ALC-Occupational Licensing Review Subcommittee
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Senator Missy Irvin
Unverified
10:00
sorry for the delay we're discussing all right we will call this meeting to order if everybody can take their seats um so i know that we have people signed up to speak and we will move through
this as rapidly as we possibly can um so last um meeting we had motions and those motions still hold unless other action is taken by this committee but we had some recommendations as it relates to the arkansas state board of acupuncture and related technologies they have on your desk members a handout the first handout is their independent comments or the second handout is their independent comments the first handout are questions answers
to questions that they have and then we also have folks from the arkansas fire protection licensing board i invited them to come to be able to give their comments and input on the motions that were made at last meeting. Now on any motions moving forward if we do have a motion at this meeting then we do contact those entities to come before us before we take action or make motions and approve them or not approve them. So that is going to be the case for items D. So we're kind of
backtracking a little bit here members so I just wanted to make those comments so that we could follow what we're doing here today um okay and with that we will move to item c which are recommendations regarding the occupational authorizations heard at our november 12th meeting that is going to be exhibit c and so with exhibit c i will remind the committee the motions and the actions taken last meeting relate to um arkansas state board of acupuncture and related
technologies acupuncturist and the recommendation was to make license optional by representative womack representative payton made that motion on his behalf because he was absent and so with that we're going to take these one at a time and with that i want to call up the folks that are related to that issue with the arkansas department of health and so we have four seats at the table because of time I'd like to bring all those individuals up that are related that are here
on that issue to come up at this time so we can hear from you and instead of going and if you will state your name for the record then I can mark you off the lists as you
Senator Missy Irvin
Unverified
13:05
the table thank you for being here with us today sit down at the table you'll press the button in front of you pull the mic down and put it right in front of your um mouth right there so we can hear you loud and clear and then you can
state your name for the record and then we'll proceed sound good okay janna brady and say who you're with just keep it on there you go
Speaker 8
13:33
vice president of the arkansas state board of acupuncture okay
Speaker 10
13:38
Kenneth Young controller with CGI okay Martin Isley
Speaker 11
13:46
with the State Board of Acupuncture okay Hayden Henningsen
Senator Missy Irvin
Unverified
14:00
of Acupuncture Matt Gilmore Department of Health all right thank you all
for being here and with that I'll let whoever wants to begin go ahead and state your comments based on the recommendation
Speaker 11
14:19
that this committee adopted Madam Chairman and committee members we have submitted through the Department of Health
which now oversees our board the comments responding to your questions and I don't know if you've had a chance to look over those but they relate to which states licensed acupuncture and have safety regulations and data from pre and post enforcing licenses and and if you want to just go
Senator Missy Irvin
Unverified
15:00
over the highlights of those
I'm sure members probably have not had the time to really read these in depth so if you want to go over the highlights of those I think that would be beneficial and tell us this is your opportunity to speak about how you feel about the motion to try to make this license optional and the pros and the cons of that the benefits that you see of doing that or not doing that so this is your opportunity to let
Speaker 11
15:31
us hear from you well we understand what the committee is trying to do we just think that the information should be
pertinent to the committee here and I think Jan and Brady will take the questions that were submitted the answers submitted to your questions and then I'll talk a little bit about the safety aspects of acupuncture okay
Speaker 24
15:53
go ahead okay so for number one the states without licensing there was some things that we couldn't include there are only three states left in the United States without acupuncture licensing requirements they are Alabama Oklahoma and South Dakota currently both Oklahoma and South Dakota have bills
Oklahoma's waiting for their legislature to open, and they talked about having issues with having no recourse if an acupuncturist or someone doing acupuncture harms you in their state. They also have people like registered sex offenders and folks that should not be practicing on anyone in any form doing acupuncture. So they're trying to put an end to that, but they're just waiting for their legislative session to open. South Dakota has a license in committee review, and they expect it to clear and be assigned a bill number.
And part of the packet we gave you is kind of their quotes from their association of why they're doing it. South Dakota is moving towards licensing acupuncture because all the states around them began licensing acupuncture, and they had an influx of people who had ethical violations or criminal charges against them, people who had committed insurance fraud and could no longer have a license, all flooded South Dakota. So now they are moving towards licensing as well. As far as the injury goes, I don't know. I know we watched the last committee meeting and there was talk about possibly damaging nerves.
