Final sunset report: Arizona Council on Arthritis and Musculoskeletal Diseases

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•••
FINAL
SUNSET REPORT
ARIZONA COUNCIL ONARTHRITIS
AND MUSCULOSKELETAL DISEASES
1996
•••
•••
•••
Date: October 23, 1996
The Arizona Council on Arthritis and Musculoskeletal Diseases be terminated.
Don Aldridge .:it~
Ka~e..!...~-:"-"::'::·~-_':"-':'~-==----
..Lou-Ann Preble
Herschella Horton
~~-~ ddt~
HEALTH COMMITTEE OFREFERENCE
Senate Health Committee ofReference &
House Health Committee ofReference
REPORT ON THE ARIZONA COUNCIL ON ARTHRITIS
AND MUSCULOSKELETAL DISEASES
Janice Brewer
To: JOINT LEGISLATIVEAUDITCOMMITTEE
Patricia Noland, Co-Chair
Sue Grace, Co-Chair
James Henderson
Pursuant to Title 41, Chapter 27, Arizona Revised Statutes, the Committee ofReference, after
performing a sunset review and conducting a public hearing, recommends the following:
~:d~ (1k--
David Petersen
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COMMITTEE OF REFERENCE REPORT
ON THE
ARIZONA COUNCIL ON ARTHRITIS AND MUSCULOSKELETAL DISEASES
I. BACKGROUND
Pursuant to section 41-2953, Arizona Revised Statutes, the Joint Legislative
Audit Committee (JLAC) assigned the sunset review of the Arizona Council on Arthritis
and Musculoskeletal Diseases to the Committee of Reference comprised of members
of the Senate Health Committee and the House of Representatives Health Committee.
A performance audit of the Council was conducted by the Committee of Reference and
is included.
II. COMMITTEE SUNSET REVIEW PROCEDURE
The Committee of Reference held one public hearing on Wednesday, October
23, 1996, to consider the sunset report and receive public testimony regarding the
Council on Arthritis and Musculoskeletal Diseases. The Committee heard testimony
from Pami Kowal, member of the Council on Arthritis and Musculoskeletal Diseases
and Bob Gilligan, Legislative Liaison, Arizona Department of Economic Security (DES).
Ms. Kowal testified that the Council pursues legislative activities and community
outreach and education. The Council holds public forums in outlying areas to educate
people about arthritis and the importance of early detection and treatment. She also
emphasized that the Council is a group of close-knit professionals who want to provide
support to and collaborate with the Arthritis Foundation, especially in the legislative
area to see that arthritis is eradicated and people educated about it. She indicated that
the Council has only had a chance to hold one meeting out of six planned for this year.
Ms. Kowal urged the Committee to allow the new Council members an opportunity to
show the State what it can do by continuing the Council
Mr. Gilligan explained that DES provides a staff person part-time to perform
Council duties and that, with per diem and transportation expenses together, the
Council's total cost for a year is approximately $6,000.
III. COMMITTEE RECOMMENDATIONS
The Committee of Reference Recommends that the Arizona Council on Arthritis
and Musculoskeletal Diseases be terminated.
IV. STATUTORY REPORT PURSUANT TO SECTION 41-2954 (F), ARS
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v.
1. Identification of the Problem or the Needs that the Council is
Intended to Address.
The Council on Arthritis and Musculoskeletal Diseases was established in
1987 to address the problem of arthritis and musculoskeletal diseases by
bringing together organizations and individuals with a knowledge and basic
interest in the area in order to develop recommendations the state may adopt to
help meet the needs of victims of these diseases. The Council consists of
twenty-one members serving staggered terms of three years each. The Council
is required to meet no less than four times a year.
2. A Statement, to the Extent Practicable, in Quantitative and
Qualitative Terms, of the Objectives of Such Council and Its Anticipated
Accomplishments.
The objectives of the Council are to advise and assist the Governor,
Legislature, and all State agencies; submit an annual report and conduct an
annual statewide conference; review and make recommendations on plans and
strategies; conduct educational programs; serve as a repository of information on
arthritis and musculoskeletal diseases; and monitor programs and services
ensuring efficient and coordinated use of resources. The Council focuses on the
education of the public and health professionals on the problems, issues and
developments in the field of arthritis and musculoskeletal diseases.
3. Identification of Any Other Agencies Having Similar, conflicting or
Duplicating Objectives.
The Council on Arthritis and Musculoskeletal Diseases coordinates,
collaborates, shares members and common goals and objectives with the
Arthritis Foundation, a national foundation with regional offices.
4. Assessment of the Consequences of Eliminating the Agency or of
Consolidating it with Another Agency.
The Council states that eliminating the Council would reduce the
communication, cooperation and collaboration efforts among the numerous
organizations serving the culturally diverse and geographically separated
members of the arthritis and musculoskeletal diseased community.
The Committee felt that there was no need for the Council and that its
function should be handled in the private sector. Specifically, the Arthritis
Foundation is performing the same functions.
ATTACHMENTS
A.
B.
C.
D.
E.
Cover Letter
Meeting Notice
Performance Audit
Minutes of Committee of Reference Meeting
Attendance List
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COVER LETTER
(Section A)
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~~rizotta ~tate ifegislature
1700 IDrst IDl1s~in~ton
J~ocnix, J\ri1!omt 85007
June 13, 1996
Ms. Gail Riggs
Arizona Council on Arthritis and
Musculoskeletal Diseases
1789 West Washington, Room 930A
Phoenix, AZ 85007
Dear Ms. Riggs:
The sunset review process prescribed in Title 41, Chapter 27, Arizona Revised Statutes,
provides a system for the Legislature to evaluate the need to continue the existence of state agencies.
Under the sunset review process, an agency is reviewed by a legislative committee of reference.
Upon completion ofthe sunset review, the committee ofreference recommends to continue, revise,
consolidate or terminate the agency.
The Joint Legislative Audit Committee (JLAC) has assigned the sunset review of Arizona
Council on Arthritis and Musculoskeletal Diseases to the Committee of Reference comprised of
members ofthe Senate Health Committee And the House ofRepresentatives Health Committee.
ARS section 41-2954 requires the Committee of Reference to consider certain factors in
deciding whether to recommend continuance or termination of an agency. Please provide your
response to those factors as provided below:
1. The objective and purpose in establishing the Council
2. The effectiveness with which the Council has met its objective and purpose and the
efficiency with which it has operated.
3. The extent to which the Council has operated within the public interest.
4. The extent to which rules adopted by the Council are consistent with the legislative
mandate.
5. The extent to which the Council has encouraged input from the public before adopting its
rules and the extent to which it has informed the public .as to its actions and their expected impact on
the public. .
9. The extent to which changes are necessary in the laws ofthe Council to adequately comply
with the factors listed in this subsection.
10. The extent to which the termination ofthe Council would significantly harm the public
health, safety or welfare.
11. The extent to which the level ofregulation exercised by the Council is appropriate and
whether less or more stringent levels ofregulation would be appropriate.
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Sue Gerard
Co-Chair
Health Committee ofReference
Sincerely,
In addition to responding to the factors in ARS section 41-2954, please provide the committee
ofreference with copies ofminutes from your meetings during fiscal year(s)1994 through 1996, and
an annual report, and respond to the attached questionnaire by July 30, 1996 so that we may
proceed with the sunset review and schedule the required public hearing.
12. The extent to which the Council has used private contractors in the performances ofits
duties and how effective use ofprivate contractors could be accomplished.
8. The extent to which the Council has addressed deficiencies in its enabling statutes which
prevent it from fulfilling their statutory mandate.
Arizona Council on Arthritis and Musculoskeletal Diseases
June 13, 1996
Page 2
6. The extent to which the Council has been able to investigate and resolve complaints that
are within its jurisdiction.
7. The extent to which the attorney general or any other applicable agency of state
government has the authority to prosecute actions under the enabling legislation.
Thank you for your cooperation. Please contact Senate or House health research staffifyou
have any questions.
AD/SG/cmh
Attachment
cc: Vincent Kelly, Council Liaison
Senator Ann Day
Co-Chair
Health Committee ofReference
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ARIZONA COUNCIL ON ARTHRITIS AND
MUSCULOSKELETAL DISEASES
Please respond to the following questionnaire:
1. Descnbe the role and function ofthe council including major activities/projects,
accomplishments and obstacles to success.
2. Provide financial data such as number offull time employees, expenditures and
revenues and fee structure.
3. Provide infonnation regarding council or board composition including number
ofmembers, number ofpublic members and method of appointment.
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MEETING NOTICE
(Section B)
MEETING NOTICE
BOARD OF RESPIRATORY CARE EXAMINERS
II. AZ Council on Arthritis & Musculoskeletal Diseases
ARIZONA STATE LEGISLATURE
Representative Gerard, Co-chair
Representative Aldridge
Representative Preble
Representative Foster
Representative Horton
AGENDA
Wednesday, October 23, 1996
9:00 a.m. - Noon
Senate Hearing Room 2
JOINT LEGISLATIVE COMMITTEE FOR THE ARIZONA HEALTH
CARE COST CONTAINMENT SYSTEM (AHCCCS)
OPEN TO THE PUBLIC
SENATE AND HOUSE HEALTH COMMITTEES OF REFERENCE
ARIZONA COUNCIL ON ARTHRITIS & MUSCULOSKELETAL DISEASES
SUNSET REVIEWS OF THE
MEMBERS:
Senator Day, Co-chair
Senator Brewer
Senator Petersen
Senator Henderson
Senator Kennedy
KB/ak
**TItle II of the Americans With Disabilities Act prohibits the Arizona Senate from discriminating on the basis of disability in the
provision of its services and pUblic meetings. Individuals with disabilities may request reasonable acconvnodations, such as
interpreters or alternative formats, by contacting the Senate Secretary's Office at (602) 542-4231 (voice) as soon as possible.
Please be specific about the agenda item in which you are interested and for which you are requesting an accommodation. The
Senate may not be able to provide certain accommodations prior to the meeting unless they are requested a reasonable time in
advance of the meeting. This agenda will be made available in an alternative format on request.
TIME:
DATE:
III. Joint Legislative Committee for AHCCCS
PLACE:
I. Board of Respiratory Care Examiners
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PERFORMANCEAUDIT
(Section C)
Some specific goals the Council has established for itself are:
GOVERNOR'S COUNCIL ON ARTHRITIS AND MUSCULOSKELETAL DISEASES
1789 West Jefferson - 930A
Phoenix, Arizona 85007
In response to your letter of June 13, 1996 pertaining to the sunset review of the Governor's
Council on Arthritis and Musculoskeletal Diseases, here are answers to the questions or topics
you inquired about:
•
Gail Kershner Riggs, MA, CHES
Chairperson
/l--:~, f' "\ :?? I _ r"~'. " ,~i ".
C-t:;" ....- -.-J ~.--...-.-. ..... -. '-.' - ~- .--
July 26, 1996
Fife Symington
Governor
Senator Ann Day, Co-chair
Health Committee of Reference
Arizona State Legislature
1700 W. Washington
Phoenix, AZ. 85007
Dear Senator Day:
• to educate the arthritis population on available services;
• to educate the public on the prevention and treatment of arthritis and musculo-skeletal
diseases;
• to communicate the needs of persons with arthritis, rheumatism,.etc. to the Governor and
state agencies, to the legislature and to state committees;
• to advocate for more funding for the prevention and care of arthritis;
• to seek to improve the status of patient care;
to submit proposals for grants for research on arthritis and access to health care;
• to sponsor an epidemiological study of arthritis and musculoskeletal diseases in Arizona.
1. The objective and purpose in establishing the Council
The Council was established in May 1987 with the purpose of addressing the challenges
that individuals who have arthritis and musculoskeletal diseases face in Arizona. The objective
of the Council is to develop recommendations for Arizona to consider to help meet the needs of
this popUlation. The Council also directly undertakes specific projects designed to provide
information and services to persons with arthritis and musculoskeletal diseases, their families,
the public at large, and to the professional health community concerned with research or
treatment of these ravaging diseases.
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2. The effectiveness with which the Council has operated within the public interest
The Council has cooperated with private and public agencies involved in the research
and/or treatment of arthritis and musculoskeletal diseases in the collection and dissemination of
data on the incidence of arthritis in Arizona and the disabling impact it has had upon its victims.
The Council has provided some of this information directly to legislators so they can have it in
mind when fashioning new health legislation and in assessing budgetary needs relating to the
health and well-being of Arizona citizens. The Council has been an effective advocate with the
Rehabilitation Services Administration in forming cooperative agreements with various chapters
of the Arthritis Foundation in Arizona to provide vocational rehabilitation counseling to persons
suffering from the many severe forms of arthritis. This Council has served the vital function of
providing communication links among Arthritis Foundation chapters, the University of Arizona
Arthritis Center, the Harrington Arthritis Research Center, private arthritis specialists, and
regional medical centers around the state.
3. The extent to which the Council has operated within the public interest
The Governor's Council on Arthritis and Musculo-skeletal Diseases has consistently
operated in the public's best interest by serving as a catalyst for promoting dialogue among the
various state or governmental agencies and those organizations interested in the prevention,
treatment or rehabilitation of persons with musculo-skeletal diseases. The Council has
consistently advocated to these groups for increased research, prevention, education and
improved services to the 606, 367* Arizona residents presently suffering from some form of
arthritis or other musculoskeletal disease. Accordingly, the Council provided its support for an
epidemiological research grant proposal in October 1993. Council members wrote letters and
made personal contact with state legislators in support of RSA's bUdget requests and advised
the DES Rehabilitation Services Admininistration on opening up the order of selection. They also
advocated for state funding of the Disease Prevention Project. Council members have also
contacted US Senators and Representatives to support the continuation of a separate agency to
provide vocational rehabilitation services. The Council requested funding of research on arthritis
from the Arizona Department of Health Services and supported an assistive technology grant
proposal by the Institute of Human Development at Northern Arizona University.
The Arthritis Council publicly expressed its support of Governor Symington's opposition to
unfunded federal mandates and, in particular, against the federal requirement that RSA provide
VR services to SSA recipients for the sole purpose or removing them from SSA roles. The
Council on Arthritis and Musculoskeletal Diseases actively recruited the support of state
chapters and the national office of the Arthritis Foundation on this issue.
