Psychiatrist Challenges Choice of Department Chair

A Pittsburgh psychiatrist has challenged the appointment of a psychologist to chair the psychiatry department at a hospital where he has privileges, claiming that the appointment of a nonphysician violates state regulations and the standards of accrediting bodies.

Jordan Garber, M.D., has raised concerns about the April 2000 appointment of psychologist Anthony Mannarino, Ph.D., to head the psychiatry department at Pittsburgh's Allegheny General Hospital (AGH), where he volunteers his time as a teacher and, until hospital officials recently terminated his appointment as a member of the Institutional Review Board.

Garber has filed complaints with the Pennsylvania Department of Health and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and has asked the Accreditation Council for Graduate Medical Education (ACGME) and the Residency Review Committee for Psychiatry (RRC) to review the issue. All of these organizations have indicated in responses to Garber that the appointment puts the hospital in violation of their requirements.

Garber had had privileges at AGH since 1990 and at Suburban General Hospital since 2001. In January 2005, AGH began operating Suburban, and he became “acutely concerned,” he told Psychiatric News, that the hospital administration's appointment of a nonphysician psychiatry department chair violated medical staff bylaws and other regulations.

His first action was to inform the compliance liaison of AGH's parent organization, West Penn Allegheny Health System, Garber told Psychiatric News. The response he received indicated that West Penn saw no violation in appointing a psychologist as psychiatry chair.

Garber next filed a formal complaint with the Pennsylvania Department of Health, which indicated that by naming a nonphysician, AGH violated state regulations regarding qualifications for a department chair position.

In a May 19, 2005, communication to the AGH's chief executive, the state health department told AGH that it needed to remove the psychologist from the chairmanship to be in compliance with its rules. The health department subsequently denied a request from AGH for a reconsideration of the decision.

In a letter to Sandra Knoble, director of the state health department's Division of Acute and Ambulatory Care, AGH President and CEO Connie Cibrone defended the hospital's appointment of Mannarino. She said that in his“ five-year tenure as chair, the Department of Psychiatry has transitioned from an unstable department to a stable, well-respected department.” She added that the Pennsylvania Department of Health“ has conducted annual site visits of our inpatient psychiatric services, and the Department of Public Health has conducted annual site visits of our outpatient psychiatric services. In each instance we have received outstanding reviews.”

The executive director of the RRC for Psychiatry, Larry Sulton, Ph.D., also indicated that the hospital is in violation of its rules, telling Garber that the RRC, which mandates that psychiatry departments must be headed by a physician trained in psychiatry, planned to investigate the matter and would request an explanation of the appointment from AGH officials. Garber told Psychiatric News that the RRC has “proposed probation” for the AGH residency program because of the chairmanship issue and will make a further determination at its April meeting.

John Herringer, associate director of the JCAHO's Standards Interpretation Group, responded to Garber by stating, “A psychologist who does not have medical training cannot oversee the clinical care provided by a physician and other members of the department.... It would be acceptable for the psychologist to be the administrative director of the department, but there would need to be a board-certified physician as the clinical person responsible for oversight of the clinical work of the department.”

Garber also took his concerns to the Pennsylvania Psychiatric Society and the Pennsylvania Medical Society. In a joint response to the Pennsylvania Department of Health, the organizations' presidents, M. Ruiza Yee, M.D., and William Lander, M.D., stated their contention that even if the psychologist chair were to delegate some clinical responsibility to a physician, the solution would not be workable. The primary role of a psychiatry department chair, they wrote, “is to move the department toward excellence. This requires not only administrative skill but intimate knowledge of medical care and psychiatric professional standards.”

They also described how the situation came about, noting that at the time Mannarino was appointed chair, “the hospital system of which [AGH] was a part had declared bankruptcy. We understand that it was difficult to find suitable psychiatrists willing to take on the chairmanship at that time, when the department had been decimated and uncertainty about the hospital's future abounded.”

This controversy is not yet over, as several of the organizations Garber contacted continue to assess the situation or plan follow-up actions.▪