REVIEW OF SENATE BILL 300
WHICH PROPOSES TO REGULATE
MASSAGE THERAPISTS


GEORGIA OCCUPATIONAL REGULATION REVIEW
COUNCIL

OCTOBER 1997

 

EXECUTIVE SUMMARY

As provided in O.C.G.A. 43-lA, the Georgia Occupational Regulation Review Council reviews all bills proposing licensure of a profession or business referred to it by the chairperson of the legislative committee of reference. Accordingly, the Council, at the request of the Chairperson of the Senate Consumer Affairs Committee, has reviewed Senate Bill 300 which proposes to regulate massage therapists.

In summary, the major provisions of Senate Bill 300 are as follows:

During the course of this study, the Council obtained input from as many sources as possible. Council staff documented the requirements of all other states that regulate massage therapists and surveyed each of the southeastern states. In addition, staff contacted Better Business Bureau offices throughout the state and the Governor's Office of Consumer Affairs to determine and assess the nature and extent of complaints. The Council analyzed the resulting information and prepared a list of findings and a recommendation. The findings and recommendation are briefly described in the following paragraphs and presented in greater detail in other sections of this report.

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FINDINGS

Adhering to the criteria in O.C.G.A. 43-1A, which the Council is required to use as a basis for its recommendations, the Council found that the following conditions exist:

RECOMMENDATION

Based on the information received and developed by the Council, the Council does not recommend passage of Senate Bill 300, which proposes to license massage therapists, because the proposal does not meet the criteria set out in O.C.G.A. 43-1A-6.

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TABLE OF CONTENTS

Topic
 		Page
   
Introduction
1
   
Description of Proposed Legislation
2
   
Present Practices
3

Potential for Harm

4

Complaints from Consumers

4
   
Present Requirements and Voluntary Efforts
4
   
Other State Programs
8
   
Findings
9
   
Recommendation
12

Appendices:

  • Appendix A - Summary of Senate Bill 300

  • Appendix B - Copy of Senate Bill 300

  • Appendix C - National Certification Board For Therapeutic Massage and Bodywork Code of Ethics

  • Appendix D - American Massage Therapy Association Code of Ethics

  • Appendix E - Regulation of Massage Therapists in Other States

 

 

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INTRODUCTION

Senate Bill 300 proposes to regulate massage therapists in Georgia. The American Massage Therapy Association supports Senate Bill 300. The Physical Therapy Association of Georgia opposes Senate Bill 300.

Membership of the Georgia Occupational Regulation Review Council for the purposes of reviewing this proposal is shown in Exhibit 1.

EXHIBIT 1
Georgia Occupational Regulation Review Council
Membership

Standing Members

 Representing
William H. Roper, Chairman
Amy Atkinson
David Baird
Alan Essig
Earl Harris
Jim Hurt
Bobby Lenihan
Bill Miller

Office of Planning and Budget
Office of Commissioner of Insurance
Department of Natural Resources
Department of Human Resources
Department of Agriculture
Governor's Office of Consumer Affairs
Department of Revenue
Office of Secretary of State

Legislative Appointees
Representing
Representative Nan Grogan Orrock
Maxine Chriszt and Cherine Dabbagh,
Senate Research Office
Georgia House of Representatives
Georgia Senate

In reviewing the bill, the Georgia Occupational Regulation Review Council solicited input from as many sources as possible. These groups and agencies contacted include the:

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All groups that responded to the Council's request for information and anyone who requested notification of Council meetings were informed in advance of the time and place of each of the Council's meetings. Representatives from all interested parties were given the opportunity to present information to the Council, either by oral presentation or through written material. Meeting information was published in the Fulton County Daily Report in accordance with the State's open meeting laws.

 

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A more detailed summary of this bill is presented in Appendix A and a copy of the bill is reproduced in Appendix B.

 

PRESENT PRACTICES

Massage therapy is described as the systematic and scientific manipulation and treatment of the soft tissues of the body. According to the American Massage Therapy Association, massage therapists provide their services in a wide range of settings such as:

Practitioners usually work independently and not as employees of an organization.

