RE: NJ Legislation

[Guest guest]

Rick, it total agreement with your responses.

Liz, are you saying that veterinarians, such as myself, are not knowledgable, trained or qualified to do Veterinary Physical Rehabilitation?

Liz states "The goal of Canine Rehabilitation is, in my understanding, to develop a peer relationship"

I dedicated my life well over 12 years ago veterinary physical rehabiliation, sports medicine and pain management . In my opinion the goal (then and now) of Canine Rehablititation is to give the best veterinary medical care before, during and after injuries and surgeries for the best recovery possible for each individual patient. To provide geriatric, handicapped and other physical ill (such as cancer, chronic pain, etc) patients with on going rehabilitation care that will help improve quality of life. I do not know that it has ever been "to develop a peer relationship", but always has been focused on the best care for the veterinary patients.

Subject: NJ LegislationTo: VetRehab Date: Tuesday, June 16, 2009, 9:18 PM

Hi, I am newly in practice in Massachusetts, and have been told by one of the best surgeons and Veterinarians in this area that I will "make him look good". I consider that a big compliment to the work that PT's do. I can tell you that there is no question in my mind, having seen these dogs pre-, post-, and non-surgery, that we (physical therapists) are VERY MUCH needed by the injured and struggling canines I have seen so far. The extensive education I received in orthopedic rehabilitation; in the orientation, dynamics, and physiological structure and mechanics of every specific tendon, ligament, and muscle; the hours upon hours spent learning the neurology and its application to things that Amie Lamoreaux Hesbach teaches: proprioceptive neuromuscular facilitation; neuromuscular techniques that are very specific to functional movements; specific tools to re-educate muscles and movement patterns. These techniques

take a long time to learn, and are what has brought impaired humans back to walking, running, and climbing stairs; and they will definitely do the same for dogs. Until one works specifically with not only just the ligament repairs, but these very complex dysfunctions (stroke, spinal injury, nerve compression or injury), you cannot fully appreciate the education a physical therapist has, its specificity, and its value to healing injuries in dogs. Yes, the body is different, the biomechanics are altered; but these techniques are just as valuable and very applicable to canines when it comes to understanding movement, neuromusculoskeleta l integration in the body and central nervous system, and how to heal the various tissue structures that are injured. A meniscus is a meniscus, regardless of whether human or canine; same with a nerve and a disc. Physical Therapists are specialists, and I would

hope would have the ability (as in the human world) to offer such specific services to canine clients outside of working for a specific Veterinarian. It is only prudent for us to work with the Veterinarian, who has the best education in terms of systems, disease processes, pharmacology, and radiology for canines (we PTs receive some education in systems, pharmacology and radiology as well...kidneys, for instance, perform the same function in both species). I hope that every dog owner has access to PT services, regardless of what Vet they go to (as in the human world). We are professionals, with an incredible education in rehabilitation. There is a clinical reason why PTs are now educated as DPTs, to be called "Dr." along with Chiropractors and others. The goal of Canine Rehabilitation is, in my understanding, to develop a peer relationship. I am very grateful for the many Veterinarians and Physical

Therapists out there who are supportive of that. I am especially grateful to those who have established institutes that provide the much needed education to both disciplines, and go to great lengths to foster this relationship between both disciplines. Thank you! The dogs need both of us!

Liz Powers, MPT, CCRTPower DogCanine Rehabilitation123 Hawley St. #8Northampton, MA 01060infopowerdogrehab (DOT) com____________ _________ _________ _________ _________ _________ ___ Click to get your online credit check report score.

[Guest guest]

