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29 April 2003

The Toy in the Cereal Box

Today's entry starts a new semi-regular feature for the Massage Politics Sheet (MPS). It stems back to the beguiling marketing of my preadolescent days, in which part of the purpose of a new box of cereal was gaining access to the toy hidden somewhere deep within. My favorite was the small gray submarines that, with the aid of a bit of reacting baking powder and a bathtub or pool, could repeatedly surface and immediately sink—all on their own. We could wish that massage regulations were more like those submarines in their tendency to sink as soon as they surfaced. But, even the serious multi-grain discussion of the MPS needs its occasional toy(s) directed more towards learning and practice. First off, Garfield has a bit of knowledge about deep tissue work, it seems. A recent Physician and Sportsmedicine article discusses, "What is Exercise?". And finally, here's "100+ Marketing Ideas" from the Online Women's Business Center. Now, don't forget to eat your cereal!

28 April 2003

You Can't Get There From Here!

My Thanks to massage practitioner Carl Brown of Able Bodyworks for bringing up an important question on the misuse of school accreditation.

If a state licensing program is dependent on COMTA standards how do new schools get started? The school must have a 500 contact hour program with supervised practice for a total of at least 600 hours. The school must have graduated at least 2 classes and have provided that training for at least 2 years. How can a school find students who will pay for that 600 hour program if they can not use the training because it comes from an unaccredited school?

The problem stems from perverting a process designed for one purpose into another use. Basically, accreditation is a process by which the Department of Education judges eligibility of educational programs to participate in federal financial aid programs. USDE recognizes agencies such as COMTA and WASC (Western Association of Schools and Colleges) to accredit schools for these purposes. In this context, consider what the delay in accreditation means. 1) You have to develop a track record before students in your program can receive federal financial aid. 2) You may institute payment programs for students or seek availability of private or state funds. 3) The above may be somewhat of a disadvantage to startups, but it doesn't rule them out. 4) If programs are shorter and more modular, it's easier for students to find funds and for new schools to be started.

The problem comes when states mandate school accreditation as a prerequisite for graduates to be eligible for practice. This is tantamount to depriving startup schools of any market viability. What was prudent in providing financial aid becomes a terrible idea in the context of occupational regulation. As noted in 4) above, requiring more education to enter practice than is necessary to effectively provide a valuable service both raises the cost to students of entering a profession (call it a door tax) and discourages startup schools (harder to find alternative funds).

Colleges and universities might be able to start up a new massage program, in that they are accredited in block by an agency such as WASC rather than program by program. On the other hand, De Anza College ran into the problem that the Washington Massage Board doesn't understand this -- the board members have been totally sold on COMTA as a brand name for accrediting massage and are apparently uninformed about the large picture of school accreditation.

500 Hours, 500 Hours, You Can Hear Them Pay Away for 500 Hours

I have never encountered any technical reason for the 500 hour concept. The best theory I've heard to date on the source is that 500 hours was once the gold standard for obtaining federal financial aid. That came up in an interview I did in 1997 of Judith Mckinnon to capture some of her history in legislative advocay for small massage schools. The closest I've seen to any methodical study of needed education was done within the context of CAMBS at the start of the BPPVE. Ramona Moody French had stated that:

I participated in a task force initiated by the BPPVE [Bureau for Private Postsecondary and Vocational Education], which legislates massage schools among others. The purpose of the task force was to decide what the absolute minimum requirements should be for massage training. The massage schools, owners who participated in the task force decided that rather than develop a curriculum for the 250 hours suggested by the Bureau representatives as a minimum, we would discuss what knowledge we feel the students really need, and how many classroom hours it realistically takes to impart that knowledge. It was a really interesting discussion, carried out over several meetings, and the conclusion we came to was that it takes about 200-300 hours in the classroom to impart to students the minimum education we felt they really need in the marketplace. This included more than one massage modality, along with health and safety, anatomy and physiology, business practices and ethics, as well as communication skills. We felt this would make the student competitive in the marketplace, as well as no danger to the public.

