Report Title:

Psychologists; Prescriptive Authority

Description:

Authorizes trained and supervised medical psychologists working in federally qualified health centers or other licensed health clinics located in federally designated medically underserved areas to prescribe psychotropic medications for the treatment of mental illness. Repeals prescriptive authority July 1, 2013. (SD1)

THE SENATE

S.B. NO.

1239

TWENTY-THIRD LEGISLATURE, 2005

S.D. 1

STATE OF HAWAII

 


 

A BILL FOR AN ACT

 

Relating to Psychologists.

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

SECTION 1. The delivery of comprehensive, accessible, and affordable medical care may be enhanced by providing trained medical psychologists, licensed in Hawaii, with limited prescriptive authority for the specific purpose of providing care in federally qualified health centers or other licensed health clinics located in federally designated medically underserved areas. The legislature has previously authorized prescription privileges to advanced nurse practitioners, optometrists, dentists, podiatrists, osteopaths, and physician assistants.

Psychologists with appropriate credentials have been allowed to prescribe medications to active duty personnel and their families in federal facilities and the Indian Health Service for years. Recently, Louisiana and New Mexico adopted legislation authorizing prescriptive authority for psychologists not limited by the service setting.

Since 2000, nine psychologists in Hawaii, all native to Hawaii, have received psychopharmacological training through the Tripler Army Medical Center, Native Hawaiian Psychology Training Program. These psychologists actively collaborate with primary care physicians to provide combined therapy and psychopharmacological care of native Hawaiians at seven federally qualified health centers (Bay Clinic, Hana, Molokai, Kauai, Waianae, Kalihi-Palama, and Waiamanalo), and two native Hawaiian health care systems clinics located in federally designated medically underserved areas (Kauai and Molokai).

To date, thousands of native Hawaiians and other ethnic minorities have received the necessary combined therapy and psychopharmacological care that was sorely lacking to address significant mental and behavioral health care needs. For example, psychologists at Waianae Coast Comprehensive Health Center completed approximately 3,840 patient encounters in 2004; seventy per cent of these patients received necessary psychotropic medication for the treatment of mental illness. Psychologists across federally qualified health centers have formed successful collaborative relationships with primary care physicians in the mental health treatment for the underserved.

Medical psychologists are licensed health professionals with an average of seven years of post-baccalaureate study and three thousand hours of post-graduate supervised practice in the diagnosis and treatment of mental illness. Because the current scope of medical psychologists' practice does not include prescribing medications, patients must consult with and pay for another provider to obtain the requisite prescription. However, physicians are not readily available in some areas and for some populations.

This is a particular hardship for patients of the twelve federally qualified health centers on Oahu and the neighbor islands. Patients of federally qualified health centers include the uninsured (thirty-six per cent), the poor (fifty-six per cent), native Hawaiian (twenty-seven per cent, sixty per cent in rural areas), other Pacific Islanders (seven per cent), and the homeless (five per cent). Timely, efficient, and cost-effective treatment of mental illnesses in federally qualified health centers could avoid the significantly greater social, economic, and medical costs of non-treatment for these underserved populations.

Research data soundly demonstrates that there is not enough mental health care available to serve the needs of all people in the Hawaii. Further, the economically disadvantaged and medically underserved would receive little or no mental health services if not for the federally qualified health centers and the services provided by clinical psychologists.

Since 1988, federal law has recognized the extraordinarily poor health of native Hawaiians. In Hawaii, native Hawaiians have the highest rate of untreated medical and psychological concerns, and higher rates than other indigenous and minority individuals in the United States. Recent concerns include the impact of the crystal methamphetamine epidemic and related substance abuse issues such as those in Waianae, Molokai, and Waimanalo. This epidemic coupled with the economic and cultural distress of the native Hawaiian population has created unprecedented demands for services from an already overtaxed mental health system.

Further exacerbating the dire need for mental health treatment in underserved areas is the fact that patients from diverse cultural backgrounds are reluctant to seek treatment due to the stigma of mental health problems. Timely access to accurate diagnosis and effective treatment of emotional and behavioral disorders also may contribute substantially to the State’s responsibilities to Hawaii’s Felix children and needy adults in underserved rural areas.

The United States Congress, through the Native Hawaiian Health Care Professions Scholarship program, requires recipients to work in federally designated medically underserved areas for a duration (typically four years) equivalent to the number of years they received scholarship funding. Under this program, psychologists of Native Hawaiian ancestry are now using modern training and education to deliver health care in a culturally appropriate manner to other Native Hawaiians through their placements in federally qualified health centers, Native Hawaiian health systems clinics, and other federally designated health clinics in medically underserved areas.

The American Psychological Association has developed a model curriculum for the education and training of prescribing psychologists. Independent evaluations of the Department of Defense Psychopharmacological Demonstration Project by the United States General Accounting Office and the American College of Neuropsychopharmacology have found that appropriately trained medical psychologists prescribe safely and effectively.

