Dry Needling Updates for LAcs

Not again! Yes, again.

[If nothing else, read: NC AG Opinion, NC Order and Opinion, Henry v NCALB, and TX AG Opinion. If you have an opinion on dry needling, and you want it to be an informed opinion, these documents are necessary reading.]

North Carolina has been a major DN battlefield. It’s been a rallying cry for strong action elsewhere. How’s it going?

Not well.

Some history –

In 2011, the North Carolina Acupuncture Licensing Board (NCALB) requested an opinion from the NC Attorney General regarding the North Carolina Board of Physical Therapy Examiners’ (NCPTE) decision that Dry Needling was within the PT scope of practice. The AG opinion was that the NCPTE could make this determination if it conducted appropriate rule-making.

Subsequent to that decision, but before the NCPTE concluded the rule-making process, the NCALB sent “cease-and-desist” letters to PT’s practicing dry needling, accusing them of illegal activity. And, in 2015, the NCALB filed a complaint, demanding a ruling that DN was the unlawful practice of acupuncture, and insisting that the PT Board inform its licensees that DN was not within the scope of practice of PT’s.

Given the AG opinion it’s no surprise that the NCPTE (and individual PT’s who had received the cease-and-desist letters) weren’t ready to roll over for the NCALB.

On August 2nd, the Court issued this NC Order and Opinion affirming the NCPTE’s decision that dry needling is within scope for PT’s, and that it is distinct from acupuncture.

(Again, please read the documents. They are critical to understanding why our arguments aren’t leading to more wins.)

In January the court ruled that Henry v NCALB could proceed. This is not good news for the NCALB and its members, who may be found (subsequent to the NC Board of Dental Examiners Supreme Court ruling) guilty of antitrust violations.

My top takeaways —

  • Don’t request an AG opinion if you won’t accept the answer. (A colleague recently wrote that he’s gearing up to “CRUSH dry needling” in Texas. Here’s the Texas AG opinion.)
  • If it’s determined that a PT Board has the power to pursue rulemaking on dry needling, we should make a good faith effort to offer respectful input. We should focus on minimizing risk to the public, while accepting that we don’t get to call the shots. Obstructing the regulatory process or making unrealistic demands puts the public at greater risk. (Also, we should make well-informed arguments. Insisting that dry needling is outside of PT scope after it’s been ruled otherwise, for example, doesn’t help our case.)
  • Don’t use dud ammunition. NCASI and others still argue, for example, that it’s illegal for anyone other than acupuncturists to possess acupuncture needles. The court wrote (highlighting mine)

¶¶ 16–20.) In particular, the Acupuncture Board contends that the needles used in dry needling “must carry a specific FDA warning as required under 21 CFR §880.109(b)(1), stating ‘Caution: Federal law restricts this device to sale by or on the order of a [qualified practitioner of acupuncture licensed by the law of the State in which he practices to use or order the use of the device.]’” (Petition ¶ 19) (brackets
and emphasis in original).
50. The Petition takes glaring liberties with the cited regulation, however. The full text of the regulation requires medical devices, such as the solid filament needles at issue here, to include a label bearing: The symbol statement “RX only” or “℞ only” or the statement “Caution: Federal law restricts this device to sale by or on the order of a ____”, the blank to be filled with the word “physician”, “dentist”, “veterinarian”, or with the descriptive designation of any other practitioner licensed by the law of the State in which the practitioner practices to use or order the use of the device[.]
21 C.F.R. § 801.109(b)(1). As such, the cited regulation does not support the Acupuncture Board’s argument that the needles used in dry needling are “medical devices” only for use by acupuncturists.

  • Our professions’ news sources are full of misleading, inaccurate, and incomplete information. This AT article, this NGAOM post, and this blog post, are inaccurate – repeating the false needle argument, misstating the finding of the NC rules review commission, and/or misrepresenting what the NCPTE told licensees. We need to do better.
  • Long-term, there may be a few states where PT’s are not permitted to do dry needling, just as there are a few states still not open to LAcs. There is already PT DN in most states. Making the argument that dry needling is acupuncture, as the NCCAOM did in their recent statement, is a terrible mistake. Do we want the PT next door to advertise “now offering acupuncture”? Our statements encourage them to do so. We need to adjust to the current reality.

