To best follow along with this report, please download a copy of the draft of the proposed code changes here. You can see the current code here.
I know this is long, but these are the notes I took during the meeting and I wanted to get this information out right away. I’m notating 5.5 hours of talk, so it takes a few pages. I can’t spoon feed you everything! - JK! ;-)
Download a pdf to read offline here.
Another way to keep up with all this information: please consider attending my monthly Massage Mastermind meetings in West Seattle. I will relate the most recent updates, people will ask questions, we will all brainstorm how to be a bigger part of this process, as well as how to modify our current practices to prepare for some of these changes. It’s way fun and there are snacks! Next one is scheduled for September 29th at 6:30pm.
Board of Massage Business Meeting 09-11-2015
Discussed license transfer credentialing process - proposed using the MBLEx or national test and certain minimum number of hours for training, plus certain amount of time in practice with license in good standing. This went over well with the Board and the audience and this text will likely be added to the code.
246-830-035 : licensing without examination
This section will be changed to "licensure by endorsement" and completely re-written for next meeting to include details listed above. The goal is to remove the wording that applicants must attend a WA Board approved school, because we live in a big world with more massage schools than the Board could ever review, so maybe it’s a little short sited to require every therapist moving to Washington attend a school in Washington before they can work here and earn a living.
246-830-201 : scope of examination
Discussion of limiting the number of times a student can re-take the exam. There is concern because people are taking the test multiple times to steal the exam questions. In some cases the same person repeated the test over a dozen times! I had no idea that stealing exam questions pays that well. I’m in the wrong business. Also the Federation of State Massage Therapy Boards (FSMTB) is proposing a max limit because their studies show that a person failing a test 6 times will never pass it (USMLE test for medical doctors, as well as physical therapy licensing exam both have a max number of retakes). They are going to wait to see what happens at the next FSMTB meeting month and draft for next meeting a new policy. This will most likely state that the student must return to school to repeat remedial training after 3 failed attempts, then bar the student from practicing after 6 failed attempts. It was also proposed to have a certain minimum passing grade to re-take the exam.
246-830-420 : approval of massage school apprenticeship program
Discussion of creating a minimum ratio of number of instructors to students and the minimum level of experience, similar to the 3 years of expertise required for teaching continuing ed. They will defer to suggestions from Washington Workforce for these guidelines. WA Workforce will be invited to the next meeting. You will begin to notice a pattern of deferring to other organizations if you stay tuned.
246-830-xxx : denial or withdrawal of approval for a massage program
Again, concern about fraud. In some cases students were found to be not actually completing the class hours that the school said they did, but passing them anyway. Proposed adding an auditing procedure to review a school's records to verify they are not pushing students through or allowing a fake transcript. This would require the board to delineate exactly what records they want the schools to have on file. This will be a new section called “auditing".
246-830-xxx : reinstatement of approval for a massage or apprenticeship program
Discussion to clarify the difference between approval lapsing due to being late to submit renewal paperwork, versus if the approval was revoked. Language is obviously unclear, because the Board spent 10 minutes discussing what it meant, changing their minds, and then realizing they really weren’t sure what was intended in the first place. There needs also to be a process for an investigation if there is complaint, versus a site review as part of the school approval process. Language needs to change to clarify remedying deficiencies vs revocation of approved status. This will go back to legal counsel to rework.
246-830-xxx : appeal rights
This section will be moved above the reinstatement section
246-830-430 : training
(2D) no more than 8 hours of training per day or maximum number of massages performed per day. Discussion to review this requirement with WA Workforce. Likely will change to no more than 8 hrs in a given day and no more than 5 days in a given week.
(2F) no more than ??? Hours of online training: this will be deferred to public comment from school owners as to what would work for them. Guidelines will likely include a maximum number of online hours allowed and what topics of study will be eligible. The Board is really hesitant to allow any online curriculum. I am having a hard time not being a bigoted age-ist here. Yes, massage therapy is a hands on profession, but I don’t need to sit in a classroom to learn about the contents of a cell or the hormones secreted by the pituitary. It could benefit the schools and the students to be able to utilize some video lectures online in the curriculum. Reduce some fossil fuel emissions, hug some trees, rinse and repeat.
