quack, regardless of how he labels himself whereas H.R. 10407 will simply make it illegal for him to call himself a psychologist.

Thank you.

Mr. SISK. Thank you, Dr. Starr, for an interesting bit of testimony, because I think you do bring out some need here and some problems that certainly we will be faced with in attempting to protect the public from unscrupulous operators or from what amounts to actually pure quackery, as you indicate in your statement.

As I would understand, you feel there is a need for licensing; however, as I understand it, in your conclusion you say:

The effect of such legislation as I am suggesting would be to rid the field of the unscrupulous quack, regardless of how he labels himself, whereas H.R. 10407 will simply make it illegal for him to call himself a psychologist.

In other words, you apparently feel there should be some broader control or some way to eliminate the pure quack in the field of counseling and so on.

Is that basically what you are saying?

Dr. STARR. Yes, sir.

The untrained and incompetent person who offers himself on a private fee basis as a therapist or counselor.

Mr. SISK. I appreciate the statement.

Are there any questions.

Mr. JACOBS. I have one question, Doctor.

On the last page of your prepared statement you mention the needed obligation on the part of nonmedical personnel to make appropriate referrals. You finish by saying "when such might be indicated or beneficial".

I assume that that which was indicated in this area would be beneficial but that which was beneficial might not necessarily be indicated. Is that the nub of the problem, establishing some standards to make that determination? Or can we establish any standards?

Dr. STARR. This is part of the problem. The nonmedical therapist is not qualified by his training to evaluate the use of therapy and treatments in which he has no experience or training. But if the burden is on him to refer those who might benefit by such treatment, I believe the competent and ethical practitioner of these other disciplines will indeed seek medical consultation.

Mr. JACOBS. He will not seek it in cases where it is beneficial and not indicated or indicative because of the lack of his understanding of the problem, will he?

Dr. STARR. I am sorry, I am not sure I can answer. I think you are making a distinction that I am sure is necessary legally.

Mr. JACOBS. I think it is necessary as a practical, social matter. I am wondering, the essence of my question, whether it is possible for us to erect legislatively standards by which these referrals can be made. Dr. STARR. No, sir; I do not think that the legislature can write standards.

Mr. JACOBS. When you get right down to it, you are possibly placing the responsibility upon those who are not competent to make a judgment as to when the referral is necessary. How do we get around that paradox?

Dr. STARR. Without any wide understanding of how laws operate, it would seem to me that if the burden is put on the practitioner that he must know what at least he cannot know or does not know. This is the same burden under which medical practitioners operate all the time, to know the limits of your competence, to not open an abdomen if you are not competent to deal with everything in it.

Mr. JACOBS. We are really talking about a "knowingly" prohibition rather than a malpractice. When we say that the psychologist is not to treat a medical problem, do we really mean he is not to knowingly treat a medical problem, and if so, do we not have evidentiary problems that would delight the wildest Philadelphia lawyer?

Dr. STARR. I think it is within the limits of his competence to make a positive judgment about what he can manage, and what I am asking is that legislation put the burden on him to stop at what he knows he can manage.

Mr. JACOBS. That is a knowingly situation.

Dr. STARR. You know what you can manage but you are not always able to evaluate what you cannot manage in terms of what the proper disposition would be.

Mr. JACOBS. My experience has been that some objective standards beyond the subject of knowing, a person doing right or wrong or proper or improper acts, is most desirable. Some objective standards. You might, in fact all of those interested in this legislation might consider that point, and I am sure the committee will consider it very beneficial to have views along those lines.

I am not talking about the competent practice of politics or even of law now. This is a highly technical matter about which I know little and would like to know more.

Dr. STARR. AS Dr. Legault pointed out, what societies were trying to do in discussions with the psychologists was come up with some kind of standards in part.

Mr. JACOBS. Thank you very much, Doctor.

Mr. SISK. Are there any other questions?

Mr. Gude of Maryland.

Mr. GUDE. I believe Dr. Starr has well pointed up what to me is a real concern.

If a psychologist is licensed or certified in the District, the general public feels they are putting themselves into the hands of people who are able to deal with problems which actually might be beyond their competency as professionals.