In 2013 I wrote Imagine, or, How I Learned to Stop Worrying and Love the Bomb. I can still only imagine where we’d be if we had spent the last four years doing those 11 things, instead of what we’ve done (and continue to do). Let’s stop doing what we’ve done. We can get something better if we understand what’s gotten us here.

 

 

 

Current Events for Acupuncturists, Spring 2016

Regulatory activity, licensure laws, and organizational news impacting LAcs –

Regulatory and Legal Round-Up:

In April the Washington State AG determined that Dry Needling was not within PT scope as currently written. The legislative session ended without success for either of  two competing bills to add DN to or restrict DN from PT scope. This fight is likely to continue in future sessions.

The North Carolina Acupuncture Licensing Board’s lawsuit against PT Dry Needling was dismissed  “without prejudice” on April 26th with a ruling that the NCALB has not exhausted its administrative remedies and so the Court lacks subject matter jurisdiction. A member of the NCALB distributed an email blast disagreeing with the ruling that seemed to have been written prior to reading the opinion. The NCALB (and anyone else crying foul) should study the Court’s ruling before pursuing the legal battle (and asking for money to fund it).

On May 9th the Texas Attorney General issued an opinion that the Court would likely conclude that the Board of Physical Therapy Examiners has the authority to determine that trigger point dry needling is within the scope of Physical Therapy.

The Virginia Board of Physical Therapy moved forward with regulatory language regarding Dry Needling. The proposed language (which will still go through a public comment period) specifies topics to be covered in the training but not required hours of training. Did the ongoing battle over number of hours in other states play a role?

A rare area of national bipartisan agreement is that Occupational Licensing has gotten out of hand. The right dislikes the burden it places on business, the left dislikes the burden it places on the working class. Add last year’s Supreme Court ruling regarding regulatory boards, and we should expect ongoing efforts to ease licensure routes and to diminish the power of active market participants on regulatory boards.

For example, the Governor of Tennessee (R) just signed The Right to Earn a Living Act, which requires agencies to limit entry requirements to those that are necessary to protect the public, and makes it easy for anyone to challenge professional entry regulations. The Governor of Delaware (D) has created a Regulatory Review Commission to review professional regulations. A North Carolina bill to disband many regulatory boards (including the NCALB) was defeated this session, but it won’t be the last we see of such efforts. (No, the PT’s had nothing to do with the bill.)

Licensure Laws:

KsAOM’s hard work paid off. The Kansas Acupuncture Act became law and licensure will begin in July 2017. The final language was a compromise that includes dry needling within both PT and LAc scope after the initial DN language almost derailed the bill. You can see the text here (see pages 11-17).

The Delaware AAC’s unwillingness to waive the requirement for all LAcs to have full herbal credentialing, even for those uninterested in prescribing herbs, has been an ongoing problem. Legislation has now been introduced which would create tiered licensing (and remove the word Oriental from the law). Tiered licensing puts acupuncture-only practitioners at a disadvantage to all other health care providers, but would nonetheless be an improvement.

Other News:

Last, but not least, CCAOM has voted to remove Oriental from the name of the organization. No word yet on the new name.

 

The Acupuncture Observer aims to inform all Acupuncturists of developments in the profession. Fallout from the previous Observer post leaves me without access to several of the newsiest FB groups. I’ll say more about that in a few weeks. In the meantime, if you know of news that deserves to be heard, let TAO know and I’ll get the word out. And, please, share this post with any groups, on Facebook and elsewhere, that could benefit.

 

 

Dry Needling and Acupuncture 2015 – The State of the Profession

Dry Needling wins again – it receives “the greatest threat to the profession” practitioner’s choice award.

In recent years, Acupuncturists have devoted more resources to this issue than to any other.

A (fairly accurate) review of legal and regulatory actions shows that we’re not having much success. (Here’s another review, APTA’s Dry Needling Resource Paper.)

Even our wins have been temporary. For example –

– the Georgia Acupuncture Board added language stating that Dry Needling is acupuncture. The PT’s then added Dry Needling to their scope via legislation. (Could Georgia PT’s now advertise they’re doing acupuncture?)

