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27 June 2004

The AMTA Yet Again in Alaska

The July/August issue of Massage Magazine has an article noting that the AMTA's Alaska Chapter is looking at state licensure (pages 188-189). With only Anchorage and Fairbanks regulating massage practice, it's not an issue of exemption from a plethora of differing local regulations but one of attitudes about learning. There's this attitude in the AMTA that the only education is school education, flying against David Kolb's formulation of experiential learning cycles. We seem culturally to have forgotten that historically most learning was from experience and peer-to-peer guidance. Schools were simply an expedient to efficiently convey a diversity of didactic information to a diversity of people all at once.

Outside the U.S., the United Kingdom and Australia have both pushed heavily into Modern (UK) or New (Aus) Apprenticeships. It seems that there was a realization in both countries that some people learn best by doing and that this was a viable way of encouraging skill acquisition. We seem hell bent on painting ourselves into a regulatory corner in regards to allowing the use of such apprenticeships. Again, it's that attitude thing.

If someone really wants to increase proficiency in the remote areas of Alaska, it would be a lot simpler to consider flying in a few traveling workshop teachers with an email list to coordinate and promote follow-up exchanges. People also keep forgetting that major elements of professionalism are altruism and simply working quietly to help others. David Lauterstein was correct in pointing out that we are too often focusing on structure and ignoring the essence of human interaction through touch.

State Approval versus Accreditation of Postsecondary Schools

The differences and overlap between state approval and accreditation of private postsecondary schools is one that keeps coming up. I'd posted back in April 2003 on the difficulties stemming from mandating graduation from an accredited school as a prerequisite to practitioner licensing. Last March, the California Postsecondary Education Commission produced a report reviewing and comparing roles of state approval versus accreditation of schools.

For purposes of wording regulation, it's important to know, as mentioned in the report, that the state education code [94739(b)(7)] specifically exempts colleges and universities accredited by the Western Association of Schools and Colleges (WASC) from regulation under the Bureau for Private Postsecondary and Vocational Education (BPPVE). Schools run by the state are also exempted [94739(b)(4)]. This would include all state community colleges, state universities, and campuses of the University of California. Community colleges are already offering massage training programs and other colleges and universities may in the near future include such training as part of a larger degree program. Including all categories of state approved schools means mentioning schools approved by the BPPVE, private colleges and universities accredited by WASC, and the California system of public higher education [100850]. Getting the wording right isn't trivial, a feature I fully expect carries over to other states.

An Update on Sacramento County

Sacramento County held an informational meeting on June 17th regarding their proposed ordinance. I've been buried in physics deadlines and wasn't able to personally make it (or write it up until now), but we had people there both from CAMEL and CAMBS. Judith McKinnon estimated a turnout of about sixty from the massage profession, all aligned against the ordinance as it was proposed with requirements for graduation from an accredited schools and taking of the national certification exam (NCE). Reactions to the meeting have been mixed, from satisfaction at getting a reasonable number of massage professionals to attend on short notice (one week) to continuing concerns that the county is not really hearing and internalizing the business needs of the profession. By analogy, there are concerns that the county is too interested in hunting werewolves with "silver bullets" to have much concern for the number of villagers blown away in the process.

McKinnon spoke from her perspective as a massage school owner for over 30 years and from her lobbying experience with the Waters-Morgan Postsecondary & Vocational Reform Act (1989) and subsequent experience as a Governor's appointee to the physical therapy board. She also carried a statement from CAMEL. One of McKinnon's points was that the Waters-Morgan Act, motivated by the financial aid abuses of a small number of accredited schools, had the collateral damage of forcing about 1600 legitimate vocational schools out of business. We are worried that Sacramento County's rush to close a law enforcement problem may result in similar collateral damage.

Both the Sacramento Bee and the Sacramento News and Review had coverage of the meeting. The Bees' coverage was reasonably balanced and straightforward. The News and Review, particularly in a closing sexual innuendo, was trying far too hard to be amusing about a situation that all involved parties take seriously. Even at that, however, getting any media coverage of the issue at all is a welcome start. I credit that to James Mally, a local school owner and CAMEL founder, getting out a press release on massage profession concerns about the meeting and ordinance.

Given that we don't have the organizational clout to exercise former President Lyndon Johnson's politics of pressure so "their hearts and minds will follow", there's still a lot of input needed to gain and keep the attention of Sacramento County. I still have my link to email supervisors available. My appreciation to all of you who have worked this issue and/or attended the meeting on the 17th.

