California bill has chance of passing next year – Governor has final say on Hawaii RxP bill

By James Bradshaw Senior Editor
July 1, 2007 - Last updated: May 31, 2011

Hawaii’s hope to gain prescription privileges for psychologists was in the hands of Gov. Linda Lingle at press time for The National Psychologist.

Lingle placed Senate Bill 1004 on a June 25 list of 33 bills that could be vetoed but stressed twice in accompanying remarks that a listing does not definitely mean a veto is imminent.

“The governor wants more information from the community,” said Carol Parker, executive director of the Hawaii Psychological Association.

Parker said it was hoped the bill, which seeks to grant properly trained psychologists RxP privileges in federally designated health centers, would not be on the list for a potential veto but Lingle’s message pointed out that some bills so listed in the past have escaped veto.

The Hawaii Primary Care Association is joining psychologists in seeking RxP privileges for trained psychologists in health centers for rural and underserved areas. The Hawaii Psychiatric Medical Association opposes passage.

Hawaiian law gives Lingle until July 10 to sign or veto the bill. If she does neither, the bill would become law without her signature. Legislative victory margins were too slim to make it likely a veto could be overridden.

If the bill becomes law, psychologists could prescribe only antidepressant, antianxiety and mood-stabilizing drugs and initially would work under direct supervision of medical doctors. After two years a psychologist could be certified to prescribe more freely from the restricted formulary but still only in collaboration with medical doctors.

Meanwhile a plan backed by an unlikely coalition to enact prescription privileges for psychologists in California has failed for now, and the prime initiator of the effort – the National Alliance of Professional Psychology Providers (NAPPP) – blames the California Psychological Association (CPA) and the American Psychological Association (APA).

A legislative promise to hold another hearing this fall leaves the possibility that the measure could be adopted in 2008.

RxP efforts in seven other states appear unlikely of action in current legislative sessions. A plan in Missouri was defeated in the senate and bills in the remaining states have languished in committees with few hearings.

The California proposal sprang up as a surprise to the CPA, which had begun organizing a fund drive to make an all-out push for RxP in 2012 when NAPPP succeeded in having a bill introduced in the state senate. NAPPP had the backing of the Service Employees International Union (SEIU).

Apparently not wanting to be upstaged by a competing union, the American Federation of State, County and Municipal Employees (AFSCME), succeeded in having an alternate bill introduced, although it was only a hollow “place-holder” with the promise that details would be added later.

CPA sided with AFSCME, which represents about 1,000 state-employed psychologists, many of them CPA members, and legislators faced the quandary of having two competing bills introduced with identical purposes.

Proponents ultimately united behind the NAPPP bill and the AFSCME bill was withdrawn, but John Caccavale, Ph.D., board member and spokesman for NAPPP, credits the resulting confusion and delays with an April defeat of the bill in committee.

“In essence, a one-year bill became a two-year bill,” Caccavale wrote in the May issue of NAPPP’s online newsletter, expressing confidence that NAPPP had devised a strategy that would have succeeded this year had CPA and AFSCME not intervened.

Caccavale said CPA consulted with APA’s Practice Directorate before backing the competing bill. He wrote that NAPPP officials at first hoped having CPA join the effort could be beneficial but ultimately came to believe “that the competing bill was introduced to stymie NAPPP from being successful.”

In an interview with The National Psychologist, Caccavale said, “Our entire board plus a whole lot of people are angry about this.” He said he believes the CPA and APA intentionally sabotaged the effort from fear that a success would bolster NAPPP’s image and enhance its ability to attract members among practicing psychologists.

“They’ve taken a victory and turned it into a defeat for all of psychology from organizational concerns,” Caccavale said.

CPA’s executive director, Jo Linder-Crowe, Ph.D., declined to respond directly to Caccavale’s charges, preferring to let the association’s commentary on its website stand as the official assessment of the 2007 RxP effort.

The website noted that CPA will consider concerns some senators raised on more fully addressing access issues and collaboration with medical doctors.

“CPA knows that prescriptive authority is a tough fight, but we have laid a good foundation this year,” the website said, adding, “The debate does not end here …. We are at the beginning of a long, sustained campaign to make prescriptive authority a reality in California.”

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