TAMPA - Providing the very best mental health care to soldiers returning from combat in Iraq and Afghanistan is one of the highest priorities for the U.S. Department of Veterans Affairs.
But at the nation's busiest VA hospital, the James A. Haley VA Medical Center in Tampa, the most-troubled and vulnerable veterans are often treated by the least-experienced psychologists, according to a complaint to the state.
About 12 of Haley's 34 psychologists - more than a third - are unlicensed and receive little if any direct supervision, according to a complaint filed Nov. 29 with the Florida Board of Psychology.
The VA disagrees with the complaint's figure, saying just nine are unlicensed.
The complaint, filed by Haley psychologist Brian Nussbaum, said some of these psychologists still use the title of either "psychologist" or "clinical psychologist" with patients.
If true, that would violate state law.
In an interview on Monday, Nussbaum said three of the four psychologists working in Haley's Post Traumatic Stress Disorder Clinic are unlicensed. Nussbaum is the only licensed psychologist in the clinic.
And he said Haley's suicide-prevention coordinator also is an unlicensed psychologist.
Nussbaum, who agreed to an interview after the St. Petersburg Times obtained a copy of his complaint, said he fears patient care is endangered by this inexperience.
Unlicensed psychologists, he said, are typically people who have recently obtained their psychology doctorate and have far less clinical experience than their licensed counterparts.
"I have nothing to gain by doing this and everything to lose," he said. "The majority of mental health services provided to our newest generation of veterans is being provided by our least-experienced staff."
VA officials denied that patient care is impacted and said that all unlicensed psychologists receive ample supervision and are on track to receive their licenses in the future.
Florida and federal law allows unlicensed psychologists to work as long as they receive constant supervision, the VA and state said.
Regional VA spokesman John Pickens said the VA places the highest priority on veteran mental health treatment and that unlicensed psychologists do receive constant supervision.
"I'm fearful these sorts of allegations are going to cause veterans to think that the care we provide is less than what they deserve," said Pickens. "The VA at Tampa and nationally has done a very good job treating vets."
Nussbaum said what is happening at Haley is not the norm. But a national VA spokesman did not return a call asking about VA hiring policy.
At the Bay Pines VA Medical Center in St. Petersburg, which also operates a PTSD clinic, none of the hospital's 22 psychologists are unlicensed, said Pickens.
Some veteran advocates questioned the practice of relying heavily on unlicensed psychologists at a time when the numbers of veterans requiring mental health treatment is increasing.
"How would you feel going to the airport and getting on an airplane and finding out the pilot didn't have a license?" said Michael O'Rourke, an assistant director of veteran health policy with Veterans of Foreign Wars. "Experience counts."
To obtain a state license, the state says an applicant must complete 2,000 hours of supervised clinical work, which must include a supervisor reviewing their notes.
In addition, the state says applicants must have two hours of direct supervision each week with a licensed psychologist. At least one hour must be face-to-face, rather than over the phone.
"For many of these unlicensed psychologists, there is no face-to-face supervision," Nussbaum's letter said. "For others, there is sporadic supervision, clearly not meeting the required two hours per week."
In his complaint, Nussbaum said the Haley doctor who supervises most of the unlicensed people, Arthur Rosenblatt, cannot provide adequate oversight. Rosenblatt could not be reached to comment.
"It is not possible for him to solely provide the supervision of such a large quantity of trainees in addition to his many other duties, especially since many of these staff are placed in outlying clinics 45-plus miles away (where they function independently) and rarely, if ever, see one another face-to-face," Nussbaum's letter said.
Complaints to the Board of Psychology, a division of the Florida Department of Health, are confidential and the department won't comment on or confirm a pending complaint.
The state investigates such complaints and can take a range of actions, from suspending a license to levying a fine against anyone accused of misconduct.
But it was unclear Monday whether the state has jurisdiction over the VA.
Nussbaum would not speculate about why he thinks Haley has hired so many unlicensed practitioners. O'Rourke at the VFW said the VA is struggling to find qualified mental health personnel.
The VA employs 10,000 mental health professionals nationally, up 15 percent since 2003.
Nussbaum said veterans deserve care from the most-experienced professionals available.
Unlicensed psychologists "often lack the specialized skills and experience that this extremely sensitive population of veterans often requires," Nussbaum said. "They've been in combat. Developing a strong, empathetic relationship with them is essential.
"That's something not easily taught in a class," he said. "It takes experience."
Times staff writer William R. Levesque can be reached at (813) 226-3436 or levesque@sptimes.
Veterans who are suicidal or have concerns about other mental health issues can call the VA at 1-800-273-TALK (8255).