A hasty state Legislature, rushing to finish a short session, just made Oregon the third state in the nation to allow psychologists to prescribe psychiatric drugs.
Gov. Ted Kulongoski should veto this half-baked bill. If he doesn't, the state medical board should work overtime to protect the safety of Oregon patients, especially children.
Today, the people who prescribe nearly all of the psychiatric drugs in Oregon are primary care doctors, psychiatrists and, on occasion, specially trained nurses. These high standards make sense. Psychiatric drugs interact in complex ways with other medication. Doses vary widely based on patients' weight, medical history and other factors.
Also, patients' mental health symptoms can be caused by underlying medical conditions (or by other medication). In short, prescribing psychiatric drugs is a lot more complicated than it looks on television, when someone in a field of flowers takes a pill and starts smiling again.
It's more like the end of the ad, when the announcer speedily lists all the ways that a drug might kill you.
Senate Bill 1046, which passed last week, would allow Oregon psychologists to get their own prescription pads. No doctor supervision would be required. Psychologists are only expected to "collaborate" with the "health care professional" who oversees the patient's medical care. The bill protects health care professionals from liability in all cases except those involving their own gross negligence or intentional misconduct.
Similar legislation has failed in at least a dozen other states in recent years, reflecting disagreements within the medical community and serious concerns over patient safety.
"The two big issues for us are training and oversight," says Bryan Boehringer, director of government affairs for the Oregon Medical Association, which joined the Oregon Pediatric Society in opposing the bill.
To be fair, Oregon's bill is more responsible than it sounds. It limits eligibility to psychologists with doctoral degrees -- a late concession won by the bill's critics. It grants the Oregon Medical Board the authority to require extensive training in pharmacology and to limit the types of drugs that psychologists can prescribe. And it creates a new task force to report back to the Legislature. With a lot more work, the idea could fly.
Yet the bottom line here is who gets to play doctor with people's brains, and under what circumstances. Lawmakers approved the experiment without insisting on supervision -- and without sufficient safeguards for children and other vulnerable patients.
"I don't know why we've done this," says Sen. Alan Bates, D-Ashland, an osteopathic physician who opposed the bill. "New Mexico did it. Louisiana did it. I don't know why we did."
It's understandable why lawmakers might be tempted to experiment, given the status quo. People in Oregon lack access to affordable and effective mental health care. Doctors lack time with their patients. Counseling as a treatment method doesn't get half the respect or insurance coverage it deserves.
It's also clear that patients would be better off if more doctors and psychologists could collaborate on cases and share their expertise. That holistic approach is the exception today, not the rule.
The trouble is that we're ending up with a health care system where everyone does someone else's job. Family doctors play counselor. Counselors play doctor. Patients play doctor too, asking for the drugs they saw on TV. Sorry, but this is nuts.
-- Associate Editor Susan Nielsen, The Oregonian