Az doc-to-patient ratio below national average

Medical student Nathaniel Rial checks on patient Rachel Trefry at the UA College of Medicine on Tuesday morning. Rial will graduate Friday.

It’s a choice fewer young doctors make.

When they recite the Hippocratic Oath on Friday, University of Arizona College of Medicine graduates Erica Lindsey and Nathaniel Rial will pursue residencies as primary care physicians. Generalists in an industry dominated by specialists, primary care doctors make hundreds of thousands of dollars less than cardiologists or neurosurgeons and work less-than-predictable hours.

Rial will remain in Tucson, beginning a three-year residency in internal medicine that will have him seeing patients at University Medical Center, Tucson Medical Center and the Southern Arizona VA Health Care System.

He spent his last week as a medical student studying for exams and working in a lab at the Arizona Cancer Center.

This summer, Lindsey will begin a three-year residency in primary care at St. Joseph’s Hospital and Medical Center in Phoenix. She spent much of the past two weeks moving into a new place.

The pair will gut out long hours, which, in the end, probably will reduce their salaries to “a little more than minimum wage,” Lindsey joked.

In recent interviews, both of the doctors-to-be said they entered primary care to fill a need.

Nearly half of the 124 students who will graduate from the UA medical school on Friday will remain in Arizona for at least the next three years, as they complete residencies at hospitals throughout the state. More than a third of the class of 2009 will go into primary care.

These are not insignificant numbers given the state’s overall shortage of doctors.

Arizona has 214 physicians per 100,000 patients, a ratio well below the national average of 250 doctors per 100,000 patients. A 2007 study by the Association of American Medical Colleges ranked Arizona 33rd out of 50 states based on that doctor-to-patient ratio.

The state’s ranking drops to 39th when the focus shifts to primary care.

In 2007, the latest data available, Arizona had 4,719 primary care physicians, a ratio of about 77 per 100,000 patients. Nationwide, the number of primary care physicians per 100,000 patients stood at 88 in 2007.

“We have more of a shortage than is found nationally,” said T. Philip Malan Jr., vice dean for academic affairs at the UA medical college. “I like it when our students go into primary care.”

As an area of practice, primary care requires physicians to do a little of everything – pediatrics, family and internal medicine, general surgery and obstetrics and gynecology.

No one can predict how many of the 43 UA medical school graduates will remain in primary care after completing their residencies.

A 2008 report by the Council on Medical Education found that 55 percent of the nation’s internal medicine residents in 2006 chose to enter a subspecialty the following year. Nearly 40 percent of pediatric residents chose to specialize as well.

A residency in primary care or internal medicine constitutes a “gateway” to specialty practices, Rial said.

He has yet to decide whether he will remain in primary care after completing his residency. Because the tuition at UA – around $18,000 a year – remains cheaper than at two-thirds of the nation’s medical schools, Rial said he has the “flexibility” to weigh his options.

“I think another way to look at why so few are going into (primary care), so many are following other pathways, is for lifestyle or quality-of-life issues,” Rial suggested.

The Council on Medical Education report found that nearly three-quarters of medical school graduates “reported that lifestyle had a strong influence on their choice” of specialty.

Mounting debt also factors heavily in medical students’ after-graduation decisions, according to the study. The average U.S. medical student had about $127,000 in debt in 2007, up 43 percent from 2000.

“You have a house in your brain by the time you’re done,” Lindsey said of the cost to complete four years of medical school.

The debt graduates must repay likely forces many of them into more lucrative specialties, she said..

“We don’t compensate (primary care doctors) well,” said Steve Nash, executive director of the Pima County Medical Society.

According to the U.S. Bureau of Labor Statistics, a family or general practitioner in Tucson can earn an average of $148,030 annually. Doctors in other specialties earn on average $52,000 more per year.

“One can live pretty well as a doctor in any specialty,” Malan said. “A student has to have a passion for primary care.”

The 43 UA graduates headed into primary care this year represent 35 percent of the graduating class.

“That’s about average for us,” Malan said.

It’s about twice the average in Pima County.

Of the 2,800 or so physicians practicing in PIma County, about 500 – 18 percent of them – focus on primary care, according to Nash. That’s about 50 primary care doctors per 100,000 patients, or 38 below the national average.

In rural or impoverished areas, like the Navajo reservation where Lindsey grew up, the average can be much worse.

“There’s a big need for primary care doctors,” Lindsey said. “It’s kind of always been the focus for me.”

Because Rial and Lindsey will remain in Arizona for their residencies, they are more likely to stay in the state afterward.

Arizona ranks 12th in the nation based on the number of its doctors who studied and completed residencies in the state, according to the Association of American Medical Colleges.

The UA medical school hopes to incrementally increase the number of doctors it trains annually, Malan said, by increasing its enrollment to 115 students per year, up from 110. “It’s all about training more physicians,” he said.

It’s long been a rule of thumb in medical circles that a doctor stays where he or she trains.

Lindsey said there’s a simple reason for that: life.

“You’re almost 30, you have a family or are thinking about starting one,” she said. “You’ve got relationships with the doctors you’ve worked with.”

Rial and his wife moved to Tucson 12 years ago.

“We’ll be here at least three more years,” he said.

Source: Association of American Medical College’s “2007 State Physician Workforce Data Book”

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BY THE NUMBERS

The University of Arizona College of Medicine will confer doctor of medicine degrees during a ceremony on Friday. The 2009 class includes:

• 124 graduates

• 66 women

• 58 men

• 17 Hispanics

• 2 Native Americans

• 61 who will remain in Arizona for their residencies

• 43 who will go into primary care

Source: University of Arizona College of Medicine

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Arizona Doctor Shortage

The University of Arizona produces about 100 medical school graduates per year, according to the Association of American Medical Colleges. Nationwide, about 16,000 graduate from medical school every year, not nearly enough to keep pace with the country’s growing population, most observers say. Compared to national averages, the shortage of doctors in Arizona is more pronounced.