– the October 2014 ruling in Washington State against dry needling was widely celebrated. Now the PT’s have introduced bills which would add Dry Needling to their scope. With almost 5,000 PT’s in the state, and about 1,100 LAcs, it’s likely they’ll eventually succeed.

We say the PT’s:

  • are stealing our medicine! (But we don’t own it.)
  • are illegally expanding their scope. (The majority of states have ruled it is in the PT scope. Modifications to scope are common in health care.)
  • are using Regulation to do what should be done Legislatively. (Scope clarification is often done via Regulation, which gives the public and other professionals the opportunity to weigh in and is preferable to politically driven legislative action. The public is protected through regulation. The PT’s have been successful in passing Legislation allowing dry needling.)
  • are pursuing this because their own techniques don’t work. (Even if true, 1) why does that matter, and 2) does the argument apply to us when we add techniques lasers, essential oils, e-stim, herbs –  to our scope?)
  • can’t possibly know enough to do this technique safely. (Many clearly do.)
  • can’t possibly be providing good treatments. (Their patients disagree.)
  • wrongly say that dry needling isn’t acupuncture. (Is it better if they say it is? Is there a legal reason our definition should prevail?)
  • make the public fear acupuncture. (Insisting this technique is acupuncture will contribute to the problem. Don’t we have the same problem when we use the technique?)
  • should use hypodermic needles. (Does that show concern for public safety?)

We can continue the fight to stop dry needling – getting caught in the cycle of suit (complaint) (never-mind the SCOTUS ruling) and counter-suit (NC PT lawsuit). We can fight state by state, and attack any Acupuncturist who suggests anything other than “the PT’s must be stopped.” We can keep insisting that if we just devote more resources and fight harder, we’ll win.

Or, we can learn from our history and the history of all of the other professions that have fought to maintain a monopoly on technique or turf.

We could be fighting for strong regulations. Mandated adverse effect reporting, strict definitions of what dry needling is and what it isn’t (other than whether or not it is acupuncture), requiring direct supervision for all clinical hours, requiring PT’s to post their hours of training, requiring registration with the PT Board, requiring physician referral for dry needling – all of these are possible.

A PR campaign promoting acupuncture and helping the public find an Acupuncturist? That’s possible too. Supporting ease of licensure so that people in every state can find an LAc? We can work for that. Support for new practitioners so that the public can actually find an Acupuncturist? That’s a great goal. Building collaborative relationships with other professionals who want to decrease pain and suffering? That would serve everyone.

Putting our energy into stopping dry needling? Not so much. It’s our obsession with stopping dry needling that is the greatest threat to the profession.

 

 

November ’15 Acupuncture News Update, Chapter 1

It isn’t easy keeping up with Acupuncture News. Now and then a “clear the decks” post (or two, or three) is needed. Here goes:

HR 3849: Representative Judy Chu (CA) introduced “The Heroes and Seniors Act ” which would add acupuncturist services to Medicare and would increase the availability of acupuncture to members of the military and Veterans. The bill has a long list of endorsing organizations. Supporters should share their analysis of what would happen in the twenty states with fewer than 100 LAcs*. In a business with competitors, creating demand for a service without the ability to provide it is a bad move.  I’d be more worried if I didn’t agree with govtrack.us – there is a 0% chance of the bill being enacted.

Dry Needling: In late September the North Carolina Acupuncture Licensing Board filed a complaint in the General Court of Justice against the North Carolina Board of Physical Therapy Examiners, asking the court, among other things, to declare dry needling the unlawful practice of acupuncture. In early October the North Carolina Board of Physical Therapy filed their counter suit in US District Court seeking triple damages for the NCALB’s illegal and anticompetitive acts. Not surprisingly the same LAcs who cheered on the NCALB suit were outraged that the NCPTE would return fire. Given the SCOTUS ruling from this past year I believe the acupuncture community is in a risky place. If the PT’s prevail it will be a game changer nationwide. Did the AG’s office (which had previously ruled that Dry Needling could be within PT scope) advise the NCALB on their complaint? Are all North Carolina Licensees picking up the legal tab for what looks like outside counsel?

