02/14/2014
February President's Message
When the system works: victories for Ohio’s emergency docs
By John L. Lyman, MD, FACEP
One of the core missions of Ohio ACEP is its tireless advocacy for emergency physicians and their patients. Yes, we have wonderful educational offerings. Our Board Review course is the Granddaddy of them all and is regarded by many as “the best.” And yes, we have fantastic leadership training. We pride ourselves on preparing new generations of physicians to accept the mantle of the physician leaders who came before them. And then there’s advocacy, a pillar of our Chapter since its inception.
But there are a couple problems that come with advocacy. For one, so much goes on behind closed doors, and it may be difficult for the emergency medicine community to appreciate what is done. Sometimes the most important victories in advocacy are victories because they never see the light of day. In instances like these, we are able to amend or stop legislation that would be detrimental to patient care and emergency medicine before it is even introduced!
The second difficulty that comes with advocacy is that so many people are understandably turned off by the “wheeling and dealing,” “pay for play” mentality that we all associate with the political process. We’re all familiar with the perception: pay enough money, contribute enough to PACs or candidates, and you’ll be able to influence lawmakers, regardless of whether it results in good policy or bad.
So it’s with great satisfaction—and with a big smile on my face—that I report to you a couple of examples of democracy and advocacy in action, demonstrations of how the system can, and should, work. Not just because these were “wins” for emergency medicine, but because they’re an affirmation of the system of democracy and a vindication of the efforts of so many dedicated advocates.
The first of these examples concerns a bill that was being promoted by a variety of groups. This legislation contained a couple provisions that the majority of emergency physicians would embrace without hesitation. But there was one provision of the bill that would simply have been a backbreaker for any contracted Emergency Physician (or for that matter, any contracted Radiologist or Anesthesiologist) working in the hospital setting. The essence of that provision is that it would have automatically exempted the hospital from any liability for a suit filed against any contracted (non-hospital employee) emergency physician.
Through the efforts of our Government Affairs Committee, we sat with stakeholders instrumental in promoting this legislation, and we took the time to educate them about our concerns. Dr. Bob Broida, one of our Board members, deserves special recognition for his efforts in organizing this effort. The result of these talks was that an amended version of the bill, one without the objectionable provision, was introduced to the Ohio General Assembly.
This is often what a victory in advocacy looks like. But unless you knew the history of the bill before it was officially introduced, you would not be able to see the effort that went into improving it.
The second example is still developing, but it so clearly demonstrates my point and deals with an issue which we read about daily, it seems appropriate for inclusion in this article. As we all know, Ohio’s legislators are committed to addressing the problem of prescription opioid abuse. There have been many ideas proffered, some better than others, and a spate of bills are under consideration in the legislature. It’s important to point out that the goal of these efforts is admirable, and Ohio ACEP was one of the first medical associations at the table to help the state confront its prescription drug abuse epidemic.
But, when appropriate, we have also pushed back on bills that would substitute the clinical judgment of emergency physicians in favor of arbitrary prescribing restrictions. One such idea would require that any prescription for a narcotic be accompanied by a check of OARRS by the physician (not a surrogate) prior to the dispensing of the drug. Any practicing emergency physician in Ohio knows that the OARRS system can be a useful tool. But we also know that it has its limitations. Sometimes the system is down. Other times we are “locked out” of our accounts. And, most importantly, treating acute pain often does not allow for the time needed to run an OARRS check.
Thanks to the efforts of Ohio ACEP (special kudos to Dr. Catherine Marco and Dr. Brad Raetzke who made personal appearances to testify at legislative committee meetings), there is the strong possibility the proposals will be eliminated for prescriptions written for less than 3-5 days of usage. While not set in stone at this point, this is a huge win for emergency medicine and our mission to treat each patient in a timely, effective, and compassionate manner.
Advocacy, at times, is unappreciated—but it is always needed. The title of “MD” or “DO” is one that comes with responsibility. You are seen as community leaders, and rightly so! So please, be involved: write letters, contact your legislators, inform the members of your community, and support Ohio ACEP in its efforts to protect the interests of patients and the clinicians who serve them.