Tuesday, May 10, 2022

Posted By on Tue, May 10, 2022 at 10:45 AM

click to enlarge Examining unidentified remains is just one of the jobs for medical examiners, who have seen caseloads surge with a spike in the state’s death rate in recent years. In this 2021 photo, a doctor with the Pima County Medical Examiner’s Office examines a set of remains. - FILE PHOTO BY RAPHAEL ROMERO RUIZ/CRONKITE BORDERLANDS PROJECT
File photo by Raphael Romero Ruiz/Cronkite Borderlands Project
Examining unidentified remains is just one of the jobs for medical examiners, who have seen caseloads surge with a spike in the state’s death rate in recent years. In this 2021 photo, a doctor with the Pima County Medical Examiner’s Office examines a set of remains.
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WASHINGTON – Dr. Gregory Hess says he has enough forensic pathologists on staff for the Pima County Medical Examiner’s Office to keep pace with the office’s caseload, but they are still stretched thin.

And his office is one of the lucky ones.

As the nation enters a third year under the threat of COVID-19, Arizona medical examiners say they are struggling to keep up with rising caseloads driven largely by rising deaths from the virus at a time when there is a shortage in forensic pathologists.

It’s not just Arizona: In states across the U.S., medical examiners are reporting sharp increases in their caseloads as COVID-19 and related increases in overdose and other deaths strain their resources.

“We are fully staffed right now but we’re kind of in the minority,” Hess said. “A lot of places in the United States don’t have enough staff to keep up with the increased caseload, never mind … the load that they had prior to the pandemic, prior to this recent wave of overdose deaths that you see across the country.”

The Maricopa County Medical Examiner’s Office reported a 26% increase in deaths from 2019 to 2020. While deaths can be expected to rise along with an increase in population, Maricopa County’s population grew just 1.9% in 2020.

Dr. Jeff Johnson, chief medical examiner in Maricopa County, said the death rate for the county has stayed high through 2021 and early 2022, creating large caseloads for an office that is already facing a shortage of forensic pathologists.

“One of the struggles that we experience is that because there’s so few (pathologists) that train every year, and so few that are available, it takes us a really long time to get somebody to join us when we have a vacancy,” Johnson said.

“So while you wait for that, you’ve got all the rest of your physicians who are struggling and if you have two or three vacancies at the same time, then that just magnifies everything,” he said.

Johnson said the National Association for Medical Examiners, the accrediting body for forensic pathologists and medical examiner’s offices, recommends that one physician do no more than 325 “autopsy equivalents” per year. The three Arizona counties accredited by the association – Coconino, Maricopa and Pima counties – all meet that standard.

But that comes as the total number of deaths in the state jumped a remarkable 25% from 2019 to 2020, a year when some smaller counties saw deaths rise almost 50% year over year. Deaths continued to rise in 2021, according to data from the Arizona Department of Health Services, from 75,700 to 80,733 – a more modest rise of 6.7% but still well over the population growth of 1.7% that year.

Pima County faces high caseloads in part because it handles deaths from Cochise, Graham, La Paz and Santa Cruz counties. But it has been able to cope because it has remained fully staffed throughout the pandemic.

Hess attributes his office’s ability to avoid the forensic pathologist shortage to the availability of the University of Arizona’s pathology residency program.

Johnson also noted that the increased caseloads have been driven by the fentanyl crisis, which was made worse by the pandemic.

“We’ve seen a really strong upward trajectory in Maricopa County since 2015, the number of fentanyl deaths that we’ve seen between then and 2021 is nearly doubled every year,” Johnson said.

Both Johnson and Hess said that even though their offices are stressed, they have been able to keep up with the caseload. Hess said it’s impossible to predict how the death rate will fluctuate or if it will return to pre-pandemic levels.

“I think everyone thought that the pandemic was going to kind of come and go, but it lingers,” he said. “We may have more waves of different variants and the mortality may stay high.”

Both Hess and Johnson agree the best way to combat the high caseloads is to increase education and opportunities for forensic pathology. The UArizona pathology residency is the only one of its kind in the state, according to Hess, making it more difficult for students to enter the field and take their expertise to other areas of the state.

It’s also not a field that many students are interested in, Johnson said, but if they recognized the importance of the work, it could help ease the strain on medical examiner’s offices.

