American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Advocacy Updates

Federal Advocacy Update

While impeachment activity on Capitol Hill continues to crowd out regular committee action, several American College of Surgeon (ACS) Committee on Trauma (COT) priorities have seen success this past year.

Pandemic and All Hazards Preparedness

On June 24, 2019, the President signed into law S. 1279, the Pandemic and All-Hazards Preparedness and Advancing Innovation (PAHPAI) Act of 2019. Included in this reauthorization is the American College of Surgeons (ACS)-supported Mission Zero Act. Mission Zero builds upon the legislative framework passed in the fiscal year 2017 National Defense Authorization Act by further incorporating military trauma care providers into the civilian setting. These military-civilian trauma care partnerships will increase military health care readiness and ensure the provision of high-quality trauma care both domestically and abroad.

The grant was authorized for $11.5 million for each fiscal year 2019–2023 and will be facilitated by the Assistant Secretary for Preparedness and Response (ASPR). The Division of Advocacy and Health Policy (DAHP) has begun to develop an appropriations request to secure full funding for these grants.

Stop the Bleed Trainings and Legislation

Over the last several years, the staff of the ACS DAHP and Fellows of the College has offered bleeding control training to members of Congress and congressional staff. Through this effort, the ACS has demonstrated the importance of Stop the Bleed® on Capitol Hill and in district offices across the nation. These trainings have resulted in the creation of bipartisan legislation focused on further disseminating Stop the Bleed trainings.

On May 7, H.R. 2550, the Prevent Bleeding Lose with Emergency Devices (BLEEDing) Act of 2019 was introduced by Representatives Alcee Hastings (D-FL) and Brad Wenstrup, DPM (R-OH). This legislation would provide grant funding to states for Stop the Bleed kits and training. ACS DAHP staff is working with Senator Menendez's (D-NJ) office to identify a Republican lead to introduce a senate companion bill to Prevent BLEEDing.

Read an in-depth article on Stop the Bleed trainings and advocacy from the Bulletin.

Ask your member of Congress to cosponsor the Prevent BLEEDing Act.

Firearms Morbidity and Mortality Prevention Efforts

Despite the polarizing political rhetoric around firearms, the ACS COT has worked to advocate and promote a nonpartisan public health approach to firearm injury prevention. The College has had numerous opportunities to share the work of the COT before Members of Congress and their staff. Including before the U.S. House of Representatives Appropriations Subcommittee on Labor, Health and Human Services at a hearing titled "Addressing the Public Health Emergency of Gun Violence" and before the U.S. House of Representatives Energy and Commerce Subcommittee on Health at a hearing titled "A Public Health Crisis: The Gun Violence Epidemic in America." Read the testimony from these hearings.

Research Funding

This year, the College joined more than 100 medical, public health, and research organizations asking Congress to appropriate $50 million in funding for firearm morbidity and mortality prevention research. Following this letter and ACS testimony before the Appropriations Subcommittee, the House passed H.R. 2740, the Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act. This legislation passed on June 19, with a vote of 226 to 203 and included ACS-supported language providing $50 million for firearm morbidity and mortality prevention research.

Background Checks

On February 27, the House passed H.R. 8, the Bipartisan background Checks Act of 2019. This legislation requires all firearm sales to go through the National Instant Background Check System (NICS) as established under the Brady Handgun and Violence Prevent Act. This bill passed the House by a 240 to 190 vote. This legislation is supported by the recommendations outlined in the ACS Firearm Strategy Team (FAST) Working Group Consensus Statement and is a key step in addressing this public health crisis.

Hospital Violence Intervention Programs Legislation

Congressman Adam Kinzinger (R-IL) has agreed to work with Rep. Dutch Ruppersberger (D-MD) to create new language and reintroduce the Stop the Violence Act to include funding for new hospital-based violence intervention programs (HVIP). This follows ACS testimony before the Energy and Commerce Committee, where Rep. Kinzinger asked Dr. Stewart about HVIP programs and how they can play a role in breaking the cycle of violence. Learn more federal trauma legislation or contact Hannah Chargin, ACS Congressional Lobbyists, at hchargin@facs.org or 202-672-1528.

