Defeating the Trojan Horse

Working closely with the Maine Medical Association (MMA), and with financial support from APA, the Maine Psychiatric Association (MPA) successfully redirected a study bill in the state legislature concerning psychologist prescribing privileges to a broader study of access to mental health care.

Maine is following the lead of the New Hampshire Psychiatric Association, which defeated a similar study bill in its legislature earlier this year and fought a successful battle over psychologists' scope of practice last year. APA Medical Director James H. Scully Jr., M.D., has congratulated the MPA for“ doing everything right” in response to the prescribing bill.

Storm warnings about a possible bill in the Maine legislature had come from Paula Johnson, deputy director for state affairs in APA's Department of Government Relations, as early as two years ago, and a psychologist bill had been offered but quickly withdrawn last year. But despite a high level of alertness, the MMA and MPA were surprised when state Sen. Mike Brennan, chair of the Health and Human Services (HHS) Committee, submitted “An Act to Allow Psychologists to Prescribe Psychotropic Drugs” in the current legislative session.

Informal consultation with Brennan by MMA Executive Vice President Gordon Smith and others led to a change in the bill's title to “Resolve, To Establish the Commission to Study Access to Prescription Medication for Persons With Mental Illness” (LD 1713).

Brennan asserted that he had not been lobbied by psychologists, but rather had acted out of a genuine concern that people in rural Maine were unable to access prescription medications. However, one psychologist in central Maine had already begun taking courses in psychopharmacology and was quick to jump aboard this “Trojan horse” all too conveniently appearing outside the city gates. Not surprisingly the beast began to roll forward as the volume of out-of-state psychologists' calls to the health committee mounted, despite little enthusiasm from most Maine psychologists.

The MPA was faced with a dilemma. Historically, groups proposing a study bill have come back to the Maine legislature in the subsequent session and succeeded in gaining whatever privileges they were seeking to study. But outright defeat of even this study bill, which was proposed by the Democratic chair of a Democratic-majority committee, seemed a remote political possibility. What to do?

As far back as fall 2002, Maine and Vermont had submitted a grant request to the APA Committee on Advocacy and Litigation Funding (CALF) to hire media strategist Jeff Toorish to develop a small-DB “pre-emptive strike” pilot project to train speakers, educate the public and legislators about who we are and what we do, and even help to develop enabling legislation to consult with and better train medical colleagues.

His expertise as we shifted from a “peacetime” to a“ wartime” mode was amplified by the hiring of additional lobbyists Cathy Lee and Andrea Maker (former MPA allies in parity campaigns) and the in-depth knowledge of the legislature provided by MMA lobbyist Andy MacLean and Smith.

A previously planned Psychiatrists' Day at the Legislature just a week prior to the first hearing on LD 1713 offered a well-timed chance to meet with Brennan, other members of the Health and Human Services Committee, and Senate and House leadership. In addition to addressing the standard “talking points” about patient safety, MPA members showcased initiatives we are taking to work with nonpsychiatrist colleagues in rural areas. These include a new telemedicine program led by MPA Legislative Committee Chair Ed Pontius, M.D.; an innovative program proposed by MPA member David Moltz, M.D., to pair MPA members with family practitioners for telephone consultation; and a program of “user-friendly psychiatry” talks at MMA annual meetings.

In addition, we repeatedly pointed out to legislators that the majority of psychotropic prescriptions in Maine are written by medically trained professionals other than psychiatrists and that the distribution of these professionals around the state is wide enough for all to have access to safe prescribing.

These points were restated at the formal hearing on the bill a week later by MPA President William Matuzas, M.D., and by Dr. Pontius, as well as other medical colleagues and overwhelmed the sparser and less-well-prepared testimony of two psychologists. We also submitted editorials and letters to the editor to local newspapers.

The happy outcome of the groundwork laid by the MMA and MPA was a unanimous (including the original sponsor Sen. Brennan!) “ought not to pass” verdict on the bill by the HHS Committee. Better yet, the committee charged the Department of Behavioral and Developmental Services with creating a task force of stakeholders to “address issues concerning access to [mental health] care and collaboration between and among medical care and [mental health] care providers.”

Perhaps Maine psychiatrists will now have the proactive opportunity to lead a multi-disciplinary force of mental health professionals back to a cash-strapped legislature in its next session to fight together for much-needed services of all kinds for our patients!

Legislative victories do not come cheap. Crucial to defeat of this study bill was strong financial support from APA. The original $45,000 grant from CALF to Maine and Vermont has been used to train speakers and advance educational and advocacy efforts on the prescribing issue, and a second CALF grant allowed MPA to hire additional lobbyists. We urge all APA members to amplify their own DB's efforts by working closely with their state's medical association and by contributing to the recharging of the CALF treasury for the long road ahead. ▪