Hi LizCould you please clarify your description of PT's being "specialists". I am in no way discrediting your accreditation but where I am from the term "specialist" is given to those who are board certified in a specific area of medicine. I just want to be clear out of respect to our veterinary specialists. Or perhaps this is only a sensitive topic up here in Alberta! Very interesting thread! Cheers! Sent on the TELUS Mobility network with BlackBerryFrom: john sherman Date: Tue, 16 Jun 2009 18:41:26 -0700 (PDT)To: <VetRehab >Subject: Re: NJ Legislation Rick, it total agreement with your responses. Liz, are you saying that veterinarians, such as myself, are not knowledgable, trained or qualified to do Veterinary Physical Rehabilitation? Liz states "The goal of Canine Rehabilitation is, in my understanding, to develop a peer relationship" I dedicated my life well over 12 years ago veterinary physical rehabiliation, sports medicine and pain management . In my opinion the goal (then and now) of Canine Rehablititation is to give the best veterinary medical care before, during and after injuries and surgeries for the best recovery possible for each individual patient. To provide geriatric, handicapped and other physical ill (such as cancer, chronic pain, etc) patients with on going rehabilitation care that will help improve quality of life. I do not know that it has ever been "to develop a peer relationship", but always has been focused on the best care for the veterinary patients. From: Craigs List <lizwiz4juno>Subject: NJ LegislationTo: VetRehab Date: Tuesday, June 16, 2009, 9:18 PMHi, I am newly in practice in Massachusetts, and have been told by one of the best surgeons and Veterinarians in this area that I will "make him look good". I consider that a big compliment to the work that PT's do. I can tell you that there is no question in my mind, having seen these dogs pre-, post-, and non-surgery, that we (physical therapists) are VERY MUCH needed by the injured and struggling canines I have seen so far. The extensive education I received in orthopedic rehabilitation; in the orientation, dynamics, and physiological structure and mechanics of every specific tendon, ligament, and muscle; the hours upon hours spent learning the neurology and its application to things that Amie Lamoreaux Hesbach teaches: proprioceptive neuromuscular facilitation; neuromuscular techniques that are very specific to functional movements; specific tools to re-educate muscles and movement patterns. These techniques take a long time to learn, and are what has brought impaired humans back to walking, running, and climbing stairs; and they will definitely do the same for dogs. Until one works specifically with not only just the ligament repairs, but these very complex dysfunctions (stroke, spinal injury, nerve compression or injury), you cannot fully appreciate the education a physical therapist has, its specificity, and its value to healing injuries in dogs. Yes, the body is different, the biomechanics are altered; but these techniques are just as valuable and very applicable to canines when it comes to understanding movement, neuromusculoskeleta l integration in the body and central nervous system, and how to heal the various tissue structures that are injured. A meniscus is a meniscus, regardless of whether human or canine; same with a nerve and a disc. Physical Therapists are specialists, and I would hope would have the ability (as in the human world) to offer such specific services to canine clients outside of working for a specific Veterinarian. It is only prudent for us to work with the Veterinarian, who has the best education in terms of systems, disease processes, pharmacology, and radiology for canines (we PTs receive some education in systems, pharmacology and radiology as well...kidneys, for instance, perform the same function in both species). I hope that every dog owner has access to PT services, regardless of what Vet they go to (as in the human world). We are professionals, with an incredible education in rehabilitation. There is a clinical reason why PTs are now educated as DPTs, to be called "Dr." along with Chiropractors and others. The goal of Canine Rehabilitation is, in my understanding, to develop a peer relationship. I am very grateful for the many Veterinarians and Physical Therapists out there who are supportive of that. I am especially grateful to those who have established institutes that provide the much needed education to both disciplines, and go to great lengths to foster this relationship between both disciplines. Thank you! The dogs need both of us!Liz Powers, MPT, CCRTPower DogCanine Rehabilitation123 Hawley St. #8Northampton, MA 01060infopowerdogrehab (DOT) com____________ _________ _________ _________ _________ _________ ___ Click to get your online credit check report score.

[Guest guest]

Hi again.

I'm posting for on , MPT, CCRP for Tami Struessel PT, DPT,

OCS, MTC.

Amie

Here’s her reply – would you mind posting it? Not sure why mine is not

going through…??

Thanks!

Hello,

I was alerted to your interesting conversation on Physical Therapists entering

into the domain of Veterinary care and would like to make a few clarifications.

Although I do not practice with animals, I was involved in the Colorado

legislation negotiations as a representative of the Colorado Chapter of the

American Physical Therapy Association (APTA) Governmental Affairs Committee. I

am a faculty member at the University of Colorado Doctor of Physical Therapy

program. I currently sit on the Physical Therapy State Board equivalent in

Colorado called the PT Advisory Committee for the Department of Regulatory

Agencies. I do not represent any of those organizations in this email however,

this is personal opinion. I understand our final law has provoked quite a bit

of unrest amongst many veterinarians. It seems the concerns are exactly the

ones raised when we went through the legislative process and rules making

process with a group of Veterinarians and Physical Therapists last legislative

session.

1. First a clarification on POPTS (Physician Owned Physical Therapy

Services), or Referral for Profit. This has been a national issue for many

years in human healthcare. If a physician (or Vet in this case) benefits

financially from a referral, their tendency is to refer more. Plain and simple.

This has been played out in human medicine by a few studies. It applies

regardless of who is paying the bill. The issue is public protection, not payor

protection. In human medicine it is regulated because of the public protection

issue. You might be interested to read an article in the New Yorker by Atul

Gawande called The Cost Conundrum. It explains very clearly the ethical issues

inherent in referral for profit situations by using an example of the town in

America with the highest healthcare expenditures. The first thing everyone says

is that their ethics are being questioned. I am not questioning the specific

ethics of any one Veterinarian. It is human nature and is regulated by the

Stark laws in human medicine for a reason.

2. First a general statement. In human medicine, physicians used to be the

only providers. They could (and did) do everything. As the professions

knowledge grew, it became apparent in a hurry that it is impossible to do

everything, and do it well. Various healthcare professions began to develop

specializing in areas that physicians used to do exclusively. There was some

resistance, but fairly quickly, the physicians figured out that the patients

benefitted if there were experts, not just generalists, providing the care. It

seems that this evolution is just starting to occur in Veterinary medicine as

the profession begins to develop more evidence based practice and knowledge.

Vets can’t do everything and do it well any more than human physicians can.

Physical Therapists are an example of a profession who, with additional training

to specialize their knowledge and already extensive education, can provide a

quality service that no technician in a Vet’s office can provide.

3. On to the Colorado law and how it came to be. The original bill was

negotiated and written with several PT’s working with animals, and several

Vets involved in the CVMA (CO Vet Med Assoc). It essentially created a new

profession, where licensed physical therapists in Colorado would work under a

Veterinarian. There was lots of language that was duplicative of the PT Practice

Act and details that are not appropriate, nor necessary for inclusion in a bill.

