Performance audit, Board of Psychologist Examiners

              PERFORMANCE AUDIT
BOARD OF PSYCHOLOGIST EXAMINERS
Report to the Arizona Legislature
By the Auditor General
May 1989
89- 3
AUDITOR GENERAL
--
REPORT SUMMARY
May 1989 Report No. 89- 3
The O f f i c e of the Auditor General has conducted a performance audit of
the Arizona State Board of Psychologist Examiners i n response to a June
2, 1987 r e s o l u t i o n of the J o i n t L e g i s l a t i v e Oversight Committee. This
performance audit was conducted as p a r t of the Sunset Review set f o r t h i n
Arizona Revised Statutes ( A. R. S.) § § 41- 2351 through 41- 2379.
The board was established i n 1965 to protect the health and welfare of
the p u b l i c as i t relates to the p r a c t i c e of psychology. To accomplish
t h i s purpose, the board performs a v a r i e t y of functions i n c l u d i n g :
examining, c e r t i f y i n g , and renewing c e r t i f i c a t i o n s of duly q u a l i f i e d
applicants; conducting i n v e s t i g a t i o n s , hearings, and proceedings
concerning v i o l a t i o n s ; and d i s c i p l i n i n g v i o l a t o r s . C u r r e n t l y , the
seven- member board i s responsible f o r r e g u l a t i n g approximately 1,200
c e r t i f i e d psychologists.
Certification of Psychologists Adequately
Protects Public Health and Welfare
C e r t i f i c a t i o n of psychologists provides adequate p u b l i c p r o t e c t i o n .
Because the p r a c t i c e of psychology exposes the p u b l i c to some r i s k ,
regulation i s warranted. Persons who seek psychological services usually
do so at a time when they are p a r t i c u l a r l y vulnerable to unprofessional
conduct by a psychologist. In a d d i t i o n , psychological evaluations are
the basis for many decisions made by courts and government agencies
concerning i n d i v i d u a l s ' personal l i b e r t y , custody o f c h i l d r e n , or the
amount of d i s a b i l i t y income.
In our 1979 report o f the Board o f Psychologist Examiners, we recommended
that psychologists be licensed. However, based on s t a t u t o r y changes made
since the l a s t a u d i t and a d d i t i o n a l data a v a i l a b l e , we now believe that
c e r t i f i c a t i o n provides an adequate level o f r e g u l a t i o n .
Licensure would r e q u i r e t h a t the scope of p r a c t i c e be defined. Such
a c t i v i t i e s could be performed by licensed psychologists only. However,
many a c t i v i t i e s which f a l l w i t h i n the p r a c t i c e of psychology also f a l l
w i t h i n the a c t i v i t i e s of several professions. Therefore, d e f i n i n g and
enforcing a scope of p r a c t i c e which i s not o v e r l y broad i s d i f f i c u l t i f
not impossible.
F u r t h e r , because the incidence of harm i s low, c e r t i f i c a t i o n and legal
remedies provide adequate pub1 i c p r o t e c t i o n . By r e s t r i c t i n g the use of
the t i t l e " psychologist" to persons who meet s p e c i f i c q u a l i f i c a t i o n s ,
c e r t i f i c a t i o n aids the p u b l i c i n i d e n t i f y i n g q u a l i f i e d psychologists.
Disclosure of p e r t i n e n t information to prospective c l i e n t s c o u l d a l s o
reduce r i s k s o f unprofessional conduct. I f harm s t i l l occurs, a c t i o n can
be taken against the p s y c h o l o g i s t ' s c e r t i f i c a t i o n and/ or against the
psychologist through the c o u r t s .
Although the Board's Complaint Handling Has Improved,
Further Improvements Can St i 1 l Be Made
The board has improved i t s t i m e l i n e s s i n r e s o l v i n g complaints i n recent
years, although some changes could f u r t h e r improve the process. During
the l a s t three years the average time t o dispose o f a complaint has
decreased from 243 days i n 1986 to 114 days i n 1988. However, some
delays i n case d i s p o s i t i o n continue. For example, nearly one- quarter of
the cases received i n 1986- 88 took seven months to over a year to close.
Two f a c t o r s appear to cause delays i n complaint handling: inadequate
d i s c i p l i n a r y options and the p r a c t i c e of using board members to
i n v e s t i g a t e complaints. C u r r e n t l y , the board lacks the a u t h o r i t y to
issue intermediate d i s c i p l i n a r y measures. The b o a r d ' s o n l y d i s c i p l i n a r y
options are p r o b a t i o n , suspension, o r r e v o c a t i o n . As a r e s u l t , many
complaints are resolved using consent agreements - a process which of ten
involves lengthy n e g o t i a t i o n s over wording. By adding a wider range of
d i s p o s i t i o n s , such as l e t t e r s of concern, decrees of censure, and c i v i l
p e n a l t i e s , the board may be able to reduce the time required to resolve
complaints.
I n a d d i t i o n , board members, who serve part- time o n l y , c u r r e n t l y perform
most complaint i n v e s t i g a t i o n s . Because board members perform
i n v e s t i g a t i o n s w h i l e a l s o engaging i n t h e i r professional p r a c t i c e s ,
complaint i n v e s t i g a t i o n s are o f t e n delayed. Many other l i c e n s i n g boards
now use consultants to i n v e s t i g a t e complaints. This can both improve the
timeliness and q u a l i t y of i n v e s t i g a t i o n s . However, i f a consultant i s
used i n a l l Psycho logy Board cases, the board may need $ 1 6,000 to $ 1 8,000
i n a d d i t i o n a l funding.
DOUGLAS R NORTON. CPA
AUDITOR GENERAL OFFICE O F T H t
AUDITOR GENERAI,
LINDA J. BLESSING, CPA
OlPUTY AUDITOR GENERAL
May 26, 1989
Members of the Arizona L e g i s l a t u r e
The Honorable Rose Mofford, Governor
Miguela Rivera, Ph. D.
Chai rperson
State Board of Psychologist Examiners
Transmitted herewith i s a report of the Auditor General, A Performance
Audit of the Arizona State Board of Psychologist Examiners. This
report i s i n response to a June 2, 1987, r e s o l u t i o n o f the J o i n t
L e g i s l a t i v e Oversight Committee. The performance a u d i t was conducted
as a p a r t o f the Sunset Review set f o r t h i n Arizona Revised Statutes
9941 - 2351 through 41 - 2379.
The report concludes t h a t although there i s a need to regulate
psychologists, c e r t i f i c a t i o n w i l l continue to adequately p r o t e c t p u b l i c
h e a l t h and welfare. I n a d d i t i o n , the report addresses suggestions to
improve complaint handling.
My s t a f f and I w i l l be pleased to discuss or c l a r i f y items i n the
r e p o r t .
S i n c e r e l v ,
KDodg as R. NortoGn
~ u Wo rt Gene ral
DRN: lmn
STAFF: William Thomson
Deborah A . K l e i n
Nancy L. Moore
George A. Anderson
Leonard P. Wojciechowicz
2700 NC? Rl H CFIJSRAL PVE. @ SLil'l E 7iiO $ PIIOEl\ I! X, i'RIZONA 85034 B) ( 60.2) 255- 4355
The O f f i c e o f the Auditor General has conducted a performance audit of
the Arizona State Board of Psychologist Examiners i n response to a June
2, 1987 r e s o l u t i o n of the J o i n t L e g i s l a t i v e Oversight Committee. This
performance audit was conducted as part of the Sunset Review set f o r t h i n
Arizona Revised Statutes ( A. R. S.) $ 541- 2351 through 41- 2379.
