Protests Not Halting Progress Of Psychologist Prescribing Law

APA, along with the Psychiatric Medical Association of New Mexico (PMANM), last month submitted strongly worded testimony to the New Mexico Medical Board calling for major changes in that state's pending regulations to implement its law allowing psychologists to prescribe psychotropic medications.

The law, passed in 2002, charges the New Mexico Medical Board and the state psychological examiners board with developing the regulations required to implement the law. The law's implementation was slowed by a series of meetings and hearings focused on promulgating final regulations to establish training and other criteria.

“APA's comments to the New Mexico Medical Board highlight the many deficiencies in the specific recommendations developed by the joint psychology/medical board process in that state,” said Nicholas Meyers, director of APA's Department of Government Relations.

“Our comments also underscore the dangers of the psychology prescribing law itself, both in New Mexico and elsewhere. Simply put, legislatures cannot safely condense the thousands of hours of education and supervised training by physicians into a few hundred hours of course work. There is no substitute for medical school and residency, and the New Mexico law and related proposals cannot escape the fact that they put patient safety at risk.”

APA's comments pointed out that while the New Mexico law was said to be intended to address access-to-care issues for underserved communities, there is nothing in the draft regulations to entice much less mandate prescribing psychologists to practice in underserved areas.

But at the heart of APA's opposition are quality-of-care and patient-safety issues.

“There is a potential in these rules,” APA's written comments emphasized, “for a prescribing psychologist to not have any contact with a psychiatrist throughout his or her training, and then, after the final certification is approved, form a collaboration with a nurse practitioner as the primary health care practitioner” for a patient. “This raises two issues: First, public safety and prudence dictate that there should be specialized training provided by a physician, preferably a specialist, and in this case a psychiatrist. Second, nurses' training does not approach that of a physician, and their qualifications to provide broad-based authoritative medical oversight to the prescribing psychologist is questionable and should be proscribed.”

Presenting APA's comments and those of PMANM was William Ulwelling, M.D., who characterized the public meeting of the medical board as “simply going through the motions.” Ulwelling is the PMANM representative to the APA Assembly.

“We knew going into the meeting that after many months of hearing our recommendations for changes without much alteration in the originally proposed rules for prescribing,” he said, “it was very unlikely there would be any movement this late in the game. [Medical board members] were polite, they listened, and we were pretty disappointed.”

Throughout the process of promulgating rules, Ulwelling noted, it seemed that the emphasis was on the need for psychologist-prescribing requirements to be “convenient.” He noted that the psychologists' association lobbyist had used that term early on, then changed to the term“ practical.”

Ulwelling said, “The legal mandate [for the board of medical examiners and the board of psychologist examiners] is safety—they are in the business of making sure that the people of New Mexico are served by safe practitioners, not ensuring that practitioners' educational and certification requirements are convenient and practical.”

Ulwelling noted that he ended his comments to the medical board by stating,“ We are in the era of evidence-based medicine. What is the evidence that this is a safe program? There isn't any. We are experimenting on the people of the state of New Mexico.”

Both APA and PMANM stressed the need for the law to restrict psychologists from prescribing for children under 18, the elderly, and those with medical comorbidities, recommendations that were not incorporated into the proposed regulations.

PMANM also strongly argued—so far to no avail—that only medications the FDA has approved for psychiatric disorders be available for prescription by psychologists and that prescription of controlled substances by psychologists should be prohibited.

Prior to being implemented, the proposed regulations will be reviewed by the Board of Psychologist Examiners at a final rules hearing, which will be the last opportunity for public comment.

The regulations will be implemented 30 days after the final legislative rules hearing.

While that may end the scope-of-practice fight in New Mexico for the time being, APA is closely monitoring Louisiana as it gears up to implement its psychologist-prescribing law and is watching other state legislatures in which psychologist-prescribing bills are being considered (see box).

Other APA district branches and state associations “will undoubtedly face redoubled assaults in the 2005 legislative session,” Meyers noted.“ We continue to work with our members and our able DB/SA executive staff to identify the most-prominent threats and to assist them in implementing an effective local response to efforts by psychology to practice medicine by legislative fiat.” ▪