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VA denies lax supervision at Haley
But officials tell a public forum they have tightened rules on the work of VA hospitals' unlicensed psychologists.
By WILLIAM R. LEVESQUE, Times Staff Writer
Published December 29, 2007
Brian Nussbaum, who sparked the forum, said he was happy to hear of the new policy.
[Chris Zuppa | Times]
TAMPA -- Officials at the James A. Haley VA Medical Center spent two hours Friday explaining why a complaint that their unlicensed psychologists are unsupervised is just plain wrong.
But before a forum on the issue closed, the Department of Veterans Affairs acknowledged something it calls coincidental:
The VA will soon release a new policy nationally, already implemented at Haley, that tightens its rules on how the work of unlicensed psychologists is documented.
U.S. Rep. Ginny Brown-Waite, R-Brooksville, who scheduled the forum after allegations about the lack of supervision hit the media, said the VA had promised to unveil the policy at her event.
But she said agency officials in Washington failed to do so, though she doesn't doubt it is forthcoming.
"I'm certainly disappointed we don't have it today," said Brown-Waite, ranking member of the House Veterans Affairs Subcommittee on Oversight and Investigations.
VA officials at the forum said the policy would ensure that a supervisor can't simply sign off on an unlicensed psychologist's patient notes without actually reading them.
VA officials in Washington could not immediately be reached for more information on the policy.
Brown-Waite suggested it may simply codify something the VA already is doing.
"I don't want anybody to be alarmed (that it hasn't yet been released) because what the directive says is a reiteration of existing supervisory practices," Brown-Waite said.
But Arthur Rosenblatt, Haley's chief of psychology, talked of Haley recently having implementing the policy.
"Guidance did come out," Rosenblatt said, "to indicate in subsequent notes (by unlicensed psychologists) the level of supervision that was provided ... and what exactly transpires" between an unlicensed psychologist and the person overseeing their work.
Brown-Waite said the VA needs to better define what supervision is. But other than that, she has no immediate plans to take the issue further.
Brian Nussbaum, 31, a licensed psychologist at Haley who filed the state complaint about unlicensed psychologists that led to Friday's forum, said he was happy to hear of the policy.
"I see it as a victory that they're trying to address the issue," Nussbaum said after the forum.
Otherwise, the event provided a tense few hours for Nussbaum as he underwent aggressive questioning by Brown-Waite over allegations that some of Haley's most vulnerable patients receive care from unsupervised, unlicensed psychologists.
The forum provided one of the oddest confrontations ever witnessed at Haley, as Nussbaum faced and challenged his bosses in an event moderated by Brown-Waite.
Haley officials say Nussbaum is mistaken in a complaint he filed with the state Board of Psychology a month ago saying up to 12 unlicensed psychologists at Haley receive little, if any, supervision.
For one, they say just eight of 36 psychologists are unlicensed right now -- the number shifts almost weekly as people leave or get hired.
"Our supervision not only meets state and federal regulations, it exceeds them," said Dr. Edward Cutolo, Haley's chief of staff.
The VA examined two months of patient notes by unlicensed psychologists before the forum and found just 2.5 percent didn't have mandatory signatures from supervisors showing they had been reviewed.
"We're not apologetic about the process," Cutolo said. "It's an excellent process."
Nussbaum, though, said supervisory duties are all up to one man -- Rosenblatt. And one man alone can't do it all, he said. But Rosenblatt said the duty is spread around his staff.
Both Nussbaum and some of his bosses walked out of the forum agreeing on perhaps only one thing -- the lines of communication could be better.
But Nussbaum, who wonders if his career is imperiled for his defiance, said fear prevents many others from stepping forward.
"I'm sitting alone here," Nussbaum said. "Some people have expressed support. They're afraid. They're afraid they're going to lose their job. They're afraid they're not going to get that transfer they want."
But Brown-Waite countered, "I guarantee you that no repercussions will happen because you had the courage to come forward."
Rep. Gus Bilirakis, R-Palm Harbor, the only other member of Tampa Bay's congressional delegation in attendance, told Nussbaum, "It took a lot of guts to testify today."
Then at the end of the hearing, Brown-Waite questioned whether Nussbaum offered to supervise unlicensed psychologists for pay in his private practice.
He said he talked to some unlicensed psychologists about joining his private practice, which he operates on his own time and with VA permission.
If they had joined, common practice dictates they pay him a small fee for the supervision, he said.
But talks never went anywhere, he said. "That's a ridiculous angle to come from," said Nussbaum, noting it was the kind of smear tactic that prevented other employes from stepping forward.
Brown-Waite, however, said, "I want to be sure it's not just an entrepreneurial interest that he has."