CSOMA: California Acupuncture Board Sunset Review

[Guest guest]

more misguided BS from CSOMA. read it and weep.

 

On Jan 4, 2005, at 12:05 AM, CSOMA wrote:

 

> <call_action_alertheader-nopic.jpg>

> Greetings CSOMA Members and Collegues:

>

> CSOMA would like to take this time to wish everyone a Happy and

> Healthy New Year! We would also like to inform our members about

> recent activity CSOMA has taken in response to the Joint Committee on

> Boards, Commissions and Consumer Protection Sunset Review of the

> California Acupuncture Board. Since receiving news of this hearing and

> the content being discussed on December 22nd, 2004, the CSOMA Board of

> Directors immediately sprang into action and has been working

> diligently through the holidays to respond to the issues concerning

> California’s Licensed Acupuncturists and Oriental Medicine

> Practitioners in its relationship with the California Acupuncture

> Board. Members of the Board have engaged in numerous conversations

> with representatives of other state and national organizations such as

> AIMS, AAOM, and FAR, as well as with heads of colleges and other

> leading professionals within the state, in order to present a unified

> approach at the Joint Committee’s Sunset Review hearing on January 4,

> 2005.

>

> CSOMA has drafted a response to the issues being raised by the

> committee. Although the comments below are representative of the

> opinions of the CSOMA Board of Directors, it is our understanding that

> other organizations at the national and state level hold similar

> positions on issues concerning our scope of practice and public

> safety. Below is a copy of our written response to the Joint Committee

> on Boards, Commissions and Consumer Protection which will be presented

> at their Hearing on January 4th, 2005 in Sacramento, both verbally and

> in writing. We appreciate and encourage feedback from our members and

> hope to hear from you in person or in writing to help us understand

> your concerns.

>

> We encourage all of our members, vendor affiliates and other

> interested parties to join us and show your support by being present

> at the Hearing by the Joint Committee on Boards, Commissions and

> Consumer Protection. Details are as follows:

>

> January 4, 2005 - 9:00am

> California State Capitol Building, Room 4203

> 10th & L Streets

> Sacramento, CA

>

> We also encourage your support by contributing to our Political Action

> Committee, which will help fund lobbying efforts. Due to our limited

> financial resources, we have been without a lobbyist. Here is an

> example of how we would be better prepared to serve you should we have

> a lobbyist on retainer. Please make your donation to CSOMA and put

> “political action†in the memo line so that we can be better prepared

> to serve you. Remember, your Board is working voluntarily on your

> behalf. We appreciate your support!

>

> Response to the Joint Committee on Boards, Commissions and Consumer

> Protection Backgrounder Paper for the Hearing on January 4th, 2005 on

> the California Acupuncture Board

>

> Issue #1: Should the Board be transformed into a bureau or be fully

> reconstituted?

>

> The CSOMA board suggests that the Joint Committee on Boards,

> Commissions and Consumer Protection reconstitute CAB, although we

> acknowledge that CAB has not been functioning under the legislative

> authority it has been given. The CSOMA board agrees the CAB’s

> fundamental purpose is to protect the public.

>

> Relating to Public safety:

>

> • The CSOMA board agrees that the use of clean needles is of utmost

> importance for the safety of the public and thus we suggest that only

> disposable needles be used by Licensed Acupuncturists.

> • The CSOMA board acknowledges that CAB has also not had the use of

> a fully functioning board. How would the board function differ if it

> had a full board?

> ◦ The CSOMA board would like to point to CAB’s response to this

> question in its October 8, 2004 letter to Ms. Tara Dias of the Joint

> Committee on Boards, Commissions and Consumer Protection regarding

> Board’s Response to Additional Sunset Review Questions where on page 1

> it states:

>

> “The Board has no authority over the functions of the Governor’s

> Office, however the Board regularly provides the Governor’s office

> with the status of Board members terms, impending vacancies and quorum

> needs. In addition, in an effort to keep the appointments and

> functions of the Board at a maximum, the Board has historically worked

> directly with all administrations evaluating and running security

> checks on possible new appointees. Three new appointments were made to

> the Board towards the end of Governor Davis’ term, however, since the

> Acupuncture Board appointees are required to be confirmed by the

> Senate these appointments were held during the transition of the new

> administration and were withdrawn by Governor Schwarzenegger upon

> taking office. Since then the Board has again been working directly

> with the administration evaluating and running security and license

> checks on possible new appointments to the Board. In addition, the

> Board notified the new administration of the Department of Consumer

> Affairs, which has been working with the Governor’s office to secure

> appointments, not only for the Acupuncture Board, but also for five

> other DCA boards affected by the lack of a quorum. It is the Board’s

> understanding that the Governor’s Office is working on getting board

> vacant positions filled.â€

> • The CSOMA board is unclear as to what it means to be under the

> Bureau of Consumer Affairs and not under the Acupuncture Board. The

> CSOMA board would like clarification on this issue.

