Critics skeptical about new step to improve transparency at Arizona State Hospital

State health officials say they're improving accountability at the Arizona State Hospital, which houses people with severe mental illnesses, but critics say the move falls short of providing outside scrutiny the hospital needs.

The governing body for the Arizona State Hospital, which is known as ASH, will increase from 11 voting members to 20 voting members, according to a Dec. 11 state Health Department news release, which says amendments to the governing body's bylaws were made by Arizona Gov. Katie Hobbs and ASH CEO Mike Sheldon.

“With these new appointments, I’m confident that we are taking important steps to promote the safety of patients and staff at ASH while increasing independent oversight," Hobbs said in a statement. “I am committed to transparency and accountability."

Seven new appointees to the expanded governing body have been announced to date, and six of them will be voting members. State officials say that 15 of the 20 members will be "fully independent and unaffiliated with the state of Arizona," providing a three-to-one ratio of independent to state-affiliated voting members.

The six people appointed to be voting members are Kathy Bashor, who is a retired bureau chief from the Arizona Health Care Cost Containment System; Kristina Sabetta, who is executive director of the National Alliance on Mental Illness Valley of the Sun; community mental health advocate Eddie Sissons; mental health peer advocate George Galliher III; Kimberly Craig, who is CEO and president of the Center for Health and Recovery (formerly known as CHEEERS Recovery Center) in Phoenix; and Steven Scott, who has a long history of experience working in Arizona’s psychiatric and medical managed care system.

While some critics point out that several of the appointees were against a bill mandating independent oversight of ASH during the last legislative session, Health Department officials defended the choices and said the appointees were selected "because they are recognized leaders in the field of mental and behavioral health."

"We have every expectation that these members will hold ASH to the highest possible standard, and that is precisely why we felt they should serve in this critical role," wrote Siman Qaasim, who is the Health Department's assistant director of policy and intergovernmental affairs.

Hobbs spokesperson Christian Slater wrote in an email Friday that the governor "knows ASH needs strong, independent oversight," which is "why she took a critical step to appoint independent community members to the governing body."

Expanding the governing body is "an important first step" and Hobbs "knows Arizona can do better to improve oversight, provide quality care and protect the health and safety of patients and providers at the state hospital," Slater wrote.

NIH awards 9M: to research effects of Covid on Indigenous communities

'Not a substitute for real governance reform'

ASH has been criticized for its lack of accountability and the way it treats patients, including providing programming that critics say is inadequate for the complex health and behavioral needs of the patients who live there. Patients and families also complain that staff retaliate against individuals who have complained, or whose families have complained, about conditions at ASH.

The 390-bed state hospital is the last resort and highest level of care for patients in Arizona with serious mental illnesses.

The hospital's civil and forensic units have a combined 259 beds and to house a single patient costs about $256,000 per year, according to state estimates from June. A separate, 131-bed Arizona Community Protection and Treatment Center on the 93-acre ASH campus, for patients who have committed sexually violent offenses and are deemed unsafe to return to the community, costs about $100,000 per patient annually.

ASH CEO Mike Sheldon himself acknowledged shortfalls at ASH in a report he submitted in September that said ASH needs to add 117 full-time employee positions at an added cost of $10 million just to meet the community standard of care.

To Phoenix attorney Holly Gieszl, who represents several patients at ASH, the state's expansion of the governing body is an acknowledgment that officials recognize what critics have long known about the hospital, "that ASH needs independent oversight," she said.

But the governing body is still appointed by the director of the state Health Department, which means, Gieszl said, "the degree of independence remains to be seen."

Arizona Public Health Association Executive Director Will Humble also thinks that it's a positive step for Hobbs, Sheldon and State Health Department Director Jennie Cunico to recognize the importance of transparency and independent governance of the state hospital. But he says their decision to expand the governing body isn't enough to provide the outside watchdogging that the hospital needs.

"It's certainly not a substitute for real governance reform," he said.

A bill in the most recent legislative session to mandate outside oversight of ASH, sponsored by Sen. David Gowan, R-Sierra Vista, failed. His proposal called for an independent state hospital governing board to take effect Jan. 1, 2025.

Oversight of the state hospital under Gowan's bill would have shifted from the Health Department to a five-member board appointed by the governor and board members would need to have experience in hospital and health care administration. Gowan's bill called for transferring powers, duties and responsibilities relating to the state hospital from the Health Department to the board.

AZ news: students are helping to decide school budgets. In the process, they're learning about democracy

State senator wants to restructure the operation of ASH

The governing body can make "critical decisions" regarding the management of ASH, state Health Department officials wrote in a statement, including, "ensuring that the hospital is in compliance for standards of patients rights, holding medical staff accountable for providing quality care, providing adequate staffing for the facility, fiscal oversight and budgeting for the hospital, and hiring the ASH Superintendent."

Yet state Sen. Catherine Miranda, D-Phoenix, characterizes the ASH governing body as a "building block," that has "no regulatory authority." Miranda, who has been advocating reforms at the hospital, called the recent expansion of the governing body an "inconsequential change." What's needed is a restructuring of ASH's governance, she said.

"We need a new statute, a new law that restructures the leadership, governance and operation of ASH," she wrote in a text message.

Two entities monitor ASH − the ASH Independent Oversight Committee and the ASH Governing Body. Critics, including Humble, who have been calling for independent oversight of ASH, say those two panels of people don't have the authority to provide ASH with effective outside monitoring.

The Independent Oversight Committee's role includes making recommendations to the Health Department director but not overriding the director. The governing body is appointed by the Health Department director and also chaired by the Health Department director or that person's designee, its 2023-24 bylaws say.

Laurie Goldstein, who is chair of the ASH Independent Oversight Committee, was appointed as a non-voting member of the governing body when the state announced the changes Dec. 11. Goldstein said she hopes that current and future appointees will be people who are committed to a robust state hospital moving into the future.

Arizona needs a state hospital for its most seriously mentally ill individuals. Many states have more than one state-operated psychiatric hospital, but Arizona has just one, she said. Not all patients with serious mental illness can be treated in community-based settings, she said.

Arizona has the lowest rate of patients served by state psychiatric hospitals in the U.S., according to a September 2021 report by NRI Inc., which does research and data analyses for behavioral health stakeholders. The NRI report, based on 2020 data, says that Arizona has 2.9 patients in state psychiatric beds per 100,000 people, whereas the U.S. average is 12.1 patients in state-run psychiatric beds per 100,000 people.

Five seats on the ASH governing body are allocated to state employees, including the state Health Department director, ASH’s CEO, chief financial officer, chief medical officer, and a medical staff member who serves as an ASH employee spokesperson. While those positions will not change, however, the news release says Hobbs and Sheldon agreed that adding more independent voting positions would "help ensure the hospital is governed by the people of Arizona."

“Our first and foremost priority is ensuring that ASH is a great place for people to get world-class treatment in a safe and caring environment,” Sheldon said in the written statement.

Reach health care reporter Stephanie Innes at Stephanie.Innes@gannett.com or at 602-444-8369. Follow her on X, formerly known as Twitter @stephanieinnes.

This article originally appeared on Arizona Republic: State says it is increasing transparency at Arizona State Hospital