Report Title:

Psychologists; Prescriptive Authority

Description:

Allows trained and supervised psychologists working in federally qualified health centers or in appropriately licensed health clinics on Molokai to prescribe psychotropic medications for the treatment of mental illness.

HOUSE OF REPRESENTATIVES

H.B. NO.

1423

TWENTY-SECOND LEGISLATURE, 2003

 

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 legislature finds that the delivery of comprehensive, accessible, and affordable medical care may be enhanced by providing adequately trained psychologists, licensed in the State of Hawaii, with appropriately limited prescriptive authority. The legislature has previously authorized prescription privileges to advanced nurse practitioners, optometrists, dentists, podiatrists, osteopaths, and physician assistants.

In federal facilities, appropriately credentialed psychologists have been allowed to prescribe medications to active duty personnel and their families for years. Currently, native Hawaiian psychologists actively collaborate in the psychopharmacological care of native Hawaiians at federally qualified health centers and in health clinics located in federally recognized medically underserved areas.

The legislature finds that 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 health illness. Because the current scope of practice does not include prescribing medications, patients who would benefit from such medication must consult with and pay for another provider to obtain the requisite prescription. In some areas and for some populations, physicians are not readily available.

This has been a particular hardship for patients of the eleven federally qualified health centers on Oahu and the neighbor islands. Patients visiting a federally qualified health center include the uninsured (thirty-six per cent), poor (fifty-six per cent), native Hawaiian (twenty-seven per cent), Pacific islanders (seven per cent), and homeless (five per cent).

The legislature finds that the timely, efficient, and cost-effective treatment of mental health illnesses in federally qualified health centers could avoid the significantly greater social, economic, and medical costs of nontreatment. The United States Congress, through the native Hawaiian health care scholarship, requires recipients to work in a federally qualified health center for four years. Under this program, psychologists of native Hawaiian ancestry are now using modern training and education to deliver healthcare in a culturally correct manner to other native Hawaiians.

The American Psychological Association has established a nationally recognized curriculum for the training and certification of psychologists in the use of psychopharmacological agents. Independent evaluations by the United States General Accounting Office and the American College of Neuropsychopharmacology have found that appropriately trained psychologists prescribe safely and effectively.

Accordingly, the purpose of this Act is to provide appropriately trained and supervised licensed psychologists, working in federally qualified health centers or in health clinics located on Molokai, with the authority to prescribe psychotropic medications for the treatment of mental illness.

SECTION 2. Chapter 465, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

"§465-   Psychologist certified to prescribe; scope and qualifications. (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 an American Psychological Association approved program in psychopharmacology and prescription privileges. This training shall include a minimum of four hundred fifty hours of didactic classroom instruction in at least the following core areas of instruction:

(A) Neuroscience;

(B) Pharmacology;

(C) Psychopharmacology;

(D) Physiology;

(E) Pathophysiology;

(F) Appropriate and relevant physical and laboratory assessment; and

(G) Clinical pharmacotherapeutics;

(3) Has completed this psychopharmacology training within five years immediately preceding the date of application;

(4) Within five years immediately preceding the date of application, has completed a supervised one year practicum of at least four hundred hours treating no fewer than one hundred patients with mental disorders. A mental health professional licensed or certified to prescribe psychotropic medications 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;

(5) Within five years immediately preceding the date of application, has passed a national certification examination approved by the board that tests the applicant's knowledge of pharmacology in the diagnosis, care, and treatment of mental disorders;

(6) The board may waive the requirements in paragraphs (2) to (5) for applicants currently holding a license in good standing in another state to prescribe medications in that state;

(7) Has malpractice insurance in place that will cover the applicant during the period the prescription certificate is in effect;

(8) Is employed at a federally qualified health center established under 42 U.S.C. 1396 or a licensed health clinic located in a federally designated medically underserved area as defined by 42 C.F.R. 62; and

(9) 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). The certificate shall be valid until June 30 of even numbered years, at the end of which the holder may again apply for renewal pursuant to the requirements of subsection (a). A psychologist holding a conditional prescription certificate may prescribe psychotropic medication under the supervision of a prescribing health professional subject to the following conditions:

(1) The psychologist shall continue to hold a current license to practice psychology in Hawaii and continue to maintain malpractice insurance;

(2) 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 promptly inform the board of any change of the prescribing mental health professional; and

(3) The psychologist holding a conditional prescription certificate shall maintain an ongoing collaborative relationship with the health care practitioner who oversees the patient's general medical care.

(c) 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 pursuant to subsection (b) and has successfully completed one year of prescribing psychotropic medication as certified by the supervising prescribing health professional;

(2) Holds a current license in good standing to practice psychology in Hawaii; and

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

(d) The board shall issue a prescription certificate if it finds that the applicant has met the requirements of subsection (c). A psychologist holding a prescription certificate may prescribe psychotropic medication pursuant to this section if the psychologist:

(1) Continues to hold a current license in good standing 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 credit hours each year.

(e) 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 prescription certificate. The department of commerce and consumer affairs may establish reasonable application and renewal fees.

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

(g) A prescribing psychologist or 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.

(h) When prescribing psychotropic medication for a patient, the prescribing psychologist or a psychologist holding a conditional prescription certificate shall maintain an ongoing collaborative relationship with the health care practitioner 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.

(i) A prescription written by a prescribing psychologist or 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 or the department of commerce and consumer affairs assigned identification number.

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

(k) When authorized to prescribe controlled substances, a prescribing psychologist or 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. The board shall maintain current records on every psychologist, including federal registrations and numbers.

(l) The board shall provide to the board of pharmacy an annual list of prescribing psychologists and psychologists holding a conditional prescription certificates 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.

(m) For the purpose of this section:

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

"Prescribing mental health professional" means a physician specializing in psychiatry, a nurse practitioner, or a prescribing psychologist."

SECTION 3. Section 465-3, Hawaii Revised Statutes, is amended to read as follows:

"§465-3 Exemptions. (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.

(b) Nothing in this chapter shall in any way restrict any person from carrying on any of the psychological activities as defined in section 465-1; provided that such person does not offer psychological services as defined in this chapter except as such activities are incidental to the person's lawful occupational purpose.

(c) A person may use the title of industrial/organizational psychologist, provided that the person registers with the board, and:

(1) Is professionally competent in the practice of industrial/organizational psychology;

(2) Holds a doctoral degree from an accredited institution of higher education with training and education in industrial/organizational psychology, satisfactory to the board; and

(3) Provides psychological service or consultation to organizations which does not involve the delivery or supervision of direct psychological services to individuals or groups of individuals, without regard to the source or extent of payment for services rendered.

(d) Nothing in this chapter shall prevent the provision of expert testimony by a psychologist who is otherwise exempted by this chapter.

[(e) Nothing in this chapter shall be construed as permitting the administration or prescription of drugs, or in any way engaging in the practice of medicine as defined in the laws of the State.]"

SECTION 4. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 5. This Act shall take effect upon its approval.

INTRODUCED BY:

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