Since the psychologists have expressed to us their desire to regulate clinical psychology in the same fashion as industrial psychology, school counselling, and other nonmedical functions, and since they have refused to write distinctions into their bill, we can only ask that H.R. 10407 not be enacted into law, or if it is to get such consideration, that it be amended so as not to repeal or vitiate the safeguards of the Healing Arts Practice Act.

To this end, we have prepared a draft bill which follows as closely as possible H.R. 10407 and S. 1864 in those areas which do not concern the medical profession, but this draft contains the minimal safeguards which we feel are necessary to eliminate unregulated and unsupervised public practice. We request the permission of this Subcommittee to present this draft for inclusion in the record after the close of these hearings.

During the prior hearings on this bill, while the representatives of the psychologists' organizations were testifying, a number of searching questions were asked by the Subcommittee and elicited responses about which we should comment. Rather than try to anticipate the further questions of the Subcommittee, however, I will reserve such comment.

The other representatives with me would like the opportunity to make brief statements, after which we all would be most happy to try and answer the question of the Subcommittee.

I believe Dr. Hughes wished to make a brief statement.
Mr. SISK. Thank you, Dr. Legault.

Dr. Hughes, do you want to make a statement now?

Dr. HUGHES. Yes. Mr. Chairman and members of the subcommittee, my name is Dr. John Hughes. I am a member of the Executive Board of the Medical Society of the District of Columbia.

The Medical Society strongly supports the statement by Dr. Legault concerning H.R. 10407. The Medical Society commends the desire of the psychological profession to regulate their practice.

We must, however, express our concern that the proposed legislation does not specifically require medical consultation for those patients suffering from physical and/or mental disease.

Training in psychology, no matter how excellent, does not lead to clinical competence in diagnosis and treatment of patients with physical and/or mental disease. These activities are sharply distinct from psychological services in counseling, testing or group evaluation.

Many physical diseases, metabolic abnormalities and toxic states may first manifest themselves by mental aberration. These circumstances require diagnosis and evaluation by a trained and licensed physician. To allow otherwise would subject our citizens to medical treatment by persons lacking proper medical training and without medical licensure.

The Medical Society of the District of Columbia earnestly requests that H.R. 10407 be amended to insure continuance of adequate safeguards in the treatment of the physically and/or mentally ill.

I am grateful for the opportunity to express the Medical Society's concern. Thank you.

Mr. SISK. Thank you, Dr. Hughes.

Dr. Meltzer?

Dr. LEGAULT. The remaining members would prefer that we simply respond to questions. We hope that unless questions are specifically directed to one of us, that we can feel free to contribute our answers as indicated.

Mr. SISK. Dr. Meltzer, or Dr. Stienbach, do either of you have a statement for the record? If so, we would like to have them for the record.

Thank you, Dr. Legault, for a rather comprehensive statement as to the position of the Psychiatric Society as well as, as I understand it, the Psychoanalytical Society and the D.C. Medico-Chirurgical Society. This is more or less of a combination of the three societies?

Dr. LEGAULT. The Medico-Chirurgical Society, that represents all the medical organizations of any significant size in the District of Columbia.

Mr. SISK. As I understand, Dr. Legault, in your statement, you recognize and agree that there is a need for and your membership does favor regulation of the practice of psychology in the District of Columbia?

Dr. LEGAULT. Very definitely.

PROPOSED AMENDMENTS

Mr. SISK. Do I understand that you have prepared, or the D.C. Medical Society has prepared, a substitute bill for this, or amendments, which you are prepared to submit to the committee?

Dr. LEGAULT. We are in the process of preparing that. We have a sort of a draft bill which we will submit shortly after the end of the meetings, or we can submit it now. We would like to polish it a little bit. Mr. SISK. Without objection, I would like to have it made a part of the record, if you will have that within a reasonable period of time. Dr. LEGAULT. Yes, sir.

Mr. SISK. I might say the Chair hopes to conclude these hearings this morning and it would be assumed we would keep the record open for a week or 10 days.