“I think that the pandemic has highlighted how important medical death investigation systems are for communities and … for those public health datasets that allow policymakers and public health officials and public safety officials to design interventions to improve the situation,” Johnson said.

“We wouldn’t know about the opioid crisis if it wasn’t for medical examiner’s offices doing this work and highlighting these things,” he said.

For more stories from Cronkite News, visit cronkitenews.azpbs.org.

Thursday, May 5, 2022

Posted By on Thu, May 5, 2022 at 10:17 AM

click to enlarge XAVIER OMAR OTERO
Xavier Omar Otero

Lila Downs took to the stag
e like a chiltepin—a wild chili pepper known for producing intense heat despite its diminutive size—at Centennial Hall (Thursday, April 28) kicking off the annual Agave Heritage Festival.

Early in the set, horn section ablaze, Downs tore into “Son del Chile Frito”—a track imbued with fiery cumbia rhythms from Al Chile (2019), her latest release—setting the tone for evening. 

A gifted dancer, her body undulated across the stage.


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Posted By on Thu, May 5, 2022 at 8:48 AM

click to enlarge Will they be gathering signatures next? - BIGSTOCK
BigStock
Will they be gathering signatures next?

Don't wait on the Democrats to win the statehouse ... These people love sending each other letters ... And a mascot after our own hearts.

Editor's note: The Arizona Agenda is a Substack newsletter about Arizona government and politics run by Rachel Leingang and Hank Stephenson. You can find their archives and subscribe at arizonaagenda.com.

Arizona advocacy groups that want to protect access to abortions have one clear option: a citizen initiative.

It’s too late to put one on the 2022 ballot. And the bar is high for signatures, especially on a constitutional amendment, which would be the likely method for a measure protecting abortion rights. Plus, the U.S. Supreme Court still hasn’t actually released a formal opinion on Dobbs v. Jackson Women’s Health Organization, the Mississippi abortion case that could overturn the landmark Roe v. Wade precedent. At this point, abortion is still legal.

Abortion rights activists are eyeing 2024, a presidential election year, to bring something to the ballot.

“I’ve been on three calls since Monday where folks are actively talking about what that would look like for 2024,” progressive lobbyist Marilyn Rodriguez told us.

The last time Arizonans were asked about abortion on their ballots was 1992, when an initiative sought to ban abortion entirely, with limited exceptions. It failed spectacularly: More than 68% of voters voted against it.

Tuesday, May 3, 2022

Posted By on Tue, May 3, 2022 at 3:42 PM

click to enlarge You think anyone really wants to know how this election stuff works? - MARICOPA COUNTY ELECTIONS DEPARTMENT
Maricopa County Elections Department
You think anyone really wants to know how this election stuff works?


It's Politico v. Wade ... Legislative Ethics Committee is an oxymoron ... And be nice to everyone, just in case.


Editor's note: The Arizona Agenda is a Substack newsletter about Arizona government and politics run by Rachel Leingang and Hank Stephenson. You can find their archives and subscribe at arizonaagenda.com.

The Maricopa County Board of Supervisors and county election officials tried to get ahead of the next election conspiracies yesterday with a two-hour meeting to explain their elections procedures to anyone willing to listen. 

But in the county that captured the nation’s attention as the epicenter of claims of a stolen presidential election, few tuned in to the board’s attempt to explain how elections work and combat disinformation.


Posted By on Tue, May 3, 2022 at 2:00 PM

click to enlarge Mark Brnovich in 2019 at his inauguration for a second term as attorney general. - PHOTO BY GAGE SKIDMORE
Photo by Gage Skidmore
Mark Brnovich in 2019 at his inauguration for a second term as attorney general.

Arizona Attorney General Mark Brnovich should resign to focus on his bid for U.S.

 Senate for “politically motivated activities” that are preventing him from his elected duties, said Kris Mayes, a former corporation commissioner and the Democratic nominee for attorney general. 

Brnovich has siphoned millions of dollars earmarked to prevent consumer fraud in Arizona in order to pay for lawsuits against Joe Biden’s presidential administration and other Democratic officials, according to an AZFamily report.

Consumer fraud complaints are rising across the country — including in Arizona — and the attorney general’s office is the venue for those complaints to be resolved. 

