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August 6, 1999
Psychologists in Louisiana recently learned a lesson that their colleagues in other states have already had to confront-that their strategy of gaining prescription privileges through state legislatures rather than medical school graduation is unlikely to succeed.
Though the state's psychologists convinced lawmakers in both houses of the Louisiana legislature to introduce bills that would grant them prescription privileges by legislative fiat, an alliance of the state's district branch-the Louisiana Psychiatric Medical Association (LPMA)-and the Louisiana State Medical Society worked to educate legislators about how patient care could be negatively affected if legislators relaxed the grueling educational regimen traditionally required of those who can prescribe medications.
The bills would have allowed doctoral-level psychologists to prescribe if they had completed a postdoctoral master's degree program in psychopharmacology that required at least 30 quarter hours of classroom instruction. The program would have to be offered by a university with a psychology doctorate program that had been approved by the American Psychological Association and include instruction in "anatomy, physiology and pathophysiology, biochemistry, neurosciences, pharmacology, clinical medicine, and health assessment, including relevant physical and laboratory assessment, and psychopharmacology."
An alternate criterion was graduation from the U.S. Department of Defense's Psychopharmacology Demonstration Project. (Only 10 psychologists graduated from that program before it closed in 1997).
Once a clinical psychologist had met the above criteria, he or she would then have had to pass "the national proficiency examination in psychopharmacology established by the American College of Professional Psychology," according to the bills.
In addition, during the first 12 months after certification the psychologist would have had to spend six hours a month in practicum training under the supervision of a physician. The practicum was to include "case discussions and skill training directly related to the psychopharmacological treatment of mental and emotional disorders."
The bill did stop short of bestowing total prescribing independence with a requirement that psychologists with prescribing privileges would have had to consult on all prescriptions "with the patient's primary or attending physician," and this consultation would have had to be documented in the patient's medical record. It also states that psychologists would not have been able to issue a prescription if that physician had informed "the psychologist. . .that the patient's physical condition contra---indicates its use."
The Health and Welfare Committee in each house approved the bill, but the sponsors of the state senate's version withdrew it after it reached the floor, apparently after informal head counting suggested there were not enough votes for it to pass. The house version died when no floor action occurred before the legislative session was adjourned on June 21.
As vice president of the Louisiana State Medical Society, New Orleans psychiatrist Dudley Stewart, M.D., was a key player in the effort to derail the prescribing bills. He told Psychiatric News that the state's psychiatric and medical associations geared up in earnest for this battle two years ago when lawmakers first began to develop psychologist-prescribing legislation.
"It became apparent that for the LPMA to have efficacy at the state capitol, we were going to have to form a strong alliance with the medical society, and that's what we've done."
The urgency for the physicians' groups to combine their resources grew when during its 1997 session the house's Health and Welfare Committee passed the prescribing proposal by an 8-to-1 vote, said Stewart, who is also the Area 5 representative to APA's Joint Commission on Government Relations.
The Louisiana district branch went on the offensive by hiring a skilled lobbyist to assist its efforts to head off the bills, in large part with money provided by APA, Stewart said. Its members also faxed legislative alerts to all members of the state and parish (county) medical societies and made sure that at least one psychiatrist was at each in the series of breakfast and dinner meetings the medical society held for state lawmakers.
In one attention-getting tactic, the LPMA borrowed a creative idea that Georgia psychiatrists had used to head off a similar threat-jelly beans. As did their Georgia counterparts, the LPMA sent jars of jelly beans to all state legislators with a copy of the bill attached with the headline "Prescription for Disaster." Accompanying the jars was a paper explaining why the state's physicians believed this to be a bad piece of legislation. (The Georgia bills were referred to various legislative committees earlier this year and carried over until the 2000 session.)
In another gesture of cooperation between APA district branches, the California Psychiatric Association's executive director, Barbara Gard, sent the LPMA a videotape and transcript of legislative hearings on California's perennial-and so far unsuccessful--psychologist-prescribing bill.
"There was a big push for these bills by the psychologists this year," including the introduction of weekend psychopharmacology seminars for Louisiana psychologists, Stewart noted. Meetings between representatives of the medical society and the state's psychologists earlier this year "had no success in working something out" to head off these bills.
The physicians' position on psychologist prescribing was bolstered somewhat by a survey released in March showing that 87 percent of Louisiana voters wanted prescriptions for themselves or their families written only by physicians; 4 percent indicated that they were not opposed to receiving prescriptions from nonphysician health professionals.
When informed that the state legislature was considering bills to allow nonphysicians to prescribe medications (a bill to allow physician assistants to prescribe under the supervision of a physician was also before the lawmakers, but did not win passage), approximately 73 percent of respondents said they disagreed with the concept, while 20 percent thought it was a good idea and 8 percent had no opinion. The survey was commissioned by the Louisiana State Medical Society and involved 1,000 randomly selected registered voters who were questioned in January.
Stewart has no doubt that the battle is far from over. "There's no question that the psychologists will be back [with a new prescribing proposal], and they'll have more money behind their efforts next time," he stated.-K.H.