(3) text added "the curriculum in massage therapy must include at least the following."
(3a)This used to be 130 hours of anatomy, physiology and kinesiology. Lengthy discussion to now make this say Will now say ninety hours A&P and 40 hours kinesiology. Any previously approved school will stay approved and have to meet this requirement at their next recertification date.
(3c) 265 hours will be reduced to 215 and a new, separate subsection (3d) will likely be created requiring minimum 50 hours of student clinic, which is overseen by faculty (not just anyone) and has a certain minimum ratio of instructors to students (discussed previously). Of course, there is no mention at any point during this discussion, nor at previous meetings, of actually amending any of this language to be greater than 500 hours of training. I can hear steam coming out of the ears of my colleagues, but they keep their cool and I am proud of them.
(4) English language proficiency requirements may be needed because there are practitioners being brought under investigation and legal counsel is having to provide interpreters for them. This is expensive for the State. Also, some concern that these practitioners can't communicate with other health care practitioners and could be a safety risk. And frequently diploma mills are issuing fake certificates to immigrants who are being sold into brothels. This could potentially help reduce this. Requiring TOEFL was discussed. Also was discussed how to word this without being discriminatory. The word “profiling” was bandied about with much concern. Will possibly put this requirement into the school approval process requirement, and put the onus on the schools to review students for proficiency. You could palpate the indignation in the room when they suggested that one!
246-830-440 : curriculum - academic standard - faculty student clinic
Possibly include reference to an instructor-student ratio at this section (clearly there needs to be some consolidation around this, since there is reference to it in three different sections).
246-830-475 : continuing education
(B) discussion on removing the CPR requirements to move to the license renewal section, so going forward, a CPR class would no longer count toward the 24 total hours. If you have let your CPR card expire, best start looking into renewing it. The Board is not going to budge on this.
246-830-xxx : equipment
The reflexology group thoroughly re-worked these last year, so the Board will refer to their language and put that in here.
246-830-xxx : hygiene
No changes. This section is important though, as I have seen this happen at many places (though I would never, ahem, be guilty of this myself, ahem.) “Impervious material must cover, full length, all massage tables or pads, directly under fresh sheets and linens or disposable paper sheets.” That means that there needs to be something plastic-ish between the sheet and the fluffy lambs wool thing. Unless you are washing the fluffy lambs wool thing between every client. oops.
246-830-xxx : scope of practice
(1a) Gluteal cleft, below tip of cleft, anus and rectum; NOTE: I made a comment that this line has an error and should read "Gluteal cleft below tip of coccyx, anus and rectum;
246-830-xxx : breast massage
246-830-xxx : draping
These areas were skipped as they had been discussed in detail during the Jan 9 and March 6 meetings. Not to my satisfaction, but nobody asked me. More on this in the public comment section.
246-830-xxx : recordkeeping
Discussion to make record keeping exceptions for brief chair massages. It did not go over well with the Board.
Public Comment is supposed to happen now, but the discussion has gone over time and one of the Board members needs to leave early, so the school reviewed two states to see if they would meet WA State requirements to be eligible for license transfer here. There was some disagreement here about Roberts Rules of Order. Then they decided to move Public Comment until after lunch. They clearly need to eat if they are arguing about Roberts Rules, because nobody with healthy blood sugar cares about this. This schedule change is unfortunate, though, because not everyone could stay that long and some public attendees had to leave.
I had the opportunity to speak with some of the therapists and massage school owners in attendance. The repeated theme was that therapists are trying very hard to have input in this process and are not seeing ANY response from the comments they are submitting in writing or in person at the meeting. In essence, suggestions are being made repeatedly, but they are not showing up in the Board’s discussion, nor in the draft itself. What gives?