I later made use of this quote with Ramona's permission in my article "With Legislative Intent". Note that Ramona is discussing marketability among the needs. A person starting part time with an established venue (e.g. a runner working on runners; a dancer working on other dancers) by word of mouth, might suffice with a bit less. This study was a prototype of the hours by need of content approach that I was advocating in my recent column "Swimming Upstream Toward Effective Practice".

Massage Regulation Debate Sees the Light of The Desert Sun

In this case, "The Desert Sun", is a newspaper covering the Coachella Valley. As seen from this article, massage partisans Burt Boss and Ramona Moody French have their opinions to voice, as does key Kehoe staffer Michael Miiller. Unfortunately, "high standards" not backed by need of content and good educational concepts can be as poisonous as arsenic in a desert well.

27 April 2003

Hearings on Amended AB 1388 Suspended until January 2004

First off, AB 1388 was amended to be a practice act and to require background checks on applicants. It also now has a board in which membership is divided up between "the two largest organizations" and "the schools". If taken literally for California, both the IMA group at 11,000 odd members and the ABMP at over 7500 members have more than CMTA at 3500 members. It seems unlikely that the sponsoring CMTA would write itself out of any chance to be represented on the board. There are also other players out there, such as the American Medical Massage Association, the American Organization for Body Therapies of Asia, the newly formed Ancient Healing Arts Association, and those unaffiliated souls getting their liability insurance via Massage Magazine's Hands-on program. If is also not clear who represents "the schools", given that the California Alliance of Massage & Bodywork Schools (CAMBS) and the AMTA's Council of Schools have very different perspectives. Once again, those playing with the wording of the bill seem to be underestimating the complexity and diversity of our California massage community. Trying to encode this type of division into the law seems about as good a way to stir up animosity as any. The board makeup, by the way, still lacks sufficient public members and the board is still given absolute authority to set eligibility requirements. There is still a lot to discuss and a lot of education to be done.

The second bit is, in the face of substantial input to the Assembly Committee for Business & Professions, Assemblymember Kehoe has seen the wisdom in having more input and a much better written bill before subjecting AB 1388 to committee hearings. I'm sure for Kehoe and hear staff, it has been an interesting introduction into how disparate we truly are. This move should provide a lot more time for considerable discussion to occur. Next Friday, CAMBS is having a meeting in the vicinity of Sacramento. I'll be there listening and talking. Among those on the panel will be Kehoe and one of the lobbyists for the CMTA. It should be an interesting time and give me some more to write about.

My thanks to all who have cared enough to give voice to their opinion. Your participation and your perspectives do matter — at lot. — ...Keith

18 April 2003

Updates on AB 1388

On Tuesday, April 29th, the Assembly Committee on Business and Professions will hear AB1388, the proposed California bill instituting state massage regulation. The bill is, at least officially, still as originally introduced by San Diego Assemblymember Christine Kehoe.

During this next week, you have the opportunity to express whatever concerns you may have regarding state regulation to members of the committee. It is very important that we are proactive in this or decisions will be made affecting our education and livelihood that could well be against the best interests of many of us.. I would recommend sending your comments to ALL committee members, not merely the chairperson. If one of the committee members is you own representative, be sure to provide input to them. It is your profession and your voice is important. For your opinions to best be heard, please be professional, writing or calling in an assertive but non-hostile manner, and expressing yourself with clear and succinct statements.

While sponsors of the bill are still planning on collecting more input and further changes after the bill would leave the assembly, there are no guarantees what would come out of the process. There has been mention of adding both grandfathering and tiers. Grandfathering certainly helps those already in practice, but does not allow for current or future students to enter limited part-time practice to support their continued learning. Grandfathering is about limiting the impact on those practicing, not about forming a social policy supporting those with limited economic means or juggling many other life responsibilities.

