has the language banning not just school districts but also counties, cities and towns from requiring the use of face coverings or proof of vaccination against Covid to participate in in-person instruction.
What’s also in the 231-page bill is a provision prohibiting teaching curriculum “that presents any form of blame or judgment on the basis of race, ethnicity or sex.” That includes concepts like saying a student “should feel discomfort, guilt, anguish, or any other form of psychological distress because of the individual’s race, ethnicity or sex” and even authorizes the state Board of Education to suspend or revoke an offending teacher’s certificate.
Only thing is, Desai said, HB 2898 is titled “appropriating monies, relating to kindergarten through grade twelve budget reconciliation.” The reality, she said, is the bill includes “substantive policies that have nothing to do with the budget.”
“It’s bad enough that the titles don’t describe what’s actually happening in these bills,” Desai told Capitol Media Services. “But the legislature went out of its way to mislead people about what’s in the bills.”
For example, SB1824, dubbed as “appropriating monies; relating to health budget reconciliation,” says students cannot be required to be immunized to attend school using any vaccination that has only been given “emergency use authorization” by the Food and Drug Administration. That, for the moment, is the status of all Covid vaccines.
And another section bars local governments from establishing a “vaccine passport” or requiring proof of vaccination to enter a business.
Then there’s SB1819 which, according to its title, deals with “budget procedures.” But that bill includes “fraud countermeasures” for paper ballots and strips power from Secretary of State Katie Hobbs to defend election law challenges. What’s also in that bill is setting up a special committee to review the findings of the audit of the 2020 election, changes to the governor’s emergency powers, investigating the practices of social media platforms and even language about condominiums.
“None of these subjects have any logical connection to each other,” Desai said.
She argued this is more than just an academic discussion.
Desai said one purpose of the single-subject rule is to prevent “logrolling,” trying to pull together the support for a series of measures that would fail on their own by adding items designed to convince foes of any particular provision to agree to support the whole package because it also contains something they want.
For example, she cited statements by Rep. Joseph Chaplik, R-Scottsdale, that he would not support HB2898 unless it also included a ban on mask mandates for students.
Desai also pointed out the measure about the teaching certain concepts about race, ethnicity and gender actually failed to get the necessary votes when offered as a separate bill. But it then was then tucked into that same K-12 education reconciliation bill to get the votes of those who had previously opposed it.
“Never before has the legislature so ignored the normal process and procedure for enacting laws as they did for this session,” Desai wrote. She said if the courts do not enforce the single-subject rule it would be “rendered wholly meaningless.”
In her filing, Desai said these are not simply academic and legal concepts.
She said if the provisions in the K-12 measure are not voided “public schools could be left powerless to protect their students and staff.” And she said that teachers who are plaintiffs in the lawsuit could find themselves disciplined for violating a “vague prohibition” on what can be taught about race and gender.
No date has been set for a hearing on the new lawsuit.
In this file photo, Arizona House Speaker Rusty Bowers speaks on a video-chat with a handful of members who planned to vote remotely before the start of an unusual session devoid of members of the public on March 19, 2020. On December 8, 2020, protesters gathered at his Mesa home after people unhappy with his decisions related to the 2020 election posted his home address on social media. (AP Photo/Bob Christie)
Protesters rallied outside House Speaker Rusty Bowers’ home December 8 and a self-declared candidate for Arizona governor threatened to remove Gov. Doug Ducey through non-legal means this week as intraparty Republican conflict reached new heights of intimidation and innuendo.
The branch of the party that cannot and will not accept the results of the presidential election, led by state party chair Kelli Ward and a small group of GOP lawmakers has grown increasingly desperate as the number of available legal options to reverse Joe Biden’s victory continues to shrink.
Arizona Republicans and the Trump campaign have brought eight lawsuits in state and federal court and lost seven so far, though Ward vowed to appeal one to the U.S. Supreme Court. Legislative attorneys shut down theories that lawmakers could appoint their own presidential electors, and Ducey, Bowers and Senate President Karen Fann have stonewalled requests to reopen the Legislature for a special session — though Fann authorized a special committee hearing on election fraud for December 11.
With slightly more than a month to go until Biden’s inauguration, elements of the Republican Party turned this week to suggesting that it was time for violence. On December 7, the state Republican Party fired off a pair of tweets advocating violence and encouraging supporters to die for President Donald Trump’s false conspiracy that the election was stolen from him.
Throughout the week, the party’s official Twitter account continued its onslaught on Ducey and Democratic Secretary of State Katie Hobbs. In one of its less aggressive tweets, the party shared a picture of the state’s top two officials from March with the caption “betrayed.”
Kelly Townsend
On December 5, a male nurse who previously accosted a female state senator and Department of Health Services Director Cara Christ appeared to threaten Ducey’s life during a rally at the Capitol. Bryan Masche, flanked on either side by men carrying rifles, said he put out a call to militia groups after he forced his way into the state House the previous week and was arrested on his way home.
“Doug Ducey will be removed from office,” Masche said. “He will be gone, either through legal means, or, beyond that, it might come down to ‘Plan B.’ We know what it means. I don’t have to tell you what Plan B means. There are people here that know exactly what Plan B means.”
And Rep. Kelly Townsend, the Mesa Republican leading many of the calls to overturn election results, earned national attention for tweeting at Ducey a phrase from the Old Testament that was written by a mysterious hand on a Babylonian king’s wall to inform him that God found him wanting and his kingdom would fall. The biblical king was killed the night he saw that message, leading some to interpret Townsend’s message as a death threat against Ducey.
Townsend did not return phone calls for comment, but tweeted that her use of a biblical message was just intended to show that Ducey has not acted sufficiently by not calling the Legislature back into session.
Other Republican lawmakers have privately condemned calls to arms, but largely stayed mum publicly. Ducey declined to call out his own party in a tweet he posted December 8, ostensibly responding to the calls to arms.
“The Republican Party is the party of the Constitution and the rule of law,” he tweeted. “We prioritize public safety, law & order, and we respect the law enforcement officers who keep us safe. We don’t burn stuff down. We build things up.”
One exception to the anti-Ducey gang was Rep. T.J. Shope, the House speaker pro tem from Coolidge. He said he used up his monthly quota of curse words in responding to tweets from the state party.
Shope has been the only outspoken member of the Republican legislative caucus to repeatedly condemn the behavior coming from his peers. In separate tweets, he publicly called the doxing and protests of the House speaker “gross” and “crappy.”
He told Arizona Capitol Times it’s “not acceptable” to do this to anyone, including to Hobbs, who faced her own doxing and home protests last month, or U.S. Senate Majority Leader Mitch McConnell.
“You shouldn’t have to fear for your safety at your own home,” he said.
Protesters showed up outside Bowers’ Mesa home the evening of December 8, and they were rowdy enough that Maricopa County Sheriff’s deputies responded. A Twitter user shared his address and a Republican Phoenix City Council candidate facing a run-off election shared his personal number encouraging people to call and text him.
Ben Toma
Incoming House Majority Leader Ben Toma, R-Peoria, was on the phone with Bowers during part of the demonstration outside the speaker’s home. He could hear cars honking in the background, he said.
That level of protest crosses the line and is “un-American,” Toma said.
“We don’t do this as Republicans,” he said. “It’s one thing to make your displeasure known to someone in their official capacity – showing up at the Capitol and protesting and whatnot. It’s quite another to try to terrorize their family at their home.”
Rep. Walt Blackman, R-Snowflake, has been among the vocal lawmakers calling to overturn election results. He insists that Donald Trump won the election in Arizona, based on unproven anecdotes about voting machines changing Trump votes to Biden votes and residents who aren’t registered voters receiving multiple ballots.
But Blackman said the protests outside Bowers’ house and the state party asking if people were willing to die to overturn election results went too far for him. Before being elected to the House in 2018, he served in the army for 21 years, including tours of duty in Kosovo, Iraq and Afghanistan.
“Being a soldier that’s deployed several times to real places where people die, I don’t use that word lightly,” Blackman said. “When people use that word like that, are they using it for showmanship or are they actually prepared to do that?”
Walt Blackman
Bowers and Ducey are far from the first high-profile Arizona elected officials to receive threats and targeted harassment from people angry about the results of the presidential election. Protesters showed up outside Hobbs’ home in mid-November, after a user on Parler posted her home address and contact information for family members.
Ducey and lawmakers denounced threats made against Hobbs and her family, but argued that there was no connection between the people harassing her and the various unfounded election fraud theories trumpeted by many elected Republicans.
That week, Townsend had resurfaced a 2017 tweet in which Hobbs — then a Democratic state senator — complained about Trump’s refusal to condemn a neo-Nazi who struck and killed a woman with his car during a white supremacist rally in Charlottesville, Virginia.
Separately, more than a dozen lawmakers signed an open letter demanding that Maricopa County redo its hand count audit of ballots because of “growing concerns expressed by voters about the integrity of the ballot counting process.”
Sen. Paul Boyer, a Glendale Republican who signed that letter, said he doubted the letter had anything to do with harassment of Hobbs.
“I mean, don’t you think that someone like that is going to do it regardless of whether or not we as a legislative body are asking for an interpretation of the statute that says 2% of precincts rather than voting centers?” he asked. “Someone like that who’s willing to be disgusting, and atrocious, and dox a public official, do they really need an excuse to do that?”
Gov. Doug Ducey is holding a town hall at 6 p.m. tonight to give updates on the state’s response to COVID-19.
Joining him are Arizona Department of Health Services Director Dr. Cara Christ, Arizona Department of Emergency and Military Affairs Director Major General Michael T. McGuire, and State of Arizona Chief Operating Officer Daniel Ruiz.
The Governor’s Office partnered with the Arizona Broadcasters Association and Arizona State University’s Walter Cronkite School of Journalism to hold the town hall, which Arizona PBS journalist Ted Simmons and long-time journalist Carey Peña are moderating.
Gov. Doug Ducey discusses COVID-19 and the state’s response at a press conference last week. (Capitol Media Services photo by Howard Fischer)
Gov. Doug Ducey has to decide this week whether his executive orders limiting activity due to COVID-19 are worth the continued harm to the Arizona economy.
The governor most immediately has to act on his month-old stay-at-home order telling people they cannot go out unless they are engaged in an essential activity. That edict self-destructs at midnight Thursday night unless renewed.
Given Ducey’s cautious approach to enacting the order in the first place — at least two dozen other governors had acted before Arizona’s March 31 implementation — it is unlikely he would allow it to simply expire. Instead the expectation is for a loosening, perhaps tied to some advisories about social distancing.
And it won’t matter much, at least to the Arizona economy, unless Ducey also alters his list of what are “essential” business and services — and the more important list of what are not and must remain shuttered. There is no deadline for Ducey to act as that order on essential businesses remains in effect until he alters or rescinds it.
The governor’s orders already permit people to go out to shop at essential businesses. So easing his order to let people go out won’t mean anything if there’s no new places for them to go, whether to shop, dine, drink or even have a picnic in the park.
Arizona Chamber of Commerce CEO Glenn Hamer, left, earlier this year with Gov. Doug Ducey (Capitol Media Services file photo by Howard Fischer)
But here, too, the governor was slow and deliberate about deciding what can remain open, even to the point of initially concluding that barber shops, hair salons, spas and tattoo parlors were essential until he finally acknowledged that there was no reasonable way to maintain social distance.
A similar loosening is likely to be in a stepped approach, providing additional opportunities for people to shop — with some controls.
That’s exactly the course being urged by Glenn Hamer, chief executive of the Arizona Chamber of Commerce and Industry and a close political ally.
“As we thaw out parts of the economy that have been frozen, we need to do that safely,” he said. That starts with opening up smaller retail operations with “appropriate social distancing” and other safety protocols.
But all that is too slow for some Arizonans who want Ducey to immediately scrap both his stay-at-home and essential services orders.
Sen. David Farnsworth, R-Mesa, said he does not dispute that the orders — fewer infections and “flattening the curve” to preserve hospital beds — appear to have worked.
“The question is, to what extent?” he told Capitol Media Services after a rally last week.
“How long do we wait to get our economy back?” Farnsworth continued. “I think the majority of the people down here feel like the time has come, that the main point of danger has passed, that it’s time to reopen.”
All this occurs against the backdrop of additional hits to the Arizona economy, with even more people applying last week for first-time unemployment benefits. That puts the number of Arizonans who have lost their jobs since the outbreak — and his executive orders — in the half-million range.
But it also comes as questions remain about how extensive is the virus in Arizona and whether, without comprehensive data, it is premature to reopen segments of the state economy.
The health department reported Monday another 1,732 people had been tested. That brings the overall tally in the state to 66,543.
That is just 0.9 percent of the total population. Kaiser Family Foundation finds only Virginia with a per capita testing rate as low.
There have been some moves to improve that, including an order from state Health Director Cara Christ last week allowing those who believe they have been exposed to COVID-19 to get tested.
And on Monday, Ducey announced what he called the Arizona Testing Blitz, aiming to get anywhere from 10,000 to 20,000 people tested every Saturday for three consecutive weeks, beginning this weekend.
“The testing is important,” said gubernatorial press aide Patrick Ptak, saying that’s why Ducey announced the blitz, though it won’t start before his boss has to make a decision on the stay-at-home order.
But Ptak said Ducey’s decision will be based on more than just test results.
“Other data is also important, like whether our hospitals are prepared,” he said. And Arizona got some good news, with the health department saying Monday was the first day in more than a month that no COVID-19 deaths were reported.
The governor separately has been promoting antibody testing to determine who already has had the virus — and may now be immune. And Ducey has made it clear that, too, will figure in the decisions he has to make.
“Antibody testing can be a game-changer in our fight against COVID-19,” he said in a prepared statement last week when Sonora Quest Laboratories announced it will offer such blood tests in addition to diagnostic tests to determine active infection. “This is another welcome expansion that will help provide certainty as Arizona looks to economic recovery at the appropriate time.”
Ducey also is touting a new program at the University of Arizona which is providing $3.5 million to test 250,000 health care workers and first responders to determine who has been exposed to the virus and developed antibodies. But the first testing won’t begin until later this week, and initially only in Pima County.
Hamer said the bottom line — and the message he wants the governor to have — is that businesses want to reopen.
“Arizonans want to work,” he said.
“We want to see people go back to work,” Hamer continued. “And we want to see our economy fully restored.”
Still, he said, it has to be done in a prudent and safe fashion.
“And it’s going to be done in phases,” Hamer said.
He said there are models out that that work.
“Protocols are going to have to be in place that limit traffic,” Hamer said.
That’s already being done in many grocery, home improvement and department stores, with a new customer being let in when one leaves. And he said that’s even more important as the rules for who can open are broadened.
“We can’t have a gazillion people in a small store when you have a pandemic without effective therapeutics and good treatment,” Hamer said. And he said there are likely to be other mandates and suggestions, ranging from sheets of plastic separating customers from cashiers to tape lines on the floor marking social distance for those waiting in line.
All this presumes that even if Ducey loosens the restrictions that Arizonans will be willing to foray out.
“Consumer confidence is the $64,000 question,” Hamer conceded. “It’s very important for the governor’s actions to continue to be consistent with the comfort level of the citizens.”
– POOL PHOTO – Arizona Republican Gov. Doug Ducey uses hand sanitizer after speaking about the latest Arizona coronavirus data at a news conference Thursday, June 25, 2020, in Phoenix. (AP Photo/Ross D. Franklin, Pool)
Gov. Doug Ducey is defending indoor political rallies with thousands of people without masks even as he admitted the only way Arizona will stop the upward trend of infections is if people mask up and stay home.
“People’s rights to assemble are not going to be infringed,” the governor said Thursday when asked about his attendance at a Trump rally earlier this week at a packed north Phoenix church with about 3,000 people, the majority of who did not have face coverings. And Ducey is expected to attend two events this coming week with Vice President Pence, one in Tucson that has been billed as a campaign stop.
Ducey also brushed aside questions about how requiring people to wear masks — which is now the law in Phoenix — interferes with their right to assemble.
“It’s in the First Amendment,” he said.
At the same time, however, the governor announced the state Department of Liquor Licenses and Control had sent notices to eight Scottsdale bars which he said were not complying with the new “guidance” he issued last week to ensure protection of employees and patrons. That agency is empowered to take away the right of any of these establishments to serve alcohol.
“The crowded social gatherings that we’ve seen must be minimized,” he said.
All this is occurring as Ducey announced that the rate of COVID-19 infection in Arizona will continue to rise.
“I don’t want there to be illusion or sugar-coated expectations,” he said. “We expect that our numbers will be worse next week and the week following, in terms of cases and hospitalizations.”
Arizona added 3,056 new cases on Thursday, bringing the total to 63,030. There also were another 27 deaths reported, with that tally now at 1,490.
Health officials reported a record 2,453 people hospitalized with COVID-19, with 611 in intensive-care beds, just shy of the record of 614 set a few days earlier.
And hospitals are now using 85 percent of their beds for all kinds of patients and 88 percent of ICU beds.
Finally, more than one out of every five tests for the virus is coming back positive.
What eventually will turn that around, Ducey said, is the fact that he agreed a week ago to allow cities and counties to impose face mask requirements.
He has refused to do this on a statewide basis. But the governor said the fact that 75 percent of the state now is under such a local mandate should finally result in the state turning the corner — for the moment.
“What we’re going to deal with now over the next 30 or 40 days, I believe will slow the spread of this virus,” the governor said.
“And then we will have a period of time,” he explained. “And then we will head into a second wave.”
Ducey, who dissolved his stay-at-home order in the middle of last month after six weeks, said he is not prepared to reinstate it.
But the governor did say that, mandate or not, people should stay at home when they don’t need to be out.
“Go out and get a haircut,” he said.
“Get something to eat,” Ducey continued. “And go home.”
Cara Christ, his health director, echoed that message.
“You are safer at home with your household contacts,” she said. And Christ said there are things people need to consider if and when they do go out.
“Indoor spaces are riskier than being outdoors,” she said. And the more people there are, Christ said, the greater the risk of infection.
But the governor said none of that convinces him that gatherings should be restricted — or that those in attendance should be required to wear personal protective equipment.
“In terms of the rights of people to peacefully assemble, those rights are not going to be infringed,” Ducey said.
“It is an election year in the United States,” he said. “And people’s constitutional rights will be protected.”
Instead, he said, it’s up to those who go to protect themselves, just as he is now doing.
“Wearing a mask is a huge part of avoiding contracting this virus,” Ducey said.
“Also physically distancing from people,” he continued. “And I’m going to continue to do that going forward.”
Ducey also defended the travel plans by both Trump and Pence.
“The president and vice president have a job,” he said.
“I have a job,” Ducey continued. “We’re not going to get in the way of the job that they have to do.”
Anyway, the governor said, both are focused on places like Arizona and “states that are having issues to address that in its turn.”
Pence is going to Yuma this coming week to meet with Ducey to discuss the state’s response to COVID-19. And the vice president’s planned visit to Tucson is billed as part of his “Faith in America” tour and not as official business.
The attorney for a locally owned chain of fitness centers told a judge Monday he should hold Gov. Doug Ducey in contempt.
Joel Sannes pointed out to Maricopa County Superior Court Judge Timothy Thomason that he had directed the governor to come up with a process to allow gyms and fitness centers to reopen even in counties where the risk of COVID-19 remains substantial.
But Sannes said all that Ducey and state Health Director Cara Christ did was to tell these businesses they can apply — and she and her agency would review what they submit.
What they did not do, he said, is give them some actual standards to meet. Instead, it comes down to making proposals beyond the basics of what will allow them to reopen at some undetermined future date and hoping state officials like them.
Mountainside Fitness attorney Joel Sannes, right, answers a question as Mountainside Fitness founder and CEO Tom Hatten, left, listens after the health club announces the they will comply with a court decision to close during a news conference at Mountainside Fitness headquarters Tuesday, July 7, 2020, in Scottsdale, Ariz. (AP Photo/Ross D. Franklin)
“The process is a black box,” Sannes said. “Due process can’t be achieved without standards.”
Thomason said he understands the frustration of businesses hoping to prove they can reopen safely despite the substantial threat of the coronavirus but not told what they need to do.
“The thing that gives me a little concern is the fact that if you’re in the ‘substantial’ category … there aren’t any standards,” the judge said. “It is a little bit shooting in the dark.”
But Brett Johnson, the governor’s attorney, said Ducey did comply with the order, directing the health department to set up a system for businesses to be able to get waivers from the normal standards.
In fact, he said, it’s working. He pointed out that EoS Fitness, which also had sued Ducey over the governor’s order shuttering gyms and fitness centers, has been allowed to open its doors again.
Documents obtained by Capitol Media Services show what EoS did is agree to limit occupancy to 10%, require electronic reservations for all clients, require masks, keep saunas and steam rooms closed and pause group activities like basketball.
But it’s not just EoS that sought a waiver from the rules that now keep certain businesses closed because they’re located in areas of substantial risk of COVID-19 spread.
As of late Friday, 89 gyms and fitness centers had submitted proposals, with Training for Warriors – Estrella also given the go-ahead to reopen.
There also are 95 applications by businesses licensed as bars to be allowed to bring customers inside, and five from movie theaters.
Four businesses have been denied.
Timothy Thomason
But as Sannes pointed out, there is no specific set of standards to get those waivers, only an application process with decisions made on a case-by-case basis.
That makes what Thomason decides crucial as it could have implications beyond this case — and even beyond gyms and fitness centers. It could determine if the health department is forced to tell businesses closed because they are in areas of “substantial” risk of COVID-19 spread exactly what they have to do to get a waiver to reopen or whether they just have to put in a proposal and hope for the best.
Johnson told Thomason that Mountainside has to go through the process — and seek an informal settlement conference if denied — before it can claim that Ducey didn’t do what the judge ordered. And he said that the whole idea of Mountainside seeking to hold the governor in contempt because they don’t like how the health department might handle its application makes no sense.
“If you don’t get a driver’s license, you don’t sue the governor,” Johnson said. “You go after DMV.”
Sannes, however, does not see it that way. He said Thomason’s order required the health department to create standards to tell businesses what they need to do to get a waiver.
Under current practices, the health department will allow gyms and fitness centers to reopen at 25% capacity with certain other protections. But Christ said that can occur only in counties where there is no longer a substantial risk of spread of the coronavirus.
Only Cochise and Yavapai counties fit that definition.
At issue here is that Christ said she will allow those in the other 13 counties to submit plans to reopen anyway. That’s how EoS and Training for Warriors got approved.
But what she hasn’t provided, Sannes said, is some clear benchmarks for what others have to do.
Johnson did not dispute that fact. Instead he urged Thomason toss the complaint.
“To say the governor is somehow subject to contempt for everything he and his administration is doing is quite honestly offensive,” Johnson said. And he said there is a remedy if Mountainside wants to know what Christ found acceptable by EoS: file a public records request.
State health officials are slow at investigating reports of abuse and neglect at long-term care facilities, to the point where residents may be put at risk, according to a new audit.
The sometimes blistering report about the Arizona Department of Health Services found that 14 of 33 complaints they examined had been open at least 229 days without an investigation.
And state auditors cited one complaint, submitted by another state agency, which alleged that inadequate staffing levels had caused a resident who was unable to feed or use the restroom, to be soaked in urine and clothes stained with dried food. That complaint, the report said, was not investigated for 851 days.
The report by the Auditor General’s Office also faulted the health department for classifying a third of “self-reports,” those submitted by licensed long-term care facilities, as needing no action beyond reviewing a facility’s internal investigation of the incident. That, the auditors said makes no sense, as facilities are required to report only items that are potential regulatory violations – incidents which the department is required to determine if a violation actually occurred.
Auditors pointed to one self-report which was closed with a “no action necessary” conclusion on the same day it was reported, an incident that involved “allegations that a resident with ambulatory issues was being thrown around like a ‘rag doll’ by a staff member.”
The report does not provide names of any facilities or patients.
In a formal response, state Health Director Cara Christ disputed the findings, taking her own slap at the auditors for failing to “provide context” in terms of all of the roles of her agency.
“Long term care facilities represent less than 0.5 percent of total licensees under department regulation,” she said. And Christ said the auditors, who acknowledged they looked at only a sample of all reports, looked at only 0.4 percent of all complaints received by her agency during the two-year period under evaluation.
“Rather than articulating how the department performs across this wide range of activities to protect public health and safety and investigating and resolving complaints within its jurisdiction, the audit findings focus on this very narrow non-representative sample,” she said.