The purpose of this Act is to authorize appropriately trained and supervised licensed medical psychologists, working in federally qualified health centers or other licensed health clinics located in federally designated medically underserved areas, to prescribe psychotropic medications for the treatment of mental illness.

SECTION 2. Chapter 465, Hawaii Revised Statutes, is amended by designating sections 465-1 through 465-15 to read as follows:

"Part I

GENERAL PROVISIONS"

SECTION 3. Chapter 465, Hawaii Revised Statutes, is amended by adding a new part to be appropriately designated and to read as follows:

"Part II

PRESCRIPTION CERTIFICATION

§465-   Definitions. As used in this part, unless the context otherwise requires:

"Collaborative relationship" means a cooperative working relationship between a psychologist holding a conditional prescription certificate and a doctor of medicine in the provision of patient care, including diagnosis and cooperation in the management and delivery of physical and mental health care.

"Narcotics" mean natural and synthetic opioid analgesics, and their derivatives used to relieve pain.

"Prescribing mental health professional" means a medically trained and licensed physician, psychiatrist, advance practice nurse, or nurse practitioner specializing in mental health care.

"Psychotropic medication" means only those agents related to the diagnosis and treatment of mental and emotional disorders, including controlled substances except narcotics.

§465-   Conditional prescription certificate; application. (a) A psychologist may apply to the board for a conditional prescription certificate. The application shall be made on a form approved by the board, and be accompanied by evidence satisfactory to the board, that the applicant:

(1) Holds a current license in good standing to practice psychology in the State;

(2) Has successfully completed a planned sequence of psychopharmacological training from an institution of higher learning approved by the board, or from a program consistent with the American Psychological Association's Recommended Postdoctoral Training in Psychopharmacology for Prescription Privileges. This training shall include a minimum of five hundred hours of didactic classroom instruction in at least the following core areas of instruction:

(A) Anatomy & Physiology;

(B) Biochemistry;

(C) Neurosciences;

(D) Pharmacology;

(E) Psychopharmacology;

(F) Pathophysiology;

(G) Health assessment, including relevant physical and laboratory assessment; and

(H) Clinical pharmacotherapeutics;

(3) Has completed a supervised practicum of at least two years involving four hundred and fifty hours treating a diverse population of no fewer than one hundred patients with mental disorders. A licensed healthcare provider who is experienced in the provision of psychopharmacotherapy shall supervise the practicum. The practicum shall include at least two hours of weekly supervision and the supervisor shall not be in the employ of the person being directed or supervised;

(4) Has passed a national proficiency examination, approved by the board, that tests the applicant's knowledge of pharmacology in the diagnosis, care, and treatment of mental disorders; the board shall establish what constitutes a passing score and the number of times an applicant may re-take the exam within a specific time period;

(5) Applies for a Federal Drug Enforcement License for limited use as restricted by state law;

(6) Has malpractice insurance in place sufficient to satisfy the rules adopted by the board that will cover the applicant during the period the prescription certificate is in effect;

(7) Is employed or contracted by, and will practice the prescribing authority at, a federally qualified health center established under title 42 United States Code section 1396 or a licensed health clinic located in a federally designated medically underserved area as defined by title 42 Code of Federal Regulations part 62; and

(8) Meets all other requirements, as determined by rules adopted by the board pursuant to chapter 91, for obtaining a conditional prescription certificate.

(b) The board shall issue a conditional prescription certificate if it finds that the applicant has met the requirements of subsection (a).

§465-   Conditional prescription certificate; powers and duties. (a) The psychologist shall continue to hold a current license to practice psychology in Hawaii and continue to maintain malpractice insurance.

(b) The psychologist shall inform the board of the name of the prescribing mental health professional under whose supervision the psychologist will prescribe psychotropic medication and the name of the federally qualified health center or other health clinic located in federally designated medically underserved area in which the psychologist practices, and promptly inform the board of any change of the prescribing mental health professional.

(c) The psychologist holding a conditional prescription certificate shall maintain an ongoing collaborative relationship with the doctor of medicine who oversees the patient's general medical care.

(d) A psychologist holding a conditional prescription certificate may administer and prescribe psychotropic medication within the recognized scope of the profession, including the ordering and review of laboratory tests in conjunction with the prescription, for the treatment of mental disorders.

(e) When prescribing psychotropic medication for a patient, a psychologist holding a conditional prescription certificate shall maintain an ongoing collaborative relationship with the doctor of medicine who oversees the patient's general medical care to ensure that necessary medical examinations are conducted, the psychotropic medication is appropriate for the patient's medical condition, and significant changes in the patient's medical or psychological condition are discussed.

(f) A prescription written by a psychologist with a conditional prescription certificate shall:

(1) Comply with applicable state and federal laws;

(2) Be identified as issued by the psychologist as "psychologist certified to prescribe"; and

(3) Include the psychologist's board number or the identification number assigned by the department of commerce and consumer affairs.

(g) A psychologist holding a conditional prescription certificate shall not delegate prescriptive authority to any other person. Records of all prescriptions shall be maintained in the prescribing psychologists’ patient records.