In February 1995 the Council sponsored educational public forums on musculo-skeletal
diseases, particularly lupus and multiple myeloma, in South Tucson, Nogales, Sierra Vista and
Guadalupe. In March 1996 both a professional and public forum on the role of infection in
arthritis were presented in Tucson and Phoenix. In collaboration with the University of Arizona's
Arthritis Center and the Arthritis Foundation, the Council has advocated, and will continue to
advocate, for a registry of arthritis patients and for improved use of media to publicize important
health issues.
Note: *This figure is provided by Dr. Tim Flood, Council member, and researcher at the
Arizona Dept. of Health Services, Office of Chrionic Disease Epidemiology
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4. The extent to which rules adopted by the Council are consistent with the legislative mandate
The by-laws of the Council are in harmony with the legislative mandate. The Council has,
howerever, attempted to influence the legislature to effect changes which would permit the
Council to function more effectively: for instance, five appointed members are advisory and
cannot vote. Since the Council has a mainly advisory function and has no budget within its
control, not allowing some or all of these persons to participate completely weakens their
motivation to attend. The number of voting members is 20, but this makes it necessary to have
11 members present to have a quorum. Since some members have to travel from Flagstaff or
Tucson to attend meetings, obtaining a quorum is difficult. Having an odd number of members,
would lessen that difficulty slightly.
5. The extent to which the Council has encouraged input from the public before adopting its rules
and the extent to which it has informed the public as to its actions and their expected impact on
the pUblic
The Governor's Council on Arthritis and Musculo-skeletal Diseases has consistently given
timely notice of Council meetings and agendas. It has, through its diverse membership,
communicated information concerning current and upcoming issues to local chapters of the
Arthritis Foundation and to public and private organizations concerned with all forms of athritis.
Information has also been shared with other Governor's Councils concerning public
presentations on arthritis which have broad public interest and on public forums on rehabilitation.
Members of the public frequently attend Council meetings as observers and are given the
opportunity to make comments, raise issues or to give suggestions to the Council.
The Governor's Council on Arthritis and Musculoskeletal Diseases is seeking to playa
more active role in the collection, synthesis and dissemination of national research data so that it
can be applied in a timely fashion to the problems and needs of persons with arthritis or related
diseases in Arizona
6. The extent to which the Council has been able to investigate and resolve complaints that are
within its jurisdiction
As the Governor's Council has become aware of specific and individual problems of
persons with arthritis or musculoskeletal diseases or of complaints from their families, it has
either referred the person to an appropriate office or agency, such as the Client Advocacy
Program, or has forwarded the content of the complaint to an appropriate level of the
organization involved. This Governor's Council tends to concern itself more with ongoing,
recurrent issues and problems that affect persons who are or will be suffering the ravages of
arthritis and arthritis-related diseases. The Governor's Council is a constant advocate for
informing and educating the public on means of resolving difficulties of communication with their
private physicians, HMO's, clinics, hospitals and Medicare concerning the availability of services,
medication issues, and, especially, the issues of prevention or treatment of secondary and
tertiary sequellae, such as joint deformity, decrease or loss of function, depression, drug toxicity,
kidney failure, and cardiac problems. According to Dr. Ted Pincus at Vanderbilt University,
persons with arthritis, particularly those with juvenile arthritis or rheumatoid arthritis, tend to have
a ten to fifteen years earlier mortality than the general population. Unfortunately, these victims
are unable to register complaints.
7. The extent to which the attorney general or any other applicable agency of state government
has the authority to prosecute actions under the enabling legislation
As a public body established by the Governor and confirmed by the Arizona legislature,
the Governor's Council is required to adhere to the requirements set forth in the enabling
legislation and also with the Open Meeting Law (Laws 1962, chapter 138, item 1). Council
officials deliberately violating the Open Meeting Laws are, under A.R.S. 38-431.07, liable to a
superior court fine not to exceed five hundred dollars.
8. The extent to which the Council has addressed deficiencies in its enabling statutes which
prevent it from fulfilling their statutory mandate
In the past the Council has requested changes in the statute which would allow ex-officio
members the privilege of voting, since the actions and decisions of the Council are of an
advisory nature and are not likely to directly influence agencies represented by these persons.
The Council has also sought to affect the requirements of a quorum, which is presently one more
than half of the voting membership. An odd number of voting members would make it easier to
achieve the present quorum requirement of 51% of voting members.
9. The extent to which changes are necessary in the laws of theCouncii to adequately comply
with the factors listed in this subsection.
The Council presently receives no financial support other than per diem and travel
expenses for its members to attend meetings. The occasional part-time services of a Council
stalff member and secretary are provided by the Rehabilitation Services Administration of the
Department of Economic Security. A formal budget with funding would increase the Council's
discretionary ability to carry out its mission and objectives.
As stated above, having a less stringent quorum requirement and allowing ex-officio
members the right to vote could improve the effectiveness of the Council.
10. The extent to which the termination of the Council would significantly harm the public health,
safety or welfare
While a number of public, non-profit, and private agencies serve certain specific needs of
persons with arthritis or musculoskeletal diseases, no official body other than the Governor's
Council on Arthritis and Musculoskeletal Diseases exists to oversee the overall problems, needs
and welfare of this sizeable population. The elimination of this Governor's Council would have
the effect of reducing the communication, cooperation and collaboration efforts among the
numerous organizations serving the culturally diverse and geographically separated, even at
times isolated, unwilling members of the arthritis and musculoskeletal diseased
community. That same ever-increasing community would lose the services of a staunch
advocate of their rights and of the varied services they require in the areas of research,
prevention, education, treatment and rehabilitation.
11. The extent to which the level of regulation exercised by the Council is appropriate and
whether less or more stringent levels of regulation would be appropriate
As an advisory body this Council has no power to enforce its decisions or
recommendations. It even lacks the funding to authorize expenditures or to hire services of
consultants. In the past it has exercised influence on the practices and procedures of
organizations with which it deals, and has focused largely on the education of the public and
health professionals on the problems, issues and developments in the field of arthritis and
musculoskeletal diseases.
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12. The extent to which the Council has used private contractors in the performance of its duties
and how effective use of private contractors could be accomplished
The Council has successfully procured volunteer services of health professionals as
presenters at regional conferences and for the collection and dissemination of research data. It
has also obtained the free use of facilities and other resources from organizations with which it
regularly interacts. However, the ability to contract persons to collect, analyze, and synthesize
research, or develop informative brochures, or to make public and/or professional presentations
on related health and rehabilitation issues would enlarge the Council's impact throughout the
state. The Council would utilize the advice and recommendations of the professional health
community in the selection of qualified persons to carry out vital functions that are presently not
being performed in Arizona. To the extent possible, those health organizations would share
responsibility for designing, implementing and funding these useful projects.
I hope that these responses meet your needs. If not, please call me at (520) 321-0692.
Copies of minutes of meeting for SFY 1994 through 1996
Annual report
I Sincerely,
~~~
I Gail Kershner Riggs
Council chairperson I Attachments
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ARIZONA COUNCIL ON ARTHRITIS AND
MUSCULOSKELETAL DISEASES
July 26, 1996
To Senator Ann Day and Sue Gerard
Co-chairs, Health Committee of Reference
Arizona Legislature
RESPONSES TO QUESTIONNAIRE:
1. Describe the role and function of the Council including major activities/projects,
accomplishments and obstacles to success.
"The Governor's Council on Arthritis and Musculoskeletal Diseases was
established by legislative statute to address the problem of arthritis and
musculoskeletal diseases by bringing together organizations and individuals with
a knowledge and basic interest in this area in order to develop recommendations
the state may adopt to help meet the needs of victims of these diseases"(Laws
1987, ch. 258, 1 and 5).
The duties and responsibilities of the Council include:
- to advise and assist the Governor, the Legislature, and all State
Agencies providing services to persons suffering from arthritis and/or
musculoskeletal diseases (such as RSA and the AZ. Dept. of Health);
-to submit an annual report, and conduct an annual statewide
conference to address issues and exchange information;
-to review and make recommendations or plans and strategies for
meeting the needs of persons with arthritis and/or musculoskeletal diseases;
-in cooperation with all related organizations, to conduct programs
of professional and public education;
-to serve as a repository of information on arthritis and
musculoskeletal diseases, referral procedures, and demographics of these
diseases;
-to monitor programs and services for persons with arthrits and
musculoskeletal diseases to encourage efficient and coordinated use of
resources.
In carrying out its responsibilities the Council, either as a whole or through
its committees or individual members, has engaged in the following activities:
-communicating with legislative committees and individual
representatives or senators involved in health and other issues relating to the
needs and interests of persons with arthritis and related musculoskeletal
diseases;
-communicating with program administrators of the Dept. of
Economic Security and the Department of Health concerning specific policies and
procedures affecting their clients with arthritis. Specifically, the Council advised
the Rehabilitation Services Administration on its Order of Selection and advised
the Dept. of Health Services on continuing its disability prevention project. The
Council also advocated to the legislature for special funding for that project;
-communication and cooperation with the Phoenix and Tucson
chapters of the Arthritis Foundation and its national office, the Harrington Arthritis
Research Center, the University of Arizona Arthritis Center, private arthritis
specialists and regional medical centers. Their collaborative efforts include public
and professional educational presentations on important issues in the prevention,
treatment and rehabilitation of diseases such as rheumatorid arthritis, lupus and
multiple myeloma in a number of cities throughout the state; Significant research
findings have also been disseminated by means of these public presentations
and by direct mailings to persons and organizations with interest or involvement
in providing services to persons with arthritis and musculoskeletal diseases;
-one member of the Arthritis Council participates on the Disability
Prevention Advisory Council; another serves on the Governor's Council on
Blindness and Visual Impairment. This cross-representation helps facilitate
communication among Councils with common interests.
- as a result of the Council's collaborative efforts with other councils
and organizations in demanding improved access to information for persons with
disabilities, the Disability Hotline of Arizona and a 24-hour, statewide information
and referral system on rehabilitation services were established.
In seeking to carry out its mission and objectives, a major obstacle is the
lack of a budget which would allow the Council the discretion to make needed
purchases, hire consultants for special projects, to purchase books and
documents and to rent or purchase equipment,supplies.or services.required for
special projects. For instance, in order to "serve as a repository of information on
arthritis... ", one of the mandated duties of the Council, space, cabinets or book
shelves, means of purchasing or publishing and reproducing documents, means
of sending and receiving information and documents, such as phone, fax, and
mail services would be required. None of these can presently be obtained by the
Council. Such necessary items and services should be able to be planned and
provided for in an approved budget with money provided by the legislature or
designated state agency.
Otherwise, mandated duties that cannot be carried out in the absence of
adequate financial assistance should be deleted from the wording of the
legislation.
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Q. 2. Provide financial data such as number of full-time employees, expenditures
and revenues and fee structure.
The only funding that the Council on Arthritis and Musculoskeletal Diseases
receives is for travel and per diem expenses for its members and staff
to travel to official Council meetings or in the performance of directly related
Council activities. The Council staff and secretary are both provided by
Rehabilitation Services Administration of DES. The. administrative staff person
( or liaison) spends about 10% of his time on assisting this Council; the clerical
staff person spends about 5% of her time on Council affairs. Thus about $3800 is
spent on staff salaries. Another $470 covers employee related expenses. The
average annual cost of transportation for Council members is $1200; Hotel
accomodations for Council related trips is $305. Per diem expenses is $184.
Thus R.S.A. pays about $5959.00 per year to support Council activities.
The Council has utilized donated space and services of community
organizations in carrying out its responsibilities.
Q.3. Provide information regarding Council composition including number of
members, number of public members and method of appointment
In compliance with 41-971, the Council consists of the following members, all of
whom are appointed by the Governor:
-nine members who are afflicted with arthritis or are parents or guardians
of arthritis victims; Six of these members are selected from a list of individuals
recommended by a statewide private nonprofit organization (the Arthritis
Foundation);
-five members who represent the professional health community in
rheumatology;
-two members from the general community and who have a knowledge of
and interest in the subject of arthritis and musculoskeletal diseases;
-one (advisory) member who represents a statewide private nonprofit
agency which provides services to persons with arthritis and musculoskeletal
diseases; .
-one (advisory) member representing a private nonprofit research center
which conducts biomedical research or bioengineering research in arthritis and
musculoskeletal diseases;
-the Director of DES or her designee (advisory)
-the Director of the Dept. of Health Services or his designee (advisory)
-the chairman of rheumatology at the U.of A research center (advisory)
Thus the Council consists of twenty-one members, including sixteen voting
members. The Council solicits recommendations from its member individuals and
organizations and from the public at large.The Council votes on which to select,
and forwards their nominations to the Governor's Office of Boards and
Commissions for his consideration. All appointments are made at the discretion of
the Governor.
Attached is a current list of members indicating the category each represents and
the date his/her term will expire.
Respectfully submitted by
,i1.J~~
Gail Kershner Riggs, MA, CHES
Council chairperson
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MINUTES OF COMMITTEE OFREFERENCE MEETING
(Section D)
BOARD OF RESPIRATORY CARE EXAMINERS
BOARD OF RESPIRATORY CARE EXAMINERS
ARIZONA STATE LEGISLATURE
MEMBERS EXCUSED
Senator Kennedy
Senator Henderson
Representative Preble
STAFF
Kitty Boots, Senate Analyst
Lisa Block, House Analyst
In response to Senator Day's request to hear examples of ways RCPs are adapting to a
changing environment, Ms. Martin explained RCPs at St. Joseph's Hospital in Phoenix are
now integrated into al/ departments, rather than ~ing centralized in a department of their
own, and are involved in total patient care, e.g. helping to move a patient as well as
Minutes of the Meeting
Wednesday, October 23,1996
9:00 a.m., Senate Hearing Room 2
ARIZONA GOVERNOR'S COUNCIL ON ARTHRITIS
& MUSCULOSKELETAL DISEASES
JOINT LEGISLATIVE COMMITTEE FOR THE ARIZONA HEALTH CARE
COST CONTAINMENT SYSTEM
SENATE AND HOUSE HEALTH COMMITTEES OF REFERENCE
SUNSET REVIEWS OF THE
Mary Hauf Martin, Executive Director, Board of Respiratory Care Examiners,
explained the Board was created in 1990 and oversees Respiratory Care Practitioners
(RCPs) who provide services in hospital settings and increasingly in alternative settings
such as skilled nursing facilities and private homes. She explained the Board must insure
an RCP cares for patients safely and effectively. Ms. Martin explained RCPs work with
health care teams to insure quality patient care and cost containment in a continually
changing environment.
