any update from CA and other states?
National Psychologist article:
Victory near on California hospital privileges
By Richard E. Gill
Assistant Editor
A surprising decision by the California Department of Health Services
(DHS) to investigate a complaint that a Los Angeles hospital is violating
state law by not granting psychologists full attending authority, plus a
lawsuit that effectively ended in their favor have psychologists on the cusp
of receiving full hospital privileges denied them for nearly 30 years.
"We were not a high priority for DHS," said Bill Safarjan, Ph.D., past
president of the California Psychological Association (CPA) and current
member of the APA Committee for the Advancement of Professional Practice.
"But the DHS is there now investigating. This is a whole new wrinkle," added
an amazed Safarjan. "They're looking to see if the Metropolitan State
Hospital is violating the law as Psychology Shield has contended in a
complaint."
But it took the threat of legal action by Psychology Shield to force
the DHS to investigate whether or not the hospital was discriminating
against psychologists by not allowing them to admit and discharge patients,
order restraint or seclusion and suicide prevention, all the things
psychologists are trained to do, said Safarjan, who is on staff at a
state-run hospital.
Safarjan said he was stunned by the DHS decision because that same
organization, charged with enforcing health regulations in the state, has
for years broken the law by not enforcing mandates passed by the state
legislature. "Getting the bureaucracy to act is incredible," he said.
Another reason psychologists are hopeful is that in February 2005
Psychology Shield, working in collaboration with the CPA and the APA
Practice Organization, finally, under threat of suit, convinced the DHS to
implement regulations that gave psychologists full attending authority.
After all, Safarjan added, the state legislature had passed laws granting
psychologists full authority that were upheld by the California Supreme
Court, signed by the governor and ruled as enforceable by the state attorney
general's office.
Almost immediately, the Union of American Physicians and Dentists
(UAPD) filed suit against DHS to suspend the regulations claiming they were
"underground regulations" because they were not held to public scrutiny and
did not protect patients from inferior care. While the UAPD won the suit, in
reality it was a victory for psychologists, Safarjan said.
Although the judge agreed with the UAPD and ordered that the
regulations must undergo public comment, a procedure by which citizens can
voice their opinion on issues and ultimately decide their fate, he declined
to rule on the legality of the regulations. "Even in his decision, the judge
was not talking about whether or not the regulations were legal. He didn't
appear to have any problems with them."
Therefore, the UAPD won the battle, but according to Safarjan, it's
gradually losing the war.
Then a second ruling by the judge in April only served to reinforce
psychologists' belief that the long and difficult battle was about to end in
their favor. Claiming that it had won the earlier decision, the UAPD argued
that it was entitled to reimbursement of legal fees.
This time the judge strongly disagreed, stating that "The primary
motivation of this lawsuit was not to protect the public but to advance the
personal economic interests of the member psychiatrists by defeating the
regulations that arguably threatened to diminish the responsibility of
psychiatrists vis-à-vis clinical psychologists."
In effect, said Safarjan, the judge said, "Hey, you say you're doing
this to help the public, but that's absurd. You're doing this to help your
own economic interests and all the while preventing patients from receiving
badly needed psychological services."
The problem now is to get the DHS to present the regulations for public
comment. Safarjan said the DHS has delayed action for eight months and
Psychology Shield may have to file suit against the DHS and force the state
body to place the issue before the public.
"We keep communicating with them and they keep saying 'in a little bit.'
The process is expensive, and we need more funds if we are to succeed,"
Safarjan said. Over the past two years Safarjan has raised almost $350,000,
$200,000 of it coming from APA, to continue the fight. But the cupboard is
nearly empty and contributions are badly needed, he said. Psychology Shield,
Safarjan explained, is a non-profit organization formed when the CPA decided
not to pursue legal action for fear it could not afford the costs. The
four-member corporation is made up of Safarjan; Gilbert Newman, Ph.D.,
president of CPA; Sallie E. Hildebrandt, Ph.D., past president of CPA, and
Ann Carson, Ph.D., chair of the CPA Legislative Affairs Committee.
Safarjan said he is confident the public will endorse the regulations,
which will benefit both state-run and private hospitals and the patients
that psychologists serve. This has been a long, frustrating and expensive
battle, Safarjan said. The process started in 1978. It was immediately
successful because it took only two years to convince the state legislature
to pass a stronger law that granted psychologists independent authority to
admit and discharge hospitalized patients without discrimination. However,
the law was never enforced.
Later, CPA went through the legislative process and was responsible for
the legislature passing new laws in 1996 and 1998 that embolden the law that
it passed in 1980. Still, more years passed and nothing happened. Also, many
psychologists stopped advocating because of continuing delays, which caused
even more setbacks.
Safarjan blamed the limbo on the DHS that continually failed to
translate the law into regulations that hospitals could follow. The DHS
ignored the law and failed in its responsibility, he said.
"Quite frankly, the process has been slow. But we do have laws in place
that put us on par with psychiatry. It's David and Goliath. We're fighting
the American Medical Association that has earmarked California non-physician
providers and is trying to keep us down to the detriment of patient care.
"But we are going to win this one. Finally, everything is on our side."