California Association of Psychology Providers v. Rank

793 P.2d 2
Brief Filed: 6/88
Court: Supreme Court of California
Year of Decision: 1990

Read the full-text amicus brief (PDF, 732KB)

Issue

Whether certain California regulations were inconsistent with legislation defining the scope of psychologists' practice in hospitals and permitting psychologists to provide services as independent practitioners "without discrimination"

Index Topics

Psychologists Scope of Practice; Hospital Privileges for Psychologists

Facts

The plaintiffs (CAPP) challenged published regulations of the California Department of Health Services. In 1978, the California Psychological Association successfully lobbied for legislation permitting psychologists to practice in health care facilities as hospital professional staff. Subsequent legislation, passed in 1980 with the help of CSPA, permitted health facilities to place psychologists on their medical staffs. Under the legislation, psychologists were permitted to provide services within the scope of their licensure. Psychologists could practice in a health care facility, without discrimination, as independent practitioners where both psychologists and psychiatrists were providers. In 1982, the Department of Health Services published regulations that were consistent with the statute. During a subsequent closed hearing, however, the Department made purported technical changes to the regulations, which, in effect, denied to psychologists the right to treat or diagnose organic mental conditions in a hospital setting. CAPP sued the Department to have the regulations, as amended, declared unlawful. The Superior Court, on CAPP's motion for summary judgment, invalidated the regulations as inconsistent with the statute. The Department and CAPP agreed that no appeal would be taken; however, the California Hospital Association, California Medical Association, and California Psychiatric Association filed to enter the case, appealing to the California Court of Appeals. The appeals court ruled that the three associations had no standing. The California Supreme Court reversed and remanded to the court of appeals. The appeals court, in a sweeping opinion, ruled against CAPP, in effect holding that psychologists could not diagnose or treat patients in a mental health facility unless a physician ruled out a medical basis for the patient's mental disorder and determined that it was not subject to medical treatment. CAPP filed a motion asking the Court of Appeals to rehear the case, or in the alternative, to decertify its opinion and remand the case to the Superior Court for development of a full evidentiary record. Ultimately, the Supreme Court of California granted review.

APA's position

APA submitted an amicus brief arguing that: (1) licensed psychologists are fully trained and qualified to provide comprehensive mental health services to patients within and outside the hospital setting; (2) psychology is recognized as an independent profession, and that the doctoral degree, licensure and certification, and the ethical codes and professional standards support this claim; (3) the appellate court's distinction between disorders with an organic origin and those with no organic origin was archaic and untenable, in that (a) a distinction maintained in actual practice can jeopardize patient care, (b) mental disorders are not neatly separated between those with organic bases and those without, and (c) frequently, physicians are incapable of detecting the presence of organic brain injury and fail to recognize the emotional and behavioral components of such injury; (4) clinical psychologists are qualified and competent to diagnose organic disorders involving injury to the central nervous system, including the brain; (5) psychologists are valued members in medical settings and as independent professionals perform essential functions not within the expertise of their physician colleagues functioning as independent providers of services on psychiatric wards and in medical treatment; (6) the recognition of psychologists as independent professionals serves a number of pro-competitive purposes including lowered health care costs and more effective collaboration among mental health providers without any harm to patient care; (7) physicians, particularly psychiatrists, have historically made and continue to make attempts to preclude psychologists from participating as members of hospital staffs; (8) and the full recognition of psychologists as independent professionals supports patients' health care interests and furthers effective collaboration among all mental health providers.

Results

The California Supreme Court found in favor of CAPP, giving a strong affirmation to the training and competence of psychologists. A divided court ruled that psychologists are permitted to have primary responsibility for patient care and do not require psychiatric supervision.