By Rebecca DeFilippo CMP
EMPS Executive Director
(St. Louis, Mo.) Two bills aimed at allowing non-medically trained psychologists to prescribe medications in the State of Missouri failed to pass during the 2008 legislative session.
The Missouri General Assembly adjourned on Friday, May 16, without acting on either Senate Bill 917 (Goodman R-29) or House Bill 1739 (Moore R-20). The identical bills, commonly referred to as RxP legislation, would have created a new category of "prescribing psychologists."
If passed, the bills would have licensed psychologists to write prescriptions for psychotropic and other brain medications after completing some courses that met training requirements set by a state committee of psychologists, not the Missouri State Board of Registration for the Healing Arts.
Further, a committee whose members had no medical training and who could not themselves prescribe would have written regulations for training to prescribe and to determine who was qualified to prescribe.
Under provisions in both the House and Senate bills, a “prescribing psychologist” would have been able to prescribe such powerful medications as antipsychotics to treat schizophrenia, Ritalin and other stimulants used in children with attention deficit/hyperactivity disorder, cognitive enhancers such as Aricept to treat Alzheimer’s disease, and antiepileptics/anticonvulsants often prescribed for bipolar disorder.
Licensing requirements under both bills included completion of a 10-week course, passing a national examination, and physician supervision for only one year.
The three American Psychiatric Association (APA) district branches in Missouri worked closely with the APA to oppose the bills. Psychiatric physicians from Central, Eastern and Western Missouri Psychiatric Societies testified at House and Senate committee hearings in February.
On February 4, then-APA President Carolyn B. Robinowitz MD testified on SB 917 before the Senate Financial, Governmental Affairs and Elections Committee. Her testimony stressed patient safety and the lack of medical education and training required for those seeking to become prescribing psychologists.
"Codifying a substandard level of care as legally acceptable in Missouri...demeans the patients it is supposed to reach and places them in substantial risk," Dr. Robinowitz stated.
She also emphasized that diagnosing illness and prescribing medication to treat it is based on a medical model of care, not on a psychological construct.
“This demands full-time, thorough, medical education and training in order to practice safely and effectively,” Dr. Robinowitz testified. “To propose crash-course, shortcut training based on ever more vague standards and requirements is an insult to persons who need treatment for mental illness, including substance abuse disorders.”
Jack L. Croughan MD, then-President of the Eastern Missouri Psychiatric Society, and EMPS Legislative Affairs Chair Paul B. Simon DO also testified at the Senate Committee hearing. Dr. Croughan said the "poorly conceived bill is bad medicine" and a risky attempt to address patient access-to-care issues.
Dr. Croughan also described the education and training requirements for psychiatric physicians, saying that the training required in SB 917 for certification involved only a fraction of the medical school classroom hours.
“To be licensed as a physician, a person must have more than 4,000 classroom hours of medical school, and a one-year internship within a medical setting,” Dr Croughan said. “In addition, psychiatrists and other specialist physicians must have at least four years of residency.”
On February 28, the House Special Committee on Professional Registration and Licensing heard testimony on HB 1739. In his testimony, Dr. Croughan described some of the medical conditions that persons with mental illness have and how medications used to treat those conditions can interact with medications to treat their mental illness. He said that established educational programs such as for Nurse Practitioner or Physician Assistant programs already existed in Missouri, and included medical curriculum and training far beyond that required by the RxP bills. He described the programs as “feasible options for psychologists to obtain a medical knowledge base.”
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