2018 State Lobby Days: Opening doors in the state capitols

The American College of Surgeons (ACS) has been increasing its advocacy presence and influence in the state legislatures through the Chapter Lobby Day Grant Program. In 2018, the program awarded the largest number of grants in the eight years of its existence.

ACS chapters in 23 states—Alabama, Arizona, Arkansas, California, Connecticut, Florida, Georgia, Illinois, Indiana, Kansas, Louisiana, Massachusetts, Michigan, Nebraska, New York, North Carolina, Ohio, Oregon, Tennessee, Texas, Virginia, Washington, and Wisconsin—nearly twice the number from 2017, applied for and received lobby day grants. The grants can be as much as $5,000 with a $2,500 match, along with ACS State Affairs staff support for planning and on-site implementation of the lobby day event. This year, the Florida, Jacksonville, and South Florida Chapters jointly received the enhanced advocacy grant of $12,000 to engage the state legislature on a high-priority issue determined by the chapter. The enhanced advocacy grant award can be up to $15,000 for the selected chapter.

Building relationships with Stop the Bleed®

Replicating the Georgia Society of the American College of Surgeons’ (GSACS) successful incorporation of Stop the Bleed training into its 2017 lobby day, chapters in 14 states included Stop the Bleed trainings in their 2018 lobby days: Alabama, Arkansas, California, Connecticut, Florida, Georgia, Kansas, Louisiana, Michigan, North Carolina, Oregon, Tennessee, Virginia, and Washington.

Incorporating the Stop the Bleed training program as part of the chapter lobby day not only educates legislators and staff on how to respond to a severe bleeding injury, but also offers an opportunity for ACS Fellows and members to build new and existing relationships with their legislators to discuss other important health care policy issues. For example, the Georgia Society advocated for trauma funding in conjunction with their bleeding control training in 2017, and in Florida earlier this year, Stop the Bleed training opened the door to discussion of other ACS legislative priorities, specifically the surgical response to opioid abuse and misuse.

Florida state lobby day: Stop the Bleed training in the Florida State Capitol. From left: Edwin Gonzalez, MD, FACS; Patricia Byers, MD, FACS; Brian Yorkgitis, DO, FACS; Ali Kasraeian, MD, FACS; and Paul Chappano, MD, FACS.

Florida state lobby day: Stop the Bleed training in the Florida State Capitol. From left: Edwin Gonzalez, MD, FACS; Patricia Byers, MD, FACS; Brian Yorkgitis, DO, FACS; Ali Kasraeian, MD, FACS; and Paul Chappano, MD, FACS.

The Florida Chapter of the ACS, in conjunction with the South Florida and Jacksonville Chapters, held its advocacy day at the state capitol in Tallahassee. The Florida Chapter was the recipient of the College’s enhanced lobby day grant and used the money to sponsor Stop the Bleed training January 31 (see photo, this page). The event was successful, training hundreds of people to save lives by applying tourniquets and packing wounds. Participants included legislative staff, Miami-Dade County firefighters, capitol visitors, and others. Florida Chapter President Patricia Byers, MD, FACS, was interviewed by news crews from several local television stations that were covering the event.

While the training was taking place in the capitol, surgeon advocates, under the leadership of Mark Dobbertien, MD, FACS, and John Armstrong, MD, FACS, took the opportunity to meet with legislators to promote the Stop the Bleed event and advocate for issues important to Florida surgeons. Legislation of particular importance included S.B. 8 and H.B. 21, addressing the state’s opioid epidemic. In addition, surgeons successfully advocated for carve outs for major surgery, palliative care, and severe trauma. The legislature enacted H.B. 21 and Gov. Rick Scott (R) signed the bill into law on March 19.

Another priority bill for the chapter was H.B. 1165, which removes the cap on the number of trauma centers in the state. Governor Scott signed the legislation in March, putting to rest contentious litigation that had been churning for years. Passage of H.B. 1165, S.B. 8/H.B. 21, and the success of the Stop the Bleed event made for one of the most positive and productive years the Florida surgical community has had in recent memory.

The Alabama Chapter and members of the Alabama Committee on Trauma (COT) hosted Stop the Bleed training at the state capitol on March 14. Fellows trained legislators, who later invited the chapter to present the Stop the Bleed training at a state Republican Caucus Luncheon. Following these events, the chapter and state COT met with acting Lt. Gov. Billy Nungesser to discuss Stop the Bleed and funding issues related to Alabama’s Trauma System. In response to the day’s activities, the House Committee on Rules introduced a Stop the Bleed resolution, H.R. 456.

