The Board of Professional Standards convened at an extraordinary meeting on Tuesday, December 12, 1989, (1) to discuss the implementation of the Gaskill proposal by the Committee on Nonmedical Clinical Training; (2) to hear from Joel I. Klein, Esq., council to the American, concerning legal issues relevant to the waiver process; and (3) to address the sharp disagreement between the Southern California Psychoanalysis Institute and the BOPS about the CNMCT's deferral of waiver for three nonmedical applicants.
The Gaskill proposal [see next page], which passed by a two-thirds majority of the membership in 1986, established a waiver committee that would review nonmedical applications and the selection process by which they are chosen, with the goal of assuring that “all accepted candidates, medical and nonmedical, meet equivalent standards.” The CNMCT sees its activity as part of an evolutionary process that seeks to develop optimal procedures while at the same time looking forward to the eventual phasing out of the Committee's work when a by-law amendment is passed.
Dr. John A MacLeod, Chairman of the Committee on Nonmedical Clinical Training, reported that the Committee had recommended that waivers be granted for 14 of the 21 applicants reviewed [see box]. These 14 waivers were approved by the Board. Thus, to date 115 waivers have been granted, and 22 applications and reapplications have been deferred. Fellows of the Board discussed the complexities of the charge to the CNMCT Committee—the determination, on one hand, of suitability and, on the other, of eligibility. Eligibility concerns the educational and professional equivalence to a medical training, whereas suitability refers to the evaluation of personal qualities. Between these two areas lies an intermediate area, clinical competence, which is assessed at the local level but is documented in the waiver application and reviewed by the CNMCT Committee. The Committee indicated that most waivers are deferred because the Committee cannot confirm clinical competence.
At issue is how clinical competence is determined and who has the final authority for the determination. The task is to achieve the right balance between the authority of the Board of Professional Standards and the autonomy of the institutes. Several institutes of the American feel that the CNMCT is applying different and more stringent standards to nonmedical applicants than to those with a medical background and that it is compromising local autonomy by “second guessing” institute evaluations. Other institutes have found that the deliberations and conclusions of the CNCMT have been fair minded and appropriate and the application procedure valuable as an informational instrument and a means to assure that the intent of the Gaskill proposal is carried out.
Joel I. Klein, Esq., addressed the Board in response to questions concerning legal vulnerability both for the American and for the institutes in connection with the waiver procedure. He explained that although the CNMCT process had been well-established as part of the settlement of the lawsuit and had been built into its agreement, there would be no violation of that agreement if the CNMCT process were eliminated. At the same time, he pointed out that, although antidiscrimination lawsuits could probably not be made on the basis of an academic degree, there is no absolute way to guard against exposure to litigation short of admitting every person who applies for admission.
On Wednesday, December 13, 1989, the Board adopted the following motion made by Dr. Jack L. Ross of Topeka concerning the workings of the CNMCT. According to the motion, (1) the CNMCT will monitor ‘eligibility’ on the basis of criteria set by the Board for academic and professional achievement; (2) the institute will have primary responsibility for “selection” on the basis of judgments of character, analyzability, educability, and clinical competence; the CNMCT will evaluate the thoroughness and documentation of the institutes' applications and will offer consultative help to the institutes
The Board reviewed the actions of the Southern California Psychoanalytic Institute taken following the May 19, 1989, meeting of the American. The chronology is as follows: At the May meeting, the Board, at the recommendation of the CNMCT, voted to defer three out of four of the applications endorsed by the SCPI. Subsequent to the Board's decision, concerned members of the SCPI met in San Francisco with members of the CNMCT and the Executive Committee of the American. The institute representatives expressed their conviction that the process of nonmedical candidate selection was untenable because, instead of evaluating nonmedical candidates as mental health professionals of proven clinical excellence, the CNMCT was insisting that they demonstrate
a theoretical and technical competency appropriate for graduate analysts. The CNMCT, on the other hand, argued that this perceived discrepancy stemmed from their adherence to the Gaskill proposal principles.
After this meeting, the SCPI accepted the three applicants deferred by the Board; the candidates began seminars in the fall of 1989. In a subsequent move the institute's Executive Committee voted unanimously to maintain local authority for acceptance of nonmedical candidates as it does for medical candidates. The SCPI indicated that for them the issue of legal jeopardy was central to the dispute, since in their opinion the settlement agreement between the American and the “psychologists class” fails to protect the individual constituent institutes.
In a letter of September 20, 1989, to the Southern California Institute, Drs. Homer Curtis and Justin Krent informed the institute that it was in noncompliance with Articles X and XI of the Association's by-laws, and the institute was asked to respond to the charge of noncompliance resulting from the authorized training of three nonmedical applicants. At the meeting of the Board in December, the Fellows representing the SCPI described their efforts to address the matter of noncompliance. They asserted, however, that the action of their Education Committee in May 1989 had propelled the institute on a course that could not easily be reversed and that they needed the help of the American in securing waivers for the three disputed candidates whose applications were again not recommended for waiver by the CNMCT in December. Others noted that the SCPI had chosen to act in violation of the by-laws, thus creating the dilemma, which they hoped the American would resolve by granting the waivers.
At the December 14 meeting, Dr. Allan D. Rosenblatt, Councilor-at-large, proposed a by-law amendment that would provide for fully autonomous selection of nonmedical candidates by local institutes. According to this proposal, the CNMCT would disseminate guidelines concerning the criteria for eligibility, but would not decide on applicants' suitability. Dr. Rosenblatt agreed to table his motion until the annual meeting in May 1990 to allow time for further clarification of the issues.
Janet Hadda