SCIENCE / MEDICINE : DEBATE : Hospital Patients Now Have Choice Between Psychologists, Psychiatrists : Con: Psychiatrists argue that only they are capable of providing a full range of medical services, including prescribing drugs and performing surgery.

On June 25, 1990, the California Supreme Court issued its decision in the case known as CAPP vs. Rank. The Court, by a 4-3 vote, ruled that any hospital with psychologists on its staff “may permit such psychologists to take primary responsibility for the admission, diagnosis, treatment and discharge of his patients. That is, psychologists are authorized to independently provide psychological services within the legal scope of their license without physician supervision and without discriminatory restriction. The provision of psychological services includes ultimate responsibility for the psychological care of the hospitalized patient.”

No longer is it necessary that psychiatric patients have their hospital treatment supervised by a physician psychiatrist. The California Psychiatric Assn. believes that this decision may compromise the quality of in-patient care delivered to the mentally ill in our state.

In her dissenting opinion, Justice Kennard challenged the majority court position that granted psychologists clinical privileges far exceeding what was intended by the California Department of Health Services and the state Legislature. Kennard then posed the critical question: “How can primary responsibility for a hospitalized patient’s care be exercised by one who lacks authority to consider the full range of possible causes of an illness and to select the most appropriate combination of methods of treatment?”

Her answer should be cause for great concern for all Californians. “Patients do not necessarily enter hospitals with psychological conditions neatly divorced from biological, neurological, physiological or genetic disorders. Physicians are legally qualified to provide comprehensive diagnosis and treatment; psychologists are not. Unlike psychologists, physicians possess the legal authority to consider all possible causes of an illness. In contrast, the diagnostic authority granted psychologists is severely limited. Unlike psychologists, physicians are authorized to use any and all methods in the treatment of physical and mental conditions. Psychologists, on the other hand, are prohibited by statute from prescribing drugs, performing surgery or administering electro-convulsive therapy. Thus, psychologists may not provide treatment that would require more than the application of psychological principles.”

Psychiatric patients deserve the best available care. California Supreme Court Chief Justice Malcolm Lucas, along with Justices Edward A. Panelli and Kennard, recognized that “the authority of a physician to diagnose and treat is different and much broader than that granted psychologists.”

The California Psychiatric Assn. trusts that citizens, hospitals and the Legislature will recognize that psychiatrists are the only mental health professionals who can provide comprehensive psychological and medical care for hospitalized patients.