Hawaii RxP bill status
- Thread starter PublicHealth
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edieb said:
That's what I thought. Are you aware of any other "official" word on RxP legislation in other states? Checking the state legislature websites does not yield much information regarding 2006 RxP bills. Is HI the only likely state this year?
PSYCHOLOGY CAN DO BETTER
Our Hawaii colleagues are currently in their
second year of serious effort to obtain
prescriptive authority (RxP). During their last
legislative session, they were one vote short of
Senate passage, having been recommended favorably
by the two Committees with jurisdiction (12-12-1
excused). Subsequently, a House Concurrent
Resolution was adopted establishing a six person
Task Force to study the accessibility of mental
health care and the feasibility of psychologists
prescribing. Ray Folen and Jill Oliveira-Berry
represented HPA over four meetings. With the
convening of the 2006 legislature, House Bill
2589 was introduced with seven House signatures
as introducers (including one of the Task Force
co-chairs), a first in HPA's RxP history. After
3½ hours of contentious debate, the House Health
Committee reported the bill favorably by a vote
of 4 yes and 3 excused. Particularly impressive
was the endorsement of the Hawaii Medical Service
Association (Blue Cross/Blue Shield), which is
the largest insurance company in Hawaii; the
support of every one of the 13 community health
center medical directors, and the Hawai'i Nurses
Association. The bill was then endorsed by
another House Committee and ultimately passed the
full House on a close vote, with 21 members
opposing. The battle has now moved to the Hawaii
Senate where its Health Committee recommended the
bill's passage on a 2-1 vote. The bill is once
again pending before the Senate Commerce,
Consumer Protection, and Housing Committee.
It is important to appreciate the societal
context in which psychology's RxP agenda has
evolved. The Hawaii bill would provide
prescriptive authority for those appropriately
trained colleagues serving in federally qualified
community health centers and in clinics located
in medically underserved areas of the
state. Earlier this year, the U.S. Senate
Committee on Indian Affairs reported: "(T)he per
capita income of Native Hawaiians living in
Hawaii is about $14,199 compared to the statewide
per capita income of $21,525. The Hawaii State
Department of Health found that 19.1% of Native
Hawaiians were living in poverty in
2000." Native Hawaiians represent the largest
ethnic group served by Hawaii's health centers
which, from a public policy perspective, are our
nation's "safety net" for a significant and
growing proportion of our society. One of
President Johnson's Great Society initiatives,
community health centers truly serve the
underserved, with 40% of their patients being
uninsured and another third on
Medicaid. Nationwide, health center patients
have significantly worse health status than those
who receive care from private practitioners,
especially for such conditions as hypertension,
asthma, diabetes and mental disorders. Women
rely heavily on health centers, representing 59%
of their clientele and accounting for one in every 10 low-income pregnancies.
In an era when the national media reports: "The
proportion of U.S. physicians providing charity
care has steadily declined over the past decade,
even as the number of Americans without health
insurance has risen significantly," it is
refreshing that Native Hawaiian psychologists,
such as Jill and John Myhre, came forth
describing their efforts to serve their people
through Hawaii's health centers. Jill:
"Fifty-one percent of my patient case load is
Native Hawaiian and 46% are in need of
psychotropic medication." John: "To date I have
served the needed healthcare for over 14,000
patient-visits.... Each and every patient shared
an unconscionable plight as they were sick and
suffering, and in many cases they have needlessly
suffered for years as no mental healthcare was available to them."
ACCESS to high quality healthcare is the
critical element of HPA's argument. Mike
Sullivan emphasizes psychology's successes have
been where the truly underserved
exist. Psychiatry: "I am opposed to this measure
because it advocates for a public policy that
lowers the standard of quality medical care for
Hawai'i's people suffering from behavioral and
mental health illnesses that may require
psychotropic medications." Yet, does psychiatry
act responsibly? "Oh, they lie.... I really
tried to take the community, grass roots approach
and not get lost in the details, which is what
the opposition does which confuses the
legislators to the point of immobility." "More
egregious were the outright lies and
misrepresentations.... One of the more
disturbing moments at the hearing was when a
noticeably medicated patient read testimony that
had been prepared for her in opposition...
stumbled over words she could not pronounce and obviously had not
seen before."