The board was established i n 1965 to protect the health and welfare of
the p u b l i c as i t r e l a t e s to the p r a c t i c e of psychology. To accomplish
t h i s purpose, the board performs a v a r i e t y o f functions i n c l u d i n g :
examining, c e r t i f y i n g , and renewing c e r t i f i c a t i o n s of duly q u a l i f i e d
a p p l i c a n t s ; conducting i n v e s t i g a t i o n s , hearings, and proceedings
concerning v i o l a t i o n s ; and d i s c i p l i n i n g v i o l a t o r s . C u r r e n t l y , the
seven- member board i s responsible for regu l a t i ng approximately 1 ,200
c e r t i f i e d psychologists.
C e r t i f i c a t i o n o f Psychologists Adequately
P r o t e c t s P u b l i c Health and Welfare
C e r t i f i c a t i o n o f psychologists provides adequate pub1 i c protect ion.
Because the p r a c t i c e of psychology exposes the pub1 i c to some r i s k ,
r e g u l a t i o n i s warranted. Persons who seek psychological services usually
do so at a time when they are p a r t i c u l a r l y vulnerable to unprofessional
conduct by a psychologist. In a d d i t i o n , psychological evaluations are
the basis for many decisions made by courts and government agencies
concerning i n d i v i d u a l s ' personal l i b e r t y , custody of c h i l d r e n , or the
amount of d i s a b i l i t y income.
I n our 1979 report o f the Board of Psychologist Examiners, we recommended
that psychologists be licensed. However, based on s t a t u t o r y changes made
since the l a s t a u d i t and a d d i t i o n a l data a v a i l a b l e , we now b e l i e v e that
c e r t i f i c a t i o n provides an adequate level o f r e g u l a t i o n .
Licensure would r e q u i r e t h a t the scope o f p r a c t i c e be defined. Such
a c t i v i t i e s could be performed by licensed psychologists o n l y . However,
many a c t i v i t i e s which f a l l w i t h i n the p r a c t i c e o f psychology also f a l l
w i t h i n the a c t i v i t i e s of several professions. Therefore, d e f i n i n g and
enforcing a scope of p r a c t i c e which i s not o v e r l y broad i s d i f f i c u l t i f
not impossible.
Further, because the incidence o f harm i s low, c e r t i f i c a t i o n and legal
remedies provide adequate p u b l i c p r o t e c t i o n . By r e s t r i c t i n g the use of
the t i t l e " psychologist" to persons who meet s p e c i f i c q u a l i f i c a t i o n s ,
c e r t i f i c a t i o n aids the p u b l i c i n i d e n t i f y i n g q u a l i f i e d psychologists.
Disclosure of p e r t i n e n t information to prospective c l i e n t s could also
reduce r i s k s of unprofessional conduct. I f harm s t i l l occurs, a c t i o n can
be taken against the p s y c h o l o g i s t ' s c e r t i f i c a t i o n and/ or against the
psychologist through the courts.
Although the Board's Complaint Handling Has Improved,
Further Improvements Can S t i l l Be Made
The board has improved i t s timeliness i n resolving complaints i n recent
years, although some changes could f u r t h e r improve the process. During
the last three years the average time to dispose of a complaint has
decreased from 243 days i n 1986 to 114 days i n 1988. However, some
delays i n case d i s p o s i t i o n continue. For example, nearly one- quarter of
the cases received i n 1986- 88 took seven months to over a year to close.
Two factors appear to cause delays i n complaint handling: inadequate
d i s c i p l i n a r y options and the p r a c t i c e of using board members to
investigate complaints. C u r r e n t l y , the board lacks the a u t h o r i t y to
issue intermediate d i s c i p l i n a r y measures. The board's only d i s c i p l i n a r y
options are probation, suspension, or revocation. As a r e s u l t , many
complaints are resolved using consent agreements - a process which o f t e n
involves lengthy negotiations over wording. By adding a wider range of
d i s p o s i t i o n s , such as l e t t e r s o f concern, decrees of censure, and c i v i l
p e n a l t i e s , the board may be able t o reduce the time required to resolve
complaints.
I n a d d i t i o n , board members, who serve part- time o n l y , c u r r e n t l y perform
most complaint i n v e s t i g a t i o n s . Because board members per form
i n v e s t i g a t i o n s w h i l e a l s o engaging i n t h e i r p r o f e s s i o n a l p r a c t i c e s ,
complaint i n v e s t i g a t i o n s are o f t e n delayed. Many other l i c e n s i n g boards
now use consultants t o i n v e s t i g a t e complaints. This can both improve the
t i m e l i n e s s and q u a l i t y of i n v e s t i g a t i o n s . However, i f a c o n s u l t a n t i s
used i n a l l Psychology Board cases, the board may need $ 16,000 to $ 18,000
i n a d d i t i o n a l funding.
TABLE OF CONTENTS
INTRODUCTION AND BACKGROUND. . . . . . . . . . . . . . . . . 1
SUNSETFACTORS . . . . . . . . . . . . . . . . . . . . . . . 5
F l ND 1 NG I : CERT l F 1 CAT l ON OF PSYCHOLOG 1 STS ADEQUATELY
PROTECTS PUBLIC HEALTH AND WELFARE . . . . . . . . . . . 9
The Practice of Psychology Poses
R i s k s t o t h e P u b l i c . . . . . . . . . . . . . . . . . . . 9
C e r t i f i c a t i o n Is an Adequate Level
ofRegulation . . . . . . . . . . . . . . . . . . . . . . 11
Recomnendations. . . . . . . . . . . . . . . . . . . . . 15
FINDING II: ALTHOUGH THE BOARD'S COMPLAINT HANDLING
HAS IMPROVED, FURTHER IMPROVEMENTS CAN
STILLBEMADE . . . . . . . . . . . . . . . . . . . . . . 17
Complaint Dispositions Have Become More
TimelybutProblemsRemain . . . . . . . . . . . . . . . 18
Refinements in Disciplinary Measures
and Investigative Procedures Could Improve
TimelinessandProvide Additional Benefits . . . . . . . 20
Recomnendations. . . . . . . . . . . . . . . . . . . . . 24
AGENCY RESPONSE
LIST OF TABLES
Page
TABLE 1 - State Board of Psychologist Examiners
Statement of Revenues, Expenditures,
and Changes i n Fund Balance
Fi scal Years 1986- 87 and 1987- 88,
and 1988- 89 Budget ( unaudited) . . . . . . . . . 3
TABLE 2 - Disciplinary Actions Taken by the Board
for Complaints Received in 1986- 88 . . . . . . . 17
TABLE 3 - Average Length of Case Disposition
for A l l Cases, 1986- 88 . . . . . . . . . . . . . 18
TABLE 4 - Length of Time for Case Disposition
Complaints Received in 1986- 88 . . . . . . . . . . 19
TABLE 5 - Length of Time Open Cases Have Been Pending,
Complaints Received in 1986- 88 . . . . . . . . . 19
TABLE 6 -- Dispositional Options of Arizona
Medical Boards . . . . . . . . . . . . . . . . . 21
INTRODUCTION AND BACKGROUND
The O f f i c e of the Auditor General has conducted a performance a u d i t of
the Arizona State Board of Psychologist Examiners i n response to a June
2, 1987, r e s o l u t i o n of the J o i n t L e g i s l a t i v e Oversight Committee. This
performance a u d i t was conducted as p a r t of the Sunset Review set f o r t h i n
Arizona Revised Statutes ( A. R. S.) 5541- 2351 through 41- 2379.
