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News in Brief
NYCC Aggregates Degree Programs in New School; Palmer Chancellor Receives Education Award From ICA; Oklahaven Announces "Have a Heart" Winners.
Sleepless nights, anxiety, mood swings, euphoric energy bursts, obsessive thinking, and a strange feeling in his chest. That is what Matt was experiencing when he first entered my practice. Rather than being concerned, he was loving every minute of it.
Hip Flexor Contractures & LBP in Above-the-Knee Amputations
Patients with above-the-knee amputations (AK or AKA) are particularly prone to developing hip flexor contractures. Not to be confused with muscle tightness, contractures are a permanent shortening of tissues which cause deformity or distortion.
The Need for Standards
ISO-TC-249: You may look at these letters and numbers and wonder what they are and what they might mean. They turn into: International Standards Organization- Technical Committee – 249. There is a global organization called The International Organization for Standardization.
Understanding Levels of Evidence
The concept of levels of evidence is a cornerstone of research literacy and a great starting point for understanding basic principles of how research works.
One of the most common trends to see in clinical medical practice and public health is the cycles of health "buzzwords." These come and go depending upon the current cultural zeitgeist. One year, "parasites" are causing all the issues, and the next year it's "candida."
Billing Timed Services
Q: I do not always use physical medicine services but in my state I do have a scope of practice that allows me to provide many of these services. I am trying to understand what "direct one-on-one patient contact" means in relation to physical medicine services.
With Low-Back Pain, Sometimes Little Things Matter
Typical treatments for low back pain involve large muscles like the quadratus lumborum, iliopsoas, and piriformis. However, there are situations when a very small muscle, the multifidus, can play a significant role in the diagnosis and treatment of low back muscular or spinal injury.
Prostate Cancer Risk
A large study published in January 2016 in the American Journal of Clinical Nutrition showed that men who are vegans had a 35% lower risk of developing prostate cancer compared to non-vegan men. The study followed more than 26,346 men who are part of the Adventists Health Study-2.
Building Bridges with Discipline
As practitioners of traditional Chinese herbal medicine, our role is to educate patients and medical practitioners about the various safety aspects of our medicine. Medical doctors that embrace Chinese medicine want to collaborate and include Chinese herbal medicine in more aspects of clinical care to support their patients.
Finger (Pad) Pointing: Repetitive-Use Injury Waiting to Happen
"My wrist and hand hurt. I spend all day working on computers and then I come home and spend more time on a computer, usually playing video games."
Discovery: Finding Insights and Each Other in Different Disciplines
Recently I've been thinking about all sorts of things which are hidden from our daily direct experience. That general category is what links nearly everything that catches my attention and then demands some kind of investigation.
Transforming Las Vegas
On a warm spring day in Las Vegas, Sonia Kim, clinic front desk staff, is busy preparing for a full day of intern shifts at Wongu Health Center. She greets patients, makes sure documents are properly signed, and lets the interns know that their patients have arrived.
How to Reach Your World With the Chiropractic Message
My latest effort to share chiropractic occurred in mid-May while I was sitting at an introductory parent information night for high schoolers. The IT instructor informed us that each student would be receiving a computer for all their studies.
Holistic Skin Care and Modern Technology
Anti-aging is a concept that we hear in reference to skin rejuvenation and growing older on a daily basis. Aging begins as soon as we are born; therefore "pro-aging" is embracing all stages of life gracefully, with vitality, wisdom, joy, and gratitude as the goal.
Keeping Malpractice Allegations at Bay
It has been suggested that in the litigious environment in which we live, the practice of chiropractic should be defensive and practitioners should constantly be watching their backs. An element of defensive practice is a good idea.
Billing One-on-One, Direct Patient Contact
This is often misunderstood and leads to trepidation when documenting and subsequently billing timed services.
Living Well: Lessons From Our Oldest Old
Aging is a significant public health problem, important to chiropractors in practice and important to DCs who teach students training to become chiropractors.
Low Fat vs. Low Carb & the Power of Protein
A science-based website recently posted a nice summary of 23 randomized, controlled trials from peer-reviewed journals pitting low-carb diets against low-fat diets.
In This Current Age of Anxiety
Anxiety, also referred to angst or hysteria, goes by many names. One, popularized by the sagacious Zhang Zhong Jing, who many practitioners of Chinese Medicine may be familiar with, is known as Restless Zang/Fu disorder.
Distal Style Treatment of Neurogenic Pain
Treat locally or distally? This question has frequented my thoughts for the treatment of pain throughout my acupuncture career. Each style has strengths and weaknesses, thus the versatile practitioner would do well to forgo dogmatic adherence to any one style in deference to the needs of the individual patient.