With HPA President Thomas Cummings and
President-Elect Robin Miyamoto actively
demonstrating that RxP is their top legislative
priority, increasing numbers of colleagues are
personally visiting with their legislators at all
hours of the day and night. Earlier this year
Bonnie Staiger, North Dakota's Executive
Director, pointed out: "To be effective in the
legislative process requires constant
presence. There is simply no time in the heat of
the legislature to learn the process or make
those all important interpersonal contacts. One
must be personally involved from the
beginning." Perhaps Bonnie's astute observation
point to why one Senator opposes RxP She is a
former HPA award recipient and a powerful
advocate for underserved children and their
families. She has concerns regarding the over
medication of children. Yet, she does not
support HB 2589. Although serving in a heavily
Democratic legislature, a number of her colleagues agree. Why?
Psychology Can Do Better. Former APA Presidents
Nick Cummings and Jack Wiggins have demonstrated
psychologists, trained in the uses of
psychopharm, successfully removed from
medications over 2/3 of the children and
adolescents who were being overly
prescribed. Former DoD Prescribing Psychologist
John Sexton reports that whereas his psychiatric
colleagues utilized medications 61-68% of the
time, only 13% of his randomly assigned patients required medications.
As Virginia enters the RxP arena, you will have
several extraordinary allies -- your former
President Tom DeMaio and former APA President
"Dr. Bob" Resnick. As I noted previously, Tom
has brought vitality and fresh vision to the APA
governance. Completing his term on the Board of
Directors, he is running for Recording
Secretary. To my knowledge, the only individual
elected to that office who did not become APA
President, simply decided not to run. Yes, Psychology Can Do Better. Aloha,
Pat DeLeon, former APA President * Virginia
Psychological Association * March, 2006
Our Hawaii colleagues are currently in their
second year of serious effort to obtain
prescriptive authority (RxP). During their last
legislative session, they were one vote short of
Senate passage, having been recommended favorably
by the two Committees with jurisdiction (12-12-1
excused). Subsequently, a House Concurrent
Resolution was adopted establishing a six person
Task Force to study the accessibility of mental
health care and the feasibility of psychologists
prescribing. Ray Folen and Jill Oliveira-Berry
represented HPA over four meetings. With the
convening of the 2006 legislature, House Bill
2589 was introduced with seven House signatures
as introducers (including one of the Task Force
co-chairs), a first in HPA's RxP history. After
3½ hours of contentious debate, the House Health
Committee reported the bill favorably by a vote
of 4 yes and 3 excused. Particularly impressive
was the endorsement of the Hawaii Medical Service
Association (Blue Cross/Blue Shield), which is
the largest insurance company in Hawaii; the
support of every one of the 13 community health
center medical directors, and the Hawai'i Nurses
Association. The bill was then endorsed by
another House Committee and ultimately passed the
full House on a close vote, with 21 members
opposing. The battle has now moved to the Hawaii
Senate where its Health Committee recommended the
bill's passage on a 2-1 vote. The bill is once
again pending before the Senate Commerce,
Consumer Protection, and Housing Committee.
It is important to appreciate the societal
context in which psychology's RxP agenda has
evolved. The Hawaii bill would provide
prescriptive authority for those appropriately
trained colleagues serving in federally qualified
community health centers and in clinics located
in medically underserved areas of the
state. Earlier this year, the U.S. Senate
Committee on Indian Affairs reported: "(T)he per
capita income of Native Hawaiians living in
Hawaii is about $14,199 compared to the statewide
per capita income of $21,525. The Hawaii State
Department of Health found that 19.1% of Native
Hawaiians were living in poverty in
2000." Native Hawaiians represent the largest
ethnic group served by Hawaii's health centers
which, from a public policy perspective, are our
nation's "safety net" for a significant and
growing proportion of our society. One of
President Johnson's Great Society initiatives,
community health centers truly serve the
underserved, with 40% of their patients being
uninsured and another third on
Medicaid. Nationwide, health center patients
have significantly worse health status than those
who receive care from private practitioners,
especially for such conditions as hypertension,
asthma, diabetes and mental disorders. Women
rely heavily on health centers, representing 59%
of their clientele and accounting for one in every 10 low-income pregnancies.