Active physicians per 100,000 patients

U.S.: 250

Arizona: 214

Arizona’s national rank: 33

Active primary care physicians per 100,000 patients

U.S. 88

Arizona: 77

Arizona’s rank: 39

Percent of active physicians in each state who completed undergraduate medical education in the state

U.S. average: 29 percent

Arizona: 10 percent

Arizona’s rank: 41

Percent of active physicians in each state who completed a residency or fellowship in the state

U.S. average: 45 percent

Arizona: 25

Arizona’s rank: 38

Percent of active physicians who graduated medical school and practice in the same state

U.S. average: 39 percent

Arizona: 47 percent

Arizona’s rank: 14

Percent of active physicians who completed graduate medical education and practice in the same state

U.S. average: 47 percent

Arizona: 47 percent

Arizona’s rank: 18

Percent of active physicians who graduated from medical school, completed graduate medical education and practice in the same state

U.S. average: 66 percent

Arizona: 73 percent

Arizona’s rank: 12

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Convocations and graduation

The University of Arizona’s colleges and schools began holding convocation ceremonies Wednesday. The College of Medicine convocation for candidates for a degree in medicine, will be at 5 p.m. Friday at Centennial Hall.

The campuswide commencement ceremony is 8 a.m. Saturday at McKale Center.

The following are the remaining school and college ceremonies scheduled for this weekend.

Friday:

Eller College of Management, undergraduates, 1 p.m. at McKale Center

College of Nursing, 1 p.m. at Centennial Hall

College of Social and Behavioral Sciences, 2 p.m. at Tucson Convention Center arena

University College, 3 p.m. at Integrated Learning Center

College of Optical Sciences, 5 p.m. at Integrated Learning Center 130

Saturday:

College of Agriculture and Life Sciences, 11 a.m. at Centennial Hall

College of Architecture and Landscape Architecture, 11 a.m. at Crowder Hall

College of Medicine, physiology undergraduates, 11 a.m. at Student Union Memorial Center

College of Law, 2 p.m. at Centennial Hall

Eller College of Management, graduate students, 5 p.m. at Centennial Hall

For more information on each college convocation, visit commencement.arizona.edu/collegeconvocations

PHOENIX – Gov. Jan Brewer signed the latest midyear budget-balancing legislation into law Thursday but added a warning to lawmakers that they should bend her way next time.

“It would be fiscally irresponsible for the Legislature to ignore the depths of the (2010-2011) state deficit by promoting a budget plan for (2009-2010) that relies primarily on one-time measures,” Brewer said in a statement.

To close the latest $650 million shortfall in the current budget, GOP lawmakers resorted to accounting maneuvers that postpone $400 million of education spending into the next fiscal year. They also included $250 million of stimulus money, an amount larger than Brewer wanted but much less than lawmakers sought.

The plan also set the stage for the state to grab some school district savings to help balance the budget for the fiscal year that begins July 1. Estimates on how much money that would produce aren’t firm.

Brewer told lawmakers that the next state budget shouldn’t rely primarily on similar maneuvers because that would spell trouble for the following fiscal year, which starts July 1, 2010. It also faces a projected big shortfall that spending cuts alone won’t close, Brewer said.

Most majority Republican legislators have balked at Brewer’s call for a temporary tax increase to produce $1 billion of new revenue to help balance the next several budgets in face of deteriorating revenue collection.

Brewer said she “will not approve” a budget that doesn’t take into account the following year’s “needs and requirements.”

“I am hopeful that, with a continued emphasis on negotiation and compromise, the Legislature can reach consensus with my policy goals to approve a (2009-2010) budget package promptly,” she said.

Lawmakers approved the $650 million plan about 3 1/2 months after they closed a previous $1.6 billion budget shortfall. That action included spending cuts, raids on special-purpose funds and use of stimulus money.

FLAGSTAFF – A group of environmentalists is appealing a plan by the U.S. Forest Service to log an area north of the Grand Canyon.

It’s the second logging plan on the Kaibab National Forest that conservationists have challenged this year. Both sites are within an area where 58,000 acres burned in 2006.

The plan approved in March calls for logging on 9,100 acres and the planting of conifer trees on nearly 10,000 acres in an effort to restore forest conditions.

Conservationists say the plan makes no sense economically or ecologically. They say it would erode soil, damage habitat for the threatened Mexican spotted owl and increase the potential for wildfires.

The Center for Biological Diversity, Sierra Club and WildEarth Guardians signed on to the appeal filed Thursday.

U.S. Customs and Border Patrol agents stop traffic recently in a search of weapons headed into Mexico at the Mariposa border crossing in Nogales.

NOGALES – Federal agents tap on car windows, opening trunks, looking in vain for contraband.

“We’re sucking up a lot of exhaust out here,” supervisory Customs and Border Protection officer Edith Serrano says, shrugging in her uniform.

This is what the Obama administration’s new commitment to help Mexico fight its drug cartels looks like.

President Obama this spring promised his Mexican counterpart, Felipe Calderón, that the United States would fight two of the biggest contributions U.S. residents make to the drug cartels Calderón has vowed to eradicate: cash and weapons, the latter hard to come by in Mexico.

For the past five weeks, hundreds of agents participating in a newly intensified $95 million outbound inspection program have been stepping into southbound traffic lanes, stopping suspicious-looking cars and trucks.

The Associated Press fanned out to the busiest crossings along the Mexican border – San Diego, Nogales, El Paso and Laredo – to see how effective the inspections are.

The findings? Wads of U.S. currency headed for Mexico, wedged into car doors, stuffed under mattresses, taped onto torsos, were sniffed out by dogs, seized by agents and locked away for possible investigations. No guns were found as the reporters watched; they rarely are.

“I do not believe we can even make a dent in (southbound smuggling) because that assumes the cartels are complete idiots, which they’re not. Why in the world would they try to smuggle weapons and currency through a checkpoint when there are so many other options?” said Border Patrol Agent T.J. Bonner, president of the agents’ union.

According to CBP, between March 12 and April 30 officers seized:

• Fifty-one pieces of ammunition, weapons parts and guns, a minuscule fraction of the 2,000 weapons the Mexican government estimates are smuggled south every day.

• $12 million in cash, less than one-tenth of 1 percent of the $17 billion to $39 billion the U.S. Justice Department estimates is illegally sent to Mexico from the U.S. annually, but more than the $10 million seized in outbound checks in 2008.

• Sixty-one people on charges involving weapons or currency offenses and on outstanding warrants.

Millions of cars pass into Mexico from the United States every year. The federal government doesn’t keep track but a count by Texas A&M International University’s Texas Center for Border Economic and Enterprise Development shows more than 27 million vehicles a year drove into Mexico just from Texas.