>

> Issue #2: What are the key differences between the scope of practice

> of an acupuncturist and the scope of practice of a physician? Does

> current law permit acupuncturists to act as primary care providers,

> even to the extent of diagnosing, prescribing, and referring based

> upon Western models of medicine? How should the Board educate

> potential licensees, depending upon the answers to these previous

> questions? How can the Board reconcile vast increases in educational

> requirements for new licenses while arguing that 30 hours of

> continuing education every 2 years for current licenses is adequate?

>

> As stated in Question #1, CAB’s fundamental purpose is to protect the

> public. The CSOMA board agrees with the Joint Committee on Boards,

> Commissions and Consumer Protection in that public safety is of utmost

> importance. It is this stress on public safety that has caused

> acupuncturists to need to diagnose using Western terms. This ability

> to diagnose allows the Licensed Acupuncturist to better serve the

> patient’s health, while concurrently enabling the Licensed

> Acupuncturist to recognize red flag conditions and refer patients to a

> medical doctor or other appropriate care.

>

> Further, the ability to diagnose using Western medical terminology is

> needed to communicate to other health care professionals in a

> collaborative process when treating shared patients. For the benefit

> of patient safety, Licensed Acupuncturists need to identify symptoms

> within the context of pathology and disease processes as understood in

> Western terms and to determine red flag conditions and the need for

> appropriate referral Licensed Acupuncturists are not a replacement for

> medical doctors. They represent a complementary health care practice,

> part of an integrative approach to patient care. By using Western

> medical terminology, Licensed Acupuncturists are able to communicate

> with medical doctors and patients. Quite often Licensed Acupuncturists

> are the ones who refer their patients to medical doctors for further

> evaluation and diagnosis.

>

> It has also been the experience of those Licensed Acupuncturists

> practicing within the state of California that patients are already

> seeking treatment from Licensed Acupuncturists as primary healthcare

> practitioners.

>

> Another reason that acupuncturists have been prompted to diagnose is

> due to the need for patient reimbursement from their insurance

> carrier. The use of ICD-9 codes allows patients to seek financial

> reimbursement from insurance companies, thus causing Licensed

> Acupuncturists to reinterpret their Traditional Oriental Medical

> diagnosis into Western medical terms.

>

> Oriental medicine is a distinct profession with unique and thorough

> training. The Licensing Act identifies the distinctive areas of scope

> of practice included within Oriental medicine. The ability to diagnose

> using Western terminology and principles does not interfere or compete

> with a medical doctor’s role, nor does it permit an acupuncturist to

> exceed the scope of practice defined within the Licensing Act. Medical

> doctors and acupuncturists both have important roles within the health

> care system, roles that are complementary and cooperative.

>

> The CSOMA board would also like to point out to the Joint Committee on

> Boards, Commissions and Consumer Protection that CAB has responded to

> this question in its October 8, 2004 letter to Ms. Tara Dias of the

> Joint Committee on Boards, Commissions and Consumer Protection where

> on page 4 states:

> “The Board feels it has adequately addressed this issue on Pages 18

> and 19 of the Board’s 2004 Sunset Review Report. B & P Code sections

> 4927 and 4937, in conjunction with Legal Opinion 93-11, prepared by

> Board’s legal counsel in 1993, defines acupuncture and the wide range

> of modalities to treat most common disorders and diseases. The Board

> believes the current scope of practice for a practitioner of

> acupuncture and Oriental medicine is adequate. The legislative intent

> in B & P Code Section 4926 defines an acupuncturist as individuals

> practicing acupuncture subject to regulation and control as a primary

> health care profession. B & P Code Section 4927(d) defines acupuncture

> to mean “the stimulation of certain point or points on or near the

> surface of the body by the insertion of needles to prevent or modify

> the perception of pain or to normalize physiological functions,

> including pain control, for the treatment of certain diseases or

> dysfunctions of the body and includes the techniques of

> electroacupuncture, cupping and moxibustion.†B & P Code Section 4937

> authorizes an acupuncturist to utilize Oriental medicine treatment

> modalities and procedures used to promote, maintain, and restore

> health; including the use of Oriental massage, acupressure, breathing

> techniques, exercise, heat, cold, magnets, nutrition, diet, herbs,

> plant, animal, and mineral products, and dietary supplements.

> Acupuncturists were included as primary treating physicians in the

> Workers Compensation system in 1989 and approved as a Qualified

> Medical Evaluator (QME)(Labor Code Section 3209.3(a)). Since the

> elimination of requiring a physician referral in 1979, an

> acupuncturist’s scope of practice has expanded to include diagnosis.

> Thus an acupuncturist is allowed to diagnose, prescribe and administer

> treatment in the practice of acupuncture and Oriental medicine.

