by Joseph M. Schwartz, M.D.
Vice-Chair, MPS Legislative Committee
[Winter 1996; Vol. 23 No. 4]
The MPS Legislative Committee, co-chaired by Scott Hagaman, M.D. and Mayer Liebman, M.D., is gearing up for the 1997 legislative session which begins on January 8. Two issues are of such great importance that the committee is already organizing its information-gathering and information-disseminating mechanisms to prepare to represent the interests of psychiatrists and our patients. These two issues are non-physician prescription authority and the threat to patient confidentiality inherent in the Health Care Access and Cost Commission (HCACC) database.
Last session we were successful in demonstrating the folly of providing prescription authority to a specific class of advanced practice nurses, nurse psychotherapists, who were seeking the independent, unsupervised right to prescribe. This authority is not even possessed by nurse practitioners, whose training in pharmacology and physical diagnosis is usually much more extensive, yet they must be in a supervisory relationship with a physician. A law giving nurse psychotherapists the independent unsupervised right to prescribe would establish through legislation what was not obtained through training.
The thrust of our argument against extending prescription authority to nurse psychotherapists continues to be that it is not necessary. Nurses who wish to use prescription medications in their practice have a mechanism to do so: they can become nurse practitioners under the current laws and regulations. We were successful in defeating this bill last year.
Senator Paula Hollinger, a nurse from the 11th district, has been the driving force behind this proposal. From her prestigious position as Vice-Chair of the Senate Economic and Environmental Affairs Committee, she has garnered impressive support for this idea. It is imperative that all members of the MPS contact their senators and delegates before the start of the 1997 session to voice there opposition to any reintroduction of this or any similar bill.
We were less successful in opposing the HCACC database thus highlighting the need to gather a much broader base of support. We can thank Jennifer Katze, M.D. for her steadfast commitment to protecting our patients’ right to privacy. We need to support her this year by quickly responding to her requests to fax, phone, and mail our comments to our legislative representatives, as well as by testifying in Annapolis.
The HCACC database is authorized to collect data on individual patients tracked by patient, not in aggregate form. Data include the diagnosis, treatment, and fee. No foolproof mechanism for assuring anonymity has been established. All proposed methods of creating “unique identifiers," codes which in theory would protect privacy, have been shown to be susceptible to de-coding. The most disturbing aspect of the database is that the information is to be collected without consent and without even informing patients that it is being collected. This is because patients are not allowed to refuse to be included in the database. The data is not collected to help in the care of any particular patient or group of patients, but simply to contain costs. It is not clear if it is ethical for a physician to participate in this type of “research."
This is an issue with obvious Orwellian implications. Most of the arguments and rebuttals concerning the database involve proposed breaches of security and unscrupulous uses of the data. But there is a more fundamental concern that is often overlooked: the concern that the government does not have the right to collect this type of information at all.
These are just two of the many legislative issues that are likely to arise this coming session. The committee leaders hope to keep the entire membership as informed as possible because we will need every member’s cooperation if we are to be successful.