Brown Spikes Psychologist Prescriber Bill

Proponents of HB 3355, including Providence Health & Services, failed to persuade the governor that the bill had adequate patient safeguards if psychologists were allowed to expand their scope of practice to prescribe medications to their clients.

Governor Kate Brown carried out her veto threat of House Bill 3355 on Tuesday, quashing a collaborative, time-consuming effort to find a narrow means of expanding the shortage of skilled psychiatric prescribers by enlisting specially trained psychologists to prescribe medications in a clinical setting.

In a lengthy statement, Brown based her opposition on what she saw as four weaknesses in the bill:

  • It did not impose age restrictions on the patients that psychologists could treat.
  • Other states that have expanded psychologists’ scope of practice have shown insufficient evidence that it improves access.
  • She also noted that psychologists are regulated by a board that does not currently oversee drug prescribers and that giving psychologists this authority creates new liability concerns in case of malpractice or negative outcomes for the patient, including death.
  • Brown took particular concern with its impact on children.

“The bill does not limit or require specialized education or training in order to prescribe to children, older Oregonians or other vulnerable populations; nor does it include patient safety, outcome data reporting or monitoring to ensure appropriate prescribing,” she said.

But the governor’s rationale belies certain realities of the status quo mental health system. With an increasing shortage of psychiatrists and psychiatric nurse practitioners in Oregon, the bulk of psychiatric prescriptions, including for children, fall on the shoulders of primary care practitioners, who have far less training than psychologists in mental health conditions and often over-prescribe these medications.

And Oregon has been a leader in expanding the delivery of medical care beyond allopathic physicians and in giving new boards authority over medicine prescribers, first with osteopathic physicians, then with nurse practitioners and more recently with naturopathic physicians, all of whom can prescribe psychotropic medications.

“I’m very disappointed, given her long history of working to ensure access for mental health,” said Rep. Bill Kennemer, R-Canby, the bill’s chief sponsor. “It didn’t solve all the problems but it was a step in the right direction of reaching our goal of mental health parity.”

Brown spokesman Chris Pair did not respond to additional questions beyond the press release.

The bill had been a bipartisan effort, sponsored not just by Kennemer, a retired psychologist, but House Speaker Tina Kotek, D-Portland, and Rep. Mitch Greenlick, D-Portland.

Sen. Laurie Monnes Anderson, D-Gresham, said the effort included a mediation in which both sides paid $10,000 to work out their differences, and she said she felt after seven years that she had finally found the proper safeguards to expand psychologists’ scope of practice and lessen the shortage of knowledgeable prescribers of psychotropic medications.

But as with many controversial subjects, the two sides could never reach beyond ideological, political and parochial turf differences to reach a consensus, and HB 3355 divided the healthcare community, pitting psychiatrists, academic psychologists and the Oregon Medical Association on one side, and the Oregon Psychological Association, the Oregon Nurses Association and the Oregon Association of Hospitals and Health Systems on the other.

As the debate fomented, it attracted strident opposition from some corners, who impugned Kennemer’s character and integrity with conspiracy theories, all for a bill that even its proponents admit would have limited impact, since it would require psychologists to seek years of additional training and force them to work in a medical setting if they wished to prescribe pharmaceuticals.

Cooler heads, such as Courtni Dresser, a lobbyist for the Oregon Medical Association, sought to maintain a more level-headed rationale for the opposition, asking for the debate to continue but insisting that HB 3355 was just not ready for prime time and that it did not provide the safeguards needed to ensure proper prescribing.

“We didn’t believe the bill had all the right pieces and sideboards,” said Dresser, who was particularly skittish that ancillary providers like psychologists could assume the role of a primary care provider and prescribe medications for the side effects of psychiatric drugs as well as the primary diagnosis. “They were able to prescribe more than psychotropic medications.”

Kennemer said Tuesday he was unsure of the next step or whether he’d reintroduce a compromise measure, perhaps one that excluded children, in 2018.

Brown appeared to leave open the door for future discussion: “Mental health drug therapies can have serious physical health impacts and over or inappropriate prescribing continues to remain a concern. It is critical that patient safety safeguards be adequate for new prescribers.”

Reach Chris Gray at chris@thelundreport.org.

 

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