Lenny Winkler, Nurse and Republicrat

How many full-time emergency room nurses are currently members of the Connecticut state legislature? Just one: Lenny Winkler, the Republican Minority Leader. Though the pairing is unusual, the two roles have proven most complementary.

Back in early 1988, Winkler was working in the ER of Lawrence and Memorial Hospital, in New London, and was a member of her local school board. When the district representative unexpectedly passed away, a special election was called to fill the seat for the 41st District. Connecticut has long been a Democrat-dominated state. Wanting to keep their hold on the seat, the Republican party approached Winkler, a party member. She was intrigued by the suggestion that she run. Winkler's husband said if she wanted it, she should go for it. The rest is history.

Recalling an early misunderstanding, Winkler laughs. Since she had arrived in the legislature in that March 1988 special election, she had to run again in November of the same year in the regular election. As a result of her peculiar circumstances (arriving "late" in a special election, then being an incumbent), she was never invited to an orientation session about legislative procedures, such as how to obtain hearings on proposed legislation. So, Winkler explains with good-natured exasperation, she was left "wondering why her proposals got nowhere." But only at first: determined to be effective, she took the initiative to learn legislative procedures on her own.

And she is effective. A tall, trim woman with frosted hair, Winkler has been consistently reelected, and is now a seasoned veteran. Her office walls (and her inbox) are filled with awards from a wide variety of groups including Mothers Against Drunk Driving, the Hospice Council of Connecticut, and the Connecticut College of Emergency Physicians.

Moreover, since 1988, the energetic Winkler has held two jobs. When the legislature is not in session, she works full-time as an ER nurse. When the legislature is sitting, she works weekends. "The hospital is wonderful to me," she says fondly. "I have a lot of flexibility to do the job." Her husband of 36 years, a retired mayor of Groton, Connecticut, helps out by managing her home office.

From Helium Balloons to HMOs

Winkler sits on the Public Health Judiciary, and finance committees. She feels that it is important to balance her time between healthcare and non-healthcare initiatives. Indeed, her first successful bill addressed the concerns of an elderly environmentalist in her district. The bill outlaws mass helium balloon releases – of more than 10 balloons. "You'd better not buy your child 11 balloons," Winkler warns with a mischievous smile, then adds seriously, "But it had become a major problem with sea turtles and other animals eating the deflated balloons and dying." (Other states have also banned mass balloon releases.)

Winkler was also instrumental in setting up a brainstorming group and grassroots organization called CHILD (Citizens Helping Institute Legal Deterrents), in response to a case of children being sexually abused in a daycare. Her work led to the creation of a registry of sexual offenders, which has expanded and is now known as "Megan's Law." This law allows authorities (under certain circumstances) to inform the public when a convicted sex offender moves into the community. Winkler also convinced the judiciary to implement a 40-hour training program for judges dealing with child sexual abuse cases. "Before," she says, shaking her head with disbelief, "they were given a pamphlet and asked to skim it."

Winkler admits that she is not a typical Republican; she describes herself as a "Republicrat." She particularly likes being a member of the public health committee because she says that here, unlike the legislature as a whole, "people do things that they feel are right," rather than resort to partisan politics.

Winkler has had many successes, and prides herself on getting legislation passed. She and another legislator were able to get an AmeriCares Clinic into their area. AmeriCares works internationally and within the United States to provide food drops and operate free clinics. Locally, mobile clinics, staffed by volunteer doctors and nurses, provide healthcare for extremely low-income people.

A target of several of Winkler's initiatives has been Health Maintenance Organizations (HMOs). She was a leading sponsor of legislation prohibiting "drive-thru" deliveries. Now, HMOs are required to pay for 48-hour hospital stays following vaginal deliveries and 96-hour stays following c-sections.