>

> Legal Opinion 93-11 found that the Legislature in repealing B & P Code

> Section 2155 (i.e., eliminating the need for a physician referral as a

> precondition for treatment by an acupuncturist) (Statutes of 1979,

> Chapter 488, effective January 1, 1980) authorized acupuncturists to

> diagnose a patient’s condition prior to providing any treatment. Thus,

> although an acupuncturist is authorized to diagnose this critical

> function it is not clearly stated in the law. Since 1980

> acupuncturists have been authorized to diagnose within their current

> scope and in their daily practice. ‘Primary health care’ means a

> licensed health care provider who provides initial health care

> services to a patient and who, within the scope of their license, is

> responsible for initial diagnosis and treatment, health supervision,

> preventative health services, and referral to other health care

> providers when specialized care is indicated. As a primary health care

> professional an acupuncturist may provide comprehensive, routine and

> preventative treatments, that includes but is not limited to, TCM

> diagnosis, palliative, therapeutic and rehabilitative care. Amending

> Section 4937 would accurately reflect the current scope and practice.

> On a daily basis acupuncturists assess and diagnose patients in order

> to provide an effective and quality treatment plan.

>

> This was recognized in 2002 by the Joint Sunset Review Committee and

> the Department of Consumer Affairs in the written comments reported in

> their final recommendations regarding Issue No. 1, relating to

> continuance of regulating the profession, wherein they stated,

> “Acupuncturists diagnose, administer treatment, and prescribe various

> treatments and herbs to promote patient health.†This is further

> recognized by the Little Hoover Commission in their September 2004

> report recently released, wherein on Page ii of the Executive Summary,

> they state “clear statutory language is needed to affirm that

> consumers have direct access to acupuncturists who can diagnose

> patients using traditional Oriental techniques….â€, and again on Page v

> in Recommendation 1, wherein they state, “the scope of practice should

> include an explicit authorization to conduct traditional Oriental

> diagnosisâ€.â€

>

> The CSOMA board further agrees with the Joint Committee on Boards,

> Commissions and Consumer Protection assessment that “eliminating the

> need for a “note†from a doctor to see an acupuncturist – the

> Legislature’s clear intent – does not logically transform

> acupuncturists into a kind of cross-discipline “gatekeeperâ€

> practitioner who determine if a patient needs to see another kind of

> practitioner and, if so, which type, and when.†That being said,

> patients are coming to Licensed Acupuncturists every day for general

> healthcare complaints not realizing that they should be seeing someone

> else for their health condition. In these instances when a patient

> should be seeing someone else for their health complaints, the

> acupuncturist can facilitate and coordinate appropriate care by making

> a referral to a medical doctor or other provider.

>

> The CSOMA board also concurs with the Joint Committee on Boards,

> Commissions and Consumer Protection that the potentially widespread

> use by licensees of unregulated and potentially untrained acupuncture

> assistants employing techniques that require an acupuncture license is

> completely disregarding the safety of the public at large. However, it

> is the board’s view that it should be permissible for properly trained

> acupuncture assistants to employ non-needling or other techniques

> which do not require an acupuncture license to perform, such as

> cupping, moxibustion and Oriental massage.

>

> In the LHC conclusion that “The persistent argument for raising the

> standards to 4,000 hours is based more on the comparison with

> biomedical [e.g., physician] practitioners than what is needed to

> safely practice acupuncture,†the CSOMA board does not see this to be

> true. If it is determined that Licensed Acupuncturists need to be able

> to recognize Western medical signs and symptoms to determine red flag

> conditions for public safety, then the increase (or significant

> modification) of the current educational standards are necessary

> particularly if the scope of practice is focused on traditional

> Oriental medicine within a modern medical framework for public safety.

>

> The CSOMA board would also like to acknowledge that it agrees with the

> Joint Committee on Boards, Commissions and Consumer Protection

> assessment that

>

> “Indeed, if the Board succeeds in expanding the scope of practice of

> acupuncturists to include more and more Western medical science and

> techniques, including the ability to diagnose virtually any disease or

> condition, would the Board be dissolving the difference between

> Eastern and Western medicine that makes acupuncture a unique

> alternative to so many Californians? As that line disappears, the

> argument for returning to a single, unified Medical Board to regulate

> all these medical professionals becomes much stronger, since the

> distinctions between acupuncturists and physicians become less

> significant.

>

> In contrast, preserving the distinctiveness of this medical profession

> helps to give Californians who want a truly different sort of medical

> experience a meaningful choice.â€

>

> Issue #3: How does the Board respond to specific issues of public

> safety set out in the LHC report, such as ensuring that acupuncturists

> use sterile needles?

>

> Please see question #1 for the CSOMA board’s opinion on this issue.

>

> Issue #4: The use of unlicensed acupuncture assistants.

>

> Please see the answer to question #2 on page 5.