It is brought to my attention that by virtue of Title 47, Section 2344 of the D.C. Code the government of the District of Columbia is authorized and empowered within its discretion to require a license of other businesses not listed in the D.C. Code which in its judgment require supervision and regulation. Perhaps the D.C. Council might well hold hearings on some of these activities you mentioned regarding marriage counseling, family counseling, etc.

Thank you.

Mr. SISK. Are there other questions?

Thank you, Dr. Starr, very much.

This concludes the witnesses except for the D.C. Government witnesses, and at this time, without objection, I am going to put in the record a statement signed by Mr. Thomas W. Fletcher, Assistant to Commissioner Walter Washington.

Also a statement from Dr. John D. Schultz, Associate Director.
These two gentlemen are both here in the room.

(The statements follow :)

GOVERNMENT OF THE DISTRICT OF COLUMBIA,

Executive Office, Washington, May 17, 1968.

The Honorable JOHN L. MCMILLAN,

Chairman, Committee on the District of Columbia,

U.S. House of Representatives,

Washington, D.C.

DEAR MR. MCMILLAN: The Government of the District of Columbia has for report H.R. 10407 and S. 1864, bills "To define and regulate the practice of psychology in the District of Columbia."

Both bills seek to protect the public welfare by requiring all persons who offer psychological services to the public for a fee to obtain a license from the District. The bills define the practice of psychology and set forth the qualifications which an applicant must have. They also provide for examination and related administrative considerations. Further, they each contain a provision allowing for the licensing by endorsement of psychologists moving to the District from jurisdictions where at least comparable controls over the practice of psychology exist. Finally, the bills list those actions which would constitute violations of the proposed Act, and the procedures for investigating and punishing those who violate its provisions.

The District government is of the view that the public should be protected by the licensing of psychologists, and believes that S. 1864 is the better bill for such purpose. While H.R. 10407 is in large part identical with S. 1864, it has certain features which the District considers undesirable. We believe that legislation licensing psychologists should emphasize more strongly the non-medical character of the profession and the necessity that a person with organic disease complications to behavioral problems must be referred by the psychologist to a medical doctor. In addition, the District believes that social psychologists should not be treated differently from other psychologists, that the Commissioner should not be bound, in selecting members of the Board of Psychologist Examiners, by lists submitted by the Psychological Association, and that a certificate of registration should not be issued to an association, partnership, or corporation, but only to an individual. The District also believes that the District of Columbia Council should have authority to make regulations to carry out the purposes of the legislation and to fix fees for services rendered in licensing by the District. Since S. 1864 meets the foregoing requirements better than does H.R. 10407, the District prefers the former bill.

If, however, the Committee desires to report out H.R. 10407, the District recommends that the bill be amended as follows:

(1) Amend section 4 by striking out "physical" in line 18 of page 3 and inserting in lieu thereof "medical";

(2) Strike section 5 (D);

(3) Amend the first sentence of section 6(b) by striking "to be selected from a list of psychologists submitted by the District of Columbia Psychological Association" in line 25 on page 5 and lines 1 and 2 on page 6; (4) Amend section 12, lines 5 to 17 on page 10, to read as follows:

"Sec. 12. The District of Columbia Council is authorized to make regulations to carry out the purposes of this Act, and, after public hearings, to fix, increase, or decrease fees to be charged for services performed by the District government pursuant to the provisions of this Act in such amounts as may, in the judgment of the Council, be reasonably necessary to defray the approximate cost of administering this act." (5) Amend section 13 by striking the second sentence.

As I have indicated above, the District favors the enactment of S. 1864, as being the preferable bill. However, if the foregoing amendments be made in H.R. 10407, the District would also favor its enactment.

Sincerely yours,

STATEMENT OF DR. JOHN D. SCHULTZ, ASSOCIATE DIRECTOR, MENTAL HEALTH AND RETARDATION, DEPARTMENT OF PUBLIC HEALTH, DISTRICT OF COLUMBIA

Dr. SCHULTZ. Mr. Chairman, the purpose of this Bill is to provide for the protection of the public from the unauthorized and unqualified practice of psychology and from unprofessional conduct of persons practicing psychology in the District of Columbia. At the present time, psychologists may practice in the District of Columbia without license or regulation. The intent of this Bill is to regulate the practice of psychology as existing law already requires the regulation of other professions within this City. We believe that the practice of psychology as is the case with a number of other disciplines, is closely akin to the practice of the healing art as currently defined by statute in the District of Columbia. We believe, therefore, that it is in the public interest to have the practice of psychology defined and regulated and we further believe that it is reasonable to expect that only licensed psycholo gists should practice their specialty in this City.