I'll note than yesterday morning's Forum program on San Francisco's KQED radio was about the disproportionate impact that the California crisis will have on the community college system. In response to the likelihood that per credit fees will double, the system's chancellor noted that both the system and the students are ill-prepared for conditions requiring financial aid, many of the students having marginal or uncertain income. The statement applies equally to the bulk of those seeking massage training in California. KQED, by the way, also has links to more resources on adult learning.

The addition of tiers to the bill could well move AB1388 between the devil and a hard place. If a lower tier does not exempt practitioners from local massage parlor ordinances, then it is effectively nonfunctional. If it does create such an exemption, placing practitioners under ongoing state supervision, then it precludes the need for a redundant upper tier. Their is no proof of harm nor even a single hierarchy of learning that would make for a single logical division on basis of scope of practice. Simply to add a second title for administrative/ marketing purposes is redundant with private certifications already offered by the NCTMB, set up for Asian bodywork, and being set up by groups such as the American Medical Massage Association.

The certification initials already identify those who have met such requirements to consumers and employers, without further state intervention. They also provide a sufficient means for providing interstate portability of credentials. I also see the Coachella valley 300/500 hour model as unworkable on the state level, although it seems to serve well where the primary entry level is into the spa/tourist industry. This model allows working for others at 300 hours of training while requiring 500 hours to practice independently. In contrast, my student constituency, and likely that of the more sparsely populated north state, is to enter via part-time, limited individual practice after 100-200 hours while juggling another job. I would be adamantly opposed to any structure that prevented this.

Finally, with words about the bill sounding like they will head more towards a practice act then a title act, I'll note that the latter establishes reserved acts without the likelihood of clients being harmed, flying in the face of current recommendations within the greater health processions towards a limited and centralized set of shared reserved acts (PEW Health Professions Commission Recommendations on Regulation, and the British Columbia Health Professions Council Review). Practice acts often ensnare related those not specifically exempted, as occurred recently in North Dakota with Native American healers. Along those lines, I've recently suggested to the Native American Rights Fund, the cost effectiveness of protecting their interests in California, Arizona, and Nevada while bills are still pending.

25 March 2003

Impressions from the 22 March CMTA Meeting in San Jose on Regulation

A fair portion of the meeting went to lobbyist Mary Griffin and her assistant lobbyist Siobhan Guiney describing their anticipated legislative schedule. Their major point was that a bill that doesn't make it out of the house of origin by Sept 12 is effectively dead.

From my look at the joint rules, the actual deadline to clear the house of origin is January 31 of an even year for a bill introduced in the previous odd year. Sept 12 is the end of the odd year legislative session, so there would be a very limited period in January for a bill to pass, requiring it to clear the Business & Professions (policy) committee by Jan 16 and the fiscal committee by Jan 23.

The lobbyists consider the current wording of AB1388 to be a "spot bill", which is defined by the legislative glossary as "A bill that proposes nonsubstantive amendments to a code section in a particular subject; introduced to assure that a bill will be available, subsequent to the deadline to introduce bills, for revision by amendments that are germane to the subject of the bill." It seems from this description that, if they wanted a spot bill, they've introduced one with far too much substance in what it would potentially affect. Griffin commented that the current wording does not specify an hour requirement, ignoring that the hour requirement is implicit in the requirement for national certification. Given the potential for divisiveness in proposing regulation, the sloppiness represented above could well engender sufficient opposition to undermine passage of the spot bill through the assembly.

A spot bill passed by the assembly, then gutted and replaced and passed by the senate would not have to return to the assembly policy and fiscal committees (I asked), but would normally go straight to the assembly floor. My sense is that, if it hit the assembly at a busy time towards the end of the 2004 session, it wouldn't get much review. Thus the bill effectively becomes a one-house bill, substantially reducing opportunities for external opposition at a later time.

The lobbyists are working on a scheme to fund a board start up without recourse to state general funds. They didn't specify, but I would suspect the likely sources as the AMTA treasury. When they didn't specify a means, I asked about the legalities of taking private funds. Griffin's reply was that there were ways to do this.