The outbound checkpoints the AP observed stopped sometimes 1 out of 4 cars, sometimes 1 out of 100, and not every day. Even that amount created huge traffic backups at some locations and, agents said, might have allowed spies to call any smugglers heading that way and warn them to put off their Mexico trip.

Agents across the border said the first few minutes of their operation are the most precious. That’s how long it takes for “scouts” watching from a bridge in San Diego lined with taxis to radio ahead to smugglers to stay away. In Nogales, a dozen men dashed along a Mexican hill about 150 yards from the checkpoint last week.

“We tend to see spotters up there,” said CBP agent Brian Levin. “They sit up on those hills and watch everything we do.”

Inspectors retreat, then mount another “surge” after a while standing on the side of the freeway.

Some of those stopped were sanguine, others annoyed.

“I guess they think I have drugs or something,” said Daniel Saucedo, a 15-year-old Albuquerque high school student who clambered out of the passenger side of a small white pickup truck with his two dogs last week in El Paso. “It’s dumb,” he said.

William Molaski, port director in El Paso, said agents at his four El Paso bridges haven’t found much since the focus on outbound checks started in early April – one handgun and only about $400,000 – “but not for lack of trying.”

Without providing any numbers, Homeland Security Secretary Janet Napolitano told attendees at the Border Trade Alliance International Conference on April 21 that, just a few weeks into the intensified outbound inspections, she was amazed at how much had already been seized. “It’s unbelievable,” she said. “So the notion that there wasn’t a river of cash and a flood of guns going into Mexico is a myth. I mean, there was. We want to stop that river.”

CBP’s 2010 budget request, released May 7, includes an additional $46 million specifically targeted at southbound enforcement.

Customs inspectors’ techniques range from primitive to high-tech, with about an equal success rate. Sometimes a small white truck drives slowly alongside vehicles that have been pulled over, beaming X-rays at them to reveal hidden cash or weapons. A smaller X-ray unit scans spare tires or pieces of luggage, a hand-held density meter called a “Buster” can reveal hidden compartments loaded with cash, a fiber-optic scope snaked into gas tanks looks for hidden cargo and trained dogs can sniff out cash or weapons.

But before they get to any of the gadgets, officers knock with a knuckle or flat palm on a car’s body panels. And they ask, again and again: “Do you have any weapons? Cash? Merchandise?”

Often the dogs make the finds.

Grill, a “currency canine,” smelled something on 63-year-old Isabel Ortega Garcia on April 3 in Hidalgo, Texas, when Ortega was walking into Mexico. When Grill got excited, agents patted Ortega down and found $148,000 in neat wads of $100 bills taped around her waist.

Two weeks earlier in Laredo, Akim sniffed cash under the floor of a southbound bus. Under the seats, in a hidden compartment, were 75 bundles of bills totaling $2,997,510.

But even finding that much cash doesn’t always yield an arrest. Without a U.S. attorney’s say-so, the best an agent can do is seize any cash amounts over $10,000 that the traveler does not declare, hand them a receipt and send them on south.

The best case scenario for agents who seize undeclared currency is that federal prosecutors decide to bring charges and begin a forfeiture procedure. But often it is a race against the clock as inspectors on the scene try to collect enough evidence to make it an attractive case for prosecutors.

Obama said while campaigning that he favored a ban on sales of assault weapons. But Congress isn’t budging on the issue, and guns in the U.S., particularly in southern border states, remain easy to buy legally.

“The real issues of assault weapons and bulk cash do not initiate at the border and cannot be solved there,” said David Shirk, director of the University of San Diego’s Trans-Border Institute. “But gun control? That’s a discussion the current administration is reluctant to wade into.”

Mexican customs inspector Ricardo Briseno, 27, says the increase in U.S. inspections of Mexico-bound cars has made his job easier, even though the only effective solution would be to stop every car.

“At least it’s something,” he said. “We are working together on a shared problem.”

Parents and other citizens are often frustrated by certain policies in public schools.

Arizona, for example, for several years has required students to pass Arizona’s Instrument to Measure Standards in order to receive a high school diploma.

An exception, called “augmentation,” allows students who fail the test to get a diploma, provided their grades are good and they take remedial courses in math, English or both.

The problem has been that students, parents and even teachers have not always known about this important exception or how students can take advantage of it. Confusion results.

The Center on Education Policy, an independent Washington, D.C., advocacy and research organization, studied policies for at-risk students and English-language learners in Arizona during the 2006-07 school year.

Researchers conducted 364 interviews with students, teachers, administrators and parents at five high schools in southern Arizona.

Three Arizona policies in particular were the focus: AIMS and augmentation, the Arizona English Language Learner Assessment and the written. individualized compensatory plan (a learning plan for English-language learners who have been classified as “fluent” in English but are not making progress).

Serious problems were found with understanding and implementing all three policies.

In addition to the confusion about the augmentation policy, many teachers believed English-language learners passing AZELLA were not necessarily ready for mainstream classrooms, let alone passing high school exit exams.

Once students pass AZELLA, in principle, they are not qualified to receive any language service; AZELLA becomes a legitimate excuse to deprive students of desperately needed services.

Under such circumstances, it is natural that some schools create their own rules of classification and manage to subsidize programs without funding from the state.

Legal arguments, such as Flores v. Arizona, should not be surprising, because the state’s identification, classification and funding system is simply not working for students, teachers and schools.

Another problem area is Arizona’s written individualized compensatory plan. Teachers are to specify learning goals for struggling students to help with their academic progress.

This is a really good idea when a couple of students in each class need such service. But when a school has to write individual plans for more than 700 students, as in some of the schools reported in the study, this well-intended policy turns out to be unrealistic.

This program was abandoned by some schools because they did not have sufficient staff, resources or knowledge to put it into practice.

Policy design is not just theory; this individualized plan program is an object lesson in how idealistic design can contribute to impractical implementation.

The lesson from our work in Arizona couldn’t be clearer: State policies may not only fail in achieving their goals, but also may bring unexpected consequences to students and schools.

CEP’s report captures this reality during 2006-07 and describes a wide range of reactions among teachers and school staff.

We hope, for the students, parents, teachers and other citizens of Arizona, the situation has improved.

But the broader lesson is that the state government and local school boards should make sure their policies make sense when implemented together and don’t conflict with one another.

They should also be sure that teachers and local administrators have the capacity to carry out those policies.

Otherwise, there will be confusion in the public and frustration in the schools.