In our testimony before the Senate Hearings on this Bill, Mr. Chairman, we recommended certain amendments, which I need not repeat in detail here. These have been incorporated in the Bill, as reported by the Senate Committee, and are identified in Mr. Morse's report of April 23, 1968, on page four, under the heading "Amendments."

I would, Mr. Chairman, like to point out that the amendment to Section 4, page 3, line 18, striking the word "physical" and inserting in lieu thereof the word "medical," has implications which may not be fully recognized. Psychotherapy is a method for the treatment of mental illness, which is a disease of the mind. Hence, psychotherapy is a medical treatment and, therefore, the Bill as amended would require the psychologist who uses the psychotherapy to refer such patients to physicians for diagnosis, thus eliminating the danger of overlooking physical or mental disorders which might affect the mental condition of the patient and mental states which cause physical or mental disabilities. There is danger in authorizing the psychologist to practice psychotherapy without medical referral.

So that there may be no ambiguity in the amendment suggested for Section 4, I would like to offer for consideration the following language:

SEC. 4. The psychologist who engages in practice shall assist his his client in obtaining professional help for all relevant aspects of the client's problem that fall outside of the boundaries of the psychologist's own competence; he shall make provision for the diagnosis and treatment of relevant medical problems by an appropriate, qualified medical practitioner before undertaking psychotherapy.

Mr. SISK. Mr. Moyer and Dr. Schultz, here is what the Chair would like to suggest.

We would like to suggest that you gentlemen be furnished a copy of the proposed amendments or possible substitute bill which you heard discussed this morning. We would like to have your comments at that time.

What Mr. Clark will do as that is made available to us, is to submit that to you and at a later date, as early as possible, we would like to ask you gentlemen to come back and be prepared at that time, in addition to comments you have made in your statement now regarding certain amendments which you have suggested to the present proposed legislation, to comment on this proposal which we will submit

Mr. SISK. With that, then, the committee stands adjourned.

(Whereupon, at 12:00 noon, the committee adjourned, subject to call of the Chair.)

(Subsequently, the following letter to Chairman McMillan, together with other documents, were submitted for the record:)

MEDICAL COLLEGE OF SOUTH CAROLINA,
DEPARTMENT OF PSYCHIATRY,

The Honorable JOHN L. MCMILLAN,
U.S. Post Office,

Florence, South Carolina

May 31, 1968.

DEAR MR. MCMILLAN: This is pursuant to our recent telephone conversation. As I discussed with you, I have become interested in the current legislation before the District of Columbia Committee concerning the licensure of psychologists. In my opinion, the licensure of psychologists is a very desirable thing. One of the problems with this profession in the past has been the fact that without licensure the door is open to any individual who calls himself a clinical psychologist and who can practice without adequate training and ability. These people frequently exploit the public and often do a great deal of harm. Appropriate licensure legislation will surely help correct many of these atrocious practices. I do not believe that the current legislaton under study by the Committee will constitute sufficient control to eliminate this kind of practice by charlatans. I have discussed this with my good friend, Dr. Richard Steinbach, Chairman of the Department of Psychiatry at Georgetown University. I believe that the District of Columbia would be greatly served by your having the chance to talk with Dr. Steinbach and other representatives of the Washington Psychiatric Society.

The vast scope of mental health problems in our own state as well as in our nation's capital is begininng to receive appropriate attention from our government. While I am greatly heartened by this enthusiasm and support I also feel that we must be cautious in studying these newer approaches to treatment.

I would like to wish you the best of luck in your forthcoming election. With kindest personal regards, I am

Strongly recommend amendments to H.R. 10407. Psychologist should not be allowed to form cooperation. Also, they definitely need consultation and/or supervision by psychiatrist.

AL B. HARLEY, Jr., M.D.