One of Winkler's current battles seeks to eliminate the HMOs' formularies. Formularies are limited lists of drugs from which physicians are able to prescribe for HMO patients. "Doctors aren't able to prescribe what they want," she explains. "A patient can't get the doctor's drug of choice. For example, an ophthalmologist may recommend an eye drop, but it's not on the formulary. The pharmacist will say that two drugs on the formulary are close. Close, but not right." Unfortunately, so far things have not progressed past the public health committee. This, Winkler says, is a result of being in the minority party "on the opposite side of the aisle." It's frustrating, but she is not about to give up.

The Big Time

In May 2001, a piece of legislation introduced by Winkler was passed by a 141 to 0 vote. This legislation (formally identified as Public Act 01-124, An Act Concerning Recommendations For And Refusals Of The Use Of Psychotropic Drugs By Children And Utilization Review Determinations Related To Mental And Nervous Conditions) prohibits school personnel from recommending the use of psychotropic drugs in children. And it has, to Winkler's amazement, brought her international attention.

Her concern initially arose out of her work as a nurse. "It bothered me tremendously. I saw it where I work. Children would come in to our facility to get baseline labs – chemistry profiles, liver profiles, CBCs, urinalysis – and then they would come into the ER for a cardiogram. I said to myself, 'Why am I doing a cardiogram on an 8-year-old or 9-year-old child?'" She provides the answer: because these children were being put on one, or a combination of, psychotropic drugs – Ritalin, Haldol, Clonopin, Prozac, Zoloft, Wellbutrin – to treat ADD/ADHD (Attention Deficit Disorder/Attention Deficit Hyperactive Disorder). More significantly, they were being placed on drugs without proper assessment.

Since the bill was passed, Winkler has been interviewed by other state governments and by media giants such as CNN, the BBC, and the Times. And in January 2002, Winkler received the American Medical Association's prestigious Dr. Nathan Davis Award (in the Member of a State Legislature category) for leadership in healthcare legislation. She was grateful to have been even nominated for the award; as for winning, she says with hushed excitement, her eyes glowing, "I am absolutely ecstatic about this."

Winkler is not an anti-medication zealot. "I don't want drugs banned. I just don't believe that psychotropics should be the first line of treatment." Concerned that children get the best care possible, she ensured that the legislation allows for flexibility regarding information exchange, and having students professionally assessed with parent permission.

But she is not content simply to point out problems; she seeks to follow through with solutions. To this end, Winkler's next big undertaking is the development of a pilot project to use neurofeedback in schools. In her research, she discovered the work of Dr. Jonathan Michaelis, who operates two neurofeedback clinics in the Connecticut communities of Newington and Norwalk. Neurofeedback is the use of EEG biofeedback to teach individuals to voluntarily regulate their own brain activity. The treatment generally is for 20 minutes, two times per week, for three to four months. (Neurofeedback is unfortunately not covered by health insurance, with families generally having to pay between US$3,000 to US$5,000 for treatment.) Significantly, Michaelis reports an over 90% success rate in increasing ADHD students' grades, improving their social skills, and, in many cases, getting the students off drugs.

Winkler explains that Connecticut currently has a US$500 million special education budget, and the numbers keep rising. Winkler's pilot project would take three years and cost US$11 million dollars. But with a test group of 1,200 children, and a very conservative success rate of 35%, Connecticut could save US$60 million in special education funding. "I'm working to promote this sort of thing as an alternative to drug therapy," she says. "We have been on the forefront with our legislation, and to follow through with treatment would keep us in the forefront. We have nothing to lose and everything to gain."

A Nurse's Insight

When asked which career she finds more rewarding, healthcare or politics, Winkler is silent and thoughtful. "I love both of the jobs I do," she finally states firmly. "Healthcare is probably my greatest love. But it's very nice when you can cut through government bureaucracy and solve problems for constituents."

And, she stresses, the fact that she is actively practicing as a nurse has helped her with her role as a representative. "As a nurse, I have to watch body language, to see if my patient is in pain," she explains. "Knowing body language is also useful for a representative."

Overall, she says, "My legislative career has benefitted greatly from my nursing career. It's given me an insight that those who don't work in healthcare don't have."

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