BILL NUMBER: SB 993 INTRODUCED
BILL TEXT
INTRODUCED BY Senator Calderon
FEBRUARY 23, 2007
An act to amend Section 2904 of, and to add Article 1.5
(commencing with Section 2919.10) to Chapter 6.6 of Division 2 of,
the Business and Professions Code, relating to healing arts.
LEGISLATIVE COUNSEL'S DIGEST
SB 993, as introduced, Calderon. Psychologists: scope of practice:
prescribing drugs.
Existing law, the Psychology Licensing Law, provides for the
licensure and regulation of the practice of psychology by the Board
of Psychology in the Department of Consumer Affairs. Existing law
excludes prescribing drugs from the scope of practice of a licensed
psychologist.
This bill would, with certain exceptions, authorize the board to
grant a prescription certificate or a conditional prescription
certificate to a licensed psychologist authorizing, within the scope
of practice of a psychologist, the prescription of certain drugs if
certain conditions are met.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. The Legislature finds and declares all of the
following:
(a) The delivery of comprehensive, accessible, and affordable
medical care may be enhanced by providing trained medical
psychologists, licensed in California, with limited prescriptive
authority for the specific purpose of providing integrated mental
health care services. The Legislature has previously authorized
prescription privileges to advanced nurse practitioners,
optometrists, dentists, podiatrists, osteopaths, physician
assistants, and naturopaths.
(b) Psychologists with appropriate credentials have been allowed
to prescribe medications to active duty personnel and their families
in military facilities for many years. Louisiana and New Mexico are
two states that have adopted legislation authorizing prescriptive
authority for psychologists.
(c) For many years, psychologists in California have been allowed
to discuss and recommend psychotropic medications to both patients
and physicians. California psychologists routinely collaborate with
primary care physicians to provide combined therapy and
psychopharmacological care for their patients. California
psychologists have independent hospital privileges.
(d) California licensed psychologists complete an average of seven
years of postbaccalaureate study and three thousand hours of
postgraduate supervised practice in the diagnosis and treatment of
mental illness. Medical psychologists have earned additional Master
of Science degrees in clinical psychopharmacology, or its equivalent,
and passed a national examination in psychopharmacology. Because the
current scope of medical psychologists' practice in California does
not include prescribing medications, patients must consult with and
pay for another provider to obtain the requisite prescription.
However, physicians are not readily available in many areas and for
minority populations.
(e) This is a particular hardship for patients residing in health
care treatment shortage areas and in rural areas. For patients who
require treatment in county and state mental health facilities,
including the Department of Corrections and Rehabilitation, medical
psychologists could eliminate the problem of access to care and
psychiatrist shortages while significantly enhancing mental health
treatment. Timely, efficient, and cost-effective treatment of mental
illnesses could avoid the significantly greater social, economic, and
medical costs of nontreatment for these needy populations.
(f) Research data soundly demonstrates that there is not enough
mental health care available to serve the needs of all people in the
California due to the severe shortages of psychiatrists. Further, the
economically disadvantaged and medically underserved would receive
little or no mental health services if not for the services provided
by clinical psychologists.
(g) The State of California has long recognized the
extraordinarily deficient mental health care of its citizens.
California has some of the highest rates of untreated psychological
concerns in the United States. Recent concerns include the
receivership of the prison system due to the state's inability to
provide adequate mental and physical health care to inmates. There
are several outstanding lawsuits against the State of California
alleging that inmates and patients at state mental hospitals are not
receiving constitutionally adequate mental health care due to the
severe shortage of competent psychiatrists.
(h) Further exacerbating the dire need for mental health treatment
in underserved areas is the fact that patients from diverse cultural
backgrounds are reluctant to seek treatment due to the stigma of
mental health problems. Timely access to accurate diagnosis and
effective treatment of emotional and behavioral disorders also may
contribute substantially to the state's responsibilities to children
and needy adults in underserved rural areas.
(i) Professional psychology has developed a model curriculum for
the education and training of prescribing psychologists. Independent
evaluations of the Department of Defense Psychopharmacological
Demonstration Project by the United States General Accounting Office
and the American College of Neuropsychopharmacology have found that
appropriately trained medical psychologists prescribe safely and
effectively. Two states, New Mexico and Louisiana, and the territory
of Guam, now allow appropriately trained psychologists to prescribe
psychotropic medications. Psychologists in the military have been
providing medication services to personnel and their families since
1990. Hundreds of thousands to over 1,000,000 prescriptions written
by psychologists with not one patient injured. This record far
exceeds the safety records of any prescribing class of professionals.
