Congratulations CA

[PsyDRxPnow]

APA APPLAUDS NEW CALIFORNIA REGULATIONS FOR INPATIENT PSYCHOLOGICAL SERVICES

Washington, D.C., April 14, 2005 -- California patients suffering from serious mental illness will now have the benefit of having their inpatient care managed by psychologists with full hospital privileges.

New state regulations issued by the state's Department of Health Services (DHS), recognizes California psychologists' expertise in diagnosing and treating mental disorders which allows them to serve their patients in acute care hospitals as attending practitioners.

The California agency's new rules allow both psychologists and psychiatrists to direct patient care as a member of the hospital medical staff, including decisions on when to admit, transfer, and discharge patients. The new regulations are a result of longstanding efforts by organized psychology to enforce laws already on the books.

The new regulations resulted from recent negotiations between DHS and Psychology Shield, a non-profit organization devoted to improving patient care in California's state-operated mental hospitals.

Psychology Shield is supported by the American Psychological Association, the California Psychological Association, and other individuals and organizations including the American Federation of State, County, and Municipal Employees Local 2620.

"California psychologists working in hospital settings, and well within the scope of their licenses, will be able to fully serve their patients as attending clinicians," says Russ Newman, Ph.D., J.D., executive director for professional practice, American Psychological
Association.

In 1978, California enacted a law granting psychologists full clinical privileges in hospitals and the authority to direct patient care as members of hospital medical staffs. In 1990, the California Supreme Court affirmed the law in CAPP v. Rank and ruled that psychologists have the legal authority to practice independently in both private and public health facilities. In spite of the Court's ruling, over the past 15 years, psychologists were prevented from directing patient care in California state mental hospitals.

The California legislature and courts have been leaders in recognizing the important role that psychologists can and should play in mental hospitals. Seventeen other states and the District of Columbia have enacted laws allowing psychologists hospital privileges.

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[50960]

This is great, but in reality the law already was in place, but some were not enforcing it. I have served on a medical staff for the last 5 years, and am now signing on to another with full privs. This decision will force the Ca DMH (mental health) to enact the law, which will be a big youknowwhat-storm with the local civil-servant psychiatrists. Good stuff, and I can guarantee you most MD's will love this when they get a whif of who we are and how we differ from psychiatrists.

 

[PsyDRxPnow]

This is great, but in reality the law already was in place, but some were not enforcing it. I have served on a medical staff for the last 5 years, and am now signing on to another with full privs. This decision will force the Ca DMH (mental health) to enact the law, which will be a big youknowwhat-storm with the local civil-servant psychiatrists. Good stuff, and I can guarantee you most MD's will love this when they get a whif of who we are and how we differ from psychiatrists.

I am sure that you well demonstrate excellence and professionalism on our behalf to the medical community.

 

[Anasazi23]

The reason it's not enforced is because it's impractical. Not to start a flame war, but I've seen this attempted in psych institutions in California. The problem is that psychiatric inpatients are notoriously medically complex quite often. In this respect, to have a psychologist be the overseer of what is essentially a medical patient doesn't make sense. The psychiatrist would have to check and approve most or all decisions a psychologist would make, since it could result in poor medical outcome to not do so. Admitting, not admitting, or transferring patients is not a big deal....at all.

"California psychologists working in hospital settings, and well within the scope of their licenses, will be able to fully serve their patients as attending clinicians," says Russ Newman, Ph.D., J.D., executive director for professional practice, American Psychological
Association.

Again, this isn't being mean spirited, and I'm too tired to truly care at this point, but this statement is misleading. You can't "fully" serve psychiatric patients unless you have medical understanding of their medical comorbidities and pharmacological regimens. Who's going to discharge patients on a Saturday if a psychiatrist isn't there? Who writes the rx's for the outpatient tests? Who writes the prescriptions? It'll come down to the psychiatrist anyway.

Psychologists sometimes run day-treatment programs. It's the same thing. They physician winds up pharmacologically managing patients, calling appropriate medical consults, and screening incoming patients out from general medical conditions. I don't know of any psychiatrist that would allow complete management of a psychiatric inpatient without them interviewing/evaluating them, especially prior to discharge, since the psychiatrist is liable under the "captain of the ship" clause in most cases.
Captain of the ship litigation

 

[50960]

True, but the capt of the ship is no longer the psychiatrist exclusively in Ca. That is the purpose of the law. Interestingly enough I am being credentialed by a large hospital organization here in Ca. I called the chief of staff to ask about a few things with the medical staff app etc.. and he said "oh we treat psychologists the same as psychiatrists, but we don't need a DEA for you". This is not a psychiatric hospital, but a general medical facility, and I have admitting/discharging privs, as well as treating privs, order writing etc. The only holdout is meds, and for that they told me the attending MD's generally follow recommendations of the admitter.
I admit.... a little scary for alot of psychologists to be doing this, but keep in mind I had to go through the same credentialling any MD would, and I did not have the benefit of having any psychologists on the credentialing committee. Should all psychologist get to practice like this?? No, but properly trained psych's should, and state law is now well ahead of training in this regard.

cheers

 

[Anasazi23]

But how can this work if you don't have a medical license? As you know, the credentialing process is simply a review process to ensure appropriatness of a hospital (usually physician) employee to practice within their training guidelines and ability in said hospital, and generally review basic things such as education, experience, licensing, malpractice claims history, specialty board certification, procedures a physician can perform and other aspects. I don't see really see how this can protect psychologists from poor patient outcome from a medical standpoint. I'm not sure, but can a psychologist be sued for medical malpractice if they don't have a medical background or license to begin with? Who would be liable in this situation? My guess would be the psychiatrist, since they are the licensed physician on the case. If this is a question you asked the hospital committee, I'd be interested in hearing the answer.

Anyway, that's what the courts are interested in when something goes wrong. They want to know who's medical license the patient was being treated under, what medical mismanagement occurred, what medical diagnosis was missed, and most importantly, what was the standard of care in that situation and if you followed it. If you didn't you better have a good medical reason for deviating from the standard, which there often is. For problems like missed high-risk suicide, I can understand psychologists being equally liable, but many psychiatric lawsuits are over adverse effect cases. In fairness to psychologists, how can they be held liable for presumed knowledge they never had? How can they be held accountable for not drawing blood, starting a line, and checking emergency labs when no phlebotomist is around? This is not to slight psychologists' knowledge base - psychologists know their business well, but despite training in health psych or hanging around with medical attendings, the core medical knowledge base isn't there. They haven't taken medical licensing boards and demonstrated medical competence. And they should not be expected to - it's a different profession.

 

[50960]

A psychology license is completely independent, and in no case would an MD be liable for anything a psychologist did or did not do. I do not know how to answer all your questions as I am not involved in the laws etc.., but some of your concerns are valid. My experience is that when a psychologist admits, they are the primary provider, but the patient will often get a mental health provider if they stay for Tx that is an employee as well as an attending MD involved. I have never, and would never admit a patient and then take sole responsibility for their care. I always have an MD involved, but rarely is it a psychiatrist. I treat and am responsible for the mental health part, and the MD treats and is responsible for the medical part. It generally works fine in practice, but in theory there are alot of "what if's", and "where does mental health end and medical begin" kinds of issues. I have yet to have any of these issues come up because I generally already know and am comfortable with their MD, and vice versa. It is a strange position to be in, but I enjoy the work, and the MD's are happy to have my assistance.
I can see alot of potential conflict for psychologists who are new and cocky, or just narcissistic if they start writing orders that augment another consults recommendations etc.., but I am not stupid and would never do this..nor would any good psychologist.