In an era when the national media reports: "The
proportion of U.S. physicians providing charity
care has steadily declined over the past decade,
even as the number of Americans without health
insurance has risen significantly," it is
refreshing that Native Hawaiian psychologists,
such as Jill and John Myhre, came forth
describing their efforts to serve their people
through Hawaii's health centers. Jill:
"Fifty-one percent of my patient case load is
Native Hawaiian and 46% are in need of
psychotropic medication." John: "To date I have
served the needed healthcare for over 14,000
patient-visits.... Each and every patient shared
an unconscionable plight as they were sick and
suffering, and in many cases they have needlessly
suffered for years as no mental healthcare was available to them."
ACCESS to high quality healthcare is the
critical element of HPA's argument. Mike
Sullivan emphasizes psychology's successes have
been where the truly underserved
exist. Psychiatry: "I am opposed to this measure
because it advocates for a public policy that
lowers the standard of quality medical care for
Hawai'i's people suffering from behavioral and
mental health illnesses that may require
psychotropic medications." Yet, does psychiatry
act responsibly? "Oh, they lie.... I really
tried to take the community, grass roots approach
and not get lost in the details, which is what
the opposition does which confuses the
legislators to the point of immobility." "More
egregious were the outright lies and
misrepresentations.... One of the more
disturbing moments at the hearing was when a
noticeably medicated patient read testimony that
had been prepared for her in opposition...
stumbled over words she could not pronounce and obviously had not
seen before."
With HPA President Thomas Cummings and
President-Elect Robin Miyamoto actively
demonstrating that RxP is their top legislative
priority, increasing numbers of colleagues are
personally visiting with their legislators at all
hours of the day and night. Earlier this year
Bonnie Staiger, North Dakota's Executive
Director, pointed out: "To be effective in the
legislative process requires constant
presence. There is simply no time in the heat of
the legislature to learn the process or make
those all important interpersonal contacts. One
must be personally involved from the
beginning." Perhaps Bonnie's astute observation
point to why one Senator opposes RxP She is a
former HPA award recipient and a powerful
advocate for underserved children and their
families. She has concerns regarding the over
medication of children. Yet, she does not
support HB 2589. Although serving in a heavily
Democratic legislature, a number of her colleagues agree. Why?
Psychology Can Do Better. Former APA Presidents
Nick Cummings and Jack Wiggins have demonstrated
psychologists, trained in the uses of
psychopharm, successfully removed from
medications over 2/3 of the children and
adolescents who were being overly
prescribed. Former DoD Prescribing Psychologist
John Sexton reports that whereas his psychiatric
colleagues utilized medications 61-68% of the
time, only 13% of his randomly assigned patients required medications.
As Virginia enters the RxP arena, you will have
several extraordinary allies -- your former
President Tom DeMaio and former APA President
"Dr. Bob" Resnick. As I noted previously, Tom
has brought vitality and fresh vision to the APA
governance. Completing his term on the Board of
Directors, he is running for Recording
Secretary. To my knowledge, the only individual
elected to that office who did not become APA
President, simply decided not to run. Yes, Psychology Can Do Better. Aloha,
Pat DeLeon, former APA President * Virginia
Psychological Association * March, 2006
> This morning's edition of the Honolulu *Star-Bulletin* includes an
article:
> "Prescription for better mental health care" by Beth Giesting.
>
> The author note states: "Beth Giesting is executive director of the
Hawaii
> Primary Care Association."
>
> Here's the article:
>
> WITH the stroke of a pen, Hawaii lawmakers have the power to improve
access
> to mental health care for tens of thousands of people -- an estimated
55,000
> -- served by nonprofit community health centers in our state's poorest and
> most underserved rural areas.
>
> Their need is dire, and the situation is getting worse.
>
> The solution is the Hawaii Primary Care Association's House Bill 2589,
which
> will allow appropriately trained licensed psychologists working at
community
> health centers to prescribe and adjust medication to treat mental health
> issues.
>
> These patients now wait from six weeks to three months to see a
> psychiatrist. On the neighbor islands, where the shortage of psychiatrists
> is most acute, many patients can't get an appointment at all. In 2005,
only
> five new psychiatrists finished their training in Hawaii, compared to 34
new
> psychologists. In 2004, there were only six psychiatrists serving three of
> Hawaii's 13 community health centers, compared to 10 psychologists serving
> nine of the centers.
>
> THE primary opposition to this bill comes from the state psychiatric
> association. This issue is not new to the Legislature. For more than a
> decade, psychiatrists have fought giving psychologists the authority to
> prescribe drugs by promising to improve care in rural areas, yet the
> situation remains dismal. There are simply not enough psychiatrists to go
> around, and as with many things in life, the poor and needy go without.