Christ also said her agency evaluates facilities for the federal Centers for Medicare and Medicaid Services and “is currently in compliance with those requirements.”
“The audit establishes expectations for the department beyond those that exist in its agreement with CMS or as currently established by the Legislature,” she wrote, including determining what are acceptable time frames – and without regard to available resources.
She did, however, agree to do more to allocate new staff or reallocate existing staff to prioritize, investigate and resolve complaints about long-term care facilities. And she said her agency is assigning two additional staffers to handle complaints.
But Christ suggested that resolving the problems may require more than just changing assignments.
“The department believes an additional 44 staff and an additional $3.3 million appropriation and general fund allocation will be needed to timely adjudicate the nearly 2,500 complaints received annually,” she said.
State auditors said that the primary responsibility for investigating allegations of abuse, neglect and exploitation of vulnerable adults in Arizona is with the Department of Economic Security. But it is the role of the health department to review the facility’s practices, policies and procedures to determine if there are “appropriate safeguards in place to mitigate the likelihood of abuse occurring.”
And the report warns that the health department not investigating complaints or taking too long to get them resolved “may put residents at risk.”
The auditors cited one case complaint by a nursing student who was on rotation at a long-term care facility who alleged residents were being subjected to abuse, neglect, unsanitary conditions and inappropriate quality of care and treatment. Yet that complaint had been open and uninvestigated for 299 days.
“By not initiating an investigation of this complaint, the department has yet to determine whether the allegations where substantiated (or) unsubstantiated,” the report reads. And if they were substantiated, the auditors said, the department should take action, ranging from requiring the facility to develop and implement a plan of correction to actually revoking the facility’s license.
“The longer a complaint or self-report remains uninvestigated, the more likely potential problems or violations will remain unaddressed,” the report says.
The state’s top health official said schools should be able to quarantine unvaccinated students and keep them out of class in at least some cases where they have been exposed to Covid.
Dr. Cara Christ told Capitol Media Services on July 20 she still believes that the best place for children is in school.
“It’s the safest place for kids,” she said, though she said unvaccinated students should be wearing masks even though state lawmakers have now prohibited districts from requiring their use.
The key, she said, is making case-by-case decisions.
“I don’t think we want to be taking broad, sweeping, quarantining entire schools if they’ve got a case of COVID-19,” the health director said.
But Christ said that there are circumstances when separating out some unvaccinated students – and maybe even some who are vaccinated but have underlying health conditions – may be appropriate when there is a confirmed case in a school.
“Isolation and quarantine does remain a tool that’s available to local public health (agencies) when they are working with school districts,” she said. And that guidance remains in place, Christ said, even after Gov. Doug Ducey, through his health policy adviser, told school districts they cannot require that unvaccinated students be quarantined even if they have had contact with someone with a confirmed case of the virus.
Cara Christ
In fact, Christ said, that guidance is again under review with the spread of the more highly contagious Delta variant of the virus. And it could result in recommendations for greater use of quarantines.
“One of the things that we’re talking about here at the department is, with how transmissible it is, that all close contacts should be quarantined potentially,” she said.
“That’s something that we’re working through right now because we want kids in school,” Christ continued. “We want to be able to use that as a tool, but we want to be able to use it sparingly and work to implement other strategies to prevent spread.”
Several school districts and health departments already were resisting Ducey’s directive, arguing that the question on the use of quarantines for unvaccinated students is beyond the governor’s authority.
Christ, in her interview, did not address what the governor has ordered. But she said the policies and guidance of her agency, including the use of quarantine for unvaccinated people who have been exposed, has not changed since that letter went out to school districts.
And, more to the point, she said any across-the-board ban on quarantines is not the right way to go.
“Schools should work with their local public health departments to determine the best course of action if they have cases” of the virus, Christ said. The question is particularly important at the lower grade levels, she said, where there is no vaccine option.
But she did say that any action has to be reasonable.
“We don’t recommend that it’s just a blanket quarantine of everybody who’s unvaccinated,” she said. That’s where follow up and input from local health departments comes in, with decisions on a case-by-case basis.
“They work on those contact tracing investigations and make specific recommendations for quarantine, ‘watch and wait,’ all different types of strategies depending on that close-contact specific situation,” Christ said.
She said that can involve making recommendations to families whose children are not vaccinated.
“What we want to make sure is we’re not just using unvaccinated status as a sole reason to quarantine people,” she said. “And that’s not how public health works.”
None of this affects the ability of districts to prohibit students who are infected from coming to school.
The discussion of the use of quarantines comes as the number of cases of the virus is on the upswing, routinely topping 1,000 a day, a rate Arizona has not seen since the end of February. But the health director said there’s no cause for alarm.
“I think we’re in a different place than we previously were,” she said. And the key is the availability of the vaccine.
“We have a tool that is highly effective in preventing hospitalizations and deaths,” Christ said.
Still, just 3.3 million Arizonans are fully vaccinated out of a population of about 7.2 million. That includes both those who refuse to get inoculated as well as those younger than 12 for whom the vaccine has not been approved.
That, in turn, goes to what has become another highly charged political issue: masks.
“We have not changed our public health guidance here in Arizona,” Christ said. “So, if you are unvaccinated, we would recommend you wear a mask when you’re around people you don’t live with.”
Ditto, she said, for vaccinated people who are at high risk.
That’s personal for her: She has three children, two of whom are not old enough to get inoculated.
“Those two will be wearing masks to school even though the school district is not requiring it,” Christ said.
Arizona can expect to have thousands, if not tens of thousands, of confirmed cases of COVID-19 this year, the state’s top health official said Monday.
“And that’s just the tip of the iceberg,” Cara Christ said at a press briefing Monday afternoon.
She said that, just like the flu, there are going to be people with mild symptoms who will not seek medical care — and not be tested for the virus.
“So we know there’s a lot more people who don’t seek healthcare with respiratory symptoms and are still in the community,” Christ said.
And they are still potentially contagious.
Cara Christ
Christ said her latest analysis that Arizona has a “heightened” risk of the new virus spreading here came after at least one of the state’s cases ended up being traced to “community spread.” That means the patient had no known travel to a country where he or she could have been exposed nor had been in contact with someone else with the virus.
The message with that risk level − and the chances of getting it − is simple.
“I think now that it’s in the community, that’s much more of a possibility than when it was just with those individuals that had traveled from Wuhan or from China,” Christ said. What that means, she said, is “act like everyone has it.”
But even with that, Christ is saying that her current advice is that the only people who should take special precautions are those who are elderly and have underlying health conditions, especially respiratory.
Still, there are special circumstances.
For example, Christ said she would advise her own mother and grandmother not to take a plane trip, particularly a long one, unless it was absolutely necessary. Part of that, she said, is the “close quarters” and the chance of ending up next to someone who is sick.
Still, Christ said, plane travel is probably a lot less risky than a cruise. In that case, it’s not only a question of close contact but things like sharing dining facilities and even touching the same utensils.
“A lot of the same facilities are being used for days on end,” she said.
As to those who are at risk, she had a special message.
“We encourage them to have supplies on hand, such as extra prescription medication, over-the-counter medications, and supplies like tissues and other household items and groceries,” Christ said. “Take everyday precautions, such as avoiding people who are sick, washing your hands often, and cleaning and disinfecting high-touch areas like your doorknobs, light switches, toilets, faucets and phones.”
And there’s something else.
“Stay away from crowds, if possible,” she said. “And have a plan if you get sick to call your health care provider and identify who else can care for you if your caregiver becomes ill.”
Gov. Doug Ducey, who also was at Monday’s briefing, said he was not concerned about reports of certain kinds of items like cleaning supplies being snapped up, leaving some store shelves bare.
“I’m confident that these items that are in the consumer market will be replenished and people should have the appropriate items in stock at home,” the governor said.
Christ said there are no plans to ask organizations to cancel events designed to attract crowds, like the Democratic presidential debate in Phoenix on Sunday, saying that decision is up to individual event planners.
The health chief also announced new protocols for nursing homes and similar facilities, including screening visitors and, to the extent possible, convincing them to stay away. Still, she acknowledged, that presents different problems.
“We understand long-term care facilities are people’s homes,” Christ said. And those living there need not only their physical needs attended to but also their mental health.
She said if a resident gets sick, these facilities should be prepared with everything from having masks and gowns immediately available outside the person’s room to ensuring that the staffers taking care of patients diagnosed with the virus are also not caring for others in the facility.
FILE – In this July 2, 2020, file photo, a trainer, top, at Mountainside Fitness, works with a client in Phoenix. Mountainside Fitness CEO Tom Hatten said Friday, July 3, he would keep his chain open for now. “We are going to stay open until we have our day in court, which is Monday morning,” Hatten said at a Mountainside location in Scottsdale. “If the court does not allow a stay, we will comply and respect the court’s decision. We will deal with being closed again.” (AP Photo/Ross D. Franklin, File)
A judge on Tuesday rebuffed a bid by a locally owned chain of fitness clubs to remain open while it challenges the order by Gov. Doug Ducey shuttering all of them through July 27 — if not longer.
In an extensive ruling, Maricopa County Superior Court Judge Timothy Thomason, an appointee of former Gov. Jan Brewer, said the evidence shows that Mountainside Fitness is a “good citizen that went above and beyond what was necessary to ensure the health and safety of its patrons and employees.” And the judge said courts have to be sure that government officials, in closing down private businesses, are not exceeding their authority.
But Thomason said that, at least at this point, there is not enough evidence to show that Ducey acted illegally in shutting down not just Mountainside Fitness but also other chain and mom-and-pop operations — at least not enough at this point to quash the governor’s June 29 executive order. It was issued following a spike in COVID-19 cases after Ducey allowed businesses, including gyms, that had been closed in March, to reopen in May.
Doug DuceyNone of that means that the judge won’t eventually conclude, following further hearings, that Ducey exceeded his legal authority.
But attorney Joel Sannes said that will now require presenting evidence and witnesses, something that could take weeks. And by that point, he acknowledged, the governor’s order affecting gyms and fitness clubs may have been lifted, making it pointless to continue the lawsuit.
Even then, there’s no guarantee that Thomason eventually will side with Mountainside or conclude that gyms can reopen despite what Ducey ordered. In fact, the judge called it “unlikely” that the company will prevail, even after a full-blown hearing.
Still, Sannes said plans are to proceed with the case. In the interim, however, Mountainside will abide by the governor’s latest order, closing its doors Tuesday afternoon at its 18 locations.
Strictly speaking, Tuesday’s order affects only Mountainside Fitness and Fitness Alliance whose challenge to Ducey’s order was consolidated with this case. But Sannes said it could be seen as setting a precedent of sorts for other similar places.
“They’ll have to make the decisions on their own,” he said.
Sannes warned, though, they remain open at their own risk now that Thomason has concluded, at least for the time being, that Ducey was acting within his emergency powers. And he pointed out that the state already had started efforts to enforce the closures even before Tuesday’s ruling.
Tom Hatten, founder and CEO of Mountainside Fitness, reacts Tuesday to a court ruling throwing out his challenge to the decision by Gov. Doug Ducey to close gyms through at least July 27. (Capitol Media Services photo by Howard Fischer)“The state may become even more serious about enforcement for gyms that choose to stay open and fitness centers that choose to stay open,” Sannes said. “They have to evaluate the consequences just as we have.”
Gubernatorial press aide Patrick Ptak said this was the outcome his boss expected.
“The issue is about protecting public health and containing the spread of COVID-19,” he said in a prepared statement. “Businesses need to comply with the public health orders.”
But this isn’t the only legal fight Ducey has on his hands.
Xponential Fitness has filed its own complaint in federal court alleging that the governor’s order violates a host of federal constitutional protections and that it violates the right of affected businesses to have due process before being shut down. The company has 50 studios around the state operating as Club Pilates, Stretch Lab, CycleBar, Pure Barre, Yoga Six, AKT, and Row House.
U.S. District Court Judge Diane Humetewa is scheduled to hear arguments in that case this coming week.
The governor’s office is likely to present the same evidence at that time that it did in this case, evidence that Thomason found sufficiently compelling to presume that Ducey had a legitimate reason to shut down the gyms. That includes statements from state Health Director Cara Christ and Marjorie Bessel, chief clinical officer at Banner Health.
Both are doctors. And both said they believe that indoor gyms and fitness centers present high risks of infection.
“Physical exercise is often not conducive to wearing a mask,” Thomason wrote.
“Exercising also results in respiratory droplet secretions that can easily be spread,” the judge continued. “Physical distancing can be difficult in gyms.”
Thomason acknowledged that some gyms say they are complying with protocols designed to protect public health. But he questioned whether that really does any good.
“The medical professionals feel that, even if gyms follow all protocols, there is still an unacceptable risk of infection,” Thomason wrote.
“Many fitness center members return to the center several times a week, increasing the risk of infection,” he said. “Other states have closed gyms and fitness centers.”
But the judge also fired a warning shot at the governor, saying he can’t keep facilities closed forever based on these fears.
He pointed out that, at least on paper, Ducey’s order allows gyms to reopen once they have completed and submitted a form prepared by the state Department of Health Services “that attest the entity is in compliance with guidance issued by ADHS.”
Only thing is, those forms are not now available. In fact, attorneys for the state could say only that the form “hopefully” will be available by July 27.
“Justice delayed is indeed justice denied,” Thomason wrote.
“If process is not provided in a reasonably timely fashion, then there really is no due process,” he continued. “In sum, the process provided must be adequate.”
And Thomason emphasized his point with a threat of sorts.
“If the form is not available well in advance of July 27, then the governor runs the real risk of depriving aggrieved businesses of any real process at all,” the judge said. “If meaningful process is not provided, the injunctive relief may ultimately be ordered.”
Tom Hatten, founder and CEO of Mountainside, said the judge’s order shows just how much deference Ducey — and most governors — are given in state laws to issue executive orders and have them upheld. And he said that should alarm owners of other firms that are not affected, at least not yet, who would be subject to “wide-ranging authority that’s arbitrary in its nature, very difficult to fight against.”
Does Hatten believe lawmakers should rein in the governor’s power to issue these orders?
“Absolutely,” he responded.
Hatten said he will keep the estimated 1,500 employees on payroll while the legal fight plays out and that members were not billed this month.
He dodged questions about whether gyms, by their nature, are more hazardous than other businesses because people are working out, raising the possibility that droplets with the virus could become aerosolized and travel more than six feet.
“There’s no evidence that the spike came from health clubs or the fact that you’re standing six feet (apart) and working out or you’re on a treadmill six feet away, there’s just nothing that proves that,” he said.
“What we do know is it’s still spreading,” Hatten continued. “There’s theories as to why.”
State health officials are looking for new ways to boost Arizona’s sagging rate of vaccination of children after scrapping a pilot program aimed at parents who opted their youngsters out.
That program, started more than a year ago in 16 Phoenix-area schools, asked parents in half of them to view a video about the need for widespread immunization, both for their own children and others who for various medical and religious reasons cannot get vaccinated. But as state health officials were reviewing the results, some parents complained to the Governor’s Regulatory Review Council that they feared what was, for now, an option to view the videos could be made a requirement for parents who oppose vaccinations.
But Colby Bower, the department’s assistant director, told Capitol Media Services Tuesday that the now-abandoned pilot program was not part of the rules under review – or even under the purview of the council. And he said the decision to scrap the pilot program – and not try to take it statewide — has nothing to do with those rules which the council ended up approving anyway.
Put simply, he said, the program didn’t work.
In fact, it’s worse than that.
Cara Christ
In a blog post Tuesday, Health Director Cara Christ said in the elementary schools where the video was shown to parents who did not want immunizations for their children, in half of those schools there actually was a slight increase in the number of exemptions requested. Conversely, in half of the schools where there was no video, there actually was a slight decrease in exemptions.
“Unfortunately, these weren’t the results we were hoping to see,” she said.
So what’s next?
“It’s time to reevaluate and readjust and figure out how we can move the needle,” Bower said.
That “needle” is the percent of children who start school with the legally required vaccinations. The reason that compliance is not 100 percent is Arizona law allows parents to refuse to go along, whether for religious or personal reasons.
What has caused concern is that in the 2016-2017 school year 4.9 percent of parents of students entering kindergarten opted out of immunization for personal reasons. That is on top of 0.3 percent seeking a medical exemption.
The most recent data available for the 2017-2018 school year found that personal noncompliance rate hit 5.4 percent, with a 0.7 percent medical exemption. And among those in child care, non-immunization for personal reasons went from 3.9 percent to 4.3 percent.
All that is significant because, in general, state health officials say it takes about a 95 percent vaccination rate to create “herd immunity.” That’s where enough people are immunized against the disease to prevent it from spreading widely into those who cannot be vaccinated for things like medical and religious reasons.
State health officials figure that the failure to achieve herd immunity for just youngsters in kindergarten would mean about 5,000 statewide would be at risk for just measles, one of the diseases now in the list of mandatory vaccinations. Other in the immunization list include polio, chickenpox, hepatitis B and diphtheria.
Under the pilot program, any parent seeking an exemption viewed an “introductory” online module about vaccinations. Then, depending on which of the multiple vaccines on the mandatory list they did not want, there were separate modules.
After viewing the applicable modules parents were able to print the forms seeking each vaccination exemption to return to the school.
But department spokeswoman Melissa Blasius-Nuanez said the program was voluntary: Parents who did not want to view the videos were still given access to the exemption forms.
In her blog post Tuesday, Christ said alternatives are being planned. But she indicated the changes proposed are not based on any concerns that the pilot program was being targeted solely on parents who choose not to immunize their children, whether for personal or religious reasons.
One option, she said is making the course into educational videos available to all and not specifically targeting parents who want to opt out of vaccinations. There is also the idea to have the program target all parents at schools with the highest percentage of children who are granted personal exemptions from immunization.
As it turns out, a 2013 University of Arizona study cited by the health department found that the highest opt-out rates tended to occur in schools with mostly Anglo students – and, in particular, those in more affluent areas.
The health department also has found a much higher rate of rejection in some areas in the northern part of the state, with the highest percentages of refusal – above 14 percent – in and around Prescott, Sedona and Page. Conversely, some of the lowest rates – below 2 percent – were in and around Tucson, Bisbee, Douglas, Yuma and Santa Cruz County.
Separately, the health department’s own data has found that, geography aside, the parents who send their children to charter schools are more than twice as likely to keep their children from getting immunized as those going to traditional public schools.
The reasons, according to the UA study, included concerns about side effects, notably a perceived link to autism despite repeated assurances by the Centers for Disease Control that there is no link. Other fears expressed by parents ranged from perceived contaminants to a lack of trust of manufacturers, pharmaceutical companies, government and physicians.
Bower said the reaction from parents to the pilot program was in some ways expected.
“Whenever we do anything with vaccines there’s always pushback,” he said.
Nurse Machrina Leach preps the first dose of the Pfizer-BioNTech vaccine for COVID-19 at the Arizona Department of Health Services State Laboratory, Wednesday, Dec. 16, 2020, in Phoenix. The Pfizer vaccine was almost 95 percent effective at preventing patients from contracting COVID-19 and caused no major side effects in a trial of nearly 44,000 people. (AP Photo/Ross D. Franklin)
The state is revamping its COVID-19 vaccine distribution system in hopes of getting more people inoculated faster.
State Health Director Cara Christ acknowledged Wednesday that only about 18% of the more than 314,000 doses received by this week actually have ended up in the arms of Arizonans.
Christ said some of that is due to the fact that some of the rural counties are just getting their inoculation systems up and running.
But she conceded that allowing each county to run its own program, with minimal state oversight, has created certain inefficiencies. So now the state will take a more active role in how the program is run, complete with the authority to take possession of vaccines rather than simply pass them along to counties.
The move comes with the blessing of Gov. Doug Ducey who issued an executive order giving Christ and her agency the additional powers.
“Any delay in the vaccine getting to Arizonans, any dose that sits in a freezer rather than reaching the arm of a health care worker or long-term care resident, carries too great a cost,” the governor said in a prepared statement.
“This is a health emergency, and we need all levels of government and our health system operating as such,” Ducey continued. “Vaccines don’t do any good sitting in a freezer.”
Cara Christ
Christ said the new system also should make it easier for individuals to keep informed about when they will be eligible to get vaccinated.
She promised that the state will post information on its web site about what is the current stage of distribution. That is critical as people are divided into priority groups based on everything from where they work to age and their own medical risk.
And Christ said her agency will have a single point of contact where any Arizonan can learn where they can get vaccinated anywhere in the state.
But one of the biggest changes is going to be that Christ and her agency will be taking possession of some of the state’s allocation.
“Our county health departments really know their community providers the best,” she said.
Christ said, however, that doesn’t always work. She said that companies like CVS and Walgreens, both of which are administering the vaccines throughout Arizona, “need to work on a statewide basis.”
“We’ll be allocating some of the vaccine directly to them as it becomes available,” she said. And that, said Christ, will ensure that each of the vaccination sites being run by those companies have the vaccines they need rather than having to rely on seeking something from each of the 15 counties who have their own allocations.
“We want people to know that when Walgreens has vaccines it’s going to be Walgreens across the state and not just the Walgreens in Maricopa or Pima county,” she said. Christ said the state needs to “really have a consistent approach so that people know where to get the information about when they should get vaccinated, where they should get vaccinated, so that we can target those very vulnerable, high-risk populations and get them done quickly.”
So, for example, the state will have a single web site where people can find out when it’s their turn.
For example, the current vaccines are being offered to those in what’s called the 1-A category. These are health care workers and staffers in long-term care facilities.
Christ said about 57,000 of the 274,000 people in that category already have gotten the first dose.
What’s next is the 1-B group, which includes educators and child-care workers, public safety workers and, recently added, those 75 and older.
That web site, Christ said, will not only say when a county has hit 1B — each county may be at a slightly different stage — but provide instructions on how to sign up.
Then there’s the question of what people will need.
So, for example, someone who is at least 75 would need a driver’s license or other proof of age. For others, it’s a little less clear.
“For essential workers it would likely be you attend an employer-based vaccination site,” she said. “Or if you were going to a pharmacy or using a retail outlet or your physician, you would need to show a badge or some type of proof that you were one of the essential employees.
Christ figures, though, 1-B inoculations are unlikely to start until as many in the 1-A category who want get immunized, something likely to take well into January if not early February.
Still, she said, it’s possible that once a county has vaccinated everyone in the 1-A category who wants immunization that it could start offering appointments to those in the next category down.
As it goes farther down the priority list, that raises different questions.
For example, the 1-C category includes adults with high-risk medical conditions. Christ said that should not necessarily require a doctor’s note to get vaccinated, particularly if a patient is getting the shot in the physician’s office.
And state health officials are hoping that by that point there will be so many doses of vaccine available that restricting people by priority won’t be an issue.
That leaves the question of when — if ever — Arizona will reach the point that enough people are vaccinated or have recovered from the virus to achieve “herd immunity,” the point at which the threat of rapid spread pretty much evaporates.
“There’s a lot of different things that have to come together for us to do that,” Christ said. But she said she remains optimistic.
“And I think as you look over the next couple of weeks, as we continue to add (vaccine) locations, and as we continue to get more vaccine into the state we’re going to see significant increases in the amount of vaccinations provided,” Christ continued. “And we’ll be able to meet that by the summer is what we’re hoping.”
The change comes as Arizona continues to set new records in the number of beds in intensive-care units occupied by people with confirmed or suspected cases of COVID-19. With 78 new deaths reported Wednesday, that brings the statewide total to 8,718, with more than 512,000 Arizonans having contracted the virus since the pandemic began.
DHS Director Cara Christ disagreed with the state auditor’s finding that her staff had misspent nearly $1 million, but the process of approving expenditures from the fund meant to keep the state’s Medical Marijuana Program functioning is getting a facelift nonetheless, starting with improved records maintenance.
“It’s not so much that we’re changing it because we agree that we misallocated [money]. We did find areas that we can improve in,” Christ told the Arizona Capitol Times Thursday.
The core issue seems to be in the program’s record-keeping – or lack thereof.
Christ pointed to the audit’s qualm with two employees whose salaries were paid for entirely through the Medical Marijuana Fund though they also worked on other programs at the department.
“We couldn’t go back and show why we felt that it was OK to pay 100 percent of that person’s [salary] because we didn’t have the records,” she said. “Had we had the records, we probably would have been able to.”