Brnovich is running for the Republican nomination for U.S. Senate and has used his office’s bully pulpit to boost his candidacy in a crowded primary election. Brnovich has used his office to file numerous lawsuits against the Biden administration over everything from immigration enforcement policies to COVID-19 mitigation efforts, and has regularly appeared on conservative news programs to both talk about the litigation and generally criticize Democrats. 

And Brnovich won’t get the coveted endorsement from former President Donald Trump. It’s unclear who Trump will endorse, though the twice-impeached ex-president recently called in to an event that Blake Masters, one of Brnovich’s opponents, was hosting.

Mayes, who faces no challenger in the Aug. 2 primary, said she had enough and wants Brnovich out of that office today.

“At a time when Arizona families are increasingly being targeted by scammers of all kinds, and when our elderly Arizonans are under assault by fraudsters, it is outrageous and unacceptable for our attorney general to divert even one penny away from fighting consumer fraud,” Mayes said at a Monday press conference outside Brnovich’s office in Phoenix. She was flanked by supporters holding up signs that read “Brnovich misspent our $$$” and “you cheated the public.” 

Brnovich told AZFamily he is allowed to spend the money how he sees fit, and even blamed the Arizona Legislature for how the law is written.

Mayes noted that is a different tone than he struck in 2017, when Brnovich wrote to Gov. Doug Ducey that the consumer fraud funds were by law required to be used for helping the victims of fraud and for addressing violations of consumer protection laws.

Brnovich’s office called Mayes’ words “cheap political theater” in a statement to the Arizona Mirror.

“It’s disappointing that anyone running for attorney general would engage in such cheap political theater. I’m not sure if it shows her blatant partisanship or her misunderstanding of how this office works, but it’s an insult to all of our hardworking public employees,” Brnovich spokeswoman Katie Conner said. 

“General Brnovich is very proud to have secured more than $300 million in consumer restitution and recoveries, more than any prior administration in state history. Our office receives its funding from the Arizona legislature, and we are in full compliance with Arizona law and the legislature’s guidelines on how money shall be expended,” Conner continued. 

Mayes said Brnovich’s reasoning was “ridiculous and wouldn’t pass the laugh test in any law school class that I’ve ever taught or been in.” 

She made a campaign pledge to restore funding to the consumer protection fund and also wants the state auditor general to look into the office’s practices. 

In his report for AZFamily, investigative reporter Morgan Loew found that Brnovich was diverting money in the Consumer Protection and Fraud Revolving Fund to be used in other areas. Even though state law says the money should be spent on consumer fraud issues, Loew found that wasn’t the case. 

The areas where Brnovich was found to divert funds were the Federalism Unit, the Government Accountability and Special Litigation Unit, the Voter Fraud Unit, the Southern Arizona Law Enforcement Unit, and the Organized Retail Theft Task Force. 

Brnovich has repeatedly touted his Federalism Unit which was almost exclusively used to fund his lawsuits against Biden. Ducey and Brnovich created the fund in 2015 with the intention to use funding to sue Barack Obama while he was in the White House, like a lawsuit against Obama’s transgender bathroom policy

Mayes said not only has the state’s top law enforcement official stopped doing his job entirely, but he “is damaging our ability to fight crime in the state.”

“If people want to run for office, they need to spend all of their time doing that and they probably need to relinquish the office they hold now,” she said.

Mayes will face the winner of a six-person GOP primary to replace Brnovich. None of their campaigns responded to questions for this story.

Posted By on Tue, May 3, 2022 at 1:00 PM

click to enlarge Protesters, demonstrators and activists gathered in front of the U.S. Supreme Court on Dec. 1, 2021, as the justices heard arguments in Dobbs v. Jackson Women's Health, a case about a Mississippi law that bans most abortions after 15 weeks. A draft opinion in the case shows that the court is poised to fully overturn Roe v. Wade. - PHOTO BY CHIP SOMODEVILLA | GETTY IMAGES
Photo by Chip Somodevilla | Getty Images
Protesters, demonstrators and activists gathered in front of the U.S. Supreme Court on Dec. 1, 2021, as the justices heard arguments in Dobbs v. Jackson Women's Health, a case about a Mississippi law that bans most abortions after 15 weeks. A draft opinion in the case shows that the court is poised to fully overturn Roe v. Wade.

