THE SENATE

S.B. NO.

2225

THIRTIETH LEGISLATURE, 2020

 

STATE OF HAWAII

 

 

 

 

 

 

A BILL FOR AN ACT

 

 

relating to the physical therapy practice act.

 

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

 


     SECTION 1.  The legislature finds that the Physical Therapy Practice Act was established in 1985, when health care focused on the curing of illness.  Since that time, health care has evolved to a greater focus on the overall wellness and prevention of illness and disability with the growth of evidence-based treatment intervention options for patients.

     The legislature further finds that dry needling is a therapeutic intervention tool that is used in conjunction with other physical therapy interventions in order to improve pain control, decrease muscle tension, accelerate active rehabilitation, facilitate normal movement, and return to function for overall better quality of life.  Dry needling is recognized by the American Physical Therapy Association, American Academy of Orthopaedic Manual Physical Therapists, and Federation of State Boards of Physical Therapists and has been utilized effectively to treat neuromuscular pain in specific populations, such as acute and overuse sport injuries, post-operative rehabilitative care, chronic pain, opioid dependence, work restrictions, and disability.

     Dry needling is allowed in all but seven states, including Hawaii.  Physical therapists practicing dry needling in federal facilities in Hawaii, as well as across the nation, have patients who have benefited from its use.  However, civilian patients in Hawaii are denied access and choice of dry needling care from a physical therapist when appropriate.

     The legislature also finds that the American Physical Therapy Association endorses the professional liability insurance administered by the Healthcare Providers Service Organization and underwritten by American Casualty Company of Reading, Pennsylvania, a CNA company.  A review of a CNA claim database from 2012 to 2017 reveals that of the total of 3,413 physical therapist claims, there were only thirty-four physical therapy claims related to dry needling reported, representing less than one per cent of the total amount of claims against physical therapists and a total loss incurred of $341,290.

     The legislature further finds that the Federation of State Boards of Physical Therapy is an organization made up of fifty-three physical therapy jurisdictions within the United States.  The Federation of State Boards of Physical Therapy upholds a mission to protect the public by providing leadership that promotes safe and competent physical therapy services, including administration and maintenance of an examination, licensure, and disciplinary database.

     The Federation of State Boards of Physical Therapy commissioned the Human Resources Research Organization for the July 10, 2015, practice analysis of the competencies required of physical therapists to perform dry needling.  These competencies can provide a strong foundation of professional standards, including education and training requirements and practice assessment, management, and regulation.  In this practice analysis, the specific definition of competency, in terms of a physical therapist performing dry needling, was determined to be safe and effective for the patient and the physical therapist.  The practice analysis further determined that eighty-six per cent of the knowledge requirements for dry needling competency is acquired during physical therapy basic entry level education and consists of knowledge related to evaluation, assessment, diagnosis, and plan of care development.  Furthermore, the remaining fourteen per cent, or sixteen individuals items, of knowledge requirements for dry needling competency must be acquired through post-graduate education or specialized training in dry needling.

     The legislature further finds that the Hawaii Physical Therapy Practice Act, which is codified under chapter 461J, Hawaii Revised Statutes, establishes the board of physical therapy to provide licensing requirements for physical therapists and physical therapist assistants in the interest of safeguarding life and health.  As such, the board of physical therapy is responsible for content standards of continuing competency related to the professional practice of physical therapy and patient or client management.

     Under existing law, physical therapists are prohibited from breaking or puncturing good skin integrity through surgery or injection.  This prohibition was originally intended to ensure that physical therapists do not perform surgery and medical procedures outside the scope of practice and education of physical therapists.  However, the existing law does not allow for modern techniques in physical therapy that are within the scope of physical therapy practice and education.

     Accordingly, the purpose of this Act is to clarify the scope of practice for licensed physical therapists to include the practice of dry needling.

     SECTION 2.  Section 461J-1, Hawaii Revised Statutes, is amended as follows:

     1.  By adding a new definition to be appropriately inserted and to read:

     ""Dry needling" means a skilled technique performed by a physical therapist using filiform needles to penetrate the skin or underlying tissues to affect change in body structures and functions for the evaluation and management of neuromusculoskeletal conditions, pain, movement impairments, and disability."

