The doctor must write a letter or prescription supporting her request as the first step. A nurse can not write such a letter. It also can not be just any doctor but one who has treated her for her mental illness.
Really? (I'm not being snarky. I'm asking because I haven't looked it up myself). I thought it was simply the treating mental health professional. Does it HAVE to be a "doctor"?
In my state, registered nurses who are nurse practitioners with appropriate certifications can and do act as primary care providers. They refer patients to specialists. They write prescriptions. In WA, they don't need to work under the direct supervision of doctors. For all intents and purposes, for many patients, they're the same as doctors.
Wednesday, April 14, 2010
Twenty-eight states are considering expanding nurse practitioners' duties to help offset the nation’s shortage of primary care physicians, the
AP/Baltimore Sun reports. NPs are nurses with advanced degrees.
Currently, laws regulating the scope of responsibilities for NPs vary significantly by state. For example, some states require physicians to manage NPs, while Montana allows NPs to practice without a supervising physician. Most states allow NPs with a doctorate in nursing practice to use the title "doctor."
In Florida, lawmakers are considering a bill that would allow NPs to prescribe controlled substances.
28 States Considering Expanding Duties of Nurse Practitioners - California Healthline
In California (where the OP lives), nurse practioners are allowed to prescribe controlled substances, sign off on placards for the DMV -- substantiating the disability, bill Medi-Cal under their own names, and a host of other responsiblities.
http://www.rn.ca.gov/pdfs/regulations/npr-b-23.pdf They have to technically be supervised by a doctor, but that supervision can be via telephone in most cases.
And for many Americans, the primary care practitioner is not the frontline but the ONLY caregiver for mental health issues:
A comparison of two nationally representative household surveys that screened for mental disorders 10 years apart found that the use of only general practitioners when seeking mental health treatment was the fastest growing and most popular approach among the survey respondents. The study, published in the July American Journal of Psychiatry, found that respondents treated by only a general physician for any mental illness grew from 2.6 percent in a previous survey to 6.5 percent in the most recent study.
The researchers attributed that finding to the increasing role of general physicians as insurance plan “gatekeepers,” increased access to mental health screening tools, the growing popularity and safety of psychotropic medications, and the increasing use of psychotherapies by general practitioners.
One of the study authors, Harold Pincus, M.D., vice chair of strategic initiatives in the Department of Psychiatry at columbia University, said the most troubling finding was that patients with serious disorders expanded their exclusive use of general practitioners to treat their mental illness.
The increased utilization of mental health care among those with moderate mental illness—such as mild to moderate depression—bodes well for the health of the population, said the authors, because research has found that, overall, psychotherapy and medication have equivalent effectiveness. However, the increased reliance on general physicians for mental health care is more worrisome among patients with more serious illnesses in light of the increasing evidence that such illnesses respond best to combined psychotherapy and pharmacotherapy, which general practitioners are unlikely to provide.
Primary Care Treating More Serious Mental Illness ? Psychiatric News
Now, you and I -- and certainly most trained psychiatrists -- may say that the PCP is NOT the most appropriate treating practioner for moderate to severe mental illness. And if the PCP is a nurse practioner, then perhaps even more so.
But health insurance, sheer cost (as more people find themselves uninsured), lack of access to specialists, comfort level with their PCP and other reasons cause patients to treat with professionals that you and I might think is most suitable.
That doesn't mean that we have the right to second-guess their diagnosis.
I don't know what is going on here, and I don't know if this property would be bound by the Fair Housing Act. But there needs to be, imo, more investigation (and more compassion) before anyone calls this fraud. This woman may have been treating with a nurse practioner. She may also be treating with a psychologist, MFCC, LCSW or other mental health professoinal, but because her RN is prescribing her meds, she felt like that professional is the best person to write the letter. I don't know. But often it is the PCP who prescibes meds while talk therapy occurs with someone else. She may have walked away saying "ok," because she didn't realize she had rights (until she spoke to someone who told her she did). She didn't realize she needed a letter; so when faced with the fact that she needed one, yes, she got one after the fact.
I'm not saying that any of this is true. But can you see how some or all of it COULD be true...?
Your county government almost certainly has a fair housing division that can give you some guidance for free. Of course, your attorney can give you advice. But it seems to me that more facts are necessary before anyone reaches any final conclusions. Here's the thing -- Until you know the facts, you don't know if she has a legitimate case for fair housing. Once you have fully investigated this, then you can reasonably and appropriately give her your decision in writing. If she files a complaint, you provide a copy of your file to the fair housing commission, which shows that you're a decent business owner who tried to do the right thing -- which includes preserving rights of access for those who really deserve them.
No one likes fraud. But I think it's a wise business decision (and a moral one) that we figure out the facts before we decide something is fraud.
Of course, that's just my opinion.
