Louisiana Lawmakers Hurriedly Pass Psychologist-Prescribing Law

On May 6 the state of Louisiana became the second state in the country to authorize psychologists to prescribe psychotropic medications to people with mental illness. The state joins New Mexico, which enacted psychologist-prescribing legislation in March 2002 (Psychiatric News, April 5, 2002).

APA’s reaction was swift and condemning. “[Louisiana] HB 1426 is a rush to judgment that puts politics above patients’ lives and safety,” said APA President Michelle Riba, M.D. “By enacting it, Gov. [Kathleen Babineux] Blanco and the Louisiana legislature have codified a dangerous, substandard level of care as legally acceptable in Louisiana. HB 1426 puts Louisiana well outside the medical mainstream in the United States and will jeopardize patients struggling with mental illnesses.”

While “the lessons to be learned from Louisiana are far from clear” at this time, Riba emphasized that APA plans to undertake “a careful review” as a “key part of continuing to block such reckless laws.” (See “From the President” on Original article: page 3.)

Blanco, a Democrat, signed HB 1426 after concerted efforts by APA, the Louisiana Psychiatric Medical Association (LPMA), the American Medical Association, and the Louisiana State Medical Association, along with local chapters of the National Alliance for the Mentally Ill and the Depressive and Bipolar Support Alliance, strongly urged the governor to veto the hastily passed legislation.

The original psychologist-prescribing bill was introduced on April 7, sponsored by Louisiana House Speaker Joe Salter (D). An identical bill was introduced on April 13 by Senate President Donald Hines, M.D. (D), who maintains a family practice while the legislature is not in session. With little discussion or debate and only minor amendments, the bill was passed by the House on April 19 by a vote of 62-31.

The next day the Senate received the House bill, and declaring it to be a duplicate of the Senate version, Hines deftly moved the House bill through the Senate chamber. On April 21 Hines used procedural privileges as Senate president to suspend the normal rules for considering legislation in an orderly manner.

When the president pro tempore, Diana Bajoie (D), attempted to offer an amendment that would have prohibited psychologists from prescribing to children, Hines dismissed the effort. He noted that as a physician himself, he could write prescriptions for children for the very medications in question, and he wasn’t required to have a master’s degree in psychopharmacology.

Hines called for a vote, and the measure passed the Senate by a vote of 21-16. In the end, only minor editorial changes and clarifying amendments were passed.

The bill went back to the House immediately, and, again with the rules suspended, representatives voted on it without any conference committee consideration. The House passed the bill by a vote of 68-30.

The final bill was signed by Salter on Thursday, April 22, and by Hines on the following Monday, April 26, starting a 10-day countdown for the governor’s action. In Louisiana the governor may sign passed legislation, veto it, or allow it to go into law without a signature.

Lobbyists for the state medical society and LPMA were so dismayed that they left the legislative chambers silently, shaking their heads.

No Regard for Patient Safety

In the ensuing 10 days, efforts were made with “warp speed,” noted LPMA legislative representative Dudley Stewart Jr., M.D. The lobbyists, Stewart, and LPMA President Patrick O’Neill M.D., called in AMA President Donald Palmisano, M.D., who is from Louisiana, to advise the governor’s office of the significant patient-safety concerns that the legislation raised.

The new Louisiana statute will allow a “medical psychologist” to prescribe and distribute “agents related to the diagnosis and treatment of mental and emotional disorders.” A “medical psychologist” is loosely defined as a “psychologist who has undergone specialized training in clinical psychopharmacology and has passed a national proficiency examination in psychopharmacology approved by the [psychologist examiners’] board and who holds from the board a current certificate of responsibility.”

The only medications that the law specifically exempts are narcotics.

Blanco asserted in a prepared statement that she was “assured by the proponents [of the legislation], including the speaker of the House and the president of the Senate,” that the new law’s “tight controls” and “tough” regulations she expects the board of psychologist examiners to promulgate will protect patients’ safety. She noted that those who “do not abide” by the provisions of the law could lose their prescribing privileges and “face misdemeanor charges.” Yet no such “tough rules” or any regulations are codified by the statute. In fact, complete oversight of psychologist prescribing is granted to the Board of Psychologist Examiners, and it is that same board that the law entrusts to create regulations and procedures to implement the law.

To be eligible to prescribe, applicants must hold a current license to practice psychology and must have “successfully graduated with a postdoctoral master’s degree in clinical psychopharmacology from a regionally accredited institution or equivalent to the postdoctoral master’s degree as approved by the board.”

The law’s language describing educational requirements is vague, but it appears to be patterned after the American Psychological Association’s preferred curriculum for prescribing psychopharmacology.

The law requires a prescribing psychologist to “prescribe only in consultation and collaboration with the patient’s primary or attending physician and with the concurrence of that physician.” However, Riba noted, “Bluntly, the vaguely defined consultative requirements cited by the governor as a safety measure do not pass muster: there is nothing in the law to ensure that a physician will ever lay eyes on the patient.”

Patients Opposed Legislation

Riba said that patient advocacy groups and patients themselves were adamantly opposed to the legislation, and she had urged Gov. Blanco to protect them and their loved ones by vetoing the bill.

“[Psychotropic] medications,” Riba emphasized, “impact the whole patient, not just the patient’s mental or emotional disorder, as the governor suggests.” These “potent medications,” she continued, “may interact with other medications and may impact other medical conditions. As behavioral scientists, psychologists are simply not trained for the medical complexities faced by psychiatrists and other physicians when they prescribe medications.”

Riba stressed that APA’s focus must be on “action.” As part of an action plan, she added, APA must “review how we respond to these assaults. We will undertake this review quickly, but we should not—unlike the Louisiana legislature—rush to judgment without the benefits of the facts.”

Such an examination—determining what was successful in some states and what was unsuccessful in Louisiana—“is a key part of continuing to block such reckless laws,” she continued. ▪