Question

Centerville psychiatric (CP) is a for-profit psychiatric hospital in a large town with two other free-standing psychiatric hospitals and with four general hospitals that have smaller psychiatric units. CP attempts to distinguish itself from its competitors by claiming to offer better doctors and more state-of-the-art structured treatment programs that combine intensive counseling and drug therapy for acute episodes for serious mental illness (so-called nervous breakdowns). This treatment approach contrasts with that in general hospitals, which is unstructured, much shorter in duration, and often administrated by non-specialists, and contrasts with other specialized psychiatric hospitals that offer long-term custodial treatment for more chronic conditions.

Consistent with its long-standing bylaws, CP’s medical staff presently consists of only board-certified psychiatrists, which are specially trained M.D.s. Alfred Zock, Ph.D. is a psychologist of good reputation with an active counseling and therapy practice in Centerville. He has decided to break the mold by applying for medical staff privileges at CP. The major practical difference between psychiatrists and psychologists is that only the former can prescribe drugs; psychologists are limited by state licensing laws to “couch therapy.” In the past, psychologists have been allowed to see CP patients who were under their care before coming to CP, but only if a staff psychiatrist approved and supervised the psychologist. Dr. Zock would like to admit his own patients directly and treat them at CP without supervision or prior approval. He has admitting privileges at one of the general hospitals in town, but he finds their facilities unsatisfactory.

They existing psychiatrists oppose Dr. Zock’s admission because they like things the way they are, for both clinical and financial reasons. The hospital administration is also not in favor, partly because it does not want to antagonize its medical staff in a competitive hospital market where they can take their patients elsewhere, and partly because reimbursement rates under managed care insurance are usually higher for drug therapy their own psychologist to be their primary physician.

            As a lawyer for CP, advise it on the safest way to exclude Dr. Zock. Consider whether to use primarily quality or economic criteria, whether to act under the existing bylaws or to change them and then consider Dr. Zock individually. Consider what procedures to follow in making these decisions.

Questions to answer….

As a lawyer for Centerville Psychiatric Hospital,

Advise it on the safest way to exclude Dr. Zock.

Consider whether to use primarily quality or economic criteria,

Whether to act under the existing bylaws or to change them,

And finally consider Dr. Zock individually.

Consider what procedures to follow

Include references.

Answer 1

1. Health care sector has its own policies and protocol /rules ad regulations . No body can break the rules and regulations of an organisation which are made under supervision of law .Here Dr . Zock must follow the policies of the hospital and should not try to admit the patient without a psychiatrist permission as per the rule of CP hospital . To make any changes in the present rules and regulations Dr. Zock must have a conversation with the administration by putting various evidence which ensures that why patient must be admitted without psychiatrist advise and should take action along with the help of court to make any changes in the present administration rules and regulations of the organisation.

2. Consider primarily the quality of care not the economic criteria because the over all outcome dependes upon the care provided in the hospital . The patient must be provided a patient centred quality care which is feasible and reliable and help in early discharge.

3. Dr. Zock must act under the existing laws , he cannot change the laws by himself . If he wants a change in the policies or protocols of the organisation ,then he should present the rationale for the change infront of the administration and if these are not considered but are evident based and helpful for patients then he should seek the help of court to proceed further.

4.Considering Dr Zock individually- Dr. Zock have PhD degree ,he is not a M.D in psychology and the person who do MBBS and then MD in any field or department has the right to admit their patient and take care of them. Both the professions are different and also the duties . A person with a PhD degree is not given the responsibility of admitting the patient etc , they basically have the scientific research related duties related to ssmples etc rather than taking care of patients in the hospital .

Procedure to follow - follow the instructions given by the administration and court regarding the issue.