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Potential for Harm

The applicant group has identified several areas that they believe pose potential harm to the general public. First, they state that inadequately trained massage practitioners can cause physical harm if the client has medical conditions — such as uncontrolled hypertension or diabetes — which indicate that massage should not be performed. Also, they expressed a concern that an inadequately trained massage practitioner may not be knowledgeable of the effect of massage therapy on infectious diseases and could spread the infection by performing massage on a client. Second, the applicant group states that unethical massage practitioners can violate clients sexually and cause psychological and emotional damage. Third, they indicate that more and more people are seeking the benefits of massage therapy, but cannot identify qualified practitioners in the telephone yellow pages because there is little to distinguish the trained, qualified practitioners from untrained persons and/or fronts for illicit services.

Complaints from Consumers

Governor's Office of Consumer Affairs

The Governor's Office of Consumer Affairs (OCA) receives complaints from consumers and investigates the complaints as warranted. OCA staff classify each complaint received as to the nature of the complaint based on the initial oral or written information provided by the complainant. OCA was contacted to determine the number and nature of complaints on massage therapy services that they had received since 1988. However, there were so few complaints received during the period that they were not separately coded.

Better Business Bureaus

Staff also contacted the Better Business Bureau offices serving metropolitan Atlanta, Albany, Augusta, Columbus, Macon, Savannah and Chattanooga, Tennessee (which serves 10 northern Georgia counties). Of the seven offices contacted, the five that were able to compile their applicable complaints reported receiving no complaints relative to massage therapists during the 12 month period ending July 9,1997.

PRESENT REQUIREMENTS AND VOLUNTARY EFFORTS

Related State Statutes

Although massage therapy is not specifically regulated under Georgia law, several statutes appear related to this proposal.

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Currently Licensed Professions With Some Relatedness in Their Scope of Practice

Licensing of Physical Therapists

Under Georgia Law (O.C.G.A. Sections 43-33-1 through 20), individuals who provide physical therapy services must be licensed. The scope of practice for physical therapists is defined in the statutes as follows:

"… the examination, treatment and instruction of human beings to detect, assess, prevent, correct, alleviate, and limit physical disability, bodily malfunction and pain from injury, disease, and any other bodily and mental conditions and includes the administration, interpretation, documentation and evaluation of tests and measurements of bodily functions and structures; the planning, administration, evaluation, and modification of treatment and instruction, including the use of physical measures, activities, and devices, for preventative and therapeutic purposes; and the provision of consultative, educational, and other advisory services for the purpose of preventing or reducing the incidence and severity of physical disability, bodily malfunction, and pain."

Licensing of Chiropractors

O.C.G.A. Section 43-9-16 defines the scope of practice for chiropractors as follows:

"The chiropractic adjustment of the articulations of the human body may include manual adjustments and adjustments by means of electrical and mechanical devices which produce traction or vibration. Chiropractors who have complied with this chapter may also use in conjunction with adjustments of the spinal structures electrical therapeutic modalities which induce heat or electrical current beneath the skin, including therapeutic ultrasound, galvanism, microwave, diathermy, and electromuscular stimulation. Chiropractors who have complied with this chapter may utilize and recommend hot and cold packs and nonprescription, over-the-counter structural supports for the articulations of the human body which are commonly available through retail pharmacy outlets.…"

Related Criminal Statutes

The applicant group in their submission to the Council cited several issues that are addressed by Georgia's criminal statutes. Each of these statutes is briefly described in the following:

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Voluntary Efforts

Massage practitioners may voluntarily obtain professional certification by passing a national examination and join one or more of several professional membership associations. A brief description of these voluntary options is presented in the following paragraphs.

Voluntary National Certification Program

The National Certification Board for Therapeutic Massage and Bodywork (NCBTMB) is an independent, nonprofit organization, comprised of nine members who represent massage therapists, massage school owners and the general public. It oversees a national certification examination program for massage practitioners. Individuals must meet the following requirements before they will be permitted to take the examination:

For those individuals who pass the national examination, they are certified for a four-year period. To have the certification renewed at the end of that four-year period, an individual must meet the following requirements:

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This organization also has a published Code of Ethics, presented in Appendix C, to which its members are required to adhere.

Professional Membership Associations

There are several professional membership associations that massage practitioners may voluntarily join that promote ethical behavior, provide training, educate the public and/or offer certification.