The APTA opposed the bill for many reasons and would have come head to head with

other PT’s in the legislature. That would not have been a good situation for

anyone. The most significant issue was that we are a profession. We are

educated and licensed. The Medical Board in Colorado in 2005 wrote a letter

that explains that, as professionals, a physical therapist who is providing

services within the scope of their license is not subject to delegation or

supervision by a physician. We do not require any sort of referral to see a

human patient, nor with the new law an animal patient. In my human practice, if

I have a referral, it is generic and 95% of the time, says evaluate and treat.

Physicians understand that they are not the experts in PT anymore than I am an

expert in gall bladder surgery or medical managment of diabetes.

4. More on the bill. Creating a seperate profession would be bad for

everyone. A separate profession would not be required to follow the law as it

is written in the PT Practice Act. There could be higher liability on the Vets

if it was not in our Practice Act. (In Colorado, the requirements for

Malpractice are written as a general requirement, not in each individual

practice act.) And, on the specific mention of malpractice, during the

negotiations, the Vets were interested to find out that on average, our

malpractice rates are actually quite a bit higher than theirs. We are trained

in the litigious world of human medicine. We document everything in detail and

are acutely aware of the possibility of being sued at any time. We are

responsible for our own malpractice insurance, and for upholding our standards

of practice as outlined in our practice act.

5. Back to the bill…The APTA became involved, met with the Vet lobbyist

and CVMA representatives, and wrote a new bill with Representative McGihon. No

one “pushed†anything through. It was carefully negotiated with the full

cooperation of the CVMA lobbyist and members of the CVMA.

6. Because we do not, nor have we had since the mid-80’s, any requirement

for referral from a provider in our Practice Act, any mention of a referral was

a deal breaker. We instead worked out a new term called “Veterinary Medical

Clearance.†Per the specific negotiations, the purpose of the Medical

Clearance was to ensure that there was no medical reason the animal was unsafe

for physical therapy, either for the providers or the animals. In the Colorado

Physical Therapy Practice Act, it is specifically stated in 12-41-115c that it

is “Grounds for Disciplinary Action†if a licensee “Failed to refer a

patient to the appropriate licensed health care practitioner when the services

required by the patient are beyond the level of competence of the physical

therapist or beyond the scope of physical therapy practice.†We do not need

additional language to tell us that it is our responsibility to communicate and

collaborate with other professionals.

7. Anne McGihon, the state legislator who sponsored the bill was very

interested in helping the public access qualified providers of physical therapy

for animals. This comes not necessarily from her background as an attorney, but

because she had a very positive experience having her 2 border collies receive

physical therapy. Rep. McGihon recognizes that there is no one more qualified

to provide physical therapy than a physical therapist. The current physical

therapist educational programs require a doctoral degree, which has recently

increased from a Master’s degree. Rule 10 of the Physical Therapist licensure

program defines the additional education required by a licensed PT to work with

non-human animals. It is all that is needed, together with a very clear

practice act, to be sure that non-human animal clients are treated with the same

skill, care and respect that we provide our human patients.

Tami Struessel PT, DPT, OCS, MTC

Denver, CO

Amie Lamoreaux Hesbach, MSPT, CCRP, CCRT

Next Step Animal Rehabilitation & Fitness, LLC

Huntingtown, land USA

www.vetmash.com

NJ Legislation

To: VetRehab

Date: Tuesday, June 16, 2009, 9:18 PM

Hi, I am newly in practice in Massachusetts, and have been told by one of the

best surgeons and Veterinarians in this area that I will " make him look good " . 

I consider that a big compliment to the work that PT's do.  I can tell you that

there is no question in my mind, having seen these dogs pre-, post-, and

non-surgery, that we (physical therapists) are VERY MUCH needed by the injured

and struggling canines I have seen so far.  The extensive education I received

in orthopedic rehabilitation; in the orientation, dynamics, and physiological

structure and mechanics of every specific tendon, ligament, and muscle; the

hours upon hours spent learning the neurology and its application to things that

Amie Lamoreaux Hesbach teaches: proprioceptive neuromuscular facilitation;

neuromuscular techniques that are very specific to functional movements;

specific tools to re-educate muscles and movement patterns.  These techniques

take a long time to learn, and are what has brought impaired humans back to

walking, running, and climbing stairs; and they will definitely do the same for

dogs.  Until one works specifically with not only just the ligament repairs,

but these very complex dysfunctions (stroke, spinal injury, nerve compression or

injury), you cannot fully appreciate the education a physical therapist has, its

specificity, and its value to healing injuries in dogs.  Yes, the body is

different, the biomechanics are altered; but these techniques are just as

valuable and very applicable to canines when it comes to understanding

movement, neuromusculoskeleta l integration in the body and central nervous

system, and how to heal the various tissue structures that are injured.  A

meniscus is a meniscus, regardless of whether human or canine; same with a nerve

and a disc.  Physical Therapists are specialists, and I would hope would have

the ability (as in the human world) to offer such specific services to canine

clients outside of working for a specific Veterinarian.  It is only prudent for

us to work with the Veterinarian, who has the best education in terms of

systems, disease processes, pharmacology, and radiology for canines (we PTs

receive some education in systems, pharmacology and radiology as well...kidneys,

for instance, perform the same function in both species).  I hope that every

dog owner has access to PT services, regardless of what Vet they go to (as in

the human world).  We are professionals, with an incredible education in

rehabilitation.  There is a clinical reason why PTs are now educated as DPTs,

to be called  " Dr. " along with Chiropractors and others.  The goal of Canine

Rehabilitation is, in my understanding, to develop a peer relationship.  I am

very grateful for the many Veterinarians and Physical Therapists out there who

are supportive of that.  I am especially grateful to those who have

established institutes that provide the much needed education to both

disciplines, and go to great lengths to foster this relationship between both

disciplines.  Thank you!  The dogs need both of us!

