Publications
APS Bulletin • Volume 18, Number 1, 2008
Pain and the Law
Ben A. Rich, PhD JD, Department Editor
It’s Time to Lobby for Pain Care
Jane Martinsons, Staff Writer
Washington, DC, lobbyists can’t catch a break these days: If they’re not being vilified in the press, the presidential candidates are swearing them off and promising voters that their future administrations won’t be sullied by the likes of them.
But not all legislative advocacy is created equal, nor is it all self-serving. This year the Pain Care Coalition, comprising the American Pain Society (APS) and three other professional pain organizations, is urging pain professionals to take an active role in helping pass various pain bills by meeting with their congressional representatives and senators—or most likely their staff. The ultimate goal is to gain sponsors and establish ongoing relationships between them and their congressional leaders. At press time, the House pain bill (HR 2994) had 39 cosponsors, according to Adam Chrisney, APS legislative consultant, representing half the initial bipartisian cosponsor targets. A companion Senate bill was in the works but not yet introduced.
APS Advocates
According to APS President Judith Paice, PhD RN FANN, APS is working hard to increase awareness of pain as a public health issue on several fronts—with legislators to increase National Institutes of Health (NIH) funding, with third-party payers to increase reimbursement to interdisciplinary pain programs, and with regulators to ensure balance in the availability of opioids.
As part of the Pain Care Coalition, APS is also working on direct legislative advocacy. Already, two members have contacted their congressional leaders who serve on the Energy and Commerce Committee, which has jurisdiction over the pain bill. Mark Jensen, PhD, professor, department of rehabilitation medicine, University of Washington, Seattle, met with a congressional aide of Rep. Jay Inslee (D-WA-1), and APS Board Member Lonnie Zeltzer, MD, director of the Pediatric Pain Program at Mattel Children’s Hospital at UCLA in Los Angeles, made contact with the office of Henry Waxman (D-CA-30), an influential congressional leader on healthcare issues. Both recently shared their experiences with APS Bulletin.
According to Jensen, congressional leaders need to know about pain care and its impact on American lives if they are to make informed decisions on laws affecting pain research and management. Still, he wasn’t sure what to expect from this first visit to Rep. Inslee’s office in Seattle. “I simply called the office of my local representative and asked to have about 30 minutes to speak with the staff person who dealt with health issues,” he says. “They were very responsive, and it was easy to schedule a meeting.”
Once there, Jensen and the staff aide discussed the frequency and impact of pain problems in the United States. He presented the bill and asked that his representative cosponsor it, but he says the greatest impact came when he talked about how the bill would affect people in Washington state.
“I told the congressman’s aide that I treat individuals with chronic pain in the UW Medical Center and that I am the principal investigator of a number of research grants funded by NIH and the National Institute on Disability and Rehabilitation Research.” Jensen emphasized that there is much to be done to help patients better manage chronic pain and much to be learned about the causes and effective treatments for chronic pain.
He also stressed that treatment and research in chronic pain are underfunded. “Many of the patients who want to see me do not have adequate insurance coverage to see a psychologist for pain management treatment,” he explained to the aide. “Also, federal agencies that fund research are underfunded, which limits the number of studies they can support. As a result, there is more suffering due to pain than there needs to be.”
Jensen stressed that people nationwide, including those in Washington state, would greatly benefit from a bill supporting increased understanding and better treatment of pain, as well as institutions like his that perform pain research.
Overall, the meeting “did not seem particularly challenging to me,” Jensen says. “They seemed interested in hearing what I had to say and set aside time for this.”
Meanwhile Zeltzer took a different approach because she has a personal connection to her representative’s office: A parent of one of her patients (“Ann”) was Waxman’s former chief campaign manager and a good friend of his current and longtime chief health aide. When Zeltzer learned that the two friends had plans to meet socially, she briefed Ann on talking points and key issues of the pain bill. After their meeting, Ann reassured Zeltzer that Waxman “gets it” and is already a staunch supporter of the bill.
“She said, ‘You don’t have to worry about Henry. He’s going to do whatever he can to push it through,’” says Zeltzer, who was ensured a meeting with Waxman on her next visit to Washington, DC, if she wished. “The next time I go there for an NIH meeting, I’ll arrange to meet with him. That was it,” she says. “The challenge I faced was: Should I leave it to Ann or push to see the health aide? I decided that Ann would be a better, more influential proponent because they were good friends, and Ann had her own personal story to tell about why the pain bill should be passed.”
At APS Bulletin deadline, however, neither representative had yet cosponsored the pain bill, prompting both Jensen and Zeltzer to contact their offices again. Meanwhile, Zeltzer now has the phone number of Waxman’s health aide, which she describes as “an open door” to the office.
For APS members interested in lobbying congressional members, it’s imperative they know the basics on advocacy. Chrisney and Zeltzer provide the following important tips.