A Different Way of Looking at It
The way you and your chiropractic colleagues access information has changed over the past decade. According to a recent survey conducted by Dynamic Chiropractic, almost half (48 percent) of DCs read online articles on their personal computer or laptop daily.
Parker University Embraces New Era
Change is in the air at Parker University, which recently announced the selection of both a new president and a new consultant for its seminar program.
Constructing Our Reality, Part 2
My last article discussed perception and its relationship to the primary channels. Before we get to the channels most commonly used to treat sensory disturbances, the small intestine and triple heater, we should first talk about the bladder channel.
A Whole-Body Approach to Chronic Tension Headaches
Nearly every day in our practices, we see patients with chronic headaches that have not responded to traditional treatment. They present in our offices with a feeble hope that "maybe" a chiropractor can help.
Streamline Your Front Desk
Your front office can be your greatest source of efficiency or it can be a constant bottleneck. Increasing the productivity of this area, while not sacrificing the quality of patient interaction, can be a little tricky. However, with some focused effort and intention, your front desk can keep your practice running smoothly.
May, 2014, Vol. 14, Issue 05
CAMTC Sunset Hearings Reveal Concerns
Prostitution, human trafficking, law enforcement and operational questions come to light at legislative hearings.
By Kathryn Feather, Senior Associate Editor
In the midst of its Sunset Review process, the California Massage Therapy Council (CAMTC) finds itself addressing concerns from law enforcement agencies, city and county leaders, as well as a former board member, all urging the California legislature to sunset - or put an end to - the CAMTC and put massage therapy regulation under the California Department of Consumer Affairs.
When the CAMTC was established in 2009, many saw this as an opportunity for the profession to show it could govern itself, harness the estimated millions in potentiall annual licensing fees and provide a model for other states to follow. However, as the sunset review process continues, this experiment could be coming to an end.
Senate Bill 731 (passed in September 2008) established a two-tier voluntary certification system that allowed a massage therapist to practice lawfully throughout the state without being subject to city or county ordinances. It also established the CAMTC, a private nonprofit organization acting as the regulator of massage therapy certification.
Prior to the passage of SB731, massage therapists in California were subjected to the ordinances enacted by individual cities and counties providing for the licensing and regulation of the business of massage. It was a patch work of various regulations many therapists were eager to see disappear as they were often paying multiple fees to practice in more than one city or county.
The sunset review process is a normal assessment of state regulatory programs, established to determine whether they should be continued by the legislature. The process for CAMTC began in 2013 when the group began drafting its sunset review report and continued on March 10, 2014 with a joint hearing before the Assembly Business, Professions and Consumer Protection Committee and the Senate Business, Professions and Economic Development Committee.
Without legislative action, the CAMTC in its current form is set to sunset - or cease to exist - on December 31, 2014.
Law Enforcement Concerns
The CAMTC has had to garner support from law enforcement and city and county officials from its inception. CAMTC CEO Ahmos Netanel said the group has "a robust communication protocol with the majority of local jurisdictions. In December 2013, we reached out to more than 400 police chiefs and sheriffs and offered a no-cost training for their officers. So far, we have received more than 120 requests for our specialized training. In the past 90 days, we trained approximately 500 law enforcement officials, including police chiefs, sheriffs, FBI agents and district attorneys."
However, the League of California Cities was quick to trot out legislators, mayors, council members and law enforcement agencies to urge the legislature to sunset SB731 and the CAMTC, as they believe this process as it stands lends to the proliferation of illegitimate massage establishments, prostitution and human trafficking.
The League is seeking a restoration to local control over massage therapy businesses. The League's Legislative representative, Kirstin Kilpitcke, outlined several priorities in her testimony at the joint hearing, including having a state agency oversee certification and licensing of massage professionals rather than a nonprofit; requiring owners of massage establishments to be responsible for what occurs in their businesses; modifying the language that authorizes local governments to regulate massage businesses to the extent a jurisdiction "uniformly" regulates all other business professionals; and clarify the statue so that local governments can charge fees to recoup the costs of enforcing the statue.
These issues stem from the fact that under the current legislation, CAMTC is only responsible for certified employees and owners. If an owner of a massage business is not certified, CAMTC can take no action against that owner and local governments have, "their hands tied and cannot regulate these businesses," according to the League. The League also said that, "because cities and counties do not uniformly regulate business professionals, the existing law effectively prevents the regulation of the massage industry."
In her testimony, San Francisco Supervisor Katy Tang expressed concerns with SB 731, saying certain provisions leave the city unable to regulate and manage massage establishments and that the city has lost significant oversight authority. Tang said many establishments closed by the city have since reopened under the CAMTC certification process.
