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Massage Today
March, 2007, Vol. 07, Issue 03

What Discipline?

By Ralph Stephens, BS, LMT, NCBTMB

This month, the ongoing discussion of professional regulation (licensure) continues. The purpose of this series is to raise your awareness of the licensing process, hoping that increased awareness will bring about the demand for well-written, more effective licensing laws.

Better laws would provide more opportunity to bring alternative health care to the public, control over (and eventual elimination of) unethical therapists and schools, and the ability to expand our scope of practice, allowing us to better serve suffering humanity.

Aside from the monopoly that licensing grants, it also gives special protection to practitioners from normal prosecution for harming the public. The disciplinary process protects licensed practitioners. Apart from extreme cases, a doctor will not be arrested for an oversight. Instead, a complaint has to be filed with the medical board. (Death is not usually considered an extreme case, as practitioners have a license to kill. And I am not talking about abortion, but the 250,000+ fatal mistakes practitioners make every year - mistakes few seem to care about.)

This same disciplinary system applies to massage therapists, DCs, PTs, etc., in licensed states. The complaint process is confidential and is investigated by the board, which is in need of more investigators. For example, one state had two investigators who handled all the complaints for 17 boards. The medical board had its own investigators, but still not very many. This means investigations take months, sometimes years, to complete.

In the typical regulatory board disciplinary system, the accused provider is judged by their peers, not by impartial citizens (a jury). They usually are able to continue practicing until the decision is reached. Over this time, any negative publicity for the profession blows over and witnesses no longer pursue the case for various reasons: simply losing interest, moving, or in some cases, death. Finally, when the decision is reached, it's announced with little fanfare and usually results in an admonishment, a cease-and-desist order, or something fairly benign, like a token fine. Occasionally, a suspension or a revocation of the license might be ordered. Seldom is a practitioner banned from the profession, and imprisonment is virtually unheard of, except in cases of political persecution by medical boards. Then the appeals start.

In other words, licensure protects providers from the public better than it protects the public from the provider. It was designed this way and used to be much worse than it is today. Since licensing has expanded to the "other" health care practitioners (which wasn't supposed to happen when the AMA created licensure for MDs only), disciplinary processes have improved and are less of a sham. However, now medical boards in particular are using their powers to persecute practitioners who step off the reservation and provide patients with "unconventional practices," including such dreadful and dangerous things as nutrition, herbs, homeopathy, yoga, successful cancer cures; you know the stuff - quackery. If the standards of practice documents are ever completed for our profession, our boards will start doing the same things to us - something to look forward to. (If you have ever filed a complaint with a regulatory board, you know this statement is true. Some states are better than others.)

The point in explaining this is that in our profession, this disciplinary system does not work very well. Most of our boards are charged with approving and disciplining massage schools. Yet, the laws we have passed, which are modeled after regulations for other professions, have left our boards completely unequipped.

Further, when we "wimp out" and pass title protection laws, the boards have no way to stop dangerous providers and sexual predators from practicing. Title protection in massage regulation means anyone can do massage, but only people with a license actually can call it massage or other titles that are protected, like "bodywork," for example. Practice protection means no one can do massage without a license or a specific exemption in the law. These exemptions have gotten out of hand and, in some states, have turned practice protection laws into title protection.

Here's what happens. Some licensed massage therapist is sexually abusing clients. A complaint is filed. The therapist is found guilty. Instead of hanging the offender by their toes in a dungeon indefinitely, which is the least they deserve, all the board can do is take away the license. All the therapist has to do is change the name of their work to something not covered by the title protection, or call it something that has an exemption. The offender is back in business, and the board can do nothing more.

So, we are writing laws that protect the worst among us and punish the ethical therapists with fees and the hassle of compliance. In no way has this protected the public. We have to do better in the future. In May, I will discuss the scope of practice and how poorly written laws are taking away our ability to help the public, and how properly written laws can further expand our opportunities.

Try This

Working with patients suffering from whiplash caused by a rear-end collision? If their hands were on the steering wheel, there is a good chance they have suffered an injury to the rotator cuff. Be sure to examine every muscle of the shoulder for tender points and trigger points. Further, their jaw most likely will have snapped open and shut. Examine the temporalis and masseter muscles. One side usually will be worse. Normalize these and you might well prevent TMJ syndrome from developing in a few years. There always is more damage than initial complaints indicate. Provide a more complete service for whiplash victims and you will soon develop a very busy practice.

The Big Two

The two most common, yet modifiable, risk factors for heart attacks and strokes are poor diet and sedentary lifestyle. This makes sense. In fact, one definition of death is "lack of movement." Actually, the underlying cause of most disease is the body being too acidic. Get your pH up to ideal levels and you'll be amazed at how much better you feel.

See you next time, when April showers bring May flowers. Have a great spring!

Click here for more information about Ralph Stephens, BS, LMT, NCBTMB.


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