Board of Massage Meeting Notes November 6, 2015

Washington State Department of Health

(Please reference the current proposed draft rules. What? You don't have one?? Here’s a link to the latest WAC draft rules.

To open the meeting, Dave Magby, Office Director of the Department of Investigation and Inspection, gave some explanations around draping and breast massage, focusing on informed consent and clear communication being the most important part of massage treatment. He shared great information about the types of complaints that his office receives. Complaints about draping are one of the most frequent issues brought to him. His office is hoping that more clear draping guidelines in the proposed massage rules will curb this happening. 

When asked by your strategic (if not diabolical) reporter if he felt having a prescription for massage to sensitive areas, such as the breast, would mitigate any of the complaints, he stressed that the communication and relationship between the client and practitioner is what would create the environment of trust. An order from the doctor would have little bearing. 

Next, FSMTB Government Relations Specialist, Brock Ingmire, says there will be a human trafficking task force initiated at the next Federation meeting. Polaris Project is involved with this policy creation. He also discussed how they are beefing up security around the MBLEx (Massage Board Licensing Exam). It will be a requirement in the future to submit evidence of graduation from massage school in order to sit for MBLEx. Also they want to limit the number of times the test can be retaken and the minimum amount of time between retaking the exam. Additionally, they are deciding what steps will be put in place to handle fraudulent documents submitted for licensing. It was news to this reporter as to all the ways that people were stealing test questions and obtaining licenses fraudulently. If only they used their powers for good…

The term "Model Practice Act”, short for Model Massage Therapy Practice Act, was bandied about as if one should know it's meaning. Notated for further investigation (39 pages long?!? Any volunteers to write about this?)

Brock also spoke regarding licensure by endorsement (or transferring license from another state): 

He recommended requiring evidence of proof of active practice with license in good standing, attending a certain minimum number of hours of training, and passing the MBLEx to transfer a license to Washington State. This would largely dispel the current problem of only allowing applicants from schools approved by the WA State Board of Massage to obtain licensure. 

Regarding proposed English proficiency requirements: no other medical profession requires proof of English proficiency, but some require "test of English as a foreign language" if schooling was obtained outside of the U.S.  The Board is considering establishing this  requirement, as it *may* sometimes help to prosecute illegal brothels, but care needs to be taken to make sure the Board is not overstepping any other regulatory agencies. There is definitely concern about being able to communicate with other health care professionals in English in the event of an emergency, but this must be balanced against creating an "unfriendly" (read profiling) environment. 

When asked by your dedicated (if not obsessive) reporter if there were any states with quality breast massage guidelines that WA State might model from, Brock said he only knew of Oregon as the state with any guidelinesEvery other state has a "do or don't" rule that either allows breast massage as part of the scope of practice, or excludes it. He suggested polling some Oregon massage therapists and seeing how their guidelines (enacted in 2012) are working.

Rules committee:

Discussion of limiting the number of times MBLEx can be failed without taking remedial re-education. Decision for there to be a procedure established by the board to provide the program to review re-education requirements with individual applicants after they have failed 3 attempts at testing. They would like to follow rules similar to those used by the Physical Therapy Board. 

Regarding licensure by endorsement: Florida only requires practitioners to have a license in good standing from a state that has the same minimum total training hours required, taking the national exam, and going to an appropriately approved school. The Board is leaning toward this model for Washington State.

Regarding requirement for delineating the ratio of student-to-teacher in student clinic at massage schools: WA Work Force does not have any such requirement. Per program, there have not been complaints from students about this, so they won't make the change. Also discussed that WA Work Force requires teachers to have two years minimum experience. They will leave this suggestion out of the proposed rules. 

Regarding minimum number of hours required for training increase to 625: Due to the insistence of the massage therapist community, this topic is finally on the table! The board is requesting input from the public as to their proposed break down of hours per topic of study. 

