Washington, D.C. – With renewed enthusiasm, nine state leaders told members attending the State Leadership Conference here in March that their associations have introduced bills that if passed would grant psychologists the right to prescribe medications.
Prospects are mixed. The consensus was that Hawaii holds the best chance of gaining prescription privileges this year but since the conference a bill in Missouri has picked up steam, passing in the Senate and gaining approval in committee for a floor vote in the House. Montana’s bill lost in a 30-20 floor vote in the Senate. An effort in the Virgin Islands appears to have died in committee.
Hawaii’s RxP bill passed last year in the House but died in the Senate. Carol Parker, executive director of the Hawaii Psychological Association, said she believes the bill has an excellent chance of passing this year.
Other states where RxP bills have been introduced include Mississippi, Tennessee, Oregon, Georgia, Illinois and California, which had two bills introduced.
The California Psychological Association (CPA) and the American Federation of State, County and Municipal Employees (AFSCME), which represents 1,000 state-employed psychologists, joined to introduce RxP legislation.
Jo Linder-Crow, Ph.D., executive director of the CPA, said the state association has a long-standing and positive working relationship with AFSCME.
Another bill to gain prescription privileges was sponsored by the National Alliance of Professional Psychology Providers (NAPPP) and backed by the Service Employees International Union (SEIU), considered the largest union in the country. NAPPP said it had been quietly working on that bill for six months building liaisons and procuring funds.
In view of the common purpose, John Caccavale, Ph.D., executive director of NAPPP, brought backers of the two bills together to present a united front. CPA and AFSCME, which had introduced only a place-holder bill without details, had their bill withdrawn and rallied behind the NAPPP bill, Senate Bill 993.
Despite the strengthened backing, the bill lost 4-1in a House committee with three members not voting, including a San Francisco psychologist who abstained on grounds he could be considered to have a vested interest.
“It was a good test of the waters,” Linder-Crow said, adding that the experence established a foundation the CPA can use in further efforts. The CPA already had begun a fund-raising drive seeking a $2.5 million war chest for another try down the road.
The committee meeting was pending when the CPA held its annual convention April 12-15 in Costa Mesa.
Russ Newman, Ph.D., J.D., executive director of the American Psychological Association’s Practice Directorate, and Pat DeLeon, Ph.D., J.D., an APA past president and the recognized “father of prescriptive authority for psychologists,” were among speakers at the convention and both extolled California’s RxP progress. Linder-Crow said the opposition was in full force at the committee hearing and the loss was not totally unexpected.
“As in every other state, this is going to require a sustained effort,” Linder-Crow said.
She said the committee chairman did keep the door slightly ajar by offering to hold a further hearing for possible reconsideration of the bill but no date was set.
The lack of access to affordable psychiatric services in the community and the deterioration of services in California’s state hospitals and prison system are strong arguments for a positive reception by the state legislature, she said.
The California Association of Professional Psychology (CAPP), the American Academy of Clinical Health Psychology, Vericare and others joined forces to support the RxP bill. SEIU is sponsoring a broad range of health care initiatives in California.
Linder-Crow was among 58 of the 60 executive directors of state, provincial or territorial association’s attending APA’s State Leadership Conference.
To date only three jurisdictions have enacted RxP – Louisiana, New Mexico and Guam – but unsuccessful bills have been introduced over the years in eight states that may try again in time – Alaska, Texas, Oklahoma, Florida, Massachusetts, Vermont and Maine.
Lance T. Laurence, Ph.D., director of legislative and professional affairs for the Tennessee Psychological Association, pointed to the two greatest hurdles psychologists face in Tennessee and other jurisdictions in promoting RxP privileges – a concern about “over-prescribing” and opposition from psychiatrists.
Educating legislators by showing them the reputation psychologists have in RxP jurisdictions for “un-prescribing” unnecessary drugs that clients had been taking can go far in alleviating concerns about over-prescribing, Laurence said.
But overcoming opposition from psychiatrists can become a bidding war, he said. “The opponents are extraordinarily rich compared to us.”
Many lawmakers also are reluctant to take sides in what they see as a squabble between two competing professions, he said. “Legislators hate turf wars, and this is the mother of turf wars.”