PointCounterpointState Bill 694, Calif. state Sen. Richard G. Polanco's (D-Los Angeles) proposed legislation granting prescriptive authority to California psychologists, is soon to be scheduled for an interim hearing (date and time to be announced). Now is as good a time as any to review the state's existing law, Polanco's proposition, history on the subject and what elements are not being addressed in the bill.
As it stands, the existing law:

(1) Provides for licensure and regulation of the practice of psychologists by the Board of Psychology (board) in the Department of Consumer Affairs (DCA), and the practice of pharmacy.

(2) Prohibits the practice of psychology from including prescribing drugs, and the pharmacy law prohibits any person other than a physician, dentist, podiatrist or veterinarian from prescribing or writing a prescription.

(3) Authorizes the board to refuse to issue any registration or license, or issue a registration or license with terms and conditions, or suspend or revoke the registration or license of any registrant or licensee if the applicant, registrant or licensee has been guilty of unprofessional conduct, as described.
In contrast, Polanco's legislation specifically would:

• Revise these provisions to authorize a certified psychologist, as defined, to prescribe or write a prescription.
• Require the board to administer a certification process to grant licensed psychologists the authority to write prescriptions, and to develop procedures for certification with the advice of the Certified Psychologist Advisory Committee, that the bill would also establish.
• Authorize the board to charge fees for the issuance of, and renewal of, a certificate, and would provide for the deposit of these fees in the Psychology Fund, a continuously appropriated fund, thereby making an appropriation.
• Set forth certification eligibility criteria, and would also require each applicant for an initial certificate for prescriptive authority to agree in a written statement under penalty of perjury to spend no less than 80% of his or her total time as a certified psychologist for three calendar years providing services to underserved populations, as defined.
• Require the board, in consultation with the committee, to establish requirements for renewal of a certificate, and continuing education requirements.
• Require the board to provide certain information to the Board of Pharmacy, including an annual list of psychologists certified to prescribe drugs.
• Require the board to encourage licensed psychologists to take continuing education courses in psychopharmacology and the biological basis of behavior.
• Require the board to encourage institutions offering doctorate degree programs in psychology to include education and training in psychopharmacology and related topics.
• Require the board to develop education and training guidelines for psychologists whose practices include patients who may require psychopharmacological treatment.
• Authorize the board to issue a certificate of completion to recognize knowledge of pharmacology and biological basis of behavior.
• Authorize the board to examine candidates in various areas of professional activity.
• Include as unprofessional conduct a violation of a provision of law relating to prescribing or dispensing drugs by a certified psychologist.

Background

Sponsored by the California Psychological Association, SB 694 is intended to address the "dire need for mental health treatment, specifically for medication, in rural counties with underserved populations throughout the state." The bill would allow doctoral-level psychologists who receive additional training and who are certified (pursuant to a certification process provided for in this bill and administered by the Board of Psychology) to prescribe medications that are recognized as effective for the treatment of patients served within the scope of practice for which psychologists are licensed.

To ensure that certified psychologists provide service to underserved populations, the bill requires that an applicant for certification sign an agreement to spend at least 80% of his/her total practice time for three calendar years immediately following certification providing service to underserved populations, as defined.

Polanco, coauthor of the bill, voiced his concerns about rural populations' limited access to prescribing physicians: "In California we have 14 counties in which not a single psychiatrist is listed by the American Board of Medical Specialties," he said. "There are 24 counties in the state with fewer than five psychiatrists. Not only are psychiatrists rare in some areas, but they are also more expensive, which further limits access."

The California Psychiatric Association (CPA), however, discounts this information indicating that the source of these numbers is out of date and inaccurate, and the numbers include only a little over half of California's psychiatrists. The CPA states that county lines are artificial boundaries and do not take into account the psychiatrists who "circuit ride" in less populous areas of the state.

The CPA's advocacy literature states: "The need for psychiatrists in rural California can be met by alternative methods of access to adequately trained psychiatrist physicians, such as by use of telemedicine; nondiscriminatory health care coverage by both managed care companies and MediCal; the recruitment efforts that have been undertaken by our association in cooperation with the counties; circuit riding; and perhaps through the establishment of a telemedicine hot line from the UC [University of California] hospital system, where consultations for primary care physicians with psychiatrists would be available 24 hours per day."