Psychiatr News August 17, 2007
Volume 42, Number 16, page 6
© 2007 American Psychiatric Association
Psychiatrists, Allies Defeat Psychology-Prescribing Bills
Rich Daly
The latest challenge facing psychiatry is the kind of union support that
California psychologists gained during their unsuccessful legislative
push.
Psychiatrists helped successfully halt bills in 10 states during the 2007
legislative season that would have extended prescribing privileges to
psychologists. The legislation advanced in only four legislatures, including a
high-profile measure vetoed by Hawaii's governor (Psychiatric News,
August 3).
The measures ranged in scope from granting psychologists prescribing
privileges to establishing psychologists as patients' primary clinicians.
District branch leaders and APA officials credited the efforts of local
psychiatrists and their legislator allies with defeat of the bills in what
was, nationally, a busy but average year for such legislation.
"The legislative success achieved by the district branches and state
associations this year was the result of strong collaborative efforts of APA,
AMA, and other national medical specialties," said Paula Johnson, deputy
director of APA's Department of Government Relations, in an interview with
Psychiatric News.
Chief among those successes was a veto by Hawaii Gov. Linda Lingle (R) of a
psychologist-prescribing bill (SB 1004) that supporters claimed was modeled on
a 1990s Department of Defense (DoD) pilot program. However, the governor
concluded that the program the bill aimed to create differed
"significantly" from the DoD program because it lacked the
requirements on the number of pharmacology classroom hours required and the
number of inpatient and outpatient cases that were needed to qualify for a
"prescription certificate."
Another difference was that the DoD program required close supervision by a
psychiatrist with "advanced training in psychopharmacology," while
the rejected bill would have required any physician to supervise psychologists
for only two hours a week.
"The governor understands that there are medical conditions that
require medical training if you are going to provide that type of
treatment," said Jeffrey Akaka, M.D., a Hawaii psychiatrist and speaker
of the APA Assembly, in an interview with Psychiatric News.
Although proponents of the psychologist-prescribing bill have pushed for
its enactment for more than 20 years, psychology advocates declined to hold a
veto override vote on it because its passage was the result of a close vote
that would have fallen short of the two-thirds majority required in both
chambers to override a veto.
Unions Active in California Approach
A much more expansive and wide-ranging legislative approach to expand
psychologists' scope of practice was undertaken in California, where the
Senate Committee on Business, Professions, and Economic Development voted in
April to stop a prescribing bill for the year. That legislative reprieve is
expected to be only temporary because of the powerful allies
psychologist-prescribing advocates gained this year.
The American Federation of State, County, and Municipal Employees joined
the California Psychological Association, and the Service Employees
International Union (SEIU) joined the National Alliance of Professional
Psychology Providers in pushing separate prescribing bills. The decision by
the two unions to throw their significant resources behind the prescribing
effort marks the first time that such a collaboration has happened anywhere in
the nation, said psychiatry supporters.
"The presence of unions in the equation really changes things,"
said Randall Hagar, director of government affairs for the California
Psychiatric Association. "It's a fear factor because the unions have
tremendous resources."
The unions became involved, in part, to help their recruitment of
psychologists who work in state hospitals and prisons as members. The
California councils for the SEIU have made the bill a leading legislative
priority and plan to devote to the effort some of a $50 million political war
chest they established for "health issues" advocacy, Hagar
said.
Another cause for concern: The unions and psychologist groups combined
their resources and legislation into a single expansive bill (SB 993), which
would have allowed psychologist prescribing and other scope-of-practice
expansions. The bill's training and scope-of-practice authority would likely
allow psychologists to function as mental health patients' primary care
providers with authority to commit them and to order restraints, Hagar
said.
Hagar said 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. That strategy will have to evolve quickly 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 11 years to pass a psychologist-prescribing
bill in California generally never moved out of committee; however, a 2000
measure was approved by the Assembly.
Bills Stopped in Committee
Psychologist-prescribing bills in Oregon and Montana also saw action this
year.
Local psychiatrists testified and lobbied against an Oregon prescribing
bill (HB 2800) that passed the House of Representatives Health Committee but
was not taken up by another committee. This was the furthest the prescribing
effort has progressed in the state since first offered as an amendment in
2003. A similar bill was the subject of a committee hearing in 2005 but not a
vote.
John McCulley, executive director of the Oregon Psychiatric Association,
said the efforts of the state's psychiatrists to lobby against the bill were
important to stop its advance. They were joined in their opposition by a
coalition that included the Oregon Medical Association, the Oregon Pediatric
Society, the Mental Health Association of Oregon, and the Oregon Board of
Medical Examiners.
Montana psychiatrists helped defeat a similar bill (SB 522) in that state.
The legislation was approved by a committee chaired by the bill's sponsor but
fell short in a vote by the full Senate, said Donald Harr, M.D., a Montana
psychiatrist who helped organize opposition to the bill. Although psychology
advocates were brought in to testify from the only two states that allow
psychologist prescribing—Louisiana and New Mexico—the bill was
defeated after informative testimony from three psychiatrists and a floor
speech by state Sen. Greg Lind, M.D., on problems that could stem from
prescribing without medical training, Harr said. "He helped convince the
majority of the people in the Senate to vote it down."
Advocates of psychologist prescribing based the need for it on the lack of
access in parts of the state. To address that and future psychologist
legislative efforts, psychiatrists are examining ways to fund a state program
for psychiatrists to give rural general practitioners in-depth training on the
use of psychiatric medications.
"They probably see as many or more patients needing this care as
psychiatrists do," Harr said.
The Hawaii bill is posted at
<www.capitol.hawaii.gov/sessioncurrent/Bills/SB1004_SD1_.htm>.
The California bill is posted at
<http://info.sen.ca.gov/cgi-bin/postquery?bill_number=sb_993&sess=CUR&house=B&site=sen>.
The Oregon bill is posted at
<www.leg.state.or.us/07reg/measures/hb2800.dir/hb2800.intro.html>.
The Montana bill can be accessed at
<http://laws.leg.mt.gov/pls/laws07/law0203w$.startup>
by searching on the bill number, SB 522. 
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