The Arkansas Chapter of the ACS hosted its lobby day February 28 at the state capitol in Little Rock. A total of 73 members of the legislature attended the event and heard testimony from ACS First Vice-President Charles Mabry, MD, FACS, and representatives from the Arkansas Department of Health and emergency medical services (EMS) system. Each speaker explained the value of the Stop the Bleed campaign. Legislators also learned that economists have begun to analyze data on penetrating wounds and trauma injuries to measure the effect of Stop the Bleed training in high-risk areas.

Following reports from members of the Arkansas Chapter and other health care professionals, participating state legislators received Stop the Bleed training from Fellows, members of the police department, and EMS volunteers. Dozens of elected officials and members of the public were awarded certificates of completion, while being cheered on by the Arkansas Chapter, the state medical society, the Director of the Department of Health, and other attendees.

California surgeons came together April 18 as part of the California Medical Association’s annual legislative day to advocate for placement of bleeding control kits in public facilities. Although participants used the opportunity to talk about this important issue with California legislators, the major topic of the day was A.B. 3087, price-fixing legislation introduced just a few days before the lobby day event. Surgeons and other physicians visited the capitol, meeting with their state legislators to deliver a clear message: oppose A.B. 3087. Fellows also helped to deliver an ACS letter of opposition to A.B. 3087 to every member of the Assembly. These efforts and grassroots advocacy activities following the lobby day contributed to the successful defeat of the bill.

The Georgia Society of the ACS, in collaboration with the Georgia Trauma Foundation, sponsored the annual Trauma Awareness Day February 14. At this event, legislators, legislative staff, and other individuals had the opportunity to receive Stop the Bleed training at numerous training stations under the Capitol Dome. A press conference was convened that afternoon highlighting H.B. 673—legislation to increase trauma funding through the assessment of fines for violations of restrictions on use of wireless devices while operating a motor vehicle. H.B. 673 passed at the end of the legislative session.

The Kansas Chapter cosponsored a lobby day January 24 with the Kansas Academy of Family Physicians. The chapter hosted a morning meeting for ACS members in which Chris Johnson, ACS State Affairs Associate and author of this article, gave a presentation on the College’s state legislative priorities and discussed how to best engage with Kansas legislators. The lobby day program included speeches from legislators including Reps. Susan Concannon (R), Don Hineman (R), and Jim Ward (D), as well as Sen. Barbara Bollier (R).

The chapter coordinated a Stop the Bleed training demonstration in the capitol for legislators and their staffs. Approximately 30 legislators received hands-on training in bleeding control techniques. Chapter members also attended meetings with their legislators.

The Louisiana Chapter centered its March 21 lobby day on Stop the Bleed activities in the state capitol, partnering with the Louisiana Stop the Bleed and Louisiana State University, Baton Rouge. Stop the Bleed activities included a demonstration in the Capitol Rotunda, as well as training for nearly 60 staff of the Louisiana Department of Health and Capitol House and Senate staff. The chapter presented a wall-mounted bleeding control kit to Rebekah Gee, MD, Secretary, Louisiana Department of Health.

The House and Senate Health and Welfare Committees both recognized the Stop the Bleed Campaign and activities in the capitol at the beginning of their respective meetings. Additionally, resolutions recognizing March 21 as Stop the Bleed Day in Louisiana were read on the House and Senate floors. Both chambers received bleeding control kits to install on their respective sides of the capitol.

Following a multi-year hiatus, the North Carolina Chapter sponsored a lobby day in Raleigh focused on support for legislation to create a pilot program to place bleeding control kits in public schools. To further this effort, Stop the Bleed training was offered to legislators, their staffs, and the general public. More than 150 people were trained at eight stations set up to accommodate the interest in this program. Surgeons from across the state served as trainers and met with their legislators to advocate for trauma-related legislation, providing informational materials for legislators and their staff.

The Oregon Chapter lobby day started with presentations from a number of speakers, including representatives from the Oregon Medical Association and the National Federation of Independent Businesses, as well as presentations from Laszlo Kiraly, MD, FACS, and Keith Thomas, MD, FACS. In addition, Oregon Secretary of State Dennis Richardson spoke about legislative and policy initiatives affecting the Oregon medical community. After the speakers had finished, the chapter led Stop the Bleed training.

The Tennessee Chapter of the ACS sponsored its lobby day on June 18 with Stop the Bleed training for legislators, legislative staff, and others. Local media reports helped encourage people to attend the event. Trauma surgeons from around the state helped with the Stop the Bleed training, giving them the opportunity to discuss future funding for bleeding control kits in public schools.

The Virginia Chapter hosted a Stop the Bleed training session, inviting legislators and staff to attend the sessions during the legislature’s veto session April 18.

The Washington ACS Chapter hosted a lobby day January 10 with the support of Harborview Medical Center, Seattle. Dozens of physicians and other health care professionals descended on Olympia, staffing more than eight bleeding control training stations throughout the capitol. Numerous elected officials, legislative staff, and Washington citizens partook of the training, with Lt. Gov. Cyrus Habib (D) availing himself of the training. The event was seen as an opportunity to begin the discussion for acquiring funding in the 2019 legislative session to place bleeding control kits in public facilities, especially schools, as well as increase funding for the state’s trauma system.

