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Re: Spinal Manipulation and States practice acts
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Re: Spinal Manipulation and States practice acts - March 20, 2006 1:47:00 AM
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chiroortho
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By the way, would I like all of the competition for my services eliminated? Well...heck yeah! Wouldn't you?
But in reality this is where I stand - if you are trained in manipulation and are safe with it, then ABSOLUTELY you should be able to do it whether you steal my patients or not. Who knows, maybe you're better at it than me.
That's the bottom line as I see it.
Have a great week, it's beautiful weather today here in Florida.
Greg
_____________________________
Greg Priest, DC, DABCO
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Re: Spinal Manipulation and States practice acts - March 20, 2006 1:53:00 AM
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Andrew M. Ball PT PhD
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"The question before the Boards is 'Are PTs allowed to do manipulation?' If the answer's yes, good on ya. If the answer's no, you've got some work to do."
That's exactly right, but what is your opinion, then, of the Arkansas case, where the PT board said that what Mr. Teson did WAS in the practice of PT, and the chiro board insisted that it was not? How is it that the chiro board gets authority to regulate PT in this one case? That, to me, is the greater issue. It opens the door for MD's to regulate DC's and DPT's on the issue of nutricudicals, or for DPT's to try to regulate DC's on the issue of rehabilitation.
Bad move. Bad move all around.
Drew
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Dr. Andrew M. Ball, PT, DPT, Ph.D.
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Re: Spinal Manipulation and States practice acts - March 20, 2006 2:31:00 AM
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TMondale
Posts: 131
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From: Newton-Wellelsley Hospital
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Greg,
The only confusion here is yours, and your professions, who think it's a good idea to perform this shameful and cowardly act in the name of exclusively protecting something that doesn't belong to you.
As pathetic as your admission is, of wishing you could limit competition for your services I think more pathetic is my sense that most PT's don't understand the importance, and urgency to get on the offensive in this battle.
I renounce any attempts to limit your practice beyond your practice acts, as you should do with ours; just do not call anything you do PT.
Tim
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Re: Spinal Manipulation and States practice acts - March 20, 2006 3:13:00 AM
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chiroortho
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Wow Tim you've got some serious angst going on buddy. I think I offended you without trying to, and you took my 'remove the competition' comment WAY too seriously. My intention was not to insult you for goodness sake.
Drew, if I'm going to be completely objective about it I'll just have to say that the Arkansas thing is nothing more than a simple TURF WAR. Unfortunately nothing you or I say is going to end that. There will always be people in every profession that fight over turf. The neurologists trash the PM&R docs for doing EDx studies (one of my very best and oldest friends, a neuro, came down on me for referring a patient to a PMR guy - another friend - for EDx). The psychiatrists will trash the psychologists. The DCs will trash the PTs and vice-versa (check out Tim's post to me - whew!), the PAs will trash the nurse practitioners, the OB-GYNs will trash the midwives...and it goes on and on.
_____________________________
Greg Priest, DC, DABCO
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Re: Spinal Manipulation and States practice acts - March 20, 2006 7:44:00 AM
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UTDC
Posts: 222
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Greg,
Don't take it personally, Tim's angst seems to flow in all directions in reference to chiropractic.
Regarding the Arkansas situation, Tim stated:
[QUOTE]I renounce any attempts to limit your practice beyond your practice acts, as you should do with ours; just do not call anything you do PT. [/QUOTE]I thought that this was the basis of the complaint. Manipulation by PT's is expressly excluded from the PT act. Now if the argument was that the PT did not perform a manipulation - which is my understanding- that is where things get fuzzy.
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Re: Spinal Manipulation and States practice acts - March 20, 2006 10:35:00 AM
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JLS_PT_OCS
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Tim-
Greg doesn't sit on the Arkansas board of chiropractic examiners.
I understand your anger about this...but perhaps it might be directed at a more...appropriate target?
J
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Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Spinal Manipulation and States practice acts - March 20, 2006 10:52:00 AM
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Enforcer
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Tim,
Greg said "all of the competition" eliminated (with tongue in cheek.)
That would include all his chiro competition too.
He's probably on your side much more than you think.
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Re: Spinal Manipulation and States practice acts - March 20, 2006 4:19:00 PM
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chiroortho
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I understand Tim's concern about this. We all get a little hot and bothered from time to time. No big deal.
_____________________________
Greg Priest, DC, DABCO
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Re: Spinal Manipulation and States practice acts - March 20, 2006 4:52:00 PM
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TMondale
Posts: 131
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From: Newton-Wellelsley Hospital
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Greg,
Nothing personal, and sorry for the tone. You seem like a decent guy, and you certainly contribute to this forum far more often than do I, and you and your colleagues should be commended for your participation.
As I said; I'm no diplomat.
Tim
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Re: Spinal Manipulation and States practice acts - March 20, 2006 7:57:00 PM
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chiroortho
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No worries, have a great week.
_____________________________
Greg Priest, DC, DABCO
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Re: Spinal Manipulation and States practice acts - March 22, 2006 2:13:00 PM
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Wisecracker
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I would be curious as to the source of the California position on PT manipulation. As a Cal chiro, I know of the attorney general's opinion from 30 years ago that forbids PT manipulation or grade V mobilization. I know of PT's who have had troubles when they have "specifically manipulated with intention" joints. I work with a number of PTs many of whom have commented that manipulation, or grade V mobilization, is not in their scope of practice in Cal. So some PTs are aware of this, but apparently not all. And maybe I'm just flat wrond and things have changed, but I wouldn't want some one to have troubles because of information they read here.
