The Northern California Chapter of the American College of Surgeons (NCCACS), continues to be involved in state-level advocacy and education efforts. With support from ACS Lobby Day Grants, the NCCACS has sponsored visits to the state capitol in Sacramento since 2011.
In 2013, the chapter received an ACS Lobby Day Grant. A key issue on which the chapter planned to lobby was passage of Uniform Emergency Volunteer Health Practitioners Act (UEVHPA) legislation. Under the UEVHPA model, physicians and health practitioners licensed in other states are able to offer medical and surgical relief services during a declared emergency. With the ACS grant support, the chapter met with legislators to discuss the issue. As a result, a draft of the model legislation was submitted for legislative counsel’s review. This analysis showed that California already appears to be compliant with the overarching intent of UEVHPA, and, it was agreed that submitting a new bill would be redundant.
After a number of well-publicized firearms-related tragedies in the U.S., the chapter chose to redirect the Lobby Day focus to firearms safety, emphasizing the principles outlined in the ACS’ revised Statement on Firearm Injuries.*
Working with a coalition of physicians in California, the leadership of the NCCACS voted to support S.B. 374, which Senate Pro Tempore Darrell Steinberg (D) introduced in February 2013. S.B. 374 required that fixed magazines on semi-automatic rifles contain fewer than 10 rounds and called for an expansion of the categories of firearms that must be registered. This bill was introduced as part of the LIFE (Life-Saving Intelligent Firearms Enforcement) Act by Senators Steinberg, Lois Wolk (D), and Leland Yee (D), consisting of eight firearms safety bills.
Among these bills, S.B. 683, introduced by Sen. Marty Block (D), sought to expand current handgun safety education and certification to include all-new gun purchases. In April, California Medical Association (CMA) past-president James Hinsdale, MD, FACS, co-author of this article, testified in favor of passage of the legislation before the State Senate Public Safety Committee; he was joined by supporters of the LIFE Act, including firearm safety advocates, survivors, health care professionals, and law enforcement.
At Senator Steinberg’s invitation, the NCCACS testified at the State Assembly Public Safety Committee hearing. Krista Kaups, MD, MSc, FACS, co-author of this article, testified on behalf of the chapter in support of S.B. 374, and Dr. Hinsdale testified for S.B. 683 on behalf of the CMA. John Maa, MD, FACS, co-author of this article, spoke on behalf of S.B. 374 from the floor. The committee passed the bill in a 4–2 voice vote. After the Public Safety hearing, the group caucused with Garen Wintemute, MD, MPH, director, violence prevention research program, University of California-Davis, the Brady Center to Prevent Gun Violence; the Los Angeles Police Department; Cleveland School shooting survivors; and CMA president Paul Phinney, MD (see photo).
Chapter participants in the hearing then met with staff from the offices of Assemblymen Richard Pan, MD (D), and Phil Ting (D) and State Sens. Jerry Hill (D) and Steinberg, to discuss legislative issues of concern to the chapter (including the Medical Injury Compensation and Recovery Act [MICRA] and optometric scope of practice expansion), and to prepare the next steps for securing passage of S.B. 374 into law (see photo, page 53). The chapter’s letter of endorsement of S.B. 374 was delivered to the staff of Assemblymen Henry Perea (D), Richard Bloom (D), Tom Ammiano (D), and Sen. Mark Leno (D), in preparation for the full Assembly floor vote.
Subsequently, the State Assembly Appropriations Committee and the full Assembly passed both S.B. 374 and S.B. 683. A final effort was spearheaded along with the California Chapter of the American College of Emergency Physicians and the CMA to urge Gov. Jerry Brown (D) to sign the legislation. Despite extensive public and editorial support, the Governor vetoed S.B. 374, but did sign S.B. 683 and other legislation banning lead ammunition.
Scope of practice
On the same day that chapter representatives testified on firearms legislation, S.B. 491, scope-of-practice legislation was being debated in the Assembly Business, Professions and Consumer Protection Committee. Introduced by Sen. Ed Hernandez (D), S.B. 491 would have allowed nurse practitioners to deliver patient care without direct physician oversight. Although collaboration with our colleagues is essential, expansion of practice responsibilities beyond training and without appropriate guidance poses potential risks to patient safety. Ultimately, the bill was amended to require nurse practitioners to undergo 6,240 hours of supervised experience before providing independent patient care and to practice in a “collaborative setting.” Consequently, AARP and the American Association of Nurse Practitioners dropped their support of the measure, and the bill did not reach the Assembly floor.†
New directions for 2014
Since the NCCACS’ 2013 State Assembly visits, further mass shootings have occurred, some involving large-magazine weapons. Although legislation clearly will not address all of the underlying causes of these acts, appropriate regulation may lessen both the number and magnitude of these tragedies. The chapter intends to continue to advocate for reasoned and rational legislation to promote public safety, recognizing that most gun owners are thoughtful citizens committed to safety and accountability.
Some of the bills introduced in the LIFE package were changed to two-year bills and are being reviewed again in the 2014 legislative session. Among these is S.B. 47 by Sen. Leland Yee (D), which seeks to eliminate the modification tools to rapidly detach and replace magazines from semi-automatic weapons, thereby circumventing the assault weapons ban in California signed during the administration of Gov. George Deukmejian (R) in 1989. On February 9, the Northern California Chapter leadership officially endorsed S.B. 47, and sent a formal letter in support of it to the state legislature. It is anticipated that S.B. 47 will arrive on the Governor’s desk in late May or early June. S.B. 53, introduced by Sen. Kevin de Leon (D), would require anyone wanting to purchase ammunition in California to obtain a permit. The permit holder would have to pass a traditional background check as well as a mental health check.
The chapter also anticipates that debate over reform of MICRA, which has remained unchanged since its passage in 1975, will continue. For the past 39 years, this legislation has placed a mandatory cap of $250,000 on noneconomic damages in medical liability lawsuits. Because of MICRA, liability insurance premiums have risen more slowly in California than elsewhere in the country, and physician workforce issues in the state are being mitigated. A statewide ballot measure has been introduced to raise the mandatory cap to $1.1 million, and is currently in the signature-gathering phase. The chapter intends to defend MICRA in 2014.
Serving as a resource
When the NCCACS first applied for a Lobby Day Grant in 2011, one of its objectives was to educate ACS Fellows about the legislative process and to encourage them to develop relationships with state and local elected officials. Additionally, the chapter sought to promote collaboration with other organizations that have similar goals and interests and to enhance awareness of the ACS and its members as a resource for thoughtful, informed positions on health care-related issues.
Although the chapter’s primary lobbying effort for firearm safety was unsuccessful, the NCCACS gained valuable experience and exposure, and anticipates increasing its advocacy efforts in 2014. In the current medical climate, with critical changes taking place with unknown and unclear consequences for the individual surgeon, active, informed participation is ever-more essential.
*ACS Statement on Firearm Injuries. Revised January 16, 2013. Available at http://www.facs.org/fellows_info/statements/st-12.html. Accessed February 6, 2014.
†Adashi EY. The JAMA Forum: California dreamin’—The story of Senate (Scope-of-Practice) Bill 491. news@JAMA. September 25, 2013. Available at: http://newsatjama.jama.com/2013/09/25/the-jama-forum-california-dreamin-the-story-of-senate-scope-of-practice-bill-491/. Accessed February 6, 2014.