Assessing Louisiana and the Challenges Ahead

As you read in the article on page 1, the Louisiana state legislature voted earlier this month to allow psychologists to prescribe medicine, an essential element of the practice of medicine. The hastiness of the legislation’s passage is astounding; at the very least, it shows the increasing political strength of psychologists who want to prescribe.

One tempting reaction to the bad news is to draw quick conclusions about APA’s strategy in confronting psychologist-prescribing initiatives.

While Louisiana is a clarion call to action, we should not forget that at almost precisely the same time, psychiatrists and patient advocates in Tennessee handily defeated a psychologist-prescribing bill in their own legislature. Georgia, Maine, and New Hampshire also scored significant victories recently with APA’s help. So the lessons to be learned from Louisiana are far from clear, at least at this time.

We do not yet know, for example, whether Louisiana is a harbinger of similar bills in other states or whether it is an isolated “perfect storm” in which every possible advantage went to the psychologists and their allies in the legislature. We need to find this out, and I intend to.

In advance of a careful review, there are many facts that we do know and that I want to share with you.

The president of the state Senate, Sen. Don Hines—a family physician—introduced his version of the psychologist-prescribing bill at 6 p.m. on April 13 and had it heard in committee at 9:30 the next morning. House Speaker Joe Salters’s version was also heard on April 14.

Families and patients had almost no time to get the word out and travel to Baton Rouge to testify. Fortunately, with significant grant support from APA, the Louisiana Psychiatric Medical Association (LPMA) had a lobbyist at the “hearing” to register psychiatry’s strong objections.

The state’s political powers, working in lockstep, pushed the legislation through on the 19th in the House and on the 21st in the Senate.

Because there was no fair hearing, APA sought to bring public attention and media scrutiny to the issue. The New Orleans Times-Picayune and the Shreveport Times editorialized that the hasty process alone warranted Gov. Kathleen Blanco’s veto of the bill.

The governor—the final arbiter of the bill’s fate—was under great pressure from both sides. Arguing for her signature were her hand-picked legislative leaders. On the other side, our colleagues in Louisiana, led by LPMA President Pat O’Neill, M.D., lobbied hard for a veto. It was heartening to see a model coalition of patients, psychiatrists, and others join forces so quickly to oppose the bill.

To that end, APA’s Department of Government Relations took the following action:

• Posted eight alerts to LPMA members on behalf of Dr. O’Neill and Legislative Representative Dudley Stewart, M.D., updating psychiatrists about developments and urging action.

• Provided toll-free numbers to LPMA members to call the House, Senate, and governor’s office.

• Posted alerts to the DB/SA list serve asking for action specified by LPMA officers and staff.

• Provided extensive background materials to LPMA officers, other psychiatrists, lobbyists, and patient groups for their use in grass-roots and public relations contacts.

• Helped with a face-to-face meeting with Gov. Blanco.

• Issued press releases condemning the Louisiana House and Senate votes.

• Wrote (via then-APA President Marcia Goin, M.D.) to Gov. Blanco urging her to veto the bill.

• Arranged for the AMA and national medical specialties to issue alerts to their own members to oppose the bill.

• Designed, developed, and conducted a call-in press conference featuring Dr. O’Neill, representatives of the National Alliance for the Mentally Ill (NAMI) from two parts of the state, and two psychologists who oppose prescriptive authority.

• Issued a steady stream of background information and calls to reporters putting APA’s concerns on the record and helping to provide the foundation for the largely negative press the legislation received.

• Arranged for APA counsel to provide a critical legal analysis of the legislation to key Louisiana public officials.

• Called several hundred LPMA members twice to urge them to take specific actions in response to developments at the time of the calls.

In the end, Gov. Blanco made a grave miscalculation.

She failed to heed her own concerns about “Louisiana standing outside of the mainstream” on the issue, as well as recommendations to veto from senior policy advisors in her own administration. She also ignored what she called a “persuasive” case made by physicians and patient groups, including NAMI and its affiliates in New Orleans and Southwestern Louisiana, the Depression and Bipolar Support Alliance and its four chapters in the state, the Louisiana State Medical Society, the LPMA, the AMA, and, of course, your APA.

On May 6, 10 days after the bill arrived on her desk, Gov. Blanco put the economic interests of psychologists ahead of the health and welfare of people of Louisiana by signing the bill. May 6, incidentally, was also the first day of my term as president of APA.

In my view, Gov. Blanco reversed her stated commitment to deliberation by making a political decision, rather than a decision based on the best medical and legal evidence. The legislature, bowing to the will of its House and Senate leaders, inexcusably fast-tracked legislation that affects patients profoundly. I am dismayed that Louisiana has codified a dangerous, substandard level of care as legally acceptable.

No doubt, many of you are hurt, frustrated, or angry, too. This is certainly appropriate when our patients are threatened and our profession attacked.

We need to focus on action. Part of that action is to 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 benefit of the facts.

Rest assured that we will continue to explore our options in Louisiana and across the country.

I will need your support—we will all need one another’s support—as we confront the challenges ahead. Also, please thank your colleagues at LPMA and your APA national staff for working around the clock to protect safe and effective medical care.

A careful review of Louisiana is a key part of continuing to block such reckless laws. Please share your thoughts and ideas with me at [email protected]. ▪