State Affairs Update

Stop the Bleed

The Stop the Bleed® campaign made significant advancements in 2019 with the enactment of legislation in three states: Arkansas, Indiana, and Texas. Arkansas (H.B.1014) requires high school students to complete a Stop the Bleed training as a requirement for graduation, while Indiana (H.B.1063) and Texas (H.B.496) both passed bills that nearly mirrors the ACS' model legislation to require public school personnel be trained and schools have bleeding control kits on site. Additionally, the Illinois Terrorism Taskforce announced in September the state would fund the installation of bleeding control kits for all public schools.

Other legislation to install bleeding control kits in schools or public places was introduced in the following states: California (A.B.1705), Illinois (H.B.3432), Michigan (H.B.4334), Missouri (H.B.1005, H.B. 249), Massachusetts (H.1870, S.1337), New York (A.4484), North Carolina (H.B.288), Pennsylvania (H.B.1072), and Tennessee (S.B.259, H.B.215).

Trauma Funding

In Connecticut, the Connecticut Chapter opposed legislation (S.B. 46) that would prohibit trauma centers from charging a trauma activation fee, which helps provide the resources required to make sure our trauma system has the correct health care providers, facilities, and equipment to save lives. Connecticut currently does not allocate public funding for the state's trauma centers. Grassroots efforts by the chapter and testimony from ACS Fellows garnered enough opposition to the bill to successfully prevent its passage.

In Louisiana, the ACS Louisiana Chapter initiated a call to action in support of H.B.380 to increase driver's license fees by $2.75 and to direct the funding to the Louisiana Emergency Response Network, the state's trauma system. Despite support from the ACS Louisiana Chapter and the state's trauma hospitals, the legislation failed to gain enough support to pass. Meanwhile, the Texas legislature passed H.B. 2048, which will eliminate the Texas Driver Responsibility Program and generate $71 million to the statewide trauma system. The revenue for the trauma system will be replaced with a mix of traffic fines and fees. On April 3, 2019, Ronald Stewart, MD, FACS, testified before the Texas House Homeland Security and Public Safety Committee in support of the bill.

The ACS Michigan Chapter received the 2019 ACS Enhanced Advocacy Grant to pursue legislation to establish a comprehensive statewide trauma system. The chapter is joined in a coalition with the Michigan State Trauma Coalition, a group of more than 90 member hospitals and trauma centers across Michigan, to push for the legislation.

Violence Prevention and Firearms

In 2019, ACS Fellows and Chapters added the surgeon perspective on state legislation to help stem the prevalence of violence and firearm injury and death. In California, Fellows supported the passage of two bills related to violence prevention. A.B. 166 would establish a pilot Med-Cal program to fund violence prevention services and A.B. 521 would fund a firearm violence prevention center at the University of California. While the governor signed A.B 521, he vetoed A.B. 166. In New Jersey, the legislature enacted a package of safety bills—S.3301, S.3309, S.3312, S.3323—that will create and fund the New Jersey Violence Intervention Program and Hospital-Based Violence Intervention Program Initiative.

The ACS Delaware Chapter supported passage and enactment of H.B.63 that revises the crime of "unlawfully permitting a child access to a firearm." The offense is renamed "unsafe storage of a firearm" to place emphasis on firearm safety and proper storage. Under the revised statute, a crime is committed when a person intentionally or recklessly stores or leaves a loaded firearm where a minor or other person prohibited by law, or unauthorized person, can access the firearm and the unauthorized person obtains the firearm.

The ACS Virginia Chapter submitted comments to the State Crime Commission charged with studying and taking public comment on potential for firearm related legislation in response the Virginia Beach shooting. The Chapter's comments included the ACS statement on firearms and a copy of the Firearm-Related Injury and Death in the United States: A Call to Action from the Nation's Leading Physician and Public Health Professional Organizations.

