Enforcement of the "Law"? (Full Version)

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kevinPT27 -> Enforcement of the "Law"? (May 30, 2008 5:26:37 PM)

I am curious if anyone can explain or help me with this.  There is a small chiropractic office near me that included in their brochure that they did "pre and post surgical PHYSICAL THERAPY".  Now I know the area and didn't know of any PT working there.  I  called the clinic and they said they didn't have a PT but the chiro "administered the PT".  I am not the PT police, just curious though.  I live in OH, and in the laws it clearly states that No person shall use PT, Physical Therapy, etc. without a valid license.  I contacted the state board and when I got a call back all I was told was that they are dealing with this law in court right now and that I could send in a comlaint form.  The Ohio website even clearly states the board only has jurisdiction over those with a license.  What gives? So only those with a PT license better make sure they don't advertise/provide PT without a license?  This makes zero sense to me.  I don't even know who else would enforce our laws if our state board wont.  Any explanations/opinions/etc would be appreciated.



T_Thom -> RE: Enforcement of the "Law"? (May 30, 2008 7:47:50 PM)

This must be the letter you are referring to on complaints process (last line of item #1). The phrasing in the letter is confusing, I see what you mean. But given the nature of your complaint, this individual is practicing physical therapy without a license which does fall within the PT Board jurisdiction. Reviewing board disciplinary actions you can see cases where they have sanctioned other individuals who practiced PT/OT/AT without a license. At the same time, I would notify the Ohio APTA. State professional associations can be quite helpful on these matters, in my experience they do want to know when things like this are happening.
 
The one loophole I have witnessed is chiros using term physiotherapy. Some state chiro practice acts allow this because one of their national board exams is titled "physiotherapy", their term for modalities, expecting consumers (like my grandmother) not to be confused over the two terms. ha.. The situation you are describing seems much more blatant, and less like a loophole. Here is the Ohio Chiro practice act to peruse, for your convenience.
 
My 2c.



bonez -> RE: Enforcement of the "Law"? (May 30, 2008 8:10:01 PM)

As a Canadian Chiropractor I can understand your concerns. We too deal with issues that seem to cross professions. Having been involved with regulatory/scope of practice issues here what is allowed often falls under the respective Act. Within my area I am allowed to not only provide the service that you might expect from a Chiro but I can provide all forms of manual care, provide supervised rehab exercise,ergonomic assessment,job site evals, use physiologic modalities and for some weird reason sign your death certificate (I have no desire to do so).
If you read the act for chiros in your area you will see they can not do exactly what you say they are doing however. See link below.

http://codes.ohio.gov/orc/4734.201



laptma -> RE: Enforcement of the "Law"? (June 1, 2008 8:39:16 AM)

This is only partially related, but I have found little interested in inforcing the practice acts.

my experiance was that there are quite a few clinics (in this case CT) that are using rehab techs to do all modalities, and some manual techniques. Some OT's are also treating the cervical spine,including manual techinques.
I email the state board, state APTA and  national APTA. They wanted no part of this (they all said they had nothing to do with enforcing the law, or disciplinary actions) and directed me toward the dept of public health.
they said that the only way to do anythign about  it was to get specific clinic information.
I didn't give that to them. This seems to be relatively widespread in CT, and I felt guilty point a couple of clinics out (i know, I should have done it anyway). I was hoping/thinking that there would be lets say a mass mailing to emphecise to the PT's that this is illegal. (like a warning type letter).

Good luck with that.



TMondale -> RE: Enforcement of the "Law"? (June 3, 2008 4:39:19 PM)

laptma,

I don't know the CT practice act for OT, but i'll bet dollars to doughnuts that it doesn't in anyway limit OT's from treating necks, or low backs for that matter.  As I see it they don't often treat these areas more by convention than anything else.  As far as Chiro's advertising PT services without a licensed PT on staff, it is deceipt of the worst kind.  They are deliberately trying to deceive the consumer public, that can't know any better.  OT's don't try to pass themselves off as PT's.  It's been gone round and round here with chiro's over this matter.  They think because they have some class in their school that is named physiotherapy, or physical therapy that they can advertise that service (as if it isn't the name of another competing profession).  It's absurd, and if we had a lobby with sufficient power we would crush these people (legally speaking of course).  At some point that profession is going to realize because they can get away with something, isn't a justification for doing it.  All chiro's should denounce this practice of false advertising in the clearest way.  Bonez seems to get it. 

