Bills to permit psychologists to prescribe drugs have been introduced in
state legislatures in Connecticut, Oregon, Tennessee, Hawaii, and Wyoming,
part of an ongoing push for prescribing privileges in the wake of their
implementation in New Mexico and Louisiana. Similar bills are anticipated in
more states this year.
APA and its local affiliates are following developments in these states
closely. They continue to oppose prescribing privileges for psychologists on
the grounds of patient safety and inadequate training.
Review of all the prescribing bills under consideration reveals a common
theme among most—a shift in the role played by the medical profession,
said Paula Johnson, deputy director for state affairs in APA's Department of
"If enacted, the big change would be the elimination of any
responsibility or authority by state medical boards or societies," she
said. "Nearly all the bills would vest authority in each state's
The Connecticut bill was submitted by Rep. Walter Pawelkiewicz (D), the
deputy majority leader of the state House of Representatives. Pawelkiewicz
holds a Ph.D. in child and educational psychology from the University of
Connecticut. The bill is in preliminary form and states that its intent is"
[t]o improve the availability of mental health services by permitting
licensed psychologists to prescribe certain pharmaceutical agents within the
scope of their practice."
The bill was referred to the Public Health Committee, which can either
draft formal legislation first and then hold hearings, or hold a public
hearing on the subject matter of the proposed bill and then draft legislative
language, said Jacquelyn Coleman, executive director of the Connecticut
A similar bill was introduced in 2001, but died in committee after public
hearings were held. This year the Public Health Committee must vote by April
to decide whether the bill proceeds.
Bills before the Hawaii legislature differ from those in other states. They
seek to offer prescribing authority only to psychologists practicing at
federally qualified health centers or clinics located in designated medically
underserved areas. Although this might appear to limit privileges
geographically, large areas of Hawaii fall within these federal designations,
Psychologists working out of the U.S. Army's Tripler Medical Center now
collaborate with primary care physicians in some of these areas.
Although advocates for the psychologists have pointed to the now-defunct
Department of Defense psychologist-prescribing program as a model, the
situation is much different at federal clinics in Hawaii, said Lydia Hemmings,
executive director of the Hawaii Psychiatric Association. The Department of
Defense patients were relatively young and healthy compared with the general
However, at the federally qualified health clinics in underserved rural
Hawaii, patients are often poor and not in good general health, and may have
comorbid substance abuse diagnoses, said Hemmings: "Psychologists would
be testing their lack of adequate training on a vulnerable population, with
few backup resources in these remote areas."
Psychiatrists in Hawaii will urge that more funds be allocated to getting
psychiatrists to rural areas (some now fly in one day a week to see patients),
increasing the use of telemedicine, and organizing community liaison
psychiatrists to work with primary care physicians in the federally qualified
clinics, she said.
The chief sponsor and advocate of the senate version of the bill is Sen.
Rosalind Baker (D-Maui), the powerful chair of the Health Committee, who
previously supported prescribing privileges for nurse practitioners and
optometrists. The Hawaii Psychological Association named her Legislator of the
Year in 2003 for "outstanding contributions to psychology and mental
health in the State of Hawaii." The committee held hearings on the bill
on February 18, voting 3-0 with two absences that the bill be adopted (with
amendments) and sent to the Commerce, Consumer Protection, and Housing
Committee. Baker is vice-chair of that body, which oversees occupational
The Oregon bill calls for 350 hours of psychopharmacology training, plus"
a supervised clinical practicum treating at least 100 patients with
mental disorder." The bill does not limit the conditions for which drugs
may be prescribed, but would create the Council on Psychologist Formulary to
establish which medications could be prescribed, "including controlled
substances listed in [federal] schedules II, III, IIIN, IV, and V."
The formulary council would include one member of the State Board of
Psychologist Examiners, one other psychologist appointed by the board, two
pharmacists, one physician, and two members of the public.
"There is no probationary or supervised prescribing period mandated
by the bill, and all rule-making authority rests with the Board of
Psychologist Examiners," said Johnson.
At a hearing in mid-February, psychologists argued that passage would
improve access to mental health care, especially in rural areas, and reduce
waiting times to see a mental health professional. Members of the Oregon
Psychiatric Association (OPA) opposed the bill as a threat to patient safety
and no cure for questions of access.
"We explained how dealing with adverse drug effects requires medical
skills and judgment and how physicians' training prepares them for that, but
psychologists' study of social sciences does not," said J. Teresa
Shelby, M.D.,the legislative representative for the OPA. "As for access,
in Oregon the problem is not lack of psychiatrists but rather one of
economics, poverty, the uninsured, and cuts in the state health plan leaving
thousands without coverage."
The committee took no vote on the bill, but the chair suggested that
proponents consider changing the composition of the formulary council. Thus,
the bill is still alive and could come back at any time during the current
legislative session, which runs until July.
Legislation introduced in Tennessee follows a familiar pattern. The bill
calls for 450 hours of classroom training and a one-year preceptorship
covering at least 100 outpatients under the supervision of a physician. The
psychology board would have sole control over who may become a prescribing
Prescribing psychologists could not treat patients who do not have an
established relationship with a primary care physician. For the first two
years after being allowed to prescribe, psychologists could do so only under a
formal, written, "collaborative practice agreement" with a
Rules, regulations, and a formulary would be set out by a group composed of
members of "current health-related boards of healing arts,"
including psychology, pharmacy, nursing, optometry, and medicine. However, the
law does not specify the presence of a physician on this group, said
"These bills have come up several years in a row," said
Nashville's Gregory Kyser, M.D., chair of the Tennessee Psychiatric
Association's legislative committee. "Last year it was defeated in
committee when no one would second the chairman's motion to bring it to the
floor." The psychologists' strategy this year has been to give an early
push to the legislation, said Kyser.
"They've done a much better job between legislative sessions, holding
regional dinners and contacting members of the health committee," agreed
Anne Carr, a lobbyist for the Tennessee psychiatrists. "We've been
Kyser said there is a difference between the psychologists' push for
prescribing privileges and rights previously granted nurse practitioners in
"Many nurse practitioners have graduated and gone to serve in rural
areas, and their work is reviewed frequently by physicians," he said."
But they have basic medical training, as opposed to just learning how
to prescribe psychotropic medications in a vacuum."
The psychologist-prescribing bill in Wyoming never had a hearing and so did
not leave the Committee on Labor, Health, and Social Services in the state
"According to the rules, that means that the bill is dead for this
session," said APA's Johnson.
The bill delineated prescribing authority by directing that the state"
board of pharmacy, in collaboration with the board of psychology, shall
develop a formulary of commonly used drugs for the treatment of mental and
emotional disorders for use by psychologists with prescriptive
The bill's education section also called for licensed psychologists with
doctorates to take 380 hours of "intensive didactic instruction"
and complete one year's "supervised and relevant clinical
experience" to qualify for prescribing authority.
The Wyoming Psychiatric Society, backed by the state's medical society,
approached legislators by talking about not just the prescribing question but
other issues, too, like changes in the involuntary commitment law and
suicide-prevention coordination. ▪