The lobbyists were noting the usefulness of forming telephone trees and having letter writing campaigns at the right moments to push the legislation.

Griffin was eager to make an unnamed poster case of one woman who practices secretly because of bad local laws (i.e. bring her to Sacramento to tell her story without naming her).

Beverly May, CMTA governmental relations chair, commented that they would run any eventual bill before the League of Cities, PTs, and Chiropractors as well as the nonAMTA massage profession. I am somewhat dubious that something flexible enough to gain the consensus of the profession will be greeted enthusiastically by the cities. The main selling point would have to be in terms of ongoing state oversight, not eligibility hurdles. May also commented about hiring Griffin in summer 2002.

There wasn't much in they way of discussion of actual bill content, beyond Mary Griffin's statement that it would be much more complex than the current language. The manner in which questions about exemption of non-massage bodywork professions were answered led me to believe that most minds are still stuck in consideration of a practice law. This is something that I would actively oppose and urge others to do likewise. Given the list of bodywork professions in a book like Mirka Knaster's "Discovering the Body's Wisdom", the possibility of other uses of massage in martial arts training or by Native American healers, and the non-harmful nature of massage, a practice law does not make good sense.

My offhand estimate (didn't actually count) was that there were about 25 people at the meeting. NCTMB strategic planning member Sally Hacking and AMTA national governmental relations chair M.K. Knollmeyer were in attendance. Hacking made a point that Nevada and Arizona both had pending regulatory bills.

The CMTA Lobbyist Employer Record

The California Secretary of State record for the CMTA lobbyist Mary Griffin includes a link to the CMTA as Griffin's Employer. One interesting feature of the CMTA entry is the attorney/agent of record.

Despite the number of attorneys and lobbyists in litigious California, the attorney /agent of record for the CMTA is Paul Hallman of MultiState Associates in Alexandria, VA. Among Hallman's representative client's is the AMTA, presumably at the national level. Hallman and Mary Griffin also share Aventis Pasteur and Healthcare Distribution Management Association as listed clients, indicative of an established relationship between the two lobbying firms.

18 March 2003

Current language of California AB 1388 to be Moved Through the Assembly

Today's "Massage Practice Sheet" update was a hard call for me that required a bit of talking to those whose interests I support. I know that Beverly May (AMTA-CA government relations chair) has been working hard to include diverse input and form a consensus in California. Perhaps that may still happen, but it will have an uphill fight of its own causation.

Immediately below is the contemplated legislative timeline for AB 1388. While I agree with the ultimate intent expressed by Beverly, I feel that the decision to push the bill through the assembly as introduced is ill-advised. Pushing the approval of the current bill in one house of a two house legislature is inconsistent with previous statements on"not moving the current bill forward", whatever the final intent. I would feel remiss if I did not urge readers to contact their Assemblypersons and members of the Assembly Committee on Business and Professions opposing the bill as currently written.

Although AB 1388 is written as a title act, it can be assumed, I believe, that in most cases those practicing massage will effectively be held to the act if it is passed. The main benefits of it being a title act will fall to those doing bodywork with overlapping scopes of technique with massage but not wishing to be considered as practicing massage. Being a title act will also be a benefit to Native American Healers including massage within their traditional practices. Native American Healers have been adversely impacted in North Dakota by the ND practice act.

Now to some of the aspects of AB 1388 which are problematic:

• This bill would establish the Massage Therapy and Bodyworks Commission in the Department of Consumer Affairs to register and regulate massage therapists and bodyworkers.

It is not clearly evident that the practice of massage requires a separate board. Because massage is virtually free of harm from technical incompetence, a boards duties would mainly be in handling complaints and disciplinary actions for actions of mal intent. Sharing an omnibus board with other noninvasive health care practiceswould considerably reduce expenses.

• The commission shall consist of seven members, appointed for four-year terms, who are registered massage therapists or bodyworkers and who have engaged in the practice of massage therapy or bodywork for at least two years preceding appointment.

