James E. Long, Jr.
The debate within the field of psychology regarding the right to prescribe psychotropic medication has persisted for the past two decades, with the American Psychological Association (APA) officially considering the matter beginning in 1989. Recent studies estimate that over 44 percent of Americans are prescribed at least one drug, and that 16.5 percent take at least three. In response to the growing debate, the APA established a task force to evaluate the "desirability and feasibility of psychopharmacology prescription privileges for psychologists." The task force proposed three levels of training in psychopharmacology, including recommended focus areas and curriculum requirements: (1) Level One - basic education; (2) Level Two - collaborative practice; and (3) Level Three - prescription privileges. The task force concluded that psychologists who provided mental health services should at least have access to level one training, and recognized an evolving "subspecialty of psychology with comprehensive knowledge and experience in psychopharmacology" that has the potential to dramatically improve patient care and treatment. In 1995, the APA Council of Representatives formally announced its objective to obtain prescription privileges, and called for the drafting of model legislation and training curriculum. The current APA model program for prescription privileges, in addition to completing an accredited doctoral program in professional psychology, requires a minimum of 300 contact hours of didactic instruction and supervised treatment of 100 patients, with no specified minimum length of training time required.
Despite what appears to be only a slight majority of support from the profession as a whole, the APA has largely been successful in spreading its initiative to the states. The cooperation and support of the state legislatures is a necessary requirement for the APA to achieve its goal, since the courts have long recognized the authority and autonomy of the states in regulating health care professionals. As of Spring 2002, after New Mexico became the first state to pass legislation enabling psychologists to obtain prescription privileges, state psychological associations in thirty-one states had assembled task forces to lobby their state legislatures to enact similar legislation that would create a special class within the licensed psychologists. Most recently, Louisiana became the second state to enact a similar law on May 6, 2004, creating a "medical psychologist" who may prescribe certain medications with the consultation of a primary care provider. The first part of this note will compare and contrast the two state statutes, New Mexico and Louisiana, which have enabled psychologists to prescribe certain medications upon completing specific requirements. In addition, the states' basis and purpose for enacting these laws will also be explored. The second part will discuss the debate over the prescription privilege from both sides, as it has evolved over the last twenty years. The third part will discuss the legal implications of a prescription privilege for psychologists, focusing mainly on liability and governmental regulation.
I. States Permitting Psychologists to Prescribe:
New Mexico and Louisiana
As previously mentioned, New Mexico became the first state to allow psychologists to obtain the right to prescribe psychotropic medication when House Bill 170 was signed into law on March 5, 2002, codified as "The Professional Psychologist Act." Under the Act, a psychologist may apply to the New Mexico State Board of Psychologist Examiners (NMSBPE) for a conditional prescription certificate. The applicant must hold a current license to practice psychology in New Mexico, and complete a doctoral program in psychology from either an accredited institution or a professional school. Subject to the approval of the NMSBPE and the New Mexico Board of Medical Examiners, the applicant must complete "pharmacological training from an institution of higher education" and pass a national certification examination testing his or her "knowledge of pharmacology in the diagnosis, care and treatment of mental disorders." Within five years preceding the date of his or her application, the applicant must have completed at least 450 hours of didactic instruction in certain core subjects. Additionally, the applicant must complete a physician supervised "80 hour practicum in clinical assessment and pathophysiology and an additional supervised practicum of at least 400 hours treating at least 100 patients;" all three training and instruction programs being subject to both Boards' approval. The Act also provides for further rules and requirements to be promulgated by the NMSBPE once it is has been established, e.g., the minimum amount of malpractice insurance which the NMSBPE has proposed to equal $1 million per occurrence and $3 million in aggregate liability. If the NMSBPE is satisfied with the application, they may grant a conditional prescription certificate that allows the psychologist to prescribe under the supervision of a licensed physician for a period of two years.
After the two-year conditional period has elapsed, the psychologist may then apply to the NMSBPE for a prescription certificate, enabling the psychologist to prescribe psychotropic medications to his or her patients without direct physician supervision. The NMSBPE may grant such a request if the applicant has passed an independent peer review approved by the NMSBPE and New Mexico Board of Medical Examiners, "holds a current license to practice psychology in New Mexico," and has complied with all other requirements that may be promulgated by the NMSBPE, e.g. carrying sufficient malpractice insurance. authority, the psychologist must continue to hold a valid license, complete at least twenty hours of continuing education requirements, and comply with any procedures for renewal of his or her certificate, i.e. annual fees. While the prescription certificate is certainly more independent authority than the conditional certificate, both are required to "maintain an ongoing collaborative relationship" with the patient's primary care provider pursuant to procedures to be developed by the NMSBPE.
Following New Mexico's lead, Louisiana became the second state to allow psychologists to obtain prescription privileges when House Bill 1426 was signed into law on May 6, 2004. The statute allows a licensed psychologist to apply for a certificate of prescriptive authority, becoming a "medical psychologist" if he or she has "successfully graduated with a post-doctoral master's degree in clinical psychopharmacology" and passed a national proficiency examination in psychopharmacology. A medical psychologist "shall prescribe only in consultation and collaboration with the patient's primary or attending physician, and with the concurrence of that physician." Further, additional consultation is required if the medical psychologist wants to change the patient's treatment, and a medical psychologist may not prescribe if a patient does not have a primary or attending physician. The Louisiana State Board of Examiners of Psychologists (LSBEP) is responsible for evaluating applications for certificates, renewals of certificates, and implementing procedures for both applications and renewals; there is no joint responsibility as there is in New Mexico. While the statute does not require any specific hours of clinical or didactic instruction (unlike New Mexico), it does require two additional curriculum concentration areas in anatomy and biochemistry, plus an additional ten hours of continuing education before renewal of a certificate is granted.
The most noticeable differences between the approaches of each state are found in the training requirements and collaboration with primary care providers. Louisiana's model places more reliance on the accredited institutions or professional schools to provide adequate instruction in psychopharmacology, while New Mexico's approach requires minimum amounts of instruction and a two-year trial period to ensure proper training. This model appears on its face to follow the APA model more strictly, however the deviance could be explained by the availability of psychopharmacology programs in each jurisdiction at the time each statute was enacted. Louisiana requires ten more hours of continuing education a year, in addition to post-doctoral training in anatomy and biochemistry. As for collaboration, Louisiana's approach is at least by statute more stringent, since a prescription may not be written without the primary health care provider's approval. New Mexico does have a skeleton structure to achieve collaboration between the prescribing psychologist and the primary physician, but their model relies on the Board to adopt rules to further this objective.