The Arizona State Board of Psychologist Examiners was establ ished i n
1965. I t s purpose i s t o p r o t e c t p u b l i c h e a l t h and w e l f a r e as i t r e l a t e s
to the p r a c t i c e of psychology. "' To accomplish t h i s purpose, the
board performs a v a r i e t y of f u n c t i o n s i n c l u d i n g : examining, c e r t i f y i n g ,
and renewing c e r t i f i c a t i o n s o f duly q u a l i f i e d a p p l i c a n t s ; conducting
i n v e s t i g a t i o n s , hearings, and proceedings concerning v i o l a t i o n s ; and
d i s c i p l i n i n g v i o l a t o r s . C u r r e n t l y , there are approximately 1,200
psychologists c e r t i f i e d by the board. Although others may o f f e r services
s i m i l a r t o a p s y c h o l o g i s t ' s , s t a t u t o r y p r o v i s i o n s p r o h i b i t use of the
t i t l e " p s y c h ~ l o g i s t ' u~ n less the i n d i v i d u a l i s board c e r t i f i e d .
The board consists of seven members appointed by the Governor f o r
five- year terms. The board members include f i v e c e r t i f i e d p s y c h o l o g i s t s
and two p u b l i c members. Two of the members represent the s t a t e
u n i v e r s i t i e s ' departments of psychology and two members must be p r i v a t e
p r a c t i c e p s y c h o l o g i s t s .
Staffing and Budget
To a s s i s t the board i n c a r r y i n g out i t s f u n c t i o n s , i t has a f u l l - t i m e
executive d i r e c t o r . The board also has one i n v e s t i g a t o r and one
consultant on contract to a s s i s t i n the i n v e s t i g a t i o n o f some complaint
cases. Monies are appropriated f o r board operations from the
The p r a c t i c e of psychology i s the assessment of behavioral and mental c o n d i t i o n s ;
the diagnosis of neuropsychologi cal disorders and dysfunctions; the prevention and
treatment of behavioral and mental disorders and dysfunctions; and the maintenance
and enhancement of physical, i n t e l l e c t u a l , emotional, s o c i a l , and interpersonal
f u n c t i o n i n g .
Psychologist Examiners Fund. The fund i s comprised of fees c o l l e c t e d for
a p p l i c a t i o n s f o r examination and c e r t i f i c a t i o n , c e r t i f i c a t e renewals, and
other miscellaneous income. The board receives 90 percent of fees
c o l l e c t e d for operations, whi le the remaining 10 percent i s deposited i n
the General Fund. Table 1 ( page 3) i l l u s t r a t e s the board's actual and
budgeted revenues and expenditures for f i s c a l years 1986- 87 through
1988- 89.
Scope of Audit
This a u d i t contains f i n d i n g s in two major areas:
a The need to regulate the p r a c t i c e o f psychology.
0 The need to f u r t h e r improve the complaint handling process.
The a u d i t was conducted i n accordance w i t h generally accepted
governmental a u d i t i n g standards.
The Auditor General and s t a f f express a p p r e c i a t i o n to the board members
and the executive d i r e c t o r f o r t h e i r cooperation and assistance during
the course of the a u d i t .
TABLE 1
STATE BOARD OF PSYCHOLOGIST EXAMINERS
STATEMENT OF REVENUES, EXPENDITURES, AND CHANGES IN FUND BALANCE
FISCAL YEARS 1986- 87 AND 1987- 88, AND 1988- 89 BUDGET
( unaud i ted )
1986- 87 1987- 88 1988- 89
Actual Actual Budget
Revenues ( a) $ 112,501 $ 45,779 $ 126,700
Expendi tures
Personal services $ 25,552 $ 26,891 $ 30,100
Employee r e l a t e d expense 5,613 5,561 6,800
Professional and outside
servi ces 32,235 40,155 69,800
Travel, in- state 1,674 1 ,499 3,900
T r a v e l , o u t - o f - s t a t e 2,228 1 ,548 900
Other ope rat i ng expenses 6,831 10; 032 12,700
Capital o u t l a y 348 - 0- 200
Total Expenditures 74,481 85,686 124,400
Excess of revenues over
( under expend i tures 38,020 ( 39,907) 2,300
Other financing uses:
Remittances to State
General Fund 10,597 3,840
Excess of revenues over ( under)
expenditures and other uses 27 ,423 ( 43,747)
Beginning fund balance 105,040 132,463 95,5OO( b)
Ending fund balance $ 132.463 $ 88.717 $ 97,800
( a) The Board o f Psychologist Examiners has a b i e n n i a l 1 i c e n s i n g c y c l e .
( b) The f i s c a l year 1988- 89 budget beginning balance was estimated p r i o r t o the end of
f i s c a l year 1987- 88. Therefore, the actual ending balance f o r f i s c a l year 1987- 88
does not agree w i t h the budgeted beginning balance f o r f i s c a l year 1988- 89.
Source: J o i n t L e g i s l a t i v e Budget Committee Appropriations Report for
f i s c a l year 1988- 89 and Arizona F i n a n c i a l Information System
reports f o r f i s c a l years 1986- 87, 1987- 88, and 1988- 89.
SUNSET FACTORS
1. Objective and purpose i n e s t a b l i s h i n g the board
Although the board's enabling statutes do not contain an e x p l i c i t
statement o f o b j e c t i v e or purpose, the board has defined i t s purposes
as the f o l l o w i n g :
The goals and objectives o f the State Board of Psychologist
Examiners are t o e s t a b l i s h and maintain h i g h standards of
q u a l i f i c a t i o n and performance for persons who are c e r t i f i e d
as psychologists and to regulate the p r a c t i c e of
psychologists for the p r o t e c t i o n of the p u b l i c .
To accomplish t h i s purpose, the board establishes c r i t e r i a for
c e r t i f i c a t i o n , t e s t s a p p l i c a n t s , and c e r t i f i e s and d i s c i p l i n e s
psychologists.
2. The effectiveness w i t h which the board has met i t s o b j e c t i v e and
purpose and the e f f i c i e n c y w i t h which i t has operated
The board has been generally e f f e c t i v e i n r e g u l a t i n g the psychology
profession through examination, c e r t i f i c a t i o n , and complaint
d i s p o s i t i o n . The board has promulgated rules and r e g u l a t i o n s
establishing standards and q u a l i f i c a t i o n s for c e r t i f i c a t i o n . The
board has also improved i t s timeliness i n resolving complaints. ( See
Finding I I , page 17.)
3. The extent t o which the board has operated w i t h i n the p u b l i c
i n t e r e s t
The board has acted i n the p u b l i c i n t e r e s t by taking d i s c i p l i n a r y
action against psychologists who have v i o l a t e d the s t a t u t e s . During
the past three years the board has placed four psychologists on
probation and revoked or suspended three p s y c h o l o g i s t s '
c e r t i f i c a t i o n s .
4. The extent t o which r u l e s and r e g u l a t i o n s promulgated by the board
are consistent w i t h l e g i s l a t i v e mandate
The board has promulgated rules and regulations that a r e c o n s i s t e n t
w i t h i t s l e g i s l a t i v e mandate. The Attorney General's o f f i c e reviews
and c e r t i f i e s a l l proposed r u l e s .
5. The extent to which the board has encouraged input from the pub1 ic
before promulgating i t s rules and regulations and the extent to which
i t has informed the public as to i t s actions and their expected
impact on the public
The board has complied w i t h the Open Meeting Law and has otherwise
encouraged input from the p u b l i c before promulgating i t s rules and
r e g u l a t i o n s . The most recent r u l e changes occurred i n 1987- 88.
Board records show that c e r t i f i e d psychologists were n o t i f i e d of the
proposed changes and were encouraged to send w r i t t e n comments to the
board or attend a p u b l i c hearing. F u r t h e r , the board has n o t i f i e d
the Secretary o f S t a t e ' s o f f i c e where meeting n o t i c e s w i l l be
posted. i n a d d i t i o n , the board's executive d i r e c t o r d i s t r i b u t e s
meeting n o t i c e s to the press.