 

11 June 2004

David Lauterstein's Take on the NCBTMB's Course

David Lauterstein's rebuke of the NCBTMB's course and stance on pages 12–13 of the June/July issue of Massage & Bodywork is a though provoking read (NCBTMB and the Soul of Bodywork). As both a school owner and a former editor of AMTA's Massage Therapy Journal, Lauterstein has a lot of perspective on the teaching and practice of massage. Lauterstein hits the NCBTMB (National Certification Board for Therapeutic Massage and Bodywork) on their ill-advised massage safety campaign, over medicalization and reduction of diversity in massage education, and lack of due notification and process in currently contemplated prerequisite changes. For a person with Lauterstein's profession history, the following is compelling:

Returning to the issue of National Massage Safety — it may be critical at this time that the profession as a whole works together to keep itself safe from the current tendencies dominating the NCBTMB.

 

26 May 2004

Follow Up on the Modesto Malpractice Trail

Since I'd posted about this trial on 22 May, the case went to the jury and was declared a mistrial yesterday afternoon by the presiding judge. While leaning toward acquitting the accused massage practitioner, the jury was apparently hopelessly deadlocked. The prosecutor still has the option of pursuing a new trial and there are still civil suits for this case pending.

 

25 May 2004

Follow Up on the San Mateo Daily Journal Article

Back on the 20th, I posted under Correcting Our Public Portrayal a letter to the editor of the San Mateo Daily Journal. The issue was the seeming use of "massage parlor" to describe all massage businesses. The journal has published my letter under letters to the editor with the lead line "It's not a Parlor". My thanks to the San Mateo Daily Journal. We can get good information on the massage profession out before the public eye.

 

23 May 2004

More on Sacramento County

I'm still requesting that practitioners and educators write the board of supervisors of Sacramento County expressing concern that they appear to be developing a massage ordinance outside of cooperation with the profession. Here's my own letter:

Again, please be concise and respectful. Be sure and state clearly why you are writing to them and what the concerns are. More on this issue and the link for emailing all the supervisors are at my previous post on 12 May.

More on Changes in NCTMB Prerequisites

Following my posting of 12 May on NCTMB prerequisite changes, I emailed the National Organization for Competency Assurance (NOCA) regarding two concerns. The National Commission for Certifying Agencies (NCCA) is the body of NOCA that approves certifying agencies such as the NCBTMB.

My first concern was whether NOCA/NCCA had a code of ethics for certifying agencies that addresses accuracy of statements made by an agency in promoting itself to the public. My second concern was whether NOCA/NCCA had any policy with respect to public accountability when use of a certification is mandated by government bodies as a partial determination of eligibility for licensing; effectively making the certifying agency an agent of the state or state actor. Here's the reply I got back.

After reviewing the NCCA Standards document at the link above, here's my analysis.

While this document speaks to the structure and responsibilities directly stemming from the certification process, it lacks any content directed toward a code of ethics prohibiting misleading statements by a board. It appears that NOCA/NCCA have not considered that a certification board could use poor judgment or weak ethics in promoting itself.

This definition makes clear that, even for a private and voluntary certification, stakeholders extend far beyond certified members. The standard is mute on the effect of government mandating of the use of a certification, i.e. having the certification board act as an agent of the state, on the relative responsibilities to stakeholders.

The keyword that seems missing here is adequately, as in "adequately
represented". The current change of prerequisites on the time scale
contemplated seems paramount to an admission that the interests of a number
of stakeholder groups were not taken seriously.

The final sentence seems to assume that certification is occurring on a voluntary basis, not as a governmental mandate to determine eligibility for licensing.

So that's about it for what is gleanable from the NCCA Standards regarding oversight of these issues.

 

22 May 2004

Links to Review of Issues in Massage Governance Fixed

Some of you tried to access my Review of Issues in Massage Governance the latter part of last week and found the link broken. This is now fixed. It all had to do with the interaction of another file that has a base and revision 1 versions and a head cold that let me to confuse "rev" for revision with "rev" for review. Looking at error logs for the site does occasionally catch one of my foibles. My apologies for the inconvenience.

This is a document I had put together two years ago to organize thoughts and references I had collected over several years. I was interested in combining discussion of regulatory issues with educational and social impact issues. The appendices point to sections of the California statute code and constitution relative to regulation by statute and charter cities.

High Stakes Massage Malpractice Trial

A trial in which a massage therapist is accused of inappropriately touching a client is playing out in Modesto, CA. The Modesto Bee reports the case going to trail, the client testifying, and character witnesses for the therapist testifying. Whether or not the therapist is found guilty, the consequences to his business and reputation have been huge. Disquieting aspects to this case include: a new law immediately elevating the offense to a felony, the period of years for which the therapist had worked with the accuser's family, and the long lineup of character witnesses for the therapist. I unsuccessfully tried to find a bill corresponding to the one mentioned in the 2001-2002 and current legislative sessions. If anyone knows about the bill mentioned in the article, please let me know (email link at bottom of page). I've sent a query to the Stanislaus County DA's office about the bill.

