Honorable Robert Bunda

President of the Senate

Twenty-Third State Legislature

Regular Session of 2006

State of Hawaii

Sir:

Your Committee on Health, to which was referred H.B. No. 2589, H.D. 2, entitled:

begs leave to report as follows:

The purpose of this measure is to authorize psychologists who have obtained the appropriate education, training, and experience, to prescribe a limited formulary of psychotropic medications for the treatment of mental illness while practicing in federally qualified health centers or licensed health clinics located in federally designated medically underserved areas or in mental health professional shortage areas.

Your Committee received testimony in support of this measure from the American Psychological Association, the Hawaii Psychological Association, Hawaii Primary Care, the Hawaii Medical Service Association, the Molokai Community Health Center, the Waimanalo Health Center, the Waianae Coast Comprehensive Health Center, the Waikiki Health Center, Na Pu'uwai, Ohana Clinical Care Inc., the Louisiana Academy of Medical Psychologists, the Health Psychology Associates, and twenty seven individuals.

Your Committee received testimony in opposition to the measure from the Department of Health, the Department of Public Safety, the Board of Psychology, the Board of Medical Examiners, Hawaii Psychiatric Medical Association, the Hawaii Medical Association, the American Association of Applied and Preventive Psychology, the University of Hawaii at Manoa Department of Psychology, NAMI Oahu, Ho'ola Lahui Hawaii, the Hawaii County Council, the Hawaii Association of Osteopathic Physicians and Surgeons, the Hawaii Physicians and Surgeons Association, Inc., and ninety-seven individuals.

Your Committee finds that a significant gap in mental health care services needs to be filled, particularly on the neighbor islands and rural areas of Hawaii.

Your Committee further finds that despite the overwhelming need for behavioral health services, the number of psychiatrists serving Hawaii community health centers has not increased for decades. Conversely, in just four years, the number of licensed psychologists serving the community health centers has doubled. Enabling licensed psychologists who serve in federally qualified health centers, licensed health clinics located in federally designated medically underserved areas, or in mental health professional shortage areas to have limited prescriptive authority will appropriately address the mental health care needs of patients on the neighbor islands and in rural areas of the State. The community health centers are at a distinct disadvantage in recruiting mental health professionals due to limited financial resources. Therefore, these community health centers need clinicians who can perform a broad range of services.

Additionally, the individuals residing in the underserved areas are often poor and have a co-morbidity with a behavioral health component. To address this growing problem, the Waianae Coast Comprehensive Health Center began integrating behavioral health into its primary care clinics. Through the utilization of medical psychologists, the number of mental health and substance abuse encounters increased from 2,133 in 2002 to 15,108 in 2005, with no quality of care issues or provider care incident reports.

Your Committee further finds that testimony in opposition to this measure expressed concerns relating to the lack of adequate didactic and clinical training of psychologists if they were to have prescriptive authority.

Accordingly, your Committee amended this measure to address those concerns by requiring the applicant to:

(1) Hold a doctoral degree in Psychology;

Your Committee further amended this measure by:

As affirmed by the record of votes of the members of your Committee on Health that is attached to this report, your Committee is in accord with the intent and purpose of H.B. No. 2589, H.D. 2, as amended herein, and recommends that it pass Second Reading in the form attached hereto as H.B. No. 2589, H.D. 2, S.D. 1, and be referred to the Committee on Commerce, Consumer Protection, and Housing.