6 . The extent to which the board has been able to investigate and
resolve complaints within i t s jurisdiction
Although the board has e f f e c t i v e l y i n v e s t i g a t e d and disposed of
complaints as recommended i n our 1979 r e p o r t , changes could f u r t h e r
improve the complaint r e s o l u t i o n process. ( See Finding I I , page
17.) C u r r e n t l y , the board sometimes uses i n v e s t i g a t o r s and
consultants t o i n v e s t i g a t e complaints; however, cases are i n i t i a l l y
assigned to a board member. Because the number of complaints
received each year has increased s u b s t a n t i a l l y since the 1979 a u d i t ,
the i n v e s t i g a t i v e process may require considerable time on the part
of a board member. The number and complexity of cases assigned to a
board member may impede t i m e l y i n v e s t i g a t i o n s . The current process
also lacks a uniform method of i n v e s t i g a t i o n and documentation. To
correct t h i s , the board should i n i t i a l l y assign cases to the
consultant and r e l i e v e the board members of i n v e s t i g a t i v e work.
Limited d i s c i p l i n a r y options may also have impeded the board i n
resolving some complaints. The board can suspend or revoke a
c e r t i f i c a t i o n , or place a psychologist on p r o b a t i o n . U n l i k e other
Arizona r e g u l a t o r y boards, the Psychology Board does not have the
a u t h o r i t y t o issue l e t t e r s of concern, decrees of censure, or levy
f i n e s . According to some board members, some cases could have been
resolved w i t h a less severe form of d i s c i p l i n e . The board may have
avoided lengthy l e g a l delays w i t h a d d i t i o n a l d i s c i p l i n a r y options
avai lab l e .
6
7. The extent to which the Attorney General or any other applicable
agency of State government has the a u t h o r i t y to prosecute actions
under enabling l e g i s l a t i o n
According to the board's Attorney General representative, the board's
statutes provide s u f f i c i e n t authority to prosecute.
8. The extent to which the board has addressed deficiencies i n i t s
enabling statutes which prevent i t from f u l f i l l i n g i t s statutory
mandate
According to the board's executive. d i r e c t o r , the board has not
i n i t i a t e d any l e g i s l a t i o n during the last three years.
9. The extent to which changes are necessary i n the laws of the board
to adequately comply with the factors l i s t e d i n the Sunset Laws
Based on our audit work we recommend that the Legislature consider
the following changes to the board's statutes.
a Amend A. R. S. 532- 2061 e t . seq. to require psychologists to
disclose to c l i e n t s the information necessary for c l i e n t s to
make informed decisions regarding r i s k s to t h e i r health and
welfare from the practice of psychology. ( See Finding I , page
9.)
a Amend A. R. S. 532- 2081 t o allow the board to issue l e t t e r s of
concern, decrees of censure, and levy fines. ( See Finding I I ,
page 17. )
a Amend A. R. S. 532- 2074 t o raise the statutory l i m i t on fees.
( See Finding l I , page 17.)
10. The extent to which the termination of the board would s i g n i f i c a n t l y
harm the public health, safety, or welfare
Termination of the board would harm the public. The practice of
psychology involves the diagnosis and treatment of behavioral and
mental disorders. Individuals seeking psychological services may do
so at a time when they are p a r t i c u l a r l y vulnerable to unprofessional
practices. Also, c l i e n t s may not have s u f f i c i e n t information to
evaluate the q u a l i f i c a t i o n s o f the psychologist. In a d d i t i o n , courts
and government agencies use psychologists to make evaluations which
a f f e c t i n d i v i d u a l s ' personal l i b e r t y , custody of c h i l d r e n , and
d i s a b i l i t y income. These i n s t i t u t i o n s informed us that they r e l y upon
the State c e r t i f i c a t i o n process to help i d e n t i f y q u a l i f i e d
professionals to perform these services.
11. The extent to which the level of regulation exercised by the board
i s appropriate and whether less or more stringent levels of
regulation would be appropriate
Based on our review, the level of r e g u l a t i o n exercised by the board
appears appropriate. As discussed i n Finding I ( page 9 ) ,
c e r t i f i c a t i o n w i t h r e s t r i c t i o n s on the use of the t i t l e of
psychologist appears to o f f e r adequate p r o t e c t i o n to the p u b l i c .
12. The extent to which the board has used private contractors in the
performance of i t s duties and how effective use of private
- co ntractors could be accomplished
The board c u r r e n t l y contracts for three services: hearing o f f i c e r ,
i n v e s t i g a t o r , and consultant. As discussed i n Finding I1 ( page 17),
we recommend the board make greater use of i n v e s t i g a t o r s and
psychologist consultants to a s s i s t i n resolving complaints.
FINDING I
CERTIFICATION OF PSYCHOLOGISTS ADEQUATELY
PROTECTS PUBLIC HEALTH AND WELFARE
The State should continue to c e r t i f y psychologists. Regulation i s
warranted because the p r a c t i c e of psychology exposes the p u b l i c t o some
r i s k s . C e r t i f i c a t i o n , however, rather than licensure, provides an
adequate level of r e g u l a t i o n .
Regulation of a p r o f e s s i o n i s necessary when the p u b l i c ' s health and
safety are threatened. The Counci I of State Governments notes that
r e g u l a t i o n may be needed i f an occupation poses a r i s k to consumers'
l i f e , health and s a f e t y , o r economic well- being. Regulation should also
be considered when p o t e n t i a l users cannot be expected to have adequate
knowledge to properly evaluate the q u a l i f i c a t i o n s o f those o f f e r i n g the
services. "' A l l states see the need for r e g u l a t i n g psychologists
e i t h e r through c e r t i f i c a t i o n or I icensure!')
The Practice o f Psychology
Poses Risks t o the Public
Regulation of psychologists i s needed to protect the p u b l i c . C l i e n t s
seeking psychological services may be vulnerable to unprofessional
p r a c t i c e s . Furthermore, psychoIogists conduct evaluations that a f f e c t
c r i t i c a l decisions concerning a person's l i b e r t y , f a m i l y , or some types
of d i s a b i l i t y income.
V u l n e r a b i l i t y o f c l i e n t s - Persons seeking psychological services
usually do so when they are p a r t i c u l a r l y vulnerable to unprofessional
conduct by a p s y c h o l o g i s t . In recent years greater p u b l i c a t t e n t i o n has
( 1 ) The Council o f State Governments has prepared and published several works and
guides on occupational 1 icensing. For example, i n 1978 the Council pub1 i shed
k c u p a t i o n a l Licensina: Ouestions a Leai s l a t o r Should Ask, w r i t t e n by Benjamin
Shimberg and Doug Roederer.
( 2) Arizona and f o u r o t h e r s t a t e s ( I l l i n o i s , Indiana, New Mexico, and Rhode I s l a n d )
c e r t i f y psychologists; the remaining f o r t y - f i v e s t a t e s l i c e n s e them.
focused on t h i s v u l n e r a b i l i t y as i t r e l a t e s to sexual misconduct. The
major insurer of psychologists i n the U n i t e d S t a t e s reports that
n a t i o n a l l y about 125 malpractice s u i t s are brought each year against the
32,000 psychologists i t insures. Approximately one- half of these cases
involve a l l e g a t i o n s o f sexual abuse.
There i s evidence t h a t sexual misconduct by psychologists also occurs i n
Arizona. In t h e years 1986- 1988, s i x complaints were f i l e d w i t h the
Board of Psychologist Examiners a l l e g i n g sexual misconduct by a
psychologist. I n v e s t i g a t i o n by the board resulted i n d i s c i p l i n a r y a c t i o n
i n four cases: two c e r t i f i c a t e s were revoked, one was suspended, and one
psychologist was placed on probation. Of the remaining two cases, one
case was dismissed and the other i s pending.
