Grassroots advocacy by several Yale Department of Psychiatry trainees and their colleagues across the medical school resulted in the passage of two new laws in Connecticut during the past legislative session.
One law will improve access to health services by clarifying which doctors listed in insurance directories will take appointments for patients outside of the hospital. The other will make the medication naloxone, an opioid antagonist, more widely available to people who overdose.
The advocacy work began last fall, when the residents and fellows gathered for a pilot Advocacy Elective taught by faculty member Katherine “Kiki” Kennedy, MD. The program was launched after the trainees said they wanted a forum to promote policies they deemed important.
“We discussed what kinds of issues we were concerned about and what kinds of issues we really wanted to advocate for on behalf of patients,” Kennedy said.
Two ideas emerged. One was a relatively small clarification of an existing law that would identify in provider directories the names of doctors available for outpatient appointments. Under the old law, insurance companies did not have to distinguish between impatient doctors and those who provide treatment outside of hospitals.
“We thought that if people could be designated as an outpatient provider, it would save (doctors) from getting calls and patients getting frustrated,” Kennedy said. “With a lot of (insurance provider) directories, they appear to be more robust than they actually are. We felt that this would be a service to the patients and help (the doctors).”
There was also support among the trainees for the naloxone “standing order” bill. Nearly two dozen people, including many Yale affiliates, testified either in person or in writing in favor of the proposal to expand access to the medication in Connecticut. Some shared experiences watching patients overdose, only to have the effects reversed after naloxone was administered.
Before the law was passed, only pharmacists could distribute naloxone in Connecticut under a doctor’s order. The new law will allow other trained people – including family and friends of patients – to dispense it. That, advocates argue, will reduce the number of opioid-related deaths in the state because there will be wider access to the medication. Similar laws have been passed in more than 40 states.
The bills were proposed in the Senate by Kennedy’s husband, Sen. Ted Kennedy, Jr., a Democrat whose district includes Branford, Guilford, Madison, North Branford, Killingworth, and parts of Durham. The senator met with the trainees to discuss the process of introducing legislation, and encouraged them to submit ideas to his office so he could formally put them forward as bills.
Luming Li, MD, a fourth-year psychiatry resident, helped research information about the two proposals, and encouraged her colleagues to work the phones, send emails, and lobby lawmakers.
“I learned a lot about the process,” she said. “I’m really indebted to Kiki and her husband and others in the department for really nurturing these ideas, and also the general leadership of the department who supported the residents.”
She relished the opportunity to work alongside colleagues not only from psychiatry, but from the VA Connecticut Healthcare System, School of Public Health, medical school, and others in building support for the legislation.
We really are, at our heart, both a services- and research-driven institution. As long as the issues are of interest to folks there is a lot of opportunity for advocacy.
Luming Li, MD, fourth-year resident, Yale Department of Psychiatry
“When the bill is passed immediately you’re like it’s so great, it passed,” she said. “But what got me really excited was seeing the interest and effort from the other residents. When I sent a notice saying please have your testimony in by tomorrow, they did. It was cool to see that other people were so interested in these key issues.”
Li’s interest in advocacy took root when she was a student at the Robert Wood Johnson Medical School in New Jersey. She became a champion for healthcare parity after she saw that psychiatric patients endured longer wait times for beds than other patients.
When searching for residency opportunities, she focused on programs that would offer a platform to continue advocating for people. She said she found that at Yale.
“We really are, at our heart, both a services- and research-driven institution,” she said. “As long as the issues are of interest to folks there is a lot of opportunity for advocacy.”
Sen. Kennedy submitted the bills in January. They were voted out of committee, and eventually put on the Senate floor for a vote.
The process took a few months. “It was an exciting time. We didn’t know what was going to happen,” Kiki Kennedy said. “But (both bills) picked up steam and generated a lot of excitement.”
In a year when the General Assembly failed to gain consensus on a state budget during the regular session, Kennedy said the advocates’ success in building bipartisan support for the two bills should not be underestimated.
“The fact that we had victory for both of those bill, I think, suggests they really picked timely topics that had broad bipartisan appeal,” Kennedy said. “They (the trainees) got to experience a different kind of system in terms of how things get done and worked on. Working on a bill and engaging with the General Assembly and their rules, how they prioritize. Having to work within a very different framework and system was very eye opening.”
There are plans to continue and even expand the elective in the next academic year. Junior residents will lead the group, and Li said she would like other residency programs across the medical school to get involved.
There will be a meeting in the early fall to consider new ideas to promote. One possibility might be a clarification of language that would enable people to get earlier treatment for alcohol abuse.
“Advocacy is not a solo sport. It’s something that is very collaborative,” Li said. “It’s amazing to see a lot of folks were interested in helping out. As long as the issues are of interest to folks there is a lot of opportunity for advocacy here.”