The American Massage Therapy Association (AMTA)

This association's Georgia chapter is the applicant group supporting this proposal to regulate massage therapists. They have adopted a code of ethics — reproduced in Appendix D — for their members and have been active nationally in promoting the benefits of massage therapy. In addition, its Commission on Massage Therapy Accreditation/Approval (COMTAA) accredits massage therapy training programs according to the guidelines of the U.S. Department of Education. To qualify for professional membership in this association, an individual must graduate from an AMTA/COMTAA accredited/approved program or pass an examination or hold a jurisdictional license consistent with AMTA policy. In addition, a member must complete an established level of continuing education to retain his/her membership. The association indicates that they have over 28,000 members in over 20 countries, with 398 members in its Georgia chapter.

AMTA also has a formal policy on the handling of grievances against its members with a National Grievance Sub-Committee and a Grievance Committee Chair in each state chapter. Complaints against massage therapists who are members of AMTA are accepted and hearings may be held. Upon majority recommendation of the Grievance Committee, disciplinary action — ranging from verbal or written reprimand to expulsion from the association — can be taken. To date, there have been no hearings held in Georgia.

The Associated Bodywork and Massage Professionals (ABMP)

This association offers individuals who practice in a state with no statewide regulations the opportunity to qualify as a certified member by meeting at least one of the following requirements:

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OTHER STATE PROGRAMS

Twenty-five other states currently license or register massage practitioners. Five of those states passed legislation instituting regulation during 1996. Each state's regulatory program is summarized in Appendix E.

Eight neighboring southeastern states that currently regulate massage therapists were surveyed as to why they chose to regulate massage therapists and the number and nature of complaints received and disciplinary actions taken to date. Seven of those states responded. The reasons for regulation most often mentioned were that the industry brought the proposal to the legislature to obtain credibility, promote professionalism and get prostitution out of massage therapy.

As to complaints and disciplinary actions taken, the State of Florida reported receiving 199 complaints in 1993-1 994, 228 in 1994-1995 and 199 in 1995-1996. They also reported 3 revocations, 1 suspension and 7 probation decisions in 1993-94; 2 revocations, 1 suspension and 1 probation decision in 1994-95; and 2 revocations, 3 suspensions and 3 probation decisions in 1995-96. The nature of most of the complaints in Florida was described as continuing education violations, violations of sexual misconduct and establishments with sanitation violations. Most of the other southeastern states' regulation is quite new but their staffs indicate that to date they have received few complaints and have taken few disciplinary actions. Only one state reported receiving a complaint that a therapist had injured a client. The nature of complaints most often cited in these states was practicing without a license and sexual misconduct.

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FINDINGS

The Georgia Occupational Regulation Review Council is required by O.C.G.A. 43-1A-6 to apply the following criteria when evaluating whether a profession or business should be regulated:

Senate Bill 300, presented to the Council for review by the Chairperson of the Senate Consumer Affairs Committee, proposes to regulate massage therapists. In this review, the Council has assessed, based on the criteria set forth above, whether or not massage therapists should be regulated, and, if so, what is the least restrictive form of such regulation.

Our findings are as follows:

The Potential For Harm To The Public Appears To Be Remote and
Would Not Be Alleviated by Licensing

As described earlier, the applicant group cited the following areas that they believe pose potential harm to the general public:

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However, our review of available information indicates that the number of complaints concerning massage practitioners is very small and, of those complaints cited, many allege sexual misconduct which under Georgia law is a criminal act. Moreover, there is little evidence that unqualified massage therapists have inflicted physical harm on clients. Instead, there are already other licensed professionals in Georgia who serve persons with medical problems and those professionals are more likely to provide relevant massage therapy services to those individuals as an adjunct to their overall treatment. Finally, the proposal includes a grandfather provision that would permit all currently practicing massage practitioners, whether trained or performing illicit services, to be licensed. These points are described in more detail in the following paragraphs.

There Is No Documented Evidence of Actual Harm to the Public

In response to a staff inquiry on behalf of the Council, the Governor's Office of Consumer Affairs researched their files for the past nine and one-half years for complaints against massage practitioners. However, they found no record of any such complaints, indicating that there were so few complaints that the Office did not establish a separate coding for massage practitioners. Similarly, contacts with Better Business Bureau offices around the state resulted in finding no documented complaints against massage practitioners during the year ending July 9,1997.

