Kansas City, Mo. – A first of its kind rally of RxP proponents from across the nation pushed Missouri’s effort to bring prescription authority for psychologists to a passing margin of support in the Missouri House even before its first hearing.
APA’s Division 55 teamed up with RxP leaders from the Missouri Psychological Association (Mo PA) to hold a five-day, two-city lobbying effort that persuaded 60 Missouri representatives to sign on immediately as co-sponsors of an RxP bill.
By the time House Bill 1739 was introduced on Jan. 17, the number of cosponsors had grown to 85 – more than half the representatives from Missouri’s 163 House districts.
The push began in Jefferson City on Jan. 8 on the eve of the session opening and went public the next day with a press conference in the House Lounge. That was followed by an evening reception attended by 40 state lawmakers that was held in a Downtown gathering spot converted from a historic opera house.
“I will bet you that no other function this year will draw that many legislators,” said Jorge Cheekier, MoPA’s lobbyist.
The swell of early support does not mean that passage of RxP for Missouri is a foregone conclusion. To become law, the bill must survive anticipated attacks from the psychiatric and medical professions during hearing processes and floor votes in the House and Senate as well as passing muster in the governor’s office.
On Jan. 21, Charles W. Van Way III, M.D., president of the Missouri State Medical Association, sent a letter to all Missouri state representatives expressing opposition to the bill “on behalf of more than 6,000 Missouri physicians.” Van Way cited the usual concerns for patient safety.
More than 60 RxP advocates continued the Missouri effort and planning for RxP movements in other states Jan.10-12 in Kansas City at the regular Midwinter Conference of Division 55, the American Society for the Advancement of Pharmacotherapy.
Beth N. Rom-Rymer, a past president of the division, said for strategic reasons proponents prefer not to announce in advance which states will be the target of RxP efforts this year. “Some want to stay under the radar,” she said, adding that 34 states have committees or task forces active in planning on prescriptive authority for properly trained psychologists.
Marci Manna, Psy.D., chair of MoPA’s RxP committee, said the support and strong presence of the coalition revived the RxP movement that six months ago was receiving little attention.
Rom-Rymer said legislative timing may not permit the en masse approach exhibited in Missouri in every state but Division 55 will invest its resources and expertise in other states with equal vigor.
Mario Marquez, Ph.D., 2008 president of the division, said although only two states, Louisiana and his home state of New Mexico, have so far approved RxP he believes it is nearing critical mass.
“As more states fall, more will get on the band wagon,” Marquez said. And, he said, experience has honed the division’s skills. “We’re getting more sophisticated. It’s not rocket science; it’s politics.”
He said the important message RxP supporters need to spread is the need for more services for more people. “This is personal with me. This has to do with treating a lot of pain and suffering.”
Elaine LeVine, Ph.D., immediate past president of the division, agreed. “The lack of service to the vulnerable and underserved is evident to everybody.”
Bob McGrath, Ph.D., who is overseeing redrafting the recommended training curriculum for RxP, said the result, which will be presented to the APA Council for approval this year, is largely a fine-tuning with no major changes. The purpose is to provide a model that state legislatures can modify to meet local needs, he said.
The Jefferson City activities demonstrated how state organizers can work with the national organization in a united front that lets state RxP proponents draw from the experience and success of prescribing psychologists in other states and the military, McGrath said.
Pat DeLeon, Ph.D., an APA past president often recognized as the father of the RxP movement, spoke at the Jan. 12 closing session of the conference.
“For me, psychopharmacology is about quality health care,” DeLeon said, adding that expanding service for those in need is much more important than the protective turf battles that often occupy psychologists. “It’s about being better, not holding others back.”
James Bray, Ph.D., APA’s president-elect, said the show of strength in Missouri will bring out powerful opposition but “psychiatry’s position on this is irrelevant. As psychologists we need to decide our own destiny. We’re prepared for a good fight and we have a good start here.”
He said as president he will work to expand practice opportunities, improve reimbursement rates and expand RxP. “The top goal of my presidency is that by the end of my term at least three new states will have prescription authority.”
Other sponsors of the conference included eight schools that offer RxP training. The Missouri Chapter of the National Alliance of Professional Psychology Providers (MoNAPPP) was listed as a sponsor on pre-conference brochures but subsequently withdrew.
Mark Skrade, Psy.D., president of MoPA, said MoNAPPP withdrew when other organizers objected to the organization’s seeking to impress its image too heavily on the combined effort.
Skrade said he has been a long-time friend of Jack Wiggins, Ph.D., a former APA president and active supporter of NAPPP since its inception in 2006, and he formerly worked at the Forrest Institute of Professional Psychology Clinic in Springfield, Mo., with Jerry Morris, Ph.D., a board member of NAPPP’s Missouri Chapter, but he could not permit NAPPP to overshadow the work of MoPA and Division 55.
Morris, who is managing editor of NAPPP’s on-line newsletter, saw the disagreement differently in a January newsletter column.
MoNAPPP proposed that John Caccavale, Ph.D., a NAPPP board member and acting executive officer, be a keynote speaker at the conference and that NAPPP would sponsor a cocktail party and a breakfast, all to be prominently featured in the conference brochure.
“They (Division 55 and MoPA) attempted to get us to sponsor Dr. Caccavale as a speaker but not put him on the brochure, to sponsor a very expensive breakfast (and pre-pay so they would have cash flow), but put us in a divided room and not on the brochure and share the program with a non-paying-sponsor,” Morris wrote.
“They offered to let us pay for a free cocktail party, but canceled it at the last minute when we wanted it on the conference brochure,” the article continued. “Finally, it became apparent that they were manipulating us and needed money but weren’t treating us in a businesslike manner and we pulled out.”
However, Morris said MoNAPPP voted not to introduce a competing RxP bill, which could have confused legislators and been viewed as sabotage by supporters of House Bill 1739.
Last year the failure of a California RxP effort was attributed in great part to competing efforts on behalf of separate bills introduced by NAPPP and the California Psychological Association.
A new California RxP bill sponsored by NAPPP was introduced in the state Senate on Feb. 22.
In a related matter, the California legislature approved a NAPPP proposal to study the potential benefits of granting psychologists in the corrections system RxP authority.
In a telephone interview, Morris said he applauds the efforts of Division 55, which in his opinion is the only practice division working to improve opportunities for practitioners, but he does not feel NAPPP’s requests were unreasonable.
“They were simple demands that a sponsor putting $3,000 to $5,000 into a conference would want.”