The overwhelming message from the public is they are NOT happy with the procedure for reviewing the draft and the public feels excluded. The most recent draft of the code is not being released to attendees, there is NO detail as to which sections of the code will be discussed or not discussed during the meeting, and there is NO response to letters mailed and emailed with comments, questions and suggestions. The gestalt is that there is a huge lack of TRANSPARENCY in this process. There is no listing on the Massage Therapist page of the DOH website that all these huge changes are under way. At one point the Board reveals that there is a place on the website to make comments on the current draft (!!!!!). No one in the audience is aware of this and wants to know more. One of the Board members doesn’t think it is necessary for the Board to “spoon feed” us this information. Snap! I get on my tablet and spend 10 minutes searching for this comment section on the interwebs. Can’t find it. Spent another 20 minutes at home looking for it. Can’t find it. I have emailed the Board asking for the link and will share it when I have it.
In that vein, public attendees offered to host Town Hall type meetings or panels that the Board members would be encouraged to attend. (Or you could attend my Mastermind. Just sayin’.) The hope is that this would help therapists understand the proposed changes and possibly suggest other avenues for change that would work better for therapists and for the public. If the Board explained some of its rational for these changes, maybe therapists would get behind it instead of getting adversarial. (There is definitely some heat behind some of the comments made, so this is no small point. If this process is going to last at least another SIX months, we better all stay friendly.)
The breast massage section needs to include a reference to wellness, as opposed to only allowing breast massage for a "medical condition”. I see heads nod on the Board, but I don’t see where this turns into any change in the draft code, or where it will show up on the next agenda. I have stated at a previous meeting, and submitted in writing that the training requirements to perform breast massage should be better delineated. Another public member made a similar comment. I have no indication that this suggestion will make it into the draft. But I will persevere….
There was considerable concern about the record keeping requirements. Particularly, who owns the records and is responsible for maintenance? Many therapists are independent contractors and are hired to work at companies on site. Does the company or the therapist need to maintain these records? If a therapist is employed at a clinic, who is responsible for those records if the therapist leaves that job? Another significant concern was to how it would be possible at a large public event to track all of these records? It seems largely untenable. If there isn’t some sort of give on this, therapists are not going to be volunteering to give chair massages at charity events. It will be too time consuming to get all this paperwork together and maintain it afterwards. One public attendee had a BRILLIANT suggestion: she maintains her chair massage records by date of event, as opposed to alphabetically. That way she doesn’t have 3 million manila folders with one half-sheet of paper in them.
The draping section with consent for undraping is confusing. It was suggested to consider putting part of this in the record keeping section, to include a requirement for a written consent that delineates certain draping borders that will be utilized during treatment. People again mentioned that draping male chests seems ludicrous. The Board is seriously attached to this one though and feels they have discussed it enough. I was there when they discussed it and I still don’t quite get it.
Multiple public attendees expressed desire to have the minimum hours required for massage training to be increased from 500 to 625 hours. The majority of states in the US have adopted training requirements that are higher than 500 hours and Washington is now behind the times.
This is where the magic happens!! The Board members finally explain that the primary objective of the code is to protect the public safety and reduce the cost of investigations. That’s it. So if you have a concern about any of the proposed changes and you cannot make an argument that it will save money or help protect the public, you will not be heard. Public attendees begin to site multiple examples of how the increase in required hours will benefit public safety. This includes a suggestion that more professional conduct teaching as part of primary training would reduce public complaints and investigations. I feel like someone has just handed me the Rosetta Stone to bureaucromancy. Public comment section is over. The meeting continues, but my allergy to stale hot air can no longer be remedied with eye rolling and I make my escape.
If you are excited, confused, scared, fired up, nauseous from all this information- do consider attending my monthly Massage Mastermind meetings in West Seattle. I was serious about the fun and the snacks! Click here to register.
submitted by Aubrey Lesicki, BS, LMP, (c) 2015