GF Revenues and Spending for FY09

Here is a quick look at where FY 2009 General Fund Revenues are derived, and how they are spent:

FY 2009 General Fund Revenue--Where It Comes From
Sales and Use Tax: $4,643.6
Individual Income Tax: $3,619.4
Corporate Income Tax: $871.2
Other: $133.7
TOTAL 1/$9,267.9
1/ Includes all legislative revenue changes, but does not include beginning balance or other one-time revenue adjustments.

The projected beginning balance is $1.0 million. Other one-time revenues adjustments equal $711.3 million.

FY 2009 Total General Fund Appropriations--Where It Goes
Education (K-12): $4,141.2
AHCCCS : $1,425.3
Universities: $1,080.4
Corrections: $947.5
Economic Security: $808.3
Health Services: $611.5
School Facilities Bd: $101.2
Other Agencies: $846.6
TOTAL OPERATING BUDGET: $ 9,962.0

Data may be obtained through the JLBC website: http://www.azleg.gov/jlbc/09app/apprpttoc.pdf

Medical Malpractice Legislation

I want to give you some background of our malpractice statutes in Arizona.

According to A.R.S. Section 12-542, there is a two year statute of limitation for medical malpractice cases. Defendants are proportionally liable for damages in direct proportion to their percentage of fault, unless the defendant acted in concert with another person (A.R.S. Section 12-2506). Also, the Constitution prohibits any limits on damages (Article 2, Section 31).
Sen. Allen has run legislation for several years that would have established statutory elements of proof for medical malpractice cases related to emergency health care professionals or hospitals. The bills have either been vetoed by the Governor, died in the process or used as vehicle bills somewhere in the process. Inevitably, the bill always dies.

In 2005, the Legislature added Laws 2005, Chapter 183, Section 1 (now A.R.S. Section 12-2604), which outlined the requirements of medical expert witnesses in medical malpractice cases. On June 17, 2008, the Court of Appeals, Division 1 held A.R.S. Section 12-2604(A) was unconstitutional because the statute "cannot be harmonized" with A.R.S. Rules of Evidence, Rule 702, which was established by the Arizona Supreme Court. Rule 702 relates to testimony by experts and the court felt that A.R.S. Section 12-2604(A) precluded witnesses that were otherwise qualified under Rule 702 from testifying in a malpractice case unless that witness met the additional criteria established in A.R.S. Section 12-2604(A).

Additionally, in 2007 Senator Leff sponsored SB 1505 which would have prohibited the admission of scientific opinion testimony in an action for person injury, death or damage to property unless the court determined that the expert's opinion is reliable and useful, based on the consideration of criteria that were outlined in the bill. The bill died in the Senate when it was Third Read. It is my understanding that the bill had similar issues as those of A.R.S. Section 12-2604(A). Some felt that the bill was unconstitutional and that it was really a separation of powers issue. It was mentioned that by establishing certain criteria, some testimony would be excluded.

Attached are the relevant statutes, sections of the Constitution, bill summaries.

Please let me know if you have any further questions.
http://www.azleg.gov/FormatDocument.aspinDoc=/ars/12/00542.htm&Title=12&DocType=ARS
http://www.azleg.gov/FormatDocument.aspinDoc=/ars/12/02604.htm&Title=12&DocType=ARS
http://www.azleg.gov/FormatDocument.aspinDoc=/ars/12/02506.htm&Title=12&DocType=ARS
http://www.azleg.gov/FormatDocument.asp?inDoc=/const/2/31.htm

http://www.azleg.gov/FormatDocument.aspinDoc=/legtext/47leg/2r/summary/h.sb1351_04-17-06_asengrossedandaspassedhouse.doc.htm

http://www.azleg.gov/FormatDocument.aspinDoc=/legtext/47leg/1r/summary/h.sb1036_04-20-05_astransmittedtogovernor.doc.htm

http://www.azleg.gov/FormatDocument.aspinDoc=/legtext/48leg/1r/summary/s.1505ced_caucus-floor.doc.htm

Universal Health Care Coverage Debate

Note: I had this post saved as a draft but was inspired to post it when I read the latest Arizona Republican Party press release.

I am going to claw my eyes out one of these days!

Every Wednesday morning from 9:00 to at least 11:00 am (today it was even later) I sit through a House Health Committee as one of six republican members. I despise this committee assignment since the majority of bills heard in this committee are stinkers. Even the Republican sponsored bills for the most part, focus expanding current government programs that offer free services or further regulation.

Today, in addition to a slew of unnecessary bills we are hearing but not voting on House Minority Leader Representative Phil Lopes (D) Universal Health Care proposal! Chairman Stump is definetly taking a risk by hearing this bill as once a bill has a hearing, any standing committee can vote on the bill without having another hearing per House rules. With committe membership skewed so that almost any bill passes out of committee, I question this move.