None of the professional liability insurance policies absorb the costs of such a conviction. Some of the policies don't include costs for defending against a sexually oriented accusation. All hinges on the jury decision of whether the client or therapist is the more credible. While such allegations need to be taken seriously and remedied, the framework on this case seems to make it a situation in which there isn't the possibility of a good outcome.

Lately, I have been reading Laurence Gonzales's Deep Survival —Who Lives, Who Dies, and Why. The book is rich both with stories and with neurology, particular the neurology that steps us between conscious thought and unconscious response. Gonzales relates a story of a group of snowmobilers returning from a search and rescue mission. Eight of them sped ahead, and then had to wait for their companions to catch up. They are waiting on a flat, underneath a large hill. Avalanche danger is extreme and they all have been informed of this. Suddenly, one of the snowmobilers cut loose, accelerating across the flat, then up the hill to see how high he could get. Another soon followed, triggering a massive avalanche when he was part way up. The first one up and one of the six at the bottom were both buried under feet of concrete-like snow and died. The second up and the other five waiting, were able to power out to the side. They all knew the danger, so the question comes up "What were they thinking?". Gonzales answers this in terms of the neurology of survival response — a response that can also lead us astray.

Because the system is designed to work without the assistance of logic or reason, there's now an answer to the question. What were they thinking? They weren't. The whole point of the system is that you don't have to think.

I find I can't help wondering if this duality in our inherent human mental nature is afoot in this case; a normally careful and well-intentioned therapist responding without thought for a few instants. Both therapist and client seem of good account and character. Serious actions have serious consequences. I also wonder how deeply we should tear apart lives without seeking after intent but only of action. Unfortunately, the legal system does not seem inclined to take on such matters.

The Dr. Gotlin "Massage Harm" Saga

Back in mid April, a news release from Dr. Robert Gotlin, a New York osteopath, was being syndicated by Ivanhoe Broadcast News. As the news release came across, it had implications of an unduly high likelihood of harm from massage and a blanket statement that thinner persons shouldn't seek deep tissue massage. A number of us, who have been working on elevating discussions of contraindications and training to be evidence-based, took issue with this. There's an analysis and rebuttal to Dr. Gotlin in the June issue of Massage Today by managing editor Rebecca Razo.

To express my concern, I wrote a letter to the American Osteopathic Association with copies both to Ivanhoe and to Medstar Television. Medstar had syndicated a similar release by Dr. Gotlin last fall.

I received back a cordial reply indicating that the AOA had looked into this to the extent of contacting Dr. Gotlin.

All in all, between my AOA dialog and Rebecca's Massage Today article, I believe we are making progress in advocating that statements of negative impacts from massage be substantiated by data that is examined and reviewed.

 

20 May 2004

Correcting our Public Portrayal

There's a quick way we all can help to correct misconceptions in our public portrayal. When you see an article, such as the San Mateo Daily's Massage meeting rubs the city the wrong way, that associates massage with the term massage parlor or other negative connotations, write an email to the editor to correct the portrayal. Here's what I just fired off.

All of us working together, each doing a little as we can, will build to make a big difference. Folksinger John McCutcheon phrased it better.

Step by step the longest march can be won, can be won
Many stones can form an arch, singly none, singly none
And by union what we will can be accomplished still
Drops of water turn a mill, singly none singly none
—John McCutcheon—

 

12 May 2004

National Certification Examination Requirements to Change

Those contemplating take the NCE later in 2004 or early 2005 should be aware that curriculum prerequisites are being changed. According to estimates in an ABMP article, only about 15.7 percent of school curricula are in accord with the new requirements and that on the order of 900 schools nationwide would be required to change their programs, including getting state reapproval.

This includes the great majority of the over 200 state approved schools in California. This could have considerable consequences in states or localities requiring passage of the NCE as a prerequisite to licensing.

I believe that the NCBTMB's ability to require changes in curricula and practice requirements in states or localities requiring the NCE to license is an over concentration of power without direct public review and accountability. As a near sole provider of a mandated product, the NCBTMB is essentially removing a required product from production and replacing it with a less available and more expensive product. I believe that people need to be aware of this and have a chance to comment on it to the multiple agencies involved.

The lack of public accountability of such changes is something that you could bring to the attention of your city councilmembers, county supervisors, or legislators, depending on the entity regulating you. Also send copies of letters to NOCA/NCCA, the agency that approves the NCBTMB to have credentialing authority.