Legally mandated evaluations - Thousands of i n d i v i d u a l s each year r i s k
loss of personal l i b e r t y , custody of c h i l d r e n , or d i s a b i l i t y income as a
r e s u l t o f l e g a l l y mandated psychological evaluations ordered by courts
and government agencies i n Arizona. For example:
0 The c r i m i n a l c o u r t s order hundreds of psychological evaluations each
year t o h e l p determine competency to stand t r i a l , and danger to s e l f
o r o t h e r s . Decisions to prosecute, sentence, i n c a r c e r a t e , or commit
may be a f f e c t e d by the f i n d i n g s .
o The Domestic Relations Court orders over one thousand psychological
evaluations of c h i l d r e n and parents each year i n connection w i t h
l i t i g a t e d divorce cases. In a d d i t i o n , the Department of Economic
Security ( DES), D i v i s i o n of Social Services orders several hundred
psychological evaluations i n order to determine custody of c h i l d r e n .
The D i s a b i l i t y Determination Service A d m i n i s t r a t i o n of the DES orders
about 1,200 psychological evaluations a year i n f u l f i l l i n g i t s
r e s p o n s i b i l i t i e s under the U. S. Social S e c u r i t y A c t . B e n e f i t s
granted or withheld i n accordance w i t h the f i n d i n g s amount to an
average of $ 750 per month for a worker w i t h dependents. Since the
average d i s a b i l i t y claim runs for s i x t o seven years, more than
$ 54,000 i s a t r i s k f o r such a worker.
Court o f f i c i a l s c l a i m t h a t they r e l y upon the S t a t e ' s c e r t i f i c a t i o n
process to help i d e n t i f y q u a l i f i e d p r o f e s s i o n a l s . The c o u r t s are n o t set
up to review and determine the competency of i n d i v i d u a l s o f f e r i n g
psychological s e r v i c e s . Without the State performing c e r t i f i c a t i o n , the
courts would be forced to f i n d a l t e r n a t i v e methods of assessing
q u a l i f i c a t i o n s .
C e r t i f i c a t i o n I s an Adeauate
Level o f Regulation
In our 1979 report on the Psychology Board, we recommended that
psychologists be licensed. We found that Arizona lacked a s t a t u t o r y
d e f i n i t i o n for the p r a c t i c e of psychology and therefore had no
r e s t r i c t i o n on who may o f f e r such services to the p u b l i c . Further, we
found that there was a p o t e n t i a l for f i n a n c i a l , psychological, and
physiological harm from incompetent or unscrupulous p r o v i d e r s . F i n a l l y ,
we found that p o t e n t i a l users of psychological services could not be
expected to possess the knowledge to properly evaluate the q u a l i f i c a t i o n s
of those o f f e r i n g services. However, based on s t a t u t o r y changes made
since the l a s t a u d i t and the a d d i t i o n a l data a v a i l a b l e , we now believe
that c e r t i f i c a t i o n provides an adequate level of r e g u l a t i o n .
Scope of p r a c t i c e i s d i f f i c u l t t o define - Licensure requires that the
scope o f p r a c t i c e be defined and, by doing so, makes i t i l l e g a l for
unlicensed i n d i v i d u a l s t o provide the services f a l l i n g w i t h i n the scope.
In the case of psychoIogists i t i s d i f f i c u l t to define a scope of
practice without being too broad and p o t e n t i a l l y r e s t r i c t i n g a c t i v i t i e s
engaged i n by numerous other persons. For example, i n i t s 1987 model act
the American Psychological Association defines the p r a c t i c e of psychology
as:
. . . the observation, d e s c r i p t i o n , e v a l u a t i o n , i n t e r p r e t a t i o n , and
m o d i f i c a t i o n of human behavior by the a p p l i c a t i o n of psychological
p r i n c i p l e s , methods, and procedures, for the purpose of preventing or
e l i m i n a t i n g symptomatic, maladaptive, or undesired behavior and of
enhancing interpersonal r e l a t i o n s h i p s , work and l i f e adjustment,
personal e f f e c t i v e n e s s , behavioral health, and mental health.(')
Such a c t i v i t i e s , while f a l l i n g w i t h i n the p r a c t i c e of psychology, also
f a l l w i t h i n the d a i l y a c t i v i t i e s of many p e o p l e ' s p r o f e s s i o n a l and
personal l i v e s . Social workers, teachers, c l e r g y , f a m i l y t h e r a p i s t s , and
( 1 ) The a c t f u r t h e r states t h a t the p r a c t i c e of psychology i n c l u d e s , b u t i s not 1 i m i t e d
to, psychological t e s t i n g , counseling, psychotherapy, hypnosis, biofeedback,
diagnosis and treatment o f mental and emotional disorders, a1 coho1 i sm and substance
abuse, as well as t h e psychological aspects of physical i l l n e s s , accident, i n j u r y ,
and d i sabi 1 i t y .
numerous other occupations observe, evaluate, and i n t e r p r e t behavior.
They counsel to e l i m i nate undesi red behavior and/ or enhance r e l a t i o n s h i p s
and i n d i v i d u a l mental health. I n a d d i t i o n , i n d i v i d u a l s may i n t h e i r
personal l i v e s counsel f r i e n d s o r family members on problems. Therefore,
d e f i n i n g and e n f o r c i n g a scope of p r a c t i c e which i s not overbroad i s
d i f f i c u l t , i f not impossible.
In a d d i t i o n , the continued use of c e r t i f i c a t i o n rather than l i c e n s u r e f o r
psychologists i s consistent w i t h the passage of recent l e g i s l a t i o n
addressing other behavioral h e a l t h p r o f e s s i o n a l s . As o f J u l y 1, 1989,
social workers, counselors, and marriage and family t h e r a p i s t s w i l l be
c e r t i f i e d by the Board of Behavioral Health Examiners. These
professions, which provide many of the same services as psychologists,
w i l l be c e r t i f i e d and not licensed.
Incidence o f harm does not warrant l icensure - In our 1979 report on
the board, we also found that there was a p o t e n t i a l for f i n a n c i a l ,
psychological, and p h y s i o l o g i c a l harm from incompetent or unscrupulous
providers. However, recent s t a t i s t i c s i n d i c a t e t h a t although harm does
occur, the incidence of harm i s not frequent enough to warrant
l i c e n s u r e . F u r t h e r , other measures e x i s t to address harm when i t does
occur .
Because Iicensure i s the most severe form of r e g u l a t i o n , i t should be
reserved for professions w i t h the greatest threat of harm to the p u b l i c .
Although harm can occur from the p r a c t i c e of psychology, the incidence of
harm does not warrant I i c e n s u r e . N a t i o n a l m a l p r a c t i c e s t a t i s t i c s
i n d i c a t e harm i s uncommon. According to the major malpractice insurance
p r o v i d e r p r e v i o u s l y c i t e d , psychologists are a " l o w - r i s k group"
nationwide. The psychologists' annual r a t e o f $ 450 per one m i l l i o n
d o l l a r s o f l i a b i l i t y coverage has not changed for years, and the company
has never paid for damage to a c l a i m a n t ' s mental health from
psychotherapy. In a d d i t i o n , the insurance c a r r i e r reported that less
than two percent o f the cases, two to three cases per y e a r , i n v o l v e
improper treatment or evaluation. S i m i l a r l y , o f f i c i a l s of two of
Arizona's l a r g e s t b e h a v i o r a l health- care p r o v i d e r s s t a t e d that no
malpractice s u i t against t h e i r i n s t i t u t i o n s has ever named a psychologist
as a p a r t y .