Prior to the hearing, staff for the joint committee issued 19 recommendations related to CAMTC and its operational structure. CAMTC addressed much of these recommendations in its testimony before the committee.
In his testimony, CAMTC board member Michael Callagy, a former deputy police chief, said that, "CAMTC recommends that it be given the authority to implement a voluntary registration program for establishments. Establishments that are not registered with CAMTC would be subject to whatever regulation a local jurisdiction would see fit to impose, regardless of whether all massage providers are certified or not." Callagy said the funds for such a program would come from existing CAMTC financial resources.
Also in response to the issues presented regarding increased local control, Callagy testified that, "CAMTC agrees that legislation should be passed which strikes a better balance between the needs of massage professionals and local control. For this reason, it has proposed legislation in 2014 that will provide local government with the explicit authority to address establishments that use massage as a subterfuge for prostitution and supports CAMTC voluntary registration of massage establishments."
Netanel said he "found the issues the committee staff raised to be sensible and predictable" and that "CAMTC is in the process of formulating a response."
In his testimony, CAMTC former board member and ABMP Chairman Bob Benson acknowledged some successes from CAMTC but sided with the staff's recommendation that "a strong argument can be made for the continuation of some form of professional regulation: statewide regulation is more efficient, consistent and the norm across the majority of states."
Benson, who served as the initial Vice-Chair and participated in 51 of the 52 board meetings held during his 2009-2013 tenure, stated in his testimony that, "the model of voluntary certification by a nonprofit organization was a good one for a five-year transition from a confusing hodge-podge of local massage regulation, often administered by individuals with little understanding of the health benefits of massage therapy and limited capability to assess whether someone seeking to provide massage was in fact well prepared to do so."
But, Benson went on to state that, "unfortunately, CAMTC approaches to managing its affairs have not matured. With no state funds provided, CAMTC initially had to make several expedient choices about cobbling together resources. As financial stability was secured, though, senior management turned a deaf ear to suggestions for building a stronger, lasting management structure."
"Weaknesses in CAMTC's underpinnings keep emerging. The staff background report cites numerous areas of CAMTC administrative weakness:
Benson went on to state that, "despite CAMTC spending over $500,000 a year for outside lawyers, a continuing backlog of hundreds of applications still awaits CAMTC attorney action to issue proposed denial or revocation letters and final letters of determination."
"The organization lacks a seasoned Controller/COO. Information systems are inadequate for needed controls." To prove his point, Benson cited the original report submitted by CAMTC to the legislative committee. Benson said it was, "riddled with errors on matters as fundamental as the number of certified individuals by category and the status of those who had been referred to PSD ... and it took CAMTC staff five weeks to produce corrected data."
"That's a portrait of an organization lacking sufficient administrative control. And now, on top of these deficiencies, CAMTC is seeking to shoulder additional responsibility for approving massage establishments and inspecting massage schools. It's delusional," said Benson.
Benson instead urged the committee to:
"The state board model works well in scores of other states. It is time for that model in California," said Benson.
CAMTC is currently formulating its response to the staff recommendations and concerns cited by those providing testimony during the legislative hearings. According to Netanel, April 29th is the last date for the sunset bill to be out of the committee and CAMTC is waiting to receive the proposed bill language.
In the meantime, there are currently four bills before the state assembly that could potentially impact the massage therapy profession (AB 1904, AB 1147, AB 1747 and AB 2739).
The purpose of AB 1147 is to "enhance the competency requirements for persons seeking certification as a massage practitioner by requiring an applicant to take and pass a massage and bodywork competency examination in addition to the 250 hours of education currently required." Assembly Bill 2739 would extend the provisions of the existing law until January 1, 2019.
With passionate testimony from both those advocating the success of CAMTC and those advocating for sunset and a state board, several scenarios remain. The legislature could sunset CAMTC and the state could revert back to the patch work pre-2009 regulations. The legislature could extend existing law to 2019 and keep CAMTC in operation as is or with various modifications found in the four bills currently before the legislature. The legislature could make licensure mandatory and put the process under state control as suggested by Benson and many local government officials and law enforcement agencies.
"CAMTC is proud of its successes and we look forward to working with the police chiefs, the local communities and other stakeholders to do great things for the massage profession and the public," said Netanel.
Massage Today will continue to report any updates to the sunset review process as details become available. To contact your legislature and let them know about your experience with CAMTC, visi www.leginfo.ca.gov/ to find the representative for your area. If you wish to contact the committee directly, visit http://abp.assembly.ca.gov/membersstaff or call (916) 319-3301.
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