WASHINGTON — President Joe Biden said Tuesday that his administration “will be ready when any ruling is issued” on abortion rights, after the nation was rocked by the leak of a draft opinion from the U.S. Supreme Court that confirmed the court is planning to overturn access to abortion.  

“I believe that a woman’s right to choose is fundamental, Roe (v. Wade) has been the law of the land for almost fifty years, and basic fairness and the stability of our law demand that it not be overturned,” Biden said in a statement.

Biden did not specifically cite any steps his administration would take if the ruling is overturned, but said that it would “fall on our nation’s elected officials” to protect pregnant people’s access to abortion, and that voters should elect candidates who back abortion rights. 

He said that he has directed his Gender Policy Council and White House Counsel’s Office to “prepare options for an Administration response to the continued attack on abortion and reproductive rights, under a variety of possible outcomes in the cases pending before the Supreme Court.”

The draft opinion, led by Justice Samuel Alito, was leaked and reported by Politico, and Biden cautioned that “we do not know whether this draft is genuine, or whether it reflects the final decision of the Court.” There’s been no challenge to its veracity, however.

“At the federal level, we will need more pro-choice Senators and a pro-choice majority in the House to adopt legislation that codifies Roe, which I will work to pass and sign into law,” Biden said.

The Biden administration in December defended its case in the Supreme Court on Mississippi’s 15-week ban on abortion. The case is known as Dobbs v. Jackson Women’s Health.

If the ruling overturns Roe v. Wade, then access to abortion would be based on a patchwork of state laws. Red states have introduced some of the most restrictive limits on abortions, while blue states have passed laws to secure access to abortion. 

Congressional Democrats have called for codifying Roe v. Wade into law. In a joint statement last night, House Speaker Nancy Pelosi and Senate Majority Leader Chuck Schumer said that “the Supreme Court is poised to inflict the greatest restriction of rights in the past fifty years.”

“The Republican-appointed Justices’ reported votes to overturn Roe v. Wade would go down as an abomination, one of the worst and most damaging decisions in modern history,” they said.

Monday, May 2, 2022

Posted By on Mon, May 2, 2022 at 1:00 PM

click to enlarge Arizona Center for Empowerment members and advocates gather in front of the State Capitol on Wednesday, April 27, 2022. ACE held the event to unveil a “people-centered” budget proposal for lawmakers considering how to spend the current state surplus. - PHOTO BY GLORIA GOMEZ | ARIZONA MIRROR
Photo by Gloria Gomez | Arizona Mirror
Arizona Center for Empowerment members and advocates gather in front of the State Capitol on Wednesday, April 27, 2022. ACE held the event to unveil a “people-centered” budget proposal for lawmakers considering how to spend the current state surplus.

Tatyanna Duchene pushed her 1-year-old son’s stroller around the State Capitol on Wednesday, following a crowd of students and volunteers as they gathered to petition legislators to use the current $5.3 billion dollar budget surplus for community needs. 

Her daughter, Khaleesi, is just 4 years old, and enjoying the one-on-one attention she gets from her preschool teachers. But Duchene is conscious that her educational future is bleak in a state that ranks 47th in the nation in per-pupil funding. She decided to add her voice to the Arizona Center for Empowerment’s advocacy day and call for budget initiatives that include increased funding for education, among other areas. 

“I just want a better future for her,” she said. 

Community advocacy organizations ACE and the People First Economy for Arizona called on legislators to ramp up education funding to mitigate the cuts made during the Great Recession more than a decade ago that haven’t yet been replaced. Advocates lobbied for the state’s record-high surplus — an estimated $5.3 billion, or about 40% of the state’s current year spending — to be used to improve teacher retention in the face of an ongoing shortage

Eddie Barron, a senior at Sunnyside High School, traveled from Tucson to the state Capitol to sound the alarm over teacher losses in his district.

“This year, I have had so many teachers step out on me and my classmates, for no other reason than the fact that they are overworked, underpaid and underappreciated by the Arizona GOP,” he said. 

