Psychologists Win High Court Ruling on Hospital Supervision : Medicine: Decision allows them to oversee treatment of hospitalized patients. Psychiatrists had fought to bar the practice.

SAN FRANCISCO —  The state Supreme Court on Monday settled a hard-fought mental health turf war, ruling that hospitals may permit clinical psychologists, like medically trained psychiatrists, to supervise the treatment of their hospitalized patients.

The court, by a vote of 4 to 3, rejected claims by medical groups, who had argued that psychologists, because they are not medical doctors, do not have the legal authority to care for the mentally ill in hospitals.

Two state statutes--one recognizing psychology as an “independent health profession,” the other barring “discrimination” against psychologists--permit hospitals to allow psychologists on their staffs to supervise the admission, diagnosis, treatment and discharge of their patients, the court said in an opinion by Justice Allen E. Broussard.

The ruling came in a lengthy dispute between psychiatrists--who as physicians may perform surgery, prescribe drugs and order shock treatment--and psychologists, who may not perform those tasks but may conduct testing, counseling and psychotherapy.

Psychiatrists, backed by the 280,000-member American Medical Assn. and the 35,000-member American Psychiatric Assn., contended that psychologists lack the broad training and experience of doctors and should not be allowed to supervise their patients when their condition is serious enough to warrant hospitalization.

Psychologists, led by the 70,000-member American Psychological Assn. and its 10,000-member California affiliate, argued that such restrictions denied patients free choice and would reduce competition, thus contributing to escalating health care costs.

Monday’s ruling was welcomed warmly by Michele H. Licht of Sherman Oaks, an attorney for the California Assn. of Psychology Providers. “This is clearly a victory for patients and consumers, who will benefit from having more competition in the health care field,” Licht said. “Patients should have the right to be under the care of their own psychologist, and not be cut off at the hospital door.”

Ellis J. Horvitz of Encino, attorney for a coalition of medical organizations, expressed several concerns about the potential impact of expanding the authority of psychologists.

Horvitz noted that much of the treatment of hospitalized mental patients requires the use of medications, which must be prescribed by physicians. He added that hospitals could open themselves to liability for medical malpractice if they granted staff privileges to an unqualified psychologist.

The case arose in 1984 after state health officials issued regulations prohibiting hospitals from permitting a psychologist to take primary responsibility for diagnosis and treatment of hospitalized patients.

A group of psychologists brought suit, contending the regulations violated state laws passed in 1978 and 1980 that appeared to ease previous restrictions on psychologists. In 1985, a Los Angeles Superior Court judge agreed with the psychologists and overturned the regulations. But three years later, a state Court of Appeal reversed that ruling and placed the prime responsibility back in the hands of psychiatrists.

In Monday’s ruling, the state high court concluded the law was intended to leave it up to hospitals whether to permit psychologists to perform the same functions that they performed in outpatient practice.

The justices acknowledged the concerns of the medical profession about placing authority in the hands of psychologists. “Such disputes over the competence of the professions must be decided by the Legislature, not the courts,” Broussard wrote in an opinion joined by Justices Stanley Mosk and David N. Eagleson and Appellate Justice Steven J. Stone, sitting temporarily by special assignment.

The court noted that physicians must still be available at a hospital to determine if a patient needs medical treatment.

Justice Joyce L. Kennard, joined by Chief Justice Malcolm M. Lucas and Justice Edward A. Panelli, dissented.