Moving forward, the program will be documenting expenditure decisions clearly, both with regard to approvals and denials.
“We do take a careful look at everything that’s being used by that fund because we are highly aware that if it is used inappropriately as determined by a court of law or the Legislature, we’ll have to pay that back,” she said, adding that “obviously, we’re not going crazy spending money.”
And she emphasized that there was no intent to misallocate any of the funds.
“It was disappointing to see the way that it was phrased,” she said of that finding in particular. “When you know the team and you talk to them on a daily basis and you know that they’re good people, it’s just a little concerning.”
Still, she said improvements are being made with regard to the Medical Marijuana Fund and other recommendations made in the audit.
DHS intends to come into compliance with all recommendations that were agreed to within six months, she said.
Of course, that leaves out those recommendations included in the audit released Tuesday that DHS did not agree to.
DHS and the Auditor General’s Office still have a fundamental legal disagreement over whether the department can conduct unannounced inspections of kitchens within dispensaries that are making marijuana edibles for sale to patients.
Each of those kitchens is licensed as a food establishment, which can be subject to unannounced inspections, according to the audit. But the dispensaries that house the kitchens are licensed separately, and state law does not allow DHS to inspect dispensaries without providing advance notice.
And inspectors have no way of simply entering the kitchens without going through the dispensaries first because dispensaries are required to have a single, secure entrance.
“We can show up to do the unannounced inspection, but we still have to cross the threshold of the dispensary. And that’s where we can be told ‘no,’” Christ said.
The original intention was to inspect the kitchens for food safety during compliance inspections, she said. But when state inspectors show up to a dispensary with a kitchen, they’ve been told it’s simply not being used that day.
“To date, we have not witnessed an operating kitchen,” she said.
In a word, the program has been challenging. Christ said it’s a particularly litigious program, one that raises new legal questions constantly.
The audit highlighted some of those challenges, and she said another audit, this time specifically on procurement, is expected to be released in the next few months.
In the meantime, the program will be using a new system to track dispensary inspections, another trouble area noted in the audit, and written policies for ensuring facilities are in compliance with the law.
Arizona Gov. Doug Ducey and Cara Christ, director of the Arizona Department of Health Services leave after giving an update on COVID-19 in Arizona during a news conference Wednesday, June 17, 2020 in Phoenix. (Michael Chow/The Arizona Republic via AP, Pool)
The state’s top health official says the key to slowing the spread of COVID-19 could be finding ways to reach the people who believe they’re the least likely to get infected or suffer ill effects.
Cara Christ said the biggest group of positive test results is now among those age 20 through 44.
“They’re likely not the ones that are going to have the outcomes and the risk factors from COVID-19,” she told Capitol Media Services.
“But we need everybody to keep in mind that all of us have connections to loved ones and family members that are high risk or people out in the community,” Christ said. “And that’s what we’re trying to protect by containing the spread.”
The trick now, she said, is crafting a message that is designed with that audience in mind.
“We do want to see these numbers come down and we want to see the percent positivity go down,” Christ said.
That, however, means convincing individuals to act safely — including those who may believe that even if they don’t think they’re invincible that contracting the virus won’t really hurt them. And that, Christ said, comes back to the messages of physically distancing and wearing a mask while out in public when staying six feet from others is impossible.
People line up to get tested for COVID-19 at a drive through testing site hosted by the Puente Movement migrant justice organization Saturday, June 20, 2020, in Phoenix. (AP Photo/Matt York)
That message, however, is not getting across to those in the 20 to 44-year-old demographic, she said, as evidenced by the high number of people in that age group who are testing positive for the virus — and as shown by videos of people crowding bars without masks.
These are the people who are less likely to suffer severe adverse effects. But they’re clearly coming down with — and probably transmitting — the disease.
Consider: Of more than 43,000 confirmed cases of COVID-19 so far, more than 46 percent fall into that age group.
But they make up less than a third of the population.
Yet they’re not dying at the same rate of the disease, accounting for just 67 of the more than 1,300 deaths.
Christ said exhortations for these people to protect themselves apparently does not work. So that, she said, requires a change in the message.
“We need everyone to think about, ‘You may not feel sick, you may not think that you’ve been infected,’ ” Christ said. And a lot of people appear asymptomatic.
“So it’s really important that if you are going to be within six feet of somebody you have got to wear that mask,” she said.
Christ said it may not be that younger people see themselves as invincible.
“I think a pandemic and a virus, they’re scary things, they’re hard to comprehend,” she said. “And I think if you are not seeing the direct outcomes, you may not think that it applies.”
Christ said her agency had the same problem crafting a message during the opioid epidemic of trying to reach those who didn’t see it as their issue.
In that case, she said, the health department crafted some very scary messages — scary enough so that her son, 8 at the time, came crying to her after seeing some on social media.
“It gave me that opportunity to talk with him about the dangers of opioids.” Christ said. “And so, it worked.”
But finding a message that resonates when warning people about a virus, she said, is something quite different. And that may be telling people that they need to think about more than how the pandemic affects them personally.
“A lot of them have grandparents and loved ones that they love and don’t want to see anything happen to,” Christ said, sending a message that “this is really, really dangerous for those you love and so we need to do everything we can to protect them.”
It’s not just that category of 20-to-44-year-olds with a sense that they’re not affected that is complicating efforts by the state to curb the spread of COVID-19. The problem, according to Gov. Doug Ducey, extends to those even younger.
The governor said that, for a long time, he didn’t personally know anyone who had the virus.
“But just recently, I know a lot of people that have contracted this,” he said. “And I want to tell you where they contracted this: at graduation parties, at private gatherings in homes.”
Christ said reaching this group isn’t a simple matter of telling them that, while they won’t get sick, they can bring the disease home to others.
“That’s not going to work with them,” she said.
One thing she said her agency has learned is that, when dealing with teens, it’s probably best that the message isn’t coming from the government.
“It probably should come from a trusted source for that group,” Christ said.
At the very least, that means using different media.
“They’re not going to watch the news,” she said. “They’re not going to be on the same social media sites that their parents are.
And then the message itself needs to be different for teens than it is for adults.
“For instance, when you’re looking at vaping, what resonated with the kids was, ‘Don’t lie to me, don’t tell me this is safe when it’s actually not,’ ” Christ said.
Ditto, she said, in reaching teens on the issue of opioids, with teens understanding that just because something is being advertised as available by a prescription that makes it safe.
“You’ve got to find what resonates with them,” Christ said.
Dr. Cara Christ, director of the Arizona Department of Health Services, speaks during news conference on COVID-19 in Arizona, Thursday, July 30, 2020, in Phoenix. (Patrick Breen/The Arizona Republic via AP, Pool)
The state’s top health official acknowledged that she and Gov. Doug Ducey are ignoring some Arizona-specific recommendations from the White House Coronavirus Task Force.
At a court hearing Monday, Dr. Cara Christ agreed that the latest report from the task force says the state should require masks of all individuals. Instead, the governor, after specifically refusing to issue a mask order — and even barring cities and counties from imposing their own — finally left that decision to local officials.
That same report also says Arizona should limit indoor dining to less than 25 percent normal capacity. But Ducey is allowing restaurants to serve up to half of the regular seating.
What makes all that relevant is that Christ testified that she and Ducey decided to keep gyms and fitness centers closed based on those same task force recommendations — recommendations that, in this case, they decided to follow.
Dr. Deborah Birx, White House coronavirus response coordinator, speaks during a meeting with higher education leaders on safely reopening schools, Friday, July 24, 2020, in Indianapolis. (AP Photo/Darron Cummings)
But under questioning, Christ conceded that Dr. Deborah Birx, coordinator of the White House task force, was probably not aware when those recommendations to keep gyms and fitness centers closed were released that her agency already had crafted some protocols that, if followed, would allow them to reopen in safe fashion. Yet even with that, Ducey and Christ have decided that these facilities have to remain closed.
All that is relevant as Joel Sannes, attorney for Mountainside Fitness, seeks to convince Maricopa County Superior Court Judge Timothy Thomason to overrule the order that keeps the doors shut for not only his client but another approximately 900 similar facilities around the state.
In essence, Sannes is arguing that Ducey and Christ are picking and choosing which task force recommendations they want to follow.
He said there is no “rational basis” to keep gyms and fitness centers closed if they can comply with the very protocols that Ducey directed the Department of Health Services to craft. That came with a promise they could serve customers again as early as July 27 if they agreed to follow those standards.
But the governor instead decided to keep the closures in place, regardless of whether they agreed to follow the guidance.
Sannes isn’t the only one attacking the governor’s decision.
In questioning Christ, Robert Zelms, attorney for EoS Fitness, argued that there have have been no instances of anyone in Arizona contracting COVID-19 from one of these facilities. She conceded the point, but with a caveat.
Timothy Thomason
“I can’t say, though, that that’s 100 percent accurate,” Christ said. “I may just not be aware of them.”
Those protocols her agency crafted are fairly specific. They include:
– Mandated use of masks or cloth face coverings for all guests;
– Operate at 25 percent or less capacity;
– Implement temperature checks or symptom screening at the door;
– Require reservations for fitness classes to limit the number attending;
– Provide hand sanitizer, disinfecting wipes, tissues and no-touch trash cans.
But Christ, whose agency crafted the protocols, told the judge she is still not convinced that gyms and fitness centers can operate safely — even if they follow them.
“The person who has COVID-19, if they are breathing vigorously, they can actually concentrate the virus in droplets that could land on surfaces,” she said. “It also allows the droplet to transmit farther.”
Those who are not infected, Christ said, are breathing deeper — and often through their mouths — which allow the particles to get farther into the respiratory system
And Christ said face coverings don’t eliminate the risk.
“We know that masks are not 100 percent effective,” she testified. “So there’s an inherent risk, even when the guidelines are put into place.”
But Sannes told the judge that, even if that is the case, that’s still no reason to shutter bars and gyms, especially when so many other kinds of places can remain open.
He said, for example, that Ducey’s order keeps bars closed on the basis that they provide opportunities for unmasked people to spread the virus. But Sannes pointed out there are about 4,000 establishments in the state that do serve alcohol for on-premises consumption: restaurants with liquor licenses.
“Those 4,000 bars can continue to be open because they serve burgers,” he said. “That is the height of the definition of arbitrary.”
Brett Johnson, the governor’s attorney, told Thomason he should defer to the decisions made by Christ and Ducey.
He specifically urged the judge to disregard the conclusions of former Health Director Will Humble, now executive director of the Arizona Public Health Association, who said that any gym or fitness center that operated according to the protocols would be no more dangerous than people going to a grocery store or doing any other kind of shopping.
“He’s not a professional or a doctor or anybody who has medical experience,” Johnson said. And he said it’s not fair to compare gyms and fitness centers with grocery and retail stores.
“You can’t get food at a health facility,” Johnson said. By contrast, he argued, there are alternatives to the kinds of services provided by places like Mountainside Fitness.
“You can run outside at 5 in the morning take walks in the evening,” Johnson said.
“You can do virtual exercises,” he continued. “We have to be able to get our food.”
Christ, in defending her decision, said she and her staff have more information about the disease than pretty much anyone else, things like data on specific patients.
“The public does not have access to that type of information,” she said. Christ also said she has more access to experts, like the state epidemiologist, the Centers for Disease Control and Prevention, and the members of the Conoravirus Task force.
Thomason said he hopes to have a ruling on Tuesday.
Faced with an average of two deaths a day, the state’s top health official is looking for ways to curb the abuse of opioids, both legal and otherwise.
And some of that may involve getting doctors to find alternative relief for patients with chronic pain — including possibly recommending the use of medical marijuana.
Dr. Cara Christ, director of the Department of Health Services, said Thursday some of the meteoric rise in deaths — up from 454 in 2012 to 790 last year — can be traced to illegal drug use, people looking for a “high.” That is reflected in a tripling in the number of Arizonans who die from heroin overdose.
But there are more actual deaths from prescription opioids. While Christ said some of these can be people misusing the drugs for recreational purposes, she suspects there are people who have become hooked on them because of chronic pain.
One indication of that, she said, is the pure data.
Dr. Cara Christ, director of the Arizona Department of Health Services (Photo by Gary Grado, Arizona Capitol Times)
Christ said the death rate from opioid abuse and overdose is higher among those in the 45 to 54-year-old age group than it is among any other 10-year spread. This is a group, she said, which is less likely using the drug for recreation.
So who’s to blame?
“That’s difficult,” Christ said.
She said some of it starts with doctors.
“People were educated years ago that they are non-addictive, that they are great resources for pain, you don’t need to use them only for cancer or terminal pain,” Christ said. “We underestimated the addictive potential of these medications.”
And the government itself, she said, shares the blame.
Christ said the federal Centers for Medicare and Medicaid Services links hospital reimbursement and hospital performance scores to patient satisfaction surveys. And those surveys include two questions about how their pain was treated.
“I think that assisted in this,” she said.
“Then when you clamp down on the supply of it, you have these people who have no other choice and choose, then, heroin,” Christ continued. “And we do know that four out of five heroin drug users started as prescription drug users.”
Changing that, she said, starts with doctors finding alternatives to pain management.
“There are a lot of other effective treatments, such as non-steroidal anti-inflammatory drugs,” she said, ranging from aspirin to ibuprofen — drugs like Advil and Motrin — and naproxen, which is marketed as Aleve and similar drugs. And Christ said her agency is going to set up a “chronic pain program” to work with insurance companies to ensure that they are providing coverage for such medications.
That program, she said, also is designed to provide help to patients to manage their chronic pain, “just like you would with diabetes or heart disease.”
And what of medical marijuana?
The 2010 voter-approved initiative allows doctors to recommend the drug to patients with certain specified medical conditions. And one of them is chronic pain.
Christ said she can’t say whether marijuana might be suitable for some people, outweighing the potential dangers of that drug.
“Each individual is going to be different,” she said, saying patients need to discuss options with their doctors.
“The voters decided that medical marijuana was one of them for chronic pain,” Christ said. “If patients are interested, that’s something they should talk with their health care provider about.”
What the new report shows, said Christ, is the need for even more data to understand the patterns — and the causes and possible cures.
There already have been various efforts to reduce the abuse and overuse of prescription opioids.
Last year lawmakers approved creating a centralized database that doctors are supposed to check before writing certain prescriptions. The idea is to curb “doctor shopping,” with patients going from one medical office to another to get prescriptions for not just opioids but other controlled substances.
Gov. Doug Ducey also signed an executive order last October limiting the first prescription of opioids to no more than a seven-day supply in cases where the state is providing the reimbursement.
On the other end of the spectrum, Arizona pharmacists can now dispense naloxone, a counter to opioid-related overdoses, over the counter so that family members can have the drug on hand if needed.
Christ said there is also a role for law enforcement — but not in going after those addicted to or abusing the drug.
I truly believe that opioid addiction and abuse is a health concern,” she said. “It’s a disease.”
And that, Christ said, means that people who want help need to feel it’s safe to get it without risk of getting arrested.
“The law enforcement component comes in with the suppliers,” she said.
“We’ve heard it anecdotally that people who really are trying to go get help, and they’re standing in line at a methadone clinic to get the medication they need to treat their illness, and they’ve got heroin dealers coming up to them in line,” Christ said. “That’s inappropriate.”
State Health Director Cara Christ speaks at press conference on May 28, 2020.. (Capitol Media Services photo by Howard Fischer)
The state’s top health official said Friday there’s no reason to continue to limit business occupancy, prohibit large group gatherings and require customers to wear masks because Arizona hospitals now have plenty of space.
Dr. Cara Christ said the main reason that restrictions were imposed and bars were closed entirely was the fear of overwhelming the state’s health care system with Covid patients.
Now, she said, the use of hospital and intensive-care beds is way down. More to the point, Christ said many of the people who are most at risk, meaning the elderly, already have been vaccinated.
The health chief acknowledged that some businesses are not following her advice that, despite dissolution of the gubernatorial orders, they should continue to enforce mask use and to maintain social distancing. There even were reports of at least one bar promoting the idea that customers are now free to crowd in.
But that, Christ said, is no reason to continue to make that illegal. She said individuals now need to assess their own risk of severe complications.
“Hopefully, there weren’t a lot of our older Arizonans at those bars,” she said, the kind of folks who are more likely to get seriously ill.
Christ also pointed out that businesses remain free to enforce mask and social distancing requirements. And she is suggesting they do that.
But she brushed aside questions about whether the new order undermines their ability to gain compliance as customers could argue that the governor has said it’s OK to go maskless.
“They’ve always had — some of them, I can’t say all of them — the ‘no shirt, no shoes, no service,’ ” Christ said.
“They can extend that,” she said, and enforce things like mask mandates at the door in exactly the same way. “They do have the authority to be able to require those types of mitigation strategies.”
All that, however, leaves the question of exactly how the decision to convert health requirements into recommendations was made.
While Christ said hospital capacity was a key factor, the health director conceded she and the governor did not consult with any of their top officials. In fact, several of the state’s major hospital chains released a statement calling Ducey’s move to jettison mandatory distancing and mask requirements as premature.
“A downward trend is not synonymous with the elimination of the virus,” they said in a joint statement.
Christ did not dispute that contention.
“We could see another spike in cases,” she said. But Christ said that’s not the metric that drove the original decisions to impose restrictions. And she said it should not be the metric to decide whether to lift them.
“Really, what we were trying to prevent is an overwhelming of our hospitals and our health care systems,” she said. That also is the reason that health care workers and those at the highest risk of developing complications from the virus — and needing hospitalization — were among the first to get the vaccine.
“We’ve got higher vaccination rates in those vulnerable populations, which is going to keep our hospitalizations down,” she said. “The severe outcomes are really what we’re trying to prevent, those hospitalizations and those deaths.”
Put another way, Christ said, the overall number of people infected is not, in and of itself, significant — and not a reason to have state-imposed mandates.
“If it’s just cases and you’ve significantly reduced the hospitalizations and deaths, do we do that with other diseases?” she asked.
“We don’t” Christ continued. “Everything is a recommendation.”
Beyond that, Christ said she and Gov. Doug Ducey made the decision that Arizona has to return to a point where people have to make their own decisions about the risk the virus poses to their own health. She said that’s no different than any other disease, like the flu, where her department makes various recommendations but ultimately leaves it up to individuals to assess their own health risks.
“It’s really about that personal responsibility,” she said.
Consider the flu.
“We’ve recommended for years that everybody get a flu shot, wear a mask, to stay home when you are sick,” she said. “All of that works for influenza, just like it does for Covid.”
But Christ pointed out that those flu recommendations never translated into mandates, even as the state sees a surge in hospitalizations every winter.
The decision to scrap mandates comes as the state remains far short of having 70% of its population vaccinated, the point at which Arizona would approach “herd immunity” so that a new outbreak would not spread rapidly.
As of Friday, the state reported only 1.2 million were fully inoculated, whether with the second dose of the Pfizer or the Moderna vaccines or the single-dose Johnson & Johnson vaccine. That is only about 22 percent of those 16 and older, the age at which the vaccine has been approved for use.
While there continues to be a demand — and people who say they’re still having problems getting appointments — that raises the question of whether the new order scrapping any mitigation mandates sends the message to some that inoculation is no longer necessary.
“I don’t know that would necessarily be based on us lifting the restrictions,” Christ said.
“There are a lot of people that don’t like getting shots, that are vaccine hesitant, especially about this specific vaccine,” she said, despite assurances that it is safe and effective. “But we know we are going to have demand decrease as we continue through the next few weeks.”
That, Christ said, will take a shift in “messaging,” getting out into communities as opposed to simply having large inoculation sites.
“We will hit a point where it’s going to be more about convenience and having it be in the neighborhood or having it being administered at a doctor’s office while they’re doing something else,” she said.
Arizona Department of Education Superintendent Kathy Hoffman speaks the latest Arizona coronavirus update during a news conference Thursday, July 23, 2020, in Phoenix. (AP Photo/Matt York, Pool)
The plan to return children to the classroom is complicated, difficult to explain and may be leaving the public confused, state Superintendent of Public Instruction Kathy Hoffman conceded.
In an interview July 29, Hoffman said she has been reflecting on the way the July 23 announcement to follow a data-driven guide to reopening schools has led to a lot of immediate confusion from teachers and the general public.
She said they may have been accustomed to having a firm date for reopening and expecting that again.
Hoffman told Arizona Capitol Times the plan is long term and complicated and includes school funding, teacher pay and metrics, and is intended to stabilize the field.
“It was very challenging to communicate those nuances in a way that was understandable,” she said.
Hoffman said that over the roughly two-week process it took to make this science-based decision, the Department of Health Services wasn’t completely sold on the idea originally.
She wouldn’t say if Gov. Doug Ducey agreed with the plan from the start, but a July 21 written statement in which she called for a data-driven plan left the impression that she was at odds with Ducey.
Hoffman said the reason she posted that statement for her followers to see was to be transparent and make sure the public knew what she was advocating. She also said Ducey’s office was not surprised by the contents of her letter.
“I think there was some surprise at the interpretation of what the statement meant. There was some reading between the lines … interpretation that we were not on the same page or not working together,” Hoffman said, adding that was not accurate. “That statement kind of had a bit of an unintended consequence, and causing people to think that we were not working together.”
She wouldn’t elaborate on what exactly people misinterpreted.
“The closer we got to the (July 23) press conference, the more back and forth there is in terms of ideas and language, and so I think at that point we were still working on these drafts of the different pieces of the executive order,” Hoffman said.
She said when the conversation about metrics began, no states were using them to open schools for in-person instruction. New York Gov. Andrew Cuomo was the first to unveil such a plan and on July 13 announced a 5% positivity rate as the benchmark for reopening.
“The way DHS explained it to us is sometimes the data doesn’t tell the whole story,” Hoffman said. “There could be a county that looks like they’re having a major spike, but that could be a more isolated outbreak.”
The health department, however, was using similar metrics to determine when it was safe to reopen the state’s economy in May. As soon as the state reached White House criteria for Phase One, Ducey and Cara Christ, the state health director, hit the green light. But for schools, something was apparently different.
Hoffman said during the July 23 press briefing that “it’s not reasonable to set a date” because it would mean having to make similar announcements every time you reach the new date if things weren’t ready to open up yet.
But why the announcement for metrics came without any metrics is still unclear.
Daniel Scarpinato, Ducey’s chief of staff, said it had to do with transparency and not rushing the entire process.
“We felt that it was important to let the community know this is what we’re working on, here’s the timeline, and here’s the plan,” he said. “And it also gives people the opportunity to weigh in and be part of the process.”
Scarpinato said it was important to set the deadline to prove information would come before schools would begin to reopen.
“We’d rather err on the side of being thoughtful than rushing to get something out,” he said.
Christ told the Capitol Times DHS is still on track to meet the deadline and they are expected to have more information by July 31, but would not share what information to expect.
“It will be a combination of different metrics,” she said. “It will be data points that people have become very familiar with.”
Those data points involve a percent positivity rate of COVID-19 tests typically below 10 (maybe as low as 5), a possible downward trajectory and even quicker turnaround time for test results. Hoffman mentioned similar metrics in her public statement, without providing figures.
Schools should be empowered to reopen their campuses this fall based on public health data rather than aiming for a particular date, Arizona’s top education official said Tuesday.
Superintendent of Public Instruction Kathy Hoffman said she outlined her priorities to Gov. Doug Ducey, who is expected to announce the next steps for schools this week. He has previously delayed the start of the school year until Aug. 17.
Hoffman outlined several metrics she said would be helpful to school officials deciding when to welcome children back on campus. They include a downward trajectory in new confirmed COVID-19 cases, a decrease in the rate of positive test results and the widespread availability of testing with timely results.
Schools also need a guarantee of full funding for distance learning, she added.
“Like all educators, I want students back in the classroom because that’s the best place for learning and growing,” Hoffman wrote in a statement posted on Twitter. “However, we cannot ask schools to make decisions that will impact the teachers’ and students’ health and safety without first providing them with the necessary public health data and funding to make safe decisions.”
Ducey and his top health official, Dr. Cara Christ, said last week that they would prefer for their own children to be in school on campus.
Close-up Of Male Judge In Front Of Mallet Holding Documents
The attorney for media outlets told a judge Wednesday that letting the Department of Health Services withhold information about COVID-19 cases elevates the financial interests of long-term care facilities above the public’s right to know — and protect itself.
David Bodney asked Maricopa County Superior Court Judge Christopher Coury to rule that the state agency is picking and choosing what information it wants to release and to whom. He said that’s not permitted by the state Public Records Law.