In other news the acupuncture community has been touting the revised AAMA Policy on Dry Needling. The Middle Eastern saying “The enemy of my enemy is my friend” comes to mind. It’s a strategy that can win battles, and can create more of them. I don’t think of Medical Acupuncturists or PT’s as enemies. I do remember our insistence that the 200 (or 300?) hour training of the MD Acupuncturists is insufficient. And I wonder whether the PT’s could increase their training to 200 (or 300?) hours and then argue that all of acupuncture is open to them.

Nevada: The minutes of the November 5th Nevada Board of Oriental Medicine haven’t yet been posted, but I understand from attendees that the Board is planning to hire legal counsel, the cost of which will fall on existing licensees. Why does the Board need to hire legal counsel? Because they continue to pursue actions that go against existing code and legislation, rejecting the counsel of the Attorney General’s office. The news from Nevada is a reminder that having an independent acupuncture board isn’t necessarily great for the public or the profession.

Looks like there will be at least one more “Clear the Decks” post. Coming soon  – news about: acupuncture and insurance, NCCAOM’s annual report and more, ACAOM’s hot news, regulation in the District of Columbia, Lamar Odom and the future of herbal regulation, and what’s happening in the AAAOM.

 

* I use LAc to refer to all professionals holding the proper government license to provide primarily acupuncture and TCM services. Having no clear way to refer to, define, or describe this group of individuals is representative of our challenges!

FPD/DAOM required, Schools, ANF, Dry Needling — and more Acupuncture News….

New news:

Word is that the Nevada acupuncture board is poised to require an FPD (or is it a DAOM?) for licensure, even though citizens there are already under-served. I’m trying to get more information. Stay tuned for updates. State actions that limit our profession tend to stay under the radar until it is too late.

The acupuncture school landscape is changing. Last week brought news that Bob Duggan and Dianne Connelly will no longer be part of MUIH faculty or staff. For those who have been paying attention as The Traditional Acupuncture Institute morphed into MUIH, it shouldn’t have been a surprise. But it is sad. While TAI had its good and its bad, many who attended did so because of Bob and Dianne’s contributions. The announcement was quickly followed by a letter, in perfect TAI-speak, that, for the sake of the students, we shouldn’t get caught up in stories about this. As in, don’t even ponder what it is we aren’t telling you.

This week also included the news that NESA is merging with MCPHS, and ACTCM is merging with CIIS.  (Thanks, Integrator Blog.) Is the age of the stand-alone acupuncture school coming to an end?

Have you heard of The Acupuncture Now Foundation? They aren’t a membership organization, and they don’t want to get involved in acupuncture-politics. They just want to educate the public about our training, our skills, and the great results from our medicine. Please, support ANF! Marketing the medicine shouldn’t have to be an individual effort.

Older News:

Developments in dry needling, with the hope that we might learn from history:

  • Louisiana joined other states with an AG opinion that dry needling is within scope for PT’s and DC’s. Other AG opinions can be seen here.
  • Tennessee’s Governor signed Legislation formally adding dry needling to scope for PT’s, joining Utah and Arizona which saw similar legislation in 2014.
  • The Maryland Acupuncture Society came out in strength behind HB 979 and SB 0580 that would have set limits for dry needling by PT’s and DC’s. The bills went nowhere, perhaps a blessing in disguise as “success” would have opened a can of worms.  (The bills did not define dry needling, MAS support put the acupuncture community’s stamp of approval on a 200 hour standard for acupuncture training that had been previously unacceptable, and the wording opened the door for PT’s with 200 hours of training to argue that they were now, indeed, doing acupuncture.)

The AAAOM website has been updated with board bios and a revamped committee list, but still no answers for any of my sixteen questions for the AAAOM.

ACAOM responded to the petition in response to their Gainful Employment letter in the ACAOM Fall Newsletter.  The good news — they heard us. The bad news, they continue to believe that significant student debt is helpful for those who want to serve low-income communities.

There you have it, at least some of the news you aren’t seeing in Acupuncture Today.

 

Acupuncture Safety, and, a Matter of Fairness

Protecting the public safety is a good reason for regulation.

People have been injured by PT’s or Chiropractors doing dry needling.  When we see a story about that we share it. So I understand the comments on the previous post.