>

> Issue #5: Under certain instances, other licensed health

> practitioners, such as physicians, podiatrists and dentists, are also

> practicing acupuncture.

>

> It is the understanding of the CSOMA board that historically CAB has

> taken a position that any reduced hour course in Oriental medicine

> taken by allopathic doctors, podiatrists, or dentists is totally

> inadequate, and that proper, adequate and complete program training in

> Oriental medicine diagnosis is essential to ensure safe and effective

> acupuncture treatment. Acupuncture and Oriental medicine should be

> restricted to those individuals who hold a valid acupuncture license.

>

> According B & P Code Section 2220.5 (a) The Medical Board of California

> is the only licensing board that is authorized to investigate or

> commence disciplinary actions relating to physicians and surgeons who

> have been issued a certificate pursuant to Section 2050 and as such

> the CAB is prohibited from taking any disciplinary action with medical

> doctors on this issue.

>

> Issue #6: The Board does not and has not had a faculty member

> appointee for two years, notwithstanding the legal requirement that

> there be one.

>

> Please refer to question #1, page 1 and 2.

>

> Issue #7: The law provides that a majority of the appointed members of

> the Board shall constitute a quorum. Vacancies continue to be a

> problem for the Board.

>

> Please refer to question #1, page 1 and 2.

>

> Issue #8: Enforcement of the Board’s continuing medical education (CE)

> program, and its ability to audit licensees to ensure compliance with

> the continuing education requirements.

>

> The CSOMA board currently holds no comment on this issue as it does

> not have enough information and history on the issue.

>

> Issue #9: Whether ACAOM’s approval process for schools used in 39

> other states is superior and less costly than the Board’s.

>

> The CSOMA board would like to point to CAB’s response to this question

> in its October 8, 2004 letter to Ms. Tara Dias of the Joint Committee

> on Boards, Commissions and Consumer Protection regarding Board’s

> Response to Little Hoover Commission’s September 2004 Findings and

> Recommendations where on page 8 and 9 it states:

> “Accreditation is not a replacement for governmental regulation.

> Public institutions receive their approval to operate through the

> state Constitution and legislative action. Accreditation is a

> voluntary, private-sector evaluation. Accrediting bodies cannot force

> institutions to comply with state and federal laws, and do not view

> their role as regulatory. There are three types of accrediting bodies,

> regional associations (e.g., the Western Association of Schools and

> Colleges [WASC]); national accrediting bodies (e.g., the Association

> of Independent Colleges and Schools, the National Association of trade

> and Technical Schools); and specialized accrediting bodies (e.g.,

> ACAOM, NOMAA, American Bar Association, National Education

> Association). The Board is opposed to naming any specific accrediting

> agency in law. If required, the legislative language should remain

> generic to recognize any school accredited by an accrediting agency

> approved by the U.S. Department of Education.

>

> National scope, practice or educational standards “do not†exist in

> this profession, which is largely due to the variance in the scope of

> practice from state to state. The spectrum is wide and diverse. For

> instance, 11 states do not license acupuncture and Oriental medicine

> practitioners, others still require a referral from an allopathic

> doctor, and some states have a limited scope of practice, while the

> profession in California has a broader scope. Therefore, at the June

> 2002 and again at the September 23, 2003 Board meeting the members

> took a position to retain the Board’s school approval process as a

> requirement for a graduate student to qualify for the CALE.

> Recognizing other approval or accrediting authorities may limit or

> compromise the Board’s ability to improve educational and approval

> standards.â€

>

> The CSOMA board agrees with CAB’s assessment of this issue.

>

> Issue #10: The Committee recommended that the Board should continue

> evaluating the National Examination, given the time, effort, and cost

> involved in providing the Board’s California-only examination.

>

> The CSOMA board currently supports the continued use of the CALE as

> the entry to the acupuncture profession over the NCCAOM exam. If it is

> determined at some later date that the NCCAOM exam has been

> significantly altered, and provides a more comprehensive and rigorous

> exam, then the CSOMA board would potentially support a move to utilize

> the NCCAOM exam in the future.

>

>  

>

> Connie Taylor

> Interim President, CSOMA.

>

> # # # # #

>

>

>

>

 

Chinese Herbs

 

 

 

 

 

 

 

 

 

 

[Guest guest]

We need our associations to get more involved like this. What do you have a

problem with?

Later

Mike W. Bowser, L Ac

 

> <

>

>cha

> Re: CSOMA: California Acupuncture Board Sunset Review

>Tue, 4 Jan 2005 10:50:40 -0800

>

>more misguided BS from CSOMA. read it and weep.