But the fact is there are reports. There are people gathering that data in the United States. And since 2013, there have been 11 lung punctures by people practicing acupuncture without a license across the United States. four I'm sorry four days in the hospital was the average amount of time that those people had to be in and almost all of those required surgical intervention there's also been cases of injury to the cervical spinal cord thoracic spinal cord injuries to nerves that require medication for the rest of their life there's been reports too
of people practicing acupuncture without a license that have caused deep infections that require intravenous you know antibiotics and time in the hospital so there's a lot there is documentation about this how you know people without a license like damage and do serious physical harm another thing that we didn't get to answer in those questions that doesn't pertain so much to public health and public safety is the fact that acupuncturists work with insurance companies there are many insurances that now cover acupuncture and to work with
insurance or to be contracted with insurance, you must be credentialed. And part of that credentialing process is keeping an active license on file with each insurance company. The same goes for the VA. The VA requires we keep an active state acupuncture license on file. Since around 2014 or 2015, the VA has been using acupuncture and other modalities beyond addictive opiates in order to manage the veteran's pain. And a lot of veterans now utilize acupuncture as their primary source of pain management.
So to get rid of licensing or to even make it optional would make it harder for people to use the plans that they have with their insurance, and it would also make it impossible for us to do business. It really hinders our ability to do business. Also, acupuncture is an invasive medical procedure. Our needles are regulated by the FDA, and because of that regulation, above the board medical supply companies require that you keep an active license. Now, anyone in here could go out and find acupuncture needles somewhere on the internet
and buy them from some shady third party, but that's not how we should have to acquire our medical instruments. We need to have the licenses in order to be able to buy the medical equipment that we need and so that we can actually do business and provide the health care
Speaker 26
19:41
services that we offer. I don't know what
Speaker 11
19:49
else I have to say, so I'm going to turn it over to someone else. so I'd like to cover the kind of the safety aspects and the reasoning for our licensing and one of the biggest factors for being licensed is the education required as licensed acupuncturists
in Arkansas were required to have four years of education which includes 800 hours of supervised clinical education which is more than any other type of acupuncture training Arkansas has the highest standards of acupuncture training in the U.S. Most of the states, like Jana said, there's only three states left that don't license acupunctures, and almost all of those follow the National Certification Commission for Acupuncture and Oriental Medicine training, which requires the four-year training. So the
trend is to license acupunctures with the highest level of training. What this education requires is and it's the outline that I've given you in your supplement there it's a one is the clean needle technique and it's a training course on how to handle needles prior to insertion how to handle the patients and the needles and the post insertion disposal and keeping a clean needle environment needle depth and angle of insertion I know that a few of you have
had acupuncture, but if you've never had acupuncture, experiencing things, you might think, well, oh, you're just going to stick a needle into a muscle and see if it gets results. That's not quite correct. All the education requires detailed training on the depth of insertion, because if I stick a needle in your arm, there's nerves, arteries, that kind of thing, but if I stick a needle in your torso, it's going to be a little bit more critical because the organs.
So we train with how deep to go and depth. It changes per person. So if you have a very thin person or a younger person, it's going to be different than if you have a larger person or a more muscular person. The angle of insertion, which angle to put it in above which organ or which artery or any of those vital points. And then any of those injuries, as Janice said, can be disabling or permanent.
We're also taught the contraindications and the cautions with different types of patients with various medical conditions, medications, restrictions. Certain points are prohibited in pregnancy. So if you have an unlicensed acupuncturist treating a pregnant person, how are they going to know which points to stick? Also, will they know not to stick needles around the abdomen when the person is pregnant? Electrical stimulation, which is a common technique with acupuncture and physical therapy too,
is prohibited in people with pacemakers. If you don't have the proper education, people might not know that. Certain points and techniques are prohibited on weak patients. These are just some examples of the training required to do this invasive technique. We're trained in knowledge of emergency procedures from simple bleeding and hematomas to fainting, dizziness, nausea, and, you know, when to call 911, right? We're also trained in knowing when to refer patients.