Complaints f i l e d against Arizona psychologists a l s o i n d i c a t e a l i m i t e d
r i s k . Although the board c e r t i f i e s about 1,200 psychologists, the board
received only 26 complaints during 1986- 88 a l l e g i n g some form of harm
( sexual misconduct and improper e v a l u a t i o n ) . Nineteen of the complaints
were dismissed, two are pending, and f i v e had d i s c i p l i n a r y a c t i o n taken
against the d o c t o r ' s c e r t i f i c a t i o n .
I f harm from the p r a c t i c e of psychology occurs, options e x i s t to address
i t . The Board of Psychologist Examiners can place a psychologist on
p r o b a t i o n , o r suspend or revoke the psychologist!^ c e r t i f i c a t i o n for
unprofessional conduct. Upon suspension o r r e v o c a t i o n , the offending
psychologist can no longer o f f e r services under the t i t l e " p s y c h ~ l o g i s t , ~ !
although he or she may be able to do so under a d i f f e r e n t t i t l e .
However, a f t e r July 1, 1989, t h i s o p t i o n w i l I be l i m i t e d w i t h the
c r e a t i o n o f the Board of Behavioral Health Examiners.
Furthermore, persons harmed by the p r a c t i c e of psychology or the
unprofessional conduct of a psychologist may also seek redress through
c i v i l and c r i m i n a l procedures. A t least four such cases are now before
the courts i n Arizona.
An a d d i t i o n a l o p t i o n to strengthen c e r t i f i c a t i o n i s t o amend the s t a t u t e s
to d i r e c t l y address p a r t i c u l a r l y serious harms, such as the r i s k of
unprofessional behavior i n v o l v i n g sexual misconduct. Minnesota r e c e n t l y
passed l e g i s l a t i o n which makes i t a felony for a psychologist to have
sexual r e l a t i o n s w i t h a c l i e n t and eliminates consent of the c l i e n t as a
defense. Minnesota's law p r o h i b i t s such r e l a t i o n s f o r a two- year period
f o l lowing terminat ion of treatment.
Methods exist to allow evaluation of qualifications - I n our 1979
report on the Board of Psychologist Examiners, we i n d i c a t e d t h a t
p o t e n t i a l users of psychological services could not be expected to
possess the knowledge needed to properly evaluate the q u a l i f i c a t i o n s of
those o f f e r i n g services. However, based on our current review o f the
q u a l i f i c a t i o n s required for c e r t i f i c a t i o n and Iicensure, we f i n d that
c e r t i f i c a t i o n requires psychologists to meet e s s e n t i a l l y the same
requirements as Iicensure. Further, i n recent years some s t a t e s have
improved prospective c l i e n t s ' a b i l i t y to evaluate psychologists'
q u a l i f i c a t i o n s and have reduced the r i s k s of unprofessional conduct by
r e q u i r i n g psychologists to d i s c l o s e p e r t i n e n t information to the c l i e n t s .
C e r t i f i c a t i o n requires psychologists to meet e s s e n t i a l l y the same
q u a l i f i c a t i o n s as might be required for licensure. To be e l i g i b l e for
c e r t i f i c a t i o n i n Arizona, an applicant must have a doctorate from an
accredited program w i t h the m a j o r i t y of coursework done i n psychology.
He or she must also pass a n a t i o n a l l y developed examination. Further,
although Arizona does not require a period of supervised c l i n i c a l
p r a c t i c e or i n t e r n s h i p , i t could do so under c e r t i f i c a t i o n ! "
Disclosure o f p e r t i n e n t information to prospective c l i e n t s could reduce
the r i s k s o f unprofessional conduct. The need for disclosure i s
explained by one a u t h o r i t y on r e g u l a t i n g psychologists: " A major problem
besetting the f i e l d o f psychotherapy has been the lack of information
a v a i l a b l e to the p u b l i c . People enter psychotherapy without a clear
p i c t u r e of the process . . and i n what s i t u a t i o n s harm i s l i k e l y to
occur . t1( 2' Disclosure would permit c l i e n t s to make more informed
decisions regarding t h e i r own health and welfare concerning behavioral
health services. Some s t a t e s now r e q u i r e d i s c l o s u r e by psychologists
and/ or other behavioral health- service p r o v i d e r s . For example:
e Washington s t a t e r e q u i r e s t h a t p s y c h o l o g i s t s d i s c l o s e i n f o r m a t i o n at
the commencement of treatment i n accordance w i t h g u i d e l i n e s s e t by
the examining board. Statutes s t i p u l a t e that the information must
include:
- the purposes of and resources a v a i l a b l e under the l i c e n s i n g
s t a t u t e ,
( 1 ) O f t h e f o u r other states which c e r t i f y psychologists, a l l require a two- year
i n t e r n s h i p .
( 2 ) Daniel Hogan, A Studv of the Philosoohy and Practice of Professional R e a u l & i w ,
v o l . 1 of The Reaulation of P s ~ c h o t h e r a p i s t r ( Cambridge, Mass., 1979), 381.
- the r i g h t o f the c l i e n t to refuse treatment and the c l i e n t ' s
r e s p o n s i b i l i t y for choosing the treatment modality best suited
to h i s need,
- the education, t r a i n i n g , and therapeutic o r i e n t a t i o n of the
p s y c h o l o g i s t ' s p r a c t i c e ,
- the proposed course of treatment where known,
- the extent o f c o n f i d e n t i a l i t y provided by s t a t u t e , and
- f i n a n c i a l requirements.
In p r a c t i c e , the examining board prepares an informational
brochure for d i s t r i b u t i o n by the psychologist and guidelines for
information to be provided d i r e c t l y by the psychologists.
e The s t a t e of Minnesota r e q u i r e s p s y c h o l o g i s t s to provide each
prospective c l i e n t w i t h a prescribed statement regarding the
c l i e n t ' s r i g h t s vis- a- vis the psychologist and the r i g h t to seek
redress under the s t a t u t e s . Minnesota requires unlicensed mental
h e a l t h s e r v i c e p r o v i d e r s who are registered w i t h a s t a t e board to
provide prospective c l i e n t s w i t h information s t a t i n g t h e i r
education, t r a i n i n g , experience, and the f a c t t h a t Minnesota has
no uniform educational and t r a i n i n g standards for mental health
service p r o v i d e r s .
RECOWENDATIONS
1. The State of Arizona should continue to c e r t i f y psychologists.
2. The L e g i s l a t u r e should consider amending A. R. S. $ 32- 2061 e t . seq. t o
require psychologists to disclose to c l ients the information
necessary t o make informed decisions regarding r i s k s t o t h e i r health
and welfare from the p r a c t i c e of psychology.
FINDING I I
ALTHOUGH THE BOARD'S COMPLAINT HANDLING HAS IMPROVED,
FURTHER IMPROVEMENTS CAN STILL BE MADE
The Arizona State Board of Psychologist Examiners has improved i t s
complaint handling process i n recent years, but some changes can f u r t h e r
improve the process. Although the board has improved i t s t i m e l i n e s s of
case d i s p o s i t i o n s , some delays continue. By adding more d i s c i p l i n a r y
measures and changing the way i t conducts i n v e s t i g a t i o n s , the board could
f u r t h e r improve t i m e l i n e s s as well as improve consistency of
i n v e s t i g a t i o n s .
The board receives approximately 35 t o 50 complaints a year. Complaints
received address such items as v i o l a t i o n of t i t l e ( e . g . , a person
advertises as a " p s y c h o l o g i s t , " though not c e r t i f i e d ) , fees and b i l l i n g ,
improper e v a l u a t i o n s , and sexual misconduct. Table 2 i l l u s t r a t e s the
d i s c i p l i n a r y actions taken on the 108 cases t h a t were presented t o the
board during the years 1986- 88 and f o r which a f i n a l decision has been
made.