Arizona is not alone in having school policies that do not fit well together and in requiring policies when there is little or no capability to carry them out.

But not being alone should not be an excuse. Policymakers must make sense out of what we ask our schools to do.

Jack Jennings is president and CEO of the Center on Education Policy. Ying Zhang is a CEP research associate.

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More online

To read the full report, Conflicts Between State Policy and School Practice: Learning from Arizona’s Experience with High School Exam Policies, go http://www.cep-dc.org and look under High School Exit Exams.

PHOENIX – A woman in Arizona suffering from a lung condition has apparently become the fourth person in the nation to die with swine flu.

The Maricopa County Health Department reported Thursday that the woman, in her late 40s, died last week of what appears to be complications of the new strain of influenza.

Laboratory tests confirmed that the woman was infected with the flu strain. Health department spokeswoman Jeanene Fowler says the federal Centers for Disease Control and Prevention is expected to add her to the official national tally on Friday.

The case would bring the number of swine flu deaths in the nation to four and put the worldwide death toll at 70, with an estimated 6,672 cases in 33 countries.

FLAGSTAFF – A federal appeals court has ruled that a woman who started part of the largest wildfire in Arizona history must exhaust remedies in a tribal court.

Valinda Jo Elliott was lost on White Mountain Apache land for two days in 2002 when she started a blaze to get the attention of a television news helicopter. That fire merged into the Rodeo-Chediski fire.

She wasn’t criminally prosecuted, but the tribe brought a civil case against her.

After she tried unsuccessfully to have the case dismissed in tribal courts, she turned to a federal district court.

That court held that Elliott must exhaust her tribal court remedies and dismissed the case without prejudice.

The 9th U.S. Circuit Court of Appeals upheld the ruling Thursday.

PHOENIX – The oldest soldier to be killed in Iraq fought in Vietnam and decided to re-enlist at the age of 59 after the 9/11 terrorist attacks and the death of his wife, according to his brother.

Army Maj. Steven Hutchison, 60, was killed in Iraq on Sunday after a homemade bomb went off near his vehicle in Al Farr, according to the Department of Defense.

Richard Hutchison of Scottsdale told The Associated Press on Thursday that his older brother Steven wanted to re-enlist immediately after the 9/11 attacks, but that his wife, Candy, didn’t want him to.

But when Candy died of breast cancer, “a part of him died,” so he signed up again in July 2007, according to his brother and the Army.

“He was very devoted to the service and to his country,” Richard Hutchison said. “For somebody to go back into the military at 60 years old, obviously I didn’t want him to do it, but he had a mind of his own and that’s what he wanted to do. He’s been a soldier his whole life.”

He said his brother never explained why he wanted to re-enlist, but that “I’m guessing it had something to do with them coming into our country and killing our people.”

“He wanted to go back in,” he added. “He wanted to do his share.”

He said Steven Hutchison served in Afghanistan for a year after he re-enlisted and went to Iraq in October as a team leader of about a dozen soldiers who would train Iraqi soldiers how to fight. But, he said his brother’s mission changed and that he was working to secure Iraq’s southern border instead.

Army spokesman Lt. Col. Nathan Banks said Thursday that Hutchison was the oldest Army soldier killed in Iraq.

An Associated Press database of soldiers killed in Iraq and Afghanistan shows that Hutchison is the oldest member of any service branch killed since the wars broke out.

Richard Hutchison said Steven was a great big brother and a best friend who was always looking out for him. “He took care of me,” he said.

“I was worried about him. I didn’t want him to go (to Iraq),” he said through tears, adding that he loved his brother “so much.”

He said Steven Hutchison worked as a college professor of psychology at a couple of California universities and then worked at a private health care corporation in Arizona before he retired a few years ago.

Records at Loyola Marymount University in Los Angeles show that Hutchison taught in the psychology department there on and off between 1988 and 1996. Hutchison’s résumé, provided by the school, shows he was a lecturer at California State University in Long Beach and taught at Claremont McKenna College in Claremont, Calif.

Hutchison was born in Cincinnati and raised in Long Beach, Calif. Steven and Richard have a half brother and half sister living in Michigan. Steven Hutchison married four times, and was married to Candy for 10 years before she died. He had no children.

Richard Hutchison said his brother will be buried next to Candy in Scottsdale, and that a funeral is tentatively planned for Tuesday.

Hutchison was assigned to the 2nd Battalion, 34th Armor Regiment, 1st Brigade Combat Team, 1st Infantry Division at Ft. Riley, Kan.

The heartbreaking case of Mikelle Biggs, an 11-year-old Mesa girl who disappeared more than 10 years ago, returns to the national spotlight Friday.

ABC News’ “20/20,” a newsmagazine show, will delve into the unsolved case as part of a series of shows featuring people who have disappeared.

Darien Biggs, Mikelle’s father, remains convinced that a sex offender sentenced to more than 100 years in prison for the brutal rape of a neighbor is responsible for his daughter’s murder.

While suspicion has focused on the convicted rapist, Mesa police consider Mikelle’s disappearance an open case and have never named a suspect. They say there isn’t enough evidence to charge anyone.

Mikelle disappeared about 6 p.m. on Jan. 2, 1999, at Toltec Street and El Moro Avenue in central Mesa. Mikelle had heard an ice cream truck and ran out to meet it. Her sister, Kimber, went home to get a jacket. Tracy Biggs, their mother, sent Kimber back to tell Mikelle to come home.

Only 90 seconds passed, but Mikelle already was gone, less than a block from the family’s house.

Mikelle’s body never was found. No one apparently witnessed what police still believe was an abduction. Police found Mikelle’s bicycle and two quarters she planned to use to buy the ice cream.

Elizabeth Vargas, an award-winning reporter who worked in Phoenix early in her career for KTVK (Channel 3) from 1986-1989, interviews the Biggs family as part of the show.

“It’s such a heartbreaking case,” Vargas said. “Within two minutes, she vanishes into thin air.”

Vargas said she has worked on profiles of 10 to 15 cases where people have vanished; some eventually were solved and others remain unsolved.

“I think the thing we have found repeatedly in these shows is that not knowing is the worst,” she said.

Darien Biggs called the “20/20″ interview another in a series of attempts to finally find out what happened to Mikelle after more than a decade.

“I won’t be a whole person again until we know for sure,” Biggs said. “I think there has to be more than one person in the world who knows what happened. It’s so hard to keep a secret.”

