Hospitals

needed.

Hospitals also asked the state to waive a requirement that hospital administrators ensure a patient is not subject to abuse or neglect because if “hard choices must be made to save patients,” the hospitals say they do not want those choices to provide grounds to allege a patient has been abused or neglected. The state did not approve that waiver request.

Similarly, they want the state to waive requirements that patients not be discriminated against based on race, national origin, religion, gender, sexual orientation, age, disability, marital status, or diagnosis.

That’s because hospitals may need to prioritize the allocation of scarce equipment, personnel and beds among COVID-19 patients and do not want the state to consider that discrimination. The state did not approve that waiver request, either.

Requesting removal of patient protection regulations is something necessary to do under exceptional circumstances, Alameddin told The Republic.

It’s for legal reasons and not intended to diminish care for patients, she said.

“For instance, hospitals right now should not be doing orientations within 30 days of getting a new staff member. We need to have that staff member hit the ground running and focus on what they need to care for COVID-positive patients,” she said.

“The point of hospitals really is to provide that optimal care during the emergency and to take care of patients as best as we possibly can. Hospitals are

Alameddin says the association first asked the Arizona Department of Health Services to waive a series of state regulations on March 31, when the COVID-19 pandemic was still in its early stages in the state.

“We didn’t have that patient surge that we were anticipating in April and May,” Alameddin said. “But now we do have that and hospitals need the support from the state and the flexibility to provide optimal patient care . ... This is just really important support that we need from our state partner.”

The federal government already issued a long list of blanket waivers of U.S. laws and regulations to give hospitals and other providers maximum flexibility during the pandemic, Alameddin said.

“The federal government acknowledged this reality that when we’re in a pandemic that the rules change,” she said. “There are federal blanket waivers that nobody had to ask for and the feds did that, particularly with telemedicine. They provided a number of waivers across the board that hospitals didn’t have to worry about . ... This really helped hospitals, and we are asking the state to do the same.”

The state health department initially enacted some waivers because of the COVID-19 emergency earlier in the pandemic, including providing temporary licenses to some physicians who are from outside the state, are recently retired or have been inactive for four years or less.

State health officials verbally acknowledged the association’s March 31 letter and identified some waivers that hospitals could apply for individually that likely would get approved, Alameddin said.

The July 1 letter urges the state to give an immediate blanket waiver to a list of more than 35 waivers that would enable hospitals to “fully implement their emergency plans and provide lifesaving care.”

State health officials on Tuesday approved 16 of the waiver requests. Hospitals may still individually request waivers of other regulations, but at this point, that would be burdensome, Alameddin said.

“As you know, Arizona is experiencing one of the fastest-growing COVID-19 outbreaks in the nation,” the letter says. “We respectfully request that ADHS issue a blanket waiver of the following regulations, applicable to all hospitals in Arizona throughout the duration of the COVID-19 public health emergency.”

Alameddin wrote that her letter is supported by a “virtual task force” comprising representatives from 12 Arizona hospitals and health care systems, including the Mayo Clinic in Arizona, Banner Health, Dignity Health, Honor Health and Valleywise Health.

Christ told the hospital association on Tuesday that she would schedule a call with the association and her licensing team to learn about the specific needs identified by the hospitals with the remaining waiver requests.

Arizona leads country in its rate of new daily COVID-19 cases

As of Sunday, Arizona had the highest rate of new daily COVID-19 cases of any state in the country, according to the Harvard Global Health Institute, which based its information on a moving average over the prior seven days.

The Harvard institute lists four states in its highest risk “red zone” for their rates of new cases over the previous seven days: Arizona, Florida, South Carolina and Louisiana.

In terms of cases overall per 100,000 people, Arizona as of Tuesday ranked eighth in the country, according to the U.S. Centers for Disease Control and Prevention. It is the 14th most populated state in the country.

Arizona’s rate of positive COVID-19 cases is 1,414.5 per 100,000 people, the CDC says. The Arizona Department of Health Services on Wednesday listed the state rate as higher — 1,510.8 per 100,00 people; the national average, according to the CDC, is 894.7 per 100,000 people.

Among

the

16

hospital

waiver

requests the Department of Health Services approved Tuesday evening:

A requirement to post patient rights language, because that could be difficult if tents or similar temporary structures are used to house patients.

A requirement that a patient or patient representative receive written patient rights statements upon admission.

A rule prohibiting seclusion of patients except in emergencies or in behavioral health settings with limitations. Hospitals don’t want the quarantine of patients who require hospital care to be considered “seclusion.”

A requirement that a patient has privacy when communicating with a personnel member providing social services. In bed areas that hospitals may need to use if there’s a big patient surge, it may not be possible to provide for privacy.

A requirement to provide 24hours-a-day emergency services in a designated area of the hospital. Hospitals say this was needed because emergency services may need to be provided at temporary and repurposed patient care areas.

Among the regulations that hospitals want waived but the state has not approved:

A requirement that emergency services are provided to all individuals who request them. Hospitals say they need the flexibility to send appropriate patients to lower levels of care to ensure that resources are available to patients with emergency conditions.

A requirement that inpatients admitted to an organized psychiatric unit have a behavioral health diagnosis, since some hospital surge expansion plans may include the use of beds in psychiatric units for other purposes.

A requirement that medical and nursing services personnel must be CPR qualified within 30 days after their start date, and they must maintain current CPR qualification. Hospitals say they are concerned that giving up personnel while they obtain requalification would deprive patients of needed services during the surge period. Also, CPR certification classes may not continue to be available, they say.

Requirements governing patient transfers. Hospitals say they may need flexibility, including the use of private vehicles, to safely move patients to ancillary facilities.

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