>

>On Jan 4, 2005, at 12:05 AM, CSOMA wrote:

>

> > <call_action_alertheader-nopic.jpg>

> > Greetings CSOMA Members and Collegues:

> >

> > CSOMA would like to take this time to wish everyone a Happy and

> > Healthy New Year! We would also like to inform our members about

> > recent activity CSOMA has taken in response to the Joint Committee on

> > Boards, Commissions and Consumer Protection Sunset Review of the

> > California Acupuncture Board. Since receiving news of this hearing and

> > the content being discussed on December 22nd, 2004, the CSOMA Board of

> > Directors immediately sprang into action and has been working

> > diligently through the holidays to respond to the issues concerning

> > California’s Licensed Acupuncturists and Oriental Medicine

> > Practitioners in its relationship with the California Acupuncture

> > Board. Members of the Board have engaged in numerous conversations

> > with representatives of other state and national organizations such as

> > AIMS, AAOM, and FAR, as well as with heads of colleges and other

> > leading professionals within the state, in order to present a unified

> > approach at the Joint Committee’s Sunset Review hearing on January 4,

> > 2005.

> >

> > CSOMA has drafted a response to the issues being raised by the

> > committee. Although the comments below are representative of the

> > opinions of the CSOMA Board of Directors, it is our understanding that

> > other organizations at the national and state level hold similar

> > positions on issues concerning our scope of practice and public

> > safety. Below is a copy of our written response to the Joint Committee

> > on Boards, Commissions and Consumer Protection which will be presented

> > at their Hearing on January 4th, 2005 in Sacramento, both verbally and

> > in writing. We appreciate and encourage feedback from our members and

> > hope to hear from you in person or in writing to help us understand

> > your concerns.

> >

> > We encourage all of our members, vendor affiliates and other

> > interested parties to join us and show your support by being present

> > at the Hearing by the Joint Committee on Boards, Commissions and

> > Consumer Protection. Details are as follows:

> >

> > January 4, 2005 - 9:00am

> > California State Capitol Building, Room 4203

> > 10th & L Streets

> > Sacramento, CA

> >

> > We also encourage your support by contributing to our Political Action

> > Committee, which will help fund lobbying efforts. Due to our limited

> > financial resources, we have been without a lobbyist. Here is an

> > example of how we would be better prepared to serve you should we have

> > a lobbyist on retainer. Please make your donation to CSOMA and put

> > “political action� in the memo line so that we can be better

>prepared

> > to serve you. Remember, your Board is working voluntarily on your

> > behalf. We appreciate your support!

> >

> > Response to the Joint Committee on Boards, Commissions and Consumer

> > Protection Backgrounder Paper for the Hearing on January 4th, 2005 on

> > the California Acupuncture Board

> >

> > Issue #1: Should the Board be transformed into a bureau or be fully

> > reconstituted?

> >

> > The CSOMA board suggests that the Joint Committee on Boards,

> > Commissions and Consumer Protection reconstitute CAB, although we

> > acknowledge that CAB has not been functioning under the legislative

> > authority it has been given. The CSOMA board agrees the CAB’s

> > fundamental purpose is to protect the public.

> >

> > Relating to Public safety:

> >

> > • The CSOMA board agrees that the use of clean needles is of utmost

> > importance for the safety of the public and thus we suggest that only

> > disposable needles be used by Licensed Acupuncturists.

> > • The CSOMA board acknowledges that CAB has also not had the use of

> > a fully functioning board. How would the board function differ if it

> > had a full board?

> > ◦ The CSOMA board would like to point to CAB’s response to this

> > question in its October 8, 2004 letter to Ms. Tara Dias of the Joint

> > Committee on Boards, Commissions and Consumer Protection regarding

> > Board’s Response to Additional Sunset Review Questions where on page 1

> > it states:

> >

> > “The Board has no authority over the functions of the Governor’s

> > Office, however the Board regularly provides the Governor’s office

> > with the status of Board members terms, impending vacancies and quorum

> > needs. In addition, in an effort to keep the appointments and

> > functions of the Board at a maximum, the Board has historically worked

> > directly with all administrations evaluating and running security

> > checks on possible new appointees. Three new appointments were made to

> > the Board towards the end of Governor Davis’ term, however, since the

> > Acupuncture Board appointees are required to be confirmed by the

> > Senate these appointments were held during the transition of the new

> > administration and were withdrawn by Governor Schwarzenegger upon

> > taking office. Since then the Board has again been working directly

> > with the administration evaluating and running security and license

> > checks on possible new appointments to the Board. In addition, the

> > Board notified the new administration of the Department of Consumer

> > Affairs, which has been working with the Governor’s office to secure

> > appointments, not only for the Acupuncture Board, but also for five

> > other DCA boards affected by the lack of a quorum. It is the Board’s

> > understanding that the Governor’s Office is working on getting board

> > vacant positions filled.�

> > • The CSOMA board is unclear as to what it means to be under the

> > Bureau of Consumer Affairs and not under the Acupuncture Board. The

> > CSOMA board would like clarification on this issue.

