The death of a 13-year-old Tucson middle school student brings Arizona’s swine flu death toll to three, according to the Pima County Health Department.

Nationwide, it’s up to seven.

The most recent Arizona deaths were the Tucson teen who died Friday and a 57-year-old Pinal County woman who died earlier this week, according to the Health Department and the Associated Press.

Arizona’s confirmed cases have risen to 476, which adds to the more than 1,650 confirmed cases in the four states that border Mexico, according to the U.S. Centers for Disease Control.

Texas leads the border states with 556; California clocks in second with 553; and New Mexico has 68.

A total of 5,100 cases are confirmed nationwide.

The state with the most?

Illinois with 696, followed by Wisconsin at 616, according to a report in BizJournals.com.

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A Phoenix school has been ordered closed for a week by Maricopa County health officials due to an apparent flu outbreak.

County public health director Dr. Bob England says Lowell Elementary School has been “experiencing a much higher than normal rate of absenteeism due to illness that looks like flu.”

England ordered the school closed as a precaution until May 26.

He says with swine flu and seasonal flu behaving much the same way, it’s not recommended that students already home with mild illness be tested for swine flu. So, England says it’s likely that the strain of flu will remain unknown.

Lowell Elementary School spokeswoman Sara Bresnahan said officials saw a spike of absences on Monday among the school’s 700-student population. About 20 percent of the student body called in sick.

England ordered three schools closed April 29 after students contracted swine flu. A few days later, he announced he wouldn’t order new closures unless a particular school had a widespread outbreak.

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 – 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.

Tucson International Airport’s Concourse P is living up to its name with a designated pet area where visiting canines can relieve themselves.

Thanks to an amendment to the Air Carrier Access Act that went into effect Wednesday, the Prickly Paws Pet Stop can be found just outside the terminal building on its east side.

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.”

Kececioglu

Someday, genomic sequence testing will help doctors identify whether newborns will develop health problems later in life.

That may seem like science fiction now, but improved technologies and techniques are making genetic sequencing quicker and far less expensive.

Mapping the human genome the first time cost about $3 billion, said John Kececioglu, University of Arizona associate professor of computer science and BIO5 Institute member. Some operations have brought the price down to $5,000.

Kececioglu is conference chair for RECOMB2009, an international conference on computational molecular biology research that will run Sunday through Thursday in Tucson.

Genomic sequencing determines the order of key components in genetic material. Abnormalities such as mutations can mean certain diseases are likely to develop.

All biological processes are governed by the 3 billion lettered segments and their order in human DNA, he said.

“There is a goal to have a $1,000 genome test that a person can actually purchase,” Kececioglu said. “Companies are making use of this data to uncover what disease susceptibilities an individual has.”

Genomics and the environment, including such behaviors as smoking and drinking, contribute to disease, and researchers are trying to offer insights on DNA’s role in the equation, he said.

In addition to identifying the diseases a person is likely to get, markers in a sequenced genome can offer information on which drugs and therapies will best help a person prevail against a specific type of cancer or other disease, he said.

“It’s key to prevention,” Kececioglu said. “It could make health care much more efficient and effective.”

“It’s certainly becoming affordable,” he said. “You do it once in a lifetime. Your genome does not change.”

Continued decreases in price could make use of the tests more commonplace.

If the cost drops to $1,000, it could make economic sense to sequence DNA on all 4 million children born in the United States each year, said Rade Drmanac, chief scientific officer and co-founder of Complete Genomics Inc.

Drmanac will participate in a RECOMB2009 industry panel discussion on personalized genomics.

His Mountain View, Calif., company offers sequencing to research organizations and drug discovery firms for $5,000.

Sequencing efficiencies are expected to increase in the next two to three years, he said, and costs will continue to go down, opening the door for widespread use of the technology.

“The bottom line is we know that having complete and accurate genome sequencing is an absolutely necessary basis for the advance of low-cost health care,” Drmanac said. “We need to do complete genome sequencing to find the genomic basis for disease.”

Pre-diagnosis leading to targeted checkups and early detection can save lives.

