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The Honolulu Advertiser
Posted on: Saturday, April 8, 2006

Psychologists' bid denied

By Derrick DePledge
Advertiser Government Writer

Psychologists who wanted the limited ability to prescribe medication to their patients were turned down yesterday by a state Senate committee that needed more information about the effects on patient safety.

State Sen. Ron Menor, D-17th (Mililani, Waipi'o), chairman of the Senate Consumer Protection and Housing Committee, said he would ask the Legislative Reference Bureau to do an independent analysis and report back to lawmakers before the next session.

The study will likely look at the available research on giving psychologists prescriptive authority and measure the level of access to psychiatric care in poor and rural areas of the Islands.

Menor said he was also influenced by the state Board of Psychology, which supported the intent of the bill but had unresolved questions, and the fact that few other states allow psychologists to prescribe. New Mexico, Louisiana and the U.S. territory of Guam have given psychologists prescriptive authority, while the U.S. Department of Defense has operated a carefully supervised research program.

"I've always erred on the side of patient safety," Menor said.

The bill would have allowed psychologists who completed additional training to prescribe antidepressants and a limited number of other drugs to patients at federally qualified community health centers and at health clinics in medically underserved areas. The psychologists would have been required to work in consultation with primary-care or attending physicians.

But psychiatrists and some other medical doctors opposed giving psychologists the privilege, contending that patients could be placed at risk because psychologists do not have the same medical training as doctors.

While psychiatrists prevailed yesterday, lawmakers warned that they need to work together with psychologists to provide more access to psychiatric care.

State Sen. Rosalyn Baker, D-5th (W. Maui, S. Maui), scolded psychiatrists for promising to do more to serve poor and rural areas but repeatedly failing to deliver. She accused psychiatrists of making "outrageous and melodramatic" claims about patient safety and refusing to compromise with psychologists.

"It makes me believe that there is a huge lack of understanding of the realities that exist in many places of our state," Baker said.

Robin Miyamoto, a psychologist who works with the Waimanalo Health Center, described the bill as a "call for help from the community health centers."

"We're not trying to cut into psychiatrists' realm, we're trying to treat these patients that they don't have the means to treat," she said.

But several psychiatrists said people in poor or rural areas often have overlapping mental and physical health problems that may not be recognized by psychologists and could be compounded by improper medication.

"Our people deserve the best care available, not just Band-Aid solutions," said Dr. Cathy Bell, program director for child and adolescent psychiatry at the University of Hawai'i-Manoa.

Reach Derrick DePledge at ddepledge@honoluluadvertiser.com.