Janice K. Brewer John M. Rhodes, P.T., L.AC., Chairman Governor Teresa A. Buechel, L.AC., Secretary

State of Arizona Acupuncture Board of Examiners

1400 West Washington, Suite 230, Phoenix, Arizona 85007 (602) 542-3095 FAX (602) 542-3093

April 24, 2014 Honorable Janice K. Brewer Governor State of Arizona 1700 W. Washington Phoenix, AZ 85007 Dear Governor Brewer: On behalf of the Acupuncture Board of Examiners I am writing to ask you to please veto SB 1154 (physical therapists; dry needling) sponsored by Senator Kelli Ward (District 5). At our meeting on Wednesday, April 23, 2014, the Board voted 6-0 to make this request of you. Our Board adopted the attached Resolution, on October 7, 2013, stating our position on the dry needling issue. This resolution was in response to numerous complaints regarding physical therapists performing dry needling. We dismissed the complaints without prejudice to allow time to attempt to find a resolution with the Physical Therapy Board and determine what if any legal options were available for our Board to act. We provided the Resolution to the Physical Therapy Board asking for a response and nothing was received. The Physical Therapy Board has since determined that dry needling was already in their scope of practice as a “therapeutic modality”. While the physical therapy community suggests that dry needling is currently part of their scope of practice as a therapeutic modality we suggest that this is not the case. If dry needling were a therapeutic modality then it would be one of the entry-level skills taught universally at all colleges of physical therapy. Evidence indicates that such universality does not presently exist In fact, according to Jim Farris, P.T., Ph.D. and Chair and Associate Professor of Physical Therapy at A.T. Still University, “Dry needling is not an entry-level skill so how to dry needle is not taught (emphasis added) in our program. We make students aware of the practice and have had an introduction to the concept of dry needling but we do not teach this skill in our program (emphasis added).” And despite assertions in public testimony by representatives of the physical therapy community that physical therapists have been doing dry needling for 30 years (later amended to 34 years) and that they all receive training for it in their core education. Representatives of the Physical Therapy Board were able to find examples of only four schools nationwide that were teaching it and none of them are in Arizona. We therefore suggest that to add dry needling to the physical therapy scope of practice would require several things. First the physical therapy community would have to go through the Sunrise Process (see ARS 32-3106). This has never been done. Secondly, and as with other practitioners who engage in the more extensive practice of acupuncture, there needs to be a statutory protocol for minimum hours of education, successful passage of a competency examination and subsequent certification (for chiropractic practice of acupuncture, for example see ARS 32-922.02). SB 1154 does not clearly meet this test.

After the bill passed the Senate Health Committee on January 23rd lobbyists for the physical therapists committed to continue to work with us on amendments that would satisfy our concerns. Shortly after the bill passed the Senate on March 3rd they informed us that they were no longer interested in working on compromise language. Before the bill went to floor debate in the House we had crafted a tentative agreement with lobbyists for the Physical Therapy Board that would have met criteria that would have satisfied the need for a statutory protocol but allowed the Physical Therapy Board to adopt the minimum hours and testing regimen through Board Rules. We accepted the latter in the spirit of compromise. Physical Therapy Board lobbyists asked Senator Ward if she would entertain the agreement and although reluctant she indicated (according to those lobbyists) that she would consider that. At a meeting on Tuesday morning April 22nd lobbyists representing the Acupuncture Board, the Physical Therapy Board, the Acupuncture Association and the Chiropractic Association came to a tentative agreement. The Physical Therapy Association demurred on this agreement. Later in the morning according to House leadership staff, and much to our collective surprise, Senator Ward told House staff that she didn’t want any amendments and that the bill should be moved without any amendments and without delay. The bill was adopted in House COW later the same morning and 3rd read later that afternoon. Allow me to make clear that our Board does not have any objection to having physical therapists engage in dry needling with the appropriate education, testing and certification. We would welcome that addition to the existing panoply of health care professionals’ services. In the interest of public health and safety and compliance with existing law that should not be done without the appropriate sunrise process and statutory protocol in place. Is it true that some physical therapists have been taught the dry needling skill in the core program of their basic training? Perhaps this is true. Is it true that some physical therapists have received supplemental training in dry needling that qualifies them to practice the technique? That is possible. But it is an incontrovertible fact that dry needling has not been universally taught to all physical therapists making it at best a supplemental specialty that requires statutory authority and protocol as a separate certification. My Board believes that there are significant public health implications of having a health care professional such as physical therapists engage in an invasive practice without clear demonstration that public health and safety is protected. My Board believes that when there is a doubt about whether a practice is in a health care professional’s scope that a sunrise process should be engaged. My Board believes that adding to scope calls for a clear statutory protocol for minimum hours of education, successful passage of a competency examination and subsequent certification even if some of the details are determined by Board rule. SB 1154 does none of these things. As such we respectfully request that you veto SB 1154. Sincerely, John M. Rhodes Chairman Enclosure