Although information from sequencing can benefit health, some fear it could also be used by insurance companies to deny coverage, Kececioglu said.

“The privacy issues are very important. That information is not shared with anyone besides the patient,” he said.

RECOMB2009 will attract 275 top researchers in the computational, mathematical and biological sciences coming from 18 nations, Kececioglu said. It is not open to the public, however.

The BIO5-hosted event, he said, will offer the latest information on how computers help make sense of the huge amount of bioresearch data being produced.

Leslie Boyer, director of the Venom Immunochemistry, Pharmacology and Emergency Response Institute, holds a tube containing a dead bark scorpion at her office at Drachman Hall, 1295 N. Martin Ave.

Dawn Bray worried she might lose a second child to a scorpion’s sting.

A bark scorpion stung her 6-year-old son Morgan last May. As the family rushed him to the hospital in Globe, a wave of fear came over Bray. Six years earlier, in May 2002, she lost her 2-year-old son Dally to a bark scorpion’s sting.

“When Morgan got bit, I was thinking that it was happening again,” Bray recalled this week. “With another son, we would have the same outcome.”

From Globe, doctors flew Morgan to Tucson for treatment. He received a dose of Anascorp, a scorpion antivenin used widely Mexico but not approved for general use by the U.S. Food and Drug Administration.

Morgan made a speedy recovery. Just hours after his treatment, the Brays ate dinner together at a McDonald’s before making the two-hour drive back to their home about 25 miles south of Globe.

Morgan’s survival means that his brother “did not die in vain,” Bray said.

After Dally’s death, the Brays met with Leslie Boyer, director of the University of Arizona’s Venom Immunochemistry, Pharmacology and Emergency Response Institute. Dally received an antivenin but died anyway, his mother said. The family wanted answers.

Of the 60 scorpion species and subspecies in the U.S., only the Arizona bark scorpion is dangerous to humans; consequently, scorpion sting deaths are exceedingly rare in the United States, with fewer than a half-dozen in the past decade. But in equatorial countries more people die of scorpion stings than venomous snake bites. More than 1,000 people a year die from scorpion stings in Mexico, according to an article in eMedicine, an online medical journal.

Two years after Dally’s death, Boyer and a team of UA researchers began studying Anascorp, a drug Mexican doctors used regularly to treat those severely affected by scorpion stings. The UA researchers published their findings in the May 14 issue of The New England Journal of Medicine.

The study focused on 15 children hospitalized for severe reactions to scorpion stings in 2004 and 2005. Eight received Anascorp, which the FDA considers an “investigational drug.” Seven received a placebo.

Symptoms of nerve poisoning disappeared in less than four hours in the children treated with the antivenin. In the placebo group, symptoms lasted for several hours. Children not treated with Anascorp required sedation and longer hospital stays, the study found.

Bark scorpion venom “goes to every nerve of the body and tells them, ‘Fire!’ ” Boyer said.

In the worst cases, the bark scorpion’s venom can cause respiratory failure.

Scorpions sting about 8,000 people in Arizona every year. In Mexico, where Anascorp is widely available, scorpions sting 250,000 people a year.

In about 200 cases a year in the U.S., usually involving children, nerve poisoning becomes severe enough to require hospitalization.

Children in Tucson can go to a hospital emergency room for treatment, Boyer said. “But what about the baby in Morenci, the toddler in Globe?”

The UA study has expanded to include 24 Arizona hospitals. About 600 patients have received Anascorp since 2004, Boyer said.

Even in rural areas, severely affected children can receive the treatment within an hour of getting stung, the doctor said.

Whether the study’s findings will lead to FDA approval remains unclear. “We’re the only state in the country where this is important,” Boyer said.

For the Brays, it was a matter of life and death.

“Dr. Boyer was our angel,” Bray said. “If she trusted it, we trusted it.”

Dr. Leslie Boyer holds a tube containing a dead bark scorpion.

Three-digit temperatures have hit Tucson, making it an ideal time for the Salvation Army’s Operation Chill Out to begin.

The summer donation campaign for homeless people starts Wednesday.