Personalize Your Message
“Think of your audience and what you want them to remember,” Zeltzer says. “Keep it simple and try to sneak in a little personal story of some sort. If you have the opportunity, put in some patient’s story or a personal story. Be very brief but poignant; that emotional tag helps create a connection and emotional pull that’s encoded on the [listener’s] memory.” Chrisney adds that “despite lobbying efforts by big-name companies, associations, and lobbyists, what really matters to members of Congress is what their voters say. Whenever a representative or senator hears from a constituent, it may be a drop in the bucket—but it’s a very relevant drop,” he says. “The more APS members can build relationships with their own congressional representative, the more likely the representative will look to them as an impartial voice on medical and pain care issues.”
Come Prepared
Know what you’re going to say so that you stay on message, Chrisney says, and “rehearse a bit.” Ask yourself, “What am I going to ask for? Are my materials prepared? Do I know something about the person with whom I’m meeting?”
Stay on Message
Never voice your personal concerns. “You’re there for one reason: To represent APS and to request that they cosponsor the bill,” Chrisney says. “The hook is that you explain to them that you are a constituent and explain why they should listen to you. Tell them, ‘I’m a clinician and I have my own practice in this city’ or ‘I have a private practice, and I’m also associated with this hospital, university, or medical center.’ Now they can identify with you and understand the link to the healthcare system in their district. They know they are listening to a constituent, as opposed to a mouthpiece.”
Zeltzer agrees, saying, “Don’t get whiny about the healthcare system and don’t complain. Be positive and direct—in other words, be professional.”
State Your Request
Surprisingly many people, particularly those visiting Capitol Hill for the first time, forget to make their request. “They get mesmerized by the spectacle of it,” Chrisney says. “They forget why they’re there and end up forgetting to make a request.”
Follow Up
“Often people feel like they came to Capitol Hill, made their request, and that was it; they’ve done what they were supposed to do,” Chrisney says. “Well, no, that’s just the first step. Two to 4 weeks later, you need to follow up with a phone call and say, ‘Do you have any further questions? Have you had a chance to talk to the representative about this? Have you made a decision? Is there any more information I can provide you?’”
Keep It Short
Keep your message simple, clear, and brief. “You don’t want to say too much,” says Zeltzer, who recommends limiting the discussion to two or three talking points. “You don’t want to be remembered as the person they want to forget.”
Also, remember that congressional aides, although generally young and energetic, keep busy schedules that may include up to five meetings a day. “More often than not, they prepare a memo [after your meeting] and say, ‘So-and-so came in, brought these materials, and made this request,’” Chrisney says. “They’ll have a recommendation based on your quick meeting. It’s another reason why you need to present a focused message and be prepared. You need to be able to punch this stuff out.”
Use ‘No’ to Your Advantage
If you repeatedly have trouble getting an appointment, let the congressional office know how you feel about it as a pain professional and a constituent. It may prove to be your ticket in next time.
Remember Your Purpose
Last, remember why you’re doing this. “If you have a commitment to people who have pain and you want the whole area of pain to be better recognized, better funded, and more researched, then you have an important voice,” Zeltzer says. “It behooves anybody who is a [pain] professional—a nurse, a physician, a social worker, a psychologist, a researcher—to have a role and a voice. Don’t minimize the importance of contacting your legislative aide.”
Advocacy TipsDos
Don’ts
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Cosponsors of HR 2994
As of mid-March, there were 38 representatives supporting the bill:
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Capps, Lois (CA-23), Sponsor Allen, Thomas H. (ME-1) Baldwin, Tammy (WI-2) Berman, Howard L. (CA-28) Boucher, Rick (VA-9) Butterfield, G. K. (NC-1) Deal, Nathan (GA-9) DeGette, Diana (CO-1) Gilchrest, Wayne T. (MD-1) Gonzalez, Charles A. (TX-20) Gordon, Bart (TN-6) Green, Gene (TX-29) Grijalva, Raul M. (AZ-7) Hinchey, Maurice D. (NY-22) Hooley, Darlene (OR-5) Kennedy, Patrick J. (RI-1) Kildee, Dale E. (MI-5) Latham, Tom (IA-4) Lofgren, Zoe (CA-16) |
Markey, Edward J. (MA-7) Marshall, Jim (GA-8) Murtha, John P. (PA-12) Platts, Todd Russell (PA-19) Rahall, Nick J., II (WV-3) Rogers, Mike J. (MI-8) Ross, Mike (AR-4) Rothman, Steven R. (NJ-9) Rush, Bobby L. (IL-1) Schakowsky, Janice D. (IL-9) Shea-Porter, Carol (NH-1) Solis, Hilda L. (CA-32) Stupak, Bart (MI-1) Tiberi, Patrick J. (OH-12) Towns, Edolphus (NY-10) Upton, Fred (MI-6) Walberg, Timothy (MI-7) Wexler, Robert (FL-19) Wynn, Albert Russell (MD-4) |