> >

> > Issue #2: What are the key differences between the scope of practice

> > of an acupuncturist and the scope of practice of a physician? Does

> > current law permit acupuncturists to act as primary care providers,

> > even to the extent of diagnosing, prescribing, and referring based

> > upon Western models of medicine? How should the Board educate

> > potential licensees, depending upon the answers to these previous

> > questions? How can the Board reconcile vast increases in educational

> > requirements for new licenses while arguing that 30 hours of

> > continuing education every 2 years for current licenses is adequate?

> >

> > As stated in Question #1, CAB’s fundamental purpose is to protect the

> > public. The CSOMA board agrees with the Joint Committee on Boards,

> > Commissions and Consumer Protection in that public safety is of utmost

> > importance. It is this stress on public safety that has caused

> > acupuncturists to need to diagnose using Western terms. This ability

> > to diagnose allows the Licensed Acupuncturist to better serve the

> > patient’s health, while concurrently enabling the Licensed

> > Acupuncturist to recognize red flag conditions and refer patients to a

> > medical doctor or other appropriate care.

> >

> > Further, the ability to diagnose using Western medical terminology is

> > needed to communicate to other health care professionals in a

> > collaborative process when treating shared patients. For the benefit

> > of patient safety, Licensed Acupuncturists need to identify symptoms

> > within the context of pathology and disease processes as understood in

> > Western terms and to determine red flag conditions and the need for

> > appropriate referral Licensed Acupuncturists are not a replacement for

> > medical doctors. They represent a complementary health care practice,

> > part of an integrative approach to patient care. By using Western

> > medical terminology, Licensed Acupuncturists are able to communicate

> > with medical doctors and patients. Quite often Licensed Acupuncturists

> > are the ones who refer their patients to medical doctors for further

> > evaluation and diagnosis.

> >

> > It has also been the experience of those Licensed Acupuncturists

> > practicing within the state of California that patients are already

> > seeking treatment from Licensed Acupuncturists as primary healthcare

> > practitioners.

> >

> > Another reason that acupuncturists have been prompted to diagnose is

> > due to the need for patient reimbursement from their insurance

> > carrier. The use of ICD-9 codes allows patients to seek financial

> > reimbursement from insurance companies, thus causing Licensed

> > Acupuncturists to reinterpret their Traditional Oriental Medical

> > diagnosis into Western medical terms.

> >

> > Oriental medicine is a distinct profession with unique and thorough

> > training. The Licensing Act identifies the distinctive areas of scope

> > of practice included within Oriental medicine. The ability to diagnose

> > using Western terminology and principles does not interfere or compete

> > with a medical doctor’s role, nor does it permit an acupuncturist to

> > exceed the scope of practice defined within the Licensing Act. Medical

> > doctors and acupuncturists both have important roles within the health

> > care system, roles that are complementary and cooperative.

> >

> > The CSOMA board would also like to point out to the Joint Committee on

> > Boards, Commissions and Consumer Protection that CAB has responded to

> > this question in its October 8, 2004 letter to Ms. Tara Dias of the

> > Joint Committee on Boards, Commissions and Consumer Protection where

> > on page 4 states:

> > “The Board feels it has adequately addressed this issue on Pages 18

> > and 19 of the Board’s 2004 Sunset Review Report. B & P Code sections

> > 4927 and 4937, in conjunction with Legal Opinion 93-11, prepared by

> > Board’s legal counsel in 1993, defines acupuncture and the wide range

> > of modalities to treat most common disorders and diseases. The Board

> > believes the current scope of practice for a practitioner of

> > acupuncture and Oriental medicine is adequate. The legislative intent

> > in B & P Code Section 4926 defines an acupuncturist as individuals

> > practicing acupuncture subject to regulation and control as a primary

> > health care profession. B & P Code Section 4927(d) defines acupuncture

> > to mean “the stimulation of certain point or points on or near the

> > surface of the body by the insertion of needles to prevent or modify

> > the perception of pain or to normalize physiological functions,

> > including pain control, for the treatment of certain diseases or

> > dysfunctions of the body and includes the techniques of

> > electroacupuncture, cupping and moxibustion.� B & P Code Section 4937

> > authorizes an acupuncturist to utilize Oriental medicine treatment

> > modalities and procedures used to promote, maintain, and restore

> > health; including the use of Oriental massage, acupressure, breathing

> > techniques, exercise, heat, cold, magnets, nutrition, diet, herbs,

> > plant, animal, and mineral products, and dietary supplements.

> > Acupuncturists were included as primary treating physicians in the

> > Workers Compensation system in 1989 and approved as a Qualified

> > Medical Evaluator (QME)(Labor Code Section 3209.3(a)). Since the

> > elimination of requiring a physician referral in 1979, an

> > acupuncturist’s scope of practice has expanded to include diagnosis.

> > Thus an acupuncturist is allowed to diagnose, prescribe and administer

> > treatment in the practice of acupuncture and Oriental medicine.

