BILL REQ. #: H-3137.1
State of Washington | 63rd Legislature | 2014 Regular Session |
Prefiled 01/07/14. Read first time 01/13/14. Referred to Committee on Health Care & Wellness.
AN ACT Relating to allowing physical therapists to perform spinal manipulation; amending RCW 18.74.010, 18.74.035, and 18.74.085; and adding a new section to chapter 18.74 RCW.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
NEW SECTION. Sec. 1 A new section is added to chapter 18.74 RCW
to read as follows:
(1) Subject to the limitations of this section, a physical
therapist, who has at least one year of full-time orthopedic practice
experience, may perform spinal manipulation and manipulative
mobilization of the spine and its immediate articulations only after
providing evidence in a manner acceptable to the board of any of the
following:
(a) Certification as an orthopedic certified specialist from the
American board of physical therapy specialists;
(b) Completion of a fellowship in orthopedic manual physical
therapy, or a residency program in orthopedic physical therapy,
accredited by the American board of physical therapy residency and
fellowship education; or
(c) Completion of the following:
(i) One hundred fifty hours of education related to spinal
manipulation and manipulative mobilization of the spine and its
immediate articulations covering the following elements:
(A) Training in differential diagnosis;
(B) Didactic and practical training related to the indications,
contraindications, assessment, and delivery of spinal manipulation and
manipulative mobilization of the spine and its immediate articulations;
and
(C) Imaging and laboratory training; and
(ii) One year of practice under the direct supervision of a
physical therapist authorized to perform spinal manipulation and
manipulative mobilization of the spine and its immediate articulations
under this section. The one year of practice must be completed within
one year of completing the educational requirements in (c)(i) of this
subsection.
(2) A physical therapist authorized to perform spinal manipulation
and manipulative mobilization of the spine and its immediate
articulations under subsection (1) of this section shall develop a
treatment plan for each patient for whom he or she performs spinal
manipulation and manipulative mobilization of the spine and its
immediate articulations. The physical therapist must discontinue
treatment and refer the patient to a licensed physician, osteopathic
physician, or chiropractor if the scope or duration of treatment
exceeds what is articulated in the treatment plan.
(3) A physical therapist authorized to perform spinal manipulation
and manipulative mobilization of the spine and its immediate
articulations under subsection (1) of this section may not:
(a) Have a practice in which spinal manipulation or manipulative
mobilization of the spine and its immediate articulations constitute
the majority of the services provided;
(b) Practice or utilize chiropractic manipulative therapy; or
(c) Delegate spinal manipulation or manipulative mobilization of
the spine and its immediate articulations.
(4) A physical therapist authorized to perform spinal manipulation
and manipulative mobilization of the spine and its immediate
articulations under this section shall complete at least ten hours of
continuing education per continuing competency reporting period
directly related to spinal manipulation or manipulative mobilization of
the spine and its immediate articulations. The training must be
approved by the board. At least five hours of the training required
under this subsection must be related to procedural technique and
application of spinal manipulation and manipulative mobilization of the
spine and its immediate articulations.
(5) If a physical therapist is performing spinal manipulation or
manipulative mobilization of the spine and its immediate articulations
on a patient who the physical therapist knows is being treated by more
than one provider for the same diagnosis, the physical therapist shall
make reasonable efforts to coordinate patient care with those other
providers.
(6) By November 15, 2019, the board shall report to the legislature
any disciplinary actions taken against physical therapists whose
performance of spinal manipulation and manipulative mobilization of the
spine and its immediate articulations resulted in physical harm to a
patient. Prior to finalizing the report required under this
subsection, the board shall consult with the chiropractic quality
assurance commission.
Sec. 2 RCW 18.74.010 and 2007 c 98 s 1 are each amended to read
as follows:
The definitions in this section apply throughout this chapter
unless the context clearly requires otherwise.
(1) "Board" means the board of physical therapy created by RCW
18.74.020.
(2) "Department" means the department of health.
(3) "Physical therapy" means the care and services provided by or
under the direction and supervision of a physical therapist licensed by
the state. Except as provided in section 1 of this act, the use of
Roentgen rays and radium for diagnostic and therapeutic purposes, the
use of electricity for surgical purposes, including cauterization, and
the use of spinal manipulation, or manipulative mobilization of the
spine and its immediate articulations, are not included under the term
"physical therapy" as used in this chapter.
(4) "Physical therapist" means a person who meets all the
requirements of this chapter and is licensed in this state to practice
physical therapy.
(5) "Secretary" means the secretary of health.
(6) Words importing the masculine gender may be applied to females.
(7) "Authorized health care practitioner" means and includes
licensed physicians, osteopathic physicians, chiropractors,
naturopaths, podiatric physicians and surgeons, dentists, and advanced
registered nurse practitioners: PROVIDED, HOWEVER, That nothing herein
shall be construed as altering the scope of practice of such
practitioners as defined in their respective licensure laws.