This board is established without public members. Having persons on a board who are not members of the profession being supervised is a means of increasing public accountability of board actions and critically important to handling of ethics violations. Recommendation 4 of the Pew Health Professions Commission (1995), included the need for public members and interdisciplinary oversight.

• The massage therapy and bodywork commission may promulgate rules establishing the education, training, and competency requirements that an applicant for registration shall satisfy in order to be registered under this chapter.

It is a conflict of interest to allow the commission implemented the regulations for massage to also set criteria. Such criteria should be set within the framework of public protection and input afforded by the legislative process.

• Require an applicant whose application is received after March 1, 2004, to successfully complete one of the following.

The exams listed are tantamount to setting a 500 hour criteria for massage practice in California. There are 193 massage schools supervised by the California Bureau for Private Postsecondary and Vocational Education. There are 28 schools listed on the AMTA national website that presumably meet their 500 program criterion. The vast majority of schools have modular programs with practice entry modules well below 500 hours. They occupy an economic niche oriented towards pay-as-you-go adult learners who are juggling multiple responsibilities in life. This requirement would have a devastating impact on these schools and on the students and community ties that they serve.

15 March 2003

AMTA Convention Meeting on Regulation

Just a reminder that there is a meeting on state regulation scheduled during the California AMTA's Massage and Bodywork Convention on Saturday 22 March 2003 from 3 to 5 PM at the Doubletree Hotel in San Jose. The meeting will by moderated by AMTA-CA governmental relations chair Beverly May with Mary Griffin, the AMTA-CA's lobbyist. Anyone can attend the meeting at no charge.

COMTA Accreditation Not a Benefit to All

Jeffrey Forman, coordinator of the massage program at De Anza College, Cupertino, CA warns about over application of COMTA accreditation.

I feel that although COMTA is a very thorough accreditation process we must prevent them from getting involved or even mentioned in any California state regulation. We can't afford their fees at De Anza and since we are accredited by the Accrediting Commission for Community and Junior Colleges of the Western Association of Schools and Colleges [WASC] we do not need their shingle. COMTA accreditation provides us with no benefits just expense. If a law passes that requires COMTA accreditation small and less affluent schools may be put out of business. At our March 4th meeting I held up the Government Relations packet that I was just sent from COMTA to warn people that I fear their goal is to get a foot in the door out here. Once in the law, they can keep raising the prices because they are the only game in town. The law in Maryland is an example of what atrocities can happen. There is a tremendous need for programs that are less than 600 hours and for community college certificate and degree vocational education programs. I'd hate to see them discontinued because of the powerful lobbies involved in the politics of massage.

Forman had previously communicated his frustration to me that De Anza College, despite their being already accredited by WASC, was finding it next to impossible to have their hours accepted by the Washington state massage board. Apparently, said board has been overly sold on the COMTA "brand name" and has little understanding of the larger picture of school accreditations.

In general, only single-profession schools are accredited by a profession specific agency such as COMTA. In contrast, colleges and universities undergo a more stringent accreditation of their entire system of degree and certificate programs. Depending on the locations of the college or university, this is done through one of six regional agencies of which WASC is a part. All of these agencies as well as agencies such as COMTA are approved as accrediting agencies by the US Department of Education (USDE). For the USDE, accreditation is part of the process of insuring that federal financial aid provided under Title IV is well-used and that education received from accredited institutions is transferable and acceptable for professional certification and licensure between schools and states.

Beyond these considerations of quality, however, the USDE sets a lower limit of 600 hours on programs eligible for federal financial aid. This is likely a viewpoint that the overhead associated with regulating shorter programs outweighs the benefits of providing aid. There may also be state programs that support financial aid for shorter and correspondingly less costly programs. Additionally, modular programs approved by individual states yet shorter than this minimum often provide quality training within a pay-as-you-go economic niche without being eligible for or being able to support the additional costs of accreditation.