Co-chairman Day convened the meeting at 9:10 a.m. and the attendance was noted.
Senator Day explained the purpose of the sunset hearings is to review the purpose and
function of each entity to determine whether they should be continued, revised,
consolidated or terminated.
MEMBERS PRESENT
Senator Day, Co-chairman
Representative Gerard, Co-chairman
Senator Brewer
Senator Petersen
Representative Aldridge
Representative Horton
Representative Foster
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Senator Day asked if Ms. Martin sees managed health care as supporting an adequate
number of home visits and extended care by RCPs. Ms. Martin indicated that managed
care has worked collaboratively to provide necessary services.
performing respiratory care. She also indicated that since patients are leaving the hospital
sooner after medical procedures, RCPs have gone into homes to train patients on the use
of respiratory equipment.
In response to Representative Aldridge's request to know how long the training program
is, Ms. Martin explained it lasts approximately a year, which is longer now than in the
recent past, due to enhanced education in using high-technology equipment.
Representative Horton referred to page five of the preliminary sunset report (filed with
original minutes) and asked for the reason behind the fluctuation in the number of license
denials and total number of complaints charted there. Ms. Martin explained a backlog in
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HEALTH COMMITTEES OF
REFERENCE SUNSET REVIEWS
October 23, 1996
Page 2
Ms. Martin explained the Board is made up of three practitioners, one medical doctor, one
hospital administrator and two members of the public, emphasizing that the majority of the
Board is not made up of practitioners and takes its responsibility to protect the public
health very seriously. She noted that Board meetings are very well attended by health
care facility representatives and interested licensees.
In response to Representative Aldridge's request to know what qualifies a person to be an
RCP, Ms. Martin explained an applicant for a license must be a high school graduate and
graduate from an accredited respiratory therapy training program. Once training is
completed, an application for a license may be filed and is granted within 24 hours at
which time the applicant may seek on-the-job training under the supervision of a doctor or
another licensee until he or she can pass a national exam called the CRTT. Ms. Martin
indicated that once the applicant passes the CRIT, he or she is eligible for a permanent
license.
Ms. Martin further explained disciplinary procedures are reviewed to assure that people
are being treated fairly and equally. She indicated an independent study performed by the
Auditor General reveals the Board compares favorably to similar boards. Ms. Martin
indicated it has taken the Board about 60 days to process a complaint from beginning to
resolution, that 26 percent of complaints have resulted in disciplinary action and that 34
percent have resulted in a warning letter of concern in the past year.
In response to Senator Day's request to know if Ms. Martin sees services being cut back
by managed care, Ms. Martin indicated that she did not feel qualified to respond. She
emphasized there is an effort on the part of the respiratory care industry to answer the
need that exists.
Ms. Martin confirmed Senator Brewer's observation there are no independent, privately­owned
respiratory therapy colleges in Arizona.
In response to Senator Brewer's further inquiry about where applicants go to school, Ms.
Martin related the majority are attending community colleges to obtain their training.
processing complaints occurred last year, but was alleviated once a staff position was
authorized by the Legislature.
David Feuerherd, Program Director, American Lung Association, expressed his
support for continuing the Board in response to 'Senator Day's inquiry.
October 23, 1996
Page 3
HEALTH COMMITTEES OF
REFERENCE SUNSET REVIEWS
Representative Horton asked if criteria used for foreign applicants are the same for
citizens of the United States. She asked how the Board determines how the foreign
applicants have the same standardized training.
In response to Senator Day's inquiry, Ms. Martin acknowledged that every year there has
been a gradual increase in the number of complaints. She explained that the biggest
problem behind complaints is substance abuse by practitioners.
Ms. Martin explained that Canada, where the majority of foreign applicants are from, has
a very rigorous training program which is accepted as an equivalent by a national
organization for respiratory care examiners.
Representative Horton asked what the Board does to screen applicants for drug abuse.
Ms. Martin explained this is a collaborative effort between the Board and care facilities that
employ RCPs. She indicated the Board does not have the ability to perform criminal
background checks on every applicant, however does ask them specific questions about
their backgrounds and requires they submit a sworn statement that everything they have
told the Board is true and factual. Ms. Martin additionally noted that facilities routinely
perform preemployment drug screenings and also have the ability to perform "for cause"
drug screenings when necessary.
In response to Senator Brewer's request to know if the Board certifies the respiratory care
training facilities that applicants attend, Ms. Martin explained a national accreditation body,
consisting of four groups of practitioners, determines what constitutes an approved
program. She further explained the Board assures that applicants have attended an
American Medical Association-approved program.
In response to Representative Horton's wish to know what legislation the Board would be
pursuing next session, Ms. Martin indicated it would be developing technical legislation to
clarify language only.
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John Coleman, RCP and Member of the Board, explained the process whereby a patient
is transferred from a hospital setting to home care using skilled, licensed RCPs.
Representative Gerard asked if employers of RCPs have an obligation to report
unprofessional conduct or incompetency to the Board and Mr. Coleman responded
affirmatively.
Representative Gerard indicated she has never received a complaint about the Board,
acknowledged the need to license RCPs and recommended continuing the Board for ten
years.
Representative Gerard asked if complaints from patients received by the Board concern
quality of care. Mr. Coleman indicated the Board does not receive these types of
complaints, as these are directed to the home care company or the insurance provider.
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HEALTH COMMITTEES OF
REFERENCE SUNSET REVIEWS
October 23, 1996
Page 4
Representative Gerard moved that the Committee of Reference
recommend to the full body the continuation of the Board of
Respiratory Care Examiners for ten years. The motion CARRIED by a
voice vote. .
Senator Day indicated that according to information she receives from constituents,
managed care cuts back on benefits to home care facilities and is not always providing
services that patients need.
In reference to Senator Day's concern about benefits being cut back in the managed
health care environment, Mr. Coleman asserted the issue requires that home care
companies adapt their contracts with managed care health plans. He explained that
typically, depending on the patient's level of acuity, they may be seen once a week, once
every six weeks or more often in the case of ventilator patients.
Senator Brewer asked if Reps bill directly or through the organization they work for. Mr.
Coleman explained this depends upon the environment in which the RCP is working,
noting that at this point in time, there is no set fee the RCP charges to go into a home care
setting. He explained that compensation for the RCPs is built into the charge for
equipment that is reimbursed. In hospital settings, Mr. Coleman explained, payment is
disbursed through the hospital, not billed to the patient directly.
In response to Senator Brewer's reference to oxygen suppliers' problem with needing to
hire RCPs to deliver their product, Mr. Coleman stressed this is a way to protect the public.
He emphasized that it is perfectly appropriate and desirable to have a licensed practitioner
teaching patients about the use of prescription drugs and oxygen equipment in their
homes.
Senator Day acknowledged the notice was late due to a lag in communication.
Senator Day questioned the purpose of the Council in view of the fact that the Arthritis
Foundation exists for much the same purpose.
ARIZONA GOVERNOR'S COUNCIL ON ARTHRITIS AND MUSCULOSKELETAL
DISEASES
Senator Day asked if the educational activities are conducted by volunteers and Ms. Kowal
confirmed that everything the Council does is conducted on a volunteer basis.
October 23, 1996
PageS
HEALTH COMMITTEES OF
REFERENCE SUNSET REVIEWS
Pami Kowal, Member, Governor's Council on Arthritis and Musculoskeletal Diseases,
explained that Gail Riggs, Council Chairperson, was only notified of the meeting yesterday
and could not attend with such short notice.
In response to Senator Day's inquiry about Ms. Kowal's understanding of the Council
budget matters, Ms. Kowal indicated the budget is small, has not changed and the Council
does not anticipate the need to request an increase.
In response to Senator Day's request to know how the Council specifically serves an
education function, Ms. Kowal indicated that the Council holds public forums in outlying
areas to educate people about arthritis and the importance of early detection and
treatment.
Bob Gilligan, Legislative Liaison, Arizona Department of Economic Security (DES),
explained DES provides a staff person part-time to perform Council duties as well as many
other duties for DES. He indicated DES provided a little more than $600 this year to the
Council to reimburse members for travel to four meetings, and approximately $400 the
year before for the same purpose.
Representative Gerard read from the Executive Summary of the preliminary sunset report
(filed with original minutes) that the Council's purpose is to "develop recommendations the
Ms. Kowal acknowledged the Foundation serves its purpose very well, but explained the
Council functions in addition to the Foundation in pursuing legislative activities and
community outreach and education.
After some discussion it was determined that per diem expenses were compensated at the
rate of $600 for an entire year, hotel and transportation expenses at $1,200, and that 5
percent of DES clerical staff committed to the Council amounted to $3,800, for a total cost
of approximately $6,000 per year.
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Representative Aldridge asserted he does not see any concrete results provided by the
Council.
Representative Aldridge suggested the work of the Council should be coordinated with the
Arthritis Foundation.
Representative Gerard asserted there is no need for the Council and that its function
should be handled in the private sector.
Representative Gerard asked if the Council is a pass-through agency for receiving any
type of federal monies and Ms. Kowal expressed her understanding it is not.
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HEALTH COMMITTEES OF
REFERENCESUNSETR~ENS
October 23, 1996
Page 6
In response to Representative Gerard's inquiry, Ms. Kowal acknowledged the Council
would not be conducting research, only applying for grants and providing support.
Representative Gerard suggested the University of Arizona Medical Center could apply
for such a grant as well. Ms. Kowal acknowledged this and noted the Foundation also
applies for grants.
Ms. Kowal responded that the Council has been actively involved in assuring vocational
rehabilitation is continually supported and has applied for funding for particular research
grants.
In response to Senator Day's request to know how successful the Council has been in
obtaining a research grant, Ms. Kowal expressed her understanding the Council has
obtained one research grant but it has not moved forward for some reason.
State may adopt to help victims of these diseases," and asked if anything specific has
been done other than to call the congressional delegation, which is noted in the Council's
response.
Ms. Kowal emphasized that the Council is a group of close-knit professionals who want to
provide additional support to the Foundation, especially in the legislative area to see that
arthritis is eradicated and people educated about it. She emphasized that the Council
members would want to continue in their efforts even without funding.
Ms. Kowal reviewed goals and objectives for the following year including setting up an
informal arthritis registry as an outreach, especially to outlying areas, to get people
properly channeled to see a specialist as soon as possible after diagnosis. She
emphasized that the Council is composed of many committed people with outstanding
ideas and has only had a chance to hold one meeting out of six planned so far this year.
Ms. Kowal urged the Committee to allow the new Council members an opportunity to show
the State what it can do.
In response to Representative Foster's inquiry about how much the Council collaborates
with the Foundation, Ms. Kowal acknowledged it collaborates functions a great deal and
noted some members of the Board are also members of the Foundation.
Senator Day related that in a recent conversation, Ms. Riggs indicated the Council expects
no additional funding from DES and is working with the Foundation to obtain matching
funds.
Representative Horton voted against the recommendation because she had remaining
questions and felt uncomfortable about terminating the Council when Ms. Riggs could not
be present to respond.
October 23, 1996
Page 7
HEALTH COMMITTEES OF
REFERENCE SUNSET REVIEWS
Representative Gerard moved that the Committee of Reference
recommend to the full body the termination of the Arizona Governor's
Council on Arthritis and Musculoskeletal Diseases. The motion
CARRIED by a voice vote.
Representative Horton read a recommendation from the preliminary sunset report stating
the "Arizona legislature should increase funding" and read from goals and objectives,
noting the Council asks for a "full match of State funding to pUll down maximum federal
funding for DES."
Senator Day acknowledged Ms. Kowal's dedication and that of Council members, and
suggested they may enjoy the status of being appointed by the Govemor. She suggested
that if members are dedicated enough, they can pursue their goals independently.
Senator Brewer voted against the recommendation, asserting that not enough information
was received to warrant termination and suggested the Council should be continued for
one year so it could be clearly established whether money should come out of DES to fund
it or not.
In response to Representative Horton's suggestion that the Council fundion as an advisory
committee to the Foundation, Ms. Kowal explained the Foundation, based in Atlanta,
Georgia, already has quite a few committees in place and questioned whether a particular
state's Governor's Council could become an advisory committee, suggesting this would
probably taking quite a bit of convincing.
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Representative Horton expressed her concern the Committee does not meet frequently
enough as it is and needs to meet more often.
Representative Aldridge agreed there is no longer a need for the Committee and Senator
Day withdrew her previous recommendation.
JOINT LEGISLATIVE COMMITTEE FOR THE ARIZONA HEALTH CARE COST
CONTAINMENT SYSTEM (AHCCCS)
Senator Day stressed the need to continue this Committee, recommended doing so for ten
years and recommended changing the statutory requirement of meeting four times a year
to "meeting at the discretion of the co-chairmen."
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HEALTH COMMITTEES OF
REFERENCE SUNSET REVIEWS
October 23, 1996
PageS
Kitty Boots, Senate Research Analyst, explained the Committee charge is to conduct
negotiations relating to all agreements with the federal government and the State
concerning Title XIX programs, to review and make recommendations concerning all
proposals for additions or modifications to populations covered or services provided by
AHCCCS or any state agency providing services to populations eligible under Title XIX.
She additionally explained the Committee is charged with monitoring the implementation
of additional fees and modifications including the review of preadmission screening
instruments, the eligibility and enrollment system and the service delivery system. Ms.
Boots indicated the Committee is also to review the implementation of the hospital
payment methodology and must review and approve all hospital rate changes before the
implementation of changes in hospital rates.
Ms. Boots indicated the Committee has met six to seven times over the past six years to
address issues, including those listed on page two of the preliminary sunset report (filed
with original minutes). She noted the Committee is required by statute to meet at least four
times per year and this charge has not been met.