Notwithstanding statutory differences, the rationale for both in enacting legislation giving psychologists the right to prescribe under certain conditions was to provide increased mental health care to their citizens. In supporting this proposition, proponents of the privilege pointed to the lack of availability of psychiatrists - especially in rural areas, the lengthy wait times to receive mental care that ensued, and the fact that some psychologists were already recommending medications for their patients to their primary physicians.  Therefore a prescription privilege would be a logical step toward more efficient treatment and counseling. Opponents of this legislation raise concerns about the amount of training a prescribing psychologist would receive compared to a physician or psychiatrist who attends medical school, resulting in adverse effects to potential patients' safety and welfare. They also doubt whether prescribing psychologists would really increase health care in rural areas, citing lack of data proving such proposition and a survey showing that both psychologists and psychiatrists often already serve concurrent areas. While the aforementioned issues represent only a sample of propositions cited in the literature - at the very least - they illustrate the core arguments put forth by both sides of the debate on prescription privileges.
II. The Debate Over Prescription Privileges for Psychologists
The debate over prescription privileges has persisted for the past two decades within the field of psychology between clinical and academic psychologists, and also by concerned outsiders such as psychiatrists, physicians, and government officials. While variance does exist in the survey data, it appears that a slight majority of psychologists are in favor of the initiative by the APA to obtain prescription privileges, with anywhere from 9 to 62 percent of psychologists who would actually pursue the training. Essentially, the increased availability of psychotropic treatments to the public - especially in rural areas - and the proposition that prescription authority is the next logical step in the professional development of clinical psychology are the two prevailing arguments advanced by proponents of the APA's initiative. According to some opponents of prescription privileges for psychologists, there have never been objections to psychologists obtaining such authority under certain conditions - for example going to medical school or training in certain nursing programs. Thus, the main concern for opponents of laws granting prescription privileges - like the statutes enacted by New Mexico and Louisiana - is the risk to patients' safety and well-being resulting from inadequate training of psychologists to prescribe medication. Because they lack the medical background of other non-physician prescribers, e.g. nurse practitioners, dentists or podiatrists, opponents claim this illustrates a lower level of competence to prescribe safely. In addition to inadequate training, opponents also raise doubts as to whether a privilege would increase access to and the efficiency of mental health care. There are also underlying issues that influence this debate, such as the increased cost of health care, pressure from pharmaceutical companies, and accusations from either side that the other is improperly motivated by economic gain rather than patient well-being.
Proponents of a prescription privilege, similar to the model advocated by the APA and enacted in New Mexico and Louisiana, seek to improve the quality of mental care by granting psychologists the right to prescribe psychotropic medications under certain conditions. Proponents argue that with instruction in psychopharmacology, like the curriculum advocated by the APA, psychologists can safely and effectively treat their patients' mental health through independent prescription privileges. As authority for this proposition, proponents often point to the Department of Defense Psychopharmacology Demonstration Project (PDP), which successfully trained psychologists to prescribe psychotropic medications in military health situations. Psychologists are the most highly trained specialists in the treatment of mental health; however, it is the general practitioner or family physician who writes approximately 80 percent of the prescriptions for psychotropic medications. Another aspect of the proponent's argument is the lack of availability or efficiency of mental health care, due to the nonexistence of conveniently located psychologists and long waiting times to see physicians. Proponents argue that allowing patients to see the same provider for both diagnosis and treatment would not only reduce the cost of health care, but would increase the availability of quality mental health treatment, including "underserved segments of society, such as minority children, those living in rural areas, and those living in chronic care facilities." According to one clinical psychologist, the non-clinician or academic psychologist does not experience the "deep frustration full-time clinicians face every day when attempting to find someone" to prescribe appropriate psychotropic medications to their patients in a timely fashion. In short, psychologists are highly trained mental health practitioners. When given the opportunity to receive additional instruction in psychopharmacology, they can prescribe medications safely and effectively to their patients, increasing the quality and availability of health care to society.
The most prevalent argument advanced against a prescription privilege for psychologists is the discrepancy in training and educational background between psychologists and prescribing professionals, and the ensuing risk of suboptimal care to patients that could result. While proponents point to prescribing non-physicians - such as podiatrists, dentists and nurse practitioners - the opponents counter with the fact that all of these specialists have undergraduate and graduate degrees that concentrate in courses relevant to a medical background, whereas a majority of psychologists do not. Because of their different educational backgrounds, opponents often claim that psychologists will require more training than currently proposed in order to handle the inherent complexities in drug interactions. The argument is that professionals with knowledge acquired from a medical background are better equipped to identify and resolve such problems. Opponents are critical of the APA's proposed training model because it is significantly shorter than what is required of a board-certified psychiatrist and approximately half the amount of training received by the PDP participants. Besides the reliance placed on the PDP experiment by proponents who argue its success justifies extending prescription privileges to other psychologists, even under a model with fewer training requirements; opponents are also critical of the applicability of the PDP results to the general population outside the military setting. Further, the discrepancies in training also raise questions regarding the prescribing psychologist's ability to recognize and predict adverse medication effects. "Psychoactive medications have been described as presenting more complex drug interactions and adverse effects than any other class of drug," thus given the dearth of studies done to substantiate the ability of psychologists to prescribe competently and the discrepancies in their knowledge and education, opponents doubt that abbreviated training would assure public safety. Several opponents also raise concerns that the additional training required for prescribing psychologists will have adverse effects on the educational institutions: increasing costs and replacing other psychology specific courses with psychopharmacology classes. Proponents of the privilege challenge the opposition's reliance on the medical model of training as over inclusive, arguing that the critical question is "what additional educational knowledge is actually, and not theoretically, required?"
Opponents of the prescription privilege also assert that arguments surrounding the general practitioner or primary physician's role in the treatment of mental health by prescribing psychotropic medication are actually quite misleading. While it is true that non-psychiatric physicians receive little mental health training during medical school, they also receive four-to-six years of medical and pharmacological training during medical school. The statistics that show a high percentage of psychotropic medications were prescribed by non-psychiatrists could be explained by the physician's role as the front-line or primary care provider, and there is no evidence that this distribution is problematic. Therefore, opponents assert that a more logical solution than giving highly trained mental health practitioners prescription privileges, would be to increase mental health training for general practitioners and encourage collaboration between the two professions. Additionally, opponents argue that prescription privileges will actually increase costs - both in the treatment of patients and in the training of prescribing psychologists. They also question the proponents' assertion that prescription privileges will serve societal needs, since there is little or no evidence that psychologists will relocate and cater to rural areas not already served by other prescribers or that needs are not already adequately being served by the medical professionals in existence. Another remote area of concern is the possibility of self-prescription abuse by psychologists - especially given the high rates of suicide by other prescribing professionals.