Arizona ranks near the bottom in the country in wages and working conditions for teachers. Investing in public school classrooms, Barron said, is the key to ensuring success for the vast majority of students in the state who attend public schools like he does — and, like him, many of whom will be the first in their families to attend college. 

The advocates also called for state action on affordable housing. Investments in the state’s Housing Trust Fund to aid with growing homelessness, rent assistance, and the construction of affordable housing all are needed, they said, as is statewide rent control.

Rents in the Phoenix metro area rose at the fifth-highest rate in the nation between 2020 and 2022, according to a recent Washington Post analysis. The average rent is now $1,550, an increase of more than 28% since the start of the COVID-19 pandemic.

For Phoenix residents like 17-year-old Victor Rodriguez, rising rent prices are an ever-present worry. A recent rent spike caught the Rodriguez family of four by surprise a few months ago. 

“Housing has become a real problem,” he said. “I live in an apartment, and we used to pay like $800 a month, and now we’re paying over $1,000, for just a two bedroom and one bathroom apartment. So, it’s getting pretty bad.” 

There were bills to address the growing crisis of housing unaffordability. One bill aimed to add $100 million to the Housing Trust Fund and another sought to repeal Arizona’s ban on rent control. But both were sponsored by Democratic lawmakers, and were killed early on in the legislative session by Republicans, who control the legislature and determine which bills are considered. 

Paid family and medical leave were among the budget priorities for ACE, which noted that the pandemic had strengthened the need for it. The group called for 24 weeks of paid leave, which would ensure that workers can recover from serious illnesses like COVID-19, care for ailing or new family members, and have adequate time to grieve if a relative is lost to the virus. 

“It won’t take me only two weeks to spend with a loved one and grieving (for) this loved one passing away,” said Alexis Garcia, a community organizer for ACE. 

Like Democrat led bills to address affordable housing, two Democrat sponsored bills in each chamber proposing 24 weeks of paid leave failed to move forward. 

Other initiatives proposed establishing funds to help alleviate the uneven access to resources caused by citizenship status or homelessness. An economic support fund would provide assistance to everybody, in sharp contrast to COVID-19 funds that were designated only for legal citizens, and the Arizona ID Project would give everyone free state-issued IDs. 

Lena Avalos, ACE’s policy director coordinator, denounced Republican lawmakers who so far have failed to mobilize the record state surplus to benefit Arizonans. 

A recent attempt at a so-called “skinny” budget by Republican lawmakers that would have merely continued the current year’s spending levels was rejected in a committee hearing last week, and negotiations on how to spend the surplus dollars are ongoing. 

The unspent funding is an opportunity to help hurting communities across the state, Avalos said, but politicians have priorities that are out of touch with the realities their constituents deal with. 

“Instead of addressing Arizona’s fastest rising rent prices and 15th-highest cost of living, many lawmakers are advocating for billions more dollars in tax cuts for the rich,” she said. “And instead of investing in public education, lawmakers and Governor Ducey are too busy banning books and allocating more money towards charter schools.”

Posted By on Mon, May 2, 2022 at 12:00 PM

click to enlarge Photos of Brandon Caserta decorate the Peoria home of his parents, Teri and Patrick, on April 16, 2022. After their son died by suicide in the Navy, the couple lobbied Congress for legislation to expand mental health services to members of the military. - PHOTO BY MADELINE BAUTISTA/ CRONKITE NEWS
Photo by Madeline Bautista/ Cronkite News
Photos of Brandon Caserta decorate the Peoria home of his parents, Teri and Patrick, on April 16, 2022. After their son died by suicide in the Navy, the couple lobbied Congress for legislation to expand mental health services to members of the military.

PEORIA – The mountain that sits just steps away from Teri and Patrick Caserta’s backyard was their son Brandon’s favorite hiking spot. Today, a statue of an angel faces the peak, marking the place where his ashes were spread.

Four years ago, the 21-year-old Navy petty officer third class killed himself on the flight line at Naval Station Norfolk in Virginia. His parents and friends later discovered notes describing hazing and bullying from some members and leaders of his helicopter squadron.

The tragedy drove the Casertas to lobby Congress for legislation to expand mental health services to members of the military. That proposal, named for their only child, is part of the new National Defense Authorization Act.