>
> This bill is widely supported by medical directors and administrators of
> community health centers and by the Hawaii Nurses Association, HMSA and
the
> Hawaii Psychological Association. Indeed, the bill was drafted by Rep.
Josh
> Green, vice chairman of the House Health Committee and a Big Island
> physician who provides emergency room care in a rural setting.
>
> In written testimony supporting the bill, HMSA states that this "could
have
> a large impact for individuals in need of these services."
>
> But is it safe?
>
> Absolutely. Non-medical doctors, including dentists and optometrists, have
> safely pre- scribed medication within their areas of expertise for years.
In
> Hawaii, advanced practice nurses and physician assistants also prescribe
> medication.
>
> Moreover, psychologists are already prescribing in New Mexico, Louisiana,
> and within the Department of Defense. In Louisiana, psychologists have
> written more than 10,000 prescriptions without incident. In fact, there is
> no record of a patient being harmed by a prescribing psychologist in any
of
> these settings. Elaine Orabano Mantell, a DOD prescribing psychologist
since
> 1997, reports:
>
> "I have never had a single adverse outcome. I have never had a single
> complaint leveled against me with regard to any of my clinical work
> including my use of medications. On the contrary, I continue to receive
more
> referrals than any one individual can handle because the need for
treatment
> is so great."
>
> HB 2589 will require doctorate-level psychologists to undergo 4.5 years of
> intensive supervised training prior to prescribing a limited number of
> medications for our neediest individuals. This is in addition to the seven
> years of doctoral training in the diagnosis, assessment and treatment of
> mental and emotional disorders already required to become a licensed
> psychologist.
>
> This advanced curriculum is based on the recommendations of a blue-ribbon
> panel, which included input from psychiatry, pharmacology and psychology.
> And just as dentists and optometrists only prescribe medications related
to
> their expertise, appropriately trained psychologists would only prescribe
> medi-cines relating to mental health.
>
> But most importantly, this bill will improve the safety of the people of
> Hawaii by increasing access to high quality mental health care in
> underserved rural areas.
>
> But can we afford it?
>
> The bill will cost the taxpayer nothing. Psychologists are already working
> in the rural health clinics. The cost of additional training will be borne
> by the individual psychologists. The real question is, can we afford not
do
> this?
>
> We have nothing to lose but the artificial roadblocks that prevent our
most
> under-served populations from getting the care they need.
>
> Ken
article:
> "Prescription for better mental health care" by Beth Giesting.
>
> The author note states: "Beth Giesting is executive director of the
Hawaii
> Primary Care Association."
>
> Here's the article:
>
> WITH the stroke of a pen, Hawaii lawmakers have the power to improve
access
> to mental health care for tens of thousands of people -- an estimated
55,000
> -- served by nonprofit community health centers in our state's poorest and
> most underserved rural areas.
>
> Their need is dire, and the situation is getting worse.
>
> The solution is the Hawaii Primary Care Association's House Bill 2589,
which
> will allow appropriately trained licensed psychologists working at
community
> health centers to prescribe and adjust medication to treat mental health
> issues.
>
> These patients now wait from six weeks to three months to see a
> psychiatrist. On the neighbor islands, where the shortage of psychiatrists
> is most acute, many patients can't get an appointment at all. In 2005,
only
> five new psychiatrists finished their training in Hawaii, compared to 34
new
> psychologists. In 2004, there were only six psychiatrists serving three of
> Hawaii's 13 community health centers, compared to 10 psychologists serving
> nine of the centers.
>
> THE primary opposition to this bill comes from the state psychiatric
> association. This issue is not new to the Legislature. For more than a
> decade, psychiatrists have fought giving psychologists the authority to
> prescribe drugs by promising to improve care in rural areas, yet the
> situation remains dismal. There are simply not enough psychiatrists to go
> around, and as with many things in life, the poor and needy go without.
>
> This bill is widely supported by medical directors and administrators of
> community health centers and by the Hawaii Nurses Association, HMSA and
the
> Hawaii Psychological Association. Indeed, the bill was drafted by Rep.
Josh
> Green, vice chairman of the House Health Committee and a Big Island
> physician who provides emergency room care in a rural setting.
>
> In written testimony supporting the bill, HMSA states that this "could
have
> a large impact for individuals in need of these services."
>
> But is it safe?
