Legislators Made the Right Choice – Manipulation Bill (SB 381) Defeated!

Thanks to all of you who sent or faxed in letters and made phone calls in opposition of SB 381.  Yesterday there was a strong coalition of physical therapists at the CA State Capital, and the legislatures made wise decisions in stopping the California Chiropractic Association’s bill, SB 381.  The legislator’s clearly saw through the rhetoric and smooth talking effort of the DC’s in attempt to restrict PTs from performing manipulation, and clearly identified that it was an effort by the CCA to try to control the marketplace rather than putting the patients’ best interests as a priority.

As an FYI, the bill was heard in the Senate Business, Professions, and Economic Development Committee, which has 10 members.  It needed 6 aye votes to pass.  There was 1 aye vote (by Senator Yee, the author of the bill), 6 no votes, and the bill was granted reconsideration.

Watch the video of the hearing below or copy and paste the following URL into your web browser: https://www.youtube.com/watch?v=lx_hD1udS4c

I am very grateful for the leaders in our state. They know the legislators, and they know and understand the politics.  The California State Physical Therapy Association makes it very easy for everyone to be involved and to create grassroots movements to help in the legislative battles.  It was inspiring to be a part of the group at the capital yesterday, and I learned from the process.  Here are some personal lessons learned:

  1. EVERY physical therapist must be involved.  It is our professional responsibility to write letters, send faxes, make phone calls, etc.  The state chapters make it so easy to do this, and each letter and phone call makes a big difference in supporting each cause.  We cannot sit by and wait for a handful of folks to protect our practice, and therefore help our  patients.  EACH OF US MUST BE INVOLVED.
  2. I vow to show up at the capital at least once each year to support the profession. I challenge each of you to do the same.  No matter how hard it is to do, the bottom line is that numbers do matter and it is important to have a presence WITH WARM BODIES at these hearings.  If my words and the video linked above are not motivation enough, check out the pictures that I have added now to the bottom of this message. These were pictures that I took while waiting in the hallway for the hearing.  One shot looks ahead of me, and one behind. I believe that only about 1/2 of the folks waiting to attend the hearing were in this big hallway, and many more were tucked around corners, in stairwells, etc.  I would bet that there were 4-5 DCs to one PT (or more).  We can do better.
  3. Many DCs are fed propaganda by their leadership. I had discussions with a handful of DCs in the hallway during the long wait to get to a hearing room.  Despite being there to support SB 381, not one of the DCs actually knew the facts (we legally perform thrust manipulation, termed Grade V mobilization; we are taught physical therapy manipulation in PT schools; we have authored a large body of literature supporting manipulation for taking care of musculoskeletal conditions; that we learn differential diagnosis in PT school; etc).  At the end of most of the conversations, the individuals I spoke with agreed with our side…. yet still kept on their “Support SB 381 for patient safety” badges and spoke out in support of the bill.
  4. We need to continue to fight in every state to protect our practice and therefore continue to offer the best care for the patients we treat.  

I know the turn around is quick, but we must now rally to support the next three bills of interest:

 POPTS, Direct Access, and ATC bills all scheduled for 8 days from now!

AB 1003, AB 1000, and AB 864 are all scheduled to be heard on Tuesday April 23rd, in the Assembly Business and Professions Committee, previously chaired by Mary Hayashi, at 9:00 am.  CA PTs, please make your calls and send your letters. The CPTA web site has all the key information to make this happen.  AND, please show up at the capital to support our profession on the 23rd.  I will work to get information posted here so that our out of state colleagues can help with letters and phone calls.

Thanks for all of your support,

Julie Whitman

 

14 responses to “Legislators Made the Right Choice – Manipulation Bill (SB 381) Defeated!

  1. Paul says:

    Thank you Dr Whitnan for the excellent post! We were so pleased and proud to have you come to the mic and oppose.
    Paul Gaspar

  2. Jesse Resari, PT, DPT says:

    Thanks Julie for being there. It’s nice to see you, Stanley Paris, Kaiser group, Folsom group, Rob Landel and the rest of the dedicated PT’s across the great state of California united. As a PT practicing in California, yesterday’s victory was sweet but we know the fight is not over. They will likely continue to push this nonsense. We will be vigilant. Faxed, called and emailed the assembly committee already for the remaining bills in front of us. Thanks again and hope to see you at Sacto!

  3. Brett J. says:

    Good morning Julie.

    Can you please point me to where I can find that manipulation and/or a Grade V Mobilization is under the scope of a Physical Therapist in California?

    I am having a hard time finding it….

    All I could find was this but there is nothing that mentions a grade V mobilization…

    http://www.leginfo.ca.gov/cgi-bin/displaycode?section=bpc&group=02001-03000&file=2620-2622

    Thank you, Brett

  4. Cheryl Sparks says:

    Brett:

    Thank you for your comment. The document provided states, “The practice of physical therapy includes the promotion and maintenance of physical fitness to enhance the bodily movement related health and wellness of individuals through the use of physical therapy interventions.” Physical therapy interventions are further defined by the American Physical Therapy Association’s Guide to Physical Therapist Practice. These include, but are not limited to, “manual therapy techniques comprising a continuum of skilled passive movements to the joints and / or related soft tissues that are applied at varying speeds and amplitudes, including a small amplitude/high velocity therapeutic movement.” Historically in the physical therapy profession mobilization grades I-IV have been defined as non-thrust, and Grade V mobilizations, thrust interventions or manipulations.