“We just don’t want anybody to go through what we did, and we certainly want to help the ones who are going through what Brandon did,” Teri Caserta said. “They serve our country. They volunteered. … And they’re treated like this? They should be put up on a pedestal.”

Earlier in April, the Casertas joined U.S. Sen. Mark Kelly, D-Ariz., members of Arizona State University ROTC and representatives of the ASU Pat Tillman Veterans Center for a panel discussion about the Brandon Act, which became law as part of the larger defense measure in December.

It requires a mental health evaluation for service members who self-report a need and allows members to seek help outside the chain of command and for cases to be kept confidential. The measure also mandates that the Department of Defense provide annual training on how to recognize when members may need a mental health evaluation.

“This law is designed to protect service members who experience mental health emergencies by requiring – requiring – the Department of Defense to create a process and reduce the stigma … a process that also protects confidentiality,” said Kelly, a former combat pilot who served in the Navy for 25 years and championed the act after hearing Brandon’s story.

“This is only the beginning.”

A worsening epidemic

Suicide rates have been increasing among members of the military and veterans alike. An annual DOD report, released in September, showed rates for active duty service members alone went from 20.3 suicides per 100,000 members in 2015 to 28.7 in 2020, with increases across all branches. That compares with a national suicide rate of 13.5 in 2020.

Last year, 580 service members died by suicide – 384 active duty members, 77 reservists and 119 National Guard members. Military members who take their own lives are largely men younger than 30.

The DOD report cites a number of risk factors, including relationship and financial problems, ineffective coping skills, access to lethal means of injury and reluctance to seek help.

The USO, a nonprofit that supports military members and their families, notes that for active duty service members, “there’s an additional layer of potential stressors on top of the regular ups-and-downs of life that puts them at risk.”

Yet most who may need help aren’t getting it.

Military research finds that up to 70% of service members with mental health symptoms do not seek treatment, and 35% have reported that they worry seeking help would negatively impact their careers.

Brandon Caserta did get some help. It just wasn’t enough.

The Casertas invited Cronkite News into their home to talk more about Brandon’s experience in the military and the son they adored.

Stepping into Brandon’s old bedroom, it immediately becomes apparent how much he loved to build, from the Lego sets he made with his father to the metal figures the size of one’s hand that he built as he got older.

Patrick Caserta recalled the passion Brandon had for building anything with his hands. Using a set of tweezers and creativity, Brandon constructed Star Wars characters such as BB-8.

“He could see things differently, and he always found ways to make things easier and better,” which, Patrick said, made Brandon such a good fit for the military. “He learned that by doing this stuff.”

​​In 2015, he joined the Navy with the dream of becoming a SEAL – the special operations force that’s part of the Naval Special Warfare Command. But a year later, a broken leg forced him to drop out of the training, reclassify as an aviation electrician and transfer to Norfolk, attached to Helicopter Sea Combat Squadron 28.

“From the very first day he arrived there,” Teri Caserta told the audience at the ASU event, “they call them a ‘BUD/S dud.’” BUD/S is shorthand for Basic Underwater Demolition/SEAL training. “He was bullied and hazed, retaliated against. He asked for help many times. They told him that he needs to suck it up and that he was fine.”

An investigation later showed that Brandon had been recommended for disciplinary review because of an issue over a driver’s license and his lead petty officer had created a hostile work environment by being belligerent. At one point, according to a military investigative report, a friend took Brandon to the chaplain for help with depression.

Before his death, the report said, Brandon emailed two others, who were deployed at the time, wondering “what was the meaning of life.”

He died soon after that, on June 25, 2018.

‘I wish we had a magic wand’

As the Casertas began pushing for change, they set up a Facebook page about their son and the legislation he inspired. Even today, Teri regularly gets messages from relatives of other service members who are struggling. She does what she can to help.

“I just reach out and ask them, ‘What can I do for you?’ And of course I have to tell Brandon’s story,” she said. “So, yeah, it’s been almost four years that that’s what we’ve been doing.”

“We don’t have a magic wand, and we’re not telling them anything they probably shouldn’t already know,” said Patrick, who spent 22 years in the Navy. “But the fact that we respond and care, that just carries so much weight with people.

“I wish we had a magic wand. It’s not like that.”