Sacramento County Therapists Concerned about Closed Door Ordinance Process

I've been contacted by Sacramento County practitioners and educators concerned that there is a closed door process afoot to create a new ordinance. The best guess in that the 500 hour / NCTMB crowd have gotten someone's ear and are trying for a stealth process complete on delivery. Because of the proximity to the state Capitol, we are feeling that this may be an attempt to create a precedent that would bias a 2005 licensing bill away from the current consensus between CAMBS, ABMP, and CAMEL of entry with no more than 250 hours from a state approved school and no required national certification exam (NCE). This consensus is supported by state norms for practitioner education and massage school programs outlined in the ABMP sunrise response. Also, as noted in the entry just above, the NCE has gained even more reason to be controversial as a mandate.

Because of the potential precedence of a Sacramento County ordinance and because they appear unwilling to deal openly with the profession, I'm urging concerned massage practitioners and massage educators throughout the state to send a note to the Sacramento County Supervisors.

Let the Sacramento County Supervisors know that you and much of the California massage profession are watching them. Let them know that you are concerned that they are not creating an ordinance in an open process with widespread review and comment by the profession. Let them know that you strongly support the CAMBS, ABMP, CAMEL consensus of no more than 250 hours from a state approved (not an accredited) school and no required NCE — that these are the California norms. Please call their attention to the home pages for these organizations. Explain your own reasons why it's important to you to have a positive business environment for massage in Sacramento County.

Please do the above in a polite and professional manner, staying away from rants on massage organization politics about which supervisors won't have a clue or the need to know. Be concise. While others may work on drafting an ordinance, it is the Board of Supervisors that has the end authority and responsibility to enact it. Help to inform them about our profession, its diversity, and our dedication to join together to support our profession and each other.

• Supervisor Roger Dickenson, District 1
• Supervisor Illa Collin, District 2
• Supervisor Muriel Johnson, District 3
• Supervisor Roger Niello, District 4
• Supervisor Don Nottoli, District 5

• All of the above (includes cc to Scott Lebar, Sacramento Bee)

Also consider cc'ing Scott Lebar, the assistant managing editor listed on the Sacramento Bee's Sacramento County Page.

Many thanks to you all in advance for helping to bring daylight to the Sacramento County process. This could conceivably be as important as anything you might write once a state licensing bill is introduced in 2005.

 

11 May 2004

ABMP Lets the Light Shine on their California Sunrise Response

CAMBS now has the ABMP's California Sunrise Questionnaire Response (pdf, 1MB) available in the library section of their web site. It's also linked from their current home page posting on state licensing. True to their policy of openness, ABMP simply sent this along as promised. The sunrise questionnaire is a document required by the legislature to justify the need (i.e. public benefit) and form of any proposed occupational regulation. While I've yet to plow through this in depth, the document is interesting, apart from the licensing question, in the demographics it captures about educational practices and current city and county licensing. ABMP has placed considerable effort into understanding the nature of massage practice in California and working from that perspective. This falls in line with my own feelings that, whatever is done in regulation, it should have a documented evidence base.

If any of you wonder why I find the willingness of the ABMP to just email us the document so refreshing, consider the contrast with CAMBS making the AMTA–CA version available last November. Teresa Nead, president of CAMBS (and a member of the coalition group of eight supposedly writing AB 1388) didn't have to spend 3.5 hours in the Business & Professions Committee office reading and taking notes before they just let her copy the document; all after much stonewalling by AMTA-CA and Christine Kehoe's office. Nor did Ramona Moody French (secretary of CAMBS) and I have to spend time scanning the copy, running it through optical character recognition, and formatting it to get a reasonably sized document out to the profession. So bear with me while I say again that the ABMP attitude of working together is refreshing. It's likely best that I don't get into details of my irritation with other attitudes.

The Invisible Touch

I recently ran across the book, The Invisible Touch, by Harry Beckwith. The topic is the selling of services. Even in the short introductory chapter available online, I found a couple of good quotes.

Work is not about business; it's about us. The human dimension of business — the messy, emotional, utterly human dimension — is not merely important; it is all-encompassing. As a result, we must plunge into the world of feelings — truly frightening territory."

"… she committed the blunder that many artists, architects, and millions of other service people commit every day. She assumed that only the quality of her product mattered. Everything else — presentation, connection, human contact— she regarded as superfluous. Maybe she considered all that to be too commercial. — And so she failed."

The latter quote speaks to what I feel the implicit message is when we design curricula and tests that convey the importance of anatomy but are silent about communication skills and the human connection we supply. There are those who create an idol of what Beckwith terms a blunder, and then proceed to worship it.

