More States Just Say No To Psychologist Prescribing

A coalition of psychiatrists, other physicians, patients, social workers, and mental health advocates pooled their outrage earlier this year to make sure that Hawaii did not become the second state to grant psychologists the right to prescribe psychoactive medications. Several psychologists also submitted testimony to the state legislature registering their opposition to the prescribing proposal.

The situation in Hawaii was particularly troubling to the coalition of prescribing opponents because the two houses of Hawaii’s state legislature were facing five bills in their current session, all designed to legislate a prescriptive authority that physicians had to go to medical school to obtain.

Only one of the five bills managed to gain a hearing. That occurred in the Senate Health Committee, where the bill did pass, but time ran out on it before a second committee scheduled to hear the bill got around to putting the proposal on its agenda. None made it to the hearing stage in the Hawaii House.

APA and the Hawaii Psychiatric Medical Association (HPMA) “are keeping a close watch [on the state legislature] because there is always a risk that psychologist prescribing proponents will try the tactic of adding it to another bill,” said Paula Johnson, deputy director for state affairs in APA’s Division of Government Relations.

Honolulu psychiatrist Jeffrey Akaka, M.D., who was a leader in the battle to stop the proposals and is the Area 7 representative to the APA Committee on Government Relations, told Psychiatric News that he helped craft a four-part strategy to defeat the bills.

The HPMA, he said, “hired the best lobbyist, empowered patients to testify for what they believe in, empowered psychiatrists to testify before the legislature, and joined with our psychologist colleagues who know enough to know that pretending to know what you don’t can kill people.”

Psychologists in New Hampshire also will not be gaining prescribing privileges any time soon, thanks to lopsided votes by two committees of that state’s legislature, as well as the full House.

On March 4 a New Hampshire House subcommittee used a procedural rule to reject by a 6-to-1 vote a bill to grant prescribing rights to the state’s psychologists. Following that vote, the bill, HB 443, was sent to the full Executive Departments and Administrative Committee, which followed its subcommittee’s lead by voting down the bill by a vote of 18 to 2.

But with New Hampshire’s unusual legislative rules, the bill was still alive, with its next stop being the full House. Finally, on March 20 members of the New Hampshire House voted it down on a lopsided voice vote.

The New Hampshire bill required that in addition to classroom instruction in psychopharmacology, physiology, and “appropriate and relevant physical and laboratory assessment,” psychologists applying for prescribing privileges would have needed a “supervising psychiatrist or physician” attest to their having successfully completed a minimum 80-hour program in clinical assessment and pathophysiology. It also required these psychologists to complete a psychiatrist-supervised clinical practicum in which at least 400 hours were devoted to treating no fewer than 100 patients with mental disorders.

If psychologists had met these conditions, they would have become eligible to receive a two-year, conditional prescription certificate allowing them to prescribe psychoactive medications while being supervised by a physician. That physician would have been “responsible for the acts and omissions of the psychologist,” though the psychologist would also have been liable for those acts and omissions, according to the bill.

After the two years, and the purchase of malpractice insurance, the psychologist would have become eligible to be licensed to prescribe independently. He or she would then have had to complete 20 hours of continuing education annually, with the content determined by the state board that regulates the practice of psychology. ▪