Dr. LEGAULT. Certainly within a week.

Mr. SISK. Without objection, submit that and we will include it in the record.

(For draft, see p. 149.)

Mr. SISK. In your reference to the Healing Arts Act in the District of Columbia, which was referred to, and I know we have gone over this in previous hearings on other legislation, let me ask you this: Do you feel that that as to act, in view of the fact it is now some forty years old, with some minor amendments, do you feel there is any need to rewrite that law and update it?

Has the Medical Society-and I might ask this of Dr. Hughes or any of you making a comment has consideration and study been given to a complete rewrite of the Healing Arts Act here in the District of Columbia?

I ask this question because in so many instances various groups raised questions about it over the period of the last several years. I would just like to discuss briefly with you what your feelings are with reference to that law.

Dr. LEGAULT. We have not considered that, Mr. Chairman. I could only answer from my personal feelings about it, without representing any particular feelings on the part of my organization, and maybe the other members of the group here have some feelings about it.

I was struck, myself, in reading the Act, with the specific reference to how it might apply to the practice of psychiatry, that the wording could be altered. It has a certain antique flavor.

Mr. SISK. Very antiquish, I might say, in many aspects of it. It is a pretty old law.

Dr. HUGHES. Mr. Chairman?

Mr. SISK. Yes.

Dr. HUGHES. The Medical Society of the District of Columbia has been actively seeking initially to amend and ultimately we hope to engender or stimulate a complete rewriting of this 1929 law with its many subsequent amendments.

I have been on the committee that has worked on this and is continuing to work on it quite actively in the Medical Society. Our concern with the changes proposed in this licensure law, Healing Arts Practice Act, involve the difficulty primarily in licensure of physicians from other jurisdictions and other countries, which is a major problem with so many foreign-trained and foreign-born physicians in the country; also, with problems in allowing some sort of temporary licensure for medical residents since the modus operandi of the practice of medicine in hospitals today is so much different from what it was in 1929.

The medical residents are six years in training and they need some licensure to allow them to function because, indeed, in many respects they are functioning beyond the stage of the ordinary trainee in the later years they are training.

The Medical Society in its consideration of the Healing Arts Practice Act has never had any quarrel with nor would we think it would be desirable to eliminate safeguards regarding adequate training, adequate background, adequate examination in the selection of candidates for licensure.

The Medical Society's concern would be somewhat antiquated licensure statutes. I don't believe from the standpoint of the Medical Society it would be applicable to this question of psychologists, which was something totally foreign to the law itself.

Mr. SISK. The thing that I was curious about, as you know, is that there are a number of groups which we might call for lack of a better term "peripheral groups" in the field of health care of one kind or another. I am trying to choose my words carefully because you may disagree. I recognize that in any profession of medicine there are many aspects in the business of specialization where everyone seems to be specializing in a particular field. Do you feel that by fragmentation by that I mean a separate Department under the Healing Arts Act for psychologists dealing with licensing procedures, and so on, the same thing for groups dealing in psychiatry, and one which we have had before us now for several years, practice of optometry in the District as differentiated from an ophthalmologists do you feel fragmentation into individual acts dealing with licensing and practice is better than an overall rewrite of the 1929 Act, or should we continue an overall law by which all people dealing with the care of our citi

zenry in every aspect of their health care, actually disease of the body, physical disease, et cetera, should be guided?

Would you make some comment on that, Dr. Hughes? This does go to the heart of some concerns by members of this committee and others who have some concern with what is going on in the District of Columbia.

Dr. HUGHES. I believe that the Medical Society would feel that the optimum situation would be if the entire Healing Arts Practice Act were rewritten, updated, modernized, and ideally that would include all professions, all endeavors that are involved in health care. It has been our understanding, perhaps erroneously, that it is a somewhat monumental task and might take a great deal of time. That is why the Medical Society in other connections has addressed itself to an amendment or two to try to meet a current problem. The ultimate optimal situation would be to rewrite the entire thing from scratch, eliminating things anachronistic and bringing it up to date. If it could include everyone that deals with sick people in any way, I think this would be ideal. I believe the Medical Society would feel that way unquestionably.