It makes no sense for state governance of massage to be so focused on single-professional schools that they are requiring redundant accreditation of colleges and universities in law or regulation. To do so is only to raise costs and unnecessarily reduce the availability of massage without corresponding benefits to the consumer. The future will only bring more colleges and universities offering massage programs. It is also unwise, I believe, to ignore hours from shorter programs meeting other economic and student needs. It's time for state laws and agencies regulating massage to wake up to the larger realities of college and university accreditation and of shorter state-approved programs.

14 March 2003

AB 1388 Referred to the California Assembly Committee on Business and Professions

As of yesterday's assembly record, AB 1388 has moved to the California Assembly Business and professions committee. Links to members of this committee are available at http://www.assembly.ca.gov/acs/newcomframeset.asp? committee=129

I believe this now makes it fair game to express whatever concerns you may hold regarding state regulation to members of this committee. Please do so in an assertive but nonhostile manner. Legislators respond best to succinct and clear statements. Ranting is more likely to get your input disregarded than to have its desired effect.

11 March 2003

ABMP Legislative Town Meetings Announced

Les Sweeney, ABMP Executive Vice President, provided the following information on the ABMP perspective and the schedule for their Town Meetings:

Assemblywoman Christine Kehoe of San Diego introduced Assembly Bill 1388 on February 21. The bill would establish the Massage Therapy and Bodywork Commission in the Department of Consumer Affairs, in order to regulate massage therapists.

The initial proposal stipulates registration requirements, but does not set an education hour requirement. It does, however, mention as a proposed requirement the National Certification Examination for Therapeutic Massage and Bodywork (NCETMB), which would in effect require applicants to have completed at least 500 hours of education.

ABMP has been in contact with both the legislator's office and the lobbyist for the legislative proposal. Our intention is to remain a part of the process in order to represent our members' views on any proposed regulation. The bill's sponsor has indicated that the language of the bill is very likely to change as more interested parties participate in the process..

You may recall that last summer, ABMP conducted a member legislative survey to assess member views on statewide regulation of the field. We would like to further engage our members on the subject by inviting you to attend one of six ABMP "Town Meetings" to be held to discuss AB 1388 and its possible impact on massage therapy in California.

Tuesday, March 25 Palo Alto Hyatt Rickeys 4219 El Camino Real Palo Alto, CA 94306-4493 650-352-1234 7:00 – 8:30 pm	Wednesday, March 26 Sacramento Hilton Sacramento Arden West 2200 Harvard St. Sacramento, CA 95815 916-922-4700 7:00 – 8:30 pm	Thursday, March 27 Berkeley Radisson Hotel Berkeley Marina 200 Marina Boulevard Berkeley, CA 94710 510-548-7920 7:00 – 8:30 pm
Monday, March 31 Anaheim Anaheim Marriott 700 West Convention Way Anaheim, CA 92802 714-750-8000 7:00 – 8:30 pm	Tuesday, April 1 San Diego Hyatt Regency Islandia 1441 Quivira Road San Diego, CA 92109 619-221-1234 7:00 – 8:30 pm	Wednesday, April 2 Los Angeles Radisson Los Angeles Westside 6161 West Centinela Avenue Culver City, CA 90230 310-649-1776 7:00 – 8:30 pm

No RSVP is necessary to attend these meetings; just show up if you care to. We hope to see you there. For information and directions/maps to the hotels, you can visit http://www.abmp.com/

Competencies for the De Anza College Program and from COMTA

Jeffrey Forman, coordinator of the massage program at De Anza College, Cupertino, CA recently attended the AMTA Council of Schools Leadership Conference. To a goodly extent such a conference is a reminder that, if we don't contribute our own individual desires and visions for the future of massage, there are forces out there that will implement theirs. Jeff contributed the following summaries for competencies defined in the De Anza program and by COMTA. These competency training tables were also presented at the 4 March meeting at De Anza that Jeff graciously hosted.