And, there were two recent threads on Facebook that caught my attention.

An LAc posted a question about whether it was possible to cause an infection by needling CO4. He’d treated a patient who later developed redness at the area. The patient visited an MD and was prescribed an antibiotic. I was surprised at the practitioner’s question, and surprised and mortified at the responses.  Which included: The MD is just trying to cover his ass, they just like to prescribe antibiotics, not if you used sterile needles, not if you used an alcohol swab on the area first, people freak out all the time, etc. A day or two later, the initial questioner reported that the patient was now hospitalized with a staph infection.

Another LAc wrote that a patient reported she’d had a pneumothorax from a treatment and was now asking for financial compensation for a portion of the medical expenses and several weeks of missed work. What should the practitioner do? Of course, getting some documentation makes sense, but the responses also included: if it really happened why doesn’t the patient have a lawyer, if you’d given her a pneumothorax you would have known it immediately, she must have had some sort of underlying medical condition so you aren’t responsible, etc.

Personally, I know some amazing practitioners who have firsthand experience with pneumothorax(i?) on both ends of the needle.

I don’t believe we have sufficient record keeping to know the relative safety records.  Dry Needling does involve a deep and aggressive needle technique and so is more likely to do damage.  That’s true even with an LAc holding the needle.

When a story comes out that involves harm done by an LAc, we make all sorts of excuses and focus on our generally good safety record. When we find out about damage done by a PT or DC, we trumpet the news, and make smug and superior comments.

When it comes to fairness, most of the things I hear LAcs complaining about are either self-inflicted or, sometimes, imagined.  The length of our training — we’ve been behind the increase. The differing insurance reimbursement — is that insurance thing working out for anyone?

This post is mostly blogger’s prerogative to give what is really a comment on the previous thread a higher visibility.  I won’t make a habit of it.  But hwds’ are one of my pet peeves — that’s hypocrites with double standards, and when our response to what happens at the pointy end of the needle seems to vary so much depending on who is at the handle, I think that term applies.

 

 

Court Ruling will Impact Acupuncture Boards

The Supreme Court ruled yesterday that the North Carolina Board of Dental Examiners violated federal law when it tried to prevent non-dentists from offering teeth whitening services.

What does this have to do with acupuncture?

The ruling has the potential to impact all professional regulatory boards.  I’m travelling and don’t have time or an internet connection sufficient to do a thorough report. I encourage you to click through and read the links below — I think most of you will be able to come up with a few areas where LAcs have been sounding an awful lot like those NC dentists….

No anti-trust immunity for Professional Licensing Boards

Unfair Competition

Dentists can’t decide who whitens your teeth

State Licensing Boards not Protected

Board Prevented from Limiting Competition

As Justice Kennedy, writing for the majority, said

“state boards composed mostly of active market participants run the risk of self-dealing.

“This conclusion does not question the good faith of state officers but rather is an assessment of the structural risk of market participants’ confusing their own interests with the state’s policy goals,” he said.

 

Many LAcs insist the only reason they want to stop PT’s and DC’s from doing Dry Needling is concern for the public. Could they be confused?

 

 

It was Twenty Years Ago Today

….. that I was granted my Virginia Acupuncture License (#4). I’d been licensed in Maryland for a few months, but the Virginia License was special. Throughout my years of acupuncture school I’d been involved with the Acupuncture Society of Virginia, working to establish a practice act. We were finally successful in 1994, and my documents were ready and waiting when the regulations were promulgated.

I’m happy I found this wonderful medicine when I did. I feel lucky to be doing this work, and look forward to continuing to practice for decades to come. And yet, these days, I’m mostly sad about the acupuncture profession.

Back in the day, when only MD’s could do acupuncture in Virginia, we argued that the public should have the right and the ability to choose their provider.

We discussed how our medicine could treat the whole person, and that treatments were uniquely tailored to the individual.  We didn’t see patients as a collection of ailments, to be sent from one specialist to the next.

We talked about the good value of our medicine and our belief that it could reduce health care spending.

We got used to the medicine being dismissed by the medical establishment, but held out hope that, some day, they would see the value of what we did.

We knew that this medicine would require lifelong study and learning, but experience told us that about 1500 hours of training was sufficient to produce competent practitioners.