In its annual report, the Department of Defense said it has taken steps to address the issue of suicide in the ranks. The agency is piloting a program in which service members complete an annual wellness check with a trained counselor, and it’s expanding another effort aimed at reducing stigma and barriers around seeking help.

The agency also added suicide prevention to its firearm safety training and says it’s working with young service members to improve problem-solving and coping skills.

“Our efforts must address the many aspects of life that impact suicide,” Karin Orvis, director of the Defense Suicide Prevention Office, said in a statement accompanying DOD’s report in September. “The department is engaged in implementing a comprehensive public health approach to suicide prevention and is providing tailored resources to mitigate the impacts of the COVID-19 pandemic.

“There is much more work ahead of us,” Orvis said, “and we will not relent in our efforts to provide the care and support our service members and their families need and deserve.”

Kelly said the military must find a way to turn the tide: “A country with such a strong military … we can’t continue to fail our service members in this way.”

The Casertas are thankful that some progress has been made through passage of the Brandon Act, and that they have been able to honor their son with their efforts.

“We were able to have his legacy live on by the Brandon Act. And he’s saving lives,” Patrick said as he looked at a photo of Brandon in the living room. “And that smile right there is always smiling on us.

“So we know he’s happy with what we’re doing. … And we’re not done.”

For more stories from Cronkite News, visit cronkitenews.azpbs.org.

Posted By on Mon, May 2, 2022 at 10:42 AM

Posted By on Mon, May 2, 2022 at 10:00 AM

Nine years ago, Laura Gjacs became a full-time mom. And while getting paid in smiles and kisses is nice, it doesn’t exactly help her care for her daughter Tori, who suffers from a rare autoimmune disorder. 

But thanks to a newly implemented program, Gjacs and 700 potentially eligible Arizona parents can be trained and then paid to care for their medically fragile children. 

Last year, Arizona became the third state in the nation to allow people to be trained and hired by home health agencies as licensed health aides to care for family members under 21 who qualify for long-term, around-the-clock care. The Family Licensed Health Aide Program launched April 1 with the goal of easing burdens on the families who need the most support. 

Days in the Gjacs household are never slow. Tori alternates between doing her favorite things like painting or watching YouTube videos and receiving necessary care like getting treatment with her inhalers four times a day to make breathing easier or using a G-tube to eat. Despite being approved for in-home nursing since she was 3, she hasn’t had one since 2020, and service was intermittent before that. 

“There were times where I really could’ve used nursing,” said Laura, who took on the role instead. 

Last summer, Tori’s health took an unexpected downturn when she developed a lesion on her brain that led to the paralysis of her diaphragm and legs. Being in and out of the hospital was especially difficult and Laura would have been grateful for some extra professional supervision — but nurses weren’t available. When Laura took a shower, Tori joined her in a high chair. And when one of Tori’s medications kept her awake long into the night, Laura was equally sleep-deprived the next morning.  

Amid a nursing shortage, training parents saves time and money

Arizona, like the rest of the country, is dealing with a nursing shortage caused by a retiring workforce and worsened by pandemic work-conditions which is estimated to continue until 2030. In Maricopa County alone, the exodus of nurses has increased by 40% since April 2020.  

Licensing parents to perform lower-need services can free up overworked nurses for patients at higher medical risk, said Fred Johnson, CEO of Team Select, a local home health agency that helped shepherd the program through the legislature.

“If I go in for a surgery, I’m not gonna do all the prep and spend every minute with the surgeon,” reasoned Johnson. 

Instead, parents are trained in the lower acuity parts of their child’s specific care plan, including things like G-tube feedings, medication administration, and tracheostomy care. Home health agencies can then direct nurses that are available to cases with higher level needs, like children on ventilators or IVs, or whose health is more at risk, as Tori’s was last summer. 

Making the training available for parents raises their confidence level, said Ann Martin, the director of operations at Thrive Skilled Pediatric Care, a Scottsdale-based home health agency. 

“People bring home newborns everyday, and you don’t know what you’re doing — and that’s a regular, typical eight-pound baby,” she said. “Some take home a baby with oxygen or a tracheostomy.” 

When parents aren’t in the know, the health outcomes for their children suffer, Johnson added. Properly cleaning the stoma created by a tracheostomy, for example, reduces the chances of respiratory distress, and keeps kids at home longer and out of hospital rooms. Continuous and careful care, Johnson said, is the key to ensuring that medically fragile children remain stable.  