Attorney Craig Morgan, representing the department and Cara Christ, its director, said the records being sought — the number of cases at COVID-19 at each of the facilities — are not public. He said there are specific state statutes prohibiting the release of any information gathered by the health department as a result of “enhanced surveillance” orders like the one Christ issued to deal with the pandemic.
Beyond that, Morgan argued that there are privacy issues that in a “balancing test” could outweigh the public’s need for the information.
But Bodney pointed out to Coury that Gov. Doug Ducey, in an order issued just this past Monday, directed nursing homes to provide that specific information not only to the relatives of people who live there but also to anyone who says they are interested in placing a relative there. He said it should not be necessary for Arizonans to make an inquiry — and possibly even be charged a fee — to each facility to find out where residents are becoming ill.
“The Arizona Public Records Law is not good for some, those willing to submit an application fee with a view toward maybe residing in one of these facilities, but not for others,” Bodney said.
Anyway, he told the judge, what his clients want is pure numbers of residents of each facility who have contracted the virus and the numbers transferred to hospitals, not the names of any individual resident. The only names that would become public would be the names of the facilities.
“Now is not the time to play games with the law or put the financial interests of the nursing home industry above the health and safety of the public,” Bodney said.
But Morgan said that’s not the case.
“This isn’t a situation where my client’s trying to withhold information,” he said, citing various statutes. “I mean, candidly, we have no choice.”
Coury agreed to put the issue on an expedited schedule, requiring Morgan to file his formal response to the lawsuit by May 15 and giving Bodney until May 21 to reply. A hearing could take place before the end of the month.
At the heart of the fight is what information the public is entitled to have about the spread of the coronavirus.
The health department does provide some detailed information about number of cases, even broken down by zip code. There also are demographic charts covering things like age, gender and race of those who contract the virus and those who die.
Bodney, representing the Arizona Republic and four Phoenix TV stations, contends the public is entitled to more, specifically the infections at state-regulated long-term care, assisted living facilities and nursing homes. And he pointed out to Coury that Christ already is requiring these facilities to produce those records for her.
Christ’s position, when asked about the refusal to release the information, has said that it could be used to figure out who are the people at each facility who are becoming ill. And that information is strictly protected by state law.
Bodney urged Coury to dismiss that contention.
He said there are more than 300 assisted living facilities in the state with an average of 85 residents. And 109 of those, Bodney said, have more than 100 people living there.
“There is a strong presumption under the Arizona Public Records Law that this information is subject to public inspection,” he said. And he said the governor’s new order on Monday allowing some people to get that information “points up the inconsistency of the application of this law.”
Morgan told Coury it’s not that simple.
“We do believe that there are rights of privacy and best interests of the state involved that warrants the withholding of the specific information being requested,” he said.
A judge refused late Monday to find Gov. Doug Ducey in contempt.
In a six-page order, Maricopa County Superior Court Judge Timothy Thomason found various problems with the process set up by the governor’s Department of Health Services to allow gyms and fitness centers to reopen in counties where the risk of COVID-19 remains substantial. He agreed with Joel Sannes, the attorney for Mountainside Fitness, that these kinds of operations are not told what will or will not satisfy the state.
“The lack of standards is a bit troubling,” the judge wrote.
But Thomason also concluded that Ducey has technically complied with his earlier order that requires there be a waiver process of some sort. In fact, he pointed out, there are two businesses — EoS Fitness and Training for Warriors-Estrella — that have managed to navigate the procedures.
“Mountainside has not even given the process a chance to work,” the judge said.
Monday’s ruling may not end the legal battle. It could be just the latest in what has become a months’ long fight between not just Mountainside but also other businesses — and not just fitness centers — to once again open their doors.
The latest comes after Thomason earlier this month ordered Ducey to come up with a system to tell businesses what they need to do to reopen.
State Health Director Cara Christ responded with a set of metrics, essentially telling gyms and fitness centers they can open their doors only when the spread of COVID-19 is no longer “substantial.” But so far that applies to only Yavapai and Cochise counties.
Even then, they would have to limit attendance to no more than 25% of capacity.
But under orders from Thomason, Christ said other businesses can apply to reopen even in those other 13 counties if they can show their operations would not endanger public health.
But Sannes pointed out that they were not told what that would take. So he asked Thomason to hold the governor in contempt.
Thomason said Sannes is correct that Christ set no standards to get those waivers.
“Fitness centers applying to reopen would have no idea what they are expected to do,” the judge wrote.
“In essence, they are being asked to meet a goal they know nothing about,” he continued. “The fitness centers are told they need to explain what additional measure they are taking to operate safely, but also told nothing about what level of precautions is necessary to satisfy ADHS.”
Still, Thomason said, the process that the state set up for businesses to petition for relief does satisfy his original order.
He said that if the health department does not find a business has submitted a satisfactory plan, there is an “informal settlement process … that can be used to ‘iron out’ an acceptable plan.” And that process, the judge said, is interactive “and does provide fitness centers a reasonable opportunity to be heard.”
Documents obtained by Capitol Media Services show what EoS did is agree to limit occupancy to 10 percent, require electronic reservations for all clients, require masks, keep saunas and steam rooms closed and pause group activities like basketball.
But it’s not just EoS that sought a waiver from the rules that now keep certain businesses closed because they’re located in areas of substantial risk of COVID-19 spread.
Johnson indicated in his arguments that 258 fitness centers have applied to reopen out of about 900 statewide, with EoS and Training for Warriors the only two which had been approved. There also are 95 applications by businesses licensed as bars to be allowed to bring customers inside, and five from movie theaters.
Four businesses have been denied.
Johnson argued to the judge that it makes no sense for Mountainside to try to hold the governor in contempt because it does not like how the health department might handle its application.
“If you don’t get a driver’s license, you don’t sue the governor,” Johnson said. “You go after DMV.”
And his defense of the governor was even more basic.
“To say the governor is somehow subject to contempt for everything he and his administration is doing is quite honestly offensive,” Johnson said. He also said there is a remedy if Mountainside wants to know what Christ found acceptable by EoS: file a public records request.
The businesses denied reopening are:
– Fourth Avenue Gym, Foothills location;
– Achieve Strength and Fitness;
– Brennan’s Pub & Grub;
– Rockabilly Grill.
State health officials say each of these businesses have an opportunity to request an informal settlement conference with the department.
FILE – In this March 18, 2020, file photo, Arizona Gov. Doug Ducey, foreground left, talks to Matt Heckard, right, assistant director of preparedness with the state’s Department of Emergency and Military Affairs, as members of DEMA work responding to the coronavirus pandemic, in the DEMA operations center at the Arizona National Guard Papago Park Military Reservation in Phoenix. Maj. Gen. Michael T. McGuire, background center, the director of DEMA, and Wendy Smith-Reeve, stand next to Ducey. Smith-Reeve, director of the Arizona Division of Emergency Management, submitted her resignation Saturday, March 29. The state’s emergency operations will now be directed by Maj. Gen. Michael T. McGuire. (David Wallace/The Arizona Republic via AP, Pool, File)
A woman who has been a key figure leading Arizona’s response to the coronavirus pandemic has resigned after complaining she was being sidelined from her role.
Wendy Smith-Reeve, director of the Arizona Division of Emergency Management, submitted her resignation late last week and it was accepted Saturday by Gov. Doug Ducey.
In Smith-Reeve’s resignation letter, she cited concerns that her job had essentially been taken over by Ducey’s staff and the state health department and her “presence and function is duplicative” during the COVID-19 pandemic.
The state’s emergency operations will now be directed by Maj. Gen. Michael T. McGuire. Anthony Cox, who has served as deputy director since 2017, now is the acting director.
Wendy Smith-Reeve
Ducey and the Department of Health Services, led by Dr. Cara Christ, have been the public face of the administration’s response to the pandemic. McGuire is leading the state’s efforts to deploy thousands of National Guard troops to help deliver food to stores and other needed support tasks.
Christ is overseeing the health response and plans to nearly double the state’s hospital capacity with help from hospitals and the U.S. Army Corps of Engineers. The health department wants existing hospitals to boost space and plans to reopen two closed hospitals, convert a specialty hospital and use large facilities for treating patients who no longer need acute hospital care. Other actions include scouring surgery centers and other facilities for space and respirators and other equipment needed to treat an expected surge of virus patients.
Christ said last week that the state could need between 7,000 and 13,000 additional hospital beds by May. There currently are 16,900 licensed hospital beds in Arizona.
The epidemic of COVID-19 is expected to peak in Arizona in mid-April, with hospitalizations hitting their high in May.
Arizona health officials reported Sunday that the state now has tallied at least 919 COVID-19 cases and 17 deaths, up from 773 cases and 15 deaths as of Saturday. Maricopa County, the state’s most populous county and where the most coronavirus cases have been reported so far in Arizona, now has 546 cases. Pima County has 147.
Of Arizona’s 15 counties, only Greenlee County hasn’t reported any coronavirus cases.
The Navajo Nation reports 115 cases of which 94 in Arizona on the vast reservation that also includes parts of New Mexico and Utah.
For most people, the new coronavirus causes mild or moderate symptoms, such as fever and cough that clear up in two to three weeks. For some, especially older adults and people with existing health problems, it can cause more severe illness, including pneumonia and death.
Smith-Reeve, who reported to McGuire, became director in May 2013 after joining the agency as a finance specialist in September 1996. She managed the state’s emergency preparedness, response, recovery and mitigation efforts.
In her resignation letter, Smith-Reeve complained about what she saw as a diminished role leading emergency response efforts and said that the governor wasn’t following the state emergency response plan, which he had approved in 2017.
“That is not healthy for the Team who are working tirelessly on this event,” she wrote. “The directives from the Governor’s office have been to work completely outside of the” plan.
Ducey’s chief operations officer, Daniel Ruiz, said in an email to the governor’s chief of staff recommending the resignation be accepted. He said Christ’s agency was designated by Ducey to lead the public health response with support from McGuire and Smith-Reeve.
“This has been a successful effort,” Ruiz wrote. “Dr. Christ has coordinated a fantastic group of professionals at the Health Emergency Operations Center, and Major General McGuire and Deputy Director Smith-Reeve, have assembled the state’s best and brightest at the State Emergency Operations Center.”
Chief of Staff Daniel Scarpinato tweeted that “Arizona is grateful to have the very steady leadership of Major General McGuire leading our emergency operations during this critical time,” adding that the state “won’t miss a beat with him and his team at the helm.”
Several media organizations are going to court to challenge the refusal of the Department of Health Services to tell the public how many residents of individual nursing homes are becoming ill with COVID-19.
The lawsuit filed Tuesday in Maricopa County Superior Court charges that the agency has the records that identify at which state-regulated sites, including assisted living centers and long-term care facilities, residents are becoming ill. Instead, the agency is releasing only information about the number of facilities in each county where the virus has shown up, claiming anything more would be a breach of personal information.
But attorney David Bodney, representing the plaintiffs, pointed out that none of the records requested seek information about individuals. And he said that state health officials could redact specific information if, somehow, identifying a specific nursing home or other institution might lead someone to learn an individual’s identity.
The lawsuit comes as the Department of Health Services — and Gov. Doug Ducey — are under increasing pressure to provide more transparency about the number of people in these state-regulated settings who are ill, with multiple reports that some facilities have had outbreaks spread among the residents.
On Monday, Ducey moved to address the issue.
Gov. Doug Ducey discusses COVID-19 and the state’s response at a press conference last week. (Capitol Media Services photo by Howard Fischer)
“We want to test everyone inside our long-term care facilities,” the governor said. “We’re going to increase the testing and prioritize our vulnerable population and staff within congregate settings.”
And Ducey, after being questioned for weeks about the issue of public knowledge, finally signed an executive order on Monday to provide some information — but not to everyone.
Instead, the governor said that anyone with a relative in one of these facilities who comes down with the virus would be notified, as would someone in a facility where others tested positive. And he said that anyone seeking to place a relative in a facility is entitled to know what is the COVID-19 situation there.
But Ducey’s executive order specifically prohibits anyone who gets the information from disclosing it to anyone else. And all efforts by the media to get information about infection rates at these facilities has been rebuffed.
State Health Director Cara Christ initially argued that release of the information would violate the federal Health Insurance Portability and Accountability Act. But Christ appears to have abandoned that after multiple other states began providing the same information and Dana Kennedy, state director of AARP, pointed out that those rules apply only to employers and health care institutions and not to public health agencies like DHS.
Now Robert Lane, the agency’s administrative counsel, is arguing the information is protected under state law.
“Even if the information you seek is a ‘public record’ under Arizona law — privacy, confidentiality, safety, public health, the state’s general responsibility to protect all Arizonans, and other overriding interests outweigh any public interest in disclosure of the information you requested,” he wrote Tuesday in a response to a request by Capitol Media Services.
Lane cited specific state statutes he said prohibit disclosure of “communicable disease related information” and another law he said that medical information that might identify an individual is “confidential and is not available to the public.”
And he said those laws are supported by a state constitutional provision that protects the right of privacy.
But Bodney, in his legal filings, said the information requested is simply what Ducey himself ordered nursing homes and other long-term care facilities to provide to the health department: the number of COVID-19 positive residents, the number of transfers to and from acute care hospitals, the number and type of personal protective equipment, and the estimated use of each type of PPE per week.
None of that, Bodney said, would identify any resident. Conversely, he said, there is a public benefit to releasing the information — and not only to those who have relatives in these facilities or are considering moving them into one.
“Disclosure, too, will allow the public and public policymakers to reach more informed judgment about the containment of this public health crisis in Arizona,” Bodney wrote on behalf of the Arizona Republic and Phoenix TV channels 3, 5, 12 and 15.
The health department has set up a “dashboard” of information about the virus.
But the only data available on congregate care settings goes to the number of facilities with positive cases. The most recent posting shows a total of 208 different facilities that fit that category, led by 79 assisted living facilities and 44 long-term care facilities.
Of that 208 total, 131 are in Maricopa County, with 52 in Pima and 10 in Pinal, though that last group of facilities might also include state prisons.
Cochise and Mohave counties each have four facilities with COVID-19 outbreaks, with three in Yavapai, two in Navajo and one each in Yuma and La Paz counties.
Other data point to the effect on the elderly: While those 65 and older make up about 23.5 percent of the 9,305 cases reported so far, they also account for 308 of the 345 deaths in the state, with that tally having gone up by 33 just on Tuesday.
A Lake Havasu City senator says he still has yet to be convinced that marijuana has any legitimate medical uses.
But Republican Sonny Borrelli said Monday the fact remains that voters did approve legalizing the drug for medical uses in 2010 and more than 150,000 Arizonans have state permission to buy and use it. So he figures it’s the state’s obligation to ensure that buyers are getting a product that’s not tainted and, in fact, has the amount of psychoactive THC that buyers are promised.
SB 1420 would give the state Department of Agriculture the same authority over marijuana as it now has over other plants offered for sale for consumption. That would give agriculture inspectors the power to inspect the cultivation facilities where marijuana is grown.
More to the point, Borrelli wants what is being grown tested for what operators are using on the plants.
Rep. Sonny Borrelli, R-Lake Havasu City
“It’s the Wild West,” he said of the current state of marijuana regulation, with no rules on pesticides and other chemicals being used on the plants.
For example, he cited a fungicide marketed as “Eagle 20.” Borrelli said federal regulations prohibit its use on tobacco “because it’s a heavy carcinogen.”
But those same federal rules are silent on use on marijuana, meaning it can be used.
“Well, I think the person that’s buying that stuff, they need to know there’s a heavy carcinogen in there,” Borrelli said. “If you’re a cancer patient, would you want to be taking medicine that could make you even sicker?”
Nothing in the legislation would ban any specific chemical. But it would require that when the marijuana is sold at the dispensary that buyers are made aware that it was used in the production.
“I want to concentrate on customer safety,” he said.
Moldy marijuana is a slightly different question.
Borrelli said he’s been told it can be treated to get rid of any fungus rather than retailers having to toss out the plants entirely. At that point it could be offered for sale — along with information on how it was treated.
But Borrelli’s legislation also has what might be considered the consumer fraud provision.
“If they’re going to advertise there’s 20 percent THC and it’s only 5 percent, they need to relabel it,” he said.
If approved, the measure would have another benefit for the more than 150,000 individuals who now have state-issued ID cards allowing them to purchase up to 2 1/2 ounces of marijuana every two weeks: More cash in their pockets.
The original 2010 voter-approved legislation did not set a fee, leaving that up to the Department of Health Services to charge enough to administer the program. In fact, the law bars the proceeds from being used for anything else.
The agency currently charges patients $150 for one of the cards, a fee that has to be paid every year.
“It’s kind of hard to justify when they’re sitting on $40 million,” Borrelli said, with current Health Director Cara Christ having refused requests to lower the fees, even in the face of a lawsuit by medical marijuana users.
Christ won the first round when Maricopa County Superior Court Judge Jo Lynn Gentry said she lacked the legal authority to declare the fees excessive, even with the health department running the program with a huge surplus.
SB 1420 would lower that to $50 for the first year and $25 for renewals.
His legislation also would give $2 million out of that health department account to the Department of Agriculture to start administering then program.
The measure is being approached cautiously by the Marijuana Policy Project, the national organization that put the initiative on the 2010 ballot and worked to get it approved.
“In principle, additional safeguards that prevent contamination with molds and pesticides is something we support,” said spokesman Morgan Fox, saying he wants to ensure they are “not too onerous for caregivers in practice.”
But he said he wants to review it further before taking a position.
“I’m particularly curious to see if there would be additional or unintended requirements or restrictions that come with medical marijuana being defined as an agricultural commodity,” Fox said.
It also appears to have the cautious support of Maricopa County Attorney Bill Montgomery who has waged repeated unsuccessful efforts to have the Arizona initiative voided because it runs contrary to federal law where possession of the drug remains a felony.
“Unless and until the federal government takes action we have an obligation to ensure the Arizona Medical Marijuana Act is truly operated as a system for people who have a medical basis for using marijuana,” he told Capitol Media Services. “Replicating the protections the users of any other type of medicine would have is a reasonable and responsible course of action.”
Because the Arizona Medical Marijuana Act was enacted by voters, it can be amended only with a three-fourths vote of both the House and Senate. Borrelli already is moving to get that margin, getting another 78 of the state’s 90 lawmakers to sign on in support, including Senate President Steve Yarbrough and House Speaker J.D. Mesnard.
But it also would have to survive a possible veto by Gov. Doug Ducey who said as recently as last week that he has seen no evidence that marijuana has any legitimate medical uses.
In this Dec. 2, 2020, file photo, Arizona Gov. Doug Ducey answers a question about the arrival of a COVID-19 vaccine in Arizona, while Arizona Department of Health Services Director Dr. Cara Christ listens in Phoenix. (AP Photo/Ross D. Franklin, Pool, File)
State Health Director Cara Christ (Capitol Media Services photo by Howard Fischer)
The state’s top health official admitted Friday she has altered the standards governing business operations during the COVID-19 outbreak to the point that none will ever have to close, no matter how serious the infection rate gets.
The reason, said Cara Christ, is that she does not believe businesses are a major source of the coronavirus infections that currently have nearly 4,000 people in Arizona hospitals and the number of intensive care beds available in the entire state down to 128, just 7% of capacity. She also said the implications of shutting down a business are greater than leaving them open.
And Christ does not foresee a situation where the spread of infection from business will get to a point where she would change her mind.
Christ acknowledged that she effectively has scrapped the “substantial risk of spread” category from the benchmarks she adopted earlier this year. Now, no county can be classified as having more than a “moderate” risk.
What makes that significant is that, using Christ’s own standards, certain businesses, including bars, movie theaters and gyms are not allowed to operate when a county is placed in the substantial category. That is based on more than 100 cases per 100,000 residents, more than 10% of people testing coming back positive, and more than 10% of people showing up at hospitals having COVID-like illness.
All but Greenlee County have all three indicators above that level according to the agency’s own data, some by quite substantial margins.
In Pima County, for example, the infection rate is 607 per 100,000 residents and 17.9% of tests for the virus are positive. Pinal and Cochise Counties has a comparable positivity rate but with 548 cases per 100,000 in Pinal and 727 in Cochise 100,000.
And Yavapai County has a positivity rate of 566 per 100,000 with 21% of tests showing infection.
But with the change in definition, Christ conceded, there is no longer any risk of any business in any county getting shuttered.
Christ justified her decision, saying those benchmarks were designed to show when businesses that had been closed early in the pandemic because they were in areas of substantial risk of spread could reopen, specifically, when the levels of infection reached moderate levels. She said it doesn’t work the same in reverse.
she said there are now “mitigation strategies” in place to reduce the risk, such as requirements for restaurants and bars that operate like restaurants — no dancing, staying at the table — to be limited to 50% occupancy.
Anyway, Christ said it’s not like these businesses are a major source of infections. Her department says information from “contact tracing” of people who have come down with the disease found that just 14% said they might have gotten it by attending large group settings outside their homes.
That, the agency said points “to spread occurring in households and small gatherings.”
But the numbers may be higher than that.
The most recent contact tracing data from Pima County, for example, finds that 26% of those questioned say they had recently been to a bar or restaurant. Christ was not impressed.
“So that would mean than 74% of those individuals that they interviewed did not they were at a restaurant or bar,” she said. And Christ said those businesses are supposed to be operating under mitigation strategies enacted this past summer, like masks when not eating and drinking and limited indoor seating.
And there’s something else.
“We also have to take a look at the whole health of the community,” she said. “Housing and food access and health insurance and access to a job all play a role in the overall health and long-term outcome of our community.”
Christ said there are ripple effects.
“If I close down a restaurant, these are individuals that are now going to find a job somewhere else because they have to work,” she said. And Christ said it’s potentially even more harmful.
“Losing a house or income has a significant impact on their overall health,” she said. “So we are taking all that into account.”
So with 26% of Pima County cases potentially traceable to bars and restaurants, is there any percentage or number of cases that would convince her to rethink the whole idea that she won’t close any business?
“I can’t say that there’s not a number,” Christ responded. “But there are other strategies that would come in before that, before we would recommend closing.”
That, she said, includes beefing up enforcement of existing rules for businesses and doing more to urge people to avoid large gatherings.
Two state agencies are scouting Old Town Scottsdale and Mill Avenue in Tempe for businesses that violate restrictions enacted to prevent further COVID-19 spread.
The Department of Liquor Licenses and Control has been conducting its own investigations into bars and nightclubs it suspects would not comply with the waiver they signed in order to partially reopen. Three nightclubs over the final weekend in August got their licenses suspended.
Daniel Ruiz, the state’s chief operating officer, said the Department of Liquor did surveillance as soon as the bars opened on August 27. Local police and the Department of Health Services conducted their own investigations into the same locations.
“We know from previous events which locations are likely to evolve into congregation, some dancing and some craziness,” Ruiz said about Old Town Scottsdale and Mill Avenue. “They [the Department of Liquor] were actually out there on [August 28] and were monitoring some of these locations and discovered what we ultimately believe should lead to a closure for two bars in Scottsdale.”
The health department and liquor department issued notices of closure for noncompliance and liquor license suspensions respectively for three locations in the first weekend the businesses were allowed to be open due to Maricopa County reaching moderate spread of COVID-19.
The two Scottsdale bars — Bottled Blonde and Casa Amigos — are owned by the family of Gov. Doug Ducey’s senior health policy adviser, Christina Corieri. The third bar, in Tempe, is Glow Shots.
Ducey and DHS Director Cara Christ pointed to bars in these locations as likely top contributors to the spiking cases in June, Arizona’s worst month for the virus. The spiking cases resulted in Ducey and Christ shutting down all bars and night clubs with a series 6 or 7 liquor license, but restaurants that served alcohol could remain open for dine-in. They issued a metric-based system following a judge’s order on how to safely reopen gyms, bars, water parks and indoor theaters.
Christ said bars were being forced to close for various reasons, including not following social distance guidelines, dancing, having patrons not seated at tables and not serving food. The benchmarks from the state laid out clearly state that bars could only open with the promise they would operate as dine-in restaurants and each location that opened signed a waiver promising to operate as such.
The bars can now only reopen once DHS thinks it’s safe, and the license suspensions are indefinite.
“Continued defiance … is unlawful, will result in legal action and may result in the imposition of any and all available civil and criminal penalties,” the agency notice displayed on the bars’ entrance reads. That notice from DHS and a notice of the license suspension were posted on all three properties.