“With the heat rising, more displaced and at-risk Tucsonans are going to find themselves needing important resources such as water and basic day-to-day items,” said Salvation Army spokeswoman Tamara McElwee.

To enhance this year’s efforts, the Salvation Army has teamed up with Walgreens and Naughton’s Plumbing, Heating and Cooling.

Walgreens locations throughout the city are hosting summer specials where customers can purchase select, tagged items found near the register that are donated to the Salvation Army.

Walgreens’ Sierra Vista store, which piloted the program, has seen about $100 worth of the tagged bottled water, soup, seasonal items and other goods donated each week.

People can also donate bottled water, hats, sunglasses, sunblock and lip balm by dropping them off at The Hospitality House, 1021 N. 11th Ave., or one of five Naughton’s locations:

• 1140 W. Prince Road

• 3940 W. Costco Drive

• 4226 S. Sixth Ave.

• 6062 E. Speedway Blvd.

• 8190 E. 22nd St.

School may be out soon, but free meals will still be in for Sunnyside Unified School District.

Starting June 1 and running through July 24, free breakfast and lunch will be served to kids 18 and younger who live within the district’s boundaries, according to a district news release.

Breakfast will be from 7:30 to 8:30 a.m. and lunch served from 11 a.m. to 12:30 p.m. at the the following locations:

• Billy Lane Lauffer Middle School, 5385 E. Littletown Road

• Challenger Middle School, 100 E. Elvira Road

• Craycroft Elementary School, 5455 E. Littletown Road

• Gallego Basic Elementary School, 6200 S. Hemisphere Place

• Liberty Elementary School, 5495 S. Liberty Ave.

• Santa Clara Elementary School, 6910 S. Santa Clara Ave.

• Sierra Middle School, 5801 S. Del Moral Blvd.

• Sunnyside High School, 1725 E. Bilby Road

• San Xavier Indian Community Education Center, 1960 Wa:k Lane

The Southern Arizona AIDS Foundation will hold a local candlelight memorial Sunday as part of the worldwide 26th International AIDS Candlelight Memorial.

The event will be at Himmel Park, near East Speedway and North Tucson Boulevards. It will start at 5:30 p.m. with music and performances, and the candles will be lit at 7:30 p.m.

The memorial is aimed at reducing stigma and discrimination associated with AIDS; ensuring access to treatment; increasing resources to HIV/AIDS, malaria and tuberculosis; and promoting greater involvement by affected communities, SAAF said in a news statement.

Similar candlelight memorials will be held in more than 1,200 communities worldwide.

AIDS group to hold

candlelight memorial

The head of Pima County’s health department will join Arizona’s director of health services and others in a public briefing here Wednesday on H1N1, the swine flu virus.

The lecture will be from noon to 1 p.m. at the University of Arizona College of Medicine’s DuVal Auditorium, 1501 N. Campbell Ave.

Among the scientists who will speak are Nafees Ahmad, Ph.D, a professor in the department of immunobiology, on the virology of the disease, and Katie Mathhias, Pharm.D, on therapeutic options for treatment of the virus.

UMC’s sister-to-sister operation gives patient new small intestine

Intestine transplant patient Leslie Teran-Richter talks about the transplant experience. Richter's sister Michelle was the donor.

The sisters looked at each other and nearly broke into tears.

Michelle Teran had donated 6 feet of her small intestines to her ailing sister, Leslie Teran-Richter, on April 30. But, as the women shared a quiet moment Friday afternoon, the donor beamed as brightly as the recipient.

Teran-Richter, 44, nearly died in October when her small intestine twisted itself into knots after a sudden illness. Blood stopped flowing to the tangled organ, and the tissue began to die.

Doctors removed all but 5 inches of Teran-Richter’s small intestine. She faced a lifetime of intravenous feedings and the ever-present risks of infection and other complications.

“I couldn’t let her do it,” Teran said of the prospect of seeing her younger sister languish in such a state.

Though 12 years older than Leslie, Teran said the siblings have remained close. “There was no hesitation to do the right thing,” she said.