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Re: Spinal Manipulation and States practice acts - March 22, 2006 7:11:00 PM
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TMondale
Posts: 131
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As stated previously, according to the APTA the california state practice act is silent on manual therapy, manipulation, or mobilization. However, although silent manipulation is considered part of physical therapy practice in California.
Having practiced in CA, I had/have never heard of any restrictions on manipulation.
Tim
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Re: Spinal Manipulation and States practice acts - March 24, 2006 10:17:00 AM
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Wisecracker
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As a follow-up, yesterday I spoke to the PTs I know here. Two of them absolutely knew that manipulation was restricted from their scope. When I asked them what their source was, both (they work for the same company) said they have been informed by their PT employer that even if they have the training and experience in other states they must refrain from performing Grade V mobilization in California. Apparently both practiced elsewhere initially and then came to California, and this was part of their indoctrination speech. They are now curious, and are going to find out where the info came from. But again, there is the attorney general's 1976 opinion, and that may be the sole source. I'll keep you posted.
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Re: Spinal Manipulation and States practice acts - March 24, 2006 12:20:00 PM
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JLS_PT_OCS
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There are several prominent PT schools in California, and several orthopedic/manual therapy residencies, eg through Kaiser Permanente.
Manipulation is routinely taught there, and in fact there are published case studies and RCTs from groups of PTs there that specifically use spinal manipulation as a component of the care provided.
So it's clearly not being hidden or anything...
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Spinal Manipulation and States practice acts - March 24, 2006 2:27:00 PM
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TMondale
Posts: 131
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From: Newton-Wellelsley Hospital
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Wisecracker,
My employer doesn't allow me to see patients without a referral, but it is perfectly legal in my state to do so. I'm glad your PT friends are going to look into it.
Jason is right, Kaiser has been running a residency program for years and teaching manipulation as part of that residency.
Tim
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Re: Spinal Manipulation and States practice acts - March 24, 2006 5:26:00 PM
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pwrandall
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From: Elk Grove, CA
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I have heard it first hand from the Executive Officer of the California PT Board, Steve Hartzell, that in his and the PTB's opinion manipulation or Grade V mobilization is outside of our scope in CA and that we can be held accountable if practicing outside of this scope. This was said to my PT class by the man himself, in no uncertain terms.
As an aside, Kaiser is known to push the envelope here in CA. Not that that is a bad thing, but they really are on the edge in terms of direct access requirements and, apparently, manipulation. I know several therapist with Kaiser Northern CA and they are amoung the best I've encountered, but they operate in a different environment than most PTs in CA.
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Re: Spinal Manipulation and States practice acts - March 25, 2006 5:41:00 AM
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TMondale
Posts: 131
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From: Newton-Wellelsley Hospital
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Sounds like we need a test case; any volunteers? (kidding). Most amazing that it seems like a good number if not a preponderance of CA PT's think they can't practice up to the evidence.
I pose this question; if someone comes to a PT office meeting the CPR for manipulation and acute LBP and a PT can't manipulate them then why should that patient come to us. Fritz has done a cost analysis( I've only seen in abstract)of not manipulating this person; the numbers aren't good for not manipulating.
I would say the california PT's have to get to the bottom of this for the sake of their patients, or join the ranks of the poor souls in WA,and AR.
Tim
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Re: Spinal Manipulation and States practice acts - March 25, 2006 6:33:00 AM
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TMondale
Posts: 131
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From: Newton-Wellelsley Hospital
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Peter,
I submit to you that Kaiser trains it's therapists to be able to manipulate because it can, and understandds the importance, not because it's some rogue renagade operation existing within an alternate practice act. This is a nationally and internationally renouned group; they're not hiding anything.
This is a great discussion; good things will come of it. Big state. Lots of people to serve.
Tim
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Re: Spinal Manipulation and States practice acts - March 29, 2006 2:56:00 PM
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Wisecracker
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Joined: November 15, 2001
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Update:
I spoke to one of the PTs yesterday and he said that he was told by his boss that a few years ago (in the late 80's or early 90's) an osteopath filed a formal complaint against a PT who was performing manipulative therapy. Allegedly the medical board became involved due to the osteopaths licsense (do DO's have the same board as MDs? it would make sense). It was apparently a big deal at the time, though I have zero memory of it.
Also, the boss informed the PT that their malpractice carrier has informed them that adverse events following manipulative therapy are not covered in the event of litigation.
I don't know anything about Kaiser's program. I do know of a few courses that train/refresh various doctors in different procedures, ie: arthroscopic procedures to the knee. I know of 2 collegues who have taken these week long programs (on cadavers of course) because it interested them. So, while they both received the same training as orthopedists, etc in the class...they could never utilize the training as they were both chiros and it was out of their scope. Maybe not the same thing.
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Re: Spinal Manipulation and States practice acts - March 30, 2006 5:11:00 AM
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TMondale
Posts: 131
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From: Newton-Wellelsley Hospital
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Wisecracker,
Interesting anecdote,wives tale, urban myth, poltergeist, learned helplesness or whatever, and thank you for your interest in this subject. I only hope your interest is based on your support for your PT colleagues, and what's best for the citizens of California.
Peter, et al.
My message is to the CA PT's; check it out. Don't let stand this hearsay that has apparently limited your ability to serve the patients, and the health care structure you are an integral part of.
Tim
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