The summarily suspension is different from a full license revocation, since bars (and other license holders) can go through a process to get their licenses back. If the license were revoked, the bars “generally” cannot get it back, the Department of Liquor told Arizona Capitol Times in June.
Before bars — and other businesses covered under Ducey’s executive order — were allowed to partially reopen once the counties reached moderate (or minimal) spread, they could apply through an attestation process to DHS to reopen earlier.
The state previously denied Bottled Blonde’s application to reopen before Maricopa County met the appropriate benchmarks for partial reopening. Casa Amigos and Glow Shots did not apply to reopen earlier.
Outside of seeing violations in person, Ruiz said the department relies on social media posts to ferret out the bad actors.
Daniel Scarpinato, Ducey’s chief of staff, said other bars were voluntarily starting to close after learning about the locations that the state was closing.
As of August 28, DHS had received nearly 1,100 complaints from various avenues. Christ said 25% of those were invalid complaints and another 25% did not regard businesses covered under the executive order.
DHS installed a complaint hotline where anybody could call about noncompliance. It’s still unclear who tipped off the health department, but a spokesman for DHS said it was an anonymous tip through the online tracker.
“We worked with the Department of Liquor Licenses and Control, which was onsite the night before the closure notices were issued, observed the activity, and physically closed down the establishments,” communications director Steve Elliott said. “(Department of Liquor) suspension of their license occurred prior to our notice of closure. However, ADHS has authority through the executive orders, emergency order, and the attestation signed by the establishments to enforce the public health requirements.”
Investigations from the agencies are expected to continue as more businesses begin to reopen and more counties reach moderate spread of the coronavirus.
The bill pushed by Ducey and health care advocates, allocated millions for educational outreach and treatment for addicts and changed regulations for how to fill opioid prescriptions. But after two years of following through on that plan, the state has failed to meet its goal of lowering opioid overdoses and overdose deaths – and addiction and recovery experts say the data doesn’t tell the whole story.
Although overdoses and overdose deaths are not decreasing, they at least now have more and better data on the problem, the governor’s spokesman and health director say.
Gov. Doug Ducey’ spokesman Patrick Ptak said the Governor’s Office, which has maintained a cautious tone since the signing and gave no lofty promises of the proposals, is pleased with the “progress” the state has made in addressing the problem. The fact that numbers haven’t gone down, he said, “proves we have more work to do.”
“[The problem is] decades in the making, but we’ve seen progress in Arizona. We have more tools and data available to us than ever before.”
Cara Christ
Department of Health Services Director Cara Christ said its goal was to decrease the number of overdoses by 5% each year. Instead, overdoses and deaths have climbed since lawmakers approved the legislation.
Christ, who helped inform and oversee the changes, said these programs and regulatory changes have “allowed Arizona to become the front runner in these issues,” and because of it, the state has a better idea of the scale of the problem, who is primarily affected and how to better treat them.
Christ boasted of the legislation’s success, saying since the bill was signed, the state has seen a 13% decrease in opioid prescriptions and a 95 percent decrease in prescriptions to so-called “opioid-naive” patients – those who have not gotten the drug in the 30 days prior to the injury or surgery. Both of those numbers are promising, she said.
Deaths may be trending up, Christ said, because of drug trafficking trends. Neither Christ nor her spokesman was able to elaborate on this hypothesis in detail and said it is not “in our wheelhouse.”
The effort to stunt skyrocketing overdose deaths started in January 2018, when Sen. J.D. Mesnard, R-Chandler, then-speaker of the House, helped shepherd the Arizona Opioid Epidemic Act, which passed unanimously within a week in a rare display of bipartisanship. The bill limited how doctors can prescribe opioids to new patients, expanded the availability of addiction treatment for the uninsured and added a Good Samaritan law encouraging people to call police during a suspected overdose without fear of prosecution.
It was a quick, however measured, response to an urgent problem that needed a solution, Mesnard said.
“Much of the bill was aimed at trying to prevent addiction from happening in the first place,” Mesnard said. “Even though it’s sort of early in trying to measure the things, that legislation, and I think part of the national discourse as well has led to greater hesitation by prescribers on these drugs, and I think that’s a good thing.”
J.D. Mesnard
Those efforts to curb new addiction have made a dent, but overdoses are still climbing and while the state can explain how, it can’t definitively explain why.
In 2018, there were 3,433 confirmed overdoses, according to DHS data. Last year, there were 3,668.
The number of people dying from opioid overdoses has also increased, from 959 in 2017, to 1,167 in 2018 – numbers for 2019 are still being verified, according to DHS, and are expected to be released in June. That increase is far from the Department of Health Service’s goal and it’s sobering.
Those trends are one of several interconnected problems fueling this problem, problems that Christ said have been piling up for decades and will take much longer than two years to solve.
Haley Coles
In order to better tackle the issue, the department has since collected data and displayed it publicly, charting and mapping the total opioid-related overdoses. But people in the addiction and recovery arena like Haley Coles, executive director of Sonoran Prevention works, said DHS data, however helpful, is somewhat limited.
“They only focus on opioids and we know that it’s not just opioids that are killing people anymore,” Coles said. “There always have been people who die from heart attacks and over ramping from stimulants and we know that that’s increasing nationally.”
The map displayed by the department, Coles said, doesn’t tell the whole story because it displays county totals, not rates. If rates were displayed, it would better highlight the disparity of rural or smaller counties with less access to treatment face.
“It’s not useful to tell us that there are more people dying of opioid overdoses in Maricopa than other counties – of course they are,” Coles said. “I think that a lot of misinformed people look at that data and make meaning of it when there really isn’t enough meaning from it.”
Coles also said the state’s approach of curbing new addiction and its hyper-focus on opioids through prescription procedural changes in particular reduced the number of opioid prescriptions, but it’s only pushing people to other cheaper, easier drugs to get, like Fentanyl. This approach, Coles said, is misguided and just shows how out of touch the state is.
While Coles applauded the Arizona Health Care Cost Containment System grant program, which funds addiction treatment for the underinsured and uninsured, more needs to be done to earn the trust of people who still haven’t asked for help. If addiction isn’t treated in a more people-centric way and if public perception doesn’t change, Coles said, the problem could get worse.
One step in the right direction, Coles said, would be to allow cities, towns, counties or any nongovernmental organization to run overdose and disease prevention programs that allow addicts to access clean needles and better educate them — which are currently illegal.
Tony Rivero
Coles and others are working with Rep. Tony Rivero, R-Phoenix, to push HB 2608, which would do just that. This is the third year Rivero has pushed for the bill, and he said it was something he and most Democrats wanted included in Ducey’s opioid bill.
Ignorance on the issue of addiction and what fuels it, Rivero said, is what’s kept his bill from getting to the House floor. Perception from lawmakers on these programs, mostly skeptical Republicans, Rivero said, “hasn’t changed completely.”
This approach shouldn’t be controversial, Rivero said, as a similar program was implemented under then-Republican Governor of Indiana Mike Pence and lauded by his surgeon general and now U.S. Surgeon General Gerome Adams.
These programs are proven to be effective in earning trust of people whose disease has been criminalized, Rivero said. Without trust, the problem may only worsen or plateau at best.
“The goal here is to have access for these individuals to have access to clean needles, but during that process, the nonprofit’s who are going to be overseeing these programs will be engaging these individuals and pushing them in the direction of rehabilitation,” Rivero said. “My goal here is to save costs for taxpayers and in order to decrease the spreading of HIV and Hepatitis B.”
But no matter how much money the state throws at this problem, Mesnard said, there are conflicting federal limitations that make solving it difficult. But above that, he said, seeking recovery is a personal choice, getting addicted isn’t.
There’s only so much the government can do. The opioid bill, Mesnard said, largely aimed to fix the influx of addicts, to help stop people from getting addicted in the first place.
While there was focus, and money spent, on helping those already addicted, there are so many variables in that, including personal choice and mental state, that solving that completely is nearly impossible — and the numbers show that, for now.
“There’s no way always to prevent every conceivable situation, and very few people grow up and think I want to be a drug addict,” Mesnard said. “There’s plenty that we can’t do, the law that we pushed, was always going to be imperfect, but we gave it our best shot.”
A panel of experts discusses the opioid crisis at an Arizona Capitol Times Morning Scoop panel on October 17, 2017. From left to right are Jennifer Siozos, chief transformation officer, Terros Health; Dr. Elisa Mashal, medical director, Mercy Care Plan and Mercy Maricopa Integrated Care; Dr. Caroline Carney, chief medical officer, Megellan Healthcare; Dr. Cara Christ, Arizona Department of Health Services director; and, Mary Cameli, Mesa fire chief. (Photo by Rachel Leingang, Arizona Capitol Times)
A task force Gov. Doug Ducey created to take aim at the opioid crisis has a lot more work to do than the initial list of proposed laws and policies it released earlier this year, a panel that included doctors said today.
Arizona Department of Health Services director Cara Christ said the task force looked at 100 ideas and winnowed it down to a dozen final recommendations.
“We know this is just the first step,” Christ said at an Arizona Capitol Times Morning Scoop panel on opioids today.
The task force’s proposals would reduce illicit use of opioids, promote safe prescribing, decrease risks of opioid use and improve access to treatment, DHS said in its opioid action plan released in September.
The proposals come after the department found two people died on average each day last year from opioid overdoses, which led Ducey to declare a statewide opioid emergency.
One proposal not found among the recommendations: a needle exchange, which would allow people to access clean needles to hinder the spread of infectious diseases.
Christ said the department did consider a needle exchange, which she called “phenomenal” at stopping the spread of communicable diseases, but ultimately didn’t decide Arizona should have a program because research didn’t show a need for one at this time.
Dr. Caroline Carney, the chief medical officer at Magellan Healthcare, saw the effects of dirty needles up close when she worked in Indiana, which experienced an HIV outbreak due to contaminated needles used to do opioids.
Needle exchanges work to avoid spreading HIV and hepatitis C, Carney said, but if there’s no evidence of infectious diseases spreading among opioid users here, then the data does not support the need for an exchange in Arizona. There are limited resources to go around, so it’s important to focus on data, she added.
The department recommended lawmakers approve a Good Samaritan law that would allow bystanders to call 911 for potential opioid overdoses, which the department said is needed because people are afraid to call 911 for fear of prosecution.
Dr. Elisa Mashal, the medical director at Mercy Care Plan and Mercy Maricopa Integrated Care, said such a law would be helpful because people shouldn’t to be afraid to call 911 when an overdose happens. While people can stop an overdose using naloxone, an opioid antagonist, it’s important for a person who overdosed to get care from a medical professional as naloxone can wear off, she said.
The task force also wants medical schools to incorporate pain management and substance-use disorder training into their curriculum. The opioid recommendation calls for an executive order requiring medical education programs in the state to add these items to their schooling.
Mashal said such training was severely lacking when she went to medical school.
“We’re trained by salesmen,” she said.
Carney agreed — typically, pharmaceutical company representatives would come in and tell medical students about their drugs, but there wasn’t training beyond the sales pitch.
Christ said the goal of the governor’s task force is to target ways to forestall opioid use and abuse in the first place, get people into care programs and prevent deaths. The group reviewed policies and best practices nationwide in the process, she said.
“There’s still a lot of best practices out there that we’ll be looking at. I don’t think anything is off the table,” she said.
In this Sept. 14, 2021, file photo, a syringe is prepared with the Pfizer Covid vaccine at a clinic at the Reading Area Community College in Reading, Pa. (AP Photo/Matt Rourke, File)
A new statewide poll suggests there may be little, if anything that Gov. Doug Ducey and his new $400-an-hour health adviser can do to convince many more Arizonans to get vaccinated against Covid than already have made that decision.
The survey conducted earlier this month by OH Predictive Insights finds an increasing number of residents are more pessimistic about what is happening with the virus. And even among those who are unwilling to take the vaccine, nearly a quarter are extremely or moderately concerned about the current state of the pandemic in Arizona, with another half saying they have at least a slight concern.
Yet about 60% of these people still say they are not willing to get inoculated. And by a virtually identical number, they say that the new more transmissible delta variant had no effect on their willingness to get inoculated.
In fact, pollster Mike Noble found 18% said the delta variant actually made them less likely to roll up their sleeves. All that, he said, undermines efforts to reach “herd immunity” in Arizona, the point at which a sufficient percentage are inoculated to make it difficult for the virus to rapidly spread.
And he pointed out that percentage of those who want to remain unvaccinated really has not changed in the last six months.
That appears to be borne out by the state’s own vaccination numbers.
Vaccinations dropped below 10,000 a day in July. And now, even with news of the delta variant, it has not hit 20,000 a day — and come close only a handful of times — and is again declining.
That compares with close to 80,000 vaccinations a day at the peak of late March and early April.
As of Tuesday, 57.4% of Arizonans had at least one dose. And fewer than 51% are fully inoculated.
It was for that reason that Ducey last month said he hired Dr. Richard Carmona, a former U.S. surgeon general, with the specific goal of boosting vaccine acceptance.
Carmona, for his part, has said he is looking at a new — and different from the past — public education campaign to address those who he believes are getting bad information about the vaccine.
In this Nov. 6, 2012 file photo, Democratic Senate candidate Richard Carmona gives his concession to Republican Rep. Jeff Flake at a Democratic Party gathering, in Tucson. On Aug. 26, 2021, Gov. Doug Ducey announced Carmona will the state’s senior health advisor on Covid matters. (AP Photo/Ross D. Franklin, File)
The state has had a series of public service announcements urging people to get vaccinated, ranging from appeals by former Health Director Cara Christ to community leaders and even, at one point, a floating hot dog with a surgical mask as parachute.
Carmona said that there probably are up to 15% of Arizonans who, for whatever reason, simply will not get vaccinated. Still, he said herd immunity is possible if Arizona gets to that 85% level.
The doctor promised a new approach.
Details, however, have been sparse. Carmona has made some general comments about emphasizing the benefits to the economy of having a vaccinated population.
But gubernatorial press aide C.J. Karamargin pointed out that Carmona has been on board for less than a month.
“You’re expecting instant results?” he asked.
Karamargin, whose boss signed legislation forbidding schools from imposing mask mandates and opposes mandated vaccines, said Ducey still believes that vaccines “are the best way to put Covid behind us.”
“Dr. Carmona is well-equipped to lead this effort,” Karamargin said. “And he, himself, has said that it’s going to require hard work on everyone’s part to persuade those who may be hesitant to change their views.”
State health officials, in confirming the $400-a-hour deal with Carmona, said there is no set number of hours or specific limit on his earnings, saying only this is supposed to be a part-time role for the doctor along with the work he does at the University of Arizona and other entities.
On the subject of schools, Noble said he found that 58% of those questioned support the idea that schools — and not parents — should make the decision about whether students should have to wear masks despite the governor signing legislation that bans districts from enforcing such rules. That tracks closely with a different survey released earlier this month by the Arizona School Boards Association and the Arizona Public Health Association.
And Noble said that by a nearly 2-1 margin the people in the survey oppose Ducey’s unilateral decision to withhold certain federal Covid relief dollars from schools who have so far ignored the yet-to-take-effect law and require students to mask up.
The governor, who cannot seek a third term, has previously pronounced himself unconcerned with such numbers.
“I’m not going to pay attention to any poll as I’m trying to put out good public policy,” he said.
The online opt-in survey of 1,000 Arizonans was conducted between Sept. 7 and Sept. 12 and has a margin of error of 3.1%.
State Health Director Cara Christ explains Thursday her belief that the benefits of getting students back in school outweigh the risks of the spread of COVID-19. (Capitol Media Services photo by Howard Fischer)
Arizona schools will reopen late this summer, pretty much no matter what is going on with COVID-19, Gov. Doug Ducey said Thursday.
And there could be summer school — and even the opening of schools that operate on a year-round basis — even earlier than that.
The governor and Cara Christ, his health director, acknowledged the risk of having children together in classrooms. That’s why schools were shuttered on March 15.
But Christ said it isn’t that simple.
“There’s a lot of public health reasons why we would want kids in school,” she said. “They provide a lot more services than just education.”
Still, she conceded, it is a bit of a balancing test.
“Schools provide nutrition, they provide safe environments, they provide physical activity,” Christ said. “All of this is important for the ongoing health of these kids, especially as they grow.”
That, she said, requires looking at it “from a holistic public health approach.”
“We are weighing it against the risk of transmission of the virus and that’s one of the things we’re taking into account,” Christ said. That includes “flexibility” to provide alternatives to students — and faculty — who may themselves be at risk or have family members and finding ways to keep them safe “while we’re still meeting the needs of the children.”
Anyway, she said, there are ways to reduce risks, ranging from more frequent disinfection of surfaces to not having students gather for assemblies and lunches.
Gov. Doug Ducey answers questions Thursday about his decision to have public schools fully opened later this summer. (Capitol Media Services photo by Howard Fischer)
Ducey defended the decision to make that announcement about August reopenings on Thursday, even with the state still in what the Centers for Disease Control and Prevention calls Phase 1. That is the earliest stage of reopening both the economy and public activity which involves not just social distancing but also prohibits gatherings of more than 10 in any one place.
“We need parents and teachers and superintendents to be prepared,” he said of the announcement.
Some of the details of how this all will work will come next week. State schools chief Kathy Hoffman on Thursday promised to issue “guidance to serve as a roadmap for preparing for a variety of learning options that keep students and teachers safe.”
“This documents … will provide adaptable, flexible recommendations, considerations and resources for districts and charters to plan for the upcoming year,” Hoffman said.
Public schools aside, the governor gave the go-ahead for summer camps to open as early as this coming week.
That, however, is for the moment going to be limited to day camps. And they will have to operate under guidelines to be issued by the state.
And the governor also announced that youth sports can return to Arizona immediately.
But here, too, it won’t look the same as before.
Christ said there will be definite limits on the number of parents and spectators who will be able to go to games. And she said there will be other changes, like cleaning commonly used equipment between players, no hanging around before or after the games, and requiring adults to wear a mask where possible.
Separately, the governor said that Prescott Frontier Days will be able to continue, uninterrupted, for the 133rd year, allowing it to keep its record as the world’s oldest rodeo. But Ducey said the question of whether anyone will be allowed in the stands to watch remains undecided.
The announcements came as the governor acknowledged that there has been an upward tick in the percent of COVID-19 tests that are coming back positive. It went from 5.1 percent for the period ending May 10 to 6 percent a week after that and 6.8 percent for the most recent week. Still, Ducey said he remains optimistic.
“If you look at this chart you can possibly see the beginning of a downward trend,” Ducey said.
“The trend is not here yet,” the governor conceded. And then there’s the fact that it can take up to seven days for the state to get complete numbers from laboratories.
“This is something that we’ll continue to monitor,” he said.
The big announcement — and the big questions — all surround having students return to the classroom. Ducey said this decision is being made from “a public health perspective” as he shunted questions off to Christ.
“We know that we’ve had daycare and child care in place where kids have been in a congregate setting,” she said. And Christ said that, in discussions with school officials, they already are coming up with plans for how to deal with 1.1 million youngsters returning to classrooms.
Some of that, she said, is focused on children or teachers who are “at risk,” providing for distance or “virtual” learning.
Also key, Christ said, are smaller class sizes and disinfecting protocols “and a lot of safety things put into place.”
But Christ said she also looks at the issue as a mother of three elementary school children
“It’s important to get these children back into school, back into a normal routine,” she said.
Still, Christ acknowledged, it’s “going to be a new normal,” with more frequent hand washing, physical distancing and even not mixing at lunch or having large assemblies.
That, however, gets into the question of cost.
Several sources say Arizona schools have larger class sizes than most other states. Physical space requirements aside, schools also will need to purchase supplies like hand sanitizer.
“That was definitely a part of the discussion that we had with superintendents, what were the needs of the schools, how would we work on flexibility for people with that underlying health condition, and what the cost would be,” Ducey said.
The governor said that there is money in the state budget as well as about $1 billion in Arizona’s “rainy-day fund.” On top of that, Ducey said the federal government is providing coronavirus relief dollars for education.
“So we do have some options,” he said. “And we’ll want to make the proper decisions so that we can successfully reopen our schools in a safe way for our kids, their teachers, the staff and the employees,” he said.
Gov. Doug Ducey waits to hear President Trump speak after a tour of a Honeywell International plant that manufactures personal protective equipment, Tuesday, May 5, 2020, in Phoenix. From left behind Ducey are U.S. Sen. Martha McSally U.S. Rep. Debbie Lesko. The event was the only time Ducey has worn a mask in public during the coronavirus pandemic, leading public health experts to say he’s serving as a bad role model. PHOTO BY EVAN VUCCI/ASSOCIATED PRESS
Arizona continues to see a spike in positive COVID-19 cases and health experts say Gov. Doug Ducey sets a bad example by not wearing a mask in public.
Arizona reached its second highest day of positive cases June 10, at 1,556 positive out of 7,770 new tests, a 20% positive result, which led one expert to say Arizona has two options to turn things around, but neither will be popular.
Dr. Joe Gerald, a professor and researcher at the University of Arizona, said it doesn’t appear the state is taking the virus seriously enough and he is worried about a resurgence, if you can call it that.
Joe Gerald (Photo by Kris Hanning/University of Arizona Health Sciences)
“Arizona was a state that intervened relatively early in the course of this outbreak before there were a large number of hospital cases and so we benefited from that early intervention, but we were never able to drive case counts down – they just kind of plateaued,” Gerald said.
He said Arizona has “less of a safety margin” to handle a second wave because the state never saw the first wave subside. Combating the spread now is going to “require some pretty urgent intervention … because there’s such a delay between when we act and when we can see the tangible benefits of that action,” he said.
Gerald said there are only “two tools in our toolbox to address this problem” – physical distancing in the form of another stay-at-home order, which Ducey has made clear isn’t an option, or requiring people to wear a mask.
“We’re missing an opportunity by not doing more to encourage mask wearing and physical distancing. And certainly the governor, by not modeling this behavior, is sending a message that these behaviors aren’t important,” he said. “The optics of it just look terrible.”
Gerald said Ducey and Department of Health Services Director Cara Christ refusing to wear a mask in public has “struck a chord” with public health officials because “we’re really looking to our leaders, both political and other, to model the behaviors that are so critical to trying to gain control of this outbreak.”
Rebecca Sunenshine,
He said wearing a mask should not be a political issue and blames elected officials for turning it into one and for not modeling healthy behavior themselves.
“I’m really disappointed that our elected officials of all stripes haven’t done more to model and emphasize the message and communicate the importance of mask wearing to protect not only others, but to protect the economy.”
Masked
Health officials in Arizona’s largest county have taken the opposite approach of Ducey and Christ in their most recent press conference on June 10.
Sporting masks and slathering on hand sanitizer, Maricopa County health officials announced that county employees are now required to wear masks and hinted that Ducey will announce a statewide campaign next week to encourage people to wear masks.
While Ducey refuses to change his actions as cases spike, Maricopa County Public Health Director Rebecca Sunenshine said as the virus has progressed, her understanding of the importance of wearing a mask has, too.
“Anybody who has seen my interview a few months ago, I did not routinely wear masks in public and I want everyone to know that I have changed my position on wearing cloth masks, mostly because the data just wasn’t there to support them when the recommendation first came out,” she said. “Now, there is a mounting body of scientific evidence that shows that cloth face masks can actually prevent COVID-19 from spreading.”
Ducey has only worn a mask in public once – when visiting the Honeywell factory with President Donald Trump, who didn’t wear a mask – but don’t expect to see the governor throw one on just yet.
One top official from the Governor’s Office said Ducey won’t wear a mask at his future briefings because he is “socially distant.” Nobody from Ducey’s office has commented on if the governor will ever wear a mask in public to set a better example for Arizonans after countless photos have circulated of Ducey and his team violating his own recommendations.
Will Humble
And whatever “campaign” Sunenshine hinted at coming from the state, seems to be nothing more than a public service announcement that won’t involve requiring people to wear a mask in public.
Some cities in other states require people to wear masks whenever they leave home, but the new effort won’t include mandates, and will instead be more like a PSA on healthy habits, like wearing a mask and staying home when sick.
Worrisome Trend
Ducey’s staff continues to post updates on Twitter downplaying the severity of the latest spike, but health officials remain concerned.
Specifically, they are freaked out about Arizona’s spiking rate of positive cases, and shrinking hospital capacity.