  5. Brett J. says:

    Thank you for the information Cheryl!

    Now I better understand why there is confusion on both sides…

    On the chiropractic side, the state board clearly states that manipulation/adjustment is in their scope:
    “(a) Scope of Practice.
    (1) A duly licensed chiropractor may manipulate and adjust the spinal column and other joints
    of the human body and in the process thereof a chiropractor may manipulate the muscle and
    connective tissue related thereto.”
    http://www.chiro.ca.gov/res/docs/pdf/business/chiroregs_jan2011.pdf

    On the PT side, the state board does not say manipulation is in the scope but “physical therapy interventions” are interpreted by the PT profession as including what is described in the American Physical Therapy Association’s Guide to Physical Therapist Practice. “manual therapy techniques comprising a continuum of skilled passive movements to the joints and / or related soft tissues that are applied at varying speeds and amplitudes, including a small amplitude/high velocity therapeutic movement.”

    So, the issue and the source of confusion is that the state board that determines scope and in this case, the state board did not clearly outline that PT’s can manipulate under section 2620
    http://www.leginfo.ca.gov/cgi-bin/displaycode?section=bpc&group=02001-03000&file=2620-2622

    Chiropractor’s were not fed propaganda, they just looked at the facts.There is obviously some gray area here.

    I believe the PT’s doing harm with a manipulaton argument is dead. There is little to no proof of this.

    However, who is better trained in manipulations/adjustments?? That battle has to go to the chiropractor. Evidence is found easily just by comparing curriculum’s and the number of hours spent in clinic performing adjustments (Over 300 adjustments performed in outpatient clinic are required for most chiropractic schools).

    Who is better at prescribing exercise programs and rehab protocols?? Obviously the PT.

    How do we work together?? Respect the expertise of one another.

    Collaboration > Competition

    Much Love, Brett J.

  6. Jesse Resari, PT, DPT says:

    Brett did you check the PT Board of California yet? if you haven’t done so, please do you’ll get your answer there. Thanks!

  7. Brett J. says:

    Hey Jesse!

    I went to http://www.ptbc.ca.gov/laws/laws.shtml and all I could find is what I already posted.

    Nothing about manipulation or grade 5 mobilization…

    Maybe I’m missing something?

    Brett J.

  8. Burton says:

    Brett J. Can you please show me where I can find language regarding manipulation or grade V mobilization in the medical board of california practice act? Can you tell me in your chiropractice act where it specifically states all the particular interventions you might use? It doesn’t have to specificly say it. Manual therapy is a halmark of physical therapy, and manipulation is a manual therapy technique. The profession of physical therapy and the boards that regulate it know what is and is not within scope.

  9. Julie Whitman says:

    Brett J,

    The ability to perform mobilization/maipulation (manual therapy) is due to the inclusion of passive exercise in the California PT practice act. It is contained in California B&P Code 2620. “(a) Physical therapy means the art and science of physical or corrective rehabilitation or of physical or corrective treatment of any bodily or mental condition of any person by the use of the physical, chemical, and other properties of heat, light, water, electricity, sound, massage, and active, passive, and resistive exercise, and shall include physical therapy evaluation, treatment planning, instruction and consultative services.”

    Passive exercises (passive ROM) can be done with our patients as either an osteokinetic (OK) or arthrokinematic (AK) exercise. The language in the code does not specify whether the passive exercise (range of motion) we utilize is osteo- or arthrokinematic in nature. That decision is to be made by the professional. If my evaluation reveals that the patient needs a non-rotary, translatoric glide type of passive exercise – then I do that type of passive exercise. My practice act does not say whether I do active or passive exercises with my patient. My practice act does not say whether I am to do arthrokinematic or osteokinematic exercises. The statute does not state where in the range I perform my passive exercise, nor does it say anything about the rate of force application, i.e., slow ossilations or a high velocity. All of these decisions are made by the professional – the physical therapist based on their evaluation and subsequent diagnosis of the movement impairment.

    Let me know if you have any questions,
    Julie

  10. JD says:

    As a chiropractor (I practice in Wisconsin), I find this attempt by CA chiropractors to dictate another profession’s scope of practice to be embarrassing, and a waste of energy. Thankfully, there are chiropractors in CA that share this sentiment, and steered clear of this legislation. I love my profession, and I think we need not concern ourselves with what others are doing. We have enough problems of our own.

    1. Peer Himler says:

      Thanks JD….thats great to hear….you are 100% correct…we both have our own houses to run and there are more then enough patients to go around. Well said…thanks for your insight….

      Peer

  11. David Jones says:

    I was looking for health related website to review many issue. Now I’ve found your blog site with lots of amazing information. You did really excellent work. I’ll read your blog regular basis.

  12. kate says:

    you have my continued support Dr Whitnan

  13. Christy says:

    Greetings! Very helpful advice in this particular article! It is the little changes that will make the most important changes.
    Thanks for sharing!

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