Doctors at University Medical Center had never performed a small intestine transplantation. No hospital in the state, or in the Southwest, had attempted such a risky procedure.

Nationwide, doctors perform between 150 and 180 bowel transplants, according to surgeon Rainer Gruessner, who led the team of doctors who operated on the sisters at UMC. Even fewer intestine transplants involve living donors. Almost all include transplanting other organs at the same time.

Small bowel transplants carry greater risks of rejection and infection than transplants of other organs, Gruessner explained.

Spending a lifetime requiring total parenteral (intravenous) nutrition could cost up to $200,000 a year, according to gastroenterologist Khalid Khan, a member of the UMC transplant team.

“That’s just really the nuts and bolts,” Khan said.

Long-term intravenous feedings can increase a patient’s risk of liver failure, Khan said. The cost of caring for patients in that state can top $500,000 annually.

UMC worked with Teran-Richter and her family to convince insurers that a transplant, which would cost $20,000 to $30,000, would be the most cost-effective option.

Once the doctors got the OK, the operation went smoothly.

As surgeons on Friday wheeled Teran-Richter into a UMC conference room, she cracked jokes about how much makeup she put on that day.

She said she’s in a great deal of pain. For the next several weeks she’ll undergo weekly biopsies to determine the continued viability of her newly transplanted bowel. She’ll remain on anti-rejection drugs the rest of her life.

“That is almost a minor issue,” Gruessner said.

About two-thirds of patients who receive small-intestine transplants live well past their first year with the new organ, the doctor said.

Teran-Richter’s operation catapults UMC onto a short list of facilities nationwide with the capability to perform intestine transplants. Just five hospitals, including UMC, perform the procedure, according to Gruessner.

In 2008, just 55 intestine-only transplants took place in the U.S., according to the Scientific Registry of Transplant Recipients. More than 200 remain on a national waiting list for the operation.

Teran-Richter and her sister “are playing around” with the idea of starting a foundation to encourage live-donor transplants, which doctors suggest increase survival rates in organ-recipients.

Gazing into her little sister’s eyes, Teran forced back the tears. “She’s the strongest person I know. She must have 25 lives.”

Teran-Richter survived breast cancer in 2008. Just nine days after her surgery, Teran-Richter on Friday talked of returning to her job as a records manager for the town of Sahuarita.

Her doctors smiled. Her recovery may take a little longer.

“Four weeks, you watch,” she promised.

Intestine transplant patient Leslie Teran-Richter (right), her sister, Michelle Teran, and her husband Eric Richter discuss their experiences. Her surgery was the first intestine transplant using a living donor in the entire Southwest.

Pima County would be hit with about $13 million more in contributions to the state long-term care program under a House committee proposal in the still-unapproved Arizona budget.

The proposal by the House Appropriations Committee would hit Pima and Maricopa counties for a combined $55 million more in contributions to the state general fund in the coming fiscal year – with Maricopa contributing the majority.

The proposal drew immediate response from Pima County officials, who this fiscal year had to scramble to replace $3.2 million from case reserves taken by the state to balance this year’s state budget.

“We weren’t pleased with the added $3.2 for ALTCS last year, let alone the $13 million more now,” Martin Willett, deputy county administrator, said Friday.

The long-term care program pays for people in nursing homes and health care for the blind and the disabled.

Willett said the $13 million the county could be paying was not included in the recently-released fiscal 2010 county budget of about $1.37 billion. The budget is scheduled to be tentatively approved May 19. The fiscal year begins July 1.

County officials have worked since late last year to eliminate a projected $38 million budget deficit – mostly through across-the-board department cuts of 7.5 percent to 10 percent, a wage and hiring freeze and layoffs, mostly in the Pima County Development Services Department.

“There was no real explanation from legislative staff on the rationale for this,” Willett said.

Rep. John Kavanagh, R-Pleasant Valley, is a proponent of transferring revenue from the counties to the state general fund.

Kavanagh on Friday said that the counties could see the money returned in the form of federal stimulus funding that will come to Arizona.