Liz Powers, MPT, CCRT

Power Dog

Canine Rehabilitation

123 Hawley St. #8

Northampton, MA  01060

infopowerdogrehab (DOT) com

____________ _________ _________ _________ _________ _________ ___

Click to get your online credit check report score.

[Guest guest]

Hi Mark

Liz said " Physical Therapists are specialists, and I would hope that would have the ability (as in the human world) to offer such specific services to canine clients outside of working for a specific veterinarian."

I commented on this because we received alot of heat for calling our rehab facility a "specialty" clinic. It is an actual licensed vet clinic with a certified vet and two certified techs (hoping for a PT in very near future!! ) and we were told by our governing body that the terms "specialty" and "specialist" were titles given to those that were board certified in an area and we needed to respect that. My concern is the perception given to clients that are referred to PTs (or any special interest group) when they are given the title of a "specialist" - holds different merit and expectations.

Cheers!

SamSam Simpson AHT, CCRT

To: VetRehab From: mbparchman@...Date: Wed, 17 Jun 2009 17:22:19 -0700Subject: NJ Legislation

Hi All, let me preface this with, Personally, and philosophically i welcome the PTs into the veterinary field and have no problem with it. I think that indeed they do offer clear advantages in augmenting our patient treatment, and I don't feel threatened nor do i care if a PT treats animals. I think it is best for the patient. The legality of it is for someone else to figure out. I have been following the conversation and it is wide and varied.First, Sammy, I read and re-read Liz's post and could not find that she referred to herself as a specialist, so did you mean she implied it?Secondly, I think one of the questions we are dancing around is "why should someone trained in the human field, in this case a PT, with no formal training as a DVM or Certified technician, be allowed to practice a form of veterinary health care?" That is what it appears this legislation is all about. But the fact of the matter is, the state boards, likely with pressure from some veterinarians and possibly veterinary PACs, are looking at the reality that PTs, even though highly trained in their areas, are trained in human healthcare and have no formal training in veterinary basic or clinical sciences . How do we reconcile that? I have been through the CRI course and it just does not equal 4 years of veterinary school or 2 - 3 years of veterinary technician school (Sorry Jan, you can hit me next time I see you). That is what the state boards are objecting to. A second question, I am sure has crossed some minds is "why should a PT be able to set up a practice treating animals, yet I as a veterinarian cannot set up a practice treating people?" I am sure that if I tried, the state medical boards would react much the same way as the veterinary medical boards. It is their job and enforcing the rules or making new rules is just one of the parts of it. Lastly, I have always questioned why PTs can be certified by CRI as CCRT and technicians can only be certified as a CCRA? In my mind, this goes back to the formal training. Why should PT that has no formal veterinary training be certified as a CCRT and the certified veterinary technician with formal training can only be certified as a CCRA? Jan has explained it to me but I still had difficulty understanding it? I would also imagine that this is the thought process of the state legislatures and veterinary medical boards.So in closing, I would pose the first three questions, as in my mind, they are really at the heart of this legislation debate. The fourth question about CRI is really CRI policy and not our business, but I thought I would throw that in to try and get Jan to jump in as I know she has alot of knowledge in the area.Humble as always yours,Mark B. Parchman, DVM, DACVS, CVA, CCRT candidate (certified sometime this year if I can figure out when to do this internship thing)Bend Veterinary SpecialistsPawsitive Strides Physical RehabilitationYES I REFER TO MY OWN REHAB PRACTICE!!!!!

Windows Live helps you keep up with all your friends, in one place.

[Guest guest]

Hallelujah Mark, thank you for your input.

Maja

NJ Legislation

Hi All, let me preface this with, Personally, and philosophically i welcome the PTs into the veterinary field and have no problem with it. I think that indeed they do offer clear advantages in augmenting our patient treatment, and I don't feel threatened nor do i care if a PT treats animals. I think it is best for the patient. The legality of it is for someone else to figure out. I have been following the conversation and it is wide and varied.

First, Sammy, I read and re-read Liz's post and could not find that she referred to herself as a specialist, so did you mean she implied it?