Ms. Boots noted there are ongoing projects the Committee may choose to review, including
reviewing and holding public testimony on the rules proposals for the new AHCCCS
reimbursement pilot project, reviewing the impact of the newfederal welfare reform bill and
reviewing the impact of pending initiatives should they pass in the November election.
Representative Gerard asserted the Committee is not necessary and recommended using
the Joint Legislative Health Committees of Reference to treat AHCCCS issues. She
acknowledged there was a need for the oversight when AHCCCS first started up and
received its federal waiver, but the need has run its course.
Respectfully submitted,
(Tape and attachments on file in the Office of the Senate Secretary)
Without objection the meeting was adjourned at 10:30 a.m.
October 23, 1996
Page 9
Alice Kloppel,
Committee Secretary
Representative Gerard moved the Committee of Reference recommend
to the full body the termination of the Joint Legislative Oversight
Committee on the Arizona Health Care Cost Containment System
(AHCCCS), expanding the scope of the Joint Legislative Health
Committees of Reference to encompass dealing with questions
concerning AHCCCS. The motion CARRIED by a voice vote.
HEALTH COMMITTEES OF
REFERENCE SUNSET REVIEWS
.1
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ATTENDANCE LIST
(Section E)
BILL NO.
Hearing Room NO •...,:f7"';.- _
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STATE OF ARIZO:"A
1700 WEST W ASHINCTON. PHOENIX. ARIZONA 85007 • (602) 542-4331
EXECLJTIVE OFFICE
Public Member
293-2843 (H) /626-6041(0)
Term Expires: 1/18/99
Replaced: Reappointment
Member wiArthritis
542-4225 (0)
Term Expires: 1/18/99
Replaced: Willard Page
Member w/Arthritis
624-1375 (H)
Term Expires: 1/18/99
Replaced: Ken Jacuzzi
Advisory Member-Arthritis
Foundation Representative
264-7679 (H)
Rheumatologist
759-0716 (H) /234-3434 (0)
Term Expires: 1/19/98
Replaced: Reappointment
ProfessioEUUJRheumatologist
246-1964 (0)
Term Expires: 1/19/98
Replaced: Leanna Crosby
Advisory Member - Dept of Health
Services Representative
230-5881 (0)
Paul H. Caldron, D.O.
3330 N. Second Street
Phoenix, AZ 85012
The Honorable Carolyn Allen
Arizona House of Representatives
1700 W. Washington
Phoenix, AZ 85007
Lee Brest
1926 E. Granito Vista
Tucson, AZ 85713
Carol Chamberlain
777 E. Missouri, #119
Phoenix, AZ 85014
ADVISORY COUNOL ON ARTHRITIS & MUSCULOSKELETAL DISEASES
A.R.S. 41-971 /972
Michelle Cornett
4737 N. Geronimo
Tucson, AZ 85704
Dr. Timothy Flood
1400 W. Washington
Phoenix, AZ 85007
Oscar Gluck, M.D.
AZ Rheumatology Center
6036 North 19 Ave, #312
Phoenix, AZ 85015
FIFE SYMINGTON
Governor
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ARTHRITIS & MUSCULOSKELETAL ADV COUNCIL
PAGE TWO
Cele Kennedy
505 W. Solano Drive
Phoenix, AZ 85013
Pami Kowal
7921 E. Willetta Street
Scottsdale, AZ 85257
Dodie M. Londen
33 Biltmore Estates
Phoenix, AZ 85016
Barbara Matia
4829 East Beryl A venue
Scottsdale, AZ 85253
Dr. Francis Nardella
10599 N. Tatum Blvd, #F-150
Paradise Valley, AZ 85253
Lori Pearlmutter - Chair
Post Office Box 23803
Flagstaff, AZ 86002
Gail Kershner Riggs
3011 N. Palomino Park Loop
Tucson, AZ 85712
Dr. Barry Sauer
1800 E. Van Buren
Phoenix, AZ 85006
Member w/Arthritis
277-3713 (H)
Term Expires: 1/20/97
Replaced: Reappointment
Member wIArthritis
946-6172 (H)
Term Expires: 1/18/99
Replaced: Ed Lynch
Member w/Arthritis
956-7971 (H) / 957-7770 (0)
Term Expires: 1/19/98
Replaced: Vacant Position
Member w/Arthritis
951-2028 (H)
Term Expires: 1/19/98
Replaced: Reappointment
Professional Community
443-8400(0)
Term Expired: 1/15/96
Replaced: Dr. Linda Karl
Professional Community
526-5555, X-6613 (H) / 773-2125 (0)
Term Expires: 1/20/97
Replaced: Reappointment
Member wIArthritis
321-0692 (H) /6266854 (0)
Term Expires: 1/19/98
Replaced: Reappointment
Advisory Member •
Harrington Research Center
254-0377 (0)
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ADVISORY COUNCIL ON ARTHRITIS & MUSCULOSKELETAL DISEASES
PAGE THREE
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..
Noreen Shcolnik
1789 W. Jefferson, #930A
Phoenix, AZ 85007
Dr. David Wayne Smith
c/o Arthritis Foundation
6464 E. Grant
Tucson, AZ 85715
Dr. John Szivek
Arizona Health Sciences Center
1501 N. Campbell
Tucson, AZ 85724-5064
Carol Wilson
8815 East Snyder
Tucson, AZ 85747
Kelly Wyland
3935 Tanyuri Drive
Tucson, AZ 85715
David E. Yocum, M.D.
Health Sciences Ctr, RID 6409
1501 N. Campbell Avenue
Tucson, AZ 85724
Vincent Kelly
DE5-RSA
1789 W. Jefferson, 930A
Phoenix,AZ 85007
Rev. 7/17/96
Advisory Member-Dept of
Economic Security Rep
542-3332 (0)
Professional Member
290-9090 (0) / 529-0155 (H)
Term Expires: 1/20/97
621-9118 - FAX
Replaced: Reappointment
Public Member
626-6094 (0)
Term Expires: 1/19/98
Replaced: Unda Brickman
Parent of Child w/Arthritis
290-9090 (H)
Term Expires: 1/19/98
Replaced: Kathleen Acciaioli
Person w/Arthritis
722-0940 (H)
Term Expire: 1/18/99
Replaced: Beverly Bulla
Adv Member-Rheumatology
Dept - Dniv of AZ
626-6041 (0)
Replaced: Dr. Eric Gall
Council Liaison
542-2595 (0)
The meeting was convened at 12:20 p.m. by Lori Pearlmutter, Chairperson.
Introductions
Members and guests introduced themselves.
Staff
David Beard
Grace VanWinkle
GOVERNOR'S COUNCIL ON ARTHRITIS & MUSCULOSKELETAL DISEASES
Minutes
November 9, 1994
Members Absent
Kathleen Acciaioli
Linda Brickman
Beverly Carol Bulla
Leanna Crosby
Tim Flood
Eric Gall
Eddie Lynch
Willard Page
Members Present
Paul Caldron
Carol Chamberlain
Michelle Cornett
Cele Kennedy
Barbara Matia
Francis Nardella
Lori Pearlmutter
Gail Kershner Riggs
David Wayne Smith
Old Business
Lori Pearlmutter reported that she has received a letter from the Arizona
Department of Health Services in response to her request for $5,000 in
grant money. The grant request was denied, but the Department of Health
Services offered to provide technical assistance in seeking funding from the
Arizona Disease Control Research Commission in the future. (A copy of this
letter is attached.)
Guests
Gail Ebeltoft, University of Arizona
Denise Hanton, Occupational Therapist, Flagstaff
Linda Olson, RSA Planning & Evaluation Manager
Richard Porter, AZ Department of Health Services, Phoenix
David Yocum, University of Arizona
Approval of Minutes
A motion was made by David Wayne Smith and seconded by Cele Kennedy
to approve the August 16, 1994 minutes. The motion carried by unanimous
vOice vote.
Dr. David Smith reported on the "Unfunded Federal Mandate" issue that
was discussed and voted on at the last meeting. Dr Smith reported that it is
among a number of unfunded federal mandate issues that will be prioritized
by the Governor's office and the legislature to take forward in a court case.
Dr. Smith will report on the timetable of this lawsuit at the next Council
meeting.
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Dr. Yocum reported on a population cluster in Nogales, Arizona who appear
to have a high rate of lupus and multiple myoma in a small area only two or
three blocks from the Mexican border. This area is in close proximity to an
old landfill/garbage dump. Additionally, investigation in an area south of
Tucson showed ground water contamination which also caused toxic
exposure. He feels there is a possible strong association with these
locations to lupus, cancer and infectious diseases that needs to be
examined. Dr. Yocum suggested that the Arthritis Council be spokespeople
for those affected by these problems and that the Council needs to take a
pro-active role regarding this issue. He suggested the Council obtain more
information, look at ways to intervene as an educated advocate, and report
on these issues to the Governor. Discussion followed. Dr. Smith asked that
the next Council meeting be held in the Nogales or Tucson area, and that
locally involved professionals be invited to make presentations at the
meeting to further investigate this issue. Larry Clark, Bridgett Walsh, Leslie
Boyer and Cecelia Campillo were suggested as presenters. Dr. Yocum will
set up an agenda, and the Council will meet at 4:00 p.m. on February 8,
1995 at the Medical School in Tucson. Further details will be sent out with
next meeting notice.
Dr. Smith inquired about Ms. Pearlmutter's letter to the federal RSA and to
the Arthritis Foundation in Atlanta regarding Order of Selection in other
states. Since she has not received a reply, he asked that she re-send the
letter to Ms. Mary Long at the Arthritis Foundation and to Commissioner
Fred Schroeder at RSA.
New Business
Barbara Matia reported that as a result of their meeting in Washington in
1982, Senator DeConcini has now introduced a bill to establish Cooperative
Units of Research in Infectious Diseases. (Copy attached.) The Senator has
made a commitment to her that it is his No.1 priority to see this bill is
passed. She enlisted the support of the Council to get this important bill
passed. Ms. Matia will keep the Council informed on this issue. Dr. Smith
recommended that Senator Orin Hatch of Utah re-introduce the bill.
Discussion followed. It was suggested that a request for support (and an
example of a letter of support to a Congressman) be included in the Arthritis
Foundation newsletter along with an article about Ms. Matia's personal
experience with arthritis over the past 20 years.
Ms. Matia also distributed copies of her letter regarding Governor's Arthritis
Council membership. She requested the Council's help in identifying new
member prospects who care deeply about arthritis. David Beard advised
that we need letters of resignation from current members who do not attend
and no longer care to be on the Council. Ms. Matia asked that the Council
redefine the role of the Governor's Council and define the role of individual
members. Lori stressed the Council's advocacy role. Cele Kennedy
suggested memoing the Governor through a staff member about current
Council issues. Dr. Yocum also suggested investigating the possibility of
newspaper and other public relations coverage.
The meeting was adjourned at 2:20 p.m.
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Dea::- Mr. Moses:
GOV:~NOh'SCOUNCIL ON ARTHRITIS AND
MUSCULOSK=LETF.L DISEASES
In states like Arizona, only limited funds are available. RSA
receives state funding and matching funds from the federal
government. Thus, RSA currently serves only the severely disabled.
The amendments now require states to provide vocational
rehabilitation to all disabled individuals, unless RSA can prove
they will not benefit. The amendments also require RSA to provide
se::-vices to the most severely disabled, before others, if only
limited funds are available. This requirement is the most
troublesone.
I a~ writing as C~air of the Governor's Council on Arthritis and
Musculoskeletal Diseases which represents over a half million
people in Arizona Nith Arthritis, to draw your attention to
amendments in the rtehabilitation Act of 1973. These amendments
will cause hardships for the Arizona Department of Economic
security, Rehabilitation Services Administration (RSA) and its
clientele, the disabled citizens of Arizona.
June 2, 1994
Mr. Howard Moses
Ac~ing Commissioner
Rehabilitation Services Administration
u.s. Depar~~ent of Education
400 Maryland Avenue S.W.
Swi~zer Building, #3028
Washington, D.C. 20202-2531
The amendment needs to be changed. Priority should be given to
serving the disabled who are most likely to benefit from vocational
rehabilitation and return to work, whether they are severely
disabled or not. Numerous state-of-the-art systems exist for
selec~ing those disabled persons for whom vocational
rehaabilitation is likely to result in success; that is, gainful
employment. The medical literature clearly indicates that
vocational rehabilitation for severely disabled persons cannot
produce success stories for all of them. Thus, the amendment's
priority for providing vocational rehabilitation to the severely
disabled should be repealed and replaced with a requirement to
evaluate disabled .oersons for their. likelihood for success.
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Howard Moses
Acting Commissioner
June 2, 1994
Page 2
A recent report by the Center for Disease Control has found the
nationwide prevalence of arthritis to be over 20\, with many of
those reporting disability. Many of these people are not able to
receive vocational rehabilitation through RSA because they do not
fit into the category of severely disabled. We do know that these
people are often the ones who will benefit most from rehabilitation
in order to return to gainful employment.
I urge you to reconsider these amendments. It is imperative that
we use our finances wisely to rehabilitate those most able to
benefit and help them to return to work.
Sincerel.y---,-.
_/~' '-;-'. (~
/' - ~..; ,./..-<- .....'v ~.J_'_
"-.-/ ~.~
Lori Pearlrnutter
c~airperson
LP:NW:gv
c:
Governor Fife Symington
Roger J. Hodges
Linda Blessing
Ma!"y Long
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J)i.fea(e PrevrnliOtl Services
Office of Chronic Disease Epidemioloty
Office ofDisability Prevention
For your review, we are enclosing 3 copy of: al the CDC project gl/ldelines that were used to
develop the project design that was submitted with the Continuation Application; aUllJ b) the
proj9ct description
If YOU decide to pr()(;t'tld with the preparation of e respon~o to tne RFP from the Commission.
contact the Commission at 542-'028 to reQuest a copy of the RFP. AftAr you have had an
opportunitY to review the material. please conta~t Dr. Pam Goslar or myself at 542·7340 H
you have decided to proceer1 and would like technical assistan(;t! in the preparation of your
responSA.
PIn IYMII'lC'TON. QOVUJ%a
'''0: D%L&.lNlPO. D.D.s N..
nlllPr.TOl
1400 W. Washington
Pboeu.i.~, Arw.na 85007
(602) 542-7340
(602) 542·1753 FAX
Septp.mber 12. 1994
Lori Pearlmutter. P.T.
