The Northern California Chapter sponsored its second Day at the State Capitol on April 17 with the support of an American College of Surgeons (ACS) chapter advocacy grant program. The event was held in conjunction with the California Medical Association (CMA) Legislative Day. This article highlights both the successes and the lessons learned from these unified advocacy efforts, and emphasizes key goals for the future.
Goals of the collaboration
Two factors played a significant role in efforts to engage surgeons in the state legislative process. The primary intent was to educate the California legislature about the growing factors that have led to emergency department (ED) overcrowding and its negative impact on the quality of care delivered in these facilities. The second goal was to increase visibility of the ACS in Sacramento, and strengthen existing relationships with state elected officials. In large part, the aim of this collaborative approach to advocacy is to enable California chapters to become more effective in their efforts to positively affect the future of surgery.
FACS in the legislature
Members of the Northern California Chapter Council met on two occasions with members of the San Diego and Southern California Chapters to unify efforts across all three California chapters—which represent nearly 10 percent of the ACS Fellowship worldwide. The opportunity to speak with a unified voice helped to strengthen surgery’s message for the members of the California legislature.
In 2012, California Chapter members focused their legislative efforts on A.B. 1621 (see Figure 1), authored by Assembly Member Linda Halderman, MD, FACS (R), which addresses a flaw relating to prostate exams in the Grant H. Kenyon Prostate Cancer Detection Act. Under the act, a surgeon or other physician who performs a prostate exam on a patient with certain risk factors must present the patient with information about prostate cancer. However, no exemption was provided for situations where giving this information is either impossible or impractical, such as when treating a trauma patient who is initially assessed for a prostate injury in one ED but then transferred to a higher-level facility for further care. A.B. 1621 provided a common-sense exemption to the act, thereby enabling trauma surgeons and ED physicians to focus on strengthening the local delivery of emergency care.
Assembly Member Halderman introduced the bill on February 8, 2012. With the assistance of Jon Sutton, Manager of State Affairs, ACS Division of Advocacy and Health Policy, a letter of support for the bill was formally approved by the Northern California Chapter Council and submitted to the State Assembly.
After hearing oral testimony from the chapter Secretary-Treasurer on March 27, the Assembly Committee on Business and Professions unanimously passed A.B. 1621. As a result of this testimony, the ACS Northern California Chapter was included as a key sponsor of the bill. Subsequently, A.B. 1621 unanimously passed through the full Assembly floor with bipartisan support, and in April, the bill was sent to the State Senate for consideration. During the legislative day, chapter members and the co-authors of this article met with Assembly Member Richard Pan, MD, FACS (D), Sen. Mark Leno (D), Assembly Member Halderman, and Sen. Ed Hernandez, OD (D), Chair of the Senate Health Committee, to advocate for passage of A.B. 1621 through the state Senate (see Figure 2).
A.B. 1621 was unanimously approved by the State Senate Business and Professions Committee on June 11. On June 25, it was debated on the Senate floor and passed by a unanimous vote. On July 10, Gov. Jerry Brown (D) signed the bill, which became California law after it was filed with Secretary of State Debra Bowen (D). This accomplishment demonstrates the positive impact state-level advocacy may have on surgeons, and was featured in the inaugural issue of the ACS advocacy eNewsletter, The ACS Advocate, in July (see Figure 3).
Alternate solutions to ED overcrowding
During Legislative Day, chapter members encouraged the California Legislature to commission a study to evaluate the magnitude of ED overcrowding and boarding in California, and to identify solutions to promote safe and timely patient care delivery that are balanced with the operational needs in hospitals. Other potential solutions discussed that would strengthen emergency care at the event included:
- Creating alternate venues for the delivery of non-emergent care, such as an outpatient facility that is open after work hours and weekends
- Ensuring adequate surge capacity for mass casualties and disaster preparedness through available operating rooms and supplies
- Conducting a statewide study to evaluate boarding and overcrowding, similar to one that had been performed in the Sacramento region
- Reprioritizing health resources and hospital beds for patients with emergent or urgent conditions
Participation in the lobby day grant program over the past few years has given the Northern California Chapter valuable insight into grassroots advocacy at the state level. Lessons we have learned as a result of this experience include the following:
- Persistent efforts to increase chapter visibility are rewarded over time. For the Northern California Chapter, this means it has now become a recognized entity in Sacramento resulting in the arrangement of a series of meetings with state elected officials, and being called upon by Senate committee staff to comment on A.B. 1621. The testimony of surgeons before legislative committees can be instrumental to catalyze change.
- By participating in grassroots advocacy on specific legislation—such as the successful passage of A.B 1621—ACS chapters can learn more about the legislative process, and empower their members to be agents for proactive change.
The long-term goal of the chapter is to inspire surgical residents and medical students to strengthen their advocacy and public policy skills, which can be a valuable addition to the clinical and professional skills necessary to become an expert surgeon. In addition, the chapter is committed to preparing a specific bill benefiting both patients and members of the ACS—one that chapter members could advocate for during their meetings at the capital on lobby day.
As policymakers continue to debate health care reform, the surgical profession has an opportunity to move the health reform debate forward both at a regional level and across the country. The chapter extends a special thanks to the visionary leadership at the College in sponsoring the chapter advocacy grant program. (It should be noted that James Hinsdale, MD, FACS, immediate past-president of the CMA, was a co‐applicant in this year’s grant application, and traveled to Chicago to attend the State Leadership Advocacy Conference in April to represent the chapter.)
Finally, chapter members applaud the efforts of the ACS Division of Advocacy and Health Policy and the ACS leadership nationally for engaging in meaningful discussions on health care reform with White House and Department of Health and Human Services officials.