Secondly, I think one of the questions we are dancing around is "why should someone trained in the human field, in this case a PT, with no formal training as a DVM or Certified technician, be allowed to practice a form of veterinary health care?" That is what it appears this legislation is all about. But the fact of the matter is, the state boards, likely with pressure from some veterinarians and possibly veterinary PACs, are looking at the reality that PTs, even though highly trained in their areas, are trained in human healthcare and have no formal training in veterinary basic or clinical sciences . How do we reconcile that? I have been through the CRI course and it just does not equal 4 years of veterinary school or 2 - 3 years of veterinary technician school (Sorry Jan, you can hit me next time I see you). That is what the state boards are objecting to. A second question, I am sure has crossed some minds is "why should a PT be able to set up a practice treating an

imals, yet I as a veterinarian cannot set up a practice treating people?" I am sure that if I tried, the state medical boards would react much the same way as the veterinary medical boards. It is their job and enforcing the rules or making new rules is just one of the parts of it. Lastly, I have always questioned why PTs can be certified by CRI as CCRT and technicians can only be certified as a CCRA? In my mind, this goes back to the formal training. Why should PT that has no formal veterinary training be certified as a CCRT and the certified veterinary technician with formal training can only be certified as a CCRA? Jan has explained it to me but I still had difficulty understanding it? I would also imagine that this is the thought process of the state legislatures and veterinary medical boards.

So in closing, I would pose the first three questions, as in my mind, they are really at the heart of this legislation debate. The fourth question about CRI is really CRI policy and not our business, but I thought I would throw that in to try and get Jan to jump in as I know she has alot of knowledge in the area.

Humble as always yours,

Mark B. Parchman, DVM, DACVS, CVA, CCRT candidate (certified sometime this year if I can figure out when to do this internship thing)

Bend Veterinary Specialists

Pawsitive Strides Physical Rehabilitation

YES I REFER TO MY OWN REHAB PRACTICE!!!!!

Dell Days of Deals! June 15-24 - A New Deal Everyday!

[Guest guest]

Posted by Rick Wall for Tomlinson, DVM, President the Association of

Rehabilitation Veterinarians;

Hello all.

Interesting discussion. I think that the point we veterinarians are trying

to get across is that we are the only professionals qualified to look after

the entire health of an animal undergoing rehabilitation. I agree that other

professionals such as physical therapists and chiropractors have skills and

ideas to contribute that greatly benefit our patients. But without the

direct involvement of a veterinarian that animal will not be getting needed

pain management and case oversight.

A couple of examples from my practice: geriatric dogs who came for therapy

'a little sluggish' and had ruptured splenic tumors, another who developed

IMHA, and one who 3 weeks after clean x rays showed up with bone cancer. Had

a veterinarian not been so closely involved then case outcome would have

been different.

Consumer choice does have to be there but owners need the guidance of their

veterinarian in order to make an informed decision and to be true advocates

for their pet. Their choice is not limited to only one veterinarian.

Veterinary medicine is very different to human medicine and PTs are trained

in only part of the latter. Human patients can verbalize their complaints

and how they feel that day, whether they feel no progress is being made and

if they hurt somewhere new. They can take a couple of ibuprofen if they get

sore.

The spectrum and incidence of disease varies greatly between species and

signs are often subtle. It takes years of shadowing vets (as veterinary

students and techs do) to learn this art.

We can make great teams to practice excellent medicine, our patients need

comprehensive care as they recover from their injury or adapt to their

disability. They don't get to make the choice.

Tomlinson

Rick Wall, DVM

Certified Canine Rehabilitation Practitioner

Diplomate, American Academy of Pain Management

Center for Veterinary Pain Management

and

Rehabilitation

The Woodlands, TX

Re: NJ Legislation

Hi again.

I'm posting for on , MPT, CCRP for Tami Struessel PT, DPT,

OCS, MTC.

Amie

Here’s her reply – would you mind posting it? Not sure why mine is not going

through…??

Thanks!

Hello,

I was alerted to your interesting conversation on Physical Therapists

entering into the domain of Veterinary care and would like to make a few

clarifications. Although I do not practice with animals, I was involved in

the Colorado legislation negotiations as a representative of the Colorado

Chapter of the American Physical Therapy Association (APTA) Governmental

Affairs Committee. I am a faculty member at the University of Colorado

Doctor of Physical Therapy program. I currently sit on the Physical Therapy

State Board equivalent in Colorado called the PT Advisory Committee for the

Department of Regulatory Agencies. I do not represent any of those

organizations in this email however, this is personal opinion. I understand

our final law has provoked quite a bit of unrest amongst many veterinarians.

It seems the concerns are exactly the ones raised when we went through the

legislative process and rules making process with a group of Veterinarians

and Physical Therapists last legislative session.

1. First a clarification on POPTS (Physician Owned Physical Therapy

Services), or Referral for Profit. This has been a national issue for many

years in human healthcare. If a physician (or Vet in this case) benefits

financially from a referral, their tendency is to refer more. Plain and

simple. This has been played out in human medicine by a few studies. It

applies regardless of who is paying the bill. The issue is public

protection, not payor protection. In human medicine it is regulated because

of the public protection issue. You might be interested to read an article

in the New Yorker by Atul Gawande called The Cost Conundrum. It explains

very clearly the ethical issues inherent in referral for profit situations

by using an example of the town in America with the highest healthcare

expenditures. The first thing everyone says is that their ethics are being

questioned. I am not questioning the specific ethics of any one

Veterinarian. It is human nature and is regulated by the Stark laws in human

medicine for a reason.

2. First a general statement. In human medicine, physicians used to be the

only providers. They could (and did) do everything. As the professions

knowledge grew, it became apparent in a hurry that it is impossible to do

everything, and do it well. Various healthcare professions began to develop

specializing in areas that physicians used to do exclusively. There was some

resistance, but fairly quickly, the physicians figured out that the patients

benefitted if there were experts, not just generalists, providing the care.