As described by the APA Task Force, collaboration between psychologists and prescribing professionals is located in the middle of a continuum ranging from basic understanding to independent prescriptive authority in psychopharmacology. Presently, collaboration between psychologists and other medical professionals exists in many forms, such as "care sharing," referrals, teaching and hospital management. Opponents of the privilege often cite Level Two, or collaboration efforts as the appropriate scope of psychologist training and practice, and argue that pursuing privileges will disrupt these collaborative efforts by placing the two professions at odds with each other. However, the proponents take different angles on collaborative efforts; some glossing over its importance, others arguing collaboration disrupts continuity of care, and a few recognizing its importance even if psychologists are granted prescribing authority. Often at the heart of the collaborative process is the psychologist who recommends medication for his patient to the primary physician or psychiatrist - thus acquiring the right to prescribe would seemingly be the next logical step. Several proponents view independent prescription privileges for psychologists as simply the natural evolution of the profession, a development that will continue to preserve their professional identity. They argue that the training model endorsed by the APA will preserve their professional identity. They argue that the training model endorsed by the APA will preserve their professional identity by "ongoing efforts to ensure that prescribing psychologists embrace a more integrative or psychological model of prescribing" and "specific training for psychopharmacology practice will occur at the postdoctoral level." Further, "[n]ot all health care psychologists would be trained to prescribe; not all psychologists would be required to prescribe; and only psychotropic medications would be in the formulary." There is also evidence that within the field of health psychology, responsibility for the patient's primary care is moving from serving as a consultant toward primary-care managers, calling for "a paradigm shift in conceptualization and training." Acquiring the right to prescribe medication would be consistent with a trending paradigm shift toward primary care responsibilities.
Many proponents of the prescription privilege initiative are not discouraged by the percentage of their colleagues who oppose such legislation; rather they acknowledge that debate has existed for over 100 years surrounding the appropriate scope and competence of their practice, maturing as a health profession. Further, some believe that the split of opinion stems from an age-old tension between academic and applied psychology, not from any rational basis in the opponents' arguments. Some proponents also point a suspecting finger at the motive of psychiatrists, and even physicians, in their opposition toward prescription privileges for psychologists, stating that "[a]t every juncture in our practice history, psychiatry's public and lobbying position was that psychologists were a hazard to public health." Courts have also recognized this problem. For example, in Virginia Academy of Clinical Psychologists v. Blue Shield of Virginia, the court stated "it is not the function of a group of professionals to decide that competition is not beneficial in their line of work," and courts are not inclined to allow anticompetitive activities simply because it is "good medical practice." These possible improper economic motives, coupled with psychiatry history of defiance toward any expansion of the scope of psychology, raise doubt as to the validity and motive of some of the groups that oppose prescription privileges for psychologists.
III. Legal Implications of the Prescription Privilege for Psychologists
One legal issue affected by a prescribing psychologist would be the appropriate standard in an action for professional negligence, or malpractice. In a claim for damages caused by a psychologist's actions, the plaintiff must establish the traditional elements of negligence: standard of care, breach of duty, causation and injury. The question when examining a prescribing psychologist, or any non-physician with prescription writing abilities for that matter, is whether the appropriate standard of care is similar to that of a physician or psychiatrist, or is the "reasonably prudent, similar professional standard" to be applied. From a patient/consumer standpoint, the standard of a physician or psychiatrist would be more beneficial since it "would promote accountability and afford greater protections and legal remedies" than a standard calculated to represent the lower levels of training received by prescribing psychologists. This standard may also be appealing given the concurrent activities of prescribing now being performed by both psychiatrists and psychologists, and the patient's reliance on the expertise of a prescribing professional, regardless of their actual training. The "psychiatrist/physician" standard would certainly find support from the opponents of the prescription privilege movement, especially given the similarities between a psychiatrist and a prescribing psychologist and the resulting comparison of training programs. At least one state legislature has recognized that certain prescribing non-physicians should be held to the same standard of care that physicians owe when prescribing medications.
Nevertheless, it appears the courts have been reluctant to apply this higher standard to the less educated non-physician prescriber. Therefore, courts are likely to apply the similar professional standard, which would consider the amount of training the prescribing psychologists received in psychopharmacology, judging the reasonableness of their actions in light of other prescribing psychologists in their state. The problem with this standard is it awards patients a lower amount of care just by seeing a psychologist who now performs tasks that were previously exclusive to psychiatrists or physicians. In order to establish all the elements of their malpractice action, the plaintiff must show the appropriate standard of care for a prescribing psychologist through expert testimony, presumably by another prescribing psychologist. There could be liability issues involving negligence in the choice of prescription, failure to warn or treat side effects, and failure to recognize or anticipate various drug interactions. These potential pitfalls are directly related to competence to prescribe, one of the chief concerns of opponents of prescription privileges for psychologists, and thus illustrate their concern for public safety. The increase of potential liability would require prescribing psychologists to maintain malpractice insurance, either with greater coverage amounts or incur more expensive premiums reflecting appropriate levels of additional risk, similar to the insurance that is required of psychiatrists.
There may also be legal issues created by the enabling statute, such as the scope of the prescribing psychologist's authority, the requirements to maintain a prescriptive license and the available drugs in the formulary. As for scope of authority, for example a prescribing psychologist under Louisiana law can only write a prescription with the primary physician's approval, while there is no such requirement in New Mexico once a prescribing certificate has been obtained. There are also varying requirements, such as amounts of continuing education, in order to renew one's license to prescribe medication pursuant to each statute. Additionally, under New Mexico law, the supervising physician is also responsible, assumingly joint and severally liable, for all acts and omissions of the conditional-prescribing psychologists. All of these issues are more policy-oriented, and will undoubtedly vary from state-to-state when more statutes like New Mexico and Louisiana's are enacted.
Another legal area that will be affected by prescription privileges for psychologists is the increased regulation from the state and federal level. Like the other issues previously discussed, the bodies responsible for regulation at the state level will likely vary by statute, with at least one board or agency responsible for direct regulation of the new class of psychologists. They will be responsible for setting training standards, approving applicants, issuing and revoking licenses to prescribe psychotropic medications. In addition to the mandated boards, any agency at the federal or state level with regulatory powers over the administration, prescription, or production of psychotropic medications will have some indirect regulatory authority over prescribing psychologists. The federal regulators include the Drug Enforcement Agency, which both New Mexico and Louisiana's statutes explicitly recognize, and indirectly the Food and Drug Administration. Additionally, there could be potential criminal penalties from the improper use or distribution of psychotropic medications by prescribing psychologists. Indeed this risk was likely anticipated by Louisiana's legislature in excluding all narcotics from the authorized formulary available to the Medical Psychologists.
IV. Conclusion: Should Alabama Consider Similar Legislation
Granting Prescription Privileges to Psychologists?
