Honorable Robert Bunda

President of the Senate

Twenty-Third State Legislature

Regular Session of 2005

State of Hawaii

Sir:

Your Committee on Commerce, Consumer Protection, and Housing, to which was referred S.B. No. 1239, S.D. 1, entitled:

begs leave to report as follows:

The purpose of this measure is to authorize appropriately trained and supervised licensed medical psychologists working in federally qualified health centers or in other licensed health clinics located in federally designated medically underserved areas to prescribe psychotropic medications for the treatment of mental illness.

Testimony in support of this measure was received from the American Psychological Association, Hawaii Primary Care Association, Hawaii Psychological Association, Kokua Kalihi Valley Comprehensive Family Services, Louisiana Academy of Medical Psychologists, National Association of Social Workers, Molokai Community Health Center, Na Pu'uwai Native Hawaiian Health Care System, and numerous individuals.

The Hawaii Medical Association, Hawaii Psychiatric Medical Association, Medical Risk Management Associates, National Alliance for the Mentally Ill Oahu, and numerous individuals submitted testimony in opposition. The Department of Health, Board of Medical Examiners, Board of Psychology, and two individuals submitted comments.

This measure establishes a process for the issuance of a conditional prescription certificate and prescription certificate to enable qualified medical psychologists to prescribe psychotropic medications for the treatment of mental and emotional disorders. Under this process, certificate holders would be required to meet educational, experiential, and examination requirements, to apply for a federal drug enforcement license, to carry sufficient malpractice insurance, and to practice in federally qualified health centers or licensed health clinics located in federally designated medically underserved areas of the State. Additionally, conditional certificate holders would be allowed to prescribe only under the supervision of a physician, psychiatrist, advanced practice nurse, or nurse practitioner specializing in mental health care and would be required to maintain an ongoing collaborative relationship with a patient's physician.

Proponents of this measure argue that the State suffers from a shortage of psychiatrists, which negatively impacts access to quality medical care for Hawaii's residents, especially for the economically disadvantaged and the medically underserved in remote and rural areas. They refer to data from a federal Department of Defense (DOD) psychopharmacology demonstration project as evidence that appropriately trained psychologists can be trained to safely and effectively prescribe psychotropic medication. Supporters further note that community health centers and clinics have begun to integrate primary care and behavioral health services, and that allowing qualified psychologists to prescribe psychotropic medication in collaboration with primary care physicians would facilitate a more holistic and interdisciplinary approach to patient care that allows the treatment of both behavioral and physical conditions.

Opponents of this measure argue that without a foundation based in medical education and training, psychologists lack the proper knowledge and unique skills necessarily to safely and effectively prescribe psychotropic medications. Further, they question claims that there is a lack of adequate access to psychiatric care in the State's rural and remote areas and the drawing of conclusions in favor of granting psychologists psychotropic prescriptive authority based on evidence from the DOD demonstration project.

Your Committee finds that this measure raises numerous unresolved issues that require further review and consideration. Therefore, to facilitate continued discussion on these matters, your Committee has amended this measure by inserting an effective date of July 1, 2050.

As affirmed by the record of votes of the members of your Committee on Commerce, Consumer Protection, and Housing that is attached to this report, your Committee is in accord with the intent and purpose of S.B. No. 1239, S.D. 1, as amended herein, and recommends that it pass Third Reading in the form attached hereto as S.B. No. 1239, S.D. 2.