It seems that this evolution is just starting to occur in Veterinary

medicine as the profession begins to develop more evidence based practice

and knowledge. Vets can’t do everything and do it well any more than human

physicians can. Physical Therapists are an example of a profession who, with

additional training to specialize their knowledge and already extensive

education, can provide a quality service that no technician in a Vet’s

office can provide.

3. On to the Colorado law and how it came to be. The original bill was

negotiated and written with several PT’s working with animals, and several

Vets involved in the CVMA (CO Vet Med Assoc). It essentially created a new

profession, where licensed physical therapists in Colorado would work under

a Veterinarian. There was lots of language that was duplicative of the PT

Practice Act and details that are not appropriate, nor necessary for

inclusion in a bill. The APTA opposed the bill for many reasons and would

have come head to head with other PT’s in the legislature. That would not

have been a good situation for anyone. The most significant issue was that

we are a profession. We are educated and licensed. The Medical Board in

Colorado in 2005 wrote a letter that explains that, as professionals, a

physical therapist who is providing services within the scope of their

license is not subject to delegation or supervision by a physician. We do

not require any sort of referral to see a human patient, nor with the new

law an animal patient. In my human practice, if I have a referral, it is

generic and 95% of the time, says evaluate and treat. Physicians understand

that they are not the experts in PT anymore than I am an expert in gall

bladder surgery or medical managment of diabetes.

4. More on the bill. Creating a seperate profession would be bad for

everyone. A separate profession would not be required to follow the law as

it is written in the PT Practice Act. There could be higher liability on the

Vets if it was not in our Practice Act. (In Colorado, the requirements for

Malpractice are written as a general requirement, not in each individual

practice act.) And, on the specific mention of malpractice, during the

negotiations, the Vets were interested to find out that on average, our

malpractice rates are actually quite a bit higher than theirs. We are

trained in the litigious world of human medicine. We document everything in

detail and are acutely aware of the possibility of being sued at any time.

We are responsible for our own malpractice insurance, and for upholding our

standards of practice as outlined in our practice act.

5. Back to the bill…The APTA became involved, met with the Vet lobbyist and

CVMA representatives, and wrote a new bill with Representative McGihon. No

one “pushed†anything through. It was carefully negotiated with the full

cooperation of the CVMA lobbyist and members of the CVMA.

6. Because we do not, nor have we had since the mid-80’s, any requirement

for referral from a provider in our Practice Act, any mention of a referral

was a deal breaker. We instead worked out a new term called “Veterinary

Medical Clearance.†Per the specific negotiations, the purpose of the

Medical Clearance was to ensure that there was no medical reason the animal

was unsafe for physical therapy, either for the providers or the animals. In

the Colorado Physical Therapy Practice Act, it is specifically stated in

12-41-115c that it is “Grounds for Disciplinary Action†if a licensee

“Failed to refer a patient to the appropriate licensed health care

practitioner when the services required by the patient are beyond the level

of competence of the physical therapist or beyond the scope of physical

therapy practice.†We do not need additional language to tell us that it is

our responsibility to communicate and collaborate with other professionals.

7. Anne McGihon, the state legislator who sponsored the bill was very

interested in helping the public access qualified providers of physical

therapy for animals. This comes not necessarily from her background as an

attorney, but because she had a very positive experience having her 2 border

collies receive physical therapy. Rep. McGihon recognizes that there is no

one more qualified to provide physical therapy than a physical therapist.

The current physical therapist educational programs require a doctoral

degree, which has recently increased from a Master’s degree. Rule 10 of the

Physical Therapist licensure program defines the additional education

required by a licensed PT to work with non-human animals. It is all that is

needed, together with a very clear practice act, to be sure that non-human

animal clients are treated with the same skill, care and respect that we

provide our human patients.

Tami Struessel PT, DPT, OCS, MTC

Denver, CO

Amie Lamoreaux Hesbach, MSPT, CCRP, CCRT

Next Step Animal Rehabilitation & Fitness, LLC

Huntingtown, land USA

www.vetmash.com

NJ Legislation

To: VetRehab

Date: Tuesday, June 16, 2009, 9:18 PM

Hi, I am newly in practice in Massachusetts, and have been told by one of

the best surgeons and Veterinarians in this area that I will " make him look

good " . I consider that a big compliment to the work that PT's do. I can

tell you that there is no question in my mind, having seen these dogs pre-,

post-, and non-surgery, that we (physical therapists) are VERY MUCH needed

by the injured and struggling canines I have seen so far. The extensive

education I received in orthopedic rehabilitation; in the orientation,

dynamics, and physiological structure and mechanics of every specific

tendon, ligament, and muscle; the hours upon hours spent learning the

neurology and its application to things that Amie Lamoreaux Hesbach teaches:

proprioceptive neuromuscular facilitation; neuromuscular techniques that are

very specific to functional movements; specific tools to re-educate muscles

and movement patterns. These techniques take a long time to learn, and are

what has brought impaired humans back to walking, running, and climbing

stairs; and they will definitely do the same for dogs. Until one works

specifically with not only just the ligament repairs, but these very complex

dysfunctions (stroke, spinal injury, nerve compression or injury), you

cannot fully appreciate the education a physical therapist has, its

specificity, and its value to healing injuries in dogs. Yes, the body is

different, the biomechanics are altered; but these techniques are just as

valuable and very applicable to canines when it comes to understanding

movement, neuromusculoskeleta l integration in the body and central nervous

system, and how to heal the various tissue structures that are injured. A

meniscus is a meniscus, regardless of whether human or canine; same with a

nerve and a disc. Physical Therapists are specialists, and I would hope

would have the ability (as in the human world) to offer such specific

services to canine clients outside of working for a specific Veterinarian.

