SENATE BILL REPORT

ESHB 2160

As of February 25, 2014

Title: An act relating to allowing physical therapists to perform spinal manipulation.

Brief Description: Allowing physical therapists to perform spinal manipulation.

Sponsors: House Committee on Health Care & Wellness (originally sponsored by Representatives Jinkins, Pollet, Appleton, S. Hunt, Buys, Haler, Warnick, Pettigrew, Manweller, Goodman, Clibborn, Santos, Harris and Kagi).

Brief History: Passed House: 2/13/14, 92-6.

Committee Activity: Health Care: 2/24/14.

Staff: Bonnie Kim (786-7316)

Background: Physical Therapists (PTs). Physical therapy services provide remediation of impairments and disabilities by promoting mobility and functional ability through examination, evaluation, diagnosis, and physical intervention. The Department of Health (DOH) licenses PTs who have earned a baccalaureate degree in physical therapy or a baccalaureate degree and a certificate or advanced degree from an approved school of physical therapy and pass an examination.

Licensed PTs may perform a variety of services, including examining individuals with mechanical, physiological, and developmental impairments, functional limitations in movement, and disability or other health and movement-related conditions; alleviating impairments and functional limitations in movement; and reducing the risk of injury, impairment, functional limitation, and disability related to movement. Licensed PTs may not use or advertise that they perform spinal manipulation or manipulative mobilization of the spine and its immediate articulations.

Chiropractors. Chiropractic services provide diagnosis, analysis, and treatment of the vertebral subluxation complex and its effects, articular dysfunction, and musculoskeletal disorders. Chiropractic treatment includes the use of procedures involving spinal adjustments and extremity manipulation. DOH licenses chiropractors who have graduated from an accredited chiropractic college, completed at least 4000 hours of a resident course of study, and passed an examination.

Summary of Bill: Endorsement. A PT may perform spinal manipulation, spinal manipulative therapy, high velocity thrust maneuvers, and grade five mobilization of the spine and its immediate articulations (spinal manipulation), only after being issued a spinal manipulation endorsement. The Secretary of Health must issue a spinal manipulation endorsement to a PT with at least one year of full-time, post-graduate orthopedic practice experience who completes the following additional requirements:

1. Ÿ100 hours of training in differential diagnosis;

2. 250 hours of didactic and practical training related to the delivery of spinal manipulative procedures;

3. 150 hours of training in spinal diagnostic imaging; and

4. 300 hours of supervised clinical practical experience in spinal manipulative procedures, which must be:

   1. supervised by a clinical supervisor who is a PT with a spinal manipulation endorsement, a licensed chiropractor, a licensed osteopathic physician and surgeon, or, until July 1, 2020, a person holding an endorsement or advanced certification with the same the training as an endorsed PT;

   2. under the close supervision for at least the first 150 hours and under direct supervision thereafter; and

   3. completed within 18 months of completing educational requirements or by January 1, 2017, if educational requirements were completed before July 1, 2015.

Requirements. Endorsed PTs must consult with another health care practitioner authorized to perform spinal manipulation if a patient requires more than six spinal manipulative treatments. An endorsed PT must also make reasonable efforts to coordinate patient care with a concurrently treating chiropractor, if any, to avoid conflicting or duplicative services. Endorsed PTs may not:

• Ÿhave a practice in which spinal manipulation constitutes the majority of the services provided;

• practice or utilize chiropractic manipulative therapy in any form;

• delegate spinal manipulation;

• advertise that the PT performs chiropractic adjustment, spinal adjustment, maintenance or wellness manipulation, or chiropractic care of any kind; or

• bill a health carrier for spinal manipulation separately, or in addition to, other physical therapy procedures.

Continuing Education. Endorsed PTs must complete at least ten hours of continuing education directly related to spinal manipulation per reporting period, of which at least five hours must be related to procedural technique and application of spinal manipulation.

Report. By November 15, 2019, the Board of Physical Therapy, after consultation with the Chiropractic Quality Assurance Commission, must report to the Legislature any disciplinary actions taken against PTs whose performance of spinal manipulation resulted in physical harm to a patient.

Appropriation: None.

Fiscal Note: Available. New fiscal note requested on February 17, 2014.

Committee/Commission/Task Force Created: No.

Effective Date: The bill takes effect on July 1, 2015, except for section 2, amending the section authorizing physical therapists to perform spinal manipulation, which takes effect July 1, 2020.

Staff Summary of Public Testimony: PRO: This bill strikes a delicate balance between physical therapist and chiropractor interests. This bill is a product of seven years of negotiation, including formal mediation last summer. We request the committee pass the bill without amendment.

OTHER: This bill ensures patient safety and care by requiring adequate training.

Persons Testifying: PRO: Representative Jinkins, prime sponsor; Melissa Johnson, Physical Therapy Assn. of WA.

OTHER: Lori Grassi, WA State Chiropractic Assn.