Clinicel SupElrvi$or, ThQrapy Services
Flagstaff Medical Center
1200 North Beaver Street
FlagSta ff. Arizona 86001 -31 1e
Dear Lori:
In response to your I.mer of May 31. , 994. the Offico of Disability Prevention did reClll(l!~T
funding in our 1994-95 Continuation Application for I project tn address the secondary
conditions O):o~oc:i3ted with .rthritis. In our reCMT budget negotiations with the Ctlnlers for
Disease Control and Pr~vention. That project was unable to be fumJtld due to decrened levels
of fundinO-While
we are unable to provide support for a proj.ct for the Governor'~ Council on Arthritis
and Musculoskoletal Diseases. we would be willing to tlrovide technical assistance ttl your
Council if you are interested in sp.p.lcing funding from the Arizona Disease Control Research
Commission. Th~ c1Acision would need to be madtl Quickly as the due date for the propo~3ls
IS October' 4. 1994.
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Old Business
Introductions
Approval of Minutes
Members and guests introduced themselves.
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Members Absent
Kathleen Acciaioli
Linda Brickman
Beverly Carol Bulla
Leanna Crosby
Tim Flood
Eric Gall
Eddie Lynch
Francis Nardella
Willard Page
Gail Kershner Riggs
Guests
Gail Ebeltoft
David Yocum
Staff
David Beard
Grace VanWinkle
A motion was made by Cele Kennedy and seconded by David Wayne Smith
to approve the May 24, 1994 minutes. The motion carried by voice vote.
MMWR Report - Since Dr. Flood could not attend this meeting, the
discussion of the Morbidity and Mortality Weekly Report of 5/6/94
scheduled for today's meeting was tabled until the next meeting of the
Council.
. . ,
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The meeting was convened at 2:05 p.m., via a telephone conference call,
by Lori Pearlmutter.
GOVERNOR'S COUNCIL ON ARTHRITIS & MUSCULOSKElETAL DISEASES
Minutes
August 16, 1994
Lori Pearlmutter reported that she has sent a letter to Ann Tarpe,
Department of Health Services, Disability Prevention Office, requesting
$5,000 to begin a pilot study for the Governor's Council on Arthritis and
Musculoskeletal Diseases to determine accessibility to rehabilitation. The
previous study determined that half a million people in Arizona have
arthritis. Cele Kennedy commented that the same study was published, in
part, in the latest issue of Arthritis Today. Carol Chamberlain volunteered to
get copies of that study to Council members.. Dr. Smith questioned the term
n rehabilitation n in the study. Ms. Pearlmutter said that the Council is
Members Present
Paul Caldron
. Carol Chamberlain
Michelle Cornett
Cele Kennedy
Barbara Matia
Lori Pearlmutter
David Wayne Smith
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write to members who have not been attending meetings and let them know
that a letter of resignation is needed if they do not wish to continue serving
on the Council. Discussion regarding potential new members followed.
Recommendations from the Council were requested. Barbara Matia will let
the Council know what categories of openings are available.
New Business
Council Meeting Dates - Lori Pearlmutter suggested the Council use
teleconferencing twice a year and have two meetings where we meet face­to-
face. Council members agreed. The next Governor's Council meeting
will be Wednesday, November 9, 1994 at 12 noon at the Arthritis
Foundation in Phoenix. It will be a luncheon meeting. It was decided that
next year's meetings should be as follows:
1. Wednesday, February 8, 1995, 2:00 p.m., teleconference at the
Arthritis Foundation in Phoenix.
2. Wednesday, May 10, 1995, at 2:00 p.m. in Casa Grande.
3. Wednesday, August 9, 1995,2:00 p.m. a teleconference at the
Arthritis Foundation in Phoenix.
The meeting was adjourned at 3: 15 p.m.
Epidemiological study
The meeting was convened at 2:15 p.m. by Chairperson, Lori
Pearlmutter. Introductions were made.
There were no corrections to the minutes. They will be voted on at
the next meeting when there is a quorum.
Governor's Council on Ar~hritis and Husculoskeletal Diseases
Kinu~es
Kay 24, 1994
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Absent
Kathleen Acciaioli
Linda Brickman v
Beverly Carol Bplla
Michelle Cornett
Leanna Crosby
Eric Gall
Eddie Lynch
Barbara Matia
Francis Nardella
Willard Page
Gail Kershner Riggs
Barry Sauer
David Wayne smith
Members Present
Paul Caldron
Carol Chamberlain
Tim Flood
Cele Kennedy
Lori Pearlmutter
staff
Nancy W.ashburn (for Noreen Shcolnik) ~
.J.)- -J:::' '::::' ~ - r ~
Tim gave copies to the members of an excerpt from the May issue of the
Morbidity and Mortality Weekly Report which reproduced the results of
a survey done by the Arizona Department of Health Services giving the
most up to date statistics on persons with Arthritis in the State of
Arizona, (1991-1992). He went over the highlights of the results,
which included the number of estimated cases in Arizona, 567,000, and
data on persons' activity limitations. These statistics were based on
a survey of persons who self-reported and were doctor diagnosed.
Copies of the report will go out with the minutes and agenda. Tim
will also provide a cover letter for the report explaining some of the
statistics.
Tim added that the Center for Disease Control (CDC) and the other
states participating in this stUdy will be presenting this information
to two national meetings and the CDC will be proposing that other
states do similar studies, thus Arizona being a leader in this effort.
Tim asked for members' feedback to the Center for Disease Control on
how the committee would use this information. Lori responded that
this data will be helpful in writing letters to legislators and others
for support of issues and projects.
Tim then proposed that the council ask Arizona's Department of Health
Services' Office of Disability Prevention for $5,000 to fund a
research project on Arthritis' secondary disabilities, specifically to
explore and better define the causes of the secondary disabilities.
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with input trom research people at one or two ot the universities,
Lori will draft a letter, get Tim's input, and send.
RSA update
Lori reviewed the history of and updated members about the two letters
that the Council was going to send out regarding the 1992 Amendments
and the Order of Selection. A letter asking the state legislature to
support additional funding to RSA was not sent this year because
specific amounts needed were not available from RSA.
Lori reported that she met with Roger Hodges today and that he is
willing to work with the Arthritis Council on these projects and will
be asking all councils to send support letters on critical RSA issues
such as the Amendments and Order of Selection.
Lori then presented a draft letter regarding the Amendments and Order
of Selection. Suggestions of changes to the letter were made and Lori
will rewrite the letter and send. Per Carol's suggestion, she will
find out from Roger the key people to send this letter. The target
date to send will be June 3, 1994 and copies will be sent to the
Governor, Roger Hodges, Linda Blessing, Director of DES, and Mary
Long, Vice President of Government Affairs of the National Arthritis
Foundation. In addition, Cele will take a copy to the Disability
Prevention council. She stressed the importance of changing the Order
of Selection for people with Arthritis who rarely would be at the top
of the priority list as it stands now.
Membership
Since Barbara has been unable to get a response from non-attending
members, she will be sending a letter out after this meeting to them,
giving them two weeks to respond. If there is no response, they will
be taken off active membership. The committee concurred with this
action, and Lori confirmed that the by-laws do state that three
consecutive absences without good cause will be considered "intent to
resign". There was a brief discussion on how new members are
appointed.
The members then had a discussion about having meetings done through a
conference call. Nancy will look into this option for the August
meeting. In the meantime, however, Carol recommended that members be
more responsive in their RSVPs to the meeting. If the meeting is not
on conference call and the RSVPs indicate that the majority of the
members will be coming from a particular area, that the meeting be
held in that area, as long as the public meeting notice would be
posted at least 48 hours before the meeting with the accurate meeting
location.
Statute Change
Cele states she believes the Council's recommended changes to the
statute passed in the legislature. Carol will call one of the
legislators to verify, and if it did, copies will be sent to members.
New Business
Lori recommended that the annual report be changed to a biannual
report. The one for '93-'94 would be submitted in November '94. Lori
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asked Tim to write an update on the Epidemiological issues and she
will do one on the RSA ~ssues. She also asked members to think of
other items that might be in the report.
Lori related that the Institute for Human Development at N.A.U. is
asking for Council members' input on needs for assistive technology
information or services because they are going to be writing an J assistive technology grant. Lori took down suggestions and will shar
these with the Institute. Per Carol's suggestion, she will also ask
them if a list of what assistive technology resources and equipment
that has been provided is available and if it is, to send it to the
Council.
The next meeting will be on August 16th either in Casa Grande or by
telephone conference call.
Nancy informed the members of an RSA and ARA (Arizona Rehabilitation
Association) joint conference, open to interested parties, on August
10-12 in Phoenix. She will send registration information to all
members when it's available.
Tim also added that since Arthritis has been asked to be added to the
disabling conditions studied by Office of Disability Prevention, that
this Council consider supporting a pOlicy issue package by the
Division of Disease Prevention asking for the state to fund this
office, once its federal funding dries up in two years. The package
will be given to the Director and then, if approved, would go to the
Legislature for consideration.
havel
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Tim asked members for a source for public information on Lupus to
available to citizens attending an information sharing open house
June 17 & 18 in Nogales, where many people have contracted Lupus.
on by the Department of Health Services and Department of
Environmental Quality, this will be a time for them to meet with
physicians to get information. Carol will provide him with printed
materials and suggested a person to attend who can inform them as
well.
Next Meetinq
Lori asked that if anyone had not filled out and sent in their
networking information to Barbara Matia, to please do so.
The meeting was adjourned at 3:45 p.m.
Dear Lori:
- Leadership for a Healthy Arizona -
Enclosure [CDC: MMWR V43i(17)i30S-9: 6May1994]
I am sending you a report of a survey that estimates the number of
persons in Arizona who have arthritis. This is the first pUblished
survey that uses data obtained directly from Arizonans.
Specialist
FIFE SYMINGTON. GOVERNOR
JACK DILLE.""BERCi. D.D.S.• M.P.H•• DlREcroR
DATE RECEIVED
NAY 27 19
REfJArot 94
'1110. S~C AD
. MIN.
Disease Prevention Services
Office of Chronic Disease Epidemiology
1400 West Washington Street
Phoenix, Arizona 85007
(602) 542-7333
May 26, 1994
Lori Pearlmutter, R.P.T., Chairwoman
Governor's council on Arthritis and
Musculoskeletal Disorders
c/o Nancy Washburn, M.A., Community Education
Department of Economic SecuritYi RSA
1789 W. Jefferson
Phoenix, AZ 85007
This survey estimates that 571,000 Arizonans have been told by a
doctor that they have some form of arthritis. As described in the
report, ADHS obtained the data by telephoning 1,847 Arizona adults
in 1992 and asking them whether they have some form of arthritis,
gout, bursitis, tendinitis, or lupus. We also asked whether they
had been told this by a doctor. Persons who said "yes" to both
questions were counted as having arthritis.
Table 1 of the report stratifies the estimated 571,000 cases by
various factors (age group, race, sex, obesity status, and
educational level). The Arizona data is very similar to data
obtained in Ohio and Missouri.
I hope this information is helpful to the Council as you deliberate
ways to help this needy group in Arizona. Please let me know if
you find this information useful or if you would like additional
analysis of the data.
Of particular importance is the activity limitation of persons with
arthri tis. The Table shows that 13.3% of Arizona's cases are
limited everyday or almost everyday by their arthritis. This is a
significant number of persons who are affected, often resulting in
lost prOductivity, not to mention pain and disability.
Sincerely,
--r~-IIu;,~I ~D
Timothy J. F~Od, M.D., Medical Director
Office of Chronic Disease Epidemiology
:(
1,1;-/-
Arizona .. ='ri~
Department of
Health Services
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National Arthritis Month - May 1994
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May 6, 1994/Vol. 43/ No.17
30S Naliona. ArulriIis Montrl- May 19M
30S Prevalence of Armnlis - AnzoN.
MissourI. ana Ohio. 1991-1992
309 reranus - i<Mlus. 1993
311 Marernal Hepemis 8 Scntening
Pm:nCft - c.Ii'omie. Connec:rlC\lt.
~nus. ana U..ea Sr.rn. 1992-1993
321 Notices to R..aers
323 Montnly 'mmulllUDOn rable R MORS/D/lYAND MORTAUlY WEEKLY REPORT M
May is National Arthritis Month. During this month, nationwide educationalactivi­ties
are planned to increase awareness of arthritis. Additional infonnation about
arthritis and addresses of local chapters are available from the Arthritis Foundation,
P.O. Box 19000, Atlanta, GA 30326; telephone (800) 283-7800.
.- -.
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Current Trends
Prevalence of Arthritis ­Arizona,
Missouri, and Ohio, 1991-1992
Although regional and national data about arthritis can be used to develop syn­thetically
derived measures of prevalence for states (1 ), few state surveys exist for
determining the prevalence and impact of arthritis at that level. To measure state­specific
prevalences, during 1991-1992 Arizona, Missouri. and Ohio added Questions
about arthritis to their Behavioral Risk Factor Surveillance System (BRFSS) surveys.
This report presents BRFSS-derived estimates of self-reported prevalence of clinically
diagnosed arthritis in these states and characteristics of adults who reported this dis­order.