I refer patients all the time. I send a lot of patients out to physical therapy. I send them to orthopedics. I send them to neurosurgeons. I send them to psych counseling and I send them to the emergency room because we know that certain patients either don't need to be in our office or they also need certain other tests, right? Regulatory oversight, what our board does with the licensing is we require CPR training. We require the level of education that I mentioned with the four years and 800-plus hours of supervised clinical practice
plus continuing education. For every two years, we require 24 hours of continuing education in related acupuncture arts. We also look at the background history of applicants, and we also will look at violations. The settings in which patients come in are very intimate, and so we need to look at the background of certain people. I have some pictures here
I kind of want to show there's a common technique that we do it's called cupping which is just basically a suction cup physical therapists use it and massage therapists use it now and it's a common technique for acupuncture it's not always used but it is common I'm going to show you these pictures these are out of China but this is just an example what you can do to a patient that with no training so this is a picture of cupping or the suction cup
where these people put the same cups on the same point every day for a month right sometimes we use alcohol to create the suction which creates a flame and there's can be some burning either within the cup area or if you're not careful you can create burns all around the cupping area and that's just the simple non-invasive part of acupuncture so we believe that the licensure equates
to education and education or training and safety of the patients and we think that is critical for the citizens of Arkansas beyond the insurance issues and the availability for certain patients and veterans to get acupuncture thank you go ahead I think
Speaker 14
25:54
my colleagues covered everything really well the last thing I'll add is on the public public safety perspective I work we work really
closely with primary care physicians we even have one in our practice and with With public safety in general, frequency of contact is very helpful for keeping us healthy and beginning treatment for beginning diseases, for new diseases. So what we talk about a lot with our referring physicians is because we have such an in-depth interview process, we often see things before a PCP will, and the nature of the therapy
relies on somewhat frequent contact during a treatment plan or a period of treatment. So like Martin was saying, we have a special ability to be able to spot things before they become real serious problems and refer them to any other healthcare professionals that need to evaluate that patient. In that sense, because of our really stringent biomedical training that we do throughout our four- or five-year education, we're another set of really trained eyes to look at patients and make sure they're getting healthier from the problem that they present with but also if anything
else is coming up for them health wise that they're getting adequate care thank you
Speaker 11
27:15
thank you and just just one more thing the flip side of that is probably in my personal practice about 70 at least 70 percent of the patients come to me from the western medical side everybody wants to go their doctor first they want to have their insurance pay pay for it so they're coming to me because they weren't able to get help through the normal western medicine channels like i said i still work with the western medicine folks i get those referrals but when they come to acupuncture
a lot of the times it will help and it's sort of i can't tell you how many people say i come
Senator Missy Irvin
Unverified
27:50
to you as a last resort so thank you all right did you want to make some
Chair
Unverified
28:00
comments or mr gilmore no we just wanted to
Representative Bruce Cozart
Unverified
28:03
let the board okay all right representative Cozart you recognized for a question thank
you madam chair I've got two if you don't mind sure I think it'll be that way so I'm hearing you talk about education is
very important in this business and I believe it is and I believe that relates back to the public health and safety issue of how that this is done and I I know I have a friend of mine in Hot Springs that also has a daughter that does this. And if you do this wrong, you can create some really bad problems. So what I'm hearing from you is that this needs to stay as a license and because of the public health and safety type situation and along with other things that if somebody just walked in off the street
and started doing this, they would not know the proper procedures and the proper handling of the tools that it takes to do this. Am I
Speaker 14
28:59
correct? Yes, sir, you are correct. And since it's primarily driven by the skill of the practitioner, it's not an overly complicated procedure. You have relatively simple tools, but the training of how to handle each specific patient, each specific condition is highly nuanced. Even if you have 20 patients with the same complaint, you would handle them really differently
based on the training and your experience. And, you know, Martin showed us a lot of significant injuries that can happen, and Jana mentioned some other ones. I'll mention even beyond those emergent conditions, there's a lot of subacute injury that can happen, worsening of conditions, exacerbation of symptoms, things that you wouldn't go to the ER for or maybe report to a licensing board, but that are clearly medically harmful in a less dramatic way, and it comes down to education. You're right in your statement, sir.