SEC. 2. Section 2904 of the Business and Professions Code is
amended to read:
2904. The practice of psychology shall not include
prescribing drugs, performing surgery or administering
electroconvulsive therapy. The practice of psychology shall not
include prescribing drugs, except as authorized pursuant to Article
1.5 (commencing with Section 2919.10) .
SEC. 3. Article 1.5 (commencing with Section 2919.10) is added to
Chapter 6.6 of Division 2 of the Business and Professions Code, to
read:
Article 1.5. Prescription Certificate and Conditional
Prescription Certificate.
2919.10. As used in this article the following terms have the
following meanings, unless the context otherwise requires:
(a) "Board" means the Board of Psychology.
(b) "Collaborative relationship" means a cooperative working
relationship between a psychologist holding a conditional
prescription certificate and a doctor of medicine in the provision of
patient care, including diagnosis and cooperation in the management
and delivery of physical and mental health care.
(c) "Narcotics" mean natural and synthetic opioid analgesics, and
their derivatives used to relieve pain.
(d) "Nonpsychotropic treating formulary" means any medication that
is labeled to treat adverse conditions caused by a psychotropic
medication.
(e) "Prescribing mental health professional" means a medically
trained and licensed physician, psychiatrist, advance practice nurse,
or nurse practitioner specializing in mental health care.
(f) "Psychotropic medication" means only those agents related to
the diagnosis and treatment of mental and emotional disorders,
including controlled substances, except narcotics.
2919.15. (a) A psychologist may apply to the board for a
conditional prescription certificate. The application shall be made
on a form approved by the board, and be accompanied by evidence
satisfactory to the board, that the applicant complies with all of
the following:
(1) Holds a current license in good standing to practice
psychology in the state.
(2) Has successfully completed a planned sequence of
psychopharmacological training from an institution of higher learning
approved by the board, or from a continuing education program
consistent with professional psychology's postdoctoral training in
psychopharmacology or has been recommended by the National Alliance
of Professional Psychology Providers. Any applicant who has received
a postdoctoral Master of Science degree in psychopharmacology from a
regionally accredited institution of higher learning, or an
educational institution approved by the state to provide this
education, or received a certificate of completion from an approved
provider of continuing education designated by the board to provide
this training to California licensed psychologists, shall be deemed
as meeting the requirements of this section. This training shall
include didactic classroom instruction in at least the following core
areas of instruction:
(A) Anatomy and physiology.
(B) Biochemistry.
(C) Neurosciences.
(D) Pharmacology.
(E) Psychopharmacology.
(F) Pathophysiology.
(G) Health assessment, including relevant physical and laboratory
assessment.
(H) Clinical pharmacotherapeutics.
(3) Has passed a national proficiency examination, approved by the
board, that tests the applicant's knowledge of pharmacology in the
diagnosis, care, and treatment of mental disorders. The board shall
establish what constitutes a passing score and the number of times an
applicant may retake the exam within a specific time period.
(4) Applies for a federal Drug Enforcement License for limited use
as restricted by state law.
(5) Meets all other requirements, as determined by rules adopted
by the board pursuant to obtaining a conditional prescription
certificate.
(b) The board shall issue a conditional prescription certificate
if it finds that the applicant has met the requirements of this
section.
2191.20. (a) A psychologist holding a conditional prescription
certificate may administer and prescribe psychotropic medication
within the recognized scope of the profession, including the ordering
and review of laboratory tests in conjunction with prescribing
medication for the treatment of mental disorders.
(b) When prescribing psychotropic medication for a patient, a
psychologist holding a conditional prescription certificate shall
maintain an ongoing collaborative relationship with the medical
practitioner who oversees the patient's general medical care to
ensure that necessary medical examinations are conducted, and to be
aware of any significant changes in the patient's physical condition.
(c) A prescription written by a psychologist with a conditional
prescription certificate shall do all of the following:
(1) Comply with applicable state and federal laws.
(2) Be identified as issued by the psychologist as a "Medical
Psychologist."
(3) Include the psychologist's board number or the identification
number assigned by the department of commerce and consumer affairs.