The BRFSS is a state-based, random-digit-dialed telephone survey that collects
self-reported data from a representative sample of civilian, noninstitutionalized per­sons
aged ~18 years (2). BRFSS data were analyzed from 4688 persons who resided
in Arizona (n.1847), Missouri (n.1509), and Ohio (n.1332). In Arizona, respondents
were asked if they currently had some form of arthritis. gout, bursitis, tendonitis, or
lupus and if they had been told this by a doctor. In Ohio, respondents were asked if
they ever had been told by a doctor that they had any of those conditions. In Missouri,
respondents were asked if they ever had been told by a health professional that they
had arthritis. For the purpose of this report, persons who answered ·yes" to any of
these Questions were considered to have arthritis. Respondents in Arizona and Ohio
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES I Public Health Service
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301 MMwn Mlly8.1994 Vol. 43 J No. 17 MMWR 309
Atfh"". - Contlnu.d
elso were Islled how often Irlhrilis prevented Ihem from performing work or parllcl·
petlng In loclal acllvilies.
rrevllence rntos Q' erlhrills wero 20.5% in Arizonn. 23.7% In Missouri. Rnd 24.5% In
Ohio ITnllle 11. rrovnlollCo Illcreosnd with n!ln, Rnd hnlf 0' rn!lllOlldollts ngod ~75 yoms
were eUoclod. For el<nmplo. In Missouri, 9.7% of I)OrSOIlS aged 18-44 yeors reportod
hevlng llllhrills, compared with 58.4% of persons oged ~75 years. Ago·adjusted preva­lence
reles wore higher for whllell, women, and overwelghl adults (men: body mass
Indel< IBMII ~27.8; women: BMI ~27.31. 01 persolls who reporled having orlhritis, 47%
In Arlzone end 46% In Ohio reporled limited oclivlly. Acllvlly IImilalions occurred
every dey or elmoll every day 'or 13% III Arizona and 14% In Ohio.
ntlpo".rl by: TJ rloorl, AfD, J C(I/",elu. rllD, Plv of Dlsnmu, r""""",o", /lr'1OII" DOl" of lI"n/l/,
Svc:•. J J.dsall· 11,o",,,so,,, rl,LJ, J nnr,nM. MS, nc BrnwlIllOII, 1"'0. Dlv of C'ItO,,'C D'~fln5e
_ ",ev'''''on ,"rl II"."Ir r/olllol/o". MI5S01/f' 0011' of 1I0nl",. E C"pwell, I'M). BII' of Cillollic
01"..... 01,100"", of 11"./1/'. 8elt.vlorl' Risk r"c,o, Survelll,,"cff 8r; Office of SlIIv.lII"nc" .IId
An,'Y."; S"".'Ie. 8, .IId /lpillp S'udl". Br; Dlv of CllIo,,'c Dlse.se Con'rol "lid Communl'y
'n'ervenl/on, N"IIon.1 C.nr., fa, CIt,olllc Dlse.5. Prev.n"on .nd Hell"" P,omo"on. CDC.
Edltorl.1 Not.: Allhough Ihere are few comparahle slole surveys 10 verify Ihe validity
of Ihese ..sulls, el leesl Iwo observollons cen he mode hy comparing Ihese findings
wllh nellonel resulls. First, Ihe pnllerns of erthrltis prevolence presenled In Ihis reporl
wllhln ege end SOl< groups are cOllsistenl wilh Ihoso In nolional studies 131. Second,
whon prevalence eSlll11Rloll for self·roporled arthrills 'rom Ihe 1989-1991 NotionAl
Heallh Interview Survey INIIISI 'or persons aged ~18 yenrs are applied 10 Ihe Ihree
,Iala populations la'ier adluslrnenl 'or region, age. sel<, race. and Ilisponic origin), Ihe
prevalences are lower Ihan Ihose In Ihls report IArlzona, 19.8% versus 20.5%; Mis­,
ourl, 19.9% versus 23.7%; and Ohio, 19.5% versus 24.5%1. Possible reasons for Ihese
differences are Ihal Ihe surveys' or Ihe respondenls' deflnilions of arthrilis diUe,
across slales or across surveys or beCAuse Ihe BRFSS Is more likely Ihan Ihe face-Io­fnce
Inlervlews of Iho NllIS 10 result In overreporting. In addillon, Ohio's and
Missouri', BRFSS qUflsllons on nrlhrilis asked aboul lifetime occurrence 0' arthritis,
whereas the NIIiS askod ahoulthe preceding 12 monlhs.
Possible reesons 'or slllle,sflocific diflerences Includa sampling error; dirreroncos
In demogrephlc composition; or vnrlatlon In Ihe unmeasured demographic, occupa­1I0nal,
or olher characlerlstlcs of respondenls. ro, eXAmple, some respondenls mny
have moved 10 a slale because Ihey believed Ihe climale and/or Rvailable services
mlghllmprove Iheir henllh. Tho vorinllon mny nlso rorloci dirrerencos in Ihe wny Ihe
quostlon" worn nskod; " lllnl1rlnlflilorl C1l1nsliol111nlro would rosolvn Ihl!! pr ohln",.
Oall collocled Rltho slnto lovol will holp 'OCIIS OflfllOlHlnlo Illtorvontlolls nud PIO'
vlmtlon meRSIIIOS 141. Such Intcrvolliions should Include slnlo erlhrills progrnms Ihnt
malle diagnostic, Irentmonl, education, and rehahililntion services accessible 10 per­Ions
wllh arlhrlll!! IS) Rnd Ihol promole primnry-provenlion mensures based on
Ilnowledge of risk fnclors, such os avoiding loilll trAuma, prevonting obesity, And
modifying occupationally relaled jolnl slress through ergonomic approachos (6).
These services cnn rcduce musculoskelotal damage, pain, and disability and substan­tlllly
Improve heRlth 17).
Slales have used Ihe BnFSS 10 I11casure Iha prevalence and impaci 01 sell reported
risk behaviors le.g., smoking) and chronic diseRses (e.g., dinhetos and hyperlonsion).
Thl BRFSS questions about arlhrilis mov have Ihe snrne ulilily and can provida
Atflrrifi. - Continued
arthritis dolo about special populations le.g., Hispanics and olher mlnorilY groups)
that may have different disease frequency than Ihe general population. Siale heRlth
deportmenls can use such dala 10 develop a h8811h plan for arthritis and 10 set arthri­tls-
relaled heallh objectives 14,8,91.
nof%llcoS
1. CDC. Prevalenca of arthritic conditions-United Stales. 1987. MMWR 1990;39:99-102.
2. Slegfli Pl. Waller MN, Frazier El. Marlolls P. Bahavloral Risk Factor Surveillance Sy5tem: slIm­mary
of data for 1991. In: CDC lurv.lllanc. lummarl.s IAugust). MMWR 1993;42Ino. 5S-41:
23-30.
3. Cunningham l5. Kelsey Jl. Epidemiology of musculosk.letallmpalrments and associated dis·
ability. Am J Public H.alth 1984;74:574-9.
4. US COlnmlllea for the Study of Ihl Future of Public Health, Instilute of Medicine. The future
of puhllc hoolth. Washington, DC: Nntlonal Acodemy Pr.... 1988.
5. CDC. Arthritis program-Missouri. MMWR 1988;37:85-7.
8. Scoll JC, Hochberg Me. Arth,ltl. and other musculoskeletal diseases. In: Brownson nc,
nemlngton Pl, David JR, .d•. Chronic dlseasa epld.mlologv and control. Washington. DC:
American Public Health Assocl.tlon, 1993:295-305.
7. Fries JF, Spitz PW. Tha hierarchy of patient outcomes. In: Spllken B. ed. Ouallty of life assess­ment
for clinical trials. New York: Raven Press, 1990:25-35.
8. Shnrp GC. Signsen BH, Hazelwood SE, Half PJ, Oliver CL, Smith C. The Missou,l Arthritis
rroorllm-Ieglslatlon, Implementation, and funding a regional centers prog,am. Mo Med 1988;
85:79-t13.
9. CDC. Ch,onlc dlseasa prevention and conl,ol activities-United States. 1989. MMWR 1991;
40:697-700.
Epidemiologic Noles Bod Reports
Tetanus - Kansas, 1993
In 1993, Iwo totonus cases· were reporlod to Ihe Kansos DopBrtmont of Hen"" nnd
Envlronment-Ihe first cases reported in Ihe stala since 1987. This reporlsummarizes
Ihe findings of Ihe cese Invesligalions.
Patlenl 1
On May 16, an 82·year-old man wilh a history of chronic obslructive pulmonAry
disonse nnd rocllrronl pneumonia was token 10 a hospltol emorgenr.v dopnrlmont ho­COlIllO
0' sho/tlloss 0' breath and Inablilly to gel 0111 0' bed. On Mny 16, ho hAcl hnd
dirrlcully chewing and swallowing. EKRmlnalion noled trismus l"lockjaw") and on
abrasion on Ihe righl elbow, which resulted from a fall on MnV 14. The palienl was
odmitted to tho hospital wilh a diagnosis of tetanus. 110 hod not boon provlously VAC­cinnted
with tetanus toxoid. Treatmont Included tetanus tOl<oid 10.5 cel and telonus
imlTluno globulin lTIGI (10,000 units).
Whilo hospitnlizcd, tho paliont experiencod generalized tetnnic spAsms, followod
by respiralorv failure and pneumonia. He was placed on mechanical venlilation and
• Bolh met the Council 01 Stele end Terrltorlel Epldemlologlsls/CDC clinical case definition lor
public heallh su,velilance of tetanus: "ecule onset of hyperronla Aml/or pninlul mu~culrtl
contrnctlons /usuolly of the muscles 01 the Jaw end neckl and goneralizcd muscle spA~ms
without other epperent medicel ceuse les reported by a heellh p,o/esslona"" 1'1.
)a I :l
:I-
;:l.
TABLE 1. Weighted number and percentage of persons aged ~18 years who rwported arthritis. by selected c:hanICbtristics - ~
Ohio. 1991.Md Arizona and Missouri. 1992 J
Ariz-. Ohio .-.....n &' I" ~
A..- ~ .... S- Weighted --- w....... ....... Weigtad ..... c:
a-.eteristlc na.- % 195% CM 11'......_·195% 01 ...- % I!!I% CD .....-._.I!!I"" en na.- "" lInoCl ........... It5"" Cl III
~
Ag1e8g-1ro4up 1.".1 178 10.5 I: 2.4%1 5S7 12.5 I: 2.""1 ~ 11.7 (:t2.2%1 1
4S-04 1112 30.3 1:1: 8.7%1 867 31.9 I: 5.""1 329 3Z.8 (:tU%1
65-14 103 38.3 1:1: 9.lWal 530 53.8 1:1: 8.ft.1 213 50.4 (:7.4%1
~75 99 52.0 1:1:10.2%1 1M 411.2 I:lo.n.l 153 58.4 (%9.4%1
"- 1 Whig ~1 21.3 1:1: 2.7%1 21.3 (±Z.8%1 1809 25.4 l± 2.""1 24.3 (±Z.8"-1 825 24.4 (:%.4%1 22.4 (:tz.l%1
Other' 26 11.1 l:t 7.1%1 12.7 (:t6.9%1 158 17.81:1:~1 19.4 (:1:5.6%1 77 18.6 (:t8.9'lfo1 21.4 (:t6.4%1
So I Male 232 17.5 (: 3.5%1 18.6 (:3.3%1 729 19.3 I: :J.5"1 111.0 (:3.3%1 303 11.9 (:%.9%1 17.0 (:%.9%1
Female 339 23.2 (:I: 3.7%1 Z2.3 (:3.4".1 1237 29.3 I: 3.""1 27.8 (±3.4%1 5911 29.8 (.t3.3'llo1 28.8 (:%.",.1
Badym_ = index I Men
W.S 47 19.2 1:1: 7.3%1 183 (±Z3%1 Z08 22.2 l± 7.ft.1 23.7 (:1:5.8"-1 128 23.5 (:1:8.1%1 23.8 (:1:5.1%1
<27.8 180 17.1 I: 3.9%1 18.0 (:1:5.7%1 4115 18.0 l± 3.ftt1 18.0 (±3.7%1 177 14.4 (:3.3%1 15.1 (:1:3.3%1
Women
~7.3 98 32.6 (:I: 9.2%1 32.7 (:t63%1 417 41.5 (:I: 8.«'1 37.2 (:1:9.2%1 ~ 48.5 (:1:8.9%1 38.4 (:t6.lWal
<Z1.3 218 20.1 I: 33%1 19.0 (:3.5%1 738 25.01:1:4.1%1 25.8 (±33%1 341 24.3 (:3.7%1 Z2.3 (:3.2%1 I EduCdion
SSthGradei
Some high
school 114 21.4 (:I: 5.1%1 20.8 (:4.7%1 415 37.6 I: 7.1%1 25.2 (:1:5.8%1 263 42.2 (:1:6.5%1 28.9 (:1:5.6%1 High school I
graduatel
GEO-· 142 19.6 (:I: 4.9".1 183 (:1:4.2%1 898 24.1 1:1: 3.7%1 22.4 (:1:3.4%1 311 22.0 (:1:3.5%1 21.1 (:3.0%1
Some !:
technical J schooV
Some
college 178 18.7 (:I: 4.1".1 20.6 (:1:4.2".1 384 20.61:1:5.1%1 25.8 (:1:5.6%1 194 19.5 (:1:4.1%1 22.5 (:1:4.2".1
cg •
I - -- ... -.--- -
College ~ c l
graouate! So ~
Post- ~ graduate! ~I .. Professional 137 24.0 (:I: 6.5%' 22.6 (:4.8%1 288 20.4 (:I: 5.""1 23.1 (:t6.2%1 133 17.3 (:4.S%1 22.1 (:1:5.5%1 I ~
Ae:tMty &' - limitation ~ ...
Every dayl g. I Almost c:
III fNery day 76 13.3 (:I: 4.3%1 10.8 (:4.0%1 278 14.0 (:I: 3.5%1 9.0 (:1:2.5%1 ~
Once a weeki
Oa:asionally 190 33.3 (:I: 5..9%1 38.0 (:t8.3%1 819 31.5 I: S.5%1 34.4 (:1:7.8%1 I Never 298 52.1 (:t 8.7%1 50.4 (:t83%1 lOll 51.4 l:t 5.""1 52..9 (:1:7..9".1
Total 571 20.5 1:1: z.s""1 20•• (:tz.4%1 1967 24.5 l± z.s""1 23.7 (±Z.4""1 902 23.7 1:1:2.4%1 22.3 (:1:1.9%1
-In thousands. For Arizona. sample size-1847; for Ohio. sample size-1332; and for Missouri. semple size-1509.
'Confidence interval.l..96 X standard error. I IStanoard population tor age. adjusted to the 1980 U.s. census.
'Numbe~ for races other than whita were too smell for ~tate .NIIysis.
-General EduClltion.1 Development CIII1ifiCllbL
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status of Legislation
Epidemiological study Update
The meeting was convened at 2:05 p.m. by Chairperson, Lori
Pearlmutter.