His hope is that the “20/20″ profile will jog memories and generate more tips for police, perhaps from someone who once lived in Mesa but has moved out of state.

“I just hope that someone will say something. You never know,” he said.

PHOENIX — School-choice backers are proposing new state income tax credits to replace private school voucher programs that a court ruled were unconstitutional. And they want Gov. Jan Brewer to call lawmakers into special session to get that done in time for the next school year.

Chandler Republican Rep. Steve Yarbrough says the proposed legislation would create new individual and corporate tax credits for donations for tuition grants for disabled and foster children attending private schools.

Yarbrough says the proposal is a reaction to a March Arizona Supreme Court ruling that overturned voucher programs for disabled and foster children. The court previously upheld an existing state individual income tax credit.

A Brewer spokesman did not immediately return a call for comment.

Danielle McBurnett has had people compare her to the main character in the old television show “Doogie Howser, M.D.,” about a teenage doctor.

The first time she heard that comparison, however, someone had to explain to her who Doogie Howser was. The show was canceled in 1993, when she was just 1 year old.

On Wednesday, McBurnett, 17, became the youngest person ever to receive a bachelor of science degree from Arizona State University’s College of Nursing and Healthcare Innovation. She graduated summa cum laude from the program and plans to enroll in the school’s doctoral program in nursing practice in the fall.

McBurnett lives in Chandler with her parents, Ray and Lori, and three siblings. She was home-schooled, but at age 12 she started taking classes at Chandler-Gilbert Community College.

She received her associate degree (4.0 grade-point average) and high-school diploma at the age of 15 and enrolled at ASU.

She said she has never let her age stand in the way of accomplishments.

“Most people (when told her age) have just said, ‘Wow, that’s amazing.’ When I meet people, I don’t wear a big name tag that says, ‘Hi, I’m Danielle, I’m 17.’ I’ll tell some people when it’s pertinent information, but I don’t let my age dictate who I am.”

McBurnett has always carried herself in a mature fashion, said her mother, Lori McBurnett.

“She was born an adult, that’s the world she wanted to live in,” she said. “When she was very, very small, she wanted to talk with the adults and be with the adults. She didn’t want to play with toys. That was her nature.”

Danielle McBurnett has also been active in performing arts: She plays piano and has acted in a variety of plays. That training has helped boost her confidence and allowed her to project herself in a more dynamic fashion.

She said college just sharpened her focus on a goal she has held since she was 10 years old.

“I knew I wanted to be a nurse,” McBurnett said. “Now, I’m more focused on what I want to be on top of that and the next degrees I want to get. Now, I want to be a nurse practitioner. After that, I’m even considering going to law school, too.”

McBurnett said she didn’t want to become a doctor because she wanted a closer relationship with patients and the doctor’s career path didn’t offer as much flexibility.

“Nurses really get to interact with patients more than doctors, typically,” McBurnett said. “I really want that human, patient interaction. Also, I want to have the ability to do lots of things. I don’t want to be confined to just being a doctor, and I feel like I can do that better as a nurse practitioner. And I want to possibly spend more time with my own children, some day in the future, and I feel I’d be better able to do that as a pediatric-nurse practitioner.”

She wants to eventually be an advocate for children, both domestically and abroad, which is why law school may be part of her future.

She has opinions on subjects ranging from the health-care system to tort reform that may make her seem mature beyond her years, but she has also taken part in more typical activities for girls her age.

“I did go to prom,” she said with a laugh. “The home-school community has its own prom. I’ve been to a number of dances, and I feel like I participated in every high school opportunity out there.”

The man in charge of building a virtual fence along America’s southern border said Thursday that the much-maligned network is moving ahead and will work despite criticism and public misunderstanding.

Mark Borkowski, executive director of the Secure Border Initiative, conceded that initial testing of the system near Tucson seemed like a “disaster” because of equipment glitches. However, he added, flaws are expected with new technology, and the problems have been resolved.

“It was a prototype. We did a bad job of communicating that,” said Borkowski, speaking at the Border Security Expo and Conference in Phoenix.

“When we got out there, it didn’t work very well,” he added. “We fixed it.”

The electronic monitoring system known as SBINet is being built by the Boeing Co. and other contractors at an expected cost of $6.7 billion. As planned, it would in the next five years cover much of the 2,000-mile Southwestern border.

The virtual fence employs motion sensors, laser lights, cameras, radar and other instruments to alert agents when people are trying to cross the border illegally.

Borkowski said the entire system, which is supposed to detect up to 80 percent of incursions in a zone, has been upgraded to meet Border Patrol specifications and needs.

Early depictions created unrealistic expectations that a virtual fence alone would stop smugglers and undocumented immigrants, Borkowski said. Rather, he said, SBINet is one tool in a defense arsenal that relies on 20,000 Border Patrol agents and physical barricades as well.

“It is not the be-all and end-all of border security,” Borkowski said. “It is a critical element of a much larger approach. . . . The idea is how to mix those three things together the right way to secure every inch of the border.”

Borkowski said 624 miles of physical fencing and vehicle barricades have been erected to delay illegal crossers long enough so Border Patrol agents can catch them.

“We know people can cut through a fence. We know they can climb over a fence,” he stressed, “but we want to slow them down.”

By contrast, Borkowski said, the virtual fence is designed for surveillance and intelligence. Sensors detect human traffic and relay signals to nearby towers with cameras. The intelligence is transmitted to Border Patrol stations, where agents monitor the network and respond to breaches.

The first operating segment covers a 23-square-mile section of desert south of Tucson.

Borkowski said the fence will be completed and evaluated this summer by the Border Patrol. If all systems are go, a second segment will be built near Ajo, then towers that stretch across most of the Arizona border zone.

The project has been criticized for its costs, and last year the Government Accounting Office panned SBINet for delays and technological glitches.

Technical woes surfaced also. For instance, Borkowski said, sensors were linked to cameras by satellite communications that took several seconds to transmit. By the time cameras were automatically trained on a target zone, intruders had moved out of view.

Gotcha! A traffic camera flashes to catch a speeder on the Piestewa Freeway in Phoenix. But the person driving may not get a speeding ticket.

Motorists activated photo-enforcement cameras on Arizona highways more than 471,000 times from December through February – more than 5,200 times each day – but on average, only about one-third of those drivers received tickets from the state Department of Public Safety.