One of the continuing difficulties often overlooked, is that you can teach the material contained in something like the COMTA competency list, assess that the student can recognize it in a test, and yet leave students so that most of the material has no connection with what they can use in actual practice. Part of this stems from what John Seely Brown, Allan Collins, and Paul Duguid called Situated Cognition and for which they proposed Cognitive Apprenticeships as a partial remedy. But, on to the lists.

10 March 2003

Summary of the De Anza College Panel Discussion on 4 March

De Anza College Massage Program coordinator Jeffrey Forman called to order the meeting at De Anza College on The Future of Massage in California. The panel included:

• David Palmer- President, TouchPro Institute of Chair Massage.
• Chris Voltarel- California Chapter President of the AMTA (CMTA).
• Burt Boss, General Manager of Soma Therapy in Palm Springs, California.
• Keith Eric Grant Ph.D. Instructor at the McKinnon Institute and columnist
  for Massage Today.
• Les Sweeney - Vice president of the ABMP.
• Jeffrey Forman, Coordinator of the De Anza College Massage Therapy Program.
• Beverly May - CMTA government relations chair

In response to opening questions from De Anza host Jeff Forman, ABMP executive vice president Les Sweeney talked a few minutes about what he knew about Illinois, Delaware, and Maryland. If I'm remembering correctly, he noted that Delaware had two tiers but didn't differentiate them except in name. Les also talked a bit about Maryland and their requirement for 60 hours of college classes — any classes.

Chris Voltarel commented briefly on the use of multiple tiers and on the difficulties they can present to legislators. Keith Grant noted that if an upper tier was simply a separate title for consumer identification of training, that the purpose could be handled by voluntary private certification.

Burt Boss described the 300/500 two-tier system of the Coachella valley and how that has worked to achieve some portability among the different cities. The lower level allows one to work for others at an established place of business. The upper level allows one to open one's own practice. Burt noted that he was presenting this as something that has worked for them on the local level, not as something he was advocating to be moved to the state level.

Jeff moved the discussion to competencies. Keith Grant showed the two tables from his March Massage Today column on guidelines for subpractices. Jeff summarized the COMTA meeting which Burt agreed was a reasonable breakdown. Michael Murphy asked from the floor about moving towards demonstrating competencies instead of counting class hours. Burt noted that what the meeting discussed was matching of COMTA program competencies with where each was taught in a given program. Keith Grant noted developmental pediatrician Mel Levine's example of a sports doctor who did fine in school but proved incompetent in residency. How do we demonstrate ability to work other than by watching people work? Residencies?

Discussion of the California environment. David Palmer talked about using chair massage as a basic touch intervention. Keith Grant noted that there were 193 state supervised schools but only 28 schools in California listed on the AMTA national web page and discussed the demographics of adult learners the former attract. Les Sweeney noted that the average of school program that ABMP covers in California was 175 hours. He noted that schools had a somewhat higher claim rate than individuals, having more people and larger signs that could be dropped on BMWs during hanging, ...

David Palmer gave a synopsis of the viewpoint of SB 577, the California Health Freedom Act. The act amends the medical practices act to allow the unlicensed practice of noninvasive, safe preventative and therapeutic interventions without it being considered a technical violation of practicing medicine without a license. In return, the act requires informing consumers about the practitioners education and means of intervention. Keith Grant noted that this law sets a precedent of having California explicitly recognize that there are legitimate unlicensed health care professions. The act's relevance for massage therapy stems from being able to make claims of therapeutic effect to health insurers to obtain reimbursement. It also removes the chance that a plaintiff in a practice liability suit might claim the the therapist was practicing medicine without a license because they had made therapeutic claims.

Beverly May arrived to join president tChris Voltarel in speaking for the CMTA (aka AMTA-CA). Beverly and Chris apologized for Kehoe's unexpected original language for AB 1388, noting that the result was substantial chaos and a lot of enraged input to Kehoe. The intent had been to have the initial bill language be that of a study. Judith McKinnon (McKinnon Institute) noted that she had called Kehoe's office several times and never heard back. There was some discussion regarding Kehoe's desire to be a state senator and how much of a loose cannon she might represent. While agreeing that California was going to have to find its own solution, Beverly mentioned problems with bad local regulations and their negative impact on those attempting to practice under them.