(d) A psychologist holding a conditional prescription certificate
shall not delegate prescriptive authority to any other person.
Records of all prescriptions shall be maintained in the prescribing
psychologists' patient records.
(e) When authorized to prescribe controlled substances, a
psychologist holding a conditional prescription certificate shall
file with the board in a timely manner all individual federal Drug
Enforcement Agency registrations and numbers.
2191.25. (a) A psychologist may apply to the board for a
prescription certificate. The application shall be made on a form
approved by the board and be accompanied by evidence satisfactory to
the board that the applicant complies with all of the following:
(1) Has been issued a conditional prescription certificate and has
successfully completed one year of prescribing psychotropic
medication.
(2) Holds a current license to practice psychology in California.
(3) Meets all other requirements, as determined by rule of the
board, for obtaining a prescription certificate.
(b) The board shall issue a prescription certificate if it finds
that the applicant has met the requirements of subdivision (a).
2191.30. A psychologist with a prescription certificate may
prescribe psychotropic medication if the psychologist complies with
all of the following:
(a) Continues to hold a current license to practice psychology in
California.
(b) Complies with the requirements set forth in paragraph (2) of
subdivision (a) of Section 2919.15.
(c) Annually satisfies the continuing education requirements for
psychologists, if any are set by the board.
2191.35. (a) By July 1, 2008, the board shall adopt rules
pursuant to establishing the procedures to be followed to obtain a
conditional prescription certificate, a prescription certificate, and
renewals of a conditional prescription certificate and prescription
certificate. The board may set reasonable application and renewal
fees.
(b) The board shall adopt rules pursuant to establishing the
grounds for denial, suspension, or revocation of a conditional
prescription certificate and prescription certificate including a
provision for suspension or revocation of a license to practice
psychology upon suspension or revocation of a conditional
prescription certificate or prescription certificate. Actions of
denial, suspension, or revocation of a conditional prescription
certificate or a prescription certificate shall be in accordance with
this chapter.
(c) The board shall maintain current records on every prescribing
psychologist, including federal registrations and numbers.
(d) The board shall provide to the California State Board of
Pharmacy an annual list of psychologists holding a conditional
prescription certificate that contains the information agreed upon
between the board and the board of pharmacy. The board shall promptly
notify the board of pharmacy of psychologists who are added or
deleted from the list.
(e) The board shall be the sole and exclusive administrative body
to implement and oversee this article.
2191.40. (a) This article shall not be construed to permit a
medical psychologist to administer or prescribe a narcotic.
(b) This article shall not apply to any of the following:
(1) Any person teaching, lecturing, consulting, or engaging in
research in psychology insofar as the activities are performed as
part of or are dependent upon employment in a college or university,
provided that the person shall not engage in the practice of
psychology outside the responsibilities of the person's employment.
(2) Any person who performs any, or any combination, of the
professional services defined as the practice of psychology under the
direction of a licensed psychologist in accordance with rules
adopted by the board, provided that the person may use the term
"psychological assistant," but shall not identify the person's self
as a psychologist or imply that the person is licensed to practice
psychology.
(3) Any person employed by a local, state, or federal government
agency in a school psychologist or psychological examiner position,
or a position that does not involve diagnostic or treatment services,
but only at those times when that person is carrying out the
functions of that government employment.
(4) Any person who is a student of psychology, a psychological
intern, or a resident in psychology preparing for the profession of
psychology under supervision in a training institution or facility
and who is designated by a title as "psychology trainee," "psychology
student," "psychology intern," or "psychology resident," that
indicates the person's training status; provided that the person
shall not identify the person's self as a psychologist or imply that
the person is licensed to practice psychology.
(5) Any person who is a member of another profession licensed
under the laws of this jurisdiction to render or advertise services,
including psychotherapy, within the scope of practice as defined in
the statutes or rules regulating the person's professional practice,
provided that the person does not represent the person's self to be a
psychologist or does not represent that the person is licensed to
practice psychology.
(6) Any person who is a member of a mental health profession not
requiring licensure, provided that the person functions only within
the person's professional capacities, and provided further that the
person does not represent the person to be a psychologist, or the
person's services as psychological.
(7) Any person who is a duly recognized member of the clergy;
provided that the person functions only within the person's
capacities as a member of the clergy; and provided further that the
person does not represent the person to be a psychologist, or the
person's services as psychological.