Like New Mexico, a comparatively large percentage of Alabama's population resides in rural areas, approximately one-third according to one study. There is also evidence that persons residing in rural areas are in poorer health and receive less health care when compared to their urban counterparts. According to many proponents of prescription privileges, this newly created prescribing psychologist would alleviate some of the rural discrepancy by providing necessary mental health treatment in rural areas. However, this proposition assumes that either prescribing psychologists will relocate to rural areas, or that psychologists already practice in rural areas and will acquire the necessary training to be able to prescribe. Until studies are done showing that either of these two conditions occurred in either New Mexico or Louisiana, or would likely occur in Alabama if a prescription privilege were adopted, the safer course of action is to watch the programs in Louisiana and New Mexico until accurate and reliable data can be obtained. While theoretically a prescription privilege may be a safe and efficient means to provide more affordable health care, the uncertainties regarding training programs, interest, competence of psychologists to prescribe, and costs of implementation all establish that this legislation should not be pursued until the uncertainties are replaced with empirical data. Learning from the results of New Mexico and Louisiana's state laws would allow Alabama legislators to better assess the cost and benefits of a prescription privilege for psychologists. This will lead to a more accurate understanding of the implications of the privilege on the overall health of Alabama citizens, the possible improved standards of care for rural areas, and the anticipated cost burden of the state and its taxpayers. At the present, Alabama should not rush to legislate a power to prescribe for their psychologists.
James E. Long, Jr. is a third-year student at the University of Alabama School of Law. He has been an editor of the Law & Psychology Review for two years, currently serving on the managing board as a Student Articles Editor. The Law & Psychology Review is a law journal that addresses the interplay between the disciplines of law and psychology. Founded in 1975 by law students of the University of Alabama who were concerned with the rights of the mentally disabled, the Law & Psychology Review was one of the first journals to combine the disciplines of law and the behavioral sciences.
This article was reprinted with permission from the Law & Psychology Review, Vol. 29 pp.243-60 (Spring 2005), published by the University of Alabama School of Law.
1. Robert J. Resnick & John C. Norcross, Prescription Privileges for Psychologists: Scared to Death?, 9 Clinical Psychol.: Sci. & Prac. 270, 272 (2002).
2. Randolph E. Schmid, More Than 40 Percent of Americans Using Prescription Drugs, at http://www.freep.com/ news/latestnews/pm1622_20041202.htm (Dec. 2, 2004).
3. William N. Robiner et al., Prescriptive Authority for Psychologists: A Looming Health Hazard?, 9 Clinical Psychol.: Sci. & Prac. 231, 231 (2002).
4. See id. See generally Michael A. Smyer et al., Summary of the Report of the Ad Hoc Task Force on Psychopharmacology of the American Psychological Association, 24 Prof. Psychol.: Res. & Prac. 394, 403 (1993) (presenting a more detailed summary of the task force's recommendations and findings).
5. See Smyer et al., supra note 4, at 402-03 (recommending level one education, i.e., psychopharmacology class, as a required course in APA accredited doctoral psychology programs and encouraging its availability in continuing education programs for existing graduates).
6. See Resnick & Norcross, supra note 1, at 273. See also Robiner et al., supra note 3, at 232.
7. See Robiner et al., supra note 3, at 237-38. In June 2001, the "Association of State Boards of Psychology accepted the APA guidelines for psychopharmacology training as the standard to implement when states pass enabling legislation for psychologists to prescribe." John Caccavale, Opposition to Prescriptive Authority: Is This a Case of the Tail Wagging the Dog?, 58 J. Clinical Psychol. 623, 623 (2002).
8. See Glenn D. Walters, A Meta-Analysis of Opinion Data on the Prescription Privilege Debate, 42 Canadian Psychol. 119, 121 (2001) (finding 52 percent in favor of the prescription privilege and 35 percent opposed to such a privilege; "[H]owever, the difference was not greater than what could be expected by chance.").
9. See, e.g., Dent v. West Virginia, 129 U.S. 114, 121-24 (1889). See also Elizabeth A. Cullen & Russ Newman, In Pursuit of Prescription Privileges, 28 Prof. Psychol.: Res. & Prac. 101, 101 (1997).
10. Jim Rosack, New Mexico Signs Nation's Only Psychologist-Prescribing Law, 37 Psychiatric News 1, 1-2 (2002). Other states that have recently reintroduced similar legislation include: Georgia, Tennessee, Illinois, and Hawaii. Id. States that have introduced legislation in the past include: Alaska, California, Arizona, Montana, Texas, Missouri, and Massachusetts. Id. Additional states where psychological associations have task forces actively pursuing privileges include: Oregon, Washington, Utah, Wyoming, Nebraska, Oklahoma, Mississippi, Ohio, Michigan, Virginia, Maryland, Pennsylvania, New Jersey, New York, New Hampshire, Vermont, Connecticut, Rhode Island, and Florida. Id.
11. See La. Rev. Stat. Ann. § 37:2371-2378 (West 2004). See also Medical Psychologists Attain the Right to Prescribe, Louisiana Psychol. (La. Psychologist Ass'n, Baton Rouge, La.), May, 2004, at 2 [hereinafter Medical Psychologists].
12. Psychotropic medication is defined as: [A] controlled substance or dangerous drug that may not be dispensed or administered without a prescription and whose primary indication for use has been approved by the federal food and drug administration for the treatment of mental disorders and is listed as a psychotherapeutic agent in drug facts and comparisons or in the American hospital formulary service. N.M. Stat. Ann. § 61-9-3(F) (Michie 1978).
13. H.B. 170, 45th Leg., Reg. Sess. (N.M. 2002). See Rosack, supra note 10, at 1.
14. N.M. Stat. Ann. § 61-9-1 (Michie 1978).
15. Id. at § 61-9-17.1(A).
16. See id. at § 61-9-4.1 (requiring a license to practice psychology). See also id. at § 61-9-8 (describing information regarding proceedings and license applications that must be made on the record by the NMSBPE; records are public unless otherwise indicated in the Act); id. at § 61-9-10 (explaining the procedures for granting a license without a written or oral exam if applicant is licensed or certified by another state); id. at § 61-9-11 (listing the qualifications required for licensing, including examination procedures).
17. See id. at § 61-9-17.1(A)(1)-(2). Even if the graduate program was not accredited upon the applicant's graduation, the program may still satisfy if the NMSBPE determines it meets professional standards. Id.
18. Id. at § 61-9-17.1(A)(3)-(4).
19. Id. at § 61-9-17.1(A)(5)(a)-(g). Required areas of instruction include: neuroscience, pharmacology, psychopharmacology, physiology, pathophysiology, appropriate and relevant physical and laboratory assessment, and clinical pharmacotherapeutics. Id.