We were happy when we were finally able to receive student loans to attend acupuncture school.

We had concerns about relying on one standardized exam as a precursor to licensure, especially one that was based primarily on one tradition. But we knew that it would relieve some of the burden on the states, and so might help with national acceptance.

It was a time of promise.

Now, my Facebook feed is full of rants — we’ve now decided that, just as the MD’s wanted to protect the public from us, we now must protect the public from the PT’s.

Rather than celebrating the professionals who see the value in this medicine and want to offer it to their clients, we scream that they are stealing our medicine and must be stopped.

We’ve justified our increasing fees (after all, if the MD’s deserve it, we deserve it), and, then chased the insurance dollar so that our patients can afford our services. We’ve adopted the billing games that come along with that, fudging fees, adding services, figuring out what diagnoses to use to get reimbursement, and expressing outrage when we’re called on our behavior. Some of us have gone so far as to attack those who have designed a system to make acupuncture truly affordable to the majority of the population.

We decided that more education would get us more respect, and so increased and increased, and increased again the hours required for entering the profession.  The number and complexity and cost of the exams increased. In a solution to a problem that didn’t exist, practitioners in some states decided an acupuncture education was not enough.  Acupuncturists now must also learn and be tested on herbal medicine, whether they want to use it or not. Various states added additional requirements, so any relocation runs the risk of shutting a practitioner out of the profession. The student loans we celebrated enabled schools to ignore the disconnect between the cost of the education and the likely income of graduates.

I could go on. I won’t.

Shaking my head at the missteps we’ve made, I comfort myself with the confidence that the medicine will survive, even if the profession won’t. Happy Anniversary.

 

 

 

An Acupuncturist Looks for Balance

How do I help the greatest number of people?

The wisdom of Acupuncture/East Asian Medicine has improved my health and the health of my clients for more than two decades. Throughout that time I’ve worked with professional regulation, legislation, and our organizations, with the goal of increasing public access to the full benefits of this medicine.

My involvement in the political sphere of our profession has taken significant qi that I could have used to study the medicine, improve my technical skills, and increase my own well being.  Most days at my clinic include at least one moment when I know that with deeper study I could have provided better care.

This fall I felt that I should choose, Practitioner or Advocate? My clients weren’t getting my best. Could I find a way to support myself through advocacy and leave my practice? Would I be happier if I focused on the intellectual challenge of working toward a widely shared vision of success for the profession, and developing a path to that success? Or should I leave the advocacy work and focus on my patients? In the clinic the appreciation doesn’t carry a side order of harassment and ill will. When I treat I see the positive impact of acupuncture and Asian medicine every day.

It’s winter. I’ve been taking a break. I can’t quite follow the Nei Ching and sleep until the sun rises, but I’ve stepped back. I’ve read the communications from ACAOM and the AAAOM (and this, and this (apologies for it being post-deadline, it was hidden), followed the complaints about health insurance (what it costs, what it covers, what it pays, the work involved in getting those payments), wondered about our dry needling strategy, and pondered whether blogging about these things is “worth” the qi.

It’s still winter….

 

 

 

 

NCCAOM/Dry Needling/A Young Profession

A survey about the possibility of a new NCCAOM certificate in Facial Rejuvenation showed up a few days ago. The online conversations were a reminder that many of us are confused about the NCCAOM — what their role is, what we want their role to be , what their role “should” be.  The topic deserves its own post, but, in short, the NCCAOM is a credentialing agency. They design, administer, and maintain the process by which most of us are able to be licensed.  There are loads of consequences of their power within our profession, especially because we have not had, for some time, a truly effective or well-functioning national professional association.

There were many complaints that the NCCAOM hadn’t done more to “stop dry needling.” That, combined with yesterday’s urgent petition regarding legislation on the Governor’s desk in Delaware, made we think I’ve got to try, one more time, to explain where we are with the issue and why what we’ve been doing won’t work. My post to my alumni group is out of context, but I hope still worth sharing (somewhat edited for clarity) —

Since Dry Needling is the issue that keeps coming up as a major focus for the profession, I wanted to give a little more info about the “court rulings” in our favor.

