Before taking a stand for or against these bills, you should actually know what's in them. That sounds simple enough and just plain common sense, but it's extremely difficult in practice to stay current with these bills. In part, this is simply a result of business as usual in the legislative process. Bills are amended frequently, sometimes quite drastically (beware the "Delete All" amendments), in nearly every hearing they go to. At times, there are so many changes floating around that no written version of the bill that is current even exists! I've seen some committee meetings where I'd swear the committee members weren't even sure what it is they were voting on.
A second big problem is that the versions of the bill in written or electronic form (including the legislature's own data base on their web site) may be days or weeks old compared to the current amended version, hence hopelessly out of date.
A third problem is that the House and Senate versions of the bills can (and most likely will) be different. Each bill before the House is given a "House File" number, while Senate bills have a "Senate File" number. For instance, the House version of the Freedom of Access bill is HF537 ("House File #537"), while the corresponding version in the Senate is SF689. If the House eventually passes one version and the Senate a different one, the differences are hammered out afterwards in a joint committee meeting (read: more amendments). See Tracking Bills through the Legislature for background information on this process. When you communicate with a Representative or Senator, it's a good idea to refer to the bill both by name and its file number, so it's perfectly clear which bill you're commenting on.
I encourage you to read the bills for yourself, instead of relying on someone else's interpretation or summary, including my own. The "legalese" is really not all that bad. If you've read a bill previously, reread the current version (they have been heavily amended). I've given links in my How to Get Bill Info section so you can research the bills yourself.
Here are my unofficial summaries of the bills (circa early Feb. 2000) we are tracking.
Caveats ("Reader Beware!")
Complementary and Alternative Health Care Freedom of Access Bill
Massage Therapists and Oriental Bodywork Therapists Registration Bill
In the interest of fairness, let me disclose the following biases on my part as an unlicensed political commentator.
House: HF537
Senate: SF689
This bill started out as a consumer protection bill and was first introduced in the House in 1999. It was an outgrowth of the grassroots work of the MN Natural Health Coalition. The current version is highly amended from the original -- much of the spirit of the original has been lost in the legislative process. Nonetheless, it represents a significant step away from the old "regulatory" mindset that's strangling the health care field, allowing consumers free access to alternative forms of care once they give their informed consent. It also frees unlicensed alternative health care practitioners from legal sanctions from existing boards or regulatory bodies for "practicing medicine without a license" under most circumstances, unless the practitioner is causing harm, violates legal or ethical standards, or engages in criminal or fraudulent behavior.
The main points of this bill include:
A wide range of healing modalities are lumped into the definition of "complementary or alternative health care practices" -- the list includes acupuncture, various kinds of massage and bodywork, herbalism and homeopathy, meditation, energy work and a whole lot more. It does not include any modality that involves surgery, X-rays, dispensing drugs or controlled substances, anything that requires puncturing the skin, or manipulation /adjustment of the joints or spine.
An "unlicensed complementary or alternative health care practitioner" (or "practitioner" for short) is someone who provides these services for pay (or represents themselves to the public as such a practitioner) and is not licensed or registered under some health-related licensing board (such as the Medical Practices Board) or the Commissioner of Health. A "client" is someone who seeks out the services of such a practitioner.
Please note: "Licensed complementary and alternative health care practitioners" (such as a licensed medical doctor that prescribes herbs) are no longer covered by the House version of this bill! All the sections of the original bill relating to licensed practitioners were removed from HF537 by amendment in the House Health and Human Services Committee meeting of 1999-3-15.
The Senate version, SF689, to my best understanding, still retains the licensed practitioner sections. I would suspect these areas will be heavily amended before SF689 gets out of committee. If contradictory versions of the House and Senate bills both pass, a joint committee will have to resolve the differences.
In order for a practitioner to legally provide his/her services to a client, the practitioner must be 18 years or older, provide the client certain disclosure information in writing, and receive written informed consent from the client prior to treatment. The disclosures include information about the practitioner (educational and training background, credentials, professional affiliations, fee schedules for services, etc.), descriptions of the treatments to be provided, their expected benefits and possible risks and side-effects. Since the practitioner is prohibited from "diagnosing diseases" (only a licensed person can do that), the client must be informed that he/she can consult a licensed practitioner at any time to receive a diagnosis. The client must sign an informed consent form acknowledging they have read the disclosures and assume all risks of choosing an alternative therapy.
Disciplinary or civil actions against the practitioner can be brought by licensing boards or other government health agencies if the evidence supports any of the following situations: lack of informed consent by the client before treatment (get those forms signed!); failure to provide proper disclosures; harm (or risk of harm in some cases) due to the treatment to the client or others. Being an unlicensed practitioner ("practicing medicine without a license") is not in itself a proof of harm (as it is under present statute). If the client delays receiving traditional medical care because they are pursuing alternative care, that is their responsibility (under informed consent) and not proof of harm.
Note:These clauses of the bill are some of the most hotly debated areas and most subject to being amended. The licensing boards consider it an infringement of their powers.