CovidExitStrategy.org, a website run by health and tech professionals to aggregate publicly available data on the pandemic that includes a state-by-state dashboard of key metrics, lists Arizona as “trending poorly.” That’s because in the last two weeks, the Grand Canyon State has had one of the highest trends of new cases (up 198%), the highest number of new cases per million in the nation and still isn’t meeting the target number of daily tests.
The latest trend, coupled with the state’s decreasing hospital capacity, is particularly concerning, according to the group, which held a conference call with reporters June 10.
Ducey’s office has repeatedly said that the spiking number of cases is because the state is doing more tests, though health experts said that that claim is misleading.
“If your positivity rate is increasing, that is a problem,” Marta Wosińska, deputy director of Duke-Margolis Center for Health Policy, said. “The fact that the positivity rate in Arizona is increasing suggests that there is more to it than testing more.”
Sunenshine said the rapid increase in the percentage of positive cases is likely to keep increasing.
“All of these numbers tell us that there is sustained community wide spread of COVID-19.”
The data shows cases began to spike right around the time Ducey lifted the stay-at-home order on May 15.
Gerald said he didn’t think stay-at-home did enough, whereas another health expert said it was working, but scientifically speaking there was no reason to end it so soon.
“It wasn’t restrictive enough, initially, and then we just didn’t keep it in place long enough,” Gerald said.
Will Humble, the Arizona Public Health Association executive director, said it was working, but now we are noticing a trend of higher positive cases.
He acknowledged elected officials must look at more than the pure science of the most effective way to slow the spread – Ducey is also taking into account the economic and psychological harm that a shutdown causes.
“If you looked solely through the lens of the spread of the virus, yes [Ducey lifted the order too soon]. But looked at it from a larger perspective, who knows?” Humble said.
Floyd Factor
Gerald and Humble said numbers will continue to climb as has been the recent trend, but things could get worse because of the nightly George Floyd protests throughout the state. However, any spike won’t come until after the incubation period. The protests began May 28 and have varied in size and intensity.
The incubation period is the time someone becomes infected to the time they recognize it, plus a day or two longer before the test results show up on the Department of Health Services dashboard. The estimate is between seven and 14 days total.
Humble, who served as Christ’s predecessor under Gov. Jan Brewer, also said Arizona is beginning to see how much, if at all, the hotter weather will affect COVID numbers.
“If the numbers begin to stabilize from here at 1,000 or so and don’t start edging towards 2,000 a day, then perhaps we’re looking at a seasonal effect where 110 degrees actually does some mitigation,” he said, adding that it doesn’t look promising.
Based on these numbers, Humble said Ducey “better not declare Phase Two,” but if he does, “[Ducey] can’t say ‘we’ve met the criteria and then therefore I’m moving forward.’”
Sunenshine said it’s also worrying that hospitals continue to fill up, which means elective surgeries, procedures she defined as ones that can be put off for more than 24 hours, might again be prohibited..
Hospitalization numbers are what is the most worrisome to Gerald, he said, and that the response to this “second surge” will be slow.
“We may substantially overshoot our capacity or ability to provide care to those who are most severely ill,” he said.
That doesn’t mean hospitals won’t be able to provide care at all, he said, but in “normal circumstances” the intensive care unit wouldn’t be overcrowded, there would be enough beds, medication, protocols and treatments.
Gerald said another issue is the severely ill may not be able to receive proper treatment.
“It’s not like we’re going to have people dying on the street, but rather, people may be cared for in an OR,
instead of an ICU, and the ventilator that they’re being used isn’t one of the normal ventilators, but it’s rather an anesthesia machine, and instead of being primarily cared for by pulmonary and critical care doctor, they may be getting their care from an anesthesiologist or a surgeon,” he said.
“And so the worry is more people would die than otherwise would die because our health care system is over its capacity to provide the expected care that we normally [provide] to everyone that needs it,” Gerald said.
As of right now, bars in nine of the state’s 15 counties can reopen.
But don’t expect them to look and operate the way they did before the governor ordered them closed in March.
No dancing.
No karaoke.
No darts or pool.
And forget about wandering around in hopes of finding someone with whom to hook up.
Put simply, they have to operate more like a restaurant, complete with food. And the number of customers is limited to just half normal capacity.
The nine counties on Thursday all have achieved at least “moderate” status as far as the spread of COVID-19. And that permits not just bars but also gyms, fitness centers, movie theaters and water parks to reopen.
Only thing is, they have to agree to a laundry list of restrictions as state health officials say there still is a risk from the coronavirus. So for each of these businesses, the mission now is finding ways to open with limited capacity and limited activities and still make a living.
The counties at moderate are Apache, Cochise, Coconino, La Paz, Maricopa, Navajo, Pima and Yavapai.
And the infection rates in Greenlee County are so low that the Arizona Department of Health Services says they have achieved “minimal spread” status. That will give businesses there even more flexibility.
Dr. Cara Christ
Pinal County did not make the cut as expected. State Health Director Cara Christ said a new set of test results received late Wednesday kept it in the category of “substantial” risk of spread.
Christ acknowledged that test results from inmates are included in the county’s tallies. But she doubted that these infections are what has kept the county from moving into the “moderate” category.
“They’ve had a pretty steady rate over the last three weeks,” she told Capitol Media Services, with no spike.
“My guess is that final bump was not related to the prisons,” Christ said. “It was likely related to something in the community.”
But Rep. Bret Roberts, R-Maricopa, is questioning why inmates who test positive are even being considered.
He said counting positive tests among staff make sense.
“They’re out in the community,” Roberts said. But he said inmates are not, meaning they’re not able to spread the disease to other Pinal County residents.
Christ, however, said it’s not that simple.
“COVID is highly contagious,” she said.
“So if it is at a prison, the correctional officers are at-risk of getting it and taking it out into the community and bringing it back into the prisons, especially if you’re going with things like restaurants and bars and gyms where they may go when they are off,” Christ continued. “There are people that work in the prisons that do things in the community.”
It’s not just bars in these nine counties where bars will again be allowed to operate, albeit in a scaled-back fashion.
Gyms and fitness centers can also reopen their doors to half of the normal capacity, with requirements for other restrictions. Ditto movie theaters, water parks and tubing operations.
But traditional bars and nightclubs won’t be able to reopen as they used to operate until the county rate for positive tests comes back at 3%.
Still, there are current options for bars that can reconfigure how they do business.
The list of dos and don’ts is extensive. And it goes beyond the ban on dancing, singing and games.
It starts when people arrive.
The state wants at least 10 square feet for each person in the waiting area, with anyone in the queue required to mask up. Overflow has to go outside, even to the point of would-be customers waiting in their cars.
Customers can choose between sitting at the bar or a table with the obligatory six-foot distance between parties. But once someone is seated, that’s it — except to go to the bathroom. And that, in turn, requires putting back on the mask.
Salad bars and buffets where people can serve themselves are forbidden.
And customers are unlikely to find a bottle of ketchup on the table. It’s not a gourmet thing. It’s just that the health department wants single-service helpings, whether in packets or small bowls.
Even the experience of paying is likely to be altered, with staff required to wipe down any pens, touchpads or other hard surfaces between each use.
Gyms and fitness centers present a different set of hurdles. Here, too, it starts at the door with a requirement for customers to submit to temperature checks or at least be screened for COVID-19 symptoms.
They can operate only at 25 percent capacity except in Greenlee County where 50 percent is OK.
Masks are required at all times, along with physical distancing of at least six feet.
There can be classes for Pilates, Zumba and other fitness exercises. But expect to find lines on the floor to demonstrate where people can safely stand.
Theaters can fill up to half their seats — but only if they can do so by limiting groups to no more than 10, separating groups by at least six feet, and keeping every other row empty.
Customers should count on having to wear a mask other than while eating or drinking at a seat. And look for more time between shows to avoid crowds and allow better air circulation.
Water parks also can operate at 50 percent capacity, with distancing between deck chairs and other actions to keep participants apart.
State Health Director Cara Christ explains on May 28, 2020, her belief that the benefits of getting students back in school outweigh the risks of the spread of Covid. (Capitol Media Services photo by Howard Fischer)
Dr. Cara Christ, the Arizona state health director who helped lead the state through the Covid pandemic, is leaving her post to join Blue Cross Blue Shield of Arizona.
Christ took over as the director of the Arizona Department of Health Services shortly after her previous director, her former boss and now top critic, Will Humble left in early 2015. Christ’s final day will be August 27.
Christ was the final state leader – outside of Gov. Doug Ducey – who remained on since the pandemic began in her role. In the early days of Covid in March 2020, Christ, Ducey, former Adjutant General Mick McGuire (who retired earlier this year to run for U.S. Senate) and Wendy Smith-Reeve, the former state emergency management director, were front and center delivering constant updates on the effects Covid would bring to the state.
Smith-Reeve resigned March 28, 2020 over feeling like her role was irrelevant and that Ducey would not listen to her. She joined ABC 15 Arizona.
“The directives from the governor’s office have been to work completely outside of the State Emergency Response and Recovery Plan,” Smith-Reeve said at the time.
Christ’s departure news comes one day after she and Ducey offered different public remarks over how the state should handle recent updates from the Centers for Disease Control and Prevention recommending all K-12 students wear masks as the Delta variant becomes dominant nationwide.
Ducey took the opportunity to criticize the Biden administration for its handling of the pandemic and arguing, without scientific support, that wearing masks at this point will “undermine” confidence in the vaccine.
“This is just another example of the Biden-Harris administration’s inability to effectively control the COVID-19 pandemic,” he said.
Christ said she agreed with the CDC and would have her kids wear masks while in school. Nobody under the age of 12 has received the vaccine yet and might not until the end of the year while kids are still able to spread the virus and some – but not many – have succumbed to Covid over the past year and a half.
“Everyone, whether you’re fully vaccinated or not vaccinated, should wear a mask when you are indoors or around others that you do not live with,” she said.
The announcement also came from Ducey’s Office rather than Christ’s, which raises questions about the timing.
The Department of Health Services could not be reached for comment about the timing of the departure.
Ducey, and therefore Christ by association, have been harshly criticized by some who said they did next to nothing to prevent a huge wave of cases, hospitalizations and deaths as 2021 rolled around. Arizona became Covid hot spots in Summer 2020 and December through February.
More than 18,000 Arizonans have now lost their lives, and the number continues to increase.
Arizona is currently below the national average for vaccination rates, even though it made early strides ahead of others throughout the country. The state just barely eclipsed the 50% threshold for people who have received a single dose and slightly less for fully vaccinated citizens. But numbers have increasingly shrunk since vaccines reached the peak in April, right around when Ducey opened up vaccines to “anybody who wants to receive one.”
Christ also pulled double duty as interim director of the Department of Economic Security before being replaced as Covid began to spread rapidly in 2020.
“When Cara Christ became a doctor, she did it to help others and save lives. That’s exactly what she’s done,” Ducey said in a prepared written statement. “She dedicated countless hours to protecting millions of Arizonans from the COVID-19 pandemic — and she’s done it with grace, stability and confidence. She implemented effective statewide testing and internationally-recognized mass vaccination sites, established the national model Arizona SurgeLine, worked hard to increase vaccinations for communities in need, and so much more.”
Christ’s new gig will be at an organization that has been a huge benefactor for Ducey during his tenure. Blue Cross Blue Shield of Arizona generously donated $10 million to help combat the opioid crisis in 2018. The group also gave $50,000 last year to Ducey’s Arizona Coronavirus Relief Fund.
This June 20, 2014 file photo shows the Southwest Key-Nueva Esperanza, in Brownsville, Texas, a facility that shelters unaccompanied immigrant children. (AP Photo/Eric Gay, File)
Recent state inspections of Southwest Key shelters that house migrant children show that some employees did not have adequate background checks on file.
Gov. Doug Ducey’s administration released the inspection reports on Thursday after ordering the Arizona Department of Health Services to check the facilities starting last month.
One of Southwest Key’s Phoenix shelters and its Tucson shelter were both cited for having employees without fingerprint clearance cards on file within the state mandated time frame, according to a report released by ADHS on Thursday. Southwest Key is the country’s largest operator of immigrant youth shelters.
All employees at the shelters are required to have fingerprint clearance cards on file within seven days of being hired. The Department of Public Safety issues the clearance cards after a thorough background check to disqualify people with certain crimes on record from working with vulnerable populations.
The fingerprint cards weed out employees who have previously committed sex offenses and other crimes. The records do not indicate that persons barred from obtaining the clearance had worked at the facilities, only that Southwest Key failed to comply with regulations to have the records on file within specified timeframes.
At the Tucson facility, ADHS found eight employees who received their fingerprint clearance outside of the required timeframe. ProPublica reported a youth care worker at the Tucson shelter was convicted of groping a 15-year-old boy.
At the Casa Phoenix facility, located near Seventh Avenue and Buckeye Road, one employee went 20 months without a fingerprint clearance card, according to ADHS. This is the same facility Gov. Doug Ducey and his wife, Angela, toured in late June.
Southwest Key has 2,061 employees in Arizona.
An Arizona Capitol Times review of the nonprofit’s state records show that it has had infractions in the past, including the failure to maintain fingerprint records at a Mesa facility, which came with a $1,000 fine. In another instance, the company was fined $500 after a resident was restrained in a Glendale shelter last year.
In the most recent round of inspections, several of the Southwest Key facilities were cited for other reasons, including some employee personnel records not showing proof that employees are tuberculosis-free, and not indicating that Southwest Key made a good-faith effort to contact employees’ previous employers. Poisonous or toxic chemicals were also unlocked, according to ADHS.
Some of the facilities were cited for not having the required square footage per resident or not having enough space between beds. Others were cited for not having bedroom or bathroom doors as required.
Cara Christ
ADHS Director Cara Christ said while Southwest Key was cited for some violations as a result of the surprise inspections, the deficiencies do not constitute an immediate threat to the safety and well-being of the children at the shelters.
“After hundreds of hours of inspections and reviews, I am confident Southwest Key is providing care within the law and Arizona’s established standards of care,” she wrote in a letter to Ducey.
Southwest Key views the eight sites it operates in Arizona as shelters, but ADHS classifies them as 13 facilities because the nonprofit holds 13 behavioral health residential facilities licenses.
Three of the 13 facilities — two in Phoenix and one in Mesa — were found to have no violations.
The state has limited oversight over the Southwest Key shelters because they fall under the federal government’s jurisdiction. But ADHS and Southwest Key have come to an agreement that will allow the state to increase unannounced inspections of the shelters. Typically, ADHS can only conduct routine facility checks or follow up on a specific complaint.
ADHS also required Southwest Key to verify that all of their current employees have valid fingerprint cards within 30 days. Southwest Key will also have to report to ADHS any corrective action taken following the state’s findings.
Southwest Key spokesman Jeff Eller said his company looks forward to working with ADHS to correct the reported defficies. The nonprofit has agreed to begin corrective action immediately, he added.
“We fully support the expanded oversight they want to do,” he said.
Ducey spokesman Daniel Ruiz said the state will ensure Southwest Key corrects the violations listed in the ADHS report.
The Southwest Key shelters are a hot topic in Arizona’s political scene, with legislative Democrats and candidates for statewide office calling on Ducey to order the state to inspect all facilities holding migrant children.
Ducey was largely quiet on the issue until he told the Capitol Times in an interview that he was “horrified” by reports of sexual abuse at some Southwest Key facilities.
The Arizona Public Health Association is urging the state’s health director to do more to prevent the spread of coronavirus in the prisons as studies and public health officials predict a nearly 100% infection rate.
The state currently houses more than 41,000 inmates who have no way to socially distance themselves from behind bars and are not permitted to wear any face protection, which could lead to a high number of positive cases over the next three weeks.
Will Humble, executive director of the Arizona Public Health Association and the state’s former health director, said if inmates end up in a more serious medical situation, they would end up in the regular community hospital system.
“How’d you like to be a hospital trying to deal with COVID patients from the community and now you have a contract with DOC, and you have all the extra security things that you have to deal with?” he said.
The private health organization, which wrote a letter on behalf of the American Friends Service Committee, urged Department of Health Services Director Cara Christ to make sure the prisons are doing enough to protect the health of inmates and employees.
“I urge you to direct your team to ‘…evaluate the medical and health-related facilities and services that are provided to inmates to determine that the facilities and services meet the applicable standards that are adopted by the director of the Department of Health Services,’” the they wrote on April 21.
Caroline Isaacs, the program director for American Friends Service Committee-Arizona, said her group and the health department held a call on April 24 to go over measures the prisons could take to become safer.
“They heard our concerns and agreed to provide us with some information, including what specific direction they have given ADC,” Isaacs said.
Will Humble
Humble said his expert advice for the corrections department would be to ask DHS to “lend me one of their most talented epidemiologists to come in and do advisories at all the prisons and just create a checklist form.” Granted, Humble said he does not know what measures prisons are taking, since he no longer is at DHS.
“But I do know, what I would want is to have somebody who’s a professional at Infection Control and Prevention to come in and give me some pointers about how to change our processes from how they operate all day long,” he said.
A spokesman for DHS said the department has had an epidemiologist assigned to serve as a liaison to the Department of Corrections “since the beginning of the outbreak.”
“They helped draft the Arizona specific correctional facility guidance and continue to provide technical assistance, as needed,” spokesman Chris Minnick said. “At this time, our understanding is that ADCRR is complying with CDC recommendations for COVID-19 in correctional settings.”
Minnick did not go into further detail or express any inclination that Christ would sway corrections into including infection information about prison employees.
At least one staffer and one inmate at Perryville prison, both of whom work in the kitchen, have tested positive for COVID-19, but the corrections department hasn’t allowed any other inmates there to be tested, and refuses to release data about testing employees.
The only reason the information about the staffer came to light was due to public records that ABC15 obtained showing the employee in the prison contracted the virus, and after prison officials circulated a memo saying that nobody else was at risk, ABC15 received a tip from a union worker that the employee who tested positive worked in the kitchen where they have repeated contact with inmates. The prison would neither confirm nor deny that claim.
Carlos Garcia, the executive director for the Arizona Correctional Peace Officers Association, described a kitchen employee being infected as a worst-case scenario.
“The worst person who can catch this is a kitchen officer…They’re having contact with inmates left and right, staff left and right. It’s close proximity,” Garcia said.
Citing federal medical privacy laws, the Arizona Department of Corrections has refused to release information on the number of staff and officers who have tested positive for COVID-19. Other states have been routinely releasing that information – either meaning those states aren’t following the law, or Arizona is applying it too broadly. The Governor’s Office does not seem likely to force the department to release testing information about its employees, either.
Patrick Ptak, Gov. Doug Ducey’s spokesman, said via text that agencies are “prohibited from disclosing information that would reveal an employee’s identity or confidential medical information.”
Of course, nobody is seeking their names, only the number of guards who have tested positive – the same information the department already provides about inmates daily. Ptak did not respond to any follow up questions including the legal basis for withholding information. Corrections Director David Shinn previously acknowledged that prison staffers have tested positive, but he did not know the number of such cases.
One prison reform organization said the lack of information and transparency coming from corrections is “unconscionable.”
“There seems to be an inordinate amount of desire by government leaders to keep the public in the dark as much as possible about what is truly transpiring in our nursing homes and prisons,” said Donna Hamm, director of Middle Ground Prison Reform. “These are the places where our most vulnerable populations live.”
Hamm said though at least in nursing homes patients are in separate rooms with clean showers and bathrooms and have plenty of soap and can wear protective gear if they so choose. The same cannot be said for inmates.
Donna Hamm
“The vast majority of prisoners live in dormitory and bunk bed style open rooms separated by about three feet,” Hamm said.
She said she has also heard reports from prison staff that inmates don’t have soap at all or worse.
“Inmates [are] being turned away when attempting to report to medical; coughing/wheezing inmates filling the dorm space at night; staff members not wearing masks; staff not changing gloves even after conducting strip searches; dining halls filled with people and no attempt to social distance,” Hamm said.
Meanwhile, Shinn continues to repeat his unsubstantiated claim that prisons are safer than the general community. In a letter to Hamm and later on KTAR, Shinn said, “The greatest threat that we face right now is not within our prisons; it is truly within our communities.”
Humble disagreed.
“The virus comes in with the staff and once it’s in, then it’s gonna spread, and it’s in close quarters,” Humble said. “It’s an environment much like a cruise ship, to be honest.”
And in prison, social distancing is not an option. Plus inmates are prohibited from wearing face protection despite them being put to work to make masks for prison staff and other law enforcement throughout the state and “each and every state employee.” Though at first, employees were told to not wear masks because it would scare the inmates.
Now, while prisoners are separated from the public, employees come and go from their respective communities, likely spreading the virus inside and outside the prison walls even if they don’t show symptoms.
“They could still be asymptomatic and spread it to the inmates,” Humble said.
But inmates still are not being tested.
Perryville, the all-female prison complex in Goodyear, houses roughly 4,100 inmates, one of the most populated facilities in Arizona. But it didn’t test a single inmate there until April 25. The test came back positive two days later.
Testing rates at other prisons are abysmally low, while rates of infection among those tested are more than double the statewide average. Only 0.5% of inmates have been tested so far.
The most recent testing numbers show the Department of Corrections, which houses 41,500 prisoners statewide, has conducted 210 tests on prisoners showing symptoms of the coronavirus – 50 came back positive and eight are still pending. That means prisons have a 25% positive rate of COVID-19, which is 2.5 times the statewide rate (discounting the pending tests). As of April 30, the rate of positive results among those tested statewide is just roughly 10% (7,648 positive cases and 71,786 people tested).
One simple improvement the corrections department could make would be to take the temperatures of prison staff every day to monitor the situation. However, it needs to do a lot more to prevent the virus from rapidly spreading throughout the prison communities. Humble said it really comes down to testing.
“You have to have the testing capacity in order to identify who’s got the illness and who doesn’t. And then you put mitigation measures in place,” he said.
Hamm agreed that testing is the most important practice to be done, but also suggested other measures.
“The ADCRR could take vastly more aggressive measures to reduce the spread by simply temporarily issuing alcohol-based cleaners, plenty of soap, masks to each prisoner, and requiring staff to wear gloves that are changed frequently and to wear masks themselves. Finally, testing, testing, testing of both staff and inmates,” she said.
A recent study estimates roughly 99% of the state’s prison population will test positive for COVID-19.
FWD.us based its projections on the Recidiviz COVID-19 Model for Incarceration, which uses “incarceration-specific” measures of how COVID-19 would likely spread within a prison or jail, along with state data on incarcerated populations to generate a likely estimate of total future COVID-19 cases in the incarcerated population, and related hospitalizations and deaths.
“Without population reductions and more protective measures within prisons, COVID-19 will peak in Arizona’s prisons in about a month,” the model predicted, estimating 41,000 inmates testing positive and 3,100 employees. Though staff numbers are currently unknown, union workers and some employees have provided estimates that roughly 30 employees have tested positive.
Advocates have been calling on Ducey to release nonviolent inmates to help save some lives, but that option does not seem to be likely. Under its current projection, FWD.us estimates at least 1,400 incarcerated people will be hospitalized, utilizing 12.6& of Arizona’s total hospital bed capacity.
“Over its course, and without action, the virus is projected to kill 360 individuals incarcerated in Arizona prisons, three times as many people as are currently on Arizona’s death row,” it says.
And if numbers get that high, there’s no telling if the prisons will be equipped to handle that many hospitalized inmates at their facilities.
“I hope they [projections] are dead wrong, but we should be acting as though they are spot on,” Hamm said.
A 10 grams piece of Hashish laid next to a 20 grams piece. (Deposit Photos)
Attorney General Mark Brnovich is asking the Arizona Supreme Court to declare possession of hashish a crime, including for patients, even as state-licensed dispensaries sell not just that but other products and edibles made with marijuana extracts, all apparently with the knowledge and approval of state health officials.
In new court filings, Brnovich contends that the Arizona Medical Marijuana Act approved by voters in 2010 legalized only the use of the leaves and flowers and preparations of them by those who have a doctor’s recommendation to use the drug. He said that while hashish is the resin of the marijuana plant, the act of separating it from the leaves and flowers makes what results illegal.
But former state Health Director Will Humble, who crafted the rules when the law was adopted, said that’s not how he reads the law.
“To me, it’s a plain reading of the words,” he told Capitol Media Services.