TABLE 2
DISCIPLINARY ACTIONS TAKEN BY THE BOARD
FOR COMPLAINTS RECEIVED IN 1986- 88
Type o f Action Number o f Cases
Dismissal
Probat ion
Suspension
Revocation
101 ( a)
4
1
2
Total s!&
( a) The board d i smi ssed 56 of the cases through informal admi ni s t r a t i v e measures.
For example, the executive d i r e c t o r n o t i f i e d i n d i v i d u a l s by correspondence t o
cease using the term p s y c h o l o g i s t w i t h o u t being c e r t i f i e d .
Source: Auditor General review of Psychology Board complaint f i l e s f o r
the years 1986, 1987, and 1988.
Complaint D i s p o s i t i o n s
Have Become More Timely
but Problems Remain
The board has shortened the length of time necessary to resolve
complaints. During the l a s t three years the average time to dispose of a
case has decreased s u b s t a n t i a l l y . However, delays i n resolving some
cases continue.
As i l l u s t r a t e d i n Table 3, the board has s t e a d i l y improved i t s timeliness
i n complaint d i s p o s i t i o n since 1986. The average time to dispose of a
case has dropped from 243 days i n 1986 to 114 days i n 1988.
TABLE 3
AVERAGE LENGTH OF CASE DISPOSITION
FOR ALL CASES, 1986- 1988
Average Number
o f Days
Year t o D i s p o s i t i o n
( a) This f i g u r e i s c u r r e n t as of March 6, 1989. One pending case w i l l go t o a hearing
on A p r i l 7, 1989. Should the case close w i t h i n a month a f t e r t h e hearing, the 1987
average w i l l increase only s l i g h t l y , t o 150 days.
( b ) As of March 6, 1989, 12 cases from 1988 remain open. If the 12 cases close i n an
average of f i v e a d d i t i o n a l months, the 1988 average w i l l remain lower than t h a t o f
1987.
Source: Auditor General review of complaint f i les for years 1986, 1987,
and 1988.
However, some delays i n case d i spos i t ion cont i nue. Of the 121 cases that
were received from 1986 to 1988, 108 have been closed and 13 are s t i l l
pending. As i l l u s t r a t e d i n Table 4 ( page 191, about one- quarter of the
closed cases took anywhere from 7 months to over a year to complete. In
addi t ion, 4 of the 13 pending cases have been open for more than a year.
Table 5 ( page 19) i I l u s t rates how long cases s t i l l pending have been
open.
TABLE 4
LENGTH OF TIME FOR CASE DISPOSITION
COMPLAINTS RECEIVED IN 1986- 1988
Time Period
0 - 3 Months
4 - 6 Months
7 - 9 Months
10 - 12 Months
Over 12 Months
Total
Number o f Complaints
Source: Auditor General review o f complaints f i l e s for years 1986, 1987,
and 1988.
TABLE 5
LENGTH OF TlME OPEN CASES HAVE BEEN PENDING,
COMPLAINTS RECEIVED IN 1986- 88( a)
Time Period
0 - 3 Months
4 - 6 Months'
7 - 9 Months
10 - 12 Months
Over 12 Months
Total
Number o f Complaints
( a) As o f March 6 , 1989.
Source: Auditor General review o f complaints f i l e s for years 1986, 1987,
and 1988.
Delays i n timeliness are sometimes linked to legal d i f f i c u l t i e s caused by
disagreement over consent agreement wording. When a psychologist has
been found to be a c t i n g i n a p p r o p r i a t e l y , the board w i l l sometimes use a
consent agreement. The executive d i r e c t o r , i n c o l l a b o r a t i o n w i t h the
Attorney General's O f f i c e , d r a f t s a consent agreement which contains
f a c t s and conclusions, and recommends d i s c i p l i n a r y steps by which the
psychologist must abide. The p s y c h o l o g i s t ' s a t t o r n e y , however, o f t e n
requests language and conditions that are less severe and that w i l l least
hinder the practice o f the psychologist. As a r e s u l t , cases are delayed
as the p a r t i e s attempt t o reach agreement on the precise wording and
sanctions to be issued i n the consent agreement.
In a d d i t i o n , delays i n timeliness are sometimes caused by the board's
f a i l u r e to e x p e d i t i o u s l y i n v e s t i g a t e complaints. When complaints are
received, they are assigned to a board member f o r i n v e s t i g a t i o n . ( 1 )
Because a l l board members are employed o u t s i d e o f the board and are often
assigned more than one case, they frequently must p r i o r i t i z e
i n v e s t i g a t i o n s . T h i s p r i o r i t i z i n g forces other i n v e s t i g a t i o n s to be
placed " on hold" u n t i l the more important i n v e s t i g a t i o n s are concluded.
In one instance, a board member was assigned three very complex cases.
The board member assigned p r i o r i t y to a sexual abuse case and spent as
much as s i x t y hours one month conducting i n v e s t i g a t i v e work. As a
r e s u l t , i n v e s t i g a t i o n of the other two cases v i r t u a l l y halted for over
s i x months.
Refinements in Disciplinary Measures
and Investigative Procedures Could
Improve Timeliness and Provide
Additional Benefits
Additional d i s c i p l i n a r y measures and changes i n i n v e s t i g a t i v e procedures
could improve timeliness i n complaint handling as well as provide
a d d i t i o n a l b e n e f i t s . I n contrast to other Arizona regulatory boards, the
Board of Psychologist Examiners lacks the a u t h o r i t y t o issue intermediate
d i s c i p l i n a r y measures, and u n l i k e other Arizona regulatory boards, the
Psychology Board u t i l i z e s only minimal assistance from outside
consultants. The implementation of changes such as these and others
mentioned below could improve the board's complaint handling process.
Disciplinary measures - The board lacks s t a t u t o r y a u t h o r i t y t o issue
intermediate d i s c i p l i n a r y measures against psychologists. C u r r e n t l y ,
A . R . S 932- 2081 provides that " [ t l h e c e r t i f i c a t e of any person c e r t i f i e d
by the board may be suspended or revoked . . . or the person may be
placed on probation. . . ." The complaint may also be dismissed. No
sanctions e x i s t between dismissal and probation.
( ' 1 A1 though a c o n t r a c t i n v e s t i g a t o r may be employed, board members o f t e n conduct an
e n t i re i n v e s t i g a t i o n themselves.
Board members have expressed f r u s t r a t i o n and concern over the lack of
intermediate sanctions. They s t a t e that i n some cases, l i k e those
i n v o l v i n g poor b i l l i n g p r a c t i c e s , psychologists may be d e a l t w i t h more
e f f e c t i v e l y w i t h d i s c i p l i n a r y measures such as a c i v i l p e n a l t y , or a
decree of censure. Board members contend t h a t such intermediate
sanctions a1 low greater f l e x i b i l i t y t o deal w i t h cases i n which there i s
probably n o t enough evidence t o issue a stronger d i s c i p l i n a r y measure
( i . e . , probat ion, suspension, or revocat i o n ) , and consequent l y , the case
would probably be dismissed. Also, the a b i l i t y to issue a l e t t e r of
concern may speed up the complaint d i s p o s i t i o n process because the board
could then avoid d r a f t i n g consent agreements or h o l d i n g hearings f o r the
less serious v i o l a t i o n s .
As shown i n Table 6, other r e g u l a t o r y boards have a wider range of
d i s p o s i t i o n a l measures than the Psychology Board. These options include
l e t t e r s o f concern, decrees of censure, and f i n e s .