(h) When authorized to prescribe controlled substances, a psychologist holding a conditional prescription certificate shall file with the board in a timely manner all individual federal Drug Enforcement Agency registrations and numbers.

§465-   Prescription certificate. (a) A psychologist may apply to the board for a prescription certificate. The application shall be made on a form approved by the board and be accompanied by evidence satisfactory to the board that the applicant:

(1) Has been issued a conditional prescription certificate and has successfully completed two years of prescribing psychotropic medication as certified by the supervising prescribing mental health professional;

(2) Has successfully undergone a process of independent peer review approved by the board and the Hawaii board medical examiners;

(3) Holds a current license to practice psychology in Hawaii;

(4) Has malpractice insurance in place sufficient to satisfy the rules adopted by the board that will cover the applicant as a prescribing psychologist; and

(5) Meets all other requirements, as determined by rule of the board, for obtaining a prescription certificate.

(b) The board shall issue a prescription certificate if it finds that the applicant has met the requirements of subsection (a).

(c) A psychologist with a prescription certificate may prescribe psychotropic medication if the psychologist:

(1) Continues to hold a current license to practice psychology in Hawaii and continues to maintain malpractice insurance; and

(2) Annually satisfies the continuing education requirements for prescribing psychologists, as set by the board, which shall be no fewer than twenty hours each year.

§465-   Administration. (a) The board shall adopt rules pursuant to chapter 91 establishing the procedures to be followed to obtain a conditional prescription certificate, a prescription certificate, and renewals of a conditional prescription certificate and prescription certificate. The board may set reasonable application and renewal fees.

(b) The board shall adopt rules pursuant to chapter 91 establishing the grounds for denial, suspension, or revocation of a conditional prescription certificates and prescription certificate including a provision for suspension or revocation of a license to practice psychology upon suspension or revocation of a conditional prescription certificate or prescription certificate. Actions of denial, suspension, or revocation of a conditional prescription certificate or a prescription certificate shall be in accordance with this chapter.

(c) The board shall maintain current records on every prescribing psychologist, including federal registrations and numbers.

(d) The board shall provide to the board of pharmacy an annual list of psychologists holding a conditional prescription certificate that contains the information agreed upon between the board and the board of pharmacy. The board shall promptly notify the board of pharmacy of psychologists who are added or deleted from the list.

§465-   Narcotics; prohibited. This part shall not be construed to permit a medical psychologist to administer or prescribe a narcotic."

SECTION 4. Section 465-3, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows:

"(a) This chapter shall not apply to:

(1) Any person teaching, lecturing, consulting, or engaging in research in psychology insofar as the activities are performed as part of or are dependent upon employment in a college or university; provided that the person shall not engage in the practice of psychology outside the responsibilities of the person's employment;

(2) Any person who performs any, or any combination, of the professional services defined as the practice of psychology under the direction of a licensed psychologist in accordance with rules adopted by the board; provided that the person may use the term "psychological assistant", but shall not identify the person's self as a psychologist or imply that the person is licensed to practice psychology;

(3) Any person employed by a local, state, or federal government agency in a school psychologist or psychological examiner position, or a position that does not involve diagnostic or treatment services, but only at those times when that person is carrying out the functions of such government employment;

(4) Any person who is a student of psychology, a psychological intern, or a resident in psychology preparing for the profession of psychology under supervision in a training institution or facility and who is designated by a title as "psychology trainee", "psychology student", "psychology intern", or "psychology resident", that indicates the person's training status; provided that the person shall not identify the person's self as a psychologist or imply that the person is licensed to practice psychology;

(5) Any person who is a member of another profession licensed under the laws of this jurisdiction to render or advertise services, including psychotherapy, within the scope of practice as defined in the statutes or rules regulating the person's professional practice; provided that, notwithstanding section 465-1, the person does not represent the person's self to be a psychologist or does not represent that the person is licensed to practice psychology;

(6) Any person who is a member of a mental health profession not requiring licensure; provided that the person functions only within the person's professional capacities; and provided further that the person does not represent the person to be a psychologist, or the person's services as psychological; or

(7) Any person who is a duly recognized member of the clergy; provided that the person functions only within the person's capacities as a member of the clergy; and provided further that the person does not represent the person to be a psychologist, or the person's services as psychological."

SECTION 5. The board of psychology shall submit a report, not later than twenty days prior to the convening of the regular session every two years, beginning with the 2006 regular session, on its evaluation of the status of conditional prescriptive and prescriptive authority to medical psychologists pursuant to this Act.

The board of psychology shall submit a final report, including any proposed legislation, not later than twenty days prior to the convening of the regular session of 2013, on its evaluation of the status of mental health care in the State after providing conditional and prescriptive authority to medical psychologists pursuant to this Act. All reports shall include recommendations as to whether the prescriptive authority should be modified, eliminated, or continued to assist the legislature in assessing the viability of psychologists maintaining prescriptive authority.

SECTION 6. New statutory material is underscored.

SECTION 7. This Act shall take effect upon its approval and shall be repealed on July 1, 2013.