 

09 May 2004

Licensing, Groups, and Staying on the Same Plateau

With CAMBS and ABMP both having well-defined, firm base positions as to entry at no more that 250 hours and no mandatory national certification, writing a California licensing bill becomes much like negotiating a common choice of position on the top of a plateau. As long as all involved agree to stay on the plateau, there's a possibility of success. If any party decides to move over the edge, the entire effort crashes to oblivion. So, a major question for 2005 will be to determine whether AMTA–CA is willing to play on the same plateau as CAMBS and ABMP. While AMTA-CA could define their own plateau, averaging the location of two separate plateaus generally places you totally off of a plateau, indicating failure of the effort in this analogy.

CAMBS Board Posts Licensing Statement

The CAMBS (California Alliance of Massage & Bodywork Schools) board has posted their own statement on exploring licensing. They note both the desire for wide knowledge and participation and the importance of having a rapid response capability. Good planning.

More on Health Savings Accounts

The Christian Science Monitor has a good article on the new Health Savings Accounts. For any massage practitioner allowed to treat conditions of pain or minor injury, HSAs have the potential to become an important mode of payment. As I'd mentioned earlier, the financial agencies managing these accounts often provide debit cards and checks to allow the consumer to make direct payments to providers. There are also considerations in Congress to loosen restrictions on other types of health accounts. The trend toward greater availability of such accounts may make them far more important to massage practitioners than conventional health insurance; the key is that the consumer decides what benefits are worth the cost. Such accounts provide new incentives to preserve or obtain a scope of practice for massage that includes the ability to treat.

 

06 May 2004

Then the Game is On

Based on the discussions at last week's CAMBS (California Alliance of Massage and Bodywork Schools) meeting in Rocklin, the state licensing game is on for 2005. What remains to be seen is whether the AMTA-CA, the likely initiator of a bill, has learned to play openly with others in the profession. Last year, the extreme disparity between the compromise being hammered out by participants and the content of the sunrise questionnaire response submitted by the AMTA was a major motivation for my urging everyone to kill AB 1388. The content of the sunrise questionnaire pretty much explained why the AMTA-CA had been stonewalling on releasing it beyond the Assembly Committee on Business and Professions. The sunrise response basically was being used as a back door method of lobbying the legislature for things in contradiction to the compromise.

Given the AMTA tendency to act like they could control the game, ABMP (Associated Bodyworkers & Massage Professionals) hired Foley & Lardner LLP as their lobbyist at the end of last year. ABMP had been rebuffed by the AMTA on suggesting that the sunrise response needed considerable modification. ABMP has thus written their own sunrise questionnaire response, bringing a draft to the CAMBS meeting. I'm assured that a PDF file will be made available when the document is finished and filed.

Bob Benson, president of ABMP, and Kathryn Austin Scott, the lobbyist from Foley, both were refreshingly impressive at the CAMBS meeting in displaying a sincere willingness to listen and to play with all cards visible on the table. ABMP has already done considerable research into current levels of training of most practitioners and recent massage school graduates and into the requirements of all the California counties and many of the cities. While ABMP is advocating licensing, they are also taking firm positions to do so in a manner that would have minimum impact on California practitioners and schools. It's a pragmatic rather than an ideological approach.

Meanwhile, AMTA-CA has announced a meeting for 20 May to be held in Emeryville from noon to 4pm for the purpose of training pro-licensing volunteers and introducing them to the new AMTA lobbyist, Mark Rakich of California Advocates Inc. Rakich certainly has the required background, having served as Chief Counsel to the Senate Committee on Business and Professions under Liz Figueroa, head of the committee. The AMTA game plan is to have Christine Kehoe introduce a 2005 bill in the Senate, assuming that she is successful in her move from the assembly to the Senate. The Senate B&P Committee would thus be first to hear the bill. Interestingly, when one of the participants at the CAMBS meeting brought the AMTA-CA 20 May meeting to our attention, the ABMP folks reacted as if this were news to them also. Perhaps the AMTA still needs to improve communications with its collaborators. Hopefully, their new lobbyist can help them with this recurring problem. In the long run, it would save me a lot of reactive writing.

What's known at this point is that there will be a legislative informational meeting on massage licensing in November or early December. This is basically reviewing and setting the framework or background under which any licensing bill would be considered. Both CAMBS and ABMP are adamant that any bill have an entry level of no more than 250 hours and that no tier in the bill have a mandatory requirement for national certification. The ABMP research on current practices supports this stand as also do CAMBS statistics on entry level programs. Both CAMBS and ABMP are in agreement that the powers of a board be limited to implementation and enforcement, without power to change entry level requirements or to lobby the state legislature for changes.

