Psychiatrists Help Defeat Hawaii Prescribing Bill

A psychologist-prescribing bill is likely to return in future legislative sessions. The 2006 version would have required psychopharmacological training from an institution of higher learning approved by the state psychology board. It also would have required a one-year supervised practicum involving 400 hours treating at least 100 patients with mental disorders. The practicum was to be supervised by a “licensed health care provider who is experienced in the provision of psychopharmacotherapy” (Psychiatric News, April 7). The prescriptive authority would have sunset in 2013 unless legislators extended it.

The bill's supporters, including the Hawaii Psychological Association and the Hawaii Primary Care Association—composed of directors of the state's community health centers—said it would benefit patients at rural community health centers who can wait from six weeks to three months to see a psychiatrist. They noted that in 2004 only six psychiatrists served in three of Hawaii's 13 community health centers, compared with 10 psychologists who served in nine of the centers.

Hawaii psychiatrists and other physicians said that the access problem stems in part from the refusal of community health centers to hire psychiatrists. The claims that psychologist prescribing would provide cost-effective assistance ignores the likely need for an expensive quality-assurance system for the new prescribing group, money that would be better spent hiring a psychiatrist in every clinic, said opponents of the bill.

Hawaii psychiatrist Jeffrey Akaka, M.D., who lobbied against the bill, compared it to allowing “trained mechanics who never went to pilot school [to fly] a gassed-up Boeing 767 full of passengers.”

“It doesn't matter if the mechanic spent seven years studying how to repair airplane-cabin cooling systems or reading pilot journals. Nothing short of pilot school with thousands of hours of training under the supervision of pilots gets you a commercial pilot's license to fly human beings,” he said

In a letter to Hawaii state senators, the American Osteopathic Association wrote that “effective use of medications to treat brain disorders requires medical training with a thorough understanding of physiology, chemistry, drug interactions, and medical problems that may masquerade as or cause brain malfunctions.”

House members sought to limit potential dangers of psychologist prescribing by amending the bill to limit allowed medications under an “exclusionary formulary” to antidepressants, benzodiazepines, and possibly Ritalin and barbiturates.

The Senate's Committee on Health approved the bill, but the Committee on Commerce, Consumer Protection, and Housing took no action, stalling its progress.

The HPMA has opposed psychologist prescribing for more than 20 years. It has fought 25 psychology prescribing bills in that time.

A copy of the nonbinding resolution is posted at<www.capitol.hawaii.gov/site1/docs/getstatus.asp?qu=SCR113&showstatus=on&showtext=on&showcommrpt=on&press1=docs>.▪