‘We’re not going to be destitute’

Laura is the first parent in the state to become a licensed health aide, having gotten her preliminary clearances and certifications done in March in anticipation of the program’s rollout in April. She finished Team Select’s training session in two days — one of them spent with her phone on hold next to her as she tried to secure a substitute for Tori’s G-tube formula, which the hospital had run out of. Those kinds of derailing incidents, she said, would make having a traditional job nearly impossible. 

Until now, her husband has been the sole source of income, and being able to supplement that with her earnings as an LHA has helped both of them breathe easier, especially as costs of living have climbed. An injury that puts him out of work won’t be as threatening, she said, and unexpected bills like the recent spike in gas prices and some of Tori’s health care costs can be more easily resolved now. 

“It definitely has offered some peace of mind, knowing that, if something horrible happens, we’re not going to be destitute, we’re going to be OK,” she said. 

COVID-19 fears are alleviated by the new income, as well. Tori takes a monthly injection to stave off neuromyelitis optica, a disease that attacks her central nervous system and which caused her recent paralysis. The shots, however, are immunosuppressants. Not having to take a job outside her home in the future means that Laura doesn’t have to worry about potentially bringing the virus back with her and infecting Tori. 

The pay also allows Laura more financial freedom. Her to-do list can be better prioritized with extra spending cash on hand. If she isn’t able to finish some of her smaller chores, she can pay a family friend’s kid to mop for $20, for example. 

“You just need help sometimes, you know?” she said. 

While the program is a boon for parents like Laura who were forced to abandon the workforce to care for children — she left a job in social work and health care administration when Tori was an infant — it doesn’t place any extra strain on the state budget. 

Saving money through ‘a better model’

The state reimburses home health agencies like Team Select and Thrive SPC for hiring registered nurses, licensed private nurses and licensed health aides at different rates, with the latter two costing the state significantly less. The home health agencies set wages based on those reimbursement rates; LHAs are reimbursed $64.85 per visit by the state, which is defined as two and a half hours. LHAs don’t get allocated extra hours either — the child is granted a set amount of hours based on their needs and those are divided up between LHAs and RNs or LPNs. 

“For every hour that we replace a nurse with an LHA, we’re saving the state probably $15 to $25 an hour,” Johnson said. 

Low cost doesn’t mean low quality, however. Emma Mamaluy, chief counsel for the Arizona Board of Nursing, which approves licenses for LHAs and training programs for agencies, said that both must meet high standards of performance. Health home agencies must be Medicare and Medicaid certified. They are also being continuously overseen by regulatory state agencies like the Department of Health and Human Services and the Department of Economic Security. 

All of this, Mamaluy said, shows that the agencies have several layers of protection in place for patients. 

Training programs must be tailored to the patient and be taught by registered nurses with at least two years of experience in pediatrics or medical care that includes the skills LHAs are required to learn. LHAs in the Family Licensed Health Aide Program are licensed only to care for their specific patient, and can’t provide services for the general public. Family members, Mamaluy said, were already providing a lot of the care an LHA is trained to do, but defining it through licensure helps protect a vulnerable population. 

“If the parent learns how to do some tracheostomy care, and that saves a couple visits from the nurse, that’s great as long as it’s safe,” she said. 

Even after they’re authorized to begin work, LHAs are subject to periodic supervisory visits from registered nurses, and their license must be renewed every four years. 

Four health agencies in the state are certified to provide LHA training. Team Select’s program is up and running, and Thrive expects theirs to begin sometime in early May. While both agencies have fielded a high rate of interest from parents in their service areas, not all will be eligible to be licensed. 

One of the biggest roadblocks is age: only those under 21 may have their family members apply. Johnson said his agency hopes to petition the legislature to expand the program in the future, after data showing its benefits can be gathered to bolster the argument. The program’s value, he said, lies in adding parents to the medical tool kits of vulnerable children, who before had to contend with nonexistent or uneven help.

“A child gets to wake up to a happy, loving, smiling face everyday instead of no one, or a (new) nurse or being stuck in a hospital,” he said. “It’s a better model for consistency and continuity of care from someone that is never going to not be there.”

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