20. See N.M. Stat. Ann. § 61-9-17.1(A)(5)-(6) (Michie 1978).
21. Id. at § 61-9-17.1(A)(7)-(8). See also HB 170 Joint Comm., Final Report of the Joint Committee for HB 170: Prescriptive Authority to Psychologists Act of 2002, H. 45-1, Reg. Sess., at 1 (N.M. 2002), available at http://www.nmpsych.org/report_hb_170.htm (last visited Feb. 23, 2004) [hereinafter Final Report].
22. See N.M. Stat. Ann. § 61-9-17.1(B) (Michie 1978) (allowing prescription privileges as long as their license is valid and they select a supervising physician); id. at § 61-9-17(B). See also Final Report, supra note 21 (proposing the idea of supervisory physicians).
23. See N.M. Stat. Ann. § 61-9-17.1(C) (Michie 1978).
24. Id. at § 61-9-17.1(C)(1)-(4). See also Final Report, supra note 21 (proposing additional requirements to obtain a prescription certificate).
25. See N.M. Stat. Ann. § 61-9-17.1(D)-(E) (Michie 1978)
26. See id. at § 61-9-17.2(B) (Michie 1978). See also Final Report, supra note 21 (proposing an ongoing collaborative relationship with primary care providers).
27. See La. Rev. Stat. Ann. § 37:2371 (West 2004). See also H.B. 1426, 2004 La. Sess. Law Serv. (La. 2004); Medical Psychologists, supra note 11, at 1.
28. La. Rev. Stat. Ann. § 37:2371(4), 2373 (West 2004).
29. Id. at § 37:2375(C)(1).
30. Id. at § 37:2375(C)(1)-(2).
31. Id. at § 37:2372(1)-(3).
32. Compare id. at § 37:2372(1)-(3) (requiring approval of licenses only by the LSBEP), with N.M. Stat. Ann. § 61-9-17.1(A)(5)-(6) (Michie 1978) (requiring approval by both the NMSBPE and the New Mexico Board of Medical Examiners).
33. See La. Rev. Stat. Ann. §§ 37:2372(2), 2374(B) (West 2004).
34. See id. at § 37:2373(2).
35. See N.M. Stat. Ann. § 61-9-17.1(A)-(B) (Michie 1978).
36. Compare La. Rev. Stat. Ann. §§ 37:2372(2) (West 2004) (listing Louisiana's required areas of instruction), and id. § 37:2374(B) (requiring 30 hours of continuing education), with N.M. Stat. Ann. § 61-9-17.1(A)(5) (Michie 1978) (listing New Mexico's required areas of instruction), and id. at § 61-9-17.1(D)(2) (setting the minimum requirement of continuing education at 20 hours).
37. This comparison becomes relevant when a psychologist has passed the two-year conditional period, since all of their prescription writing up until that point was directly supervised by a physician. See id. at § 61-9-17(B)-(C).
38. See id. at § 61-9-17.2(B).
39. See, e.g., Medical Psychologists, supra note 11, at 4 (Louisiana); Rosack, supra note 10, at 2 (New Mexico).
40. See Medical Psychologists, supra note 11, at 4; Rosack, supra note 10, at 2-3 (noting that in New Mexico while only about 60 out of 250 psychiatrists practice in rural areas, 61 percent of the 1.8 million residents live in rural areas).
41. See Medical Psychologists, supra note 11, at 4-5; Rosack, supra note 10, at 4.
42. See, e.g., Medical Psychologists, supra note 11, at 4, Rosack, supra note 10, at 2.
43. See Rosack, supra note 10, at 3-4.
44. For example, the entire June 2002 edition of the Journal of Clinical Psychology was devoted to presenting each side of the debate between psychologists, with the APA supporting legislation and the American Association of Applied and Preventive Psychology (AAAPP) opposed to legislation granting a prescription privilege. Elaine M. Heiby, Prescription Privileges for Psychologists: Can Differing Views Be Reconciled?, 58 J. Clinical Psychol. 589, 589 (2002). See also Peter M. Gutierrez & Kenneth R. Silk, Prescription Privileges for Psychologists: A Review of The Psychological Literature, 29 Prof. Psychol.: Res. & Prac. 213 (1998).
45. See, e.g., Walters, supra note 8, at 119; Rosack, supra note 10, at 1-4.
46. One survey found that only 9 percent of supportive psychologists would actually pursue the prescription privilege if available. John Winston Bush, Prescribing Privileges: Grail for Some Practitioners, Potential Calamity for Interprofessional Collaboration in Mental Health, 58 J. Clinical Psychol. 681, 692 n.7 (2002). However, a meta-analysis conducted by another researcher resulted in 52 percent in favor of the prescription privilege. Walters, supra note 8, at 121. According to one survey of 302 PhD and PsyD students in clinical psychology, 62 percent would personally pursue a prescription privilege if available. Id. at 120.
47. See, e.g., Elaine M. Heiby et al., A Debate on Prescription Privileges for Psychologists, 35 Prof. Psychol.: Res. & Prac. 336, 337, 342 (2004); Kim L. Lavoie et al., Should Psychologist Be Granted Prescription Privileges? A Review of the Prescription Privilege Debate for Psychiatrists, 47 Canadian J. Psychiatry 443, 445-46 (2002); Mary Ann Norfleet, Responding to Society's Needs: Prescription Privileges for Psychologists, 58 J. Clinical Psychol. 599 (2002); Resnick & Norcross, supra note 1, at 271-73; Ralph S. Welsh, Prescription Privileges: Pro or Con, 10 Clinical Psychol.: Sci. & Prac. 371, 371-72 (2003).
48. See Heiby, supra note 44, at 596; Heiby et al., supra note 47, at 338.
49. See, e.g., Heiby, supra note 44, at 595; Heiby et al., supra note 47, at 338; Lavoie et al., supra note 47, at 446-47; Robiner et al., supra note 3, 234-239. See generally Brent Pollitt, Fool's Gold: Psychologist Using Disingenuous Reasoning to Mislead Legislature's Into Granting Psychologists Prescriptive Authority, 29 Am. J.L. & Med. 489 (questioning the validity and attempting to disprove five common arguments put forth by proponents of a prescription privilege for psychologists).
50. See, e.g., John Winston Bush, Prescription Privileges: Comments on Robiner et al., 9 Clinical Psychol.: Sci. & Prac. 443, 444 (2002); Heiby, supra note 44, at 595; Heiby et al., supra note 47, at 338; Lavoie et al., supra note 47, at 446-47; Robiner et al., supra note 3, 234-239; Id. at 242-44; William N. Robiner et al., Prescriptive Authority for Psychologist: Despite Defects in Education and Knowledge?, 10 J. Clinical Psychol. Med. Settings 211 (2003) (analyzing a statistical comparison between education and training of doctoral level psychologists and psychiatric residents).