It is only prudent for us to work with the Veterinarian, who has the best

education in terms of systems, disease processes, pharmacology, and

radiology for canines (we PTs receive some education in systems,

pharmacology and radiology as well...kidneys, for instance, perform the same

function in both species). I hope that every dog owner has access to PT

services, regardless of what Vet they go to (as in the human world). We are

professionals, with an incredible education in rehabilitation. There is a

clinical reason why PTs are now educated as DPTs, to be called " Dr. " along

with Chiropractors and others. The goal of Canine Rehabilitation is, in my

understanding, to develop a peer relationship. I am very grateful for the

many Veterinarians and Physical Therapists out there who are supportive of

that. I am especially grateful to those who have established institutes

that provide the much needed education to both disciplines, and go to great

lengths to foster this relationship between both disciplines. Thank you!

The dogs need both of us!

Liz Powers, MPT, CCRT

Power Dog

Canine Rehabilitation

123 Hawley St. #8

Northampton, MA 01060

infopowerdogrehab (DOT) com

____________ _________ _________ _________ _________ _________ ___

Click to get your online credit check report score.

[Guest guest]

Ideally, for all of us (those who are or

desire to work on animals) to fit into a medical system and be able to apply

our skills to animal rehabilitation could follow the role of a physiatrist in the human health care

system. Here there would be a specialist veterinarian (boarded in the

specialty of Physical Medicine and Rehabilitation by a credited institution) who

the veterinary community or other refers their clients to. This

veterinary specialist (who in my mind is the best advocate for the animal

patient) will then use their skills to determine which other specialists or highly

trained interest groups would be involved in the patients’ health

care. The other players would include pain management specialists,

orthotists, physical therapists, animal chiropractors, animal acupuncturists,

trainers, sports medicine specialists, surgeons, etc. etc. Then all the

other specialists/interest groups will be treated equally (if you will) and can

all contribute their skills and art to the non-human species (and yes, I do

often think that animals are superior to us; whoever mentioned this in a

previous post J) wellness and all live in harmony.

Just wishful thinking,

Mayer DVM, CVA, CVC

Healing Arts For Animals

President and Founder

President and Co-Founder

From: VetRehab [mailto:VetRehab ] On Behalf Of mbparchman@...

Sent: Wednesday, June 17, 2009

7:22 PM

To: VetRehab

Subject: NJ Legislation

Hi All, let

me preface this with, Personally, and philosophically i welcome the PTs into

the veterinary field and have no problem with it. I think that indeed they do

offer clear advantages in augmenting our patient treatment, and I don't feel

threatened nor do i care if a PT treats animals. I think it is best for the

patient. The legality of it is for someone else to figure out. I have been

following the conversation and it is wide and varied.

First, Sammy, I read and re-read Liz's post and could not find that she

referred to herself as a specialist, so did you mean she implied it?

Secondly, I think one of the questions we are dancing around is " why

should someone trained in the human field, in this case a PT, with no formal

training as a DVM or Certified technician, be allowed to practice a form of

veterinary health care? " That is what it appears this legislation is all

about. But the fact of the matter is, the state boards, likely with pressure

from some veterinarians and possibly veterinary PACs, are looking at the

reality that PTs, even though highly trained in their areas, are trained in

human healthcare and have no formal training in veterinary basic or clinical

sciences . How do we reconcile that? I have been through the CRI course and it

just does not equal 4 years of veterinary school or 2 - 3 years of veterinary

technician school (Sorry Jan, you can hit me next time I see you). That is what

the state boards are objecting to. A second question, I am sure has crossed

some minds is " why should a PT be able to set up a practice treating an

imals, yet I as a veterinarian cannot set up a practice treating people? "

I am sure that if I tried, the state medical boards would react much the same

way as the veterinary medical boards. It is their job and enforcing the rules

or making new rules is just one of the parts of it. Lastly, I have always

questioned why PTs can be certified by CRI as CCRT and technicians can only be

certified as a CCRA? In my mind, this goes back to the formal training. Why

should PT that has no formal veterinary training be certified as a CCRT and the

certified veterinary technician with formal training can only be certified as a

CCRA? Jan has explained it to me but I still had difficulty understanding it? I

would also imagine that this is the thought process of the state legislatures

and veterinary medical boards.

So in closing, I would pose the first three questions, as in my mind, they are

really at the heart of this legislation debate. The fourth question about CRI

is really CRI policy and not our business, but I thought I would throw that in

to try and get Jan to jump in as I know she has alot of knowledge in the area.

Humble as always yours,

Mark B. Parchman, DVM, DACVS, CVA, CCRT candidate (certified sometime this year

if I can figure out when to do this internship thing)

Bend Veterinary Specialists

Pawsitive Strides Physical Rehabilitation

YES I REFER TO MY OWN REHAB

PRACTICE!!!!!