Distracted Driving

State legislatures continue to pass legislation to address the problem with distracted driving. There were 131 bills on various versions of distracted driving introduced in 2019. Legislation enacted or vetoed includes Arizona, H.2318, which includes all driver texting ban, handheld ban, and banning the viewing and transmitting of non-navigational video. However, the governor vetoed S.1141 to classify distracted driving as "reckless driving" in certain circumstances. Arkansas, S.534 bans use of handheld devices in work and school zones, as well as a cell phone ban on GDL drivers. Enforcement will become primary offenses. Florida, H.B.107 upgrades the texting ban enforcement to primary however permits video chatting when the vehicle is stationary and exempts autonomous vehicles. Illinois, S.B.85 will prohibit the viewing of video or using a hand or finger to compose, send, read, access, browse, transmit, save or retrieve e-mails, text messages, instant messages, photographs, or the other electronic data. H.B.2386 increases the fine and penalties for crashes involving electronic device use that cause great bodily harm. Louisiana, H.R.303 Creates the Wireless Telecommunications and Vehicle Safety Study Commission to study the use of a wireless telecommunications device while operating a motor vehicle. Minnesota, H.F.50/S.F.91 broadens the definition of the handheld ban to include prohibition on video viewing while in traffic. It permits hands-free mode for composing, reading, or sending electronic messages. Rhode Island, H.6186/S.785 bans the use of wireless handset for texting messages. Tennessee, H.B.164/S.B.173 extends the handheld ban in school zones and includes prohibition on viewing and taking video, gaming, and amusements. Virginia, S.B.1768 prohibits the use of any personal electronic device in a work zone. In New Hampshire, the Governor vetoed H.B.198, which would have repealed the prohibition on texting while driving.

Motorcycle Helmets

The ACS Connecticut Chapter testified at hearing of the Joint Transportation Committee in support of H.B. 7140, which would require a person to wear a helmet while on a motorcycle. The bill passed out of the legislature after it was amended to remove the universal helmet requirement. A similar bill in Iowa to create a universal helmet law for all motorcycle riders and passengers failed.

Legislation was introduced in Arizona, Maryland, Massachusetts, Missouri, Nebraska, New Jersey, North Carolina, Virginia, Washington, and West Virginia to weaken existing state law by exempting adults 21 years or older from the requirement to wear a helmet, while legislation in New York called for a study by the state department of transportation on the efficacy of motorcycle helmets preventing injury.

All the proposed bills failed except for Missouri, which was passed out of the legislature but was vetoed by the governor. The ACS sent a letter urging Missouri Governor Mike Parson to veto the bill. The North Carolina Chapter initiated a call to action resulting in over 7,000 e-mails sent to the House Health Committee opposing the legislation to repeal the state's universal helmet law.

Seat Belts

There were 75 bills introduced in 2019 related to seat belt and child restraints in motor vehicles. The ACS Louisiana Chapter engaged the legislature with grassroots in support of S.B.76 to update the state's child safety guidelines to mirror the requirements set by the American Academy of Pediatrics. The Louisiana bill passed and become law on August 1, 2019 when Governor Jon Bel Edwards singed it. While, the ACS New York Chapter initiated a call to action in support of A.6163/S.4346 that would require the use of seat belts by all passengers sixteen years of age or older riding in any seating position in a motor vehicle. The New York bill failed despite the chapter's efforts.