It isn't as clear whether CAMBS or ABMP would accept any language limiting scope of practice of the 250 hour tier, something I find personally repugnant and would work against. There isn't any training differential specific enough to warrant such differentiation. I believe that any such language limiting the ability to provide health care treatment for minor injuries, sufficient to IRS definitions for the new Health Savings Accounts (HSAs), would become enough of a gut issue to enough practitioners to make passage of a bill extremely difficult. This basically leaves the 500 hour tier without much to distinguish itself — a potential Trojan horse for other requirements, but with everyone watching that potential like hawks and ready to dive with talons bared. Those advocating practice under the Health Freedom Act, SB 577, would happily join the carnage against such a bill, like dwarves with battle axes too long sheathed.

It remains to be seen if, with all these restraints, the product is something the legislature will buy, particularly amid ongoing economic woes. The probability goes down the more that proponents are less than open and candid with the professional community. If that lesson wasn't learned last year, there are enough of us willing to provide the instruction again. However much time and effort gets spent on working with a bill, being clear on the boundaries from the beginning is medicine against a lowballing attempt.

Ultimately, my goals and commitment are to insure that there is time and distribution of bills and documents for widespread discussion, review, and input so that all feel they have had a chance to be knowledgeable and heard, that current school and practitioner status in California is acknowledged and not dismissed, and that the cards are all visible on the table and goals are as stated. As Sean Connery says in The League of Extraordinary Gentlemen, "Then the game is on".

 

24 April 2004

A bit more on CAMEL

The California Massage Education League (CAMEL) web area now has a formatted (PDF file) cover letter for those wanting something to include in a letter to city council members our county supervisors, directing (and motivating) them to the CAMEL web site. The cover letter is linked both from the beginning of the CAMEL main page and from the perspectives index. As an additional aid to sharing the site, it's now indexed by Google. Just search on the words "camel" and "massage". At the moment, there doesn't appear to be a plethora of pages up about actually massaging camels.

 

21 April 2004

Have you seen the CAMEL?

It's still a work in progress, but a core group of California massage educators and practitioners have put together a new resource. Welcome to the CAMEL — California Massage Education League. CAMEL's goal is to advance a positive business environment for practicing and teaching massage within California. What's up so far is a set of questions and answers targeted for local officials. What's still to come is the addition of other core member names and bio's along with short perspectives from each.

 

11 April 2004

Becoming Involved — Having an Impact

Much of what I write here is about becoming involved in the processes that shape the future of the massage profession. Part of this is about opening up the flow of information so that it's known, reviewed, and commented on outside of small groups framing legislation. Part of it's holding organizations accountable for their public faces. It is individuals acting together that remind organizations of the need to serve the massage community rather than to expect the reverse. We can learn from some activism resources for the wider world.

In the larger community of the country and world, The Democracy Owner's Manual and Organizing for Social Change share the same goals we do here. The two books are, respectively, by Jim Shultz of The Democracy Center and Kim Bobo, Jackie Kendall, and Steve Max of The Midwest Academy. Jim Shultz makes some important opening observations:

I come to this challenge of democratic participation with three basic premises, ones that also form the basis of the book in your hands. First, I believe that we have both the right and the responsibility to be involved in the decisions our democracy makes. These are decisions not just about who we elect, but about how our public officials exercise power once we give it to them. Second, I believe that when we do become involved in public issues we have a responsibility to understand them. Our aim should be a democracy that is not only participatory, but also informed. third, I believe that public participation can have an enormous and positive impact, but that to be effective we need to understand the basic tools of democratic activism and how to use them wisely. …

Let us be clear about one other point. Democracy, most of all, is about power. Even if, on paper, we all have just one vote and are supposedly equal in the eyes of the law, the truth is that we are far from equal. How much actual political power we have depends on how much money we have, what social connections we can call on, our race, our sex, and many other factors that tip democracy's scales steeply toward some people and away from others. The public activism that this book seeks to inspire and strengthen is activism that aims to right those scales back toward equality, to help those with less power get more.

Within the more limited context of the interaction of the individual massage practitioner with the organizations and government agencies that set the context of massage practice, I have similar goals. Of course, you could do worse than to carry activism learned here out into the wider world. On what ever level you will, find a voice and make it heard!

Whether in the professional or world context, public relations are important to us. Real-World PR has put together About PR as a free public relations resource site. The are other PR and activism resources linked to my Massage Activist's Resource Page.

 

06 April 2004

Julie's Blog

For those who haven't been there yet, Julie Onofrio also has set up a massage blog. She's good at pondering those issues of attitude and orientation. Also check out her resources at The Bodyworker.

