Small State Notches Big Prescribing Battle Victory

While lawmakers in one small Western state—New Mexico—saw fit to grant psychologists the right to prescribe psychoactive medications, those in another one decided that such an action was not in the best interest of their citizens.

On February 3 the Wyoming Senate voted down a bill that would have granted prescribing privileges to psychologists who have not graduated from medical school. The vote on the proposal was 9 to 16.

Psychologist-prescribing proposals are still alive, however, in Hawaii and New Hampshire and are expected to be introduced in states as disparate as Texas, Illinois, Tennessee, Louisiana, Connecticut, and Florida.

Efforts to pass such legislation have recently been thwarted in Arizona and Maine.

APA Medical Director James H. Scully, M.D., attributed the Wyoming Senate’s defeat of the bill to “a strong and active group of members of the Wyoming Psychiatric Society, working with the Wyoming Medical Society, and effective lobbyists.” The two organizations were ready with educational materials and argued their case early with lawmakers and allies in nonphysician organizations.

“APA provided both resource support and financial assistance in the form of an educational grant to the Wyoming Psychiatric Society,” Scully noted.

The Wyoming bill (SF0053) was broader and included fewer specific requirements than the one passed in New Mexico. It said that psychologists who wanted prescription privileges must have graduated from an accredited doctoral program, but if their program had not gained accreditation, they could still be eligible if the program “meets recognized, acceptable professional standards as determined by the [state’s psychology] board.”

The bill also required that a psychologist must have completed a program of “intensive didactic instruction” within the five years immediately preceding his or her application to get prescribing privileges. It specified that the program must include course work in neuroscience, psychopharmacology, pathophysiology, and “appropriate and relevant physical and laboratory assessment.” The bill included a loophole around the five-year requirement, however, by granting the psychology board the right to waive that standard if it determines that the applicant has taken adequate “refresher” training even though the course work was completed before the five-year period kicked in.

Passing a certifying examination would have been required as well, though it could have been one “developed by a nationally recognized body approved by the board” or one that the board developed on its own.

The success of Wyoming psychiatrists in ensuring that the prescribing-privilege bill died a quick death is particularly noteworthy in that the Wyoming Psychiatric Society (WPS) is APA’s smallest district branch, with only 27 members.

WPS President Kevin Robinett, D.O., began gearing up in June for the possibility that a psychologist-prescribing bill would be introduced in the legislature, when he began to mobilize district branch members for a lobbying effort. They expected to have little notice before the psychologists managed to get their bill introduced, “and that is essentially what happened,” he told Psychiatric News.

In November Robinett did uncover one important clue—that the psychologists had hired a lobbyist. (In Wyoming, lobbyists have to register with the state.) “We figured something was up,” he said.

By fall, district branch members had talked with all but one state senator on the committee in which they were sure the bill would originate—the Labor, Health, and Social Services Committee. In all, 10 district branch members, nearly half the membership, met with state lawmakers to convince them of the wisdom of rejecting the bill. That senate committee’s chair, however, realized that other committee members were being heavily lobbied against the bill, making it unlikely to pass. He responded with a legislative maneuver that resulted in its being introduced in another committee, the Corporations Committee, where it had a better chance of passing.

“We were caught off guard when one of the [Department of Defense] psychologists trained to prescribe gave powerful testimony” in favor of the bill at a January 28 hearing of the Corporations Committee, Robinett said. He added that his wife, WPS Secretary/Treasurer Jane Robinett, D.O., quickly put together testimony explaining why the bill was a bad idea and was able to deliver it to that committee later on the same day the psychologist appeared.

As soon as the bill made its debut, Robinett requested, and received, funds from APA that would allow the small, cash-starved district branch to hire a lobbyist.

District branch leaders also began lining up allies. They already had enjoyed several years of good relationships with the state medical society, Robinett explained, and this year’s president is a psychiatrist, Steven Brown, M.D. The Wyoming Nurses Association also turned out to be a strong ally. “Their lobbyist was very active in speaking out against the bill,” he said.

The initial reaction from the leadership of the Wyoming Alliance for the Mentally Ill was not what they had hoped, with the president publicly advocating for passage of the prescribing bill. After meeting with Jane Robinett, the president of Wyoming AMI changed her position and testified against the bill. The state hospital association also opposed the bill.

The WPS had a strong and early ally in the state’s medical society. This is a different experience from the one that New Mexico psychiatrists faced. In that state some of the leadership of the medical society pursued a strategy contrary to the one the psychiatric association wanted. The Wyoming Medical Society, however, quickly issued a member alert and request for help in derailing the bill. It said, “It is critical for all physicians—especially primary care physicians—to contact members of the Senate and ask them to defeat this dangerous legislation.” It also posted “talking points” to help physicians frame their arguments when they discussed their opposition with state lawmakers.

In addition, two members of the WPS posted talking points on the district branch’s Web site. WPS President-elect Mark Kline, M.D., and Jane Robinett each developed an extensive list of issues that routinely are raised in the psychologist-prescribing debate and responses to them. These topics include the differences in training between psychiatrists and psychologists, the skill needed to treat the difficult and complex medical conditions that characterize many of the most seriously mentally ill patients, and the fact that Wyoming is actually seeing an increase in the number of psychiatrists.

Kevin Robinett believes the bill will likely make another appearance two years from now, “and we’ll have to wage this fight all over again.”

The WPS’s Web site is www.wyopsychiatry.org. The Wyoming Medical Society’s member alert is posted at www.wyomed.org/legis_update3.htm. ▪