House committee advances Kauai pilot to let trained psychologists prescribe — with limits

The House Committee on Health on March 20 voted to advance Senate Bill 847, a pilot program that would let specially trained psychologists prescribe a limited set of psychotropic medications at a federally qualified health center on Kauai.

Chair Greg Takayama, opening the committee's decision session, said the measure seeks to address mental‑health access shortages on Kauai while emphasizing caution: “We should do something to improve the situation but be cautious in doing so,” he told the committee as he recommended advancing the bill with several technical and substantive amendments.

Why it matters: Supporters said the pilot would expand access in areas with few psychiatrists. Critics, mainly from the medical community and DOH, argued the training and oversight in the draft needed strengthening to avoid patient harm. The committee's amendments reflect a compromise: the pilot will be limited in duration and site, require psychiatric supervision, and exclude certain drugs and age groups pending further evaluation.

What supporters said: Dr. Samuel Dutton, who described himself as a prescribing psychologist, told the committee that “prescribing psychologists have been safely prescribing for over 20 years” in other U.S. systems and outlined a postdoctoral Master of Science in clinical psychopharmacology plus supervised prescribing experience used elsewhere. Health‑services researcher Dr. Philip Hughes summarized peer‑reviewed work he said shows similar safety and efficacy outcomes for prescribing psychologists compared with psychiatrists and pointed to improvements in access in underserved communities.

What opponents said: Several physicians and health organizations opposed the measure in part or raised concerns. Dr. Blaisdell Brennan, a rural practitioner, cited a Government Accountability Office review and personal cases of harm that are included in his written testimony and said the GAO questioned cost‑effectiveness. A Department of Health medical director for Kauai, James Dillon, told members the bill “would need a lot of work for us to think it was a good one,” expressing concern about whether the proposed training would sufficiently prepare clinicians for pediatric and complex cases.

Committee amendments and outcome: Chair Takayama asked the committee to advance SB 847 with amendments he outlined on the record. Those changes — which the committee adopted — included: keeping the pilot to three years and limiting it to a federally qualified health center on Kauai; requiring that qualifying psychologists prescribe only under the supervision and approval of a Hawaii‑licensed, board‑certified psychiatrist; restricting patient age to 18–65 as recommended by some medical testifiers; excluding controlled substances listed on schedules 2–5 and prohibiting off‑label drugs; and adopting the Board of Psychology's recommended training wording (including an education and training program in clinical psychopharmacology approved by the APA and the Board of Psychology). The chair also said the board recommended an effective date of 07/01/2028.

What happens next: The committee's recommendation to pass SB 847 with amendments was adopted in committee; the measure will move forward in the legislative process for further review and possible drafting into a House draft. Several members recorded reservations during the roll call.

Reporting note: The hearing record includes detailed written testimony from multiple professional associations and dozens of individuals in support and opposition. The committee's oral record shows the balance between access arguments and concerns about training, oversight and potential adverse events.