Absent
Paul Cauldron
Carol Chamberlain
Edwin Lynch
Barbara Matia
David Smith
Barry Sauers
Leanna crosby
Cele Kennedy
Kathleen Aciaioli
Carol Bulla
Linda Brickman
Bill Page
Members Present
Tim Flood
Eric Gail
Michelle Cornett
Lori Pearlmutter
Gail Kershner Riggs
Frances Nardella
Ken Jacuzzi
Guests
David Yocum
Bridgett Walsh
Lori advised the council that Cele Kennedy had contacted Lou Ann
Preble, Republician from District 9 who has offered to sponsor
the bill which would change the number in the council's quorum to
the majority of the members. We would also like to eliminate
"advisory" and allow all members to be voting members. In
addition, there is a change to two members from two non-profit
research centers in the state.
Governor's council on Arthritis and Huskuloskeletal Diseases
Hinutes
January 11, 1994
There was a motion and second to approve the minutes from the
October 13, 1993 meeting as mailed. The motion passed. There was
a motion and second to approve the minutes as mailed. The motion
passed.
Bridgett stated that she had discussed the study with a number of
people with experience in grant writing (incl. Dave Yocum and Tim
Flood), and had decided that there needed to be some changes
made. The concern was that if the grant was not approved', she
would have difficulty resubmitting for approval at a later date.
She stated that two NIH reviewers had felt the survey was not
focused enough. Tim Flood had advised Bridgett prior to this
meeting that he had already done a prevalence stUdy based on
random telephone surveys of 2000 homes and shared his finding
with the group. Arizona has an arthritis prevalence rate of 20.5%
which is closed to findings of other states doing the same
survey. Ohio has a rate of 24.5%, and Missouri has a rate of
23.7%. Eric Gall felt this was a surprise as we have always
considered Arizona would have a hig~er prevalence. David was
concerned that many households without phones, specially in rural
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areas were not contacted. Discussion ensued and Bridgett pointed
out that the national figures cited are 10-14%, so that now we
have a higher number to present to legislators. Lori stated that
even if the figures are slightly lower than the two other states
surveyed, we still have a one in five incidence of arthritis with
many of those reporting significant disability. It was also noted
that Ohio and Alabama have major funded initiatives while there
is no state wide effort in Arizona to reach people with arthritis
in terms of health care or disability issues. Tim wished to hold
on sending all the members of the written stUdy until he had sent
it for publication.
The council then discussed what the focus of our survey should be
After some discussion, the council decided that since
approximately 3% of those surveyed by Tim Flood's group cited
significant disability, there is a great economic impact on the
state. Bridgett stated she would look into stUdying the
prevention of disability - specifically secondary prevention (if
the disease itself cannot be prevented, then perhaps
disabililty/impairment can be prevented through education,
therapy, etc.).
Rehabilitation Services Administration - Voc. Rehab. update
Lori stated that she received a letter from David Smith to send
to legislators and the Governor. The issued being a complex one,
Lori stated that she rewrote the letter, after some input from
Roger Hodges. She thought two letters might be more appropriate,
with one recognizing the problems of reduced funding, asking the
legislators for more money. The draft letter was passed to the
members, with some input for changes. Lori will be rewriting the
letter and then sending it to all the legislators, with follow-up
to the chairs of the health committees. Eric Gall agreed to work
with David Smith on a second letter which addresses the problem
of the order of selection, and the problem inherent in assisting
the most severely disabled first without regard ~potential for
rehabilitation. Eric stated that David had research regarding
potential for rehabilitation. He thought it might be more
effective if we go to some national groups such as the Arthritis
and Health Professionals Association, and the American College of
Rheumatology, and ask for their support when we approach U.S.
Senators and Congressman.
Membership Update
Barbara Matia spoke with Lori prior to the meeting, and stated
she would contact all the members who had not been attending and
ask them to resign if they would be unable to attend regular
meetings. She stated she had a few resumes of those interested in
being on the council.
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Next Meetinq
The next meeting will be held on April 12, 1994 at the Casa
Grande Regional Medical Center from 2:00pm-4:00pm.
There being no new business, the meeting was adjourned at 3:55pm.
3
Old Business:
Approval of Minutes
The meeting was convened at 4:10pm at the Arthritis Foundation, 777 E. Missouri
#119, Phoenix, AZ by Lori Pearlmutter, Chairperson. Michelle Cornett, Gail Kershner
Riggs and Carol Wilson from Tucson were hooked up via conference call.
The Missouri Arthritis Program: A discussion was held regarding the Missouri
Arthritis Program which included a Statewide Arthritis Survey. Michelle Cornett inquired
as to how the Missouri Survey compared with what was reported to the Council by Dr.
Flood on the study on the prevalence of persons with arthritis in Arizona done in 1993.
This was a telephone survey of the population which included (1) the estimated number
of persons with arthritis, and (2) the number of persons that are disabled from arthritis.
Beverly Carol Bulla
Paul Caldron
Cele Kennedy
Dodie Londen
Eddie Lynch
Barbara Matia
Dr. Francis Nardella
Willard Page
Dr. David Wayne Smith
Dr. David Yocum
Linda C. Olson, Acting Liaison
Ellen Vercellino, Secretary
Members Absent
GOVERNOR'S COUNCIL ON ARTHRITIS
AND MUSCULOSKELETAL DISEASES
Minutes
October 12, 1995
Members Present
Lori Pearlmutter, Chairperson
Tim Flood
Carol Chamberlain
Oscar Gluck
Michelle Cornett
Gail Kershner Riggs
Carol Wilson
The following corrections were noted in the 7/26/95 minutes, Carol Wilson noted
that under Old Business it was stated that she announced the Arthritis Foundation
presented a Public Education Forum on arthritis. It should have stated that Carol
Chamberlain announced the forum. Also, on page 2, it should read the Council
accepted the offer of the Southern Arizona Chapter to present the two forums planned
for Nogales & Sierra Vista. A motion was made by Gail Kershner Riggs to accept the
minutes with the corrections and they were seconded by Carol Wilson. The motion was
carried.
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Arthritis & Musculoskeletal Diseases
Minutes
Odober 12, 1995
Page 2
It did not address services. The percentage of the general population with arthritis in
Arizona was in close comparison to other states. Arizona did not show a higher
percentage of persons with arthritis. The survey showed that 100,000 persons suffered
with arthritis in the State.
Ms. Pearlmutter mentioned the need for the Council to set objectives. The State
of Missouri has defined what is needed for their state. Arizona has made a similiar
conclusion, even though the same exact survey has not been done. Part of the survey
has been done estimating the number of persons with arthritis in Arizona. Missouri
developed good goals for setting up Arthritis Centers. An Arthritis Board and a State
Arthritis Program Coordinator were established through a paid position by the State.
There are Regional Arthritis Centers in each area.
Gail stated, that in her opinion, Missouri has probably done some of the best work
than any of the states. This could be a model for the Council, if not goals and
objectives. The Council could advocate more on behalf of underserved areas. Also, the
Council advocates for the best Continuing Medical Education for this population. The
Council needs to support this effort. The need to identify potential Arthritis Centers
within the state of Arizona was noted. The goals would be to identify Regional Arthritis
Centers and in conjunction with those entities develop more continuing medical
education, not only in Phoenix and Tucson but in the outlying areas.
Dr. Flood mentioned that the legislature defunded the Area Health Education
Centers. The centers are still in business but funding has been withdrawn.
Carol Chamberlain noted that the Missouri Plan has no legislative advocacy and
that it is certainly the responsibility of the Council to add that as an additional goal.
Lori Pearlmutter stated that it would be beneficial to set one goal to achieve; set a
time to achieve that goal: and then work on the next goal. The Council needs to
establish timeframes and accomplish goals related to their workplan.
Gail reported that there are prepackaged programs that could be used as a
boilerplate.
Carol Chamberlain suggested that the rhuematologists from Phoenix could go to
the outlying areas and ask the hospitals to coordinate a program that they could get
other health professionals involved in.
Dr. Flood stated that there is no central staff person from the Council and it
doesn't look like there is any central agency that could coordinat~eStatewide
conference. Dr. Flood suggested to do a hospital-based one ho CME· pe of program
for their staff physicians. As a Council, a goal should be set for wha IS realistic for the
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Arthritis &Musculoskeletal Diseases
Minutes
Odober 12, 1995
Page 3
next 12 months. Hospitals throughout Arizona should be encouraged to put on a one
hour CME regarding arthritis and its complications and the prevention there of.
The following persons have identified geographical areas that they will contact to
coordinate Continuing Education programs. Carol Chamberlain volunteered the Central
Arizona Chapter to focus on Payson and Prescott; Lori Pearlmutter will contact Flagstaff
and Cottonwood; Carol Wilson, Michelle Cornett and Gail Kershner Riggs will coordinate
Sierra Vista, Casa Grande and Yuma areas.
Gail will send material explaining the program to Lori after Carol Wilson has typed
the Continuing Education Agenda on Rheumatology. Ms. Wilson will have the agenda
to Lori by early next week so it can be presented to the CME person at Marcus C.
Lawrence Hospital. By the end of November a date and topics should be selected. Ms.
Chamberlain will also be able to contact Payson and Prescott in that time frame.
Dr. Flood volunteered to estimate the number of persons with arthritis by county
to present to the CME directors. The information will be forwarded to Linda C. Olson for
distribution to Council members.
Ms. Chamberlain suggested that the National Arthritis Foundation submit a plan
for CME and take it as a traveling show; and that an information and referral service for
people with arthritis in the state be established.
By doing the CME programs in the outlying areas, the possibility of recruiting new
persons for the Council was mentioned. Anyone interested in participating would be a
potential Council member.
Ms. Pearlmutter noted that she felt a more productive approach would be to
select a project, set timelines, and meet as a Council as many times as necessary to get
that project completed.
Ms. Pearlmutter also stated that she probably will be resigning as Chair but that
she still would like to be involved in the Council.
New Business
Access to Care Issues: Dr. Smith was not available to present, but he would
like to present at the next meeting.
Next Meeting Date: The next meeting will be a short teleconference on January
10 at 4:00pm.
Arthritis & Musculoskeletal Diseases
Minutes
October 12,1995
Page 4
Call to the Public
There was no public comment.
Adjournment
A motion to adjourn was made by Dr. Flood and seconded by Carol Chamberlain,
and the meeting adjourned at 5: 16pm.
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Introductions
Old Business
Members and guest introduced themselves.
Approval of Minutes
Members Absent
Beverly Bulla
Michelle Cornett
Timothy Flood
Dodie Londen
Eddie Lynch
Willard Page
Gail Kershner Riggs
David Yocum
Staff
David Beard, Council liaison
Ellen VercelJino, Secretary
Members Present
Lori Pearlmutter, Chair
Barbara Matia
Cele Kennedy
Francis Nardella
David Wayne Smith
Carol Wilson
Carol Chamberlain
Oscar Gluck
Paul Caldron (Phone Hookup)
Guests
Becky Rebenstorf
GOVERNOR'S COUNCIL ON ARTHRITIS
& MUSCULOSKELETAL DISEASES
MINUTES
JULY 26, 1995
The meeting was convened at 12:40pm at the Phoenix Arthritis Foundation by Lori
Pearlmutter, Chairperson.
Dave Beard announced his re-assignment within ARSA and that he will no longer
be Council Liaison. He stated that he would be leaving following the August
meeting. Mr. Beard expressed his regret at leaving the Council but was looking
forward to his return to working with blind people.
Carol Wilson announced that the Arthritis Foundation presented a public education
forum on arthritis in Spanish on July 20, 1995, at. the Guad~~upe Senior Center.
A motion was made by David Wayne Smith and seconded by Cele Kennedy to
approve the minutes as mailed. The motion carried by unanimous voice vote.
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Govemor's Council on Arthritis & Musculoskeletal Diseases
Minutes
July 26, 1995
Page 2
Forty-two people attended. She expressed concern that the Governors Council
focusing on public education is a duplication of effort and resources. She
suggested that the Council co-sponsor forums with the Arthritis Foundations.
The Council accepted the offer of the Tucson Chapter of the Arthritis Foundation to
present the two forums planned for Nogales and Sierra Vista. The Council would
assist in any way possible.
Lori Pearlmutter felt the Council needs to be more active. There was considerable
discussion on the needs of citizens of Arizona citizens with arthritis. Dr. Smith
suggested that many individuals with arthritis are not getting appropriate medical
care as well as having many other unmet needs. He suggested that the Council
be more of an advocate for people with arthritis.
The Council debated what some of those unmet needs might be. After lengthy
discussion it was decided that the Council may want to survey people who have
arthritis or an interest in arthritis and musculoskeletal diseases..
Dr. Smith related that the states of Missouri, Ohio, and Wisconsin have completed
needs assessment. Carol Chamberlain will contact these states for a copy of their
surveys and results. Ms. Pearlmutter will contact the Indian Health Service to see
if they have surveyed their target population or have other demographic
information that would be of use. When information is received, it will be
distributed to Council members for review and comments. Mr. Beard will supply
the Statewide Needs Assessment for blindness for the Council to review and
compare. A teleconference was scheduled for August 30, 1995 at 4:00pm at the
Phoenix Arthritis Foundation for anyone interested to discuss the surveys and to
discuss the next step to be taken.
New Business
Dr. Smith announced the formation of a new multi-disciplinary team to assist the
rehabilitation counselor assess their more difficult cases. He stated that about
30% of those seen, so far, are people with musculoskeltal disease and arthritis.
He offered to bring several members of the team, along with a video tape
demonstrating their services to a meeting. This would provide insight into the
kinds of people that the vocational rehabilitation agency sees today with the
diagnoses of arthritis. The video tape will show the complete process; the
diagnosis, the recommendations, what the client and rehabilitation counselor
propose, what action was taken at the diagnostic level, etc. The presentation will
occur at the next meeting of the Council to be held on October 12 at 4:00pm at the
Arthritis Foundation in Phoenix.
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Gov.mor's Council on Arthritis & MUSCUloskeletal Diseases
Minutes
July 26. 1995
Page 3 •
Barbara Matia infonned members of the roof breaking ceremony at University of
Arizona" Arthritis Section, on Saturday, October 14 at 10:30am. Formal invitations
are forthcoming.