Tim



Tom Reeves DPT ATC -> RE: Enforcement of the "Law"? (June 3, 2008 5:55:10 PM)

I can't call myself an optometrist.  I can't call myself a chiropractor. I can call myself an athletic trainer and a physical therapist. 

Go ahead and advertise once that you do chiropractic treatment and see how many local and state and maybe even national chiropractors' lawyers contact you.



bonez -> RE: Enforcement of the "Law"? (June 3, 2008 8:51:46 PM)

quote:

ORIGINAL: TMondale

laptma,

I don't know the CT practice act for OT, but i'll bet dollars to doughnuts that it doesn't in anyway limit OT's from treating necks, or low backs for that matter.  As I see it they don't often treat these areas more by convention than anything else.  As far as Chiro's advertising PT services without a licensed PT on staff, it is deceipt of the worst kind.  They are deliberately trying to deceive the consumer public, that can't know any better.  OT's don't try to pass themselves off as PT's.  It's been gone round and round here with chiro's over this matter.  They think because they have some class in their school that is named physiotherapy, or physical therapy that they can advertise that service (as if it isn't the name of another competing profession).  It's absurd, and if we had a lobby with sufficient power we would crush these people (legally speaking of course).  At some point that profession is going to realize because they can get away with something, isn't a justification for doing it.  All chiro's should denounce this practice of false advertising in the clearest way.  Bonez seems to get it. 

Tim


I don't want to beat a dead horse but the real issue lies in what the local (state) association says fallls within the scope of practice for the profession. I think that any complaints will get the most action there if they are in the wrong.
To be a devil's advocate, manipulation is just that. I can call it an adjustment, you can call it a grade 5 mob, lay healers can call it cracking. The act crosses many domains and really no one can lay exclusive claim to it. Twenty years ago you probably could count on one hand the number of PT's who were manual/manipulators with most PT's zapping and frying conditions.
If we want to call PT now assessment, evidence based treatment, exercise prescription and move on patient then that type of care may fall in many different professions hands. Everyone will assume their group does it better.
The PT population can't lay exclusive claim to it either because it is the right thing for all MSK practitioners to do for patients and if you are trained to do it correctly and it's in your scope then you should be able to do it.
I realize that this will stir up a kettle of fish but I thought I would provide a view from someone looking in who has no axe to grind.



steve -> RE: Enforcement of the "Law"? (June 3, 2008 10:37:10 PM)

Bonez,

I agree with pretty much everything you say but heres the one important difference (According to what we have been told about state laws in this situation) - its the equivalent of me practicing manipulation in my PT clinic and advertising my service as chiropractic to the consumer. This is deceptive advertising in all situations and when used in a state where a physical therapist has sole rights to the use of the words "Physical therapy" and "Physiotherapy" it is illegal.

I dont think anyone here would say that they have any exclusive rights to providing these services and my guess is that other than the professional letters behind their name you would be hard pressed to see the difference between an OT, PT, AT and DC practicing in an evidence based manner on everyday MSK problems.

Steve



bonez -> RE: Enforcement of the "Law"? (June 4, 2008 1:25:43 AM)

quote:

ORIGINAL: steve

Bonez,

I agree with pretty much everything you say but heres the one important difference (According to what we have been told about state laws in this situation) - its the equivalent of me practicing manipulation in my PT clinic and advertising my service as chiropractic to the consumer. This is deceptive advertising in all situations and when used in a state where a physical therapist has sole rights to the use of the words "Physical therapy" and "Physiotherapy" it is illegal.