An Arizona Republic analysis of three months of records shows Redflex Traffic Systems Inc. and the DPS threw out more than 65 percent of the photos captured.

The reasons for rejecting tickets vary but are relatively uncomplicated: Sun glare, dirty windshields and traffic rank as top causes.

Redflex, a Scottsdale-based company that operates Arizona’s statewide system, has a goal of issuing tickets 80 percent of the time the cameras are activated, DPS Lt. Jeff King said.

A Redflex spokeswoman clarified by saying that figure applies only to photos that aren’t compromised by factors such as the weather. Redflex refused to comment on the expectations or success of the program in Arizona.

King wouldn’t characterize the DPS’ position on the number of activations and the percentage of tickets issued but said the agency is pleased with photo enforcement’s impact on public safety.

“I think there’s always room for improvement, but we also recognize that there are some things outside of everybody’s control. It’s nature. You cannot fix the sun,” King said. “Between sun glare, dirty windshields, shade, there’s really not a whole lot you can do with that.”

Part of the problem in Arizona, King said, is that the state has a driver-responsibility law, like Colorado, California and Oregon. That distinction means DPS officers have to match the photo of the speeder with one on a driver’s license.

Authorities issue notices of violation to owners when a speed camera captures a clear picture of a license plate and a driver. But the vehicle’s owner may deny being the driver. If authorities can’t then match the camera image to a driver’s-license photo, they can’t issue a ticket.

Other states, like Louisiana, have a registered-owner responsibility law, which requires authorities to match only the license plate with a registered owner. The owner gets the ticket, even if he or she wasn’t the one driving.

“I don’t think you could ever get to that perfect 80 percentile that they’re targeting,” King said. “We have to actually be able to look in the picture and identify that person.”

Redflex officials would not discuss the technology that operates the photo-enforcement system, but the cameras have high-powered lenses, King said. The cameras are designed to take high-resolution photos across multiple lanes of traffic.

“We can just about zoom in and see stuff on the dash,” King said.

Motorists occasionally beat the cameras by blocking their faces or having a fortuitously placed visor.

Walter Figueroa’s case, though it didn’t arise from a freeway camera, shows that other factors can be at work, too.

Figueroa received a violation notice in his Laveen mailbox earlier this week for driving 50 mph through a 35-mph zone in Mesa on his motorcycle on April 25.

But Figueroa doesn’t own a motorcycle.

He drives a Nissan SUV, as the violation notes, with a license plate of ONIX.

The citation also contains a picture of a man on a motorcycle, making an obscene gesture toward the camera, with a license plate of ON1X.

“I’m just a little bent. Two people physically signed this ticket,” he said.

American Traffic Solutions operates Mesa’s photo-enforcement system. Figueroa called the toll-free number on the back of the violation, and the operator forwarded his dispute to Mesa police, who issued the ticket.

“What if I was out of state or out of the country and never acknowledged that and missed the court date, then my license is suspended because of their mistake,” Figueroa said. “Did it not behoove you to check my registered vehicles? I don’t even own a motorcycle.”

Legislators approved the statewide program in July, giving the DPS a mandate to install 100 fixed and mobile cameras on Arizona highways.

The DPS suspended the program’s expansion in mid-January, with 36 fixed locations and 42 mobile units in place. The suspension coincided with a wave of anti-photo-enforcement efforts that included residents’ protests and legislative efforts to end the program, but DPS officials insist they suspended the program to seek the best locations for the remaining cameras.

The most recent data from the DPS shows cameras snapped motorists more than 1 million times on Arizona highways during the program’s first seven months.

More than 80,000 drivers have paid the fines.

Arizona has collected nearly $12 million through the process, with more than $1.3 million going to Redflex, according to terms of the contract.

King and other DPS officials cite statistics that show traffic fatalities have dropped dramatically in areas where photo-enforcement cameras are stationed. Critics deride that data, which compared the same 80-day periods in consecutive years, as incomplete.

The April 19 murder of Redflex employee Doug Georgianni while he worked in a mobile photo-enforcement unit near Seventh Avenue and Loop 101 in Phoenix brought the program, and the controversy surrounding it, into the spotlight again.

DPS authorities have tried to focus on photo enforcement’s safety benefits from the beginning but have been plagued by a 2008 prediction from then-Gov. Janet Napolitano that the program could generate as much as $90 million in revenue in the first year.

Critics point to that prediction as evidence that speed cameras are nothing more than a revenue generator masquerading as a safety program.

By JJ Hensley, Matt Wynn

Overflow stadium crowd braves heat to hear upbeat message

President Obama makes a point during the Arizona State University commencement ceremony on Wednesday in Tempe.

TEMPE – President Obama apologized for “stealing away” former Arizona Gov. Janet Napolitano and urged students to never stop achieving as he made a commencement speech Wednesday night at Arizona State University.

Some 63,000 people filled the stands and most of the football field at Sun Devil Stadium.

It will be up to young people to redefine success, Obama told graduates, from materialistic greed to building a quality life while taking on the nation’s challenges. That means serving a higher purpose than themselves, he said.

Developing clean energy and improving failing schools will be this generation’s job, he said. He pointed to his own job title and said that doesn’t define success, comparing Abraham Lincoln to Millard Fillmore.

Being a superpower isn’t enough for America, he said. It must be mindful of the struggles of the rest of the world.

“Class of 2009, that’s why we’re going to need your help,” he said of issues such as global warming, rebuilding the economy and solving other “unprecedented” problems.

Careers such as engineering and teaching can be crafted with service in mind, he said.

A body of work is never finished, he said. He went on to cite the achievements of people who never gave up, including Kurt Warner, a former Arena Football League player who led the Arizona Cardinals to their first Super Bowl in 2009.

He also pointed to late achievers Julia Child, Col. Sanders and Winston Churchill.

While acknowledging that graduates were facing a tough economy – the nation has lost 1.3 million jobs since February – he called the challenges an opportunity.

“Because it’s moments like these that force us to try harder and dig deeper and to discover gifts we never knew we had – to find the greatness that lies within each of us. So don’t ever shy away from that endeavor,” Obama said during a speech that invoked the bravery firefighters demonstrated on Sept. 11, 2001, and the civil rights movement.

