After a series of defeats over the last several years, California psychologists have an initial victory to show for their well-financed campaign to gain prescription privileges through legislative fiat rather than medical school graduation.

On June 12 the California Senate Committee on Business and Professions passed a bill that would give prescription privileges to the 10 psychologists who graduated from the Department of Defense's (DoD) now-defunct program to train psychologists to prescribe psychoactive drugs.

The bill, known as AB 1144, passed by a 4-2 vote, with one member abstaining. One of its strongest proponents is Senate Majority Leader Richard Polanco of Los Angeles, who had introduced versions of the bill—all of which went nowhere—in previous legislative sessions. Polanco is a former chair of the Committee on Business and Professions.

The bill now goes to the state senate's Appropriations Committee.

It allows the 10 psychologists to write prescriptions in California for persons aged 18 to 65 only and calls for the legislature to receive a progress report after five years of the experiment.

The committee passed the bill despite opposition from an impressive coalition of groups including APA; the California Psychiatric Association (CPA); the National Alliance on Mental Illness, California; the Depressive and Manic-Depressive Association; the California Medical Association; the state medical board; Kaiser Permanente; and even some psychologists, according to the CPA’s government affairs director Conni Barker, J.D.

These three provisions were added to AB 1144, which was designed to clarify a 1998 law instructing the state Board of Psychology to develop guidelines that can be used to create a psychopharmacology curriculum that would become part of psychology graduate programs.’

The exact wording of the prescribing amendments has yet to be worked out, Barker said, but will probably be written quickly so that the bill can go to the Appropriations Committee either at press time or early next month.

The Appropriations Committee will assess the costs associated with allowing the 10 psychologists to prescribe and preparing the five-year evaluation. Costs triggered by the bill’s passage would include those for establishing a certification program and a mechanism to police the psychologists who gain prescribing privileges, Barker pointed out. The state Board of Psychology has never been faced with these tasks, and it is not clear how they would go about monitoring the psychologists. The Appropriations Committee routinely gives approval to legislation whose costs are projected to come in under $25,000, Barker said.

She noted that two factors seemed to sway committee members in favor of the bill. Polanco dropped a provision that would have granted prescribing privileges not just to the 10 DoD graduates but also to psychologists who have completed "comparable" education and training. In addition, the state psychological association arranged for legislators to meet the DoD graduates, who impressed the senators. "Legislators think highly of the U.S. military and were willing to see how it goes," Barker told Psychiatric News. Unfortunately, California’s prescribing experiment could set "a frightening national precedent," she emphasized.

The state Assembly had already passed AB 1144, though it did not contain the psychologist-prescribing amendments added by Polanco in the state Senate. The Assembly, primarily bill author Sam Aanestad, would have to agree to the prescribing program amendments.

In a June 1 letter to Aanestad, APA President Daniel Borenstein, M.D., himself a California resident, tried to convince him that permitting psychologists "to prescribe such potent brain medications not only would place individuals with mental illnesses at risk, it would further stigmatize them. If such legislation were enacted," he said, California’s lawmakers would be declaring "that second-class health care is acceptable for our family members and our neighbors in the community who have mental illnesses."

Borenstein told Psychiatric News that this development is particularly troubling for psychiatrists and their patients for two reasons. It signals a reversal on psychologist prescribing by two lawmakers "who previously had clearly understood our concerns about expanded scope of practice," he said. "And make no mistake," he added, "permitting up to 10 psychologists to prescribe in California would lead to psychologists prescribing medications in all 50 states. Soon thereafter, others without medical degrees will be demanding prescribing privileges."