Kavanagh said the state budget is far from ready for votes by both the House and Senate, and transmittal to Gov. Jan Brewer.

“We still have a lot of talking to do,” he said. “It could be a week; it could be a month,” Kavanagh said.

County governments are experiencing budget crises just like the state, which has a projected $3 billion deficit for next fiscal year, Willett said.

“Are we just supposed to write them a check?” Willett asked.

There is no guarantee that the state would return the money to counties from federal stimulus funds, either, Willett said.

Lambeth in 2005

A medical malpractice lawsuit filed by the mother of a mentally ill man who stabbed his grandparents to death on April 10, 2005, is being heard this week in Pima County Superior Court.

The suit was filed by Lisa Lambeth and her sister, Karen McCollum, daughters of the late Carl Gremmler, 76, and Patricia Gremmler, 72, against a publicly funded behavioral health agency and the psychiatrist who treated Christopher Lambeth for bipolar disorder and schizophrenia.

Filed in March 2007, the suit alleges medical malpractice by the psychiatrist, negligence by the behavioral agency and asks for punitive damages from all defendants for the loss of their parents.

However, COPE Behavioral Services Inc. says in court documents that it “believes” Lambeth, now 24, “was wholly and/or partially at fault in causing” damages to the Gremmler family.

Lambeth pleaded guilty but insane to two counts of first-degree murder in March 2007.

His attorney, Ryan Metcalf, said then that Lambeth was in a psychotic state when he stabbed the couple multiple times in their bed. The bodies were found two days after the stabbings.

Lambeth, who had been living with them, was found lying in his bed at their home.

In April 2007, Lambeth was sentenced to two concurrent life sentences at the Arizona State Hospital in Phoenix.

According to documents in the civil suit, Dr. Virgil Hancock was a contract psychiatric provider for COPE.

He began treating Christopher Lambeth in late 2003 and was his psychiatrist until Lambeth killed his grandparents.

On Sept. 22, 2004, Hancock saw Lambeth “in the presence of his mother” and the youth reported he was taking his medications.

His mother said he wasn’t taking the medication and on Oct. 19, 2004, she called Hancock, asking that her son be admitted to a psychiatric hospital without going to an emergency room, but the psychiatrist refused.

On Oct. 26, 2004, she told Hancock her son “would not be medication compliant in the future and would become violent.”

On Nov. 16, 2004, he was admitted to Sonora Behavioral Health Hospital “after physically menacing his mother and punching holes in the walls at her home.”

“A COPE note prepared at or about this date signed by Dr. Hancock states that Christopher Lambeth was unable to control his anger and was homicidal and had a target and a plan,” the lawsuit states.

“This homicidal ideation was not disclosed to the family before, during or at any time after his hospitalization,” according to the lawsuit.

Lambeth was discharged from Sonora and then spent 24 hours at COPE’s Ocotillo drug treatment facility.

He was discharged on Nov. 19, 2004, and taken to his grandparents’ home.

A COPE case manager had called Lambeth’s mother and sister and asked them to take him into their homes. They refused, saying they feared having him in their homes.

His mother said he was “dangerous and violent” when he didn’t take his medications.

“No day program or other supportive behavioral health services were offered,” the suit states.

“The case manager then persuaded Christopher’s sister to transport Christopher directly from Ocotillo to his aging grandparents’ home.”

According to the suit, Lambeth’s mother repeatedly asked for residential behavioral health services for him in 2004 and was told none was available.

On April 7, 2005, Hancock saw Lambeth for a regularly scheduled appointment, along with his mother and his case manager.

“Lisa again asked COPE to get Christopher out of her parents’ home. No residential or other behavioral services were offered,” the suit states.

“(Lisa) expressed fear and concern about Christopher’s history of violence toward her and his grandparents when he was not taking his medicine.”

Lambeth said he wasn’t happy living in the rural community of Rillito with his grandparents.

Lambeth was incarcerated as a juvenile in 2001 for nearly 10 months in a domestic violence case. His parole in that case ended in October 2002.

In 2003, he was court-ordered to receive services from COPE after he was arrested for marijuana possession.