Nurse psychotherapists in Maryland tried in vain to get the legislature to approve a bill allowing them to prescribe psychotropic medications. The bill was defeated in the Senate in March by a 19-2 vote, and the House companion bill died in committee.

The Maryland Psychiatric Society (MPS) was pleased with the results. MPS President Harry Brandt, M.D., told Psychiatric News, "This is a real victory for patients in Maryland. Legislators understood the complexity of prescribing psychotropic medications, especially for the indigent, and struck the bills down."

Brandt noted that this is the fifth year that nurse psychotherapists have had bills introduced in the state legislature that would allow them to prescribe medications.

The nurse psychotherapists tried a different legislative tactic this year, which was to focus on prescribing for poor people, who they claimed were underserved by psychiatrists in Maryland, said Brandt.

"This is a distortion because many psychiatrists treat indigent patients on a pro bono basis," he said. "We persuaded legislators that letting nurse psychotherapists prescribe medications for poor people would have set a bad precedent and resulted in two-tier system of health care. Psychotropic medications are the most complex to prescribe, and poor patients deserve to be treated by qualified professionals."

He added, "What many people don’t realize is that nurse psychotherapists have advanced training only in psychotherapy." The bill would have required them to take only one graduate-level course in psychopharmacology and one physical-assessment course to be eligible to prescribe, all without direct supervision.

In contrast, licensed nurse practitioners, who can legally prescribe medication in hospitals and public clinics in Maryland, have more general medical education with advanced clinical training, according to James Thompson, M.D., an APA deputy medical director and head of its Division of Education, Minority, and National Programs. Thompson testified on behalf of APA before the Maryland Senate Economic and Environmental Affairs Committee in March.

Thompson, who is also a clinical professor of psychiatry at the University of Maryland School of Medicine, added that the law requires licensed nurse practitioners to be directly supervised by a physician, who must provide clinical oversight and cosign prescriptions.

"Does this committee believe that nurse psychotherapists with less medical training than nurse practitioners should have the primary responsibility for the health care of Maryland citizens who suffer from biologically based brain disorders? As a psychiatrist and resident of Maryland, I would hope not," testified Thompson.

Brandt said MPS appreciated APA’s collaboration in opposing the bill. He noted that former APA Medical Director Melvin Sabshin, M.D., testified last year against a similar bill introduced in the Maryland legislature.