“Don’t stop adding to your body of work. As a nation, we’ll need a fundamental change of perspective and attitude,” he said. “It’s clear that we need to build a new foundation – a stronger foundation – for our economy and our prosperity, rethinking how we grow our economy, how we use energy, how we educate our children, how we care for our sick, how we treat our environment.”

Some 9,000 students were awarded diplomas at Sun Devil Stadium on a day when the high temperature in Phoenix was 101, but Obama wasn’t going to be one of them. University officials declined to give him an honorary degree, saying he had not yet accomplished enough to deserve the honor.

“His body of work is yet to come. That’s why we’re not recognizing him with a degree at the beginning of his presidency,” university spokeswoman Sharon Keeler said shortly after the school’s student newspaper reported the decision.

Obama said he “heartily concurred” with that assessment.

Officials later backtracked and instead named a scholarship in honor of the nation’s first African-American president. The President Barack Obama Scholars program will offer students up to $17,000 annually to pay for tuition, books, room and board.

Some sweated the wait for Obama’s speech. An official at the university’s emergency operations center said about 95 people were treated for heat-related illness while waiting for Obama’s address. None of the illnesses was considered life-threatening.

Rocker and Phoenix-area resident Alice Cooper was to perform “School’s Out.”

Obama was to fly to Albuquerque, N.M., after the speech. The president planned to have a town hall-style meeting Thursday in Albuquerque on proposed restrictions on credit card companies before he returned to Washington.

The White House has announced Obama plans other commencement addresses at the University of Notre Dame and the U.S. Naval Academy.

Student protests were expected Sunday at Notre Dame over Obama’s support for abortion rights and embryonic stem cell research.

Nancy Tranchese (center) and her mother, Kathleen Tranchese, both of Tempe, join members of the End the War Coalition in a protest Wednesday in front of Sun Devil Stadium.

President Obama and Arizona State University President Michael Crow sing the National Anthem before the commencement address Wednesday at the university stadium.

President Obama arrives at the Arizona State University commencement ceremony at Sun Devil Stadium in Tempe Wednesday.

By Citizen Staff Report, Wire Report

The text of President Obama’s speech, as prepared for delivery:

Thank you, President Crow, for that generous introduction, and for your inspired leadership here at ASU. And I want to thank the entire ASU community for the honor of attaching my name to a scholarship program that will help open the doors of higher education to students from every background. That is the core mission of this school; it is a core mission of my presidency; and I hope this program will serve as a model for universities across this country.

Now, before I begin, I’d like to clear the air about that little controversy everyone was talking about a few weeks back. I have to tell you, I really thought it was much ado about nothing, although I think we all learned an important lesson. I learned to never again pick another team over the Sun Devils in my NCAA bracket. And your university President and Board of Regents will soon learn all about being audited by the IRS.

In all seriousness, I come here not to dispute the suggestion that I haven’t yet achieved enough in my life. I come to embrace it; to heartily concur; to affirm that one’s title, even a title like President, says very little about how well one’s life has been led – and that no matter how much you’ve done, or how successful you’ve been, there’s always more to do, more to learn, more to achieve.

And I want to say to you today, graduates, that despite having achieved a remarkable milestone, one that you and your families are rightfully proud of, you too cannot rest on your laurels. Your body of work is yet to come.

Now, some graduating classes have marched into this stadium in easy times – times of peace and stability when we call on our graduates to simply keep things going, and not screw it up. Other classes have received their diplomas in times of trial and upheaval, when the very foundations of our lives have been shaken, the old ideas and institutions have crumbled, and a new generation is called on to remake the world.

It should be clear by now the category into which all of you fall. For we gather here tonight in times of extraordinary difficulty, for the nation and the world. The economy remains in the midst of a historic recession, the result, in part, of greed and irresponsibility that rippled out from Wall Street and Washington, as we spent beyond our means and failed to make hard choices. We are engaged in two wars and a struggle against terrorism. The threats of climate change, nuclear proliferation, and pandemic defy national boundaries and easy solutions.

For many of you, these challenges are felt in more personal terms. Perhaps you’re still looking for a job – or struggling to figure out what career path makes sense in this economy. Maybe you’ve got student loans, or credit card debts, and are wondering how you’ll ever pay them off. Maybe you’ve got a family to raise, and are wondering how you’ll ensure that your kids have the same opportunities you’ve had to get an education and pursue their dreams.

In the face of these challenges, it may be tempting to fall back on the formulas for success that have dominated these recent years. Many of you have been taught to chase after the usual brass rings: being on this “who’s who” list or that top 100 list; how much money you make and how big your corner office is; whether you have a fancy enough title or a nice enough car.

You can take that road – and it may work for some of you. But at this difficult time, let me suggest that such an approach won’t get you where you want to go; that in fact, the elevation of appearance over substance, celebrity over character, short-term gain over lasting achievement is precisely what your generation needs to help end.

I want to highlight two main problems with that old approach. First, it distracts you from what is truly important, and may lead you to compromise your values, principles and commitments. Think about it. It’s in chasing titles and status – in worrying about the next election rather than the national interest and the interests of those they represent – that politicians so often lose their way in Washington. It was in pursuit of gaudy short-term profits, and the bonuses that come with them, that so many folks lost their way on Wall Street.

The leaders we revere, the businesses that last – they are not the result of narrow pursuit of popularity or personal advancement, but of devotion to some bigger purpose – the preservation of the Union or the determination to lift a country out of depression; the creation of a quality product or a commitment to your customers, your workers, your shareholders and your community.

The trappings of success may be a by-product of this larger mission, but they can’t be the central thing. Just ask Bernie Madoff.

The second problem with the old approach is that a relentless focus on the outward markers of success all too often leads to complacency. We too often let them serve as indications that we’re doing well, even though something inside us tells us that we’re not doing our best; that we are shrinking from, rather than rising to, the challenges of the age. And the thing is, in this new, hyper-competitive age, you cannot afford to be complacent.

That is true in whatever profession you choose. Professors might earn the distinction of tenure, but that doesn’t guarantee that they’ll keep putting in the long hours and late nights – and have the passion and drive – to be great educators. It’s true in your personal life as well. Being a parent isn’t just a matter of paying the bills and doing the bare minimum – it’s not bringing a child into the world that matters, but the acts of love and sacrifice it takes to raise that child. It can happen to presidents too: Abraham Lincoln and Millard Fillmore had the very same title, but their tenure in office – and their legacy – could not be more different.