51. See Robiner et al., supra note 3, at 240-42. Opponents assert that evidence showing that access to psychiatrist and psychologist typically overlaps even in rural areas, the fact that few psychologists will actually pursue the prescription privilege, and the "absence of any concrete plan to redistribute prescribing psychologist to meet the actual needs of undeserved populations" refutes the proponents claim of increased access of mental health care in rural areas. Id. at 240 (citation omitted). Further, "broadening psychologists' scope of practice to include prescriptive authority [is] an indirect, needlessly risky, and highly inefficient public policy response to rural areas' shortage of psychopharmacologic prescribers." Id. See also George W. Albee, Just Say No to Psychotropic Drugs!, 58 J. Clinical Psychol. 635 (2002).
52. See Lavoie et al., supra note 47, at 445.
53. See David O. Antonuccio et al., Psychology in the Prescription Era: Building a Firewall Between Marketing and Science, 58 American Psychol. 1028 (2003) (proposing a barrier between the science behind prescription drugs and their economic incentives to the pharmaceutical industry, since the extensive influence that the industry possesses on markets, regulators, medical education, consumer advocates, etc., has created conflicts of interest that are harmful to both education and research); Lavoie et al., supra note 47, at 445. See also Norfleet, supra note 47, at 601 (noting that pharmaceutical companies "apparently anticipate the dawn of prescription privileges for psychologists, since several of them have had booths at the APA convention for the past few years").
54. See Albee, supra note 51, at 636 (proponents may be motivated by the desire to recoup lost revenues from refusal of managed health care providers to pay for traditional psychological treatments); Bush, supra note 50, at 445-46 (opposing tactics employed by APA in pushing their prescription privilege agenda); Norfleet, supra note 47, at 601 ("As other professions gain greater prescriptive rights, they will be less inclined to support psychology obtaining prescriptive authority.") (citation omitted). Psychologists could be motivated to increase their scope of practice to raise their personal revenue potentials, while psychiatrists and physicians could be attempting to protect their own market by blocking potential competitors.
55. See Ronald F. Levant & A. Eugene Shapiro, Training Psychologist in Clinical Psychopharmacology, 58 J. Clinical Psychol. 611 (2002).
56. See, e.g., Heiby, supra note 44, at 591-594; Resnick & Norcross, supra note 1, at 273.
57. Robiner et al., supra note 3, at 232-33. "The PDP ultimately trained ten psychologists to prescribe in military health care settings." Id. at 232 (citation omitted). The program lasted for four years beginning in 1991, its final curriculum consisting of one year of coursework and a year of supervised clinical practice, whereas the initial program contained an additional year of coursework. See id.; Bush, supra note 50, at 445. A report evaluating the PDP graduates stated that they "filled critical needs, and performed with excellence wherever they served." Resnick & Norcross, supra note 1, at 270 (citation omitted).
58. See Heiby, supra note 44, at 592; David Hines, Arguments for Prescription Privileges for Psychologists, 52 Am. Psychol. 270, 270-71 (1997); Norfleet, supra note 47, at 605 ("psychology has the largest number of doctoral level mental health providers in this country").
59. Patrick H. DeLeon & Jack G. Wiggins, Jr., Prescription Privileges for Psychologists, 51 Am. Psychol. 225, 228 (1996); Lavoie et al., supra note 47, at 445 (general practitioners "typically receive only 4 to 12 weeks' training in mental health"). See also Resnick & Norcross, supra note 1, at 273 ("[n]on-psychiatric physician's training in mental health is, on average, only 6.8 weeks" during the third year of medical school). Another contributing factor to the proponent's concern is the high percentage of patients who are misdiagnosed or over medicated for psychological disorders, for example according to one study "depression is misdiagnosed 30% to 50% of the time." See Lavoie et al., supra note 47, at 445.
60. See, e.g., Heiby, supra note 44, at 501-02; Norfleet, supra note 47, at 604-07; Resnick & Norcross, supra note 1, at 273; Welsh, supra note 47, at 372. Advancements in neuroscience have resulted in the development of new medications, and because psychologists have been heavily involved in the basic science in which these drugs are based, they would be able to provide valuable services to consumers. See Hines, supra note 58, at 271. Additionally, prescription privileges would reduce the fragmentation of mental health care that exists today. See id.
61. See Norfleet, supra note 47, at 604-05. "One-stop shopping" reduces cost in the private sector by paying for only one visit, instead of paying for treatment and medication consultations in two separate visits. See id.
62. See Lavoie et al., supra note 47, at 445.
63. Welsh, supra note 47, at 372 ("It is not good medicine to ask a suicidal patient to wait three weeks to be medicated, to tell a parent she must wait for a month for her child to receive stimulant-type medication, or to attempt to find a psychiatrist who will take a Medicaid patient.").
64. Robiner et al., supra note 3, at 234-39. See, e.g., Bush, supra note 50, at 444 (2002); Heiby et al., supra note 47, at 338; Lavoie et al., supra note 47, at 446-47; Robiner et al., supra note 50, at 211-21. See also Richard M. McFall, Training for Prescriptions v. Prescriptions for Training: Where Are We Now? Where Should We Be? How Do We Get There?, 58 J. Clinical Psychol. 659 (2002).
65. Robiner et al., supra note 3, at 235-37. A recent survey showed only 27 percent of psychology graduate students though they had an adequate base education to purse prescription training, while only 7 percent had taken the required biology and chemistry courses. See id. at 236 (citation omitted). On average psychologist take less than five biological or physical science class during their graduate and undergraduate educations. See id. at 236 (citation omitted). See generally Robiner et al., supra note 50, at 211-21 (comparing the training, knowledge, and proficiency of psychologists and psychiatrists).
66. See Robiner et al., supra note 3, at 242-43.
67. See id.
68. See Bush, supra note 50, at 443-46 (referring to the APA training program as "PDP Lite," representing its reduced amounts of training when compared to the PDP program). There is no public record of the proceedings that formulated this model. Id. at 445. In order to explain why the APA has lobbied for its current training model, "we are forced to resort to speculation." Id. The APA was aware that while many may support prescription privileges, few would actually undergo an additional training program, especially since an adequate program in psychopharmacology would take at least 2 more years of school. Id. Since few people would be expected to pursue training, it would be very difficult to convince universities to offer training programs. Id. In short, "a good program won't find a market, and a marketable program won't be good." Id. at 446.
