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California psychologists have fashioned the ultimate legislative "Trojan horse" in their ongoing effort to obtain the right to prescribe medicine.
A proposed initiative titled "The Mental Health Parity Act," ostensibly mandating parity coverage of mental illness, would also expand the scope of practice for psychologists to include prescription and hospital staff privileges.
The initiative, now under review by the state's attorney general, could be placed on the ballot for California voters next year.
"The real name of this initiative should be the 'Psychologists Full Employment Initiative of 1997,' " said California Psychiatric Association President Thomas Ciesla, M.D., in an interview with Psychiatric News.
"The psychologists are mounting a furious effort to persuade someone of the rightness of their preposterous assertion that they can practice medicine without going to medical school," Ciesla said.
The initiative is authored by Encino, Calif., psychologist John Caccavale, Ph.D., and sponsored by an organization called the Committee for Mental Health Parity.
In an interview with Psychiatric News, Caccavale claimed that the right to prescribe is integral to parity because of what he called a dearth of psychiatrists to treat the mentally ill.
He denied that the initiative is a "Trojan horse," explaining that the initiative's goal is parity, not the expansion of psychologists' scope of practice.
Yet when asked if he would exclude the section on prescribing and hospital staff privileges to garner the support of individual psychiatrists and organized psychiatry, Caccavale said he would not.
In an "Initiative Update" sent out under the committee's letterhead, Caccavale writes: "We will be calling upon all psychologists to be active participants in securing mental health parity for clients and prescription privileges for colleagues. At the same time we will support any legislative agenda to accomplish these goals. However, putting all of our eggs in one basket is not a sound strategy. If we do not get what we want from one source, we need to look to another. . . . Remember, if we cannot support our own issues and causes, we can hardly expect others to support us."
The Committee for Mental Health Parity is also receiving support from the Prescribing Psychologists' Register Inc., a Miami-based organization that seeks prescribing privileges for psychologists through state legislation.
If the initiative is approved, signatures will then be obtained by petition for placement on the ballot in the 1998 general election.
The number of signatures required is 5 percent of the number of voters in the state's last general election, or approximately 600,000 signatures.
The strategy of including prescription and hospital admitting privileges as part of an initiative for mental health parity is a new wrinkle in the continuing effort by organized psychology to obtain privileges through state legislation.
The California effort also capitalizes on that state's unique use of voter initiatives to decide public policy issues that are elsewhere deliberated in state legislatures.
Barbara Gard, executive director of the California Psychiatric Association (CPA), told Psychiatric News that the CPA is seeking to get the name of the initiative changed to reflect more accurately the "total content" of the initiative. (See below for language in the initiative that would grant psychologists the right to prescribe.)
"My feeling is that if the title remains [as it is], that will positively publicize the initiative," Gard said.
Gard also noted that written into the legislation is a provision that requires a two-thirds majority of the state's Assembly--or a new legislative statute--to repeal any part of the act.
"If this gets in, it's in concrete," she told Psychiatric News.
Area 6 Trustee Richard Shadoan, M.D., a past president of the CPA, said he believes the initiative should be taken seriously as a threat.
"What is dangerous about this initiative is that it is misnamed," he said. "It really splits the mental health community. Up to now all the mental health groups have worked together to support parity.
"This initiative, masked as an initiative for parity, divides the mental health community at a critical time."
Shadoan said legislation mandating "true" parity coverage of mental illness has been introduced in the California Assembly by Helen Thomson, wife of psychiatrist Captane Thomson, M.D. (see story on page 45).
The California initiative is accompanied by a bill in the state legislature that would grant psychologists the right to prescribe.
As Psychiatric News went to press, the bill was expected to be acted on by the California Senate Business and Professions Committee on April 14.
Both the legislation and the initiative in California appear to be part of a nationwide strategy by the American Psychological Association to obtain through state legislative fiat the right to prescribe medicine.
In Hawaii identical pieces of legislation to grant psychologists the right to prescribe were introduced in the state Senate and House. Both were swiftly and easily defeated while still in committee, according to Jeffrey Akaka, M.D., chair of the legislative committee for the Hawaii Psychiatric Medical Association.
Akaka is also chair of APA's Caucus of American Indian, Alaska Native, and Native Hawaiian Psychiatrists in the APA Assembly.
Akaka said he believes the bills were copied from model legislation drafted by the American Psychological Association.
Hawaii, home state of psychologist Patrick DeLeon, Ph.D. (a legislative aide to Senator Daniel Inouye and a board member of the American Psychological Association), has been the site of repeated attempts by psychologists there to obtain prescription privileges.
"More members of the general public, other mental health providers, and other physicians are letting their legislators know what a bad idea this is," Akaka told Psychiatric News.
At the same time, he said he suspects the psychologists will be heard from again.
"As long as unqualified people persist in their false belief that they can practice medicine without going to medical school, this will be an issue," he said.
In Tennessee the Psychologist Prescribing Register Inc. has hired a professional lobbyist to file a bill in the Tennessee House and Senate, according to the newsletter of the Tennessee Psychiatric Association.
The Tennessee bill states the following: "[The] practice of a psychologist also includes the prescription and administration of psychotropic drugs within the recognized scope of practice of the profession. Such a prescribing psychologist shall meet the profession's established standards of training according to the board's professional guidelines or be a nationally recognized listed Fellow of the Prescribing Psychologists' Register."
As Psychiatric News went to press, legislation to grant psychologists the right to prescribe was also introduced in Missouri, Florida, and Louisiana. --M.M.
"I. A program of course work covering the principles, pharmacokinetics, and practice of psychotropic medications. . . .Two hundred and fifty hours of continuing education units shall constitute the minimum hours devoted to course work. However, any psychologist who is listed as a Fellow in the Prescribing Psychologists' Register shall be deemed as meeting the course-work requirements of this article. . . .
"II. A program of supervised practical experience comprising a minimum of one year in duration prescribing psychotropic medications for a minimum of 100 distinct patients. . . .
"III. Upon successful completion of all course work and supervision, a psychologist must pass a competency examination acceptable to the Board of Psychology in a format consisting of 200 multiple-choice-type questions with a minimum score of 70 percent. . . .
"a. During the supervisory phase of training, a psychologist may prescribe psychotropic medications only under the immediate supervision of a health care professional currently licensed to prescribe medications. Prescriptions must be signed by the psychologist and countersigned by the supervisor. . . ."
The California initiative also contains the following section granting psychologists hospital staff privileges:
"No hospital or facility that provides inpatient care to mental health professionals and provides for medical staff membership for psychiatrists or other physicians shall adopt any rules, special procedures, or policies that have the effect of barring, excluding, or hindering a psychologist from obtaining full medical staff membership as required by current California law and as enunciated in the California Supreme Court case of Capp v. Rank.
"a. Any psychologist who is denied medical staff membership without good cause shall be entitled to relief in state court by way of a Writ of Mandate. There shall be a rebuttable presumption that the hospital or inpatient facility is in violation of the applicable law. Should the court find against the [hospital], medical staff membership shall be immediately ordered. The court shall award reasonable attorney fees to the prevailing psychologist."
(Psychiatric News, April 18, 1997)