Union's M.D. Members Protest Support for Psychologist Prescribing

Despite opposition from one of its affiliates, an influential union representing physicians is pushing adoption of a psychologist-prescribing bill. Talks are planned to try to resolve the standoff.

For the first time, the California chapter of the Service Employees International Union (SEIU), which represents 600,000 workers in the state, threw its considerable weight behind a state bill (SB 993) that would allow psychologists to prescribe psychotropic medications, as well as medications to treat the side effects of those psychoactive drugs.

The bill is a much more wide-ranging approach to expanding psychologists' scope of practice than any of the several previous bills the state legislature has faced over the last dozen years. The California Senate's Committee on Business, Professions, and Economic Development voted in April to stop a prescribing bill for this year (Psychiatric News, August 17), but that reprieve is expected to be only temporary because of powerful allies psychologist-prescribing advocates gained this year. Among these new supporters is the American Federation of State, County, and Municipal Employees.

The union-based effort in support of the legislative agenda of the California Psychological Association and the National Alliance of Professional Psychology Providers came without the knowledge or backing of a California physicians union that is part of SEIU.

“We are not supporting it,” a senior official with the Committee of Interns and Residents (CIR), who asked not to be identified, said about the prescribing bill in an interview with Psychiatric News.

The CIR, which has been affiliated with the 1.6 million-member SEIU since May 1997, has begun discussions with the parent union regarding its support for the psychologist-prescribing bill. The CIR, which represents more than 12,000 house-staff physicians in California, Florida, Massachusetts, New York, New Jersey, Washington, D.C., and Puerto Rico, has about 2,500 members in California.

The CIR official would not comment on what outcome was expected from the discussions and downplayed the level of conflict, saying, “This is not an adversarial situation.”

Representatives at the national office of SEIU and the SEIU California State Council—which is supporting the prescribing bill—did not return calls from Psychiatric News for comment by press time.

The unions became involved in the California legislative campaign to allow psychologist prescribing as part of a membership strategy to recruit psychologists who work in state hospitals and prisons, according to Randall Hagar, director of government affairs for the California Psychiatric Association.

The SEIU California State Council lists the bill on its Web site as one it is sponsoring. The SEIU, Hagar said, has made the bill a leading legislative priority and plans to earmark a substantial portion of a $50 million political war chest the council has set aside for “health issues” advocacy.

The bill is needed, according to a statement by the California Psychological Association, because of the “lack of access to affordable psychiatric services in the community and the deterioration of services in California's state hospitals and prison system.”

The bill's training and scope-of-practice authority, Hagar said, would likely allow psychologists to function as mental health patients' primary care providers with authority to commit them and to order restraints.

Abigail Donovan, M.D., APA's member-in-training trustee, said that psychiatrists in training are uniquely positioned to join the fight against psychologist-prescribing privileges because they fully understand the extensive training, both didactic and clinical, that is needed to prescribe psychiatric medications in a safe and effective manner.

“This is training that psychologists simply don't have and can't get through a limited 'prescribing' curriculum,” Donovan said. “As doctors, we are dedicated to the health and well-being of our patients; psychologists' prescribing psychiatric medication is not only bad medicine, but it is also potentially detrimental to the health of our patients.”

She encouraged members of CIR to tell their union leadership that they oppose remaining affiliated with a union that supports psychologist-prescribing privileges. CIR's psychiatrist members could also contact their APA district branch for additional support, Donovan suggested, and other physicians could contact their local specialty society or medical society chapter.

The presence of unions in the prescribing fight will require a new strategy to neutralize their impact in a legislature where they wield tremendous influence, Hagar said. The timing on that strategy is limited because the bill, defeated in committee, is allowed to return in 2008, during the second half of California's two-year legislative session.

Previous efforts over the last 12 years to pass a psychologist-prescribing bill in California have rarely moved out of committee; however, a 2000 measure was approved by the state Assembly.

The California bill is posted at<http://info.sen.ca.gov/cgi-bin/postquery?bill_number=sb_993&sess=CUR&house=B&site=sen>.▪