Mr. SISK. I appreciate your statement, Dr. Hughes. I realize the question was all-comprehensive and all-inclusive. The reason that I ask the question is that there is pending now in Congress a variety of bills dealing with licensing procedures, practices, all in the peripheral area of care of people and of their needs from the standpoint of physical needs.

For example, there is a bill dealing with the practice of podiatry here in the District. We have this one on psychology. There is another one on optometry. I remember there are also two or three more dealing with specific licensing procedures for specific groups. That is the reason why it seems to me maybe at some point there should be a comprehensive study and analysis made on how best to proceed in this field. It is evident there is some need to rewrite and update old, outmoded laws. I believe we all recognize that.

Dr. LEGAULT. May I add to something I said before?
Mr. SISK. Yes.

Dr. LEGAULT. Although our psychiatric and psychoanalytical societies have not considered the actual mechanics of the problem of writing laws for what we would call the ancillary professions, those professions that serve in a helping mode the central profession of medicine, though we have not considered how the regulation of such professionals should be written into the law in the District, we have been concerned certainly with a particular point which I think all medical organizations agree on; that is, that in the writing of separate laws for either separate or comprehensive laws for the regulating of such ancillary professions there not be lost sight of the fact that medicine is organized in a rather hierarchal fashion and that this organization of medicine in writing such separate laws must not be interfered with. It must provide for central responsibility of the physician at the core of all licensing acts, provisions for necessary consultation with him whenever it is required.

Mr. SISK. Thank you, Dr. Legault.

I don't wish to take more time. We have a good turnout of the committee here this morning and I am sure the members have questions. I would like to quickly explore one further thought with you. As I understand it, this bill has passed the Senate. What was the date of the passage in the other body? Do you recall?

Dr. LEGAULT. I don't recall. It was the 25th, I believe.

Mr. SISK. April 24, 1968. At that time, I understand that your Society did make a presentation to the other body?

Dr. LEGAULT. We did.

Mr. SISK. Let me hasten to say what the other body does would not govern what this body does or what the committee may do. I am a little bit concerned. This bill did pass the Senate unanimously, is that correct?

Dr. LEGAULT. Yes, sir.

Mr. SISK. Yet you presented basically the same testimony there you presented here?

Dr. LEGAULT. Basically, yes.

Mr. SISK. The Chairman of our committee, Mr. McMillan, introduced this bill on May 29, 1967. That has been slightly over a year ago. In view of that, I was curious; have you been interested in this throughout this time? Have you made your feelings known or discussed them with interested people?

Dr. LEGAULT. We have discussed our approach of our organizations at the time the psychologists were planning to introduce the bill. We knew of their intention to gain a licensing bill before the bill was introduced. Our organizations have been in contact with the psychologist up to the time that they broke off negotiations with us concerning the wording of their bill. We have met many times with the representatives of their organizations and during the time that we were involved in discussing the proposed legislation with the psychologists we made no attempt to present our views which we felt were in the process of formation rather than fixed views to any member of the Senate. As a consequence, no representative of any of our organizations has personally contacted any Senator at any time. The only representations we ever made to the Senate were at our formal hearings. As a consequence, we feel that our views were really not very adequately presented to the Senate.

Mr. SISK. Apparently after it passed the Senate, as I recall, you were somewhat more active in letting your views be known.

Dr. LEGAULT. We have been considerably more active, Mr. Chairman. Mr. SISK. Thank you, Doctor, and gentleman, for your appearance this morning.

The gentleman from North Carolina, Mr. Whitener.

Mr. WHITENER. Doctor, the only thing that I would ask about is Section 4 in H.R. 10407, the House bill. As I understand it, it is identical to Section 4 in S. 1864, the Senate bill. In view of this language about a psychologist engaged in practice expected to assist his client in obtaining professional help outside of the known area of competence, for example, provision should be made for the diagnosis and treatment of relevant physical problems by an appropriate qualified medical practitioner.