Representative Bruce Cozart
Unverified
29:51
So you do take, when a patient comes in, you do paperwork, background, all the things on them before you ever start so you know their
Speaker 14
29:59
history. I assume my colleague's process is similar, but we spend about 90 minutes to two hours getting to know our patients, their full medical history, their reason for coming in, and then a whole host of examination that we're specially trained to do. So before I even approach a patient, I tell them we're not going to determine what techniques are appropriate until we know your health history where you are and then what your goals are and
then we determine what to do whether that's cupping acupuncture or a whole host of other secondary therapies that are part of the medicine so we don't just hand out acupuncture we really want to treat the person and that's for their safety but also for their
Representative Bruce Cozart
Unverified
30:38
benefit yeah thank you thank you madam chair I have a quick question
Senator Missy Irvin
Unverified
30:43
from what I hear heard just wanted to verify so the license itself provides for this is what I hear number one insurance credentialing is that correct number two purchase of medical equipment particularly needles so you have to have a
license in order to purchase those needles is that correct from durable medical equipment companies is that correct that's correct and then three safety
background checks is that correct you do background checks for the licensees is that correct yes and we make
Speaker 24
31:10
sure that as the licensing board we make sure that everyone's maintaining everyone who is licensed in the state maintain their CPR certification the health care provider CPR certification we make sure that they're doing their continuing education and that
Senator Missy Irvin
Unverified
31:23
was my number four yeah verification of initial
education and ongoing education right and also speaking to his
Speaker 24
31:29
question I just want to add because we do take medical history we're all bound by HIPAA and not sharing patient information and And when you start talking about people who are unlicensed doing acupuncture and gathering all this information and not really having any rules about sharing, I mean, where do they fall into HIPAA? It's just not safe. That's, first and foremost, it's just not safe for the public. And the public isn't going to sit and read all of our credentials. The 47 states regulate acupuncture.
When you look up licensed acupuncturists, you expect them, well, I mean, it's licensed acupuncturists, that, I mean, you know, people aren't going to take the time to really research our individual backgrounds. like going to Walgreens you don't research your pharmacist you know that that pharmacist whoever they are
Speaker 48
32:12
is going to have that license and we you know have we're medical providers we have the same standards
Speaker 11
32:21
or should right madam chair we we like to make one little correction we don't actually do a background check what you would think is the typical background check but we
do ask them about any sort of history you know just a questionnaire that that they provide with us and and we also require letters of support from people that know them okay as far as the HIPAA goes I'll just give you an example I had a mother daughter in my office today the daughter was telling me about one of her new issues and she says my mother who's in the other room she says she does not know about this and doesn't need to so you know we don't we want to keep
information tight with the patient there okay thank you madam
Representative Richard Womack
Unverified
33:05
chair um one I wanted to remind the committee that that motion that was made did not do away with the license in any way shape form or fashion it did not change anything to do with their license it simply made it optional and if everything they're telling us today is true and I have no reason to doubt that it's not I can't fathom why anybody would want to practice not being able to collect insurance not being able to buy the equipment they need and not doing right by their patients
without a license however the act 600 and i want to read a line of it uh let me get this open the uh the reason that we're here in this committee i want to read a couple lines of that act said it's the intent of the general assembly to determine and implement the least restrictive form of occupational authorization to protect consumers from significant and substantiated harm to public health and safety so so to me that means they have to show us when they come here a
need that somehow that their license protects the public from a significant and substantiated harm we're using the answers that they provided this committee if you do the math those 16 injuries in the last decade out of a population these these figures were on the entire population united states if you do the math there's been 16 issues out of 327.2 million people in the united states roughly and not all of those were terrible you know one or two of them i don't remember were
you know there was an infection well those things happen far more likely in pretty much any other arena in the world i mean i i i just can't fathom how you could make an argument that it's it's somehow a public health and safety issue for somebody that might want to practice without a license it just doesn't doesn't hold muster according to the to the words in the act uh you know you look at arkansas the there's 37 practitioners according testimony originally
that's point oh oh oh one two three percent of the population i mean this is not a significant issue for public health and safety thank you may i
Senator Missy Irvin
Unverified
35:21
respond yes i just want to ask a quick question before you respond one of the things you just brought up though with was hipaa
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Agenda
A. Call to Order
B. Comments by the Co-Chairs: Senator Missy Irvin and Representative Richard Womack
C. Recommendations Regarding Occupational Authorizations Heard at the November 12, 2019, Meeting [Exhibit C]
D. Recommendations Regarding Occupational Authorizations Heard at the December 18, 2019, Meeting [Exhibit D]
E. Review of Reports from Occupational Authorization Entities
F. Other Business
G. Adjournment
Documents
Speakers
Senator Missy Irvin
Unverified
Speaker 5
Speaker 8
Speaker 10
Speaker 11
Speaker 16
Speaker 24
Speaker 26
Speaker 14
Chair
Unverified
Representative Bruce Cozart
Unverified
Speaker 48
Representative Richard Womack
Unverified