I dont think anyone here would say that they have any exclusive rights to providing these services and my guess is that other than the professional letters behind their name you would be hard pressed to see the difference between an OT, PT, AT and DC practicing in an evidence based manner on everyday MSK problems.

Steve

Steve please refer to my original post on this topic where I pulled wording out from the act in that state regarding the word physiotherapy.
I absolutely concur with your post but the perception by the public still persists. I recently saw a patient (in an area with manipulating PT's) that stated his problem(t spine issue) was caused by the PT when he gave him a chiropractic treatment that went wrong.
He received manipulation but in his mind it was "chiropractic". It is one thing to make the misrepresentation on his part to me but how about the professional damage control when he describes this to his friends?



T_Thom -> RE: Enforcement of the "Law"? (June 4, 2008 2:24:43 AM)

quote:

He received manipulation but in his mind it was "chiropractic". It is one thing to make the misrepresentation on his part to me but how about the professional damage control when he describes this to his friends?

 
Bonez: How did the chiropractic profession get sooo good at branding?! Seriously.
 
As has been stated multiple times, the main point is the professional and their employees who are responsible for what they say. I have certainly learned to take what a patient says with a grain of salt.
 
I now routinely ask my patients when they talk about previous PT visits "was this a physical therapist, or a chiropractor." Surprisingly, at least 30% of the time, they tell me it was the chiro who "did my therapy". Do patient's just dream this up, or is this being planted in their head? Because of the regularity of this happening, this is not just coincidence. PT and chiro do not sound alike. I understand when people get things like neurology & neurosurgery or optometry & ophthalmology confused. The problem is when it is presented in the manner the OP describes, blatantly and intentionally misleading to the public by someone who should know better. 

Speaking of tactics. My husband and I watched the documentary Jesus Camp last night on Netflix. Aside from the subject of religion, it's amazing how ignorance and propaganda can influence democracy.



goodlooks58 -> RE: Enforcement of the "Law"? (June 4, 2008 3:23:16 AM)

In California now many of the MDs are hiring DCs and calling it PT. This is rampant and growing like wildfire. The DCs wear a "hat" of a PT while doing "PT" work in an MD office. I called our CA chapter of APTA and very lukewarm response: "Anyone can use the modality codes to treat the patient". Yes, but do not call it PT. I went to a podiatrist's office to do marketing, the podiatrist invites her "Sportstherapy" team of 2 LMTs in the meeting. This podiatrist has the gaul to put Sportstherapy on her Rx pad. The "Sportstherapist" do all the modalites  oh, yes they only see non-medicare pts. This blatant fraud is due to the loophole in the Stark Laws of--incident to rule. The issue I do not get is why are these docs afaraid of Medicare (Federal) and not afaraid to see private insurances? Do the Aetnas and Cignas of the medical ins world allow the docs to commit fraud and look the other way? Or has our APTA failed in doing the police work for the PTs of this country? If this continues why would anybody want to go to PT school?



TMondale -> RE: Enforcement of the "Law"? (June 4, 2008 7:44:22 AM)

bonez,

I sincerely hope you took the opportunity with that patient to point out that there should have been no harm from the PT treatment, and that everyone involved in their care is trying to help (you sound like the type of professional that would handle this appropriately).  As I think I do in the multitude of times that patients come in to me and say this or that chiropractor "hurt" me , or "made me worse".  I'm continually amazed when I see someone who should have been a great fit for chiropractic treatment, ie meeting the CPR for acute LBP and manip. and they don't do well.  We have a problem where I work in that a group of physiatrists we are supposed to "work closely with" throw us under the bus regularly if a patient goes back to them and mentions that they had some reaction to an applied manual therapy.  It's ridiculous, and lacks in any degree of professional courtesy.  to me it proves what a lost lot most physiatrists are when involved in non-medical neuro-musculo-skeletal care (another thread). 