Call for Public Comment:
There was no comment from the public.
Adjournment:
Cele Kennedy made a motion to adjourn and the motion was seconded by Barbara
Matia. The motion passed by unanimous voice vote and the meeting adjourned at
2:06pm.
Introductions
Members and guests introduced themselves.
The meeting, by teleconference, convened at 3:00 p.m. by Loro Pearlmutter,
Chairperson.
Approval of Minutes
Dave Beard requested that changes in the minutes, if any, be sent to his attention
otherwise the minutes were approved as mailed.
GOVERNOR'S COUNCIL ON ARTHRITIS &MUSCULOSKELETAL DISEASES
Teleconference Meeting Minutes
March 22, 1995
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Staff
David Beard. ARSA laison
Melodee Miller, ARSA secretary
Members Absent
Kathleen Acciaioli
Linda Brickman
Beverly Carol Bulla
Willard Page
Leanna Crosby
Timothy Flood
Cele Kennedy
Eddie Lynch
Guests
Denise Hampton
Old Business
Suggested ideas for follow-up of the February meeting were: 1.) Registry for
people with auto-immune diseases in Arizona; 2.) an information hot-line
number; and 3) the Council presenting public education forums in local
communities.
Each of these options were discussed. Dr. Yocum stated that the Governor's
Council should act, as Ms. Pearlmutter previously indicated, as a pro-active
group. The Council could develop a more positive image and community
identification by taking this role, especially through the hot-line and presenting
public forums. It was felt that the Council should work in cooperation with the
Arthritis Foundation in Phoenix and the Arthritis Foundation in Tucson if forums
were presented. The resources for a hot-line are limited unless both the Tucson
and Phoenix Arthritis Foundations are willing to do this task. It appears that the
Arthritis Foundation Chapter of Tucson does have what is called "AIRS" - Arthritis
Information Referral Services.
Members Present
Paul Caldron
Gail Riggs
Francis Nardella
David Wayne Smith
Lori Pearlmutter, Chair
Michelle Cornett
David Yocum
Barbara Matia
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Governor's Council on Arthritis & Musculoskeletal Diseases
Minutes Page 2
March 22, 1995
It was also suggested that the two Arthritis Foundation Chapters gather data and
get it back to the Council so that the Council has a more clear picture regarding
whats happening in Arizona. It was indicated that one of their major functions of
the Tucson Chapter is education. It was suggested that perhaps the forum
approach is probably the most practical avenue of the options. The hot-line
would give the Council some names and concerns, but, the forums would get the
Council a larger audience It was also suggested the Council pilot two or three
forums, one in South Tucson and one in Nogales. Dr. Yocum responded by
suggesting that Sierra Vista might be a valid neutral site for a forum. In regard to
the forums, Dr. Yocum felt that the Governor's Council should be sponsors of
forums also involving Southern Arizona Arthritis Foundation with speakers from
Arizona Arthritis Centers. Topics for the forums would be arthritis, lupus and auto­immune
diseases. After discussion the Council recommended holding three
forums in the following areas; Sierra Vista, Nogales and Guadalupe. Guadalupe
was suggested due to high percentage of Hispanics and to note if there are more
lupus problems in the population. This information might be helpful in the overall
concern of looking at the problem of lupus in Hispanic people. Dr. Yocum asked
Dr. Nardella if he would consider doing the Guadalupe forum and he agreed to
assist. Dr. Yocum and an associate will be speaking at Sierra Vista and Nogales.
Suggested time frames for the forums was sometime within the next two or three
months.
Dr. Yocum asked if the Council wanted to make a report to the Governor on what
the Council is doing. Ms. Pearlmutter responded by informing the Council that
this action was on hold until the Council had actually started activities.
In the discussion of the hot-line and possible registry it was noted that the Council
did not possess the resources to undertake these projects. A letter from Dr.
Flood to the Centers for Disease Control and Prevention in Atlanta, was reviewed
that related the Arizona Dept. of Health resources are not sufficient to fund this
type of projects.
Dr. Smith suggested the Council put together some articles on arthritis and/or
lupus that could be distributed to various organizations or placed into
newspapers. Dr. Smith informed the Council that he had an article in the early
stages, being prepared by staff at the Medical Center. He requested another
member of the Council assist in editing so it would be readable by the general
public. Then he suggested trying the article experimentally in the Arizona
Department of Administration's publication that is sent to all State employees and
retirees (60,000 people).
Governors Council on Arthritis & Musculoskeletal Diseases
Minutes Page 3
March 22, 1995
Gail Riggs addressed the issue of the registry. She suggested this idea is
something that might be presented to the Arthritis Foundation Boards and is
something they may want to get involved in through their various committees.
Other Business
Dr. Smith mentioned that he was a member of the Governor's Oversight
Committee for health insurance for State employees. It had been brought to the
attention of the committee by the Governor's Arizona Office of Americans with
Disabilities Act (ADA) staff that disabled people with arthritis and other conditions
are having difficulties in finding physicians with accessible offices. Mr. Guerry
Dalrymple of the Governor's ADA Office has lead on this project. Dr. Smith
asked for volunteers to work on this problem. Ms. Pear/mutter agreed to
volunteer to assist. It was suggested that other councils may also wish to get
involved regarding this issue. Dr. Paul Caldron addressed the issue stating that
statutes are in place to ensure accessibility. He stated that anyone who does.
business with the public, including physicians offices, now have to comply with
accessibility statutes. Mr. Beard stated that he would talk to Mr. Dalrymple and
asked that volunteers for this subcommittee let him know of their interest. Dr.
Smith and Ms. Pear/mutter volunteered to serve on this committee.
Announcements
The next Council meeting is scheduled for May 10, 1995,2:00 p.m. in Casa
Grande but it was suggested that the meeting be rescheduled for May 17, 1995.
It was agreed upon by the group that the next meeting should fol/ow one of the
forums so that the Council could evaluate this plan of action.
Adjournment
Dr. Yocum made the motion to adjourn the meeting and was seconded by Dr.
Smith. The motion carried by voice vote.
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The meeting was convened by Lori Pearlmutter, Chairperson.
Introductions
Members and guests introduced themselves.
Approval of Minutes
A motion was made and seconded to approve the November 9, 1994 minutes. The
motion carried by unanimous show of hands.
GOVERNOR'S COUNCn.. ON ARTHRITIS & MUSCULOSKELETAL DISEASES
MINUTES
February 15, 1995
MEMBERS ABSENT
Kathleen Acciaioli
Linda Brickman .
Beverly Carol Bulla
Leanna Crosby .
Tim Flood (~v,j~ I
Eric Gall .
Eddie Lynch
Barbara Maria
Carol Chamberlain (e-J If I J ~)
Bonnie Seashore
Leslie Boyer
Larry Cloud
Thili Kinlatilake
Bridget Walsh
GUESTS:
Cecilia Campillo
Susan Malloy
Linda Braun
Gail Ebeitoft
Lee Crosby
Renaldo Jacques
STAFF:
David Beard
Melodee Miller
Old Business
David Beard addressed "Unfunded Mandates" as they affect the Vocational
Rehabilitation Program. Mr. Beard stated that both houses ofCongress are considering
legislation on unfunded mandates. The President says he is willing to sign the right
unfunded mandate bill._ It would not be retroactive. This legislation would not ban
unfunded mandates outright. It would create a parliamentary presumption within
MEMBERS PRESENT
. Cele Kennedy
David Wayne Smith
David Yocum
Gail Riggs
Lori Pearlmutter
Michelle Cornett
Francis Nardella
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Governor's Council on Arthritis & Musculosheletal Diseases
Minutes Page 2
February 15, 1995
Congress against them, and require exclusive majority votes in both houses to impose
them on the States. Future bills imposing mandates on the states without the federal
funds to carry them out, would be subject in Congress to a "point of order". A member
.of Congress could raise the point of order, another could move to waive it, and then there
would be a recorded roll-call vote,.if they indeed want to waive this unfunded mandate.
The Vocational Rehabilitation grant to Arizona (Title I), is one ofthe federal programs
covered by provisions ofthe proposed legislation.
Old Business
Leslie Boyer, MD, Medical Director ofthe AZ Poison Center,..Clinical Toxicologist &
Pediatrician. made a comprehensive presentation on TriChloroethylene (TCE) and the
affects and results ofhuman exposure to various amounts ofTCE. She also provided
background regarding the Nogales and South Tucson toxic exposure situations.
Cecilia Campillo, Program Manager ofthe El Pueblo Clinic distributed information
about the clinic and presented background regarding its program in South Tucson. She
requested assistance in helping them find answers to their question and in understanding
their various problems. She stated that their staff wishes to network with appropriate
entities. Past studies regarding TCE contamination in South Tucson were also
discussed. Present data collection was discussed and suggestions made. The overriding
need for health care was emphasized by several ofthose present. A high degree oflupus
In the community has been noted. It was also suggested separating the link to TCE from
the "what's the problem in the community".
Larry Clark, Ph. D. reviewed The Santa Cruz County Community Health Survey he
directed, prepared under contract from the Arizona Department ofHealth Services. He
described the methodology and discussed the clustering that was found. The study
focused on two areas of concern, lupus and multiple myeloma,. and the study confirmed
that these two conditions occurred more frequently in Nogales than expected. Elevated
blood tests were much more frequent among females than males, but that was expected
regarding lupus. The study is consistent with, but does not confirm environmental risk
factors for lupus.
Bridget Walsh, DO described the community survey, the interviewing process as well as
other details of the study. Dr. Walsh described numbering each ofthe 5000 households
in Nogales - divided into neighborhoods - and then with a random starting point within
each neighborhood, started interviewing in a clockwise manner. So it was a random
sample ofthe community, and then a proportion of those people volunteered to give
blood. She also discussed the control group in the community ofPatagonia. Patagonia
residents reported a higher level of symptoms and illnesses than Nogales. But when it
came to looking at the blood test, Nogales had the high levels and Patagonia didn't. Drs.
Walsh and Clark explained how the data was analyzed and the conclusions. In the
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Governor's COWlcil on Arthritis & Musculosheletai Diseases
Minutes Page 3
February 15.1995
conclusions, leukemia wasn't in excess and myeloma was. Most ofthe findings were
for lupus. The association is stronger for women than for men.
Following dinner there was debate regarding the next steps the Council could take with
respect to these issues. The paths of discussion centered around several possibilities: 1)
Asking the Arizona Department ofHealth Services to begin a registry for autoimmune
disease, particularly lupus in Hispanics. Developing a "hot line" for providing and
gathering information regarding arthritis, lupus and autoimmune diseases was also
discussed and 2) The Council should do more to educate communities on relevant
issues regarding toxic exposure and resultant conditions. One ofthe options discussed
was to sponsor an education public forum in South Tucson. It was decided that the
Council would address the various options at their next meeting to be held on March 22,
1995 at 3:00 p.m. This will be a conference call meeting.
Adjournment
A motion was made and seconded to adjourn. The motion carried by voice vote.
APPROVAL OF MINUTES
OLD BUSINESS
The motion to approve the minutes as presented was made by Dr. Gluck and
seconded by Cele Kennedy. The motion was carried.
Nomination of New Members: Dr. Gluck and Gail Riggs read the list of
persons nominated for re-appointment or appointment to the Governor's Council of
Arthritis and Musculoskeletal Diseases:
Carol Chamberlain
Barbara Matia
Dr. David Wayne Smith
Dr. David Yocum
Vince Kelly, Council Staff
Members Absent
GOVERNOR'S COUNCIL ON ARTHRITIS
AND MUSCULOSKELETAL DISEASES
Minutes of June 19, 1996
Teleconference
Members Present
Gail Riggs, Chairperson
Dr. Oscar Gluck, Co-Chairperson
Michelle Cornett
Dr. Tim Flood
Cele Kennedy
Dodie Londen
Carol Wilson
Guests
Robert Case, Director of Harrington Center
Kathy Matt, Professor at ASU
Alex Zautra, Professor at ASU
The meeting was convened at 3:02 P.M. via teleconference at the Arthritis
Foundation, 6464 E. Grant Road, Tucson, AZ. and at the Harrington Arthritis Research
Center, 300 N. 18th Street, Phoenix, AZ by Gail Riggs, Interim Chair. Dodie Londen,
Michelle Cornett and Dr. Tim Flood were also linked in on the conference call meeting.
Election of the Chair and Co-Chair: Gail Riggs stated that, although she and
Dr. Gluck had been nominated and elected as co-chairs at the previous meeting, to
assure that the election was fully in accordance with the Open Meeting regulations
promulgated by the Attorney General, a new vote would be taken to confirm the results
of the previous election. Dodie Londen re-nominated Gail Riggs as Chair and Dr. Gluck
as Vice-Chair of the Council; Carol Wilson seconded the motion and the two were
unanimously elected by all the members present.
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Governor's Council on Arthritis and Musculoskeletal Diseases
Minutes of June 19,1996
Page 2
Michelle Cornett (re-appointment)
Steve Hollander, M.D.
Kelly Wyland
Lee Brest
Alex Zautra, Ph.D.
Kathy Matt, Ph.D.
Robert Case
John Svicek
Gail Riggs moved for acceptance of the nominees; Carol Wilson seconded the motion.
The nominations were approved by all members present. The Chair of the Council will
forward the list of nominees to the Governor's Office of Boards and Commissions. Ms.
Riggs announced that there were still two or three openings for new members: one
from among persons with arthritis or some other form of musculoskeletal disease; one
from the general community; and one from among professional health workers. The
Chair then asked for further nominations or suggestions. Dodie Londen suggested that
the new nominees be recruited from other regions of the state besides Phoenix and
Tucson. Cele Kennedy suggested that any new candidates should be nominated and
voted on in the next Council meeting. A new member to replace Carol Chamberlain, '
the representative of the Arthritis Foundation/Phoenix Chapter, should also be sought,
since Ms. Chamberlain indicated she will no longer be able to serve on the Governor's
Council.
COMMITTEES
Ms. Riggs announced that she was establishing a Resource and Planning
Committee. Members are Gail Riggs, Oscar Gluck, Carol Chamberlain and Bob Case.
A Chair will be appointed when the new committee meets on August 1, 1996 at 1:00
P.M. The meeting will be held at the Harrington Arthritis