According to Arizona Legislative Council (2003), health policy formation goes through three phases in the legislative process: formulation, implementation, and evaluation. The policy formulation phase includes drafting a bill in proper form and getting a legislator to sponsor your bill from either the House or the Senate. The bill is assigned a number and goes through the First Reading. The Speaker/President assigns the bill to the appropriate Standing Committee. The Standing Committee reviews the bill (e.g. holds hearings, expert testimonies, and statements) and makes amendments. The Rules Committee, composed of attorneys, makes sure that the bill is constitutional before it goes to the Whole House for the Second Reading. The Whole House is a floor debate and it is opened to the public. If the bill clears by the majority of a voice vote, then it is given to the Legislative Counsel for engrossing before the Third Reading. There are no more debates or amendments in the Third Reading and a formal vote is counted. If it passes, then the Speaker/President signs it and it goes to the other House/Senate to go through the whole process all over again. If the bill passes without amendments, then it goes to the Governor. If it has amendments, then it goes to the Conference Committee (with members from both the House and the Senate) so that both the House and the Senate can work together to agree on the amendments before passing it on to the Governor to sign. If the Governor does not sign the bill in 5 days, then it automatically becomes a law/statue or if the Governor vetos the bill, then the House and Senate may override the veto by two thirds vote (Arizona Legislative Council, 2003). Citizens may also petition for an “initiated state statute” so that the public can vote on the proposition or measure (BallotPedia, n.d.).
Once a statue has been passed, there is a 90 day period before the “general effective date” (Arizona Legislative Council, 2003). The 90 day period is to allow an opportunity for a veto referendum (BallotPedia, 2003). Next is the implementation phase where the statute or law is put into action through regulatory mechanisms by the state (Abood, 2007). In this case, the Arizona Department of Health Services (AZDHS) was put in charge to develop the policies, rules, and regulations for the Arizona Medical Marijuana Program.
The evaluation and modification phase is when policies are re-evaluated and may be amended, usually in an incremental fashion (Abood, 2007). The AZDHS usually holds an annual rulemaking review. Medical Marijuana was on the 2015 Regulatory Agenda to review Articles 1-3. However, the AZDHS is currently not conducting any rulemaking activities this year due to a rulemaking moratorium established by the Governor, Doug Ducey (Arizona Department of Health Services, 2015).
A personal interview with Dr. Gina Mecagni (February 8, 2015), an ER physician and Medical Director of several medical marijuana dispensaries in Arizona, states that if she could change anything about the Medical Marijuana Program, it would be allow dispensaries to be present in more populated areas. Pharmacies are not allowed to sell medical marijuana because they are regulated by the DEA (Morran, 2014). Therefore, patients have to travel to a remote, unpopulated, industrial area to pick up their medicine. Dr. Mecagni (February 8, 2015) points out the perpetuating stigma surrounding medical marijuana as patients with legitimate medical conditions have to pick up their medications in an undesirable area surrounded by barb wire, junk yards, and security dogs.
Lastly, if we wanted to change the legislative language in the Arizona Medical Marijuana Act (ARS 36-2801) to include nurse practitioners, we would have to go through the legislative process again and there would only be two ways. One would be if the state legislature votes for the amendment to be placed on the ballot, called a “legislatively-referred constitutional amendment” or if there is a petition to include this initiative on the ballot called an “initiated constitutional amendment” (BallotPedia, n.d.).
Abood, S. (2007). Influencing health care in the legislative arena. Retrieved from http://www.medscape.com/viewarticle/553404_3
Arizona Department of Health Services. (2015). Office of administrative counsel and rules. Retrieved from http://www.azdhs.gov/ops/oacr/rules/index.htm
Arizona Legislative Council. (2003). Arizona legislative manual: Legislative procedure. Retrieved from http://www.azleg.state.az.us/alisPDFs/council/legman2003.pdf
BallotPedia. (n.d.). Laws governing the initiative process. Retrieved from http://ballotpedia.org/Laws_governing_the_initiative_process_in_Arizona
Morran, C. (2014). Why can’t you get medical marijuana at CVS or Walgreens? Reviewed from http://consumerist.com/2014/05/13/why-cant-you-get-medical-marijuana-at-cvs-or-walgreens/