Re1445port Title:

Psychologists; prescriptive authority

Description:

Provides prescriptive authority to psychologists.

HOUSE OF REPRESENTATIVES

H.B. NO.

 

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:

SECTION1. Findings and purpose. Consistent with the recommendations of the Ad Hoc Committee to the Board of Psychology, the legislature finds that the delivery of comprehensive, accessible and affordable medical care can be enhanced by providing adequately trained psychologists, licensed in the State of Hawaii, with appropriately limited prescriptive authority for the specific purpose of providing care in federally qualified health centers or in health clinics located in federally recognized medically underserved areas. Authority to prescribe has been recently accorded to Advanced Nurse Practitioners in Act 277, Session Laws of Hawaii (SLH) 1994, and to Optometrists in ACT 71, SLH 1996. Other practitioners to include dentists and podiatrists are also permitted prescriptive authority.

In federal facilities, appropriately credentialed psychologists continue to prescribe medications to active duty personnel and their families. 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. In 1988, Federal Public Law 100-579, reauthorized in 1992 as Public Law 102-369 and again in 2000 as Bill S1929, recognized the extraordinarily poor health of native Hawaiians.

Licensed psychologists are licensed health professionals with an average of seven years of post-baccalaureate study and three thousand hours post-graduate supervised practice in the diagnosis and treatment of mental health illness. Absent a physician license, however, they are generally not permitted to prescribe psychotropic medication. Patients who would benefit from such medication must consult and pay for another provider prior to obtaining a prescription, if such help is available at all. Currently, tens of thousands of native Hawaiians who live in rural areas have been unable to obtain any adequate psychiatric care since Statehood. Due to the gross shortage of mental health care in these underserved areas, native Hawaiians have had to endure protracted mental illnesses.

Hawaiians and part-Hawaiians comprise about twenty per cent of the population of Hawaii, yet less than one per cent of doctors are Hawaiian in any blood quantum. As a result of these findings, the native Hawaiian health care scholarship was formed to assist in the delivery of culturally competent care to Native Hawaiians. Each scholar recipient must, by contractual agreement, meet a four year repayment obligation working in federally designated medically underserved areas. Over the last two years, as part of a native Hawaiian project mandated by the congress of the United States of America, as Public Law 106-79, Hawaiians were designated as federal beneficiaries. Since then psychologists of native Hawaiian descent that have been clinically trained by the department of defense in psychopharmacology and behavioral medicine. These psychologists and psychology trainees have provided care to thousands of previously untreated Hawaiians and others who reside in medically underserved areas.

It is of particular concern to the State that timely access to the accurate diagnosis and effective treatment of emotional and behavioral disorders may contribute substantially to the State’s responsibilities to Hawaii’s Felix children and needy adults in underserved rural areas. Current inefficiencies delay timely and effective access to the necessary diagnosis and integrated treatment care and raise costs. Currently, a demonstration project at Hana community health center under a memorandum of Agreement with the Department of Defense is sending native Hawaiian psychologists trained in psychopharmacology and behavioral medicine to serve the children at the school in the community of Hana. Seamless services that integrate care across the medical, family and school settings significantly benefit the underserved in that area.

Further exacerbating the dire need for mental health treatment in underserved areas is that fact that patients from diverse cultural backgrounds are reluctant to seek treatment due to the stigma of mental health. Having an established relationship with a psychologist, it is a further intrusion on a patient’s privacy to demand that they see yet another provider for needed medications.

The American Psychological Association has established a nationally recognized curriculum for the further training and certification of psychologists in the use of psychopharmacological agents to ease the suffering of people with mental health problems. Recently, the Hawaii board of psychological examiners has proactively recommended that licensed psychologists appropriately trained in psychopharmacology be granted prescription privileges to care for the mentally ill and their specific recommendations are incorporated herein.

Independent evaluations by the GAO and American College of Neuropsychopharmacgy have found that appropriately trained psychologists prescribe safely and effectively. In Hawaii, native Hawaiian psychologists providing medication consultation to primary care physicians have been extremely well received in the community health centers.

Accordingly, it is the purpose of this Act to provide appropriately trained and supervised licensed psychologists, working in federally qualified health centers or in health clinics located in federally recognized medically underserved areas, with the authority to prescribe psychotropic medications for the treatment of mental illness, similar to that recently provided by advanced practice registered nurses and optometrists.

SECTION 2. Chapter 465, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated 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 of Hawaii;

(2) Has successfully completed a planned sequence of psychopharmacological training from an institution of higher learning approved by the board, or from an APA approved program in psychopharmacology/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 must supervise the practicum. The practicum must include at least two hours of weekly supervision and the supervisor shall not be in the employ of the person being directed/supervised;

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

(6) The board may waive requirements (2) through (5) above for applicants currently holding a license in good standing in another state to prescribe such 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 affiliated with a Federally Qualified Health Center or a health clinic serving federally designated medically underserved areas;

(9) Meets all other requirements, as determined by rule of the board, 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 with 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 with 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 and has successfully completed one year of prescribing psychotropic medication as certified by the supervising prescribing health professional; and

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

(3) Meets all other requirements, as determined by rule of the board, 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 with a prescription certificate may prescribe psychotropic medication pursuant to the provisions of the Professional Psychologist Act 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 providing for the procedures to be followed in obtaining a conditional prescription certificate, a prescription certificate, and renewals of a prescription certificate. The department of commerce and consumer affairs may set reasonable application and renewal fees.

(f) The board shall adopt rules 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 with 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 with 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/department of commerce and consumer affairs assigned identification number.

(j) A prescribing psychologist or a psychologist with 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 with 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 with 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 with 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, nurse practitioner or 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; and

(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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