And that’s not just true for individuals – it is also true for this nation. In recent years, in many ways, we’ve become enamored with our own success – lulled into complacency by our own achievements.

We’ve become accustomed to the title of “military super-power,” forgetting the qualities that earned us that title – not just a build-up of arms, or accumulation of victories, but the Marshall Plan, the Peace Corps, our commitment to working with other nations to pursue the ideals of opportunity, equality and freedom that have made us who we are.

We’ve become accustomed to our economic dominance in the world, forgetting that it wasn’t reckless deals and get-rich-quick schemes that got us there; but hard work and smart ideas -quality products and wise investments. So we started taking shortcuts. We started living on credit, instead of building up savings. We saw businesses focus more on rebranding and repackaging than innovating and developing new ideas and products that improve our lives.

All the while, the rest of the world has grown hungrier and more restless – in constant motion to build and discover – not content with where they are right now, determined to strive for more.

So graduates, it is now abundantly clear that we need to start doing things a little differently. In your own lives, you’ll need to continuously adapt to a continuously changing economy: to have more than one job or career over the course of your life; to keep gaining new skills – possibly even new degrees; and to keep taking risks as new opportunities arise.

And as a nation, we’ll need a fundamental change of perspective and attitude. It is clear that we need to build a new foundation – a stronger foundation – for our economy and our prosperity, rethinking how we educate our children, and care for our sick, and treat our environment.

Many of our current challenges are unprecedented. There are no standard remedies, or go-to fixes this time around.

That is why we are going to need your help. We’ll need young people like you to step up. We need your daring and your enthusiasm and your energy.

And let me be clear, when I say “young,” I’m not just referring to the date on your birth certificate. I’m talking about an approach to life – a quality of mind and heart.

A willingness to follow your passions, regardless of whether they lead to fortune and fame. A willingness to question conventional wisdom and rethink the old dogmas. A lack of regard for all the traditional markers of status and prestige – and a commitment instead to doing what is meaningful to you, what helps others, what makes a difference in this world.

That’s the spirit that led a band of patriots not much older than you to take on an empire. It’s what drove young pioneers west, and young women to reach for the ballot; what inspired a 30 year-old escaped slave to run an underground railroad to freedom, and a 26 year-old preacher to lead a bus boycott for justice. It’s what led firefighters and police officers in the prime of their lives up the stairs of those burning towers; and young people across this country to drop what they were doing and come to the aid of a flooded New Orleans. It’s what led two guys in a garage – named Hewlett and Packard – to form a company that would change the way we live and work; and what led scientists in laboratories, and novelists in coffee shops to labor in obscurity until they finally succeeded in changing the way we see the world.

That is the great American story: young people just like you, following their passions, determined to meet the times on their own terms. They weren’t doing it for the money. Their titles weren’t fancy – ex-slave, minister, student, citizen. But they changed the course of history – and so can you.

With a degree from this university, you have everything you need to get started. Did you study business? Why not help our struggling non-profits find better, more effective ways to serve folks in need. Nursing? Understaffed clinics and hospitals across this country are desperate for your help. Education? Teach in a high-need school; give a chance to kids we can’t afford to give up on – prepare them to compete for any job anywhere in the world. Engineering? Help us lead a green revolution, developing new sources of clean energy that will power our economy and preserve our planet.

Or you can make your mark in smaller, more individual ways. That’s what so many of you have already done during your time here at ASU – tutoring children; registering voters; doing your own small part to fight hunger and homelessness, AIDS and cancer. I think one student said it best when she spoke about her senior engineering project building medical devices for people with disabilities in a village in Africa. Her professor showed a video of the folks they’d be helping, and she said, “When we saw the people on the videos, we began to feel a connection to them. It made us want to be successful for them.”

That’s a good motto for all of us – find someone to be successful for. Rise to their hopes and their needs. As you think about life after graduation, as you look in the mirror tonight, you may see somebody with no idea what to do with their life. But a troubled child might look at you and see a mentor. A homebound senior citizen might see a lifeline. The folks at your local homeless shelter might see a friend. None of them care how much money is in your bank account, or whether you’re important at work, or famous around town – they just know that you’re someone who cares, someone who makes a difference in their lives.

That is what building a body of work is all about – it’s about the daily labor, the many individual acts, the choices large and small that add up to a lasting legacy. It’s about not being satisfied with the latest achievement, the latest gold star – because one thing I know about a body of work is that it’s never finished. It’s cumulative; it deepens and expands with each day that you give your best, and give back, and contribute to the life of this nation. You may have set-backs, and you may have failures, but you’re not done – not by a longshot.

Just look to history. Thomas Paine was a failed corset maker, a failed teacher, and a failed tax collector before he made his mark on history with a little book called Common Sense that helped ignite a revolution. Julia Child didn’t publish her first cookbook until she was almost fifty, and Colonel Sanders didn’t open up his first Kentucky Fried Chicken until he was in his sixties. Winston Churchill was dismissed as little more than a has-been, who enjoyed scotch just a bit too much, before he took over as Prime Minister and saw Great Britain through its finest hour. And no one thought a former football player stocking shelves at the local supermarket would return to the game he loved, become a Super Bowl MVP, and then come here to Arizona and lead your Cardinals to their first Super Bowl.

Each of them, at one point in their life, didn’t have any title or much status to speak of. But they had a passion, a commitment to following that passion wherever it would lead, and to working hard every step along the way.

And that’s not just how you’ll ensure that your own life is well-lived. It’s how you’ll make a difference in the life of this nation. I talked earlier about the selfishness and irresponsibility on Wall Street and Washington that rippled out and led to the problems we face today. I talked about the focus on outward markers of success that can lead us astray.

But here’s the thing, graduates: it works the other way around too. Acts of sacrifice and decency without regard to what’s in it for you – those also create ripple effects – ones that lift up families and communities; that spread opportunity and boost our economy; that reach folks in the forgotten corners of the world who, in committed young people like you, see the true face of America: our strength, our goodness, the enduring power of our ideals.

I know starting your careers in troubled times is a challenge. But it is also a privilege.

Because it is moments like these that force us to try harder, to dig deeper, to discover gifts we never knew we had – to find the greatness that lies within each of us. So don’t ever shy away from that endeavor. Don’t ever stop adding to your body of work. I can promise that you will be the better for that continued effort, as will this nation that we all love.

Congratulations on your graduation, and Godspeed on the road ahead.