New York American College of Emergency Physicians

Mark Curato, DO FACEP

Mark Curato, DO FACEP

Assistant Professor of Emergency Medicine Weill Cornell Medical College NY Presbyterian- Weill Cornell

Improving Emergency Care in New York (Help Wanted)

March 5th was wet and windy in Albany, I was at the state capitol in a business suit waiting for an elevator with my friend, colleague and fellow Upper West Sider, Dr. Elaine Rabin. As the relative absurdity of the moment washed over me, I ask her: “Elaine, what are we doing here? This is our day off!”

What were we doing there?

We, along with about 20 other NY ACEP members from around the state (including residents, junior and senior attendings, department chairs and regional chiefs of service) were in Albany with appointments to meet elected officials and their staff to help them understand how various proposed laws and budget items would affect the delivery of emergency care in our state. We were representing Emergency Medicine in NY, we were lobbying.

Most of us (myself included) are not particularly interested in lobbying. We’re not policy wonks, movers, shakers, or legal eagles. But at some point over the years a friend or colleague invited us to lobby day and that helped us to understand just how close we are to the levers of power. We learned that simply taking some time to explain the Emergency Physician’s point of view to lawmakers can have seismic effects on our personal and professional lives and on how emergency care is delivered to New Yorkers.

Every year there are legislative threats and opportunities relevant to Emergency Medicine in New York and lawmakers often have an absent, incomplete, or inaccurate understanding of the intended and unintended consequences. In lobbying, we doctors educate the politicians about what a proposed new law could mean to the way Emergency Medicine is practiced and delivered in NY. And we often open their eyes to things they hadn’t considered.

To wit, a few years ago the I-STOP program became law in New York. Had it been adopted as initially written, we’d all be required to spend 5-7 minutes using I-STOP and documenting the same every single time we prescribed an opiate. Thankfully, a group from NY ACEP lobbied lawmakers and explained to them that Emergency Physicians do not prescribe more than a few tablets at a time, we do not prescribe refills and we are not the intended targets of an “over prescribing” initiative. Furthermore, the burden of compliance would drain our limited time and have a deleterious effect on our ability to tend to the real needs of emergency patients. In a stark and wonderful example of how lobbying works, the lawmakers listened to these points, appreciated the unintended consequence of the legislation and agreed to create a specific carve-out exempting Emergency Physicians prescribing a 5-day supply of medication from the requirement.1 So, tomorrow, when you prescribe 12 tablets of Percocet to a patient with a long bone fracture, you are not required to utilize I-STOP. I wasn’t involved back then, but I am very grateful to those who were.

As someone who was never keen to get involved with lobbying, let me share why I’m glad I did, and why you should consider it too…

It’s Easy.

You don’t need to do any homework, possess any specific prior knowledge or skills, read any pending legislation, or prepare in any way—NY ACEP retains the services of a professional lobbying firm to do all that hard work. You’ll simply show-up in the morning and (over coffee and bagels) get briefed on our appointments for the day and the issues we want to discuss. We’re provided background, talking points and a meeting schedule in a clean and concise packet. Also, we work in groups, so we’re never 1-on-1 in a meeting; there’s a “veteran” who’s done this before on every meeting team. The tools you need are given to you on a silver platter and the value you bring to the process is simply being yourself, an Emergency Physician who works, lives and votes in New York. The lawmakers listen respectfully because a busy Emergency Physician who has taken the time to come to their office to speak on issues important to the health of New Yorkers.

It’s important.

The issues on our agenda are not abstractions, they have tangible impact on our professional lives, on the way we deliver emergency care and on the health and safety of New Yorkers. It’s surprising to learn just how accessible the decision makers are; we can exert actual influence on what becomes law. Of course, for each of our positions there is an opposing (sometimes far more powerful) lobby. For example, the trial lawyers are in favor of the Grieving Families Act, and the nursing lobby successfully achieved independent practice for Nurse Practitioners. While it would be naïve to think that simply showing up gets the job done, failing to show-up certainly surrenders our interests. There is nobody else who can sit with the decision makers and educate them about the implications of their decisions. It has to be working New York Emergency Physicians, it has to be you and me.

It’s fulfilling.

Lobbying doesn’t need to be your niche. Ultrasound, critical care, med-ed, EMS, wilderness, narrative medicine, toxicology, whatever—we all have our individual professional sub-interests, but we have collective interests which require safeguarding and advocacy. Lobbying isn’t “fun” per se, but there is a certain satisfaction explaining something to a lawmaker that they didn’t know before and that may influence their support for (or opposition to) a new law. After your meetings, when you’re in your car or on the Amtrak, there is a certain satisfaction to knowing that you carved out a little time in the service of your profession and the people of New York. It feels good.

Please have a look at the next page detailing issues we worked on this year, I think you’ll find them eminently relevant.

I hope you’ll consider joining us next March.

Email kethier@nyacep.org, we’ll put you down as a “maybe”, and contact you when the time comes.

Independent Practice for Physician’s Assistants (PA’s)2:

There is an item in the proposed state budget granting PAs the right to practice medicine independently, without any supervision or input from a physician. We explained to lawmakers the gaping difference in training between a physician and a PA and the threat to safe high-quality of care if PAs are granted the right to practice independently. We urged them to strike this from the budget.

Insurance Companies Must Cover Epinephrine Auto injectors3:

We explained to lawmakers that “Epi Pens” are lifesaving devices in situations where minutes count. We urged them to support a bill sponsored by Assemblyperson O’Donnell and Senator Rivera which would require insurance companies cover them.

The Grieving Families Act4:

Senator Hoylman-Sigal and Assembly person We in stein have re-introduced a bill which would expand the damages available in wrongful death (i.e., medical malpractice) suits and also extend the statute of limitations to bring these suits. We urged lawmakers to oppose this bill. We explained that New York is already a national outlier with regard to the medical malpractice climate and this bill would result in an explosive increase in the already high liability costs for practicing medicine in the state.

Preventing Violence in Hospitals5:

Workplace violence is intolerable and Emergency Departments are especially vulnerable. We urged lawmakers to support a bill authored by Senator Sepulveda and Assembly person Cruz which would require hospitals to establish formal violence prevention programs.

Dispensing Buprenorphine6:

We urged lawmakers to support legislation which would allow Emergency Departments to prescribe and dispense a 3-day supply of buprenorphine. We explained the benefits to patients and to public health and also explained this would bring New York into alignment with federal DEA regulations.

Medical Malpractice Insurance 7:

In New York we are susceptible to medical malpractice judgements in excess of what our insurance will cover. For this, there exists the state-funded Excess Medical Malpractice Insurance Program. We urged lawmakers to oppose legislation which would require physicians to cover 50% of the cost for the state excess medical malpractice program. The program is essential to providing patients access to specialized care (not just Emergency Medicine), and passing 50% of the insurance premium to the physician would further threaten and degrade the availability of high-quality care in New York.

Medicaid Reimbursement:

In New York, Medicaid reimburses emergency care at 33% of Medicare rates and also at a fraction of the Medicaid rates in neighboring states. While we are realistic in understanding that parity with Medicare or neighboring states is untenable, we urged lawmakers to support a significant increase.

References