Seventeen states, plus the District of Columbia, have statutes or regulations that allow psychologists to apply for hospital practice privileges. Implementation of those statutes, however, has not always been smooth. Nebraska is a case in point.
Nebraska's hospital privileges law, enacted in 1998, met huge resistance from some in the psychiatric community. Psychologists were prevented from applying for clinical privileges and for voting membership on the hospitals' medical staffs.
"The bottom line is, we had a right to be at the table, but they were arbitrarily saying we didn't," says Mario Scalora, PhD, former president of the Nebraska Psychological Association.
So a group of 15 psychologists went to court to fight for their rights. The APA Psychology Defense Fund awarded the Nebraska psychologists two grants to help defray legal expenses. And after four years, they've reached a favorable settlement.
"The settlement is a big win and will be encouraging to other states where similar resistance from organized psychiatry is common," says Cherie Jones, director of legal and regulatory affairs in APA's Practice Directorate.
The 1998 Nebraska statute says private and state hospitals--called regional centers there--cannot deny clinical privileges to licensed psychologists solely based on their license. The law also states that each hospital should establish reasonable standards and procedures for medical staff membership and privileges. But that didn't happen. When the new law was enacted, Dan Ullman, PhD, chair of the Lincoln Regional Center Psychology Department, applied for medical staff membership and was denied. Hospital officials said psychologists weren't even allowed to apply.
Several other psychologists, including William Spaulding, PhD, and Scalora, were denied medical staff membership. Spaulding and Scalora, both University of Nebraska faculty, provide contracted services to Lincoln Regional Center.
The discrimination also appeared in other state hospitals. Despite the new law and legal opinion from the state department of health and human services that psychologists had a right to medical staff membership, psychiatrists refused to amend medical staff bylaws to provide for psychologist membership.
"My license says I can practice as a practitioner of psychology," says Scalora. "That is true everywhere except in state hospitals--just because administration people saw this as a turf battle or certain groups of professionals didn't see this as their idea of practice." In November 2000, 15 psychologists sought to remedy the injustice by filing a suit in federal court under provisions of the federal civil rights act. In a unique move, the psychologists sued individual psychiatrists, asserting that the psychiatrists had violated their constitutional rights by depriving them of a property interest without due process of the law. By bringing action against the individual psychiatrists who were trying to block their privileges, the psychologists hoped to both remedy the problem and hold the psychiatrists personally accountable.
The state attorney general filed a motion to dismiss the suit, claiming that medical staff privileges didn't constitute a property interest. But the court denied the motion--a favorable move for the psychologists.
"It's interesting, while these things have been viewed as turf battles, in reality, they're not," Scalora notes. "It's a due process and civil rights issue."
Despite the eventual success, the case was tough going. Indeed, hospital administrators and psychiatrists still continue to obstruct psychologists' practice in state hospitals. At Lincoln Regional Center, psychiatrists and administrators erased all language concerning interdisciplinary decision-making in the biopsychosocial rehabilitation program and replaced it with assertions that psychiatrists were in charge. In another center, the clinical psychology internship program was targeted for elimination.
Just as the case came to trial, the defendants proposed a settlement--perhaps swayed by the judge's initial indication that he was inclined to interpret the statute favorably for psychologists, say Spaulding and Scalora. According to Spaulding, the agreement was reached "about three minutes before we went to court."
The settlement will guarantee that:
Psychologists will have full voting membership on medical staffs at regional centers.
Psychologists will have one or more seats on executive committees, and psychologist committees will pick psychology representatives.
Licensed psychologists will control their own clinical privileges and will not be supervised by another discipline.
The defendants will pay damages.
"This isn't revolutionary. It allows us a seat at the table," says Scalora. "Our license reflects our property rights, our right to make a living and practice what we've worked years for. Sometimes our profession has been hesitant to recognize that or be assertive in that."
"I don't think any of us would have fought as hard as we have if we didn't feel that, in addition to our personal interest, having psychology practice within its full scope in state hospitals and pushing for reform across the mental health system are very much in the public interest," adds Spaulding.
"Fighting the state is not an overnight battle," says Scalora. "It's not a sprint; it's a marathon. The state always has more time, more resources and more patience. This takes commitment."