I find Representative Lopes Universal Health Care bill outrageous on several levels and offer these comments:

1. We are in the middle of a tremendous budget crisis with an ever-increasing shortfall. State Treasurer Dean Martin has said on several occasions that the state's money runs out in May. What is not clear about this picture Representative Lopes?
2. This would be an Arizona-specific program. Can you imagine the huge numbers of people who would flock to Arizona if this bill passed? You think we have grid-lock on our roads now, over-crowded classrooms, etc...just wait.
3. As P.J. O'Rourke famously said, "If you think health care is expensive now, wait until you see what it costs when it's free." I have yet to learn about a government program that has remained uncontaminated, uncorrupted and I cannot fathom that people think government intervention is a viable solution.
4. Rep Lopes bill mandates health care coverage for all Arizona residents. This is his answer? More mandates? Oy vey!

Stop the Bleeding ~ Commentary on SB1223

By Glenn Hamer

Arizona has an estimated physician shortage of over 2,200, based on 2005 findings. At 219/100,000, the physician to population ratio is well below the national average of 283/100,000. Although the number of doctors in Arizona increases each year, it's not enough to meet the demands of Arizona's growing population. In fact, every county in Arizona has been designated in part or whole as a Health Professional Shortage Area (HPSA).

These are troubling figures that should prompt Arizona to examine its medical environment. There is an increasing complaint among hospitals about the diminishing number of physicians willing to serve in emergency rooms. Having to assume additional medical liability is one factor that contributes to the decline in available ER physicians. A recent survey by the Arizona Medical Association showed 23 percent of physicians who do not currently take emergency department calls stated the primary reason was increased medical liability exposure.

A bill currently in the Arizona Senate would improve upon Arizona's medical liability environment by raising the burden of proof to "clear and convincing evidence" to show medical malpractice. The measure, SB 1223 introduced by Sen. Carolyn Allen, is currently working its way through the legislative process. This bill would make Arizona's liability environment more equitable for those providing emergency services. It would also stop the loss of doctors and start to replenish Arizona's supply.

In 2006, Governor Napolitano assembled the Emergency Medical Services Access Task Force to study ways to increase the number of physicians providing emergency and trauma care. The task force made numerous recommendations, including increasing the burden of proof to "clear and convincing evidence" in civil medical liability cases filed against physicians providing mandatory, emergency care. The task force said, "This reform is necessary because emergency department patients present unique challenges that make physicians less willing to assume their care, yet preserves the right of emergency patients to receive compensation in the event of clear and convincing evidence of a malpractice event."

Meeting our emergency medical needs is an issue of critical importance not only to Arizona's economic health, but its physical health. Raising the burden of proof for emergency services will improve access to emergency care for all. It would be malpractice for Arizona to ignore this issue and not initiate reforms to make Arizona ERs more attractive to doctors.

Glenn Hamer is president and CEO of the Arizona Chamber of Commerce and Industry.

An Ounce of Prevention is Worth What?

This article, from the respected Cato Institute dispels the myth that I hear perpetuated so often by those who testify/lobby for the health care industry that if we (legislators, government) would only "invest money now, on the front end" that it would save us money in the long run. Though I have long held this belief, verification from the Cato Insitute is satisfying.

Fetal Alcohol Syndrom Workshop for Parents

Arizona Department of Economic Security,
Division of Developmental Disabilities
Fetal Alcohol Resource Center

Teresa Kellerman’s Magical FASD Mystery Tour

Survival strategies for families of alcohol-affected children and adults

Wednesday, October 17, 2007
9 a.m. to 4 p.m.
Kingman Community Foundation
2985 E John L Ave, Kingman, AZ

Families of individuals with fetal alcohol spectrum disorders (diagnosed or suspected) are invited to a powerful, positive, realistic, funny and FREE one-day workshop by FASD pioneer, parent and inspirational speaker, Teresa Kellerman of Tucson, Arizona.

Topics to be covered in this jam-packed day include:
· Understanding FASD behavior (Why they do what they do!)
· The 9-step Ladder to Success for parents and caregivers
· How to care for the caretaker (especially when it’s you)
· Nutritional recommendations for children and adults
· How to avoid “FPSD” (FASD Parent Stress Disorder)
· A Reasonable Plan for supporting adults with FASD
· How to work through your grief, anger, fear and frustration

The adoptive mother of an alcohol-affected young adult, Teresa is Director of the FAS Community Resource Center in Tucson and is a consultant to the U.S. government’s FASD Center for Excellence. She is co-founder of International FAS Awareness Day, and creator of www.fasstar.com, the Internet’s most comprehensive website on FASD.

There is no fee for this seminar, but registration is required.
Childcare will not be available.

RSVP: Vicki Brewster 928-753-8077 or KAPCSN@yahoo.com
Provide your name and your phone number and relationship to person with FASD.

Hosted by Kingman Area Partnership for Children with Special Needs (KAPCSN)

For FASD resources in Arizona, visit FAS Arizona http://www.fasarizona.com/