The applicant group indicated that there is a potential for a massage practitioner to cause physical harm to a client if the client has undisclosed or unidentified physical problems. In their submission of information to the Council supporting regulation of massage therapists, the applicant group provided copies of a number of anonymous, individual complaints lodged against individual massage practitioners. In addition, the applicant group orally described several other instances in which physical harm was believed to have resulted from a massage. This information, although helpful, does not suggest that widespread harm is resulting from massage therapists being unregulated for two reasons. First, many of these complaints alleged improper sexual advances which under existing state law is a criminal offense. Therefore, a legal remedy already exists for these type of complaints. Second, the total number of complaints and other incidents cited is quite small when considered in comparison with the number of massages performed in Georgia in a year. Representatives from the applicant group estimated that there are probably 1,000 massage practitioners in Georgia and that each practitioner performs an average of 20 massages per week. This information translates into over one million massages currently being performed during a one year period.

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Individuals Who Are Most Susceptible to Being Harmed Are More Likely to Be Served by Other Licensed Professionals

Individuals who have medical problems or physical disabilities are more likely to be under the care of a physician and utilize the services of other licensed professionals that include some, if not most, of the services performed by massage therapists. Based on information provided to the Council, physical therapists and chiropractors may include massage as an element of their treatment to a patient.

The Proposal Would Not Address Any Current Deficiencies in the Quality of Services

As proposed, all massage practitioners who are currently providing massage services would be eligible to be licensed under a grandfather clause in the bill without having to meet any educational, training or experience requirements. This means that any massage practitioner who is inadequately trained or who renders illicit services under the guise of massage therapy could be licensed just as any other massage practitioner, simply continuing the current situation.

The Proposed Scope of Practice for Massage Therapists Appears to Overlap the Statutorily Established Scope of Practice for Physical Therapists and Chiropractors

Representatives from the State Board of Physical Therapy and the Physical Therapy Association of Georgia presented information to the Council indicating that certain elements in the proposed scope of practice for massage therapists are inappropriate for non-medical personnel to perform and overlap the statutorily established scope of practice for physical therapists. After reviewing the current statutes for physical therapists, as well as the statutes for chiropractors, it appears that there is some overlap which, should the bill proposing regulation of massage therapists be enacted, could create confusion among the several professions as to who is authorized to do what.

The Practice Of Massage Therapy Requires Specialized Training But the General Public Can Identify Qualified Practitioners by Existing Mechanisms

Based on information presented by the applicant group and other research, it is evident that there is a body of knowledge with which practitioners need to be familiar to be most effective in rendering their services. In addition, there are many different techniques that may be employed in the practice of massage therapy. Therefore, specialized training appears to be needed.

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At the same time, there are mechanisms which permit the general public to differentiate between trained, qualified practitioners and other practitioners. First, there is a voluntary national certification program administered by an independent, nonprofit organization through which massage practitioners may obtain professional certification. Second, there are at least two professional organizations which qualified massage practitioners may join. Both organizations have an impressive code of ethics to which members must adhere. By confirming that a practitioner is certified by the nonprofit organization and/or is a member of one of the professional associations, a prospective client currently can select a qualified massage practitioner.

The Overall Cost Effectiveness and Economic Impact Of Regulating Massage Therapists On The Citizens Of The State Cannot Be Determined

Since massage practitioners are largely independent contractors, it is likely that any regulation that requires additional training and passage of an examination will reduce the numbers of individuals providing such services. However, the decision by individuals in the general public to obtain the services of a massage therapists is largely discretionary, making continued competition among members of the profession probable. Therefore, it is not possible to determine if regulating massage therapists would cause the cost of services to the general public to increase.

RECOMMENDATION

Based on the information received and developed by the Council, the Council does not recommend passage of Senate Bill 300, which proposes to license massage therapists, because the proposal does not meet the criteria set out in O.C.G.A. 43-1A-6.

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For a printed version of this report, contact the Georgia State Office of Planning and Budget
270 Washington Street S.W. Atlanta, Georgia 30334.