The one that received the most notice and attention was the case in Oregon regarding Chiropractors and Dry Needling.  The outcome of the case was widely misrepresented within the acupuncture community. Various stories indicated that the courts said that dry needling was acupuncture or that it had been determined that the training programs were insufficient.  This was not the case.  You can read a fuller explanation of the outcome of the case here – http://theacupunctureobserver.com/a-practical-next-step/. The gist of the ruling is that dry needling does not meet the implied definition of physiotherapy within the Oregon code.

Other states have also had rulings (usually informal) from the Attorneys General stating that dry needling is not within PT scope.  These rulings have typically been much celebrated within the acupuncture community, but we haven’t been hearing what happens next.  For instance, some time ago Utah was celebrating such a ruling.  Since that time, legislation added dry needling to the scope of physical therapists.  Similar legislation passed in Arizona.  When the AG recently ruled that dry needling was not within PT scope in Tennessee, the ruling included phrasing that basically said, PT’s will need to address this legislatively, as was done in Utah.  (You can get the link to the ruling here — http://theacupunctureobserver.com/late-july-acupuncture-news/).  Illinois is another state where the AG’s latest opinion agreed with the argument that dry needling was not within PT scope, but where the PT groups are already preparing legislation for the next session.

There will probably be states where the acupuncture community is large enough and well-connected enough (and Maryland might well be one) where similar legislation would not be successful, but if you look at the numbers in most states, the PT’s (who also often have business connections with the medical establishment) are likely to prevail.

Today I received a notice of a petition regarding DE HB 359, adding dry needling to the scope of PT’s in Delaware.  HB 359 passed by overwhelming majorities in the House and Senate and needs only the Governor’s signature.  Among the “gems” in the petition – “Accordingly, HB 359 will potentially place the general public in significant danger of injury and harm due to unsafe and unqualified needle practices.”  There are about 800 PT’s in DE, and even more PT Assistants.  There are 45 LAcs.  The odds of the Governor exercising his veto are slim, the odds of pissing off 800 PT’s?  Pretty good, considering we’ve just stated they are putting the public in significant danger.  Interestingly, one of the authors of this petition is the same person who pushed for the requirement of the NCCAOM OM credential in DE, putting practice off limits to about 70% of US acupuncturists.  Isn’t it ironic that the profession’s self-imposed restrictions on licensure in Delaware have left the LAcs scrambling to block action by an overwhelmingly larger group?

Had LAcs been more willing to work with the PT’s from the start, I suspect that in many jurisdictions we’d have come out ahead.  We’d have built relationships and understanding and had some influence, perhaps, on how this modality is practiced.  By sending PT’s to the legislative fix (that’s what “we” said right from the beginning – if they want to do this they should do it legislatively) we’ve taken ourselves out of the process.  As they succeed with changing the law we’ve lost any influence on the procedure.

Of course, trying to work together might not have changed anything.  Professions (including our own) are universally unhappy about outsiders coming in to tell them what they should do and how they should do it.

I will add three things in response to the previous post.  1) While I appreciate the frustration felt by LAcs when dry needling and acupuncture are spoken about as being equivalent, hasn’t it been our insistence that dry needling IS acupuncture that led to this? Wouldn’t we be better served by clarifying the distinction between the two? (Of course, that would undermine our argument that we have a right to regulate the procedure.)  2) There are many cases of patients not wanting to report harm suffered at the hands of providers.  This happens among acupuncture patients too. Even LAcs can cause a pneumothorax.  3) The cease and desist orders can’t help but remind me of the stories from decades ago of acupuncturists being threatened with arrest for practicing medicine without a license.

It hasn’t taken long for us to go from being the scrappy upstarts just wanting to help people with a simple technique, and frustrated by the establishment that was trying to shut us down, to acting like the establishment.  We’ve got our ever-increasing credentials, and maybe specialties soon, and are increasingly able to participate in the bureaucratic system of figuring out which set of codes gets us a reimbursement we can live with. Now, in Maryland, LAcs can interfere with a citizen’s ability to choose what treatments they get from which providers, and can throw their weight around in the provider community.

PT’s will outnumber us for a long time to come.  It’s a shame we’ve pissed in that particular well.