The Connecticut Chapter had planned to host a lobby day March 8, including Stop the Bleed training in the state capitol and at the office of the Connecticut Department of Public Health, but had to cancel due to a winter storm that forced the legislature to close the capitol. The chapter rescheduled the bleeding control training with the Department of Public Health April 18.

The Wisconsin Surgical Society, a Chapter of the ACS-sponsored Wisconsin Doctor Day 2018 January 30, joining more than 400 physicians from throughout the state. The chapter hosted a Stop the Bleed demonstration for Doctor Day participants. The event’s main program included a speech by Gov. Scott Walker (R), touting his administration’s policies aimed at improving access to care for the state’s residents without expanding the state’s Medicaid program. Chapter members then joined other physicians in meetings with legislators and staff in the Capitol Building. The chapter advocated for legislation to promote the National Stop the Bleed Day on March 31 and oppose legislation to mandate video recording of operations; prohibition of Maintenance of Certification as a criterion for hospital employment, admitting privileges, insurance reimbursement, and state licensure; as well as reductions to the workers’ compensation fee structure.

The Michigan Chapter also included Stop the Bleed at its lobby day April 26.

Other issues addressed

Several chapter lobby days focused on topics other than Stop the Bleed.

New York state lobby day, clockwise from center: Senator Hannon discussing pending legislation with ACS Fellows (all MD, FACS) Arthur Cooper, Steven Burger, Charles Coren, and Daniel Huang

New York state lobby day, clockwise from center: Senator Hannon discussing pending legislation with ACS Fellows (all MD, FACS) Arthur Cooper, Steven Burger, Charles Coren, and Daniel Huang

The New York and Brooklyn-Long Island Chapters joined together to host a lobby day June 4 in Albany, NY. Members of both chapters met in the morning for a briefing on the health care legislative issues important to surgical patients and the profession still pending before the legislature. Chapter members met with key legislators and their staffs, including the offices of Sen. John Flanagan (R), Temporary President of the Senate; Sen. Kemp Hannon (R), Chair of the Senate Health Committee and Assistant Majority Leader; Sen. Andrea Stewart-Cousins, Democratic Conference Leader; Sen. Kenneth LaValle (D), Chairman of the Majority Conference; Carl Heastie (D), Assembly Speaker; and Richard Gottfried (D), Chair of the Assembly Health Committee (see photo, page 37).

Chapter members advocated on behalf of legislation to reduce prior authorization burdens, liability reform that would set standards for affidavits of merit and expert witnesses, and providing a safe workplace for physicians, as well as opposing legislation that would prohibit the use of Maintenance of Certification for hospital admitting privilege, employment, and insurance reimbursement and a bill to create a state-run single-payor insurance plan in New York.

The Arizona Chapter hosted its first ever lobby day event January 11 at the state capitol in Phoenix. Attendees from across the state included surgeons from the Phoenix metropolitan area, as well as Tucson and Pima County. Together, these chapter leaders educated legislators on ACS priority issues, which resulted in important legislation being introduced in the House.

Sen. Nancy Barto (R), Chair of the Senate Health Committee, and Rep. Heather Carter (R), Chair of the House Health Committee, attended the event and spoke with Fellows about issues affecting surgical patient care in Arizona. Ranking Arizona Democratic Member Steve Firese also stopped in to share his insights on budget issues likely to affect Arizona health care in 2018 and beyond.

The chapter weighed in on an opiate bill and succeeded in getting a colorectal screening proclamation introduced in the House. The chapter was able to secure carve outs in the opiate bill for major operations, palliative care, and burns. The chapter also successfully advocated for the introduction of the House proclamation, which raised awareness about the need to improve patient access to colorectal screening—especially for low-income individuals in rural areas who have the highest risk of developing colorectal cancer.

Fall lobby days

While most state legislatures conduct their business during the first half of the year, a few states meet year-round, which provides an opportunity for chapters to schedule their lobby days later in the year. Additionally, scheduling meetings when the legislature is out of session can make it easier to gain key legislators’ attention and participation.

The Massachusetts Chapter of the ACS is scheduled to host its lobby day October 10. The chapters in the states of Illinois, Indiana, Nebraska, and Ohio are looking at dates in the fall for their lobby days, and at press time, the North and South Texas Chapters were planning to host a Stop the Bleed training for legislative staff in September to educate them on the chapters’ 2019 legislative priorities.

To learn more about how to participate in a state chapter lobby day, contact your local chapter. To learn more about how to engage in state advocacy, visit the ACS website. For more information, e-mail state_affairs@facs.org or call 202-337-2701.

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