(8) "Practice of physical therapy" is based on movement science and
means:
(a) Examining, evaluating, and testing individuals with mechanical,
physiological, and developmental impairments, functional limitations in
movement, and disability or other health and movement-related
conditions in order to determine a diagnosis, prognosis, plan of
therapeutic intervention, and to assess and document the ongoing
effects of intervention;
(b) Alleviating impairments and functional limitations in movement
by designing, implementing, and modifying therapeutic interventions
that include therapeutic exercise; functional training related to
balance, posture, and movement to facilitate self-care and
reintegration into home, community, or work; manual therapy including
soft tissue and joint mobilization and manipulation; therapeutic
massage; assistive, adaptive, protective, and devices related to
postural control and mobility except as restricted by (c) of this
subsection; airway clearance techniques; physical agents or modalities;
mechanical and electrotherapeutic modalities; and patient-related
instruction;
(c) Training for, and the evaluation of, the function of a patient
wearing an orthosis or prosthesis as defined in RCW 18.200.010.
Physical therapists may provide those direct-formed and prefabricated
upper limb, knee, and ankle-foot orthoses, but not fracture orthoses
except those for hand, wrist, ankle, and foot fractures, and assistive
technology devices specified in RCW 18.200.010 as exemptions from the
defined scope of licensed orthotic and prosthetic services. It is the
intent of the legislature that the unregulated devices specified in RCW
18.200.010 are in the public domain to the extent that they may be
provided in common with individuals or other health providers, whether
unregulated or regulated under Title 18 RCW, without regard to any
scope of practice;
(d) Performing wound care services that are limited to sharp
debridement, debridement with other agents, dry dressings, wet
dressings, topical agents including enzymes, hydrotherapy, electrical
stimulation, ultrasound, and other similar treatments. Physical
therapists may not delegate sharp debridement. A physical therapist
may perform wound care services only by referral from or after
consultation with an authorized health care practitioner;
(e) Reducing the risk of injury, impairment, functional limitation,
and disability related to movement, including the promotion and
maintenance of fitness, health, and quality of life in all age
populations; and
(f) Engaging in administration, consultation, education, and
research.
(9)(a) "Physical therapist assistant" means a person who meets all
the requirements of this chapter and is licensed as a physical
therapist assistant and who performs physical therapy procedures and
related tasks that have been selected and delegated only by the
supervising physical therapist. However, a physical therapist may not
delegate sharp debridement to a physical therapist assistant.
(b) "Physical therapy aide" means a person who is involved in
direct physical therapy patient care who does not meet the definition
of a physical therapist or physical therapist assistant and receives
ongoing on-the-job training.
(c) "Other assistive personnel" means other trained or educated
health care personnel, not defined in (a) or (b) of this subsection,
who perform specific designated tasks related to physical therapy under
the supervision of a physical therapist, including but not limited to
licensed massage practitioners, athletic trainers, and exercise
physiologists. At the direction of the supervising physical therapist,
and if properly credentialed and not prohibited by any other law, other
assistive personnel may be identified by the title specific to their
training or education.
(10) "Direct supervision" means the supervising physical therapist
must (a) be continuously on-site and present in the department or
facility where assistive personnel or holders of interim permits are
performing services; (b) be immediately available to assist the person
being supervised in the services being performed; and (c) maintain
continued involvement in appropriate aspects of each treatment session
in which a component of treatment is delegated to assistive personnel.
(11) "Indirect supervision" means the supervisor is not on the
premises, but has given either written or oral instructions for
treatment of the patient and the patient has been examined by the
physical therapist at such time as acceptable health care practice
requires and consistent with the particular delegated health care task.
(12) "Sharp debridement" means the removal of devitalized tissue
from a wound with scissors, scalpel, and tweezers without anesthesia.
"Sharp debridement" does not mean surgical debridement. A physical
therapist may perform sharp debridement, to include the use of a
scalpel, only upon showing evidence of adequate education and training
as established by rule. Until the rules are established, but no later
than July 1, 2006, physical therapists licensed under this chapter who
perform sharp debridement as of July 24, 2005, shall submit to the
secretary an affidavit that includes evidence of adequate education and
training in sharp debridement, including the use of a scalpel.
Sec. 3 RCW 18.74.035 and 2007 c 98 s 4 are each amended to read
as follows:
(1) All qualified applicants for a license as a physical therapist
shall be examined by the board at such time and place as the board may
determine. The board may approve an examination prepared or
administered by a private testing agency or association of licensing
authorities. The examination shall embrace the following subjects:
The applied sciences of anatomy, neuroanatomy, kinesiology, physiology,
pathology, psychology, physics; physical therapy, as defined in this
chapter, applied to medicine, neurology, orthopedics, pediatrics,
psychiatry, surgery; medical ethics; technical procedures in the
practice of physical therapy as defined in this chapter; and such other
subjects as the board may deem useful to test the applicant's fitness
to practice physical therapy((, but not including the adjustment or
manipulation of the spine or use of a thrusting force as
mobilization)). Examinations shall be held within the state at least
once a year, at such time and place as the board shall determine. An
applicant who fails an examination may apply for reexamination upon
payment of a reexamination fee determined by the secretary.
(2) All qualified applicants for a license as a physical therapist
assistant must be examined by the board at such a time and place as the
board may determine. The board may approve an examination prepared or
administered by a private testing agency or association of licensing
authorities.
Sec. 4 RCW 18.74.085 and 1988 c 185 s 4 are each amended to read
as follows:
(1) Physical therapists shall not advertise that they perform
spinal manipulation ((or)), manipulative mobilization of the spine,
chiropractic adjustment, spinal adjustment, maintenance or wellness
manipulation, or chiropractic care of any kind.
(2) A violation of this section is unprofessional conduct under
this chapter and chapter 18.130 RCW.