More to the point, Humble said he and his staff wrote the health department’s rules for what can be sold at state-licensed dispensaries in consultation with the Attorney General’s Office. And at no time, he said, did any of the attorneys there say that extracts like hashish should be excluded.
Humble also noted that the department, now under the direction of Cara Christ, continues to allow for the sale of edibles even after he quit in 2014.
For example, the department has published recommendations for the safe practice of handling marijuana extracts and making edible products containing marijuana. And the agency even has a separate application for those who want to operate dispensary infusion kitchens.
And Humble dismissed any suggestion that hashish – the issue in the legal battle – is somehow legally different than other extracts that are now used to make edible products. In both cases, he said, it’s a preparation.
“It started with the marijuana flower and ended up with hashish,” he said.
Neither Brnovich nor any staffer would comment on the case, the outcome of which could determine if the only form of marijuana that patients could purchase is flowers and leaves.
In a prepared statement, the health department said it has been “monitoring” development in the pending lawsuit “and will comply with any decision of the Arizona Supreme Court.”
The 2010 law allows those with certain medical conditions and a doctor’s recommendation to obtain up to 2 1/2 ounces of marijuana every two weeks. Those conditions range from glaucoma and AIDS to post-traumatic stress disorder and severe and chronic pain.
At last count more than 180,000 people had qualified as medical marijuana patients.
One of them was Rodney Jones, who in 2013 was found in possession of a jar containing 0.05 ounces of hashish. Prosecuted by the Yavapai County Attorney’s Office, he was found guilty and sentenced to 2.5 years in prison for possession of a narcotic drug and a concurrent one-year term for drug paraphernalia — specifically, the jar holding the hashish.
A divided state Court of Appeals sided with prosecutors, agreeing that hashish, essentially the resin of the cannabis plant, is legally not the same as the plant itself. More to the point, the majority concluded the 2010 law makes it legal to possess only the plant itself and not the resin.
Now attorneys for Jones want the Supreme Court to conclude otherwise. And that petition puts Brnovich, whose office handles criminal appeals, in the position of defending the conviction and the lower court rulings.
In his legal filings, Brnovich says the 2010 law talks about “usable marijuana” and said that is defined as “the dried flowers of the marijuana plant, and any mixture or preparation thereof.”
He does not dispute that hashish is a resin extracted from the marijuana plant. But Brnovich argues that it also is not a “preparation” and that hashish is not in the same legal category as marijuana.
But much more than this conviction is at stake.
If separating an extract from the flowers and leaves makes the resulting product illegal, that, in turn, undermines not just hashish but also other oils and extracts used directly by patients or that are part of the process for creating things like candy bars and drinks, none of which any longer contain the flowers or leaves of the plant.
Humble, who opposed the 2010 ballot measure, said that’s not what voters intended.
“Reasonable persons can argue the wisdom of the voters’ decisions to approve the Arizona Medical Marijuana Act,” he said in a sworn affidavit prepared for the Supreme Court. “But I believe that it’s unreasonable to conclude that the act does not provide for mixtures and preparations of marijuana such as extracts, resins and edibles made with extracts.”
In that affidavit, Humble said the conclusion that the law allows for edibles is “consistent with medical practice,” as some patients cannot smoke or inhale the drug.
Exhibit 1 is Zander Welton, a 5-year-old Mesa boy who got a doctor’s permission to use medical marijuana to treat his seizures.
His parents, Jacob and Jennifer, had been giving him a liquid tincture with marijuana extract until Maricopa County Attorney Bill Montgomery threatened to prosecute them and anyone who supplied the product. The couple then tried to get the boy to swallow applesauce with crushed marijuana leaves, a process that proved not only difficult but made it impossible to determine if he was getting the correct dosage.
Maricopa County Superior Court Judge Katherine Cooper ruled in 2014 it made no sense to interpret the law that qualified patients could use medical marijuana, but only in one particular form.
“Such an interpretation reduces, if not eliminates, medical marijuana as a treatment option for those who cannot take it in plant form, or could receive a greater benefit from an alternative form,” she wrote.
Humble is not alone in his view that extracts like hashish are legal for medical marijuana patients.
Judge Kenton Jones, dissenting from the Court of Appeals ruling, said that his colleagues effectively were torturing the wording – and the intent – of the law in trying to say while a marijuana plant is legal for patients, a product that comes from that plant is somehow a crime.
“The resin extracted from the marijuana plant – cannabis – is part of the plant … just as sap is part of a tree,” he wrote.
Gov. Doug Ducey and the Department of Health Services released benchmarks today on how bars, gyms, movie theaters and other businesses can safely reopen.
The guidelines piggybacked on the state’s guidance for schools released last week. Like the guidelines for schools, reopening is largely based on counties’ virus statistics, which are broken into three groups: Minimal spread, moderate spread and substantial spread.
The plan doesn’t allow for any reopenings until counties have reached at least a moderate spread — except it includes one huge caveat: Businesses can apply for a waiver even if their county is overwhelmed with COVID-19.
Currently, most counties have a substantial spread, though Yavapai and Coconino counties qualify for the moderate spread category because they meet all three reopening requirements. Pima County is close, Dr. Cara Christ, the state’s health director, said. They have reached the positivity rate measure for one week, but two consecutive weeks is the requirement.
Doug Ducey
Before reopening, businesses must first attest they have developed and implemented best practice policies from Centers for Disease Control and Prevention, such as enforcing social distancing.
Substantial spread means counties are seeing a more than 10 percent positivity rate, more than 10 percent of hospital cases showing COVID-like illnesses and more than 100 cases per 100,000 residents. Moderate spread is between 5 and 10 percent positivity rate, 5 to 10 percent of hospital cases showing COVID-like illnesses, and 10 to 100 cases per 100,000 residents. Minimal spread is less than 5 percent positivity rate, less than 5 percent of hospital cases showing COVID-like illnesses and fewer than 10 cases per 100,000 residents. Like schools, the data used to reopen business will be on a 12-day lag, and will also have its own page on the Department of Health Services dashboard.
One major difference between today’s announcement and the one for schools is schools put in a 7% threshold for moderate spread to be met rather than just meeting a 5-10% measure. So some of these counties do not meet the school requirement, but Yavapai at 7.8% percent positivity rate for the week of July 19 and 9.4% positivity rate for the week of July 12 and Coconino at 9.6% meet the requirement for businesses. Maricopa County is not close yet, still sitting at 13.2% positivity and 16.9% the week prior.
Gyms can reopen at 25 percent capacity once a county has reached moderate spread, though the guidelines still require symptom screening, face masks and other preventative measures. Movie theaters, waterparks and tubing can resume in counties with moderate spread, with protective measures like face masks for everyone and symptom screening for staff. Bars and nightclubs are slightly more complicated.
Bars and nightclubs with food permits can implement a plan to operate as dine-in restaurants, such as having hostesses seat people at a table for dine-in services, and reopen at 50 percent capacity when their county reaches moderate spread. Even if counties reach the minimal spread category, they must remain at 50 percent capacity until positivity rates drop below 3 percent.
Bars and nightclubs that don’t convert to a restaurant style, must remain fully closed until positivity rates drop below 3 percent in their county, then are allowed to reopen at 50 percent capacity with additional preventative measures in place.
For businesses that go through the attestation process and are denied by the Department of Health Services, they can fight the decision through a multi-step process that can eventually go to the Superior Court for a final decision. The Department of Health Services dashboard will update the data for each county every Thursday.
Last week Maricopa County Superior Court Judge Timothy Thomason ruled that the state had to provide gyms and fitness centers an opportunity to show they could operate safely. What was announced Monday may be legally sufficient.
In issuing his order last week, Thomason gave wide berth to the decisions being made by Ducey and state Health Director Cara Christ.
“It is not the function of the judiciary to second-guess policy decisions on matters of public safety,” the judge wrote. But he said it is his role to ensure that the constitutional rights of business owners are protected.
“The injuries to these businesses have to be staggering,” Thomason wrote.
“The order only gives the gyms a chance to apply for reopening,” he continued. “It does not order that any fitness center be opened or that anyone be immediately put back to work.”
The Arizona Department of Health Services released health benchmarks schools should use to determine whether it’s safe to resume in-person instruction.
The benchmarks, which come a day before the August 7 deadline Gov. Doug Ducey set two weeks ago, are still considered guidelines and ultimately districts and charters can opt to ignore or implement their own plans.
The metric-based system will vary county by county, but essentially the benchmarks will be broken down into two key components: how and when.
The “how” will be determined by using strategies schools will implement to reduce the spread of COVID-19 among students and staff upon reopening school buildings, regardless if the building is open for on-site support services, or in-person instruction. This information will be adopted, implemented and posted to each school district website before onsite or in-person instruction can begin.
The “when” relates to the level of spread occurring within the community. The Centers for Disease Control and Prevention defines community spread into three subcategories – minimal, moderate or substantial.
Minimal, which is fewer than 10 cases per 100,000 population, and has “evidence of isolated cases or limited community transmission, case investigations underway; no evidence of exposure in large communal setting.”
Moderate, which is between 10 and 100 cases per 100,000 population, and has “sustained transmission with high likelihood or confirmed exposure within communal settings and potential for rapid increase in cases.”
Cara Christ
Substantial is more than 100 cases per 100,000 population with “large scale, controlled community transmission, including communal settings” like schools and workplaces.
The Arizona Department of Health Services divides those into three color groups.
Green (minimal spread) means the percent positivity rate is below 5% and schools can reopen for traditional instruction. Yellow (moderate spread) means between 5% and 10% positivity rate, but respective communities must remain under 7% positive to be considered safe for hybrid learning (distance and in-person).
If the community goes over 10% positive, schools will have to pull back and return to entirely distance learning, mixed with the on-site requirement. And red (substantial spread) means 10% positive or higher, where Arizona is overall, and only distance learning can happen, with the already determined targeted on-site support.
The other metrics counties must meet for in-person instruction to continue is fewer than 100 cases per 100,000 residents over two weeks not including the current week. Or a decline in weekly average cases for two consecutive weeks not including the current week. Additionally, two weeks of COVID-like illness below 10% must be met.
If a county has even one aspect of the benchmark in the red, then DHS strongly recommends going completely virtual, with onsite learning capabilities. In order for schools to go to completely traditional learning, all requirements must be in the green. Even if one is in the yellow, then it will recommend hybrid learning. Hybrid is where there would be a teacher teaching in the classroom as well as online for virtual or distance learning options.
However, since these are not mandated, local districts and charters can determine to continue in-person instruction completely even if they don’t meet the health requirements, but a Department of Education official said in that scenario it would be likely teachers would not show up if they don’t feel safe.
As things currently stand, there aren’t any counties that meet all three green requirements and realistically, Superintendent of Public Instruction Kathy Hoffman said it could be a while before schools can fully open up.
Cara Christ, director of the Department of Health Services, agreed. She said: “It’s likely going to be several weeks before we have a county that will be fully in the yellow and green. We do have some counties that are close, but we don’t have any county that’s meeting those benchmarks right now.”
Maricopa County is expected to create a data dashboard for schools that will track cases and percent positivity rates by zip code, but it’s unclear if other counties will follow suit or just rely on the Department of Health Services dashboard.
Some Arizona resorts could find themselves facing orders to shut down part of their water parks.
State Health Director Cara Christ said Monday she is sending inspectors to these resorts to find out exactly how they are operating their water features. And Christ told Capitol Media Services that those that are operating in an unsafe fashion will face orders to close.
Part of the issue, she said, is that several resorts are advertising to get day visitors to their facilities to generate additional cash. That includes not just the pools but also the water slides, hot tubs and “lazy river” floats.
But Christ also said that even those facilities that limit attendance to guests could wind up in trouble — and with an order to limit activities — if they are operating in ways that allow people to gather together in a way that could spread the virus.
The key, she said, is avoiding having large groups of people congregating.
“So if they’re limiting the activities and it’s limited to hotel guests and they’re not drawing large crowds like people waiting, that will be taken under consideration,” Christ explained
“But if they’re bringing in the public and everything’s open and they’re operating as a water park, that’s going to be a much different scenario,” she continued. “And if you’re doing both of those, that’s completely off the table.”
Christ’s comments come as her boss, Gov. Doug Ducey, on Monday asked a federal judge to throw out a lawsuit filed against him by the owners of Mesa Golfland Sunsplash which has been forced to remain closed. Its attorney, Joel Sannes, says there are resorts in Arizona which appear to be operating nearly identical facilities, not only for their own guests but even for day visitors willing to pay an admission fee.
Legally speaking, Sannes charges that there is no “rational basis” for the disparate treatment. So he wants U.S. District Court Judge John Tuchi, an appointee of President Obama, to order the governor to give the Mesa facility — and any other freestanding water parks — the same ability to operate.
Sannes may have a point.
Christ said when she and Ducey first crafted the order of what was allowed and what was not, the assumption was that resorts would limit attendance to guests. In that way, Christ said, there would be a list that health officials could use for contact tracing should someone come down with the coronavirus.
But all that was before Capitol Media Services provided her agency with an extensive list of resorts in Arizona that allow outsiders to pay a fee to use the facilities for a day. That got her agency’s attention.
“What we’re doing is we are sending our licensing surveyors out to do an on-site inspection of several of the facilities we have heard about to identify what they’re doing and whether they are operating as a water park,” Christ said.
So where is the line?
“If it’s a pool with a slide, that’s not a water park,” she said. For example, Christ said, the governor’s executive order permits city-run pools to operate.
Pools at hotels also can remain open if there are prohibitions against groups larger than 10 or more from congregating together in or near the water. And even pools at apartment complexes can be open if there are signs reminding people that they should not gather in groups of more than 10.
“Operating multiple attraction-type is also a different game than just operating a pool with a slide,” Christ said.
What her investigators find after visiting the resorts to see what is and is not open could prove material to whether the governor wins the lawsuit.
In his Monday filings, Ducey attorney Brett Johnson told Tuchi that the governor’s orders “do not permit hotel, resort, or municipal-owned water parks to operate.”
Even if they are open, Johnson said, it’s legally irrelevant.
He said Golfland in essence is arguing that Ducey cannot enforce his executive order because other businesses may be operating illegally.
But Johnson said Golfland has submitted a request to reopen. And he argues that the facility can’t go to court until there’s a decision on that and it has exhausted its administrative remedies.
And the governor’s attorney said there are other reasons for Tuchi to send Golfland packing.
“There is no property interest in operating a business,” Johnson wrote. And he said temporary pauses of business operations, as is at issue here, do not deprive a business of any property interests they have.
Tuchi has scheduled a hearing on the issue for the end of the week.
As a renewed effort to legalize marijuana for recreational use in Arizona ramps up, substantial issues identified by state auditors still hover over the existing Medical Marijuana Program and solutions aren’t quite as clear as some might suggest.
Under the Arizona Medical Marijuana Act approved by voters in 2010, the state Department of Health Services is responsible for operating the state’s program. Industry insiders have given the department credit for its work on an industry that is still new, but a state audit released on June 19 was less than flattering.
Among the findings, auditors noted that state inspectors haven’t been inspecting “infusion kitchens” producing marijuana edibles for ongoing food safety compliance. Those kitchens are licensed as food establishments, which can be subject to unannounced inspections. But they’re typically housed within dispensaries, which are licensed separately, and state law does not allow DHS to inspect marijuana facilities without providing advance notice.
But whether the state’s failure to perform kitchen inspections is due to dubious business practices, bureaucratic malaise or something else entirely is not clear.
SERENDIPITOUS
DHS Director Cara Christ told the Arizona Capitol Times state inspectors tasked with enforcing the rules of AMMA have been unable to witness an operating kitchen to date.
Explaining why exactly seems to be as difficult as actually performing the inspections.
According to the audit, DHS “does not inspect infusion kitchens for ongoing food safety compliance because facilities typically close” when inspectors arrive for scheduled visits.
Cara Christ
Christ said dispensaries have claimed the kitchens are simply not open.
And Arizona Dispensaries Association Executive Director Tim Sultan said, “It’s just serendipitous that they happen to be showing up and the lab’s not operational.”
The latter didn’t sound entirely implausible to Stacy Pearson, a campaign consultant working on a 2020 ballot measure to legalize marijuana for recreational use. The effort to usher in recreational marijuana at the ballot is expected to launch by the end of July.
Pearson said the infusion kitchens aren’t typically daily operations. They churn out pre-packaged marijuana edibles, like brownies and gummies, that have a shelf-life like any other mass-produced goodie. That means they don’t need to run all the time.
Still, she said figuring out a way to get dispensary inspectors into facilities when they’re operating shouldn’t be an issue – it’s simply a matter of knowing the production schedule.
“The industry itself wants that to happen. That most certainly should be happening,” she said.
Steve White, the president of Harvest Health and Recreation and one of the movers behind the 2020 ballot initiative, agreed DHS should be able to inspect kitchens and contends they are. He said he knows a handful of operators whose kitchens have been inspected.
“They can come see ours if they want to,” White said, noting his kitchen would operate for just two days a month.
And White suspects that inspectors’ ability to do their job will become clearer. That’s because the state audit came at an unintentionally good time, Pearson said.
The campaign behind the 2020 initiative hopes to have the language circulating by the end of July, but it’s not yet complete. Pearson said that means they have time to “do better, to get better language.”
“We’re hoping to clarify some of that vague language from AMMA and give DHS all of the tools it needs and all of the authority it needs to solve any of the problems that came up in the audit,” she said.
That includes the authority DHS needs to inspect infusion kitchens
“There’s no reason that a kitchen that produces THC-infused products should be regulated any differently than a kitchen that produces sugar-infused products,” she said. “Whatever we need to do to clarify DHS’s authority on that, we’re open to doing that.”
SIMPLE SOLUTION
The audit made the solution sound simple. Auditors recommended DHS conduct unannounced food safety inspections of infusion kitchens similar to ones done for other licensed food establishments.
The current opinion of the state Attorney General’s Office has been that DHS cannot follow that recommendation without violating the law for dispensary inspections.
Steve White
DHS would need explicit statutory authority to perform unannounced inspections, approval it could get from the Legislature with a three-fourths vote. The AMMA is shielded from legislative amendments under the Voter Protection Act.
White said that’s a broad proposal, but generally speaking, the industry is supportive of oversight.
“Of course, in theory, we would be supportive of that,” he said when asked specifically about unannounced kitchen visits.
And Sultan said his members would not stand in the way of such legislation, but would rather commit to complying with the rules whatever the government decides those might be.
Democratic lawmakers are on board, too.
House Minority Leader Charlene Fernandez, D-Yuma, said her caucus would happily help get the three-fourths vote necessary to close the loophole, noting that they supported new marijuana testing requirements, and don’t want to put medical marijuana patients’ health at risk as the audit suggested.
Christ pointed out that a new law eventually will give her department the authority to inspect everything that’s being sold out of state-licensed dispensaries. And that includes not just the unprocessed leaves and flowers but anything made from those items, including those coming out of kitchens.
“I don’t know that it’s going to help us with the inspection piece, because it just doesn’t touch that,’’ she said. “But what it will do is allow for analysis of the product before it’s used.’’ And that, she said, is more than exists now.
White contested that point, too.
“Harvest Health and Recreation has spent millions of dollars on testing since the inception of the company. Most responsible operators do not sell untested products,” he said. “The issue is one of regulatory oversight rather than results-based analysis.”
REASONABLE NOTICE
File photo of Rep. Sonny Borrelli, R-Lake Havasu City (Cronkite News Service Photo by Jessica Boehm)
For those keeping score: Democrats have said they’d support a bill to close the kitchen inspection loophole, while industry insiders have said they wouldn’t resist such legislation, and those working on a campaign to legalize marijuana for recreational use believe inspectors’ authority could be clarified in new language possibly bound for the 2020 ballot.
But that’s not enough to convince everyone there might be a path forward.
Sen. Sonny Borrelli, R-Lake Havasu City, remains among the skeptics.
Borrelli noted he already had a bill to close the inspection loophole.
Senate Bill 1222 would have removed language in the Medical Marijuana Act stating that the department must give “reasonable notice” before inspecting a dispensary. Instead, the bill would have required dispensaries be open to inspection during business hours. That bill would have applied to dispensaries themselves, not just the kitchens.
“The problem is that reasonable notice,” Borrelli said. “DHS can go into everything from a Burger King to an abortion clinic unannounced – but not a dispensary.”
And he was both outraged and dubious of Democrats’ and industry folks’ pledge to support a fix in the wake of the state audit, noting that when his proposal came up in the Senate, not one of them supported it.
“Democrats killed the bill,” he said. “The Medical Marijuana Act was written by the industry to protect the industry. … The industry was the one that blocked any kind of reform.”
That “maybe they won’t be obstructing any kind of medical marijuana reform” moving forward is good, he said, because he’ll be running his bill on unannounced dispensary inspections again.
And he scoffed at the idea that he might try instead to pass a watered down version focusing on kitchen inspections, for which there appears to be support.
He’s not actually convinced those who stood against his bills before won’t fight back, even if they’re now saying otherwise.
“They said they’re willing to learn and listen and work with somebody? Um, it took us three years to finally get some type of reform through,” Borrelli said, referring to the new marijuana testing requirements. “So, you know what? I’ll believe it when I see it.”
Howard Fischer of Capitol Media Services contributed to this report.
The state university system is defending the broad executive powers being exercised by Gov. Doug Ducey arguing it will keep their students out of bars — at least for the time being.
“Bars such as those surrounding the universities are breeding grounds for COVID-19,” wrote a team of attorneys from two private law firms representing the Arizona Board of Regents.
The filing at the Arizona Supreme Court comes as the governor seeks to defend himself from a lawsuit filed by dozens of bar owners challenging his ability to use executive orders to close businesses, including their own. Their attorney, Ilan Wurman, charges that the law giving Ducey that authority is itself unconstitutional.
Ducey already has filed his own legal papers arguing that there’s nothing legally wrong with the statute.
Ilan Wurman
And the governor has picked up support from other groups who have filed their own legal arguments telling the justices why they should throw out the challenge. These include state and local chambers of commerce, organizations representing hospitals, doctors and nurses, and Maricopa County.
The governor’s Department of Health Services even hired an outside attorney so Cara Christ, the agency’s director, could give the state’s high court her own arguments about the nature of COVID-19 and how guidance from federal, state and local health officials “supports (if not compels) Gov. Ducey’s decision to temporarily close bars in Arizona.”
In urging the justices to spurn the legal challenge, the attorneys for the universities detailed all the things they are doing to protect students. That includes promoting social distancing by offering more classes online, spreading out students attending courses in person, and moving things like counseling and academic advising online.
In fact, University of Arizona President Robert C. Robbins on Thursday warned students they could face suspension if they violate health safety rules during the pandemic. Those comments were specifically aimed at social media posts claiming intentions to have parties once classes resume Aug. 24.
The attorneys for the regents told the justices that allowing bars to reopen would undermine all those efforts, calling them “particularly risky.”
“They allow (and even invite) an environment that, in most respects, is exactly the opposite of the safe environment that public health officials recommend — and that the universities are diligently working to create,” the legal brief states.
Put simply, the lawyers say, the bars encourage “unhealthy personal behaviors.”
Consider the issue of masks.
“It is virtually impossible to wear a mask when drinking,” they argue.
“As people become intoxicated, they tend to talk louder, tell jokes or sing, which spreads more droplets,” the attorneys said, quoting newspaper articles. “In many bars, loud music or noisy crowds force you to move closer to hear.”
And then there’s the argument that alcohol compounds the risk.
Robert Robbins
“Alcohol of course can disinhibit people and perhaps promote even more breaches of social distance and sharing of drinks and food,” they argue.
To drive home their point, the attorneys counted the number of bars in the zip codes of each of the three universities.
For Northern Arizona University the tally is 31. It is 44 around the main campus of Arizona State University and 56 in the four zip codes around the University of Arizona. And that, they said, is not by accident, saying that bars market to university students, providing the justices with photos of ads placed by establishments near the schools.
“Similar advertisements fill student and local newspapers, student informational pamphlets, and local tourism guides,” the attorneys told the court.
More to the point, they said there’s a definite link between colleges and bars — and why the latter seek out the former.
“According to one study, the ‘wet’ alcohol environment around campuses — including lower sale prices, more promotions, and alcohol advertising at both on- and off-premises establishments — was correlated with higher binge drinking rates on the college campuses,” the brief states.
And what of the interests of the business owners?
The lawyers say the board “sympathizes” with them and their patrons. But they said the governor’s order “merely sets reasonable limitations as a result of this global pandemic.”
