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The Saga of South Dakota Senate Bill 179
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It didn’t seem quite fair. Occupational therapists in South Dakota were prohibited by an interpretation under the South Dakota Board of Medical and Osteopathic Examiners from treating their patients through the use of physical agent modalities (PAMs), which include ultrasound, electrical stimulation, deep heating agents, etc. In South Dakota, only physical therapists were allowed to use those tools.
“Apparently, the board had ruled in 1994 that PAMs were not within the scope of practice for occupational therapists, although specific language prohibiting their use by OTs was absent,” says Jim Wahner, regional director of government relations for Golden Gate National Senior Care (formerly Beverly Enterprises). The problem is, South Dakota’s 75,885 square miles are home to a population of 770,883. With only 10.2 people per square mile, physical therapists are harder to find than prairie dogs. With PTs forced to ride the circuit to several rural locations, the physical care needs of South Dakota seniors were not always met.
Mark Richards, national director of clinical services for Aegis Therapies, is a PT himself, but he knew that trained OTs were just as capable as PTs to administer PAMs. Richards contacted Wahner and suggested they mount a campaign to change the law. “I thought we had about a 60% chance,” says Richards. “But South Dakota seniors were being underserved, and I felt we had to try.”
Wahner and Richards went to work. It was mid-January, 2005, and the South Dakota legislature would only be in session until March 15. Time was tight. “Mark identified a number of OT therapists in South Dakota who would be willing to be politically active, and I tracked down Maria Klamm, the president of the South Dakota Occupational Therapy Association,” says Wahner. Kramm mobilized her OTs, and along with Aegis therapists they began an e-mail and letter writing crusade to let legislators know that their constituents were not getting needed care.
Meanwhile, Wahner and Richards enlisted the help of the South Dakota Health Care Association and Beverly nursing homes, asked researcher Candace Bartlett of the Beverly Government Relations Department to draft a bill, and hired contract lobbyist Dennis Duncan. “We started doing regular conference calls so we could share strategy weekly and keep everyone on track,” says Wahner.
Duncan went into high gear, talking to the healthcare committees in the state House and Senate, but he says he couldn’t have accomplished his mission without the grassroots effort. “I relied on the OTs to a great degree,” he says. “I told Jim from the start that it would not be an effective campaign without a focused effort by the OTs to communicate their support to the legislators.”
Duncan’s method was straightforward: Develop the message, then determine who to contact and who best could deliver the message. “We put together guidelines for the OTs so they would know what to say and how to respond to questions that the legislators asked,” he says. “The key was for them to report back so we knew what the legislator was thinking.”
When it came time for the vote, OTs filled the gallery, recruited by the OT association, Aegis and Beverly nursing homes. “They were primed and ready to testify, but we’d laid such a strong foundation that by that time we didn’t need them,” says Wahner. “We had the votes, and there’s an old saying in the legislative halls: When you don’t have the votes, you talk; when you do have the votes, you vote.”
In the end a compromise was reached with the physical therapists. “It was an agreement that both sides felt they could work with,” says Richards. “It was one that would ultimately serve the best interests of therapy patients in South Dakota."
Senate Bill 179 was signed into law on March 9, 2005. It expanded the scope of practice of occupational therapists to include PAMs. “It was the result of a collaborative effort led by Aegis therapists with the South Dakota Occupational Therapy Association, Beverly’s South Dakota nursing home operators, the South Dakota Health Care Association, numerous OTs and a compromise by the South Dakota Physical Therapy Association,” says Wahner. “We had a beautiful bill-signing ceremony. Political advocacy really works.”
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