 

04 April 2004

Health Savings Accounts

Here's a bit of useful information to help celebrate triple-four day (i.e. 04-04-04). Starting this year, there's a new opportunity to plan for your own health care needs and to provide for the health care needs of your massage clients. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003, added section 223 to the Internal Revenue Code to permit eligible individuals to establish Health Savings Accounts (HSAs) for taxable years beginning after 31 December 2003. Amounts are contributed to an HSA on a pre-tax or tax-deductible bases and may be accumulated over multiple years to pay or reimburse qualified medical expenses.

HSAs are similar to the previous Archer Medical Savings Accounts (MSAs). MSA eligibility, however, was restricted to employees of small businesses and the self-employed. HSAs are open to everyone covered (only) by a high deductible health insurance plan. The only limitation on the health plan is that the annual deductible must be at least $1,000 for individual coverage and at least $2,000 for family coverage.

Eligibility of expenses will be determined by the IRS based on Internal Revenue Code (IRC) §213(d). Here's an additional summary of this section's effects (PDF file). Section 213(d) is further interpreted in IRS Publication 502 (PDF file). The operative phrase for eligibility directs sessions towards treatment or preventative care relative to specific dysfunctions rather than towards generalized massage. The implication is that you will have to assess treatment needs and maintain treatment notes.

Typically, eligible health care expenses are expenses incurred for medical care. Medical care expenses include amounts paid for the diagnosis, care, mitigation, treatment, or prevention of disease or illness and for treatments affecting any part or function of the body.

Account trustees such as FirstMSA, MSABank, and HSA Trustee Services provide debit cards and checks to allow account holders to directly pay medical expenses out of their HSA accounts. For HSA's there is a 10% penalty assessed by the IRS for ineligible expenses. Account trustees are not required to determine eligibility of a debited expense, but they are required to report all such distributions to the IRS (See questions 29 and 34).

Consideration of the social effects of medical savings accounts raises another interesting issue, that of being able to claim to do treatment. With different forms of medical savings accounts now becoming widely available (HCRA's, MSA's, and HSA's), the aspect of client direction of medical expenditures takes on new meaning. I suspect that medical savings accounts will mean much more to massage than traditional health care insurance ever did, simply because the client has more say. In California and Minnesota, health freedom acts allow practitioners to claim ability to treat. Many licensed states also allow this. However, the proposal by the nursing board administering massage in New Jersey, specifically disallowed "treating". This could have profound effects on access to providing services under medical savings accounts.

This could also become a very hot potato if a California bill emerges in 2005 with two tiers. There was talk with AB 1388 of restricting the 250 hour tier scope of practice simply to be able to float the 500 hour tier as something different. Questions about scope of practice restrictions on a lower tier were included in a recent ABMP member survey. Attempts to legislatively cut the lower tier from any claims of treatment could easily become a "gut" issue. Benny Vaughn has said that sports massage is about the treatment of minor injuries to muscles, tendons, and ligaments, Many California massage schools teach basic sports massage and deep tissue, including concepts of treatment for simple minor injuries, by the time students reach the 250 hour mark.

My thanks to Carl Brown of Able Bodyworks for steering me back onto track on several aspects covered above.

 

03 April 2004

The Dialog Springs Forth Anew

Lest those of you who have read here before, think I've given up the fine art of weblogging, I haven't. I did, however, find that I needed a period just to put my mind elsewhere to cool it off a bit, while also catching up in other areas of life. So, with spring here and daylight savings time about to begin, I can start again, with what comes to mind on the social context of practicing massage.

The Context of Professionalism

For those who don't normally catch it, my April Massage Today column was a chance for me to ponder about the underpinnings of professionalism. There are contexts of social responsibility that, I believe, many lose sight of in focusing just on technical competence. In the same issue, Cliff Korn's column Of Foxes and Henhouses notes some of the ways that state massage boards are too often acting in a manner hampering the development of the profession. The title of Cliff's column is reminiscent of a book and later article on occupational regulation by Stanley Gross.

Picture This

To some extent, the battles over regulation are about choices in control and shaping of the profession of massage. Another element, however, is in the literal differences in how we, as individuals, perceive and organize the world. Some of us are verbal-linguistic-sequential learners and some of us are visual-spatial-global learners. Many of the battles come from global learners getting tired of (and irritated with) having the structures created by the more sequential forced upon them via regulation. It's an area in which words quite literally fail.

Psychologist Linda Kreger Silverman has captured much about Visual-Spatial Learners (VSLs) in her recent book, Upside-Down Brilliance. Online, she has an Introduction to VSLs, Visual Spatial Resources (notice the cartoon), and a list of common strengths and weaknesses of VSLs. While part of the reason the oft-touted concept of a base set of knowledge breaks down is the diversity of touch techniques, another powerful reason is the diversity of our learning and processing approaches. Silverman, by-the-way, groups kinesthetic-tactile learners on the VSL side of the aisle, in good reason because of their global "grokking it" approach.