Back to the original point, Steve is right, there may not be, and shouldn't be much difference between us in terms of how we perform our duties, but to call what you (speaking of some in your profession here bonez, not you) offer PT is beneath any profession.

Tim



TMondale -> RE: Enforcement of the "Law"? (June 4, 2008 7:54:41 AM)

Goodlooks,

That is bad what's happening around you; perhaps that is more prevelant than we know.  In terms of the podiatrist, again what an unnecessary group they are.  Instead of trying to gain her approval and referrals you should market her patients away from her.  If your patients need foot surgery send them to an ortho.  You are much better and more qualified to treat the non surgical foot pain patients than she is, or anyone in her profession.  We can leave the toenail work to them though.  Sorry folks those are my only two gripes in medicine (again another thread).

Tim



kevinPT27 -> RE: Enforcement of the "Law"? (June 4, 2008 1:16:32 PM)

Thanks for the replies.  I am well aware of the practice acts, and that other professions share the same billing codes.  Actually, if this chiro can get away with doing this and the OPTA/APTA want to do nothing, than I guess good for him and poor us PTs.  This is exactly why I am not an APTA member.  If no one wants to enforce our laws-then why have them.  If the law clearly states that no one can use the term physical therapy but someone is clearly doing just that, than the issue is with the governing body itself(not the offender). 



bonez -> RE: Enforcement of the "Law"? (June 4, 2008 8:31:28 PM)

quote:

ORIGINAL: TMondale

bonez,

I sincerely hope you took the opportunity with that patient to point out that there should have been no harm from the PT treatment, and that everyone involved in their care is trying to help (you sound like the type of professional that would handle this appropriately).  
Tim


Yes I did Tim but I had a harder time rationalizing the t/spine manipulation to a patient that attended therapy for an acute ankle sprain. I just could not reason it my self.



T_Thom -> RE: Enforcement of the "Law"? (June 5, 2008 12:15:13 AM)

quote:

ORIGINAL: kevinPT27
Actually, if this chiro can get away with doing this and the OPTA/APTA want to do nothing, than I guess good for him and poor us PTs.  This is exactly why I am not an APTA member. If no one wants to enforce our laws-then why have them. If the law clearly states that no one can use the term physical therapy but someone is clearly doing just that, than the issue is with the governing body itself (not the offender). 

 
While I can see why you and many other people feel this way towards the APTA, really they are all we have representing us. We have nothing else.
 
I have colleagues who share the same view, and what has changed their mind about this is why should some of us pull the weight for everyone?
Members and non-members benefit from the legislative gains. If we don't like how things are going, as in this very case we are discussing; we have everything within our power to change it. And at least if we don't have the time, energy, etc. to tackle the whole problem independently, the ~$50/month for membership at least kicks some money towards someone else who is voluntarily fighting these battles. This is job security.
 
What is the alternative if we don't have some form of professional representation? Can you imagine what could be accomplished if 80%, rather than 40% were members?? 
If you are a PT and not a member, please join! We need a bigger voice.
 



goodlooks58 -> RE: Enforcement of the "Law"? (June 5, 2008 2:37:25 AM)

Please do not get me wrong. I am all for having a united voice i.e. APTA even if it is a small whimper and not a voice. I think that every PT should pitch in $1000 per year or when they get their license renewd. As far as know there are 65000 PTs mulitplied by $1000 and we have a bigger war chest to fight any crap coimg our way! I just feel a 2nd class citizen sometimes when craps like the DPMs are manipulating words like "therapy" with lay people. Why do PTs allow ourselves to be governed by others in the medical profession? In California we have fought so hard for Direct Access and it seems like we are still far away from it. Public awareness is a big part in it. Any public event like a community event or a fair I see LMTs and DCs all over and hardly ever see any PT having any kind of booth or public awareness show. Are we that lazy that we are willing to give up our profession to others?



laptma -> RE: Enforcement of the "Law"? (June 5, 2008 8:11:25 AM)

quote:

ORIGINAL: TMondale

laptma,

I don't know the CT practice act for OT, but i'll bet dollars to doughnuts that it doesn't in anyway limit OT's from treating necks, or low backs for that matter.  As I see it they don't often treat these areas more by convention than anything else.  As far as Chiro's advertising PT services without a licensed PT on staff, it is deceipt of the worst kind.  They are deliberately trying to deceive the consumer public, that can't know any better.  OT's don't try to pass themselves off as PT's.  It's been gone round and round here with chiro's over this matter.  They think because they have some class in their school that is named physiotherapy, or physical therapy that they can advertise that service (as if it isn't the name of another competing profession).  It's absurd, and if we had a lobby with sufficient power we would crush these people (legally speaking of course).  At some point that profession is going to realize because they can get away with something, isn't a justification for doing it.  All chiro's should denounce this practice of false advertising in the clearest way.  Bonez seems to get it. 

Tim


Please don't misunderstand me, my problem is with the rehab techs providing PT, the OT thing I just found interesting bc I just found out about it just prior to the post, and I made no mention of that on the communication with the state agencies.
I should've made that clearer.

It do find it interesting however that everyone gets up in arms when DC are doing/billing PT, but no-one really cares about techs doing PT!
from a pt safety standpoint, which sometimes is used as reason why other professions should not do some of the things we may be qualified to do, I would rather have a DC, who has medical training, doing some of that, than a tech!
That just gives those who don't think much of what we do more ammunition "if it's that skilled why can techs do it." 



laptma -> RE: Enforcement of the "Law"? (June 5, 2008 8:45:10 AM)

I am an APTA member bc they are the only lobbying voice we have, but they seem to be a one trick pony. Direct access or bust.

Although I think that is important, there are other professional issues we have as well (ie poor reimbursement, issues like this one,where other professions are advertising themselves as performing "physical therapy", etc.) that seems to get little to no attention!



bonez -> RE: Enforcement of the "Law"? (June 6, 2008 1:25:52 AM)

quote:

ORIGINAL: laptma

quote:

ORIGINAL: TMondale

laptma,

I don't know the CT practice act for OT, but i'll bet dollars to doughnuts that it doesn't in anyway limit OT's from treating necks, or low backs for that matter.  As I see it they don't often treat these areas more by convention than anything else.  As far as Chiro's advertising PT services without a licensed PT on staff, it is deceipt of the worst kind.  They are deliberately trying to deceive the consumer public, that can't know any better.  OT's don't try to pass themselves off as PT's.  It's been gone round and round here with chiro's over this matter.  They think because they have some class in their school that is named physiotherapy, or physical therapy that they can advertise that service (as if it isn't the name of another competing profession).  It's absurd, and if we had a lobby with sufficient power we would crush these people (legally speaking of course).  At some point that profession is going to realize because they can get away with something, isn't a justification for doing it.  All chiro's should denounce this practice of false advertising in the clearest way.  Bonez seems to get it. 

Tim


Please don't misunderstand me, my problem is with the rehab techs providing PT, the OT thing I just found interesting bc I just found out about it just prior to the post, and I made no mention of that on the communication with the state agencies.
I should've made that clearer.

It do find it interesting however that everyone gets up in arms when DC are doing/billing PT, but no-one really cares about techs doing PT!
from a pt safety standpoint, which sometimes is used as reason why other professions should not do some of the things we may be qualified to do, I would rather have a DC, who has medical training, doing some of that, than a tech!
That just gives those who don't think much of what we do more ammunition "if it's that skilled why can techs do it." 


I think that the real concern here is more to the point of anyone (this time chiro) crossing the professional border into another ones turf. Here in Canadian medicare politics some have defined it as healthcare funding being like a pie and please don't take my share.
I have been a contrairian and have bucked the trend with "do a good job at what you do, involve others when their work is better" as my approach. When the patient is satisfied they WILL refer others and you WILL prosper both financially and professionally. Unfortunately this leaves some who expect their share of the pie but don't earn it on the sidelines.



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