Thank you for allowing me to comment.

I oppose the administrative rules on the grounds that I believe the Virginia Board of Physical Therapy does not have the statutory authority to expand a scope of practice through administrative rulemaking. In Oregon Association of Acupuncture and Oriental Medicine versus the Board of Chiropractic Examiners the court determined that dry needling was an expanded scope of practice and could not be expanded through administrative rulemaking.  In South Sound Acupuncture Association versus Kinetacore the court determined that penetrating the tissue was the practice of medicine and needed specific legislative statutory authority to perform.  The medical devices of acupuncture needles and hypodermic needles to penetrate the skin in an effort to cause a trigger point to release through a mechanical mechanism is a new and expanded scope of practice for physical therapist.  Using acupuncture needles to stimulate trigger points is a long and historical practice of acupuncture to treat local area of pain and competency is important for patient safety

All states regulate health care in an attempt to regulate the practice of medicine, each profession has what is considered to be within their defined scopes of practice.  If it is not defined within the scope of practice it is not within the scope of practice.  The argument that no one owns a particular skill or tool is possibly true.  Each profession can be defined by the skilled intervention which they have trained for thousands of hours to be competent to perform.  For Physical Therapist it is physical therapy and Acupuncturist it is acupuncture needling.  The fact that in all the years of physical therapy practice that using an acupuncture or hypodermic needle to penetrate the skin into a trigger point has not been within the defined statutory physical therapy practice is because it is NOT physical therapy. Physical Therapy/physiotherapy has never included invasive procedures in the therapeutic component of therapy and to do so would then need to be defined as an expanded scope within the physical therapist scope of practice act.  As contemporary practices evolve and as the entire healthcare workforce changes, evolving practices that expand or add new skills to their scope of practice there is a need for community involvement at the statutory level. What is currently being proposed is a new and or expanding scope of practice.  This needs an assessment by the entire healthcare workforce and approval of the legislative bodies who are responsible for regulating intrastate commerce in healthcare.

As the Board of Physical Therapist I believe that this job includes maintaining minimum standards to make sure that you protect the public and NOT expand the scope of practice to create NEW revenue sources for physical therapist.  You need to oppose this administrative expansion in scope of practice and send it to the legislative body where most states have adopted laws to deal with new and expanded scopes of practice. This is about the entire healthcare workforce and how your expansion will impact patients health care.  Who gets to decide expanded scopes?

Questions to consider regarding the expanded scope dealing directly with dry needling:

1) How will the public know which providers can practice dry needling and how are they able to determine when a Physical Therapist is practicing acupuncture?  

2) What are the grounds for discipline when a practitioner is no longer practicing dry needling?

3) What type of discipline will there be when advertising and marketing dry needling when FDA regulations states that each state by statute determines whom can use an acupuncture needle and the clear marketing of that product in truthful advertising?  When someone asks if a Physical Therapist is using an acupuncture needle the answer should be yes.  Saying you are using a filament needle is not an appropriate marketing of an acupuncture needle.

4) In regards to billing practices what will be the disciplinary action for submitting fraudulent claims using CPT code 97140 manual therapy?

5) Will there be discipline for failing to refer to an Acupuncturist when it is appropriate?

6) Will Physical Therapist be able to practice on all types of patients (for example babies, toddlers, elderly)  or ones with a specific diagnosis of trigger point pain as has been determined by a physician?  Or will Physical Therapist diagnosis the trigger points and the conditions that they are allowed to treat?

7) What will the grounds for discipline be for failing to following the limitations on practice of dry needling?  Criminal or Civil?

Any profession can expand their scopes of practice and this is clearly a new or expanded scope of practice. Minnesota Representative Tina Liebling drafted the following questions to professions who wanted new or expanding scopes of practices.  It is known that states have an invested interest in regulating intrastate commerce and healthcare. Here are some great questions the Virginia Board of Physical Therapy should have answers to for the legislative body with this proposed new and expanded scope.

1) How is the profession's scope of practice in the area of proposed change currently defined and what shortcomings are being addressed by the proposed changes?

2) Does specialized skill or training support the expansion this occupation into proposed areas of practice?  If so, what skills of training?

3) How would the public benefit by the occupations ability to practice in the new proposed areas of practice? Is there potential detriment to the public?  Who would monitor practitioners to insure high quality service?

4) Could the public effectively receive the impacted services by means other than the proposed changes to scope of practice?

5) How would the new or expanded services be compensated?  What other costs and what savings would accrue and to whom? (Eg. The state, providers, patients)

6) What, if any economic impact is foreseeable as a result of proposed change.

7) What other professions are likely to be impacted by the proposed regulatory change?

This is a copy of what the state of Minnesota requires when you want a new or expanded scope in 2014.

Your decision should be to oppose the adoption of this expanded scope which I believe is not within your statutory authority. Now I want to mirror what you are intending for reflection.

1) If the acupuncture profession said we want to expand our scope of practice to include physical therapy within our scope with 54 hours of training would that be sufficient to perform with a level of competency?  Physical therapy services should be available to any professional with appropriate background and training. 

2) Would it be appropriate to expand acupuncture practice to include the definition of physical therapy through administrative rule making or would it be appropriate to be determined and defined in statute?  Who gets to decide?

3) What impact would the expanded scope by defining physical therapy within the acupuncture practice act have on the physical therapy profession?

Using an acupuncture needle or hypodermic needle is not an entry level skill that is taught at a formal physical therapy education.   It is an advanced skilled intervention that requires a diagnosis, appropriate training in classroom and clinical skills to address safety issues related to competency in a clinical setting.  Using the administrative rulemaking process to expand the scope of physical therapy to encompass a needling technique not currently a standard to physical therapy practice is an expansion and needs statutory authority with appropriate regulation for competency and definition of what the scope of practice covers and discipline for failing community standards..  I oppose this administrative rule making as I believe it goes beyond the statutory authority granted to the Virginia Board of Physical Therapy and expands the scope of physical therapy.

These statements are my own and do not represent any professional body.  Thank you again for consideration of my comments.

Bonnie Bolash, M.Ac, L.Ac.

4060 Hampshire Ave. N.

Crystal, Mn 55427