[Guest guest]

WOW! I forgot just how literal/exact I have to be when speaking in this forum. Okay Acupuncture, human side 4, animal side 10...

In regards to my first question...what sparked the recent discussion to change legislation in NJ?

Maja

Re: NJ Legislation

I really don't want to take the podium again, but, honestly, I'm

really pleased to see what Dr. Tomlinson says here. I agree

(personally and professionally, not representing the APTA or Animal

Rehabilitation Special Interest Group) with much of what she has to say.

To understand a little more the role of the PT in the human medical

world, we are not specialists in medicine. We are experts in the

evaluation and treatment of the neuromusculoskeletal system of

humans, which is similar, but admittedly not the same as that of

other animals. We do not evaluate or treat infections, tumors, or

other internal medical disorders/diseases. We do not prescribe

medications. This is, admittedly, why we need the veterinary

professional to be the manager of the patient-- "looking after the

entire health of the animal undergoing rehabilitation." We are

trained to identify the "red flags"-- things that might present

similar to musculoskeletal issues, but that "just don't fit." We are

trained to refer when appropriate. Why would I want a sick patient

in my office? I want to be successful in rehab!

I'd welcome anyone to check out the APTA website for consumers. It's

http://www.moveforwardpt.com/index.html and will give you more

information about PTs, physical therapy, our education, background,

and expertise in rehabilitation medicine for human patients/clients.

Dr. Tomlinson does say: "But without the direct involvement of a

veterinarian that animal will not be getting needed pain management

and case oversight." I think that this statement could be

misinterpreted. The PT is definitely part of the rehab team, part of

the pain management team, etc. The veterinarian absolutely must

continue to manage his/her patient. Referring to a PT does not

change this fact.

"Consumer choice does have to be there but owners need the guidance

of their veterinarian in order to make an informed decision and to be

true advocates for their pet. Their choice is not limited to only one

veterinarian." Absolutely this is true, however, by limiting the

employment of a physical therapist to a veterinarian alone, practice

and choice is restricted. (This was my original question with

regards to the NJ proposal and I'm not certain that my question has

been answered.)

"Veterinary medicine is very different to human medicine and PTs are

trained in only part of the latter." ABSOLUTELY! PTs do not want to

practice veterinary medicine!

"Human patients can verbalize their complaints and how they feel that

day, whether they feel no progress is being made and if they hurt

somewhere new. They can take a couple of ibuprofen if they get

sore." This statement, however, is much too general. What about the

4 week old baby with torticollis, the great-grandfather with

Alzheimer's, my grandmother with a left hemisphere stroke, the brain

injured motorcyclist? These are all traditional PT patients who have

difficulty communicating (verbally) with their therapist and entire

medical management team. We all (whether initially trained on

animals or people) have learned to identify non-verbal and

physiologic cues to pain. This can not be a reason to limit practice

of animal rehabilitation to only veterinary professionals as it is an

incredible component of clinical, didactic, and practical education

of the PT in the existing certification programs as well as in our

entry-level education.

It is too bad that we ONLY have these certification programs at this

time. I'm certain that as this field evolves that we'll have more

opportunities to take our anecdotal clinical experiences and publish

them as evidence. We'll have more opportunities to educate each

other and the high school and college students who NOW identify the

desire to practice animal rehabilitation someday. It is a start and

this education will and must evolve.

In no way are PTs attempting to limit the practice of veterinary

medicine by veterinarians and their technicians nor are PTs

attempting to limit the practice of animal rehabilitation by

veterinarians and their technicians. We would like, however, (if I

can speak for my colleagues) to have the respect for the knowledge

and skills that we do have and are able to share with our animal

patients and their owners/handlers/guardians. To be able to call

myself a physical therapist, call what I do physical therapy, and be

recognized and respected as a professional in the field of animal

rehabilitation.

Maja, you mentioned that chiropractors have 1-2 years of schooling.

It's more likely 7-8. Acupuncturists usually have 3-4 years of

training prior to licensure. PTs: around 7-8 years.

Dr. Wall asked about "my" opinion on direct access. I can't really

avoid that question because it is a HUGE issue with regards to PT

boards and our APTA and APTA chapters supporting animal

rehabilitation. MY opinion? I would not have wanted direct access

to animal patients 8 years ago, when on too many occasions a case

referred to me (by a veterinarian) with, for example, a diagnosis of

hip dysplasia, presents to me actually with a cruciate tear. My

inexperience at that time (and with only my FIRST certification)

necessitated my partnering with a veterinary surgeon who would do

team evaluations of those cases. Now? A different story. The

surgeons with which I collaborate look to me to "diagnose" soft

tissue dysfunctions and challenging lamenesses. They look to me to

examine the entire patient-- to find that the cause of the iliopsoas

strain is not a traumatic injury but a cervical instability. You

might not want to hear it, but it is true, and I'd guess that every

single one of you practicing animal rehabilitation (whether DVM, RVT/

LVT/AHT, or PT) has had a similar experience. Direct access in

physical therapy of human patients did not happen overnight, it has

evolved, and is not standard in every state. These are baby steps.

You've got to walk before you can trot, that is, unless you've got a

neuro diagnosis. (Some of you might get that, right? ;-) )

So how 'bout those Penguins!?!

Amie

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