Opinion ID: 2608898
Heading Depth: 3
Heading Rank: 1

Heading: Scope of Licensure

Text: The Psychology Licensing Law is set forth in Business and Professions Code section 2900 et seq. Business and Professions Code section 2903 defines the practice of psychology as follows: The practice of psychology is defined as rendering or offering to render ... any psychological service involving the application of psychological principles.... [¶] The application of such principles and methods includes, but is not restricted to: diagnosis, prevention, treatment, and amelioration of psychological problems and emotional and mental disorders of individuals and groups. As the majority points out, Business and Professions Code section 2903 was drafted to regulate outpatient practice where no other professional is even involved. (Maj. opn., ante, at p. 13.) Because its focus is outpatient care, the provision does not apply to hospitalized medical care. Nor does it apply to primary responsibility for the obvious reason that primary responsibility cannot be an issue when there is only one professional involved. Thus, Business and Professions Code section 2903's history and purpose cannot support the majority's position of an implied grant to psychologists of primary responsibility over hospitalized patients. Moreover, as explained below, the express terms of the statute preclude such an implied grant. The key word in the language of Business and Professions Code section 2903 is psychological. The majority correctly notes that psychologists have authority to diagnose and treat psychological problems of patients in hospitals. (Maj. opn., ante, at p. 13.) The majority, however, equates such authority with primary responsibility for the admission, diagnosis, and treatment of hospitalized patients. 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? Patients do not necessarily enter hospitals with psychological conditions neatly divorced from biological, neurological, physiological or genetic disorders. The nature of an illness cannot be ascertained prior to diagnosis by a legally authorized professional. 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. The State Medical Practice Act (Bus. & Prof. Code, § 2000 et seq.), which governs physicians, defines diagnosis as including any undertaking by any method, device, or procedure whatsoever ... to ascertain or establish whether a person is suffering from any physical or mental disorder. (Bus. & Prof. Code, § 2038.) In contrast, the diagnostic authority granted psychologists is severely limited. The scope of their licensure limits psychologists to the diagnosis of psychological problems. (Bus. & Prof. Code, § 2903.) Unlike physicians, psychologists are not allowed to use any method, device, or procedure or determine whether a person is suffering from any physical or mental disorder. (Compare Bus. & Prof. Code, § 2903 with Bus. & Prof. Code, § 2038.) Psychologists are limited to the application of psychological principles to psychological disorders. (Bus. & Prof. Code, § 2903.) Thus, they may not diagnose an illness caused or complicated by nonpsychological factors. Unlike psychologists, physicians are authorized to use any and all ... methods, including drugs and devices, in the treatment of physical and mental conditions. (Bus. & Prof. Code, § 2051.) Psychologists, on the other hand, are statutorily prohibited from prescribing drugs, performing surgery, or administering electroconvulsive therapy. (Bus. & Prof. Code, § 2904.) Nor may they use biofeedback instruments that pierce or cut the skin (Bus. & Prof. Code, § 2903.1); the law restricts them to the use of psychological principles (Bus. & Prof. Code, § 2903). Thus, psychologists may not provide treatment that would require more than the application of psychological principles. There is no support for the majority's assertion that the authority to diagnose and treat subsumes the authority to admit patients into hospitals. (Maj. opn., ante, at p. 13, fn. 7.) The assertion cannot be statutorily based; the statutes say nothing about who can admit patients to hospitals. The Department, not this court, has the expertise necessary to resolve this issue. As demonstrated above, the authority of a physician to diagnose and treat is different and much broader than that granted psychologists. Because the concept of primary responsibility includes the ability to evaluate a hospitalized patient's overall condition and to select the most appropriate methods of treatment, the Legislature's grant of limited authority to psychologists cannot be equated with primary responsibility. Nothing in the statutory scheme suggests otherwise. The majority, albeit obliquely, concedes the difference. In a footnote at the very end of its opinion, the majority, without discussion, prior explanation, or citation of relevant authority, says: Under the trial court's order, a physician must be available to examine the patient upon admission and provide medical treatment as needed. (Maj. opn., ante, at p. 21, fn. 14.) This concession by the majority is inconsistent with the position it has maintained throughout its opinion that psychologists can take primary responsibility for the admission, diagnosis, and treatment of hospitalized patients.