Oregon eyes prescriptive authority goal for 2010

A new prescriptive authority law brings the Oregon Psychological Association much closer to its ultimate goal

by Legal and Regulatory Affairs and Communications Staff

June 30, 2009 — Oregon Psychological Association's (OPA) prescriptive authority legislation, HB 2702, was signed into law on June 25. Although the legislation fell short of OPA's ultimate goal, this is the farthest a prescriptive authority bill has progressed since the first one was introduced in Oregon six years ago.

Organized psychology leaders hail the development as a significant milestone, while emphasizing that the state psychological association's work is not done. The compromise bill that passed in the Senate and became law fell short of the version that the Oregon House passed with strong support.

The House bill would have allowed appropriately trained psychologists who met designated criteria to prescribe. The bill would have given the state's psychology licensing board regulatory authority over prescribing psychologists, while also calling for a new advisory committee to make recommendations to the licensing board about certification and approval processes, and other designated matters.

According to Robin Henderson, PsyD, past president of the Oregon Psychological Association (OPA) and a member of OPA's legislative committee, support for the House legislation was bolstered by letters from prescribing psychologists in Louisiana, New Mexico and the military filled with compelling stories about the positive difference these practitioners have been able to make in their communities because of their authority to prescribe.

The amended bill that later emerged from the Senate establishes a seven-person workgroup comprised of three psychologists, one primary care physician, a pharmacist, and two psychiatrists to work with a paid professional mediator on specific recommendations for legislation granting prescriptive authority for psychologists.

The workgroup is charged with developing recommendations about accredited psychopharmacology training programs, the training needed for dealing with special populations and legislative language that would authorize trained psychologists to prescribe.

The workgroup must report its recommendations to the legislature by January 31, 2010 so that a prescriptive authority bill can be considered during the special legislative session that concludes at the end of next February.

The amended legislation that passed the Senate was the result of a hard-fought compromise by OPA. Dr. Henderson explained that psychology was able to present its case in the House without having to combat widespread misinformation from organized psychiatry. "But the misinformation campaign intensified considerably once the bill moved to the Senate," she said, and it involved national representatives of psychiatry.

Dr. Henderson said much of the misinformation concerned the availability and content of postdoctoral psychopharmacology training programs. Psychology advocates have reported that in Oregon and other states where prescriptive authority battles have been fought, psychiatry has consistently linked such misinformation to false claims of patient endangerment.

The few Senate hearings held offered little time to combat the forceful opposition. While OPA originally sought the same bill in the Senate that the House had just passed, more than one dozen different versions ultimately were considered over just a period of days. "We had to compromise, or the bill would have died completely," said Henderson.

Should the workgroup created by the 2009 Senate legislation fail to reach an agreement, the legislators would then have documented evidence from the mediator — a neutral third party — establishing psychiatry's refusal to budge on the issue of prescriptive authority for psychologists.

Henderson said she intends to "hold psychiatry's feet to the fire" to act in good faith during mediation in the next six months and look at the actual evidence, including the lack of documented issues of patient safety when psychologists have prescribed medication to patients. Regardless of the workgroup's outcome, OPA has a commitment from key Oregon legislators to hear a prescriptive authority bill from OPA in 2010.

According to Henderson, those commitments are a reflection of the fact that many House members and several Senate members were disappointed in the outcome of this year's session. "Our supporters worked hard to achieve the bill, and many in the House thought it was the right bill," she observed.

If OPA achieves its ultimate goal by the end of next February of gaining legislation that authorizes qualified psychologists to prescribe, Oregon will become the third state in which eligible psychologists are able to prescribe. Nearly 70 trained psychologists are prescribing in New Mexico and Louisiana, in addition to psychologists in the Department of Defense, Indian Health Service and the U.S. Public Health Service.

Staff for the APA Practice Organization work closely with state psychological associations, approximately 35 of which have prescriptive authority task forces, on their advocacy efforts. Once again, OPA's efforts this year were funded by a legislative grant from the Committee for the Advancement of Professional Practice (CAPP).

These grants are made possible through Practice Assessment monies provided to the APA Practice Organization by licensed APA members.

According to Deborah Baker, JD, director of prescriptive authority and regulatory affairs, although the recent outcome in Oregon was not ideal, it was still a significant achievement accomplished in relatively short time. "OPA was able to make some lemonade out of a big lemon thrown their way," she said.