When Gov. Kathleen Blanco signed prescriptive authority for psychologists into law in May, Louisiana became the second state to pass a law allowing psychologists to prescribe. New Mexico enacted a similar law in 2002 and is presently in the final stages of developing regulations to implement the law. Louisiana psychologists have been working for a decade to educate their legislators and the public about the ability of appropriately trained psychologists to prescribe safely and effectively, and they are to be congratulated for their successful efforts.
Normally, being No. 2 does not match the excitement of being the first to accomplish a challenge like attaining prescription privileges (RxP). In this case, however, not only does being the second state to pass a law come with considerable excitement, but it carries special significance for the RxP movement. For the last two years since New Mexico's law was enacted, organized psychiatry has relied heavily on the argument that New Mexico was an aberration that would not be repeated.
Each time a prescribing bill appeared in one of the dozen or so legislatures that considered the issue, psychiatry was quick to isolate New Mexico's success and caution legislators not to "make the same mistake" as their colleagues in New Mexico. In fact, when Gov. Blanco first received the bill from the legislature, she was reported by The Times-Picayune to say that if Louisiana would be among the first states to implement such a program she "would hesitate to be a leader on that kind of legislation."
A new trend
But in the end, the governor did lead, and now a beginning trend exists for states enacting prescriptive authority legislation. The difference between having two state laws in place as opposed to a single law has not gone unnoticed by the American Psychiatric Association (ApA). That organization's new president, Michelle Riba, MD, in a May Psychiatric News column said, "We do not yet know...whether Louisiana is a harbinger of similar bills in other states or whether it is an isolated 'perfect storm' in which every possible advantage went to the psychologists and their allies in the legislature."
For the record, I believe it is a sign of not only more bills to follow in many states, but more laws to come around the country. Interestingly, Dr. Riba also accused Gov. Blanco of "put[ing] the economic interests of psychologists ahead of the health and welfare of the people of Louisiana by signing the bill."
It is true that the Louisiana Academy of Medical Psychologists and the Louisiana Psychological Association worked skillfully for many years to give psychology every possible advantage in passing the legislation. Led by Jim Quillan, PhD, and John Bolter, PhD, organized psychology saw to it that 50 Louisiana psychologists completed a master's program in clinical psychopharmacology in anticipation of the law. Louisiana Families for Access to Comprehensive Treatment, an organization of approximately 5,000 consumers, was formed to help support the bill and underscore the need for services in a state where wait times to see a psychiatrist can reach five months.
The support of many physicians was successfully cultivated. The services of, reportedly, the best lobbyists in the state--Jim Nickel and Bud Courson--were secured. And strong relationships were developed with many legislators, including Sen. Don Hines, a family physician and president of the Louisiana Senate, and Rep. Joe Salter, Speaker of the House, who championed the bill in their respective chambers. Rather than being the "perfect storm" of political circumstances, the Louisiana prescriptive authority legislative effort is a model that other states will now emulate.
Lessons for the future
Among other lessons learned from the Louisiana experience was to not underestimate the role of the media. During the 10 days that Gov. Blanco was considering whether to sign or veto the legislation, at least one major newspaper in the state showed itself to be anything but neutral and objective on the issue. An editorial, op-eds, letters to the editor and even news coverage were decidedly opposed to the legislation. Articles reporting on the issue were extremely thin on the psychologists' side of the story, if that side of the story was reported at all.
In the end, however, the governor signed the bill into law, an affirmative act she did not have to take, as the legislation would have passed into law had she not signed but also not vetoed it. Many people, both in Louisiana and associated with APA, helped enact this law, and they are to be commended. With the two state laws (and a territorial law in Guam) now enacted, many more are sure to follow.
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