69. See Heiby et al., supra note 47, at 339 (describing the Department of Defense program as "excessive").
70. See Robiner et al., supra note 3, at 232. "Some of the program's psychiatrists, physicians, and graduates expressed doubts about the safety and effectiveness of psychologists prescribing independently outside of the interdisciplinary team of the military context." Id. Additionally, supporters of the APA training model at the state level sometimes cite the PDP project as proof that the training is adequate, which is misleading since the training models differ from one another. Heiby et al., supra note 47, at 340.
71. See Robiner et al., supra note 3, at 242-43.
72. The study most often cited by both sides in the literature is the Department of Defense's PDP. Additionally, several projects were undertaken in California in the early 1980s to train a new breed of practitioner with prescription writing abilities. Heiby et al., supra note 47, at 339. Although the project was an ultimate failure, the trainees saw a million patients over a three-year period with not one quality-of-care problem reported. See id. Of particular interest to the proponents are the educational background of the trainees, with only 56 percent possessing a bachelors degree or higher, and the training methods used which consisted of anywhere from sixteen to ninety-five hours of seminar and lecturers. See id. The last projected cited in the literature was another federal program, where the Indian Health Services expressly recognized prescribing authority for psychologists. See id.; Lavoie et al., supra note 47, at 446.
73. See Robiner et al., supra note 3, at 242-43.
74. See Heiby et al., supra note 47, at 341-42; Mervyn K. Wagner, The High Cost of Prescription Privileges, 58 J. Clinical Psychol. 677, 677-79 (2002). See also Elaine M. Heiby, It Is Time for a Moratorium on Legislation Enabling Prescription Privileges for Psychologists, 9 Clinical Psychol.: Sci. & Prac. 256 (2002) (calling for the APA to place a moratorium on future legislation enabling privileges and to withdraw their support because of the reduction of resources in psychological sciences and increased costs of implementing psychopharmacology programs for universities); Robiner et al., supra note 3, at 237-39 (describing various models of proposed postdoctoral training for prescribing psychologists).
75. Heiby et al., supra note 47, at 339.
76. See Lavoie et al., supra note 47, at 445 (explaining general practitioners "typically receive only 4 to 12 weeks' training in mental health"); Resnick & Norcross, supra note 1, at 273 (pointing out that mental health training is 6.8 weeks, on average, during the third year of medical school).
77. See Lavoie et al., supra note 47, at 446; Robiner et al., supra note 50, at 213-14.
78. See Lavoie et al., supra note 47, at 446.
79. See Robiner et al., supra note 3, at 241-42. These statistics could reflect several factors, including: patients' comfort level and preference to see their primary physician for treatment; and managed care organizations influence on primary care providers to provide treatment, instead of recommending a specialist. Id. at 241. Additionally, the percentage of psychotropic prescriptions that are written by non-psychiatrists emphasizes the importance and necessity of improved collaboration between psychologists and physicians. Id. at 242. "Such trends do not, however, indicate a need or justification for psychologists to prescribe." Id. 95 (focusing on the likely impact of prescription privileges on collaboration efforts between psychologists and physicians).
80. See, e.g., Lavoie et al., supra note 47, at 446; Robiner et al., supra note 3, at 242. See generally Bush, supra note 46, at 681-95 (focusing on the likely impact of prescription privileges on collaboration efforts between psychologists and physicians).
81. See Heiby, supra note 44, at 595 (noting that increased cost of training would include additional expenses for additional faculty, more state regulatory agents, and several additional years of training, all of which would be unnecessarily duplicative because the medical profession already provides prescription services); Wagner, supra note 74, at 677-80 (estimating costs, using the University of South Carolina's program as its basis for approximation purposes, for pre-doctoral training and the internship year on the University and participating psychologists). In 1997, the General Accounting Office reported that the training of military psychologists to prescribe cost $610,000 per psychologist. Heiby, supra note 44, at 595.
82. See Heiby, supra note 44, at 595; Lavoie et al., supra note 47, at 446-47; Robiner et al., supra note 3, at 240-41. See also Albee, supra note 51, at 635-48 (questioning the societal need for prescribing psychologists and their true motives in pursuing such a privilege, based on health maintenance organization and other insurers refusal to pay for psychotherapy (thus prescription privileges would presumably counteract this lost income) and the fundamental differences between psychologists concerned with practice, and those concerned with science).
83. See Heiby, supra note 44, at 595 (explaining how the geographic maldistribution of health professionals could be remedied with the number of already existing health professionals if the right incentives are provided). According to one commission, as of 1995 there was a surplus of 150,000 physicians and approximately 20 percent of medical schools should be closed. See id.
84. See Lavoie et al., supra note 47, at 447 (citing high suicide rates from self-prescription among health professionals, including dentists and physicians) (citation omitted).
85. See Smyer et al., supra note 4, at 398-402.
86. See Bush, supra note 46, at 682-83.
87. See Bush, supra note 46, at 681-95; Lavoie et al., supra note 47, at 446; Robiner et al., supra note 3, at 242; Robiner et al., supra note 50, at 219.
88. See Bush, supra note 46, at 684-86.
89. See, e.g., Resnick & Norcross, supra note 1, at 272-73 (stating that Level Two "is not under discussion" because it "has no champion" but training in psychopharmacology and obtaining prescription privileges does).
90. See, e.g., Heiby, supra note 44, at 594 (summarizing APA's position on whether collaboration is an adequate treatment as interfering "with continuity of care"). But see Bush, supra note 46, at 683 n.3 (arguing that if "collaboration by definition precludes continuity of care," then already-existing effective collaboration between professionals would also violate this principle, and such is obviously not the case).
91. See generally Kenneth A. Weene, The Psychologist's Role in the Collaborative Process of Psychopharmacology, 58 J. Clinical Psychol. 617 (2002) (recognizing the importance aspects and overall effect of collaboration between psychologists and physicians, with or without psychologists successfully obtaining prescription privileges).
92. See id. at 617-18.
93. See Norfleet, supra note 47, at 602.
94. See DeLeon & Wiggins, supra note 59, at 225; Resnick & Norcross, supra note 1, at 271-74.
95. Resnick & Norcross, supra note 1, at 272. See also Heiby et al., supra note 47, at 337 ("psychopharmacology training should be at the postdoctoral level"). "The prescribing psychologist must foremost be a psychologist. He or she can then obtain the pharmacology expertise as an additional skill." Id.
97. See Norfleet, supra note 47, at 602 (citation omitted).
98. See, e.g., DeLeon & Wiggins, supra note 59, at 225; Resnick & Norcross, supra note 1, at 272.
99. See Caccavale, supra note 7, at 624. But see Steven C. Hayes et al., Prescription Privileges for Psychologists: Constituencies and Conflicts, 58 J. Clinical Psychol. 697, 698 (2002) (attempting to show that the strongest support for prescription privileges is found in the practice-based organizations, and the strongest opposition stems from the scientist-practitioner organizations, rather than the basic science organizations).
