HOUSE BILL REPORT

ESHB 2160

This analysis was prepared by non-partisan legislative staff for the use of legislative members in their deliberations. This analysis is not a part of the legislation nor does it constitute a statement of legislative intent.

As Passed House:

February 13, 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:

Committee Activity:

Health Care & Wellness: 1/30/14, 2/3/14, 2/5/14 [DPS].

Floor Activity:

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

Brief Summary of Engrossed Substitute Bill

  • Allows physical therapists to perform spinal manipulation and manipulative mobilization of the spine and its immediate articulations.

HOUSE COMMITTEE ON HEALTH CARE & WELLNESS

Majority Report: The substitute bill be substituted therefor and the substitute bill do pass. Signed by 10 members: Representatives Cody, Chair; Riccelli, Vice Chair; Clibborn, Green, Jinkins, Manweller, Moeller, Morrell, Tharinger and Van De Wege.

Minority Report: Do not pass. Signed by 7 members: Representatives Schmick, Ranking Minority Member; Harris, Assistant Ranking Minority Member; DeBolt, G. Hunt, Rodne, Ross and Short.

Staff: Jim Morishima (786-7191).

Background:

Physical Therapists.

Licensed physical therapists may perform a variety of services, including:

To be licensed as a physical therapist, an applicant must:

A licensed physical therapist may not use spinal manipulation or manipulative mobilization of the spine and its immediate articulations. A physical therapist may not advertise that he or she performs spinal manipulation or manipulative mobilization of the spine.

Chiropractors.

Chiropractic is a health care practice involving the diagnosis, analysis, care, and treatment of the vertebral subluxation complex and its effects, articular dysfunction, and musculoskeletal disorders, all for the restoration and maintenance of health and recognizing the recuperative powers of the body. To be licensed as a chiropractor, an applicant must:

Summary of Engrossed Substitute Bill:

A physical therapist 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 physical therapist with at least one year of full-time (at least 36 hours a week), post-graduate, orthopedic practice experience that consists of direct patient care who completes the following additional requirements:

A physical therapist authorized to perform spinal manipulation must consult with another health care practitioner authorized to perform spinal manipulation if spinal manipulative procedures are required beyond six treatments. A physical therapist authorized to perform spinal manipulation may not:

A physical therapist authorized to perform spinal manipulation must complete at least 10 hours continuing education directly related to spinal manipulation per reporting period. At least five hours of the training must be related to procedural technique and application of spinal manipulation.

If a physical therapist intends to perform spinal manipulation on a patient the physical therapist knows is being treated by a chiropractor, the physical therapist must make reasonable efforts to coordinate patient care with the chiropractor in order to avoid conflict or duplication of services.

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

Appropriation: None.

Fiscal Note: Available.

Effective Date: The act takes effect 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:

(In support) The stakeholders have done good work over the past year trying to work this bill out. Passing this bill will ensure the best possible care for patients by allowing physical therapists to use evidence-based treatments that they are trained to perform. Washington is one of two states that prohibits physical therapists from performing spinal manipulation. Physical therapists who provide care for members of the military are authorized to perform spinal manipulation. Without this bill, physical therapy patients will have to seek out another provider if spinal manipulation is indicated, which wastes time and money. All schools of physical therapy teach these skills, which students must master before graduating. Physical therapy training is skills-based, not hours-based. Physical therapists are taught that spinal manipulation is not required for every patient, which is consistent with best practices. Physical therapy students are reluctant to attend Washington schools because they know they will be learning skills that are illegal to practice in the state. This bill can also adversely affect research, because researchers are forced to go to other states to perform spinal manipulation. The parameters in this bill will make Washington the strictest state in the nation with respect to spinal manipulation.

(Opposed) This is not a chiropractors versus physical therapists issue. Spinal manipulation is a safe and effective technique, but only with appropriate training; spinal manipulation is a complex skill and must be adaptive and context-specific. These are highly refined skills that take years to acquire. There has been no evidence presented that physical therapy education is adequate; physical therapy training is too narrow and is buried within broader training. Chiropractors learn multiple techniques to give appropriate care. There are at least six other states with some sort of prohibition against physical therapists performing spinal manipulation; some states are silent on the issue. Over half the injuries from spinal manipulation are caused by providers who are not chiropractors. Members of the military get spinal manipulation only from physical therapists; the bias continues. Other states and many organizations, including the World Health Organization, recommend significantly more training to perform spinal manipulation than is required by this bill. Physical therapists currently do not refer to chiropractors. Under this bill, a physical therapist may be able to start clinical training without ever laying hands on a patient.

Persons Testifying: (In support) Representative Jinkins, prime sponsor; and Elaine Armantrout and Dan Anton, Physical Therapy Association of Washington.

(Opposed) Lori Grassi and Austin McMillin, Washington State Chiropractic Association.

Persons Signed In To Testify But Not Testifying: None.