'Grok' means to understand so thoroughly that the observer becomes a part of the observed - to merge, blend, intermarry, lose identity in group experience. It means almost everything that we mean by religion, philosophy, and science - and it means as little to us (because we are from Earth) as color means to a blind man. —Robert Heinlein, Stranger in a Strange Land.

 

27 January 2004

The Current Spin on AB 1388

Since the month's and year's beginning, AB 1388 has been amended. This presumably was to correct some of the minor wording problems introduced last September, but introduced new problems as well. Most notably, the notation of 250 hours was left off of the lower tier. Such activity currently appears to be to present the bill in its best light at a likely March informational hearing by the Assembly Committee on Business and Professions. It also is a logical step to facilitate reintroduction of the bill wording in the 2005-2006 legislative session.

AMTA promoters of AB 1388 have written an article for the February issue of Massage Today. There are some definite inaccuracies and some interesting glossings over that occur.

Although a fair number of smaller California towns have no local regulation, the vast majority of massage therapists often work under very onerous local laws; years of efforts to improve these local regulations have been frustrating. The intention of AB 1388 is to create the least, most appropriate regulation possible.

While there are certainly some major cities in urban areas that have onerous laws, it does not clearly follow that "the vast majority" of practitioners work under such laws. There are some statistics collected by Burt Boss, general manager of the Desert Resorts School of Somatherapy that indicate a high likelihood that most local laws are reasonable. In adding a second tier, unrelated to ability to practice, the bill framers also seem to stray from their stated intent of creating the least appropriate regulation possible.

Curious aspects of the article is that it claims that the bill has progressed further than expected and that the bill will lie dormant in committee until 2005. In fact, AB 1388 was never formally heard within its first committee in the 2003-2004 session. The only progress has been that the framers have found some actual language with which to flesh out the bill. Nor can AB 1388, as such, lie within committee. To reach the 2005-2006 legislative session, it will have to be reintroduced in early 2005 as a new bill. As with the sunrise application, creative wording is still active. You can email your comments to the editor of Massage Today.

 

03 January 2004

ABMP now has their own Lobbyist in California

ABMP has announced that they have retained the firm of Foley and Lardner to represent their members' interests in Sacramento. Foley and Lardner recently played pivotal roles in the shaping of the landmark health freedom bill (SB 577) and establishment of licensing for naturopathic doctors (SB 907). ABMP's instructions to Foley and Lardner are to work with other parties in support of a licensing bill, but to make clear that continued ABMP support is contingent upon key features remaining in the bill.

Congratulations to the San Francisco Ordinance Coalition

The coalition of organizations and schools working on creating a new San Francisco ordinance more congenial to the interests of massage practitioners have succeeded. The new ordinance defines 100 and 200 hour training tiers and including moving the administration from the police department to the department of health.

A rather unique aspect of the San Francisco law is that it recognizes a legitimate role for sensual/erotic massage as well as a role for therapeutic massage. In contrast, AB 1388, as a practice act, basically attempts to eliminate the former category, partly by eligibility requirements and partly by advertising restrictions. Its nice to see an alternative approach that aims to achieve some differentiation for therapeutic massage and leaves adult entertainment as a local option. Here's a quote from the San Francisco coalition position statement.

The adult entertainment industry, who initiated this new ordinance, is very sincere in its desire to make massage parlors safe and profitable for the women who work in them. Most San Francisco elected officials have no desire to wipe out the massage parlors so, the net result is that therapeutic practitioners have to coexist, for the time being, with adult entertainment practitioners. We have come to the best compromise that we believe possible at this time.

The new ordinance also sheds some light on successful two-tier implementations. I believe, where two-tier laws are successful, they have based on differentiation in massage establishment licensing, an inherently local affair. The differentiation is in whether one can establish an individual practice, do outcalls, or practice in one's home. This is evident in the Coachella valley system and in the current law and future hope for zoning changes San Francisco. It is also in marked contrast to scope of practice differentiation that had been proposed for AB 1388. Scope of practice differentiation basically restricts what a lower tier can practice rather than where and when they can practice. A desire to stay with zoning-based tier systems may well be an argument in favor of keeping regulation at the local level.

Massage Politics Sheet Entries for November and December Archived

The MPS entries for November and December 2003 have been moved into their own archive file. There's also a link to the archive index page on the navigation bar to your left.

 

Copyright by Keith Eric Grant — The Ramblemuse^SM — Last revised Tue 27 May 2008

Masthead and border based on the photo Knight by Elvinstar.