Prescribing Law in Louisiana Rankles Psychiatrists: APA Warns That Move to Grant Rights to Psychologists Will Threaten Patient Safety

By Worcester, Sharon | Clinical Psychiatry News, July 2004 | Go to article overview

Prescribing Law in Louisiana Rankles Psychiatrists: APA Warns That Move to Grant Rights to Psychologists Will Threaten Patient Safety


Worcester, Sharon, Clinical Psychiatry News


Psychiatry is still reeling from the latest blow in the battle over psychologist prescribing privileges.

Louisiana Gov. Kathleen Blanco has signed into law House Bill 1426, which grants prescribing privileges to specially trained psychologists. The move makes Louisiana the second state, after New Mexico, to enact such a law. Similar initiatives have been introduced in several other states.

The bill passed 62-31 in the state House chamber and 21-16 in the Senate, despite vigorous opposition by organizations such as the American Psychiatric Association, the American Medical Association, and the American Academy of Family Physicians. It grants psychologists who have completed a postdoctoral master's degree in clinical psychopharmacology and passed a national certification examination the right to prescribe medications, such as antidepressants and psychotropics, used for the treatment of mental health disorders.

"Reason has not prevailed," Dr. Michelle Riba, president of the APA, told this newspaper.

"The legislators in Louisiana don't understand or don't care to understand the need for appropriate medical evaluation and treatment," she said, predicting that lives will be jeopardized as a result of the law because the complexities of prescribing and making differential diagnoses cannot be adequately addressed without proper medical school training.

A statement on the APA Web site calls the move a "rush to judgment that puts politics above patients' lives and safety" and challenges claims that the law includes "tough rules" and regulations that will protect patients.

The law gives sole oversight of prescribing psychologists to the State Board of Examiners of Psychologists, which is made up of members not trained in the practice of medicine, Dr. Riba argued.

Dr. Lee H. Beecher, a psychiatrist and president of the Minnesota Physician-Patient Alliance, agreed that such laws are misguided.

"You can't turn a psychologist into a physician without medical school," he said. But don't blame psychologists for the current state of affairs: the path that led to enactment of the laws in Louisiana and New Mexico started on the doorstep of managed care, and was reinforced by psychiatry's lack of initiative in building bridges with primary care physicians to improve access to mental health care, he added.

Managed care carve-outs have trivialized the doctor-patient relationship, particularly in the mental health arena. The psychotherapy services provided by psychologists have been jeopardized--often, only short-term treatment is allowed. …

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