>
> Absolutely. Non-medical doctors, including dentists and optometrists, have
> safely pre- scribed medication within their areas of expertise for years.
In
> Hawaii, advanced practice nurses and physician assistants also prescribe
> medication.
>
> Moreover, psychologists are already prescribing in New Mexico, Louisiana,
> and within the Department of Defense. In Louisiana, psychologists have
> written more than 10,000 prescriptions without incident. In fact, there is
> no record of a patient being harmed by a prescribing psychologist in any
of
> these settings. Elaine Orabano Mantell, a DOD prescribing psychologist
since
> 1997, reports:
>
> "I have never had a single adverse outcome. I have never had a single
> complaint leveled against me with regard to any of my clinical work
> including my use of medications. On the contrary, I continue to receive
more
> referrals than any one individual can handle because the need for
treatment
> is so great."
>
> HB 2589 will require doctorate-level psychologists to undergo 4.5 years of
> intensive supervised training prior to prescribing a limited number of
> medications for our neediest individuals. This is in addition to the seven
> years of doctoral training in the diagnosis, assessment and treatment of
> mental and emotional disorders already required to become a licensed
> psychologist.
>
> This advanced curriculum is based on the recommendations of a blue-ribbon
> panel, which included input from psychiatry, pharmacology and psychology.
> And just as dentists and optometrists only prescribe medications related
to
> their expertise, appropriately trained psychologists would only prescribe
> medi-cines relating to mental health.
>
> But most importantly, this bill will improve the safety of the people of
> Hawaii by increasing access to high quality mental health care in
> underserved rural areas.
>
> But can we afford it?
>
> The bill will cost the taxpayer nothing. Psychologists are already working
> in the rural health clinics. The cost of additional training will be borne
> by the individual psychologists. The real question is, can we afford not
do
> this?
>
> We have nothing to lose but the artificial roadblocks that prevent our
most
> under-served populations from getting the care they need.
>
> Ken
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edieb said:
4/7/2006 S The committee on CPH deferred the measure.
any idea what does that mean?
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- Mar 18, 2003
- Messages
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doctorpsych said:
Not this year.
Join Division 55 (www.division55.org) and you'll get the listserv. Plenty of action there.
5
50960
Psychologists Defeated in Hawaii Again
--------------------------------------------------------------------------------
From the Hawaii Medical Association
Opinion piece from the Honolulu Advertiser
I'm back working in the inpatient unit for a couple months. I recently saw one serious medication side effect that nobody could have predicted. Psychologists want to prescribe - even in hospitals. Who will do the workups and medical management when things go wrong? They're not qualified to do this, despite the rxp training. That's a fact.
For example, if a patient developed a serious medication side effect from a psychologist that prescribed on an inpatient unit, would they have to call the psychiatry resident to assess the patient and write medical orders? What if there's no psych resident? Many (most) attending psychiatrists will not want to be responsible for medical management of a patient that they did not treat initially on a floor. It doesn't make medical or financial sense.
__________________
--------------------------------------------------------------------------------
From the Hawaii Medical Association
Opinion piece from the Honolulu Advertiser
I'm back working in the inpatient unit for a couple months. I recently saw one serious medication side effect that nobody could have predicted. Psychologists want to prescribe - even in hospitals. Who will do the workups and medical management when things go wrong? They're not qualified to do this, despite the rxp training. That's a fact.
For example, if a patient developed a serious medication side effect from a psychologist that prescribed on an inpatient unit, would they have to call the psychiatry resident to assess the patient and write medical orders? What if there's no psych resident? Many (most) attending psychiatrists will not want to be responsible for medical management of a patient that they did not treat initially on a floor. It doesn't make medical or financial sense.
__________________
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psisci said:
Don't internists manage medical problems and psychiatrists manage psychiatric problems? Aren't psychiatrists specialists to whom internist refer patients referred when there is question regarding psychiatric functioning? If so, then why wouldn't psychologists with training in psychopharmacology be able to treat psychiatric symptoms in patients who have been medically cleared by internists or other primary care providers?
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PublicHealth said:
This a wonderful point, in my experience psychiatrists would refer anything possible to the staff internist. They would rarely handle non psychiatric medical questions. Of course, alot goes into the equation, but the way I've seen things work follow this model.
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- Messages
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- Reaction score
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PublicHealth said:
how did this happen? it sure seemed that HI was going to happen this year...
