Hawaii gains new ground in quest for prescriptive authority

by Legal and Regulatory Affairs and Communications Staff

May 9, 2006 — Leaders of organized psychology in Hawaii and their advocates made substantial strides during the 2006 legislative session toward gaining prescriptive authority legislation for licensed psychologists in that state.

The Hawaii House of Representatives and the Senate Health Committee approved a bill that would have authorized qualified psychologists to prescribe psychotropic medications in federally qualified health centers and other designated settings. However, after a spirited hearing before the Senate Committee on Commerce, Consumer Protection and Housing in early April, the chairman held back the bill from further consideration.

The full legislature followed up by passing a concurrent resolution calling for a study on authorizing qualified psychologists “to prescribe a limited formulary of psychotropic medications for treating mental illness while practicing in federally qualified health centers or licensed health clinics located in federally designated medically underserved areas or in mental health professional shortage areas.”

This year was the first that a prescriptive authority bill in Hawaii cleared the full House.

According to Jill Oliveira-Berry, PhD, co-chair of the Hawaii Psychological Association’s (HPA) prescriptive authority initiative along with Robin Miyamoto, PsyD, the 2006 session saw greater support among state legislators for organized psychology’s quest than in previous years. The issue of psychologists gaining prescriptive authority in Hawaii has been debated periodically since the first state bill was introduced in the mid-1980s.

Dr. Oliveira-Berry noted Rep. Joshua Green as a “new champion who demonstrated unwavering commitment to prescriptive authority [for psychologists].” According to Oliveira-Berry, Green is a physician who practices in a rural area and “knows intimately what happens to patients when mental health care is not available.”

Dr. Oliveira-Berry also credits heightened media coverage of the prescriptive authority bill with increasing public visibility of access to care problems in the state and the valuable health services that Hawaii psychologists are providing in rural areas and community health centers. Meanwhile, psychologists, primary care physicians and community health center executive directors joined together during legislative hearings to speak firsthand about the serious access issues and psychiatry shortage problems that plague the state. HPA’s legislative efforts gained further support this year from the state’s largest insurance provider, Hawaii Medical Service Association, which submitted positive written and oral testimony.

The study called for by the state legislature is directed to include:

  • a comparison of the education required of psychologists and other categories of nonphysician health professionals who prescribe medications, including advanced practice nurse practitioners and physicians’ assistants, as well as psychiatrists

  • evidence of patient safety where psychologists have experience with prescribing

  • trends in other states related to conferring prescriptive authority for psychologists

  • a review of the arguments for and against granting prescriptive authority to psychologists

  • an evaluation of any barriers or obstacles to hiring psychiatrists at federally qualified health centers as well as solutions

  • a review of the U.S. Department of Defense psychopharmacology training program for psychologists.

The report is due no later than 20 days before Hawaii’s 2007 legislative session begins.

The Legislative Reference Bureau conducting the study is a nonpartisan agency that provides research and analysis for the state government. The legislative resolution calls for HPA, the Hawaii Primary Care Association (a vocal supporter of HPA’s prescriptive authority bill) and the Hawaii Psychiatric Medical Association to authorize representatives to consult with the bureau. According to Dr. Oliveira-Berry, the state psychological association will be actively involved in providing relevant and accurate data reflecting the study objectives and will closely monitor the study’s progress.

Psychology proponents are hopeful that the study results will bolster prospects for success when HPA again champions prescriptive authority legislation in 2007. They note that the legislative resolution calls for specific, detailed information to be included in the study findings and recommendations. That should result in a comprehensive report with data and other information that psychology advocates can cite in making their case with state legislators.

State psychological association leaders anticipate that the study results may be particularly helpful for countering arguments that the opposition continues to make with legislators. For example, the resolution indicates that the study should include evidence of patient safety when psychologists prescribe psychotropic medications. The resulting information should help debunk organized psychiatry’s persistent claims that allowing psychologists to prescribe will put patients’ lives at risk.

“The most important part of the steady progress we’ve made in recent years is that prescriptive authority for psychologists is on the radar screen of all legislators and most of the health care community in Hawaii,” says Oliveira-Berry. These same individuals, she says, are mindful of the “biases, distortions and unkept promises that the opposition continues to put forth.”

The upshot, says Oliveira-Berry, is that, even with the well-entrenched opposition, organized psychology in Hawaii is well poised to build on its strong foundation of support.

National psychology leaders credit Hawaii for gaining ground through perseverance and determination. According to APA Executive Director for Professional Practice Russ Newman, PhD, JD, “Psychologists in Hawaii deserve high praise for their continued success in moving the prescriptive authority debate forward and for taking significant next steps in their effort to pass prescriptive authority for psychologists in Hawaii.”