Report Title:

Psychologists; Psychotropic Medicine Prescriptive Authority; Medically Underserved

Description:

Authorizes licensed psychologists affiliated with a federally qualified health center or a health clinic serving federally designated medically underserved areas to prescribe psychotropic medication, subject to educational, experiential, and examination requirements.

THE SENATE

S.B. NO.

387

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, consistent with the recommendations of the Ad Hoc Committee to the Board of Psychology, 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. The authority to prescribe has recently been accorded to advanced practice registered nurses in Act 277, Session Laws of Hawaii 1994, and to optometrists in Act 71, Session Laws of Hawaii 1996. Other health professionals, including dentists and podiatrists, have been granted prescriptive authority.

In federal facilities, appropriately credentialed psychologists prescribe medications for active duty personnel and their families. Currently, Native Hawaiian psychologists actively collaborate in the psychopharmacological care of Native Hawaiians in federally qualified health centers and in health clinics located in federally recognized medically underserved areas. In 1988, P.L. 200-579, reauthorized in 1992 as P.L. 102-369, and in 2002, 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 of post-graduate supervised practice in the diagnosis and treatment of mental health illness. Absent a medical license, however, psychologists 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 Hawaii's population, 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, by contractual agreement, must 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 United States Congress, psychologists of Native Hawaiian descent 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 raises 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 behavior medicine to serve the children at the school in the community of Hana. Seamless services that integrate care across medical, family, and school settings significantly benefit the underserved in that area.

The fact that patients from diverse cultural backgrounds are reluctant to seek treatment due to the stigma of mental illness further exacerbates the dire need for mental health treatment in underserved areas. 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 prescriptive privileges to care for the mentally ill, and their specific recommendations are incorporated herein.

Independent evaluations by the General Accounting Office and American College of Neuropsychopharmacology 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 locate in federally recognized medically underserved areas with the authority to prescribe psychotropic medication for the treatment of mental illness, similar to that recently granted to advanced practice registered nurses and optometrists.

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

"§465-   Prescriptive authority; qualifications; scope. (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) Within the five-year period immediately preceding the date of application, 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/prescriptive privileges. This training shall include a minimum of four hundred fifty hours of didactic classroom instruction in, at a minimum, the following core areas:

(A) Neuroscience;

(B) Pharmacology;

(C) Psychopharmacology;

(D) Physiology;

(E) Pathophysiology;

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

(G) Clinical pharmacotherapeutics;

(3) Within the five-year period immediately preceding the date of application, has completed under the supervision of a mental health professional licensed or certified to prescribe psychotropic medication, a one-year practicum of at least four hundred hours, in which the applicant has treated no fewer than one hundred patients with mental disorders; provided that the practicum included at least two hours of supervision and the supervisor was not in the employ of the supervisee;

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

(5) Has malpractice insurance in place that covers the applicant during the period the prescription certificate is in effect;

(6) Is affiliated with a federally qualified health center or with a health clinic serving federally designated medically underserved areas; and

(7) Meets all other requirements for obtaining a conditional prescription certificate, as established by rule pursuant to chapter 91.

The board may waive the requirements in paragraphs (2) to (4) for an applicant holding a license in good standing in another state which authorizes the licensee to prescribe psychotropic medication.

(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 expire on June 30 of each even-numbered year, at the end of which the certificate holder may 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 mental health professional, subject to the following conditions:

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

(2) The psychologist shall provide the board with the name of the supervising prescribing mental health professional and promptly report any changes thereto; and

(3) The psychologist shall maintain an ongoing collaborative relationship with the health care practitioner who oversees the patient's medical care.

(c) A psychologist may apply 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 successfully completed one year of prescribing psychotropic medication under a conditional prescription certificate, as certified to by a supervising prescribing mental health professional;

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

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

(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 medicine pursuant to the Professional Psychologist Act if the psychologist:

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

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

(e) The board shall adopt rules establishing procedures for obtaining and renewing a conditional prescription certificate and a prescription certificate. The department may establish 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, including a provision for suspension or revocation of a license to practice psychology upon certificate suspension or revocation. 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 of mental disorders.

(h) When prescribing psychotropic medication for a patient, a prescribing psychologist or 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 medial 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 a prescribing psychologist or a psychologist with a conditional prescription certificate, as appropriate; and

(3) Include the psychologist's license 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 their 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 certificate that contains information agreed upon by the boards. The board shall promptly notify the board of pharmacy of changes to the list.

(m) For purposes 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, 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; 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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