Louisiana regulators heard one more round of comments on the state's new
law governing prescribing privileges for psychologists in November and expect
to implement rules governing prescriptive authority soon.
"The rule should become final on January 20, barring any unforeseen
problems," said Brenda C. Ward, executive director of the Louisiana
State Board of Examiners of Psychologists.
Representatives of APA and other medical groups again registered objections
to the draft regulations at the hearing, while officials of the Louisiana
Psychological and American Psychological associations offered their support.
However, the board made no substantive changes to the draft.
David Edward Post, M.D., a Baton Rouge psychiatrist and president of the
Louisiana Psychiatric Medical Association, acknowledged the duty of the
psychology examiners board to implement the new law, but also said that
proposed regulations "fail to protect patients, fail to establish
adequate training requirements, and do not address access-to-care
Patient safety could be compromised because the proposed rules do not
require prescribing psychologists to have any contact with a physician during
training or to undergo any medically supervised clinical experience with
patients, he said.
The proposed rules demand "successful graduation with a postdoctoral
master's degree in clinical psychopharmacology" or the equivalent,
including instruction in anatomy and physiology, biochemistry, neurosciences,
pharmacology, psychopharmacology, clinical medicine/pathophysiology, and
health assessment, including relevant physical and laboratory assessment. No
supervised practicum is required, according to Paula Johnson, deputy director
for state affairs in the APA Department of Government Relations.
The California School of Professional Psychology, a division of Alliant
International University in San Francisco, already offers one such training
program in Baton Rouge in cooperation with the Louisiana Psychological
Association. The two-year program is held on weekends, costs $9,500, and
claims 195 graduates as of 2004. Such bare-bones instruction and a lack of
clinical experience concern Post and other physicians.
"It's hard enough to be a psychiatrist and do a good job with
medications," said Jeanne Estes, M.D., a psychiatrist and
president-elect of the East Baton Rouge Parish Medical Society. "The
psychologists think they can waltz in after two years of part-time training
and know what we learned in medical school."
Post also expressed concern regarding special populations."
Psychologists should not be allowed to prescribe to children and the
elderly, who have physiologic and pathophysiologic differences well beyond the
scope of the training," he said. He also raised concern about patients
with mental disorders and comorbid conditions like diabetes and cardiovascular
The draft rules also contain no provisions to provide more access to care
for underserved populations by inducing or requiring prescribing psychologists
to serve in rural or inner-city communities, he added. Access was a prime
argument proffered by psychologists in favor of prescribing.
Even the phrase designating psychologists licensed to prescribe medications
for the management of "mental and emotional disorders" came under
fire. The term "medical psychologist" prompted objections from the
Louisiana Council of Child and Adolescent Psychiatry, arguing that patients
might confuse "M.P.s" with "M.D.s."
The Louisiana law also lacks a provision requiring prescribing
psychologists to carry malpractice insurance, raising the possibility of
higher malpractice liability premiums for physicians working with medical
psychologists, said Estes.
The lack of medical expertise among members of the psychology board
troubled Post, as well. No recognized medical organizations—such as the
state medical society or a medical school—will have any role in
overseeing practitioners covered by the new law, he said. This has drawn
opposition by other medical organizations as well.
"We believe that the present rules do not provide adequately for the
safety and protection of patients," said Vincent Culotta Jr., M.D., an
obstetrician/gynecologist and spokesperson for the Louisiana State Medical
Society, in an interview. "There's no real definition of `consultation'
with physicians, and if that is not adequate, then patients may not get the
best medications or may have problems with drug-drug interactions."
"We hope that there will be no problems, but we remain very
concerned," he added.
The psychology board took note of the written and oral comments, but
largely dismissed objections, saying that it lacked any authority to change
the statute. The board said it "welcomes the new challenge of regulating
medical psychologists and believes the proposed rules will assist the board in
carrying out its mandate."
APA will look at the final regulations to see whether they conform to the
law, said APA's Johnson. Major discrepancies between the final rule and the
statute may provide an opportunity for further challenges. ▪