Feature

This year, across the country, the fight for prescription privileges has advanced with significantly more skirmishes, innovative strategies and pitfalls that have served as learning experiences. Advocates from the three states that have seen legislative action--California, Georgia and Louisiana--gave attendees at an APA convention session an overview of their tactics and battle scars.

California

A major lesson from the California focus on the Department of Defense psychopharmacology grads, Faltz indicated, is the importance of the building of relationships in the legislature on various issues, then using the connections for this purpose. The California Psychological Association (CPA), he says, regularly sponsors two to four major bills a year and has built up a number of helpful contacts in the legislative body.

But Faltz warned psychologists not to count on fairness even from supposedly neutral parties: In California, he said, the opposition, led by psychiatrists, is spending a lot of money on media relations. And, as a result, he said, publications have printed editorials against the proposal even though editors "never contacted us and got no background whatsoever other than the spin of psychiatrists."

In August, with calculations indicating its bill was one vote short of passage in a key committee, CPA stopped actively pushing for the legislation for the 2000 session. Faltz noted the significant progress CPA made this year in pushing legislation further than it has gone before and indicated the association would be ready to promote prescribing bills in upcoming legislative sessions.

Georgia

Last spring, Georgia had a good chance of becoming the first state to pass prescription privileges. But of all the legislative battles the Georgia Psychological Association (GPA) had taken on over the years, this was by far the toughest, according to Cal VanderPlate, PhD.

In the midst of it all, VanderPlate, chair of the GPA task force on prescription privileges, got mailings, which went to registered voters all over the state, of slick brochures from the opposition, indicating, "Some politicians are trying to make it hard for you to see a doctor," and "Some politicians are trying to blur the lines between licensed medical doctors and untrained medical workers."

That campaign illustrates one of VanderPlate's messages to other states seeking the right to prescribe: The battle can move to the theater of public opinion.

Eventually, Georgia's bill fell a few votes short in the key committee. But VanderPlate says, this round of the fight did advance the cause: Legislators are now better educated, there has been considerable public debate.

In the meantime, says VanderPlate, GPA members have illustrated another how-to point by working hard in the state primaries: "This is a 365-day-of-the-year effort. And the friends that you make in the primaries, who you help get elected...are generally your friends for life."

Louisiana

The Louisiana Psychological Association (LPA) has been working on prescription privileges since 1995, but gets a chance to pass a bill only once every two years when the legislature takes up nonfiscal matters.

Their next chance is coming in January 2001.

The bill for psychologists' right to prescribe has come out of a committee twice before and, Gregory Frost, an LPA lobbyist, credits much of that success to the members of the state's first class in psychopharmacology. In 1999, he said, "Those 35 students were tireless, absolutely, totally invested."

He expects no less of an effort by the graduates and students in the upcoming legislative session.

It also helped, he said, that from the outset, LPA "asks for an appropriate, workable approach." For instance, the psychologists put into the legislation the highest educational requirement for the privilege they thought feasible: a postdoctoral master's degree in psychopharmacology. And to counter the opposition's argument that anyone who wants to prescribe medications should go to medical school, LPA inserted a requirement that prescribing psychologists consult with the patient's treating physician: "Not getting his approval, but putting him in the loop."

LPA also used to advantage the argument that, "Medicine is full of providers, who are not physicians, who prescribe. Optometrists prescribe, podiatrists prescribe and so on and so forth."

In addition, the association pointed out the shortage of psychiatric care. In Louisiana, said Frost, "There's a long waiting list to see psychiatrists for a first-time appointment." That point, he said, "had some effect, particularly with rural legislators."

In contrast to the public debate that happened in Georgia, said Frost, "We weren't able to get the public interested much. It became a professional issue as opposed to a public issue."

Because of that indifference, he feels that the money the association has spent on public relations has not leveraged "much bang for the buck."

Frost points out that LPA had help from some physicians in its previous rounds, and that's a cadre he wants to develop for future advocacy:

"What's important here is that the legislature understand that the rank and file MDs don't care....That orthopedists and dermatologists couldn't care less about whether psychologists have prescription privileges."

But grassroots organizing among psychologists "is absolutely the key, unquestionably the key."

And building on that, he said, should be the hard work, the "personal effort" of political relationships and political participation. He urges advocates to visit legislators on a one-on-one basis repeatedly, to use the between-session periods "to educate, to promote, to encourage," and to be part of the political process, including paying for help from professional lobbyists and making political contributions.