The Mysterious Recurring Two Physician Approval Question

Another of the more persistent myths in mental health practice is whether certain acts require the approval of two physicians. In the last 6 months I have been asked the following question, in varying form, four times:

“Is it true that if two physicians sign off on _______, this satisfies the legal requirement for _______?”

This question often comes up in the context of involuntary medication, conservatorships, informed consent, capacity determinations, etc.

While there are many circumstances where the approval of two physicians is required to perform an act, these requirements tend to be in private agreements or hospital/clinic guidelines. For example, a power of attorney agreement might state that it goes into effect when the principal’s physician, along with another consulting physician agree that _____ (the condition) has occurred. Another place where these types of guidelines are seen is in hospital, HMO, or other organization where the operating procedures to approve certain tests or perform certain activities requires the signature of two physicians. In these cases the procedures are often used as cost-saving mechanisms to limit unnecessary tests or as a methods of peer review and risk management. Yet, these are not legal requirements, per se.

Some states (though not California) have laws that allow for the involuntary administration of psychotropic medications on an emergency basis following the agreement of two physicians that the medications are necessary. There are several variations of these laws in different states. It is common for practitioners who have moved to California or have been trained in another state bring their knowledge bases with them, and to mistakenly assume that everything transfers. Physicians sometimes misstate the law, as well.

To date, I have found no basis in statutes, regulations, or case law that suggests there is a similar requirement in California for anything directly related to mental health practice. Practitioners who run across this “requirement” while practicing in California should consider asking: (1) what is the source of this “requirement,” and (2) whether it applies to their work.

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