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N.M. Governor Agrees Patient Safety Comes First

APA leaders discuss their concerns about ensuring patient safety as the state develops regulations on psychologist prescribing.

APA President Marcia Goin, M.D. (left), and Medical Director James Scully, M.D. (far right), meet with N.M. Gov. Bill Richardson (seated), along with Bruce Hinrichs, M.D. (second from left), and George Greer, M.D. (second from right), to discuss implementation of the state's psychologist prescribing law.

APA President Marcia K. Goin, M.D., and Medical Director James H. Scully Jr., M.D., along with Bruce Hinrichs, M.D., president of the Psychiatric Medical Association of New Mexico (PMANM), and George Greer, M.D., PMANM’s legislative representative, have secured the support of New Mexico Gov. Bill Richardson for medical board oversight of psychologists’ prescribing. He has also agreed to support stringent educational requirements for prescriptive authority.

Both crucial issues have been debated at length as state regulators have struggled to create a set of rules governing the implementation of the state’s Prescriptive Authority to Psychologists Act, which became law in 2002 (Psychiatric News, April 5, 2002).

A joint committee of physicians and psychologists has been working to formulate regulations implementing the law, but significant differences on numerous points led to a preliminary report containing both a majority and minority stance (Psychiatric News, November 7, 2003).

In essence, the majority recommendations in the report favored weaker oversight of psychologists’ prescribing practices and less-stringent educational requirements than did the minority recommendations, which were supported by PMANM.

The December 23, 2003, meeting in the governor’s office was scheduled with only three days’ notice, as a result of concerns, Hinrichs said, that "several members of the medical board have felt a great deal of pressure from state legislators to resolve the disagreements of the committee by compromising their recommendations for training standards."

Hinrichs told the governor that "such compromise would inevitably loosen the already lax training requirements [in the law] even further." He explained to Richardson (who inherited the implementation of the law from the previous administration) that under the current recommendations, "a prescribing psychologist would be able to write prescriptions with far less training than any other type of prescribing practitioner in the state," creating vital concerns about patients’ safety.

The four psychiatrists told the governor that if patient safety is to be protected, psychologists must prescribe under medical supervision, just as nurse practitioners, physician assistants, and clinical pharmacists do in the largely rural state. In addition, educational requirements must be set high to maintain an appropriate and adequate skill and knowledge base.

Goin underscored that, with regard to psychologist-prescribing legislation, "the eyes of the nation are on New Mexico." She pointed out to the governor that more than 20 other state legislatures had considered and rejected bills granting prescribing privileges to psychologists.

Richardson acknowledged that although he "didn’t like the bill," since it was enacted, it must be implemented. He directed his health policy advisor, who also attended the meeting, to inform the president of the medical board to "do the right thing," elaborating that he felt that education and training must be of high quality. He also agreed that medical board oversight was a high priority and noted that he would inform the medical board that there was no pressure on them to compromise their requirements.

"It was a very positive meeting," Scully told Psychiatric News. "Given the realities, [the governor] was very supportive."

Goin added, "The governor heard what we had to say, and we came away feeling he really heard the importance of patient safety."

Since the meeting, the governor’s health advisor met with the president of the New Mexico Medical Board, communicating the governor’s support for stringent standards and medical oversight. The medical board and psychology board must iron out a final set of regulations implementing the law, which would then undergo a public-comment period and legislative rules hearings prior to implementation.

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