Anyway, they said, the restrictions are temporary — though the governor’s latest order issued just Thursday, extends the closure indefinitely, with a promise to review it every two weeks. And the attorneys said that bars can still provide pick-up, deliver and drive-thru services.
The attorneys do address the legal question at issue, but only briefly.
In challenging Ducey’s action, Wurman said the statute giving the governor broad police powers, including closing businesses, is an unconstitutional delegation of the legislature’s own power.
So the regents are telling the justices that if they find that Wurman’s arguments have legal merit, they should not simply overrule and void Ducey’s order. Instead, they said, the court should give the legislature “an opportunity to correct that purported issue.”
That assumes, however, that lawmakers, confronted with having to debate emergency powers, would give this governor — or any governor — the same sweeping authority.
There is sentiment among some Republicans that how those powers have been used goes beyond what the legislature was thinking when they adopted the law. And they want to revisit the issue, if not immediately, then once the emergency is over.
Affordable housing advocates scored a win this legislative session after lawmakers voted to reverse a decade-long trend of capping the state Housing Trust Fund’s budget.
Now, the people who fought for the funding increase will have to figure out how to best stretch the new dollars and prepare their case for even more.
And the state Department of Health Services has been accused of misspending money from the Medical Marijuana Fund among other unflattering findings from state auditors.
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Music in this episode included “Creative Minds,” “Funky Element” and “Energy” by Bensound.
The state’s top health official wants to limit how many pills with opiates patients can get at once, outlaw paper prescriptions for those drugs and outlaw doctors from giving out the drugs themselves.
And Dr. Cara Christ even wants opioid bottles to have a red cap to help educate patients that this isn’t just another drug.
Christ said Wednesday those steps are needed to combat a rising death rate from overdoses of the drug, both legal and otherwise. The director said she believes broad-based action is necessary, saying the problem has reached epidemic proportions.
She acknowledged under questioning that more people actually die each year in Arizona from other preventable causes, including automobile accidents and smoking-related diseases.
“We actually take all of those issues very seriously,” she said, with her agency also trying to address many of those. But she said it is the sharp rise in the number of opioid-related deaths that, in her opinion, requires the label of an “epidemic.”
Dr. Cara Christ, director of the Arizona Department of Health Services (Photo by Gary Grado, Arizona Capitol Times)
“It’s at its highest point ever,” Christ said.
Opioid deaths hit 790 last year, up from 638 the year before. That includes 482 people who died from prescription misuse and another 308 who overdosed on heroin.
And there’s another reason she thinks the epidemic label will help.
“It also is a preventable issue that we feel by putting in certain recommendations and providing resources that public health can have the ability to impact and turn this epidemic around,” Christ said. Her target is to drop the overall death rate to 592 by 2020.
Daniel Scarpinato, press aide to Gov. Doug Ducey, also said there is a greater awareness of the problem now than even a year ago, albeit some of that generated by Ducey himself with his emergency declaration earlier this year and the publicity that generated.
Anyway, Scarpinato said, it’s not like focusing on this problem means less attention for everything else. He pointed to the governor’s directive to the state Department of Transportation to do more to keep motorists from driving the wrong way on freeways.
One of the biggest changes Christ wants is to limit prescriptions for what she calls “opioid naive” patients – those who have not been taking opiates in the past three to six months — to a pill supply of no more than five days.
“We’re eliminating the risk of people becoming opioid-use dependent while not taking the medication away from those who are currently on them and truly need them,” she said.
There is some basis for what she wants lawmakers to enact.
Using his power of executive order, Ducey earlier this year limited doctors in both the state’s Medicaid program and the state employee health plan to giving out no more than a seven-day supply of drugs. But Christ said Wednesday more recent research by the Centers for Disease Control suggests even that may be too much.
“The CDC released a paper that showed that the risk of long-term opioid use significantly increases after Day 5 of taking this medication,” she said. “So on Day 6, you have a significant increase of still being on an opioid a year later.”
Christ said that should be enough.
“Most people, according to the CDC and Arizona prescribing guidelines usually need about three days after an acute injury or surgery,” she said. “This gives an additional couple of days, with the opportunity for people to go back.”
That limit also could result in fewer pills on the black market as patients won’t have as much left over.
Christ is also proposing some limits on exactly how doctors could prescribe drugs to patients who need them.
As she sees it, Arizona law should have a limit on dosages to less than 90 “morphine milligram equivalents.” The CDC reports that the risk of overdose doubles above 50 MME.
Christ acknowledged there are probably some patients who already are getting a higher dosage. Her proposal would require that to be tapered off to that 90 MME figure, albeit over a period of years, with the law allowing for certain as-of-yet-to-be-specified exceptions.
The question of illegal opioid sales also fits into Christ’s recommendation to allow only electronic prescriptions for the drug.
“Patients wouldn’t be able to take a paper prescription off of a prescription pad to a pharmacy,” she said. “That has high risk for abuse as well as fraudulent prescriptions.”
And Christ said it should not interfere with the ability for patients to get the drugs they need, saying there’s no reason an electronically written prescription could not be ready by the time someone gets to the pharmacy.
Along the same lines, Christ wants to overturn laws that now allow doctors to distribute opioids themselves.
“What you don’t want is the same person who is prescribing to be the same person who gives you the pills,” she said. If nothing else, Christ said opioids should be distributed by pharmacies who can check electronic databases to see if patients are taking other drugs that might interact badly and create health problems.
Doctors also would have to have at least three hours a year of continuing medical education courses on the use of opiates.
She also wants to remove laws that now preclude the state pharmacy board, which keeps track of prescriptions for narcotics, from informing medical boards when it appears a doctor may be overprescribing. It would then be up to that medical board to review the doctor’s records and determine if proper medical standards are not being followed and discipline is appropriate.
Another change would be to amend the state’s “Good Samaritan” laws to cover those who report apparent drug overdoses. Christ said situations arise where two people are both doing illegal drugs and one goes into convulsions.
“They’re afraid of when law enforcement and first responders show up they’ll be arrested for illegal activity,” she said. Christ said granting them immunity for their own acts in these situations ensures that the other person can get prompt medical attention.
FILE – In this March 16, 2020 file photo, tourist Ines Tshiyomba, center, poses as her friend Garethe Mawonso takes her photo on the Brooklyn Bridge in New York. New York, Connecticut and New Jersey will require visitors from other states with high infection rates to quarantine for 14 days. New York Gov. Andrew Cuomo announced the “travel advisory” Wednesday at a briefing joined via video feed by New Jersey Gov. Phil Murphy and Connecticut Gov. Ned Lamont. (AP Photo/Mark Lennihan, File)
Planning on a trip to the Big Apple?
Be prepared to spend two weeks locked away somewhere as a new directive from the governors of three Northeast states proves that sometimes what goes around comes around.
The chief executives of New York, New Jersey and Connecticut announced June 24 they would require a 14-day quarantine for visitors arriving from states that have “significant community spread.” The definition they chose includes Arizona. And that, according to New York Gov. Andrew Cuoma, includes Arizona and eight other states
The order was to take effect at 12:01 a.m. June 25.
If the verbiage used by Cuomo sounds familiar, it should.
In April, Arizona Gov. Doug Ducey ordered a similar two-week quarantine for visitors to Arizona from areas with what he described as “substantial community spread.”
New York Gov. Andrew Cuomo (AP Photo/Jacquelyn Martin, File)
Ducey said at the time that his powers under state emergency laws allow him to tell new arrivals that they must go directly to their place of isolation or self-quarantine “and only leave that location for essential services.” And he said the move was aimed at the tri-state area of Connecticut, New Jersey and New York because it has become of COVID-19 hotspot.
That Arizona order has since expired as infection rates in those states have gone down.
But just the reverse is happening here.
Cuomo, in a joint announcement with his counterparts, said this isn’t meant to single out any particular state. He said the governors have come up with what they consider an infection rate that is unacceptable.
“Any state that goes over that infection rate, that state will be subject to the quarantine,” Cuomo explained.
That rate, he explained, is based on one of two standards: 10 positive cases for every 100,000 residents on a seven-day rolling average, or 10% of the total population testing positive.
New figures June 24 from the Arizona Department of Health Services put the total of positive tests at 10.7%. And looking just at the past full week, the figure is 19%.
But part-week data for the current week shows a positive rate of 21%. And the Center for Bioscience at Arizona State University, doing its own reports, on June 24 pegged the most recent seven-day average at 22.1%, its highest point ever.
Doug Ducey
Overall, the health department reported another 1,795 cases on June 24, bringing the state’s tally to just slightly less than 60,000. There also were 79 deaths reported with the total now at 1,463.
The state also reported a new record of 2,270 individuals suffering from COVID-19 in hospital beds. ICU bed usage was 581, down from the prior day’s record of 614.
Overall, the health department said that 86% of hospital beds and 88% of ICU beds were in use by all types of patients, though the agency has yet to reimpose limits on elective surgeries despite the governor’s prior order saying these would be put back in place at facilities where the average exceeded 80%.
On Wednesday, state Health Director Cara Christ said her staff is in contact with hospitals to ensure they understand their obligations to keep beds available should there be a surge in COVID-19 cases. To date, however, Christ said she has issued no such orders.
Cuomo, in announcing the quarantine on Arizonans and others, said it’s not personal.
“It’s only for the simple reason that we worked very hard to get the viral transmission rate down,” he explained. “We don’t want to see it go up because a lot of people come into this region and they could literally bring the infection with them.”
New Jersey Gov. Phil Murphy called it “a smart thing to do.”
“We, the three of us, have taken our states through hell and back,” he said. “The last thing we need to do right now is to subject our folks to another round. This virus is risky enough on its own in terms of the potential to flare back up.”
That sentiment was echoed by Connecticut Gov. Ned Lamont who shared a similar sentiment.
“We’re not an island,” he said. “As we look around the rest of the country we have seen not just spikes but we’ve seen real community spread, better than 10% positivity rate, in a number of these states that we’re talking about right now.”
Other states subject to the quarantine, according to Cuomo, include Alabama, Arkansas, Florida, North Carolina, South Carolina, Washington, Utah and Texas.
Ducey press aide Patrick Ptak said his boss is not focused on the order.
“These states can make decisions they consider most appropriate, just as we have and will continue to do,” he said.”Our complete focus is on slowing and containing the spread in Arizona and ensuring care for those who are infected by the virus.”
Cuomo said each of the three states will do its own enforcement.
In his case, Cuomo said he envisions situations where hotel clerks, checking people in, ask the visitors why they are not in quarantine.
“You go to a business meeting, someone says, ‘Aren’t you supposed to be in quarantine?’ ” Cuomo continued. And he expects police officers to ask the same question if they stop someone driving with license plates from one of the affected states.
“Any of those mechanisms you can be detected as violating your quarantine,” Cuomo said.
And he said the order has teeth.
Cuomo said anyone caught violating the quarantine could be subject to a court order and a mandated quarantine – including paying for the cost if they get caught.
“There are also fines that go along with violating quarantine,” he said, starting at $2,000 for a first violation, $5,000 for a second and up to $10,000 if the person causes harm.
That compares with the possibility of a $2,500 fine and six months in jail that was the penalty for violating Ducey’s order.
On June 23, Cuomo took a swipe at states that have decided to reopen – he did not name names – before there was scientific evidence that the virus had abated.
“New York went from one of the highest infection rates in the country to one of the lowest because we made decisions based on science, not politics,” he said.
“We’re seeing in other states what happens when you just reopen with no regard for metrics or data,” Cuomo said. “It’s bad for public health and for the economy, and states that reopened in a rush are now seeing a boomerang.”
Ducey has repeatedly defended his decisions both to allow non-essential businesses to reopen and to dissolve his stay-at-home order. And it was only within the past week, facing spiking infection numbers, that he agreed to allow city, town and county officials to impose requirements for people to cover their faces while in public.
Citing medical risks for older adults, state health officials are now making Covid vaccines available for adults at least 55 years old.
But not everywhere just yet.
Beginning at noon Tuesday the Department of Health Services will be taking about 50,000 appointments for those 55 and older at the state-run vaccination sites at State Farm Stadium and Phoenix Municipal Stadium. Anyone from any county is free to book a vaccination there.
For those looking for something closer to home, however, it may take more time.
That’s because the change in rules, made on the advice of the state’s Vaccine and Antiviral Prioritization Advisory Committee, applies only to counties where at least 55% of residents age 65 and up already have gotten their first dose. And most counties haven’t quite gotten there yet.
But Dr. Cara Christ, the state health director, said there is a workaround of sorts.
“Say that they hit 52% (of those 65 and older) and nobody’s signing up for appointments,” she said. “If a county feels that they’ve met the demand they can move on to the next group earlier than that.”
The move is a sharp departure from the priority-based system the state had been running. That put people in line generally based on their occupations, with those 65 and older being added only relatively recently.
Cara Christ
But Christ tells Capitol Media Services the change makes sense, citing figures that those in the 55-plus age group are far more likely to die from the virus. And adding everyone older than that, she said, would cover anywhere from 56% to 66% of Arizonans who have medical conditions that place them at severe risk.
“What we’re seeing is that the data is showing us that as you move up in groups of 10 years it significantly increases an individual’s risk, regardless of chronic medical condition, for hospitalization and death,” Christ said. “It made sense to move to an age-based prioritization.”
What it also does is sharply cut the wait time for those 55 and older.
The next priority that had been set to open for vaccines was Phase 1-B.
That includes front-line essential workers, ranging from grocery store clerks and bank tellers to bus drivers and funeral directors. Christ said that is a “huge group,” likely more than a million Arizonans.
Also in the next category were adults with high-risk medical conditions, but only if they were living in a congregate care setting like a nursing or assisted-living facility.
Other high-risk adults were in Phase 1-C.
“It was going to take us quite a while before we even got to 1-C,” Christ said.
And if you’re 55 or older but didn’t have an underlying medical condition? The old system put you in Phase 2, a group that would not be eligible for even a first dose until something this spring or summer.
Now they won’t have to wait that long.
“We’re going to start going 55-64, all adults, whether you have a chronic medical condition or not,” Christ said. And she figures that make sense, given the number of people in that age group that have medical conditions, rather than forcing them to wait.
The new system also sets the stage for vaccines for even younger people.
Christ said the same rules would apply: When a county gets at least 55% of people age 55 and older vaccinated, then it can open the doors to those 45 and older. And so on.
Agency spokesman Steve Elliott said the fact that Maricopa County is now opening up appointments for those 55 and up does not mean anything is being denied to other counties, some of whom are still struggling to meet the needs of older residents.
He said each county gets its own allocation based on population. So the doses being given out at the two state-run sites in Maricopa County are from that county’s share of the vaccines and do not cut into the supply elsewhere.
And he noted that the state-run sites use the Pfizer vaccine because they have the facilities to keep it at the sub-zero temperatures necessary; rural counties have been shipped only the Moderna vaccine which can be kept in regular freezers.
Elliott said that some rural counties may have run short recently because of delays in the Moderna vaccine linked to the storms in Texas, though he said they should now be back on schedule.
Finally, he said anyone from any county where they cannot get a vaccine is free to make an appointment at either of the state-run sites.
The new system also sets the stage for vaccines for even younger people.
Christ said the same rules of availability would apply: When a county gets at least 55% of people age 55 and older vaccinated, then it can open the doors to those 45 and older. And so on.
There’s something else in the changes Christ announced Monday.
She said that counties that have sufficient supply now will have the ability to vaccinate those front-line essential workers who, under the current priority system, are not yet eligible.
Individuals 65 and older who have gotten at least one dose of vaccine
Arizona’s rate of new infections of COVID-19 is skyrocketing.
An analysis of figures by Capitol Media Services shows that there were nearly 27,000 new confirmed cases in the most recent seven-day period available.
Looking at it another way, that computes out to nearly 3,700 new infections this past week for every million Arizona residents.
TheNew York Times, looking at its own data set, puts the figure at closer to 3,300. But even at that, the paper says the rate of new infections in Arizona, computed at a rate of per million residents, is higher not just than any state in the country but any other country in the world.
Gubernatorial press aide Patrick Ptak called that conclusion “misleading and inaccurate.” And part of that, he said, is that Arizona is doing so much more testing than other countries.
Arizona Republican Gov. Doug Ducey uses hand sanitizer after speaking about the latest Arizona coronavirus data at a news conference Thursday, June 25, 2020, in Phoenix. (AP Photo/Ross D. Franklin, Pool)
But other data analyzed by Capitol Media Services shows the trend is not headed in the right direction.
The Biodesign Institute at Arizona State University figures that, on a seven-day average, Arizona is now adding 3,452 new cases each day.
In June, the figure was 843.
In May it was 337 new cases each day on average. And in April it was just 191.
Much of the increase comes in the wake of decisions made by Gov. Doug Ducey to loosen the restrictions he had placed both on individual travel and the kinds of businesses that could be open.
Ducey, facing rising numbers, has backtracked.
The governor, who for months refused to order Arizonans to wear face masks – and would not wear one himself while out in public – finally relented a bit last month and agreed to allow local officials to impose their own mask requirements.
And last week, as the numbers headed still higher, he reversed course and re-closed bars, water parks, gyms and fitness centers. And he also said that movie theaters had to shutter, though most had not yet reopened following his original March directives.
State Health Director Cara Christ told Capitol Media Services the good news is that the rate of positive tests has stabilized.
“And, also, the rate of growth is slowing,” she said.
Christ said she expects to start seeing results from the governor’s more recent actions – the face mask permission and the closure of certain businesses – “probably by the end of next week.” In the meantime, the health director said she will continue to emphasize her message that “you really are safer at home.”
If people decide to go out, she said, they need to “assess their risks,” looking at the number of people to whom they are going to be exposed, how close they will be to those people and for what period of time.
And what if that doesn’t bring down the numbers?
Christ said the most effective move would be to once again disallow dine-in services at restaurants “where you know that people are going to be sitting for longer periods of time in an enclosed area, potentially close to other people.” She said a better alternative is to encourage take-out or at least have people dine outside “because the better ventilation is going to decrease the risk of transmission.”
Christ said she agrees with Ptak that Arizona should not be measured against infection rates elsewhere.
“I don’t believe that it’s fair to compare us to other countries that may not have the same access or ability to test their citizens,” she said.
Ptak said Arizona on July 7 got the results from 12,212 PCR tests. Those are the ones that determine an active case, versus serology tests which determine if someone had it in the past and has developed antibodies.
That, Ptak said, works out to 167,000 tests per 100,000 residents. By contrast, he said, Brazil is testing just 0.025 residents per 100,000.
State Health Director Cara Christ (Capitol Media Services photo by Howard Fischer)
And in both Brazil and Peru, he said, the positivity rate is higher.
“This, in combination with their much lower testing, suggests the outbreaks in these places are much larger than is being reported,” Ptak said. And he said that the positivity rate in Arizona now is less than half of what it was when New York hit its peak.
But that tells only part of the story.
Figures from Johns Hopkins University show half of the tests run in New York came back positive in early April. But in that state, which imposed strict controls, there has been a steady decline to the point where just 1.1 percent of all tests now are positive.
By contrast, Arizona has seen a steady increase in positive tests since the middle of May and now stands about 25%.
The timing of that is not coincidental.
It was on May 8 that Ducey agreed to allow barber shops and beauty salons to reopen, albeit with restrictions.
Restaurants were once again allowed to begin sit-down service on May 11, here, too, with limits on the number of people who can be inside.
And on May 16, the governor’s order for people to stay at home except to participate in “essential” activities and services expired.
The result is that 25% of tests are coming back positive, versus less than 7% before Ducey eased the restrictions.
All that is shown up in other ways.
On July 8, the Department of Health Services reported 36 new deaths, bringing the statewide total to 1,963. There also were 3,520 new cases, with 108,614 Arizonans who at one point or another have been infected.
State health officials say the most recent figures show there were a record 3,421 hospital beds occupied by positive or suspected COVID-19 patients.
That’s more than the number of patients hospitalized for any other reason. Overall, 6,784 of the state’s regular hospital beds were occupied, 85% of the regular capacity.
The situation was even more pronounced for intensive-care units, where there are 871 COVID-19 patients, also a new record. Patients in ICUs for other reasons were only about 600, with total occupancy now at 91%.
Part of what makes those numbers critical is that the state Department of Health Services has agreed to allow hospitals to implement the state’s Crisis Standards of Care. That would permit them to triage patients, the way they would during a natural disaster, “to optimize health care resources and do the greatest good for the greatest number of patients.”
Put another way, it decides who is to be treated, and in what order, including who gets into intensive care units.
And what that also means, according to the state plan, is providing “comfort care” to patients “for whom curative therapies are futile, given available resources.”
Christ said she knows of no hospital that has implemented those standards.
Gov. Doug Ducey has been coming up short on his promises to increase testing for COVID-19 statewide, and his “Project Catapult,” a plan to ramp up testing to 35,000 results per day before August, has failed to take flight.
But Department of Health Services Director Cara Christ claimed the state is still on track to get to 60,000 tests per day by the end of August.
Christ at the July 30 press briefing also pushed back her promised deadline to clear out the 29,000 backlogged tests at Sonora Quest labs from July 31 to August 2, but the backlog has still not been fully cleared, at one point reaching 60,000 tests.
Ducey blamed private testing labs and a lack of demand for not being able to meet the goal, saying Sonora Quest needs to “step up their game” and deliver results faster, and the two testing sites that have two-day turnaround times haven’t hit capacity in the 12 days they were open.
Arizona Republican Gov. Doug Ducey uses hand sanitizer after speaking about the latest Arizona coronavirus data at a news conference Thursday, June 25, 2020, in Phoenix. (AP Photo/Ross D. Franklin, Pool)
“There simply wasn’t the demand,” he said.
The basic laws of supply and demand have hindered Ducey’s efforts to expand testing. After Ducey started imploring people to go get tested last month, the state was flooded with headlines about miles-long lines for drive-up testing sites, many of which were turning people away for lack of tests, and Ducey said the state was caught flat-footed by the incredible demand. Since then, the state has been flooded with headlines about the long turnaround time for tests, which have sometimes taken two weeks or more to provide results.
Former Department of Health Services Director Will Humble said that turnaround times for tests are “terrible” and the Ducey administration’s inability to get test turnaround times down is “malfeasance” that is contributing to the lack of demand.
“It’s super hot. Who… wants to go into the sun to get a test when they likely won’t get an answer for 2 weeks? That has to be part of [the lack of demand],” he said. “Turnaround times have just never been a priority for Cara. They have been bad for weeks now. When it became news, it became a priority.”
The state is processing roughly 12,790 tests a day in the three weeks since Ducey announced Project Catapult on July 9. Only twice in that time has the state exceeded 20,000 tests.
Two months before launching Project Catapult, Ducey announced a “testing blitz” with the goal of testing 10,000 to 20,000 people per weekend. Although it fell short of the goal, DHS declared the blitz a success.
Now, the Governor’s Office has again been urging people to take advantage of testing options, sending out press releases offering to pre-register for tests as fewer people are taking advantage of them, possibly because of the long lag time between taking a test and receiving a result. Dave Dexter, the CEO of Sonora Quest, told 12 News it would shrink the lag time to under 48 hours by July 31, saying he “never really expected” this level of demand.
Ducey and Christ have also failed to test all prisoners in the state after making the promise to do so on May 12. To date, only about 15% of the entire prison population has received a diagnostic test. There are roughly 40,000 prisoners in Arizona.
Christ said the state hasn’t made much progress because up until recently, the state was only testing those showing symptoms. Prisons started testing more inmates last week after dropping Sonora Quest as the contractor because the testing company is facing a backlog.
Christ wouldn’t say if she thinks the current number of inmates tested to date is acceptable, but said she’s hopeful for future testing.
“I think it’s a pretty good number that will continue to grow, but it does take a bit to get the staff out there to do the assessment [and get results],” she said.
Christ said that the Dept of Health Services and Department of Corrections Rehabilitation and Reentry have been working closely to “develop a testing plan” and while she would not provide Capitol Times with a timeline, she said she would check with Director David Shinn to hopefully come up with one.
Ducey and Christ also promised to test everybody in long-term care facilities, and say they’ve reached that goal, although it’s impossible to verify that claim since the state doesn’t report those numbers separately and a court blocked news organizations’ attempts to access those records.
Yellow Sheet Report editor Hank Stephenson contributed to this story.
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