> >

> > Legal Opinion 93-11 found that the Legislature in repealing B & P Code

> > Section 2155 (i.e., eliminating the need for a physician referral as a

> > precondition for treatment by an acupuncturist) (Statutes of 1979,

> > Chapter 488, effective January 1, 1980) authorized acupuncturists to

> > diagnose a patient’s condition prior to providing any treatment. Thus,

> > although an acupuncturist is authorized to diagnose this critical

> > function it is not clearly stated in the law. Since 1980

> > acupuncturists have been authorized to diagnose within their current

> > scope and in their daily practice. ‘Primary health care’ means a

> > licensed health care provider who provides initial health care

> > services to a patient and who, within the scope of their license, is

> > responsible for initial diagnosis and treatment, health supervision,

> > preventative health services, and referral to other health care

> > providers when specialized care is indicated. As a primary health care

> > professional an acupuncturist may provide comprehensive, routine and

> > preventative treatments, that includes but is not limited to, TCM

> > diagnosis, palliative, therapeutic and rehabilitative care. Amending

> > Section 4937 would accurately reflect the current scope and practice.

> > On a daily basis acupuncturists assess and diagnose patients in order

> > to provide an effective and quality treatment plan.

> >

> > This was recognized in 2002 by the Joint Sunset Review Committee and

> > the Department of Consumer Affairs in the written comments reported in

> > their final recommendations regarding Issue No. 1, relating to

> > continuance of regulating the profession, wherein they stated,

> > “Acupuncturists diagnose, administer treatment, and prescribe various

> > treatments and herbs to promote patient health.� This is further

> > recognized by the Little Hoover Commission in their September 2004

> > report recently released, wherein on Page ii of the Executive Summary,

> > they state “clear statutory language is needed to affirm that

> > consumers have direct access to acupuncturists who can diagnose

> > patients using traditional Oriental techniques….�, and again on Page

>v

> > in Recommendation 1, wherein they state, “the scope of practice should

> > include an explicit authorization to conduct traditional Oriental

> > diagnosis�.�

> >

> > The CSOMA board further agrees with the Joint Committee on Boards,

> > Commissions and Consumer Protection assessment that “eliminating the

> > need for a “note� from a doctor to see an acupuncturist – the

> > Legislature’s clear intent – does not logically transform

> > acupuncturists into a kind of cross-discipline “gatekeeper�

> > practitioner who determine if a patient needs to see another kind of

> > practitioner and, if so, which type, and when.� That being said,

> > patients are coming to Licensed Acupuncturists every day for general

> > healthcare complaints not realizing that they should be seeing someone

> > else for their health condition. In these instances when a patient

> > should be seeing someone else for their health complaints, the

> > acupuncturist can facilitate and coordinate appropriate care by making

> > a referral to a medical doctor or other provider.

> >

> > The CSOMA board also concurs with the Joint Committee on Boards,

> > Commissions and Consumer Protection that the potentially widespread

> > use by licensees of unregulated and potentially untrained acupuncture

> > assistants employing techniques that require an acupuncture license is

> > completely disregarding the safety of the public at large. However, it

> > is the board’s view that it should be permissible for properly trained

> > acupuncture assistants to employ non-needling or other techniques

> > which do not require an acupuncture license to perform, such as

> > cupping, moxibustion and Oriental massage.

> >

> > In the LHC conclusion that “The persistent argument for raising the

> > standards to 4,000 hours is based more on the comparison with

> > biomedical [e.g., physician] practitioners than what is needed to

> > safely practice acupuncture,� the CSOMA board does not see this to be

> > true. If it is determined that Licensed Acupuncturists need to be able

> > to recognize Western medical signs and symptoms to determine red flag

> > conditions for public safety, then the increase (or significant

> > modification) of the current educational standards are necessary

> > particularly if the scope of practice is focused on traditional

> > Oriental medicine within a modern medical framework for public safety.

> >

> > The CSOMA board would also like to acknowledge that it agrees with the

> > Joint Committee on Boards, Commissions and Consumer Protection

> > assessment that

> >

> > “Indeed, if the Board succeeds in expanding the scope of practice of

> > acupuncturists to include more and more Western medical science and

> > techniques, including the ability to diagnose virtually any disease or

> > condition, would the Board be dissolving the difference between

> > Eastern and Western medicine that makes acupuncture a unique

> > alternative to so many Californians? As that line disappears, the

> > argument for returning to a single, unified Medical Board to regulate

> > all these medical professionals becomes much stronger, since the

> > distinctions between acupuncturists and physicians become less

> > significant.

> >

> > In contrast, preserving the distinctiveness of this medical profession

> > helps to give Californians who want a truly different sort of medical

> > experience a meaningful choice.�

> >

> > Issue #3: How does the Board respond to specific issues of public

> > safety set out in the LHC report, such as ensuring that acupuncturists

> > use sterile needles?

