Louisiana Lawmakers Hurriedly Pass Psychologist-Prescribing Law

In the ensuing 10 days, efforts were made with “warp speed,” noted LPMA legislative representative Dudley Stewart Jr., M.D. The lobbyists, Stewart, and LPMA President Patrick O’Neill M.D., called in AMA President Donald Palmisano, M.D., who is from Louisiana, to advise the governor’s office of the significant patient-safety concerns that the legislation raised.

The new Louisiana statute will allow a “medical psychologist” to prescribe and distribute “agents related to the diagnosis and treatment of mental and emotional disorders.” A “medical psychologist” is loosely defined as a “psychologist who has undergone specialized training in clinical psychopharmacology and has passed a national proficiency examination in psychopharmacology approved by the [psychologist examiners’] board and who holds from the board a current certificate of responsibility.”

The only medications that the law specifically exempts are narcotics.

Blanco asserted in a prepared statement that she was “assured by the proponents [of the legislation], including the speaker of the House and the president of the Senate,” that the new law’s “tight controls” and “tough” regulations she expects the board of psychologist examiners to promulgate will protect patients’ safety. She noted that those who “do not abide” by the provisions of the law could lose their prescribing privileges and “face misdemeanor charges.” Yet no such “tough rules” or any regulations are codified by the statute. In fact, complete oversight of psychologist prescribing is granted to the Board of Psychologist Examiners, and it is that same board that the law entrusts to create regulations and procedures to implement the law.

To be eligible to prescribe, applicants must hold a current license to practice psychology and must have “successfully graduated with a postdoctoral master’s degree in clinical psychopharmacology from a regionally accredited institution or equivalent to the postdoctoral master’s degree as approved by the board.”

The law’s language describing educational requirements is vague, but it appears to be patterned after the American Psychological Association’s preferred curriculum for prescribing psychopharmacology.

The law requires a prescribing psychologist to “prescribe only in consultation and collaboration with the patient’s primary or attending physician and with the concurrence of that physician.” However, Riba noted, “Bluntly, the vaguely defined consultative requirements cited by the governor as a safety measure do not pass muster: there is nothing in the law to ensure that a physician will ever lay eyes on the patient.”

Riba said that patient advocacy groups and patients themselves were adamantly opposed to the legislation, and she had urged Gov. Blanco to protect them and their loved ones by vetoing the bill.

“[Psychotropic] medications,” Riba emphasized, “impact the whole patient, not just the patient’s mental or emotional disorder, as the governor suggests.” These “potent medications,” she continued, “may interact with other medications and may impact other medical conditions. As behavioral scientists, psychologists are simply not trained for the medical complexities faced by psychiatrists and other physicians when they prescribe medications.”

Riba stressed that APA’s focus must be on “action.” As part of an action plan, she added, APA must “review how we respond to these assaults. We will undertake this review quickly, but we should not—unlike the Louisiana legislature—rush to judgment without the benefits of the facts.”

Such an examination—determining what was successful in some states and what was unsuccessful in Louisiana—“is a key part of continuing to block such reckless laws,” she continued. ▪