Oregon Governor Vetoes Psychologist Prescribing Bill

Oregon Gov. Kate Brown (D) last month vetoed legislation (Oregon House Bill 3355) that would have authorized the Oregon State Board of Psychologist Examiners to issue prescriptive authority to licensed psychologists who meet specified requirements.

Rejection of the prescribing bill by the governor was a victory for the Oregon Psychiatric Physicians Association (OPPA) and APA, whose Department of Government Relations lobbied against the bill along with state representatives from child psychiatry, academic psychiatry, and patient and community advocates.

“Access to appropriate and timely mental health services is a serious issue in Oregon,” Brown said in a statement. “I share the concerns about inadequate services that arose during the debate on this bill, particularly for children, vulnerable populations, and rural communities. Unfortunately, [HB 3355] is not a proven solution. There remains a lack of evidence that psychologist prescribing will improve access or quality of care. While prescription drugs may be appropriate mental health treatment for some patients, there are also significant health risks with some drug therapies. HB 3355 contains several flaws that prevent the policy from being implemented safely.”

APA CEO and Medical Director Saul Levin, M.D., M.P.A., hailed the governor’s decision. “We applaud Gov. Brown for her decision to reject this bill as a solution to the problem of access to care, and we congratulate the leaders of the Oregon district branch for their tireless work advocating for patient safety. APA will continue to support members in Oregon and elsewhere in their efforts to expand access to care through appropriate means, including expansion of integrated care and telepsychiatry.”

OPPA President Jonathan Betlinski, M.D., told Psychiatric News that OPPA, with APA’s assistance, helped organize a broad coalition of physician and allied health providers (including some psychologists opposed to prescriptive privileges) as well as patient advocacy groups focusing on patient safety and access to care.

He echoed the governor in saying that access to mental health care in Oregon is a legitimate problem that the bill’s proponents claimed to be trying to solve. “This was clearly a team effort to share fact-based concerns about whether the bill would do what it claimed to do,” he told Psychiatric News. “We were able to make a strong, fact-based case that the bill did not adequately protect vulnerable populations and wouldn’t expand access.”

The legislation would have given the Oregon State Board of Psychologist Examiners authority to appoint a Committee on Psychologist Prescribing, with representatives from psychology, medicine, psychiatry, and nursing, that would advise the board about training psychologists to prescribe. According to the bill, the board could issue prescriptive authority to a psychologist who “has a master’s degree in clinical psychopharmacology, including training in physical assessment, pathophysiology, psychopharmacology, and clinical management from a program designated by the American Psychological Association or its successor organization; has proposed a clinical residency program that has been reviewed by the Committee on Prescribing Psychologists …; and has passed a national certification examination in psychopharmacology as specified by the board.”

Ajit Jetmalani, M.D., director of child psychiatry at Oregon Health Science University, said protection of child safety was a special concern that resonated with the governor.

“We emphasized collaboration with family and peer groups, youth and family advocates, primary care physicians, and the Oregon Medical Association,” he told Psychiatric News. “We were able to speak in a united way to the concerns about what child and adolescents need and why this bill would inadequately train providers to treat a very vulnerable population.”

Jetmalani noted that in Oregon—as in other locations—overprescribing of antipsychotics to children had been an issue. “Several years ago, we participated in a statewide effort to improve prescribing practices for children in foster care and saw a real decline in antipsychotic prescribing, while also recognizing that trauma-informed care, psychosocial supports, and psychotherapy were what was missing.”

Jetmalani is also a consultant to the Oregon Health Authority, which oversees the state’s Medicaid program, and a consultant to the Department of Human Services, which oversees the state’s foster care program.

Jetmalani said the coalition was able to point to success in addressing access to care through collaborative care models. “We have found that primary care providers are very capable of appropriately diagnosing early-onset conditions with support from psychiatrists, and that having embedded psychological and social workers in the office setting, along with psychiatric consultation, is a very effective model,” he said.

Betlinksi said the coalition of groups opposed to the prescribing bill was also able to take their case to the public through a local public radio show called “Think Out Loud”; an editorial in The Oregonian in Portland, Ore., urging the governor to reject the bill; and an op-ed piece in the June 24 Register Guard in Eugene, Ore., by leaders of OPPA, the Oregon Council on Child and Adolescent Psychiatry, and others, who called HB 3355 “a reckless experiment.”

OPPA leaders said ultimately it was Brown who made a judicious choice in rejecting the bill. In addition to addressing the patient safety and access issues in a letter to the Oregon Secretary of State Dennis Richardson, she said the bill lacked clear lines of legal responsibility.

“While this bill wisely encourages prescribing psychologists to collaborate with primary care physicians or nurse practitioners, it also immunizes collaborators from responsibility for giving bad advice,” she wrote. “As a result, the bill leaves unclear who would be legally responsible for a psychologist’s decision to prescribe a drug that injures or kills a patient. …”

OPPA Chair of Legislation Daniel Dick, M.D., said OPPA and other opponents of the bill want to work with the governor to improve access. “We want the governor to know that we take this issue seriously,” he told Psychiatric News. “We are working together in a coalition that includes psychologists to improve access to care in Oregon.” ■