Regarding CEU and CPR requirements: the Board wants CPR recertification to be required for license renewal. The trouble is that the documentation provided by the CPR trainers does not give enough information on the certificate. It was decided that CPR classes will not fulfill continuing education requirements (currently 24 hours), but will be required for license renewal. Language will be added as to exactly what documentation must be submitted by a practitioner if a renewal is audited. 

No changes to the Breast Massage section of the rules  >:-||

Draping requirements will be largely unchanged, except adding a sentence about not unnecessarily exposing the client when they are turning over on the table. The Board is holding onto this section with both hands and two feet. Most likely the best course of remediation will be to obtain clearer guidelines as to how to document a patient's consent to undrape for clinical OR comfort reasons. 

Record keeping guidelines will remain largely the same, except to include that destruction of records must be HIPAA compliant. In this reporter’s humble opinion, this section could really use some guidelines as to what written consent should include.

Public comment: 

Many speakers were in favor of increasing the primary training hours to 625, as listed in the ELAP or Entry Level Analysis Project. The report is only 256 pages long. Piece of cake :-/

Some speakers had concerns about records keeping for massage at public events. Who is responsible for keeping these records? How could the records be securely kept at a public event? If the current guidelines are imposed at a public event (think Walk for the Cure), it is unlikely many massage therapists will volunteer to work at these events. Handling and maintaining the paperwork will be too daunting.

What got a lot of attention was a petition submitted from members of the public who disagreed with the proposed requirement to drape a man's chest the same as you would a woman's chest during treatment. There were 170 signatures. While this did not get the draping rules changed, it very clearly led to the aforementioned speakers being invited to the meeting to help educate us as to what the Board is trying to accomplish. It got the Board to listen. This is a HUGE thing. 

Acting in dual role of advocate and journalist, your courageous (if not obnoxious) reporter asked why, yet again, no changes have been made to the rules proposed for breast massage. Particularly, noting that advanced training should REALLY be required (this will help in prosecution of unsavory individuals), breast massage for wellness should be explicitly allowed, and requiring a prescription to work on the areola and nipple will NOT protect the public (see Dave Magby's response above) but rather increase health care costs and delay care. For the fourth time the Board nodded their heads and took notes. It seems to be a pattern. Sigh. 

In an effort to not bore the pants off all the public attendees, the Board is going to split its business meetings away from the Rules Committee meetings. A business teleconference (open to the Public) is going to be the first Friday of every month (to discuss schools approval, budgets, etc.) and the Rules meetings will be (mostly) the second Friday of every other month, starting Jan 15. These will be held in person and if there is any Higher Power, they will please be much shorter than previous meetings. This much bureaucracy in one dose makes ones ears bleed. 

2016 Rules Committee meeting dates:

January 15

March 11

May 13

July 8

September 9

November 4

The locations are still being determined.

Reynaldo Guajardo was voted to be the new Chair of the Board of Massage for 2016. 

FSTMB meeting report:

Reynaldo attended the Federation meeting in October. He reported that WA State seems ahead of the curve compared to other states, in regard to legislative policy and organization. Dr. Michael Plaut gave a fantastic keynote address on"Professional-Client Boundaries in Health Care: Practice, Regulation & Education.”

The Federation's Model Practice Act has been published online if anyone would like to investigate (thank you very much).

The next meeting is in Cleveland, Ohio, October 6th-8th, 2016.

In the spirit of developing consistent national guidelines for massage therapy, the Board would like to defer whenever possible to the Fstmb guidelines on testing, English proficiency requirements and most anything else that is applicable. They heart the Federation.

There is something called a "Legislative Meet Me" call that happens every Tuesday morning from 8-8:30am. Not clear what the purpose is, but definitely something to investigate. 

The budget has not been finalized by the Department of Health, so it can't be finalized for the Board. There will (hopefully) be more news on this at the next meeting. The writing on the wall, though, is that licensing fees will likely increase.

That’s the report from November 2015 meeting. Stay tuned for more updates by signing up for the Massage Your Practice newsletter.