Article archive / January 1, 2015
Originally published: . Volume 6, No. 1. Source pages: 15.
(Editor’s note: The Times’ publisher had been asked by a number of people outside of Louisiana to write an article for the National Psychologist explaining what happened with Psychology and RxP in Louisiana. The following was published in the NP November/December issue, and is used here with permission.)
In 1995 the American Psychological Association (APA) endorsed state legislation for psychologists to obtain prescriptive authority, or “RxP.” Louisiana psychology put forth its first bill that same year and by 2004 became only the second state to pass the legislation. However, the organizational changes needed to fuel a successful political effort also set in motion group dynamics that have changed psychology in Louisiana, splitting the community and causing the erosion of the state’s psychology practice act.
Here is a review of some of what has happened in Louisiana.
The emergence of the RxP subgroup
Some have said that APA chose Louisiana as a testing ground for RxP. It is a small state and therefore relatively inexpensive to wage a political battle. It is also highly political. Fortune currently places Louisiana as #2 in the most corrupt states. Locals say, “For $1 million you can pass any law you want.”
Some of the needed money for RxP came from APA. By 2009 APA had given the Louisiana Psychological Association (LPA) various grants totaling $527,000. More money was needed, however, and also people.
“The [LPA] leadership had come to believe that having a cadre of psychologists well trained in psychopharmacology would also mean that there would be a nucleus of psychologists personally invested in and committed to advancing prescriptive authority legislation,” wrote an early leader, Dr. Tom Stigall, in “The struggle in the states,” a chapter in M.T. Sammons’ edited book on prescriptive authority, published by APA.
One key to developing this cadre was the shared experience of training. LPA partnered with the California School of Professional Psychology to create a Baton Rouge campus. In 1999 a group of 35 psychologists graduated with masters in psychopharmacology, a shared vision, purpose, and each loyal enough to contribute $2500 a year to the goal of RxP. They would come to be referred to as “the Class.”
Members of the class assumed key positions in LPA and on the state psychology board. The expensive and politically savvy firm of Courson & Nickel replaced the long-time, more conservative lobbyists. A new Political Action Committee, the “Louisiana Academy of Medical Psychology” (LAMP) replaced the older PAC. Leaders emerged whose style was consistent with the mission and the political culture and older leaders were pushed out.
In-group, out-group differences became salient. At the annual convention LAMP discussions were restricted to devotees. The LPA newsletter was terminated. Non- LAMP psychologists were edged away from decision-making. “If you weren’t in the Class,” one officer said, “you were voted off the island.”
The strategy worked. By 2004 RxP was passed in Louisiana. Medical psychologists, “MPs,” were now official.
But other organizational goals had almost completely vanished. In 2008 LPA spent $153 on public education campaigns but $72,000 on lobbying. One insider reported, “When we went to APA, we were rock stars. Here, at home, nothing was going on.”
But by 2009 the momentum carried the community over an edge.
Act 251: LAMP and medicine create a “New, hybrid profession”
In 2009 LAMP leaders secretly negotiated with the state medical board to pass a bill, Act 251, which repealed the 2004 law and created a “new, hybrid profession,” as described by LAMP leader, Dr. James W. Quillin, PhD, MP.
Act 251 transferred the medical psychologists (MPs) from the psychology board to the medical board. MPs would no longer need to hold a state psychology license. Medicine would regulate the psychology practice of the MPs. While Act 251 provided for an advanced certificate, doing away with the consultation clause for experienced MPs, it also placed them under medicine as “mid-level providers.”
Several national groups registered concerns. These included APA Board of Educational Affairs, the Interdivisional Healthcare Committee, Committee for the Advancement of Professional Psychology (CAPP), and Academy of Medical Psychology (AMP).
Conflict broke out in LPA over both the specifics of Act 251 and because rank and file members had been deceived by MPs who held leadership positions in both LPA and the psychology board. When LPA members discovered the bill by accident––“Who let this slip pass LPA?”––it was by then too late. Eventually it was discovered that the lobbyists for Act 251 were paid from LPA and APA funds.
While two surveys confirmed that about 70 percent of LPA members were concerned about Act 251 and wanted some type of remedy, motions passed for this goal have made no progress.
The more heated debates that marked the 2009 to 2011 time frame have cooled to a cold war.
Most MPs have dropped from LPA. In 2013 LAMP formed a new regional organization to match their PAC. LPA is forming new alliances in the larger Louisiana community.
MPs continue to hold three of the five positions on the psychology board, even though only 5 percent of licensed psychologists are dual licensed as MPs. In 2011 the board voted to qualify MPs to supervise psychology interns, even when the MP did not hold a state psychology license. The decision has been called “bizarre” by a past board chair and the Executive Director of the Association for State and Provincial Psychology Boards said, “Louisiana is playing with fire.”
The MP Chair during that 2011 decision, Dr. Joe E. Comaty, PhD, MP, was recently reappointed to the psychology board, despite considerable opposition from the community. LAMP’s influence appears to be the main reason for Comaty’s appointment.
The continued political influence of LAMP is not surprising. In the 2011–2013 time frame contributions to LAMP were $324,771 while contributions to the LPA PAC were $22,115.
Sources at LPA say that there is little to be done about Act 251 because of this.
RxP in Louisiana created a new and strong identity group with many unintended consequences. The bleeding over of norms from the political culture, such as the tolerance for deception and ends– justifying–means, are inconsistent with the foundational values of psychology, both the profession and the science.
Perhaps in Louisiana the LPA parent group was naive in its understanding about what group dynamics could emerge from this type of effort. Perhaps the identity and boundaries for the parent group, the state association, were too fragile in the first place to support this type of organizational change. Perhaps it was simply the typical corrupting influences of power.
Whatever the reasons, states considering RxP should be careful. If in pursuit of prescriptive privileges organized psychology loses, or worse yet willingly gives up, the values of openness and truthfulness, we will have lost what makes us most worthy to serve others in our society.
This article is part of a historical newspaper archive. Read the original issue for its original layout, photographs and graphics.