ARIZONA STATE SENATE
RESEARCH STAFF
TO: MEMBERS OF THE SENATE
HEALTH & HUMAN SERVICES
COMMITTEE
DATE: February 14, 2022
SUBJECT: Strike everything amendment to S.B. 1444, relating to Arizona state hospital
Purpose
Prohibits administration and employees of the Arizona State Hospital (ASH) from
retaliating against a patient due to family participation in Arizona State Hospital Independent
Oversight Committee (ASH-IOC) meetings and requires the ASH Superintendent and Chief
Medical Officer to attend and participate in meetings. Directs ASH administration to develop and
implement an innovative clinical improvement and human resources development plan.
Background
ASH is a 260-bed facility, operated and regulated by the Department of Health Services
(DHS), that provides long-term inpatient psychiatric care to individuals with mental illnesses,
personality disorders or emotional conditions who are under a court order to receive treatment.
Statute outlines a number of administrative requirements of DHS relating to ASH, including
submittal of an annual report outlining ASH finances, collecting census data for adult civil
commitment treatment programs and administering the ASH Fund.
The Civil Adult Rehabilitation Program at ASH includes treatment units that specialize in
providing services to adults who are civilly committed as a danger to themselves or others, gravely
disabled or persistently and acutely disabled. Patients admitted to ASH under the Civil Adult
Rehabilitation Program must first have completed a minimum of 25 days of treatment in a
community inpatient setting prior to admission. Forensic patients at ASH are court-ordered for
either pre-trial or post-trial treatment as a result of involvement with the criminal justice system
due to a mental health issue. The Forensic Adult Program includes individuals who have been
committed through a court-order as part of a criminal process for patients who either: 1) are being
housed in one unit providing pre-trial evaluation, treatment and restoration to competency to stand
trial; or 2) have been adjudicated guilty except insane and are serving a sentence under the
jurisdiction of the Psychiatric Security Review Board (A.R.S. Title 36, Chapter 2, Article 1).
Statute establishes independent oversight committees (IOCs) under the Arizona
Department of Administration (ADOA) for: 1) persons with developmental disabilities;
2) children, youth and families; and 3) the mentally ill. Each IOC must adopt guidelines that govern
its operation, subject to the approval of the ADOA Director. The ASH-IOC has oversight of
patients who have been determined to have a serious mental illness and who are hospitalized and
receiving behavioral health services at the ASH civil and forensic hospitals (A.R.S. ยงยง 41-3801;
41-3802; and 41-3803).
The Joint Legislative Psychiatric Hospital Review Council (Council) is a 10-member
committee charged with reviewing, analyzing and making recommendations regarding at least the
following: 1) psychiatric hospital capacity in Arizona, including the bed capacity at the ASH and
MICHAEL MADDEN
LEGISLATIVE RESEARCH ANALYST
HEALTH & HUMAN SERVICES
Telephone: (602) 926-3171 STRIKER MEMO
S.B. 1567
Page 3
other public facilities; 2) the role of private facilities in addressing psychiatric treatment needs;
3) innovative programs to ensure public safety while providing clinically appropriate treatment in
the most integrated setting; 4) legal barriers; 5) current waiting lists; 6) barriers to accessing
appropriate inpatient care; 7) licensing barriers; and 8) any other issues related to inpatient
psychiatric treatment. The Council is required to submit a report of its findings and
recommendations by December 31st of 2021 and 2022 (Laws 2021, Ch. 402).
There is no anticipated fiscal impact to the state General Fund associated with this
legislation.
Provisions
Arizona State Hospital Independent Oversight Committee
1. Prohibits ASH administration and employees from retaliating against a patient because the
patient or the patient's family participates in the ASH-IOC meetings.
2. Requires the ASH Superintendent and Chief Medical Officer or their designees to attend and
participate in scheduled ASH-IOC meetings.
3. Requires the ASH Superintendent to ensure that ASH administration:
a) fully cooperated with the ASH-IOC in all aspects of its work;
b) facilitates and supports the ASH-IOC's activities;
c) timely responds to the ASH-IOC with responsive information to each inquiry; and
d) does not impede the ASH-IOC in discharging its statutory responsibilities.
ASH Clinical Improvement and Human Resources Development Plan
4. Requires ASH administration, by January 1, 2023, to develop and provide an evidence-based
and innovative clinical improvement and human resources development plan and proposed
budget to the:
a) Governor;
b) President of the Senate;
c) Speaker of the House of Representatives; and
d) chairpersons of the Legislative Health and Human Services committees.
5. Requires the clinical improvement and human resources development plan to:
a) be fully implemented by January 1, 2024;
b) be developed in collaboration with the ASH-IOC, the Mental Health IOC, public and
private community resources, community providers and guardians, families and
representatives of ASH patients;
c) identify necessary enhancements to ASH services, facilities and staff to provide statutorily
required treatment and services to patients in each division, including treatment and
services for secondary diagnoses; STRIKER MEMO
S.B. 1567
Page 4
d) provide options and recommendations to reduce the number of patients statewide who are
seeking admission to ASH and to reduce the wait time for admission;
e) identify optimal levels of acuity-based staffing with full-time employees and minimal use
of contract staff as well as ways to increase the number of forensically trained clinical staff;
f) include a pandemic response and preparedness plan that creates a set of clinical metrics to
significantly mitigate the effects of the COVID-19 pandemic on treatment and ensures
continuous ASH operation with minimal disruption of treatment in the event of a
subsequent pandemic;
g) identify, in collaboration with community-based treatment facilities, levels of service that
assist in transitioning patients from ASH into clinically appropriate settings as well as ways
to increase the number of patients that have transitioned into the community without
readmission to ASH or another facility; and
h) identify an independent third party, residing outside of Arizona, to investigate incident
reports and to receive complaints from patients, families and advocates.
6. Repeals ASH development plan requirements on January 1, 2025.
Miscellaneous
7. Adds, to the charge of the Council, reviewing, analyzing and making recommendations on the
feasibility of transferring ASH to the Arizona Health Care Cost Containment System or an
alternative oversight entity.
8. Extends the reporting requirements of the Council for an additional year, until December 31,
2023.
9. Delays repeal of the Council from August 31, 2023, to August 31, 2026.
10. Makes technical and conforming changes.
11. Becomes effective on the general effective date.