100. Resnick & Norcross, supra note 1, at 271-72. See also Heiby, supra note 44, at 593 (citing third point of APA representative's argument to Hawaii legislature for prescription privileges: "Opposition to psychologist's efforts by psychiatry is not new to our profession when any form of advancement is proposed").
101. 624 F.2d 476 (4th Cir. 1980).
102. Id. at 485. In this case, the court rejected a policy requirement that forced psychologist to work under the supervision of a physician in order to receive reimbursement under an insurance policy. Id.
103. E. Ala. Behavioral Med. v. Chancey, 883 So. 2d 162, 172 (Ala. 2003).
104. See Phyllis Coleman & Ronald A. Shellow, Extending Physician's Standard of Care to Non-Physician Prescribers: The Rx for Protecting Patients, 35 Idaho L. Rev. 37, 71-81 (1998); Robiner et al., supra note 3, at 239-40. See also Bush, supra note 50, at 444-45. According to the Alabama Medical Liability Act, the appropriate standard of care when: [P]erforming professional services for a patient, a physician's, surgeon's, or dentist's duty to the patient shall be to exercise such reasonable care, diligence and skill as physicians, surgeons, and dentists in the same general neighborhood, and in the same general line of practice, ordinarily have and exercise in a like case. Ala. Code § 6-5-484 (1975).
105. Robiner et al., supra note 3, at 240. 102(2)(1997). But see Coleman & Shellow, supra note 104, at 75 n.175 (illustrating that not all non-physician prescribers are held to the higher standard of a physician or other medical professional, e.g. advanced nurse practitioner not held to physician standard).
106. See Bush, supra note 50, at 444 (prescribing Psychologists will be duplicating the work of psychiatrist, who are "mental health specialists whose legal scope of practice permits them to prescribe psychotropic drugs," therefore their respective training programs must be compared) (emphasis omitted). Consider the hypothetical where a state passes prescription privilege legislation, e.g., New Mexico, and a psychologist is sued for malpractice although their treatment was fine. Id. In trial it is discovered they received their one-year of pharmacology training through continuing education and "distance learning" over the Internet. Id. at 444-45. Imagine what side and how hard the jury will come down on the psychologist that received less training than a psychiatrist. Id. at 445. Obviously, this is a rather cynical example that may be tainted with the author's bias against prescription privileges. Surely a jury's verdict that focused on what it perceived to be "inadequate training" rather than finding a cognizable wrong would never stand on appeal. However, the author's point may be established simply with the entry or potential for a verdict, and the ensuing effect on the psychological community regardless of the end result.
107. Optometrists in Colorado are held to the same standard of care as an Ophthalmologist would be when prescribing medications. See Colo. Rev. Stat. 12-40-102(2)(1997). But see Coleman & Shellow, supra note 104, at 75 n.175 (illustrating that not all non-physician prescribers are held to the higher standard of a physician or other medical professional, e.g. advanced nurse practitioner not held to physician standard).
108. Coleman & Shellow, supra note 104, at 73. See, e.g., Fein v. Permanente Med. Group, 695 P.2d 665, 673-74 (Cal. 1985) (refusing jury instruction that held proper standard for nurse in diagnosis and examination of a patient was that of a physician or surgeon; proper standard was that of a "reasonable prudent nurse practitioner"); In re Abdo, 852 So. 2d 513, 518 (La. Ct. App. 2003) (stating that the applicable standard for a nurse whose medication of a patient was allegedly negligent was the "nursing standard of care"); Silves v. King, 970 P.2d 790, 795 (Wash. Ct. App. 1999) (finding that nurse did not have duty to warn of drug interactions because they are not qualified to assess what risks are material like a physician).
109. See, e.g., Ala. Code § 6-5-484 (1975).
110. See Coleman & Shellow, supra note 104, at 78.
111. See E. Ala. Behavioral Med. v. Chancey, 883 So. 2d 162, 172 (Ala. 2003) (citing Rivard v. University of Ala. Health Serv. Found., P.C., 835 So. 2d 987, 988 (Ala. 2002)).
112. See 61 Am. Jur. 2d Physician, Surgeons, etc. §§ 235-37 (2004). See generally 25 Am. Jur. 2d Drugs and Controlled Substances §§ 240-58 (2004) (describing civil liabilities of pharmacists when prescribing drugs, which could be analogous to a psychologist with prescriptive authority).
113. See Wagner, supra note 74, at 679 (estimating an increased cost of insurance premiums for psychologist to psychiatrist ranging from 300 to 600 percent depending on the jurisdiction). But see Jack G. Wiggins & Danny Wedding, Prescribing, Professional Identity, and Costs, 35 Prof. Psychol.: Res. & Prac. 148, 150 (2004) (challenging the proposition that professional liability rates will increase with prescriptive ability by comparing the liability rates for nurses with prescriptive authority, which where actually lower than rates for psychologists without authority).
114. See Robiner et al., supra note 3, at 240.
115. N.M. Stat. Ann. § 61-9-17.1(B)(3) (Michie 1978).
116. See, e.g., La. Rev. Stat. Ann. § 37:2372 (West 2004); N.M. Stat. Ann. § 61-9-6 (Michie 1978).
117. An example of indirect regulation occurs when the FDA mandates a certain warning of a side effect or other adverse effect to be issued with the sale or prescription of a psychotropic drug. The prescribing psychologist, like the physician, will have to adhere to agency regulations concerning procedures for relaying this information to their patient. Additionally, the psychologist may also be required to warn their patient under the learned intermediary doctrine to avoid liability from failing to warn, if the manufacturer is not responsible to warn the consumer directly, e.g., no advertising of medication. See, e.g., Walls v. Alpharma USPD, Inc., 887 So. 2d. 881, 883 (Ala. 2004) (discussing the learned intermediary doctrine).
118. La. Rev. Stat. Ann. § 37:2376 (West 2004); N.M. Stat. Ann. § 61-9-17.2(E) (Michie 1978).
119. The Food and Drug Administration has been authorized by Congress to regulate prescription drugs through their rulemaking ability as an administrative agency. See National Nutritional Foods Ass'n v. Weinberger, 512 F.2d 688, 698-99 (2d Cir. 1975).
120. La. Rev. Stat. Ann. § 37:2371(3) (West 2004).
121. Barbara A. Ormond et al., Rural/Urban Differnces in Health Care Are Not Uniform Across States, New Federalism: National Survey of America's Families (The Urban Institute, Washington, D.C.), May 2000, at 2, available at http://www.urban.org/UploadedPDF/b11.pdf (last visited Feb 23, 2004).
122. See id. at 2-3.
123. See, e.g., Lavoie et al., supra note 47, at 445.