     2.  By amending the definition of "physical therapy" or "physical therapy services" to read:

     ""Physical therapy" or "physical therapy services" means the examination, treatment, and instruction of human beings to detect, assess, prevent, correct, alleviate, and limit physical disability, bodily malfunction, pain from injury, disease, and any other physical or mental condition as performed by a physical therapist appropriately licensed under this chapter.  It includes but is not limited to:

     (1)  Administration, evaluation, modification of treatment, and instruction involving the use of physical measures, activities, and devices, for preventive and therapeutic purposes; provided that should the care or treatment given by a physical therapist or physical therapist assistant contravene treatment diagnosed or prescribed by a medical doctor, osteopath, or as determined by the board, the physical therapist shall confer with the professional regarding the manner or course of treatment in conflict and take appropriate action in the best interest of the patient; and

     (2)  The provision of consultative, educational, and other advisory services for the purpose of reducing the incidence and severity of physical disability, bodily malfunction, or pain[.], including the promotion and maintenance of fitness, health, and quality of life in all age populations."

     3.  By amending the definition of "practice of physical therapy" to read:

     ""Practice of physical therapy" includes, but is not limited to, the use of the following:

     (1)  Physical agents, such as heat, cold, water, air, sound, compression, light, electricity, and electromagnetic radiation;

     (2)  Exercise with or without devices, joint mobilization, mechanical stimulation; dry needling; biofeedback; postural drainage; traction; positioning, massage, splinting, training in locomotion, and other functional activities with or without assisting devices; and correction of posture, body mechanics, and gait;

     (3)  Tests and measurements of:  muscle strength, force, endurance, and tone; joint motion, mobility, and stability; reflexes and automatic reaction; movement skill and accuracy; sensation and perception; peripheral nerve integrity; locomotor skill, stability, and endurance; activities of daily living; cardiac, pulmonary, and vascular functions; the fit, function, and comfort of prosthetic, orthotic, and other assisting devices; posture and body mechanics; limb strength, circumference, and volume; thoracic excursion and breathing patterns; vital signs; nature and locus of pain and conditions under which pain varies; photosensitivity; and the home and work physical environments."

     SECTION 3.  Section 461J-2.5, Hawaii Revised Statutes, is amended to read as follows:

     "[[]§461J-2.5[]]  Prohibited practices.  A physical therapist shall not use invasive procedures.  For purposes of this section, an invasive procedure is the breaking or puncturing of a person's good skin integrity, for example, through surgery or injections[.], with the exception of dry needling."

     SECTION 4.  Section 461J-10.13, Hawaii Revised Statutes, is amended to read as follows:

     "[[]§461J-10.13[]]  Authorized providers of continuing competence units.  Continuing competence units shall be obtained from a provider or agency approved by the board, including but not limited to:

     (1)  Continuing education courses, including home- and self-study courses, obtained from an agency recognized by the board;

     (2)  College coursework from an educational institution accredited by the United States Department of Education or other agency recognized by the board; and

     (3)  Other competence related activities approved by the board or an agency recognized by the board[.]; provided that other competence related activities may include and reflect the following requirements for dry needling specific knowledge, as needed:

          (A)  Surface anatomy as it relates to underlying tissues, organs, and other structures, including variations in form, proportion, and anatomical landmarks;

          (B)  Emergency preparedness and response procedures related to secondary physiological effects or complications associated with dry needling;

          (C)  Emergency preparedness and response procedures related to secondary emotional effects or complications associated with dry needling;

          (D)  Standards for needle handling;

          (E)  Factors influencing safety and injury prevention;

          (F)  Personal protection procedures and techniques as related to dry needling;

          (G)  Theoretical basis for dry needling;

          (H)  Theoretical basis for combining dry needling with other interventions;

          (I)  Secondary effects or complications associated with dry needling on other systems;

          (J)  Theoretical basis of pain science, including anatomy, physiology, pathophysiology, and relation to body structures and function;

          (K)  Contraindications and precautions related to dry needling;

          (L)  Palpation techniques as related to dry needling;

          (M)  Needle insertion techniques;

          (N)  Needle manipulation techniques;

          (O)  Physiological response to dry needling; and

          (P)  Solid filament needles."

     SECTION 5.  Statutory material to be repealed is bracketed and stricken.  New statutory material is underscored.

     SECTION 6.  This Act shall take effect on July 1, 2020.

 

INTRODUCED BY:

_____________________________

 

 


 


 

Report Title:

Dry Needling; Physical Therapists; Scope of Practice

 

Description:

Clarifies the scope of practice for licensed physical therapists to include the practice of dry needling.  Expands other competence related activities to include certain dry needling specific knowledge.

 

 

 

The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.