There is a long list of restrictions on unlicensed practitioners. They are prohibited from certain unethical activities (sexual conduct with clients; improper use of legend drugs or controlled substances; revealing confidential information about the client without written authorization; certain "fee splitting" arrangements). They are prohibited from practicing at all if found guilty of a serious crime (felony or gross misdemeanor) in the last 5 years or if found incompetent to practice (e.g., mentally ill or retarded, chemically dependent, dangerous to the public, a sex offender). These prohibitions can be enforced by city or county attorneys through fines of up to $10000 per violation or injunctions that limit or restrict the practitioner's right to practice.
House: HF685
Senate: SF1042
This bill was originally introduced as a "licensure" bill in 1998. It has been heavily amended and is now softened into a "voluntary registration" bill. It was removed from consideration by the House Health and Human Services Committee before being voted on in 1998, and voted down in a sub-committee of HHS in 1999.
This is not a consumer protection bill, per se (despite the rhetoric). The driving forces behind it are the massage and oriental bodywork schools (and their owners, who stand to profit under this bill), and a number of state and national organizations for massage and bodywork practitioners. This is not a consumer grassroots proposal.
The main points of this bill are as follows:
The bill first attempts to define "massage therapy" and "oriental bodywork therapy" and the practitioners of these techniques. These therapies do not include diagnosis of diseases or any manipulation/adjustments of the spine or joints. It is not necessary to register with the state to provide these services, as long as you do not imply or represent that you are a registered practitioner falsely.
Registration of massage therapists and oriental bodywork therapists is the duty of the State Board of Chiropractic Examiners ("the Board"), which will handle all the paper work, collect registration fees, and maintain public records. The Board can establish rules governing practitioners. An Advisory Council of 7 members is set up under the Chiropractic Board to handle the nitty-gritty details of registration and investigating complaints.
This is one area that has been diluted several times, from "licensure" to "registration" to "voluntary registration." This provides "title protection" for registered practitioners -- only a registered practitioner can call themselves a "(state) registered massage therapist" or "(state) registered oriental bodywork therapist." Unlike the 1999 version, you can call yourself a massage therapist if you're not licensed, as long as you don't use the protected title. Under the original 1998 licensure bill, which provides for "restricted scope of practice", an unregistered person could neither practice massage therapy or even imply they did massage -- you were effectively out of a job or went underground.
To qualify as a registered practitioner, you must: be 18 or older; have a high school diploma or equivalent; have professional liability insurance; passed certain national exams in your field; passed 500 hours of training in an approved school (or tested out); passed an exam of relevant state laws, if the Board requires it. These education requirements at "approved schools" are where the school owners stand to benefit, not too surprisingly.
Reciprocity agreements with other states or countries are possible under certain circumstances. Visiting instructors are not required to be registered in MN in order to teach here (in some states, this is illegal).
City and county governments can not require registered practitioners to obtain municipal licenses in order to practice; unregistered practitioners are not so lucky. A municipality may also require all practitioners in their jurisdiction to be state registered -- so much for "voluntary registration."
This is the "Big Brother" part of the bill that always gives me the willies.
The Board is allowed to impose disciplinary actions on state registered practitioners for a wide variety of reasons. Some examples:
The Board may direct the practitioner to undergo evaluation for mental, physical or chemical dependency problems with no rights of refusal (registration is considered to be your consent). Failure to submit to evaluations is considered an admission of guilt in most cases. The Board may also obtain your medical or health records without your consent to aid in its investigations.
Disciplinary actions include:
Registration can be suspended if the practitioner is found incompetent, is committed by a court order, or placed under a guardian under court order until found competent again. Temporary suspension of up to 60 days is possible for most allegations of improper actions.
Any person or organization that reports an improper action in good faith, and personal of the Board investigating these complaints are immune from civil or criminal liability. The accused practitioner must cooperate fully with the Board's investigation.
Certain violations of registration (such as obtaining registrations fraudulently, misuse of title protection, violating suspensions or conditions on your registration, knowingly employing a practitioner operating under a fraudulently obtained license, registration or diploma) by a person or organization is a misdemeanor. A municipality may issue a citation for such an offense.
Training requirements for massage and oriental bodywork therapists in order to be registered are written into the bill. They include 500 hours of study, with a minimum number of hours in various areas. My personal impression is that the school owners are writing their curriculum into state law (how convenient). The Board can define continuing education requirements as a condition of renewal of registration.
The "grandfather" clauses (which allow practitioners currently operating to continue under registration) have gotten much looser since 1998. In the 2000 version of HF685, you must provide notarized affidavits attesting: completion of 100 hours of training; one year's residence in Minnesota with no convictions; evidence of having an ongoing practice (there are 4 standards mentioned, of which you must meet 2). You must be 18 years or older, and provide a statement that you will abide by the Board's code of ethics. Applicants have one year to apply for registration under these grandfathering rules.
Revision date: 2000-2-23
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