TABLE 6
DISPOSITIONAL OPTIONS OF ARIZONA MEDICAL BOARDS
L e t t e r o f C i v i I Suspension/
Conce r n Censure P e n a l t i e s Probation Revocation
Regulatory Board
Psychology Board
Board of Medical
Examiners x x x
C h i r o p r a c t i c Board x x
Dental Board x x
Osteopathic Board x x x
Board of Optometry x x x
Board of Nursing x x x
Source: Arizona Revised S t a t u t e s , T i t l e 32.
Changes in procedure - Changes i n i nves t i gat i ve procedures cou Id a l so
improve the complaint d i s p o s i t i o n process. C u r r e n t l y , board members
perform most complaint i n v e s t i g a t i o n s as was recommended i n our 1979
r e p o r t . However, a s u b s t a n t i a l increase i n the number of complaints
received each year may p r o h i b i t board members from i n v e s t i g a t i n g
complaints i n a timely and consistent manner. A b e t t e r approach would be
to have a consultant i n i t i a l l y process complaints and prepare
recommendations for board a c t i o n . I f a consultant i s used, the board may
need to increase funds.
The current complaint i n v e s t i g a t i o n process r e l i e s heavily on board
members to i n i t i a t e and complete i n v e s t i g a t i o n s . Board members are
assigned complaints and conduct i n v e s t i g a t i o n s w h i l e engaged i n t h e i r own
professional p r a c t i c e s . Further, the i n v e s t i g a t i v e process also lacks
u n i f o r m i t y ; board members follow no set i n v e s t i g a t i v e procedures. Only
one board member has c o n s i s t e n t l y provided w r i t t e n reports to the board.
Most board members provide t h e i r f i n d i n g s to the board o r a l l y and f i l e
t h e i r notes or dispose of them a f t e r completing the i n v e s t i g a t i o n . In
a d d i t i o n , board members receive no formalized t r a i n i n g for complaint
i n v e s t i g a t i o n such as that offered by the National Clearinghouse on
L i censure, Enforcement, and Regu I a t ion ( CLEAR). CLEAR'S Nat i onal
C e r t i f i e d I n v e s t i g a t o r T r a i n i n g ( NCIT) curriculum includes t r a i n i n g i n
i n t e r v i e w i n g techniques, evidence development, fundamentals of
a d m i n i s t r a t i v e law, and report w r i t i n g .
Furthermore, p u b l i c members may not have the expertise to i n v e s t i g a t e
complaints. As complaints are received, they are assigned to board
members, including p u b l i c members, on a r o t a t i n g basis. The two p u b l i c
board members are not psychologists; t h e r e f o r e , they may have less
understanding of the p r a c t i c e and standards of psychology than the
psychologists on the board.
Rather than r e l y i n g on board members to i n i t i a t e and complete
i n v e s t i g a t i o n s , i t may be b e t t e r t o use a consultant for t h i s purpose.
Some other regulatory boards give cases i n i t i a l l y to a consultant. Such
consultants review the case, determine i t s m e r i t , and o f f e r
recommendations. The case i s only l a t e r given to the board for f u r t h e r
a c t i o n or d e c i s i o n . For example, the Board of Medical Examiners ( BOMEX)
d i r e c t s a l l of i t s cases i n i t i a l l y to a s t a f f p h y s i c i a n . The physician
reviews the case, conducts necessary invest igat ive work, and f i les a
report w i t h the board. The board determines what a c t i o n i s necessary to
complete the case.
In November 1988, the board contracted w i t h a psychologist to review
c e r t a i n cases and to provide a professional o p i n i o n . Although board
members s t i l l receive the complaint i n i t i a l l y and only a few cases have
been reviewed by the consultant, board members feel t h a t the consultant
has provided guidance and time savings i n the complaint review process.
To involve a consultant i n a l l Psychology Board cases the board may need
to increase i t s funding for consultant and i n v e s t i g a t i v e services. BOMEX
s t a f f physicians are employed h a l f - t i m e at a s t a r t i n g s a l a r y of $ 28,340.
The Osteopathic Board employs a consultant at a cost of $ 25,852. I f the
Psychology Board were t o e s t a b l i s h a simi l a r p o s i t i o n , i t may require an
a d d i t i o n a l $ 16,000 to $ 18,000. Currently the board has $ 10,000 budgeted
for consultant fees.
Funding a d d i t i o n a l consultant services may require a s t a t u t o r y change to
increase fees. In 1980 the L e g i s l a t u r e established a maximum fee of
$ 200. The Board raised i t s fee to the s t a t u t o r y maximum i n 1988.
However, the J o i n t L e g i s l a t i v e Budget Committee ( JLBC) analyst estimates
an a d d i t i o n a l increase w i l l be needed to meet the board's r i s i n g level of
expenditures. Although the board has carryforward revenues a v a i l a b l e ,
the analyst i n d i c a t e d t h a t even the board's current expenditures w i l l
soon deplete the reserves. He estimates t h e board expenditures have
doubled i n the l a s t f i v e years. Therefore, the board may need to increase
i t s c e r t i f i c a t i o n fees i n order to finance a d d i t i o n a l consultant
services. This would require amending A. R. S. 332- 2074 to r a i s e the
s t a t u t o r y limit on fees.
RECOIMENDATIONS
1. The L e g i s l a t u r e should consider amending A . R . S . 332- 2081 t o allow the
board t o issue l e t t e r s of concern, decrees of censure, and levy c i v i l
p e n a l t i e s as means of d i s p o s i t i o n .
2. The board should i n i t i a l l y assign complaints to a consultant to
review and i n v e s t i g a t e , and to formulate recommendations.
3. The board should request an amendment to A . R . S . 332- 2074 to increase
the s t a t u t o r y l i m i t on f e e s . This would allow the board t o r a i s e
fees to cover the a d d i t i o n a l funding needed f o r consultant s e r v i c e s .
State of Arizona
Board of Psychologist Examiners
1645 West Jefferson, Room 410
Phoenix, Arizona 85007
602- 542- 3095
May 19, 1989
Mr. Douglas R. Norton
Auditor General
2700 N. Central Avenue # 700
Phoenix, Arizona 85004
Dear Mr. Norton:
The following represents the response of the State of Arizona Board of
Psychologist Examiners to the recommendations of the Office of the
Auditor General as contained in the performance audit report received
April 27, 1989. The Board has responded to the non- controversial
recommendations specifically:
FINDING I
Recommendation 1. " Continue to certify psychologists"
The Board concurs with this recommendation.
Recommendation 2. " Amend A. R. S. 532- 2061 et. seq. to require
psychologists to disclose to clients the information necessary to make
informed decision regarding risks to their health and welfare from the
practice of psychology"
The Board concurs with this recommendation.
FINDING I1
Recommendation 1. " Amend A. R. S. 532- 2081 to allow letters of concern,
censure, levy civil penalties."
The Board concurs with this recommendation.
Recommendation 2. " Initially assign complaints to a consultant"
The Board concurs with this recommendtion, providing an additional
$ 16,000-$ 18,000 appropriation for Professional and Outside Services is
granted to the Board.
Douglas R. Norton
May 19, 1989
Page 2
Recommendation 3. " Increase limit on fees"
The Board concurs with this recommendation, as additional revenue may
be necessary if . all complaints are to be handled by paid consultants
rather than Board nembers.
INTRODUCTION AND BACKGROUND
S. taf f ing and Budget
The Board now has two investigators on contract. The Board has'engaged
the services of an additional consultant who will be hired as soon as
the contract is approved by the Attorney General's Office.
The Board of Psychologists wishes to compliment you and your staff on
the thoroughness of your investigations, the comprehensiveness of your
final report and your sensitivity to the issues faced by this Board and
by consumers of psychological services. We appreciate your
recommendations, and have already moved to affect improvements. Most
important, we appreciate the high degree of confidence in the Board
which is represented overall by your report.
Sincerely,
~ i& ela C. Rivera, Ph. D. '
Chairperson