Marcia Kraft Goin Is Chosen APA President-Elect; Paul Appelbaum to Succeed Richard Harding as APA President

Marcia Kraft Goin, M.D., Ph.D., of Los Angeles, California, was chosen president-elect of the American Psychiatric Association in balloting by APA members this winter and will assume the APA presidency in May 2003.

The current APA president-elect, Paul S. Appelbaum, M.D., of Worcester, Massachusetts, will become APA president next month at the conclusion of the APA annual meeting in Philadelphia. He will succeed Richard K. Harding, M.D., of Columbia, South Carolina.

Dr. Goin, an APA vice-president since 2000 and APA trustee-at-large from 1997 to 2000, received 62 percent of the vote in a race against Sidney H. Weissman, M.D., of Chicago. Dr. Goin is clinical professor of psychiatry and director of residency training in the adult psychiatric outpatient department of the Los Angeles County General Hospital and University of Southern California School of Medicine.

In the race for APA vice-president, Steven S. Sharfstein, M.D., of Baltimore, defeated Barry F. Chaitin, M.D., of Irvine, California, in winning a two-year term. Dr. Sharfstein, who received 65 percent of the votes cast, has served as vice-chair of the APA joint commission on government relations since 1998 and as cochair of the APA committee on psychiatric reimbursement since 1999. He was APA secretary from 1991 to 1995. Dr. Sharfstein is president of Sheppard Pratt Health System and clinical professor and vice-chair in the department of psychiatry at the University of Maryland in Baltimore.

Carol A. Bernstein, M.D., of New York City, was elected APA treasurer with 57 percent of the vote. Her opponent was Michael J. Vergare, M.D., of Philadelphia. Dr. Bernstein is associate professor of clinical psychiatry, director of residency training in psychiatry, and assistant dean for graduate medical education at New York University School of Medicine.

David Fassler, M.D., of Burlington, Vermont, was elected trustee-at-large with 53 percent of the vote, defeating Herbert S. Peyser, M.D., of New York City. Dr. Fassler is clinical director of Otter Creek Associates and clinical associate professor in the College of Medicine at the University of Vermont in Burlington.

In a three-way race, Angela D. Harper, M.D., a resident in general psychiatry at Palmetto Health Alliance and the University of South Carolina School of Medicine in Columbia, was elected to the post of member-in-training trustee-elect. Her opponents were Sonia G. Patel, M.D., of Honolulu, Hawaii, and William C. Wood, M.D., of Boston. Dr. Harper won 54 percent of the votes cast.

Ann Marie T. Sullivan, M.D., of New York City, defeated Richard I. Altseman, M.D., of Chappaqua, New York, with 63 percent of the votes for the post of area 2 trustee. Dr. Sullivan is regional director of psychiatry at Elmhurst and Queens Hospitals and clinical associate professor of psychiatry at Mount Sinai School of Medicine in New York City.

Jack W. Bonner III, M.D., of Greenville, South Carolina, was elected to the post of area 5 trustee, winning 53 percent of the vote. His opponent was Anita S. Everett, M.D., of Richmond, Virginia. Dr. Bonner is medical director of the Marshall I. Pickens Hospital in Greenville.

This is the second APA election in which eligible voting members have been able to cast their votes online by visiting APA's Web site. The APA committee of tellers reported that 9,564 paper and online ballots were returned, representing 31 percent of the eligible voting membership. About 7 percent of the ballots were cast online.

New Mexico Governor Signs Law Allowing Psychologists to Prescribe Psychotropic Medications

On March 5, the governor of New Mexico, Gary Johnson (R), signed a bill that greatly expands psychologists' scope of practice by allowing them to write prescriptions for psychoactive drugs without being required to attend medical school. The bill, which takes effect July 1, was passed by wide margins in the New Mexico house and senate.

Both the American Psychiatric Association and the American Medical Association lobbied intensively for derailment of the bill, not only in the current legislative session but also in 2001, when a similar bill was nearly passed before time ran out on the legislative calendar. The lobbying efforts have focused primarily on educating legislators and the public about the dangers for patients in allowing clinicians with inadequate or no medical or pharmacy training to make decisions about medications, including combinations and dosages, and to manage the treatment of patients who may experience a wide range of adverse physical effects. Both physician groups noted that 14 state legislatures have rejected similar bills over the past decade because of public health risks.

Proponents of the bill argued that special conditions exist in New Mexico because of extremely rural conditions and the resulting gaps in mental health care, as well as severely limited state funds for medical personnel and health care. They further argued that the state had already granted independent prescribing privileges to nurse practitioners, physician assistants, and clinical pharmacists. According to psychiatrists and other physicians monitoring the progress of the bill into law, proponents were successful in persuading legislators that extending privileges to psychologists was not a radical step. The legislators also appeared convinced that the move would save health care dollars because psychologists' reimbursement rates are substantially lower than those of psychiatrists.

The final law incorporates amendments that were missing from the bill that was considered by New Mexico legislators in 2001. The amendments spell out stringent educational requirements for psychologists who wish to obtain prescribing privileges, including a two-year "conditional prescribing" period, and give joint regulatory oversight of the process to the New Mexico Board of Psychologist Examiners and the New Mexico Medical Society. Doctoral-level psychologists must attend 450 hours of classroom training in physiology, pathophysiology, pharmacology, clinical pharmacotherapeutics, and neuroscience. The training courses must be jointly approved by the two oversight groups. After completing classroom training, candidates must spend another 400 hours treating at least 100 people who have mental illnesses under the supervision of a psychiatrist or other physician.

Candidates may then apply for a "conditional prescription certificate." All prescriptions written during the first two years must be made under the supervision of a licensed physician whose name is reported to the oversight boards. After the conditional period is successfully completed, a certificate will be awarded that allows the psychologist to prescribe without supervision as long as he or she participates in 20 hours of continuing education each year.

The final bill also mandates that the psychologist "maintain an ongoing collaborative relationship with the health care practitioner who oversees the patient's general medical care to ensure that necessary medical examinations are conducted, the psychotropic medication is appropriate for the patient's medical condition, and significant changes in the patient's medical or psychological condition are discussed."

In a statement issued in the wake of the bill's passage, APA President Richard K. Harding, M.D., said, "The American Psychiatric Association deplores the decision of the New Mexico legislature and governor to permit clinical psychologists to prescribe potent medication." He called the law "the result of a cynical, economically motivated effort by some elements of organized psychology to achieve legislated prescriptive authority without benefit of medical education and training…. By virtue of their training and education, psychologists simply do not have the background or experience to safely and effectively use powerful medications in the treatment of mental illnesses. Psychologists have always had a clear path to prescribing privileges: medical school. No psychology-designed and administered crash course in drug prescribing can substitute for the comprehensive knowledge and skills physicians achieve through medical education and rigorous clinical experience."

The American Medical Association reacted to the passage of the law in a letter to Governor Johnson, which reiterated the AMA's "steadfast position that psychologists lack the appropriate training and education to prescribe medications under any circumstances."