Other seat belt legislation that passed were enacted or vetoed includes: Alabama, S.B.254 requires all passengers wear a seat belt while the car is in motion however only front seat belt usage is primary enforcement. Maine, S.B.389 exempts passengers over 18 years of age to wear a seat belt if the number of passengers exceeds the vehicle seating capacity and all of the seat belts are in use. Oregon, H.B. 2347 clarifies that a person driving a vehicle for the purpose of delivering newspapers or mail is exempt from wearing a seat belt. Texas, Governor Abbott vetoed H.B.448, a child safety restraint bill creating of an offense for failing to secure certain children in a rear-facing child passenger safety seat system. Washington, H.B.1901 provides a medical exemption issued by a physician for an individual from having to wear a seat belt. H.B.1012 requires that a child under the age of two must be secured in a rear-facing child restraint system, a child under four in a forward-facing secured seat and a child under 4'9" must be in a booster seat.

ACS Professional Association Update

Through the American College of Surgeons Professional Association (ACSPA), ACS COT members have several advocacy and political resources at their disposal. SurgeonsVoice offers members opportunities to become educated about current federal legislative trauma priorities, contact members of Congress about these important issues, and more. The ACSPA Political Action Committee, SurgeonsPAC, continues to help build and maintain relationships with trauma advocates in Congress.

During the ACS Clinical Congress 2019 in San Francisco, several COT members visited the ACSPA booth to learn more about ongoing improvements to the SurgeonsVoice online Action Center, including additional opportunities to engage members of Congress. Demonstrating strength in numbers, particularly through the ACS Health Policy Advisory Council (HPAC) grassroots network, is a critical component to help ensure trauma efforts rise to the level of Congressional action. Currently, 15 COT members participate in HPAC, and more than 145 actions pertaining to trauma legislation took place via SurgeonsVoice online.

SurgeonsPAC raised more than $50,000 from ACSPA members and meeting attendees. In addition to raising funds to support important trauma advocates, Clinical Congress provided an opportunity to recognize 2019 COT contributors, including Executive Committee, State Chair, Vice-Chair, and Region Chief members. While final numbers are still being calculated, as of this report, approximately 157 of 311, or 50 percent, of COT members participate in SurgeonsPAC for a total of $71,058. Special thanks to the following individuals for contributing $1,000 or more in 2019: John H. Armstrong, MD, FACS; Kevin M. Bradley, MD, FACS; Eileen M. Bulger, MD, FACS; Brendan T. Campbell, MD, MPH, FACS; Amalia L. Cochran, MD, FACS; Kimberly A. Davis, MD, FACS; Warren C. Dorlac, MD, FACS; Jay J. Doucet, MD, FACS; Richard J. Fantus, MD, FACS; Lillian S. Kao, MD, FACS;, Robert W. Letton, Jr.; MD, FACS; Peter T. Masiakos, MD, FACS; Patricia A. O'Neill, MD, FACS; Stanley E. Okosun, MBBS, FACS; Ronald M. Stewart, MD, FACS; Michael J. Sutherland, MD, FACS; and Wayne E. VanderKolk, MD, FACS.

To learn more about ongoing SurgeonsVoice and SurgeonsPAC activities available to all COT surgeon advocates, contact Katie Oehmen, Manager, ACSPA-SurgeonsPAC and Grassroots, or Austin O'Boyle, Grassroots and PAC Coordinator, at koehmen@facs.org or aoboyle@facs.org.

Contributions to ACSPA-SurgeonsPAC are not deductible as charitable contributions for federal income tax purposes. Contributions are voluntary, and all members of ACSPA have the right to refuse to contribute without reprisal. Federal law prohibits ACSPA-SurgeonsPAC from accepting contributions from foreign nations. By law, if your contributions are made using a personal check or credit card, ACSPA-SurgeonsPAC may only use your contribution to support candidates in federal elections. All corporate contributions to ACSPA-SurgeonsPAC will be used for educational and administrative fees of ACSPA and other activities permissible under federal law. Federal law requires ACSPA-SurgeonsPAC to use its best efforts to collect and report the name, mailing address, occupation, and the name of the employer of individuals whose contributions exceed $200 in a calendar year. ACSPA-SurgeonsPAC is a program of the ACSPA, which is exempt from federal income tax under section 501c (6) of the Internal Revenue Code.