> >

> > Please see question #1 for the CSOMA board’s opinion on this issue.

> >

> > Issue #4: The use of unlicensed acupuncture assistants.

> >

> > Please see the answer to question #2 on page 5.

> >

> > Issue #5: Under certain instances, other licensed health

> > practitioners, such as physicians, podiatrists and dentists, are also

> > practicing acupuncture.

> >

> > It is the understanding of the CSOMA board that historically CAB has

> > taken a position that any reduced hour course in Oriental medicine

> > taken by allopathic doctors, podiatrists, or dentists is totally

> > inadequate, and that proper, adequate and complete program training in

> > Oriental medicine diagnosis is essential to ensure safe and effective

> > acupuncture treatment. Acupuncture and Oriental medicine should be

> > restricted to those individuals who hold a valid acupuncture license.

> >

> > According B & P Code Section 2220.5 (a) The Medical Board of California

> > is the only licensing board that is authorized to investigate or

> > commence disciplinary actions relating to physicians and surgeons who

> > have been issued a certificate pursuant to Section 2050 and as such

> > the CAB is prohibited from taking any disciplinary action with medical

> > doctors on this issue.

> >

> > Issue #6: The Board does not and has not had a faculty member

> > appointee for two years, notwithstanding the legal requirement that

> > there be one.

> >

> > Please refer to question #1, page 1 and 2.

> >

> > Issue #7: The law provides that a majority of the appointed members of

> > the Board shall constitute a quorum. Vacancies continue to be a

> > problem for the Board.

> >

> > Please refer to question #1, page 1 and 2.

> >

> > Issue #8: Enforcement of the Board’s continuing medical education (CE)

> > program, and its ability to audit licensees to ensure compliance with

> > the continuing education requirements.

> >

> > The CSOMA board currently holds no comment on this issue as it does

> > not have enough information and history on the issue.

> >

> > Issue #9: Whether ACAOM’s approval process for schools used in 39

> > other states is superior and less costly than the Board’s.

> >

> > The CSOMA board would like to point to CAB’s response to this question

> > in its October 8, 2004 letter to Ms. Tara Dias of the Joint Committee

> > on Boards, Commissions and Consumer Protection regarding Board’s

> > Response to Little Hoover Commission’s September 2004 Findings and

> > Recommendations where on page 8 and 9 it states:

> > “Accreditation is not a replacement for governmental regulation.

> > Public institutions receive their approval to operate through the

> > state Constitution and legislative action. Accreditation is a

> > voluntary, private-sector evaluation. Accrediting bodies cannot force

> > institutions to comply with state and federal laws, and do not view

> > their role as regulatory. There are three types of accrediting bodies,

> > regional associations (e.g., the Western Association of Schools and

> > Colleges [WASC]); national accrediting bodies (e.g., the Association

> > of Independent Colleges and Schools, the National Association of trade

> > and Technical Schools); and specialized accrediting bodies (e.g.,

> > ACAOM, NOMAA, American Bar Association, National Education

> > Association). The Board is opposed to naming any specific accrediting

> > agency in law. If required, the legislative language should remain

> > generic to recognize any school accredited by an accrediting agency

> > approved by the U.S. Department of Education.

> >

> > National scope, practice or educational standards “do not� exist in

> > this profession, which is largely due to the variance in the scope of

> > practice from state to state. The spectrum is wide and diverse. For

> > instance, 11 states do not license acupuncture and Oriental medicine

> > practitioners, others still require a referral from an allopathic

> > doctor, and some states have a limited scope of practice, while the

> > profession in California has a broader scope. Therefore, at the June

> > 2002 and again at the September 23, 2003 Board meeting the members

> > took a position to retain the Board’s school approval process as a

> > requirement for a graduate student to qualify for the CALE.

> > Recognizing other approval or accrediting authorities may limit or

> > compromise the Board’s ability to improve educational and approval

> > standards.�

> >

> > The CSOMA board agrees with CAB’s assessment of this issue.

> >

> > Issue #10: The Committee recommended that the Board should continue

> > evaluating the National Examination, given the time, effort, and cost

> > involved in providing the Board’s California-only examination.

> >

> > The CSOMA board currently supports the continued use of the CALE as

> > the entry to the acupuncture profession over the NCCAOM exam. If it is

> > determined at some later date that the NCCAOM exam has been

> > significantly altered, and provides a more comprehensive and rigorous

> > exam, then the CSOMA board would potentially support a move to utilize

> > the NCCAOM exam in the future.

> >

> >  

> >

> > Connie Taylor

> > Interim President, CSOMA.

> >

> > # # # # #

> >

> >

> >

> >

>

>Chinese Herbs

>

>

>

>

>

>

>

>

>

>

[Guest guest]

Does anyone know how today's hearing went?

Any info you could pass along would be most appreciated.

 

Kindest Regards,

 

Andrea Miller Anderson