Not surprisingly, closing one of the Oregon legislature’s most longstanding “scope-of-practice” issues still feels unresolved
February 25, 2010 -- Beginning in July of next year, licensed psychologists may gain the right to prescribe certain mental health drugs under a bill (Senate Bill 1046) that passed the Oregon House and Senate this week. Everything hinges on whether Gov. Kulongoski decides to veto
The bill sets up training and certification requirements for prescribing psychologists. While the bill marks the culmination of a longstanding debate at the state capitol, this issue is by no means resolved.
The matter must still come before a new committee that reports to the Oregon Medical Board before issuing its first license. In addition, lawmakers created yet another task force to bring recommendations to the 2011 Oregon Legislature.
And it still faces controversy. One of the votes against the bill came from Sen. Alan Bates (D-Ashland), a medical doctor who made his opposition known early on. Bates started something of a legislative dust-up in a Feb. 2 public hearing when he said a workgroup charged with recommending curriculum requirements “went off the track and did some things that were very inappropriate.”
At issue was the appointment to the workgroup of Dr. Morgan Sammons
, dean and professor at the San Francisco-based California School of Professional Psychology, which has trained 350 psychologists to prescribe psychotropic drugs in the United States. Bates claimed Sammons was brought up from California and temporarily licensed in Oregon to serve on the workgroup with the implication being that schools such as his would benefit from the legislation.
“We license people in our state to practice medicine,” Bates said. “We don’t license people to serve on a committee to present something new and dramatically different in our state. We don’t do that. It’s outrageous and completely inappropriate. To me that corrupts the entire process.”
Debra Orman McHugh, executive director of the Oregon Board of Psychological Examiners, which appointed Sammons to the committee, called Bates’ comments “unfortunate” and that Sammons was chosen for his unique expertise.
McHugh delivered a written response
to the committee and later told The Lund Report that Sammons, a native Oregonian, was granted a limited permit as any licensed psychologist in another state would receive. Legislation that created the workgroup, McHugh said, required Sammons to be licensed, but not necessarily practicing in the state.
“We allow them to get a temporary permit to practice until they take a state exam,” McHugh said. Sammons received this temporary license in June 2008 and passed the Oregon written exam in October 2008.
Sammons told the committee at that Feb. 2 hearing that he was chosen for the workgroup for his experience. He said he planned to move back to Ashland, though he had never practiced psychology in Oregon. He now holds an administrative job and did apply for the Oregon license after being approached to serve on the workgroup.
“When this issue came up in the spring,” Sammons said, “people asked that I be a member of this workgroup since I’m a native of Oregon, and everyone knew of my deep affiliation with the state and the prescriptive authority movement for psychologists. (They) asked if I would serve on this (workgroup) since I have a great deal of experience designing curriculum and working on this issue, so I received a temporary license on (sic) that.”
McHugh scoffed at whether Sammons had a conflict of interest. “You wouldn’t put somebody on a workgroup who had no knowledge about the topic,” she said. “To me that’s kind of silly.”
Sen. Laurie Monnes-Anderson (D-Gresham) who chairs the Senate Health Care Committee, called the episode a political stunt. “I’m appalled I was not notified earlier,” she told Sen. Bates. “To me, this looks like gaming the system to prevent something from going forward.”
Divisions Run Deep
Those opposed to the idea of giving psychologists prescribing authority, represented most vocally by the Oregon Medical Association and the Oregon Psychiatric Association, still say the legislation provides inadequate training and supervision.
Patient safety could be at risk, said John McCulley, lobbyist for the Oregon Psychiatric Association. In just two other states that grant similar privileges, New Mexico and Louisiana, a medical doctor must directly supervise a prescribing psychologist for at least two years after receiving a license, McCulley said. The Oregon bill, in contrast, requires “collaboration” with a healthcare provider.
“What Oregon is establishing here is much looser oversight,” said McCulley who said none of his proposed amendments reported in our earlier story
, such as restricting prescriptive authority to adults, were included in the final version.
Supporters of the bill say it sets up equally rigorous clinical training requirements that meet or exceed those needed to prescribe drugs in other medical professions.
The bill also opened deep fissures within the medical community and between psychologists, including testimony from Tanya Tompkins, a professor in psychology at Linfield College, who opposed the measure.
“Psychologists are deeply divided over the policy of the American Psychological Association (which supports prescriptive authority),” according to Tompkins. “Typically, although about 60-65 percent of those polled agree to nominal support for prescription privileges, questions have not typically addressed the extent of training that would be required.”
A national group, Psychologists Opposed to Prescription Privileges for Psychologists, also opposed the bill because it “allowed psychologists to prescribe medication with less than half of the medical training required of all other prescribing professionals.”
Psychological Association, which has lobbied for prescriptive authority for more than 10 years, said the issue always ranks high on member opinion surveys, particularly among those living in rural areas where there’s an acute shortage of mental health providers. They contend psychologists are more qualified to prescribe mental health drugs than primary care providers who have such authority. (See related article
Opponents contend they have no problem giving prescribing authority as long as psychologists receive proper training. It’s not about turf, but patient safety, according to Dr. James Cho.
“Several of the antidepressants such as the monoamine oxidase-inhibitors could be easily fatal if taken with the wrong foods,” according to Cho. “Lithium is known to be very toxic and can exacerbate several medical conditions, and several of the antipsychotics such as Clozapine require frequent blood test monitoring. All the antipsychotics by the standard of care require that lab tests be done to monitor possible metabolic side effects that could lead to metabolic syndrome, and worse, possibly diabetes, a heart attack, or stroke.”
In our previous article on this topic, we referenced a 15-year precedent with the Department of Defense in training psychologists to safely prescribe medications. Several astute readers took issue with this comparison.
Dr. James Cho provided a link to a study
about the DOD program and an independent review of the study
by the National Association of Mental Illness. He said military psychologists had more limited prescribing authority compared to what the Oregon bill grants.
“The psychologists in the military study had more limitations in their ability to prescribe, and the study, while not even applicable to the public by the military's admission was considered cost-ineffective,” Cho wrote.
“The citizens of Oregon deserve that an actual study be done that emulates the parameters of the proposed bill before they allow it to become a reality,” Cho continued. “To do otherwise would be to put patients through an untested medical process that could yield negative outcomes including death.”
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