Both ABMP and Kehoe are planning local meetings for input. David Palmer commented that such meetings were unusual from a bill author, perhaps indicative of an additional agenda on Kehoe's part. There was some discussion about what might occur if the bill took on a form that no one wanted and that everyone in the profession opposed.

Beverly May noted that in doing the sunrise questionnaire that they weren't attempting to claim physical harm from massage but indirect harm to clients via reduced availability of services and harm to the massage profession.

Les Sweeney noted the emerging health professions model of overlapping scopes of practice. Defining a single set of reserved acts deemed dangerous for the untrained to perform and then having acts that allow a given profession to have an act within its scope. This shows up in the British Columbia Health Professions Council report and in the Pew Health Professions Committee report. Both of these reports note massage therapy as a candidate for title protection, not being inherently risky. This could potentially lead to a hybrid of a title act with guaranteed allowed scope of practice, exemption from local regulation, and potentially a requirement for zoning congruent with other professions.

The economic niches of current schools and adult students will be a big influence in input for any bill ultimately written. There are many small schools will some being members of the California Alliance of Massage and Bodywork Schools. Most of these small schools have an economic niche of pay-as-you-go adult students. Probably most would not make the transition to larger, longer program schools using federal and state financial aid

Partly in response to a question by Kevin Minney, Les Sweeney noted the eight ABMP guidelines for supporting legislation, noting in addition that in the California case that the usual 500 hour concept will probably not be applicable because of an already highly established cottage industry business model.

Beverly noted that this was going to have to be a two-year bill attempt, given the complexity of the environment and the need for considerable discussion.

The most apparent outcomes are that those attending have a much clearer concept of what's involved and that we are all still talking and, perhaps more importantly, listening.

The kicker in all of this is also the budget crises. Beverly mentioned that they were working on a way of starting up a board without a loan from the state. I can't think of a path for this except via a loan or donation from a private organization. It's not clear what the legal issues involved in such a move would be.

02 March 2003

Four Studies Concluding Lack of Harm from Massage Techniques

I'm now aware of four solid agency studies that have resulted in a report with analysis and in which the investigating agency concluded that there is little likelihood of harm from massage. I am not aware of any similar reports in which the potential for harm was analyzed and in which the investigating agency concluded the likelihood of significant harm.

• Pew Health Professions Commission, 1995 - REFORMING HEALTH CARE WORKFORCE REGULATION Policy Considerations for the 21st Century <http://www.futurehealth.ucsf.edu/summaries/reforming.html>

Grant title protection without accompanying scope of practice acts to some professions. This would be appropriate for professions (e.g., massage therapy) which provide services which are not especially risky to consumers.

• Georgia Occupational Regulation Review Council, October 1997 <http://www.mckinnonmassage.com/articles/ga_opb_masgrev.html>

The potential for harm to the public appears to be remote and would not be alleviated by licensing. Moreover, there is little evidence that unqualified massage therapists have inflicted physical harm on clients.

• British Columbia Health Professions Council Post Hearing Update of Preliminary Report (1999) <http://www.healthplanning.gov.bc.ca/leg/hpc/ review/part-i/update-massage.html>

The Council has seen no evidence that massage therapy carries with it such a sufficient risk of harm to warrant making any portion of its practice a reserved act.

• West Virginia Legislative Auditor’s Sunset Review (2003) <http://www.legis.state.wv.us/Joint/perd/MassTher_1_2003.pdf>

Licensure of the practice of Massage Therapy is not needed to protect public interest. In determining if there is a need for the Massage Therapy Licensure Board, a primary consideration is whether the unregulated practice of the profession clearly harms or endangers the health, safety or welfare of the public. Supporting data indicates that there is no easily recognizable harm to the public